Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 68-year-old male, having just returned from a two-week holiday on the Island of Ischia, developed unilateral pneumonia for which he was treated with oral amoxicillin-clavulanic acid and hospitalized within three days when the disease worsened and spread to both lungs. Despite parenteral amoxicillin-clavulanic acid (up to 2.2 g i.v. t.i.d.) the pneumonia spread rapidly over the next three days. Sputum cultures returned post mortem yielded Legionella pneumophila serogroup 1 and urine tests revealed the presence of Legionella antigen. Disk diffusion susceptibility testing on BCYE of the causative pathogen revealed zone diameters of inhibition of the clinical isolate exceeding 50 mm, indicating high susceptibility to this antibiotic combination. The therapeutic failure of amoxicillin-clavulanic acid should stimulate further reports and studies on the efficacy against legionellosis of this drug and similar beta-lactam inhibitor combinations as well as other beta-lactamase-stable beta-lactams.
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PMID:Fatal Legionella pneumophila pneumonia: treatment failure despite early sequential oral-parenteral amoxicillin-clavulanic acid therapy. 158 91

Moraxella (formerly Branhamella) catarrhalis is a gram-negative coccus now recognized as one of the common pathogens in respiratory infections. Documented cases of bacteremic pneumonia due to this organism, however, have been a rarity. Two cases of Moraxella catarrhalis bacteremic pneumonia in immunosuppressed adult patients are reported. The clinical characteristics of these patients together with those of the seven adult and the six pediatric patients reported to date in the literature, are analyzed. All patients had an underlying condition and most were male. The mean age was 64.9 years. No adult patient had skin lesion, although purpuric rash was frequent in children. The overall morality rate was only 13.3%, in spite of the underlying diseases. In three patients the pneumonia was nosocomial. The seasonal recovery of Moraxella catarrhalis in respiratory infections is significantly increased during the late fall through early spring period. Because most strains are beta-lactamase positive, empiric use of penicillin, ampicillin or amoxicillin for this organism can no longer be recommended.
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PMID:Moraxella catarrhalis bacteremic pneumonia in adults: two cases and review of the literature. 159

Moraxella subgenus Moraxella sp. was isolated in pure culture from the sputum of a 43-year-old male with pneumonia and congestive heart failure due to idiopathic dilated cardiomyopathy. In this case, we concluded that the patient's bacterial pneumonia was caused by M. (M.) sp. based on a Gram stain of the sputum smear and bacterial findings, increased WBC count, and elevated CRP. A chest X-ray revealed right middle, and left upper and middle lobe infiltrates. This Moraxella strain produced a BRO-type beta-lactamase, a carbenicillinase-type enzyme.
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PMID:[Pneumonia caused by Moraxella subgenus Moraxella sp]. 162 33

We experienced a case of a 68-year-old female with beta-lactam antibiotics including penicillin G (PCG) resistant pneumococcal pneumonia, leading to death during the treatment with ceftizoxime (CZX). We reported the clinical course and the mechanism of resistance of isolated bacteria. The present case is the first in Japan. Minimum inhibitory concentration (MIC) against Streptococcus pneumoniae 88031 isolated from the present case was 1.56 micrograms/ml in PCG and 6.25 micrograms/ml in CZX, showing PCG resistance. The isolate was no beta-lactamase production and serotype 23. The drug susceptibility in 34 strains of S. pneumoniae which were isolated as causative organism of respiratory infection in our department in 1988 was studied. PCG high resistant strain (PCG MIC greater than 1.56 micrograms/ml) was only observed in the isolated strain in the present case and PCG low sensitive strains (PCG MIC = 0.1-1.0 micrograms/ml) were observed in 3 strains (8.8%). The CZX resistance was observed only in the present case. The detection of penicillin-binding protein (PBP) and binding affinity of beta-lactam antibiotics were studied using PCG sensitive strain, S. pneumoniae type I (preserved strain PCG MIC = 0.05 micrograms/ml, CZX MIC = 0.1 micrograms/ml, CMX MIC = 0.025 micrograms/ml) and PCG resistant strain, S. pneumoniae 88031. The result obtained showed that PBP1a, detected in sensitive strain type I, was not detected in resistant strain 88031 and PBP1b was increased. The binding of 14C-PCG of PCG resistant strain to PBP1b showed lower affinity for CZX and CMX than PCG sensitive strain.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of penicillin-resistant pneumococcal pneumonia and penicillin-binding proteins of the clinical isolates]. 162 45

Efficacy of sulbactam, a beta-lactamase inhibitor, in combination with ampicillin, was evaluated for treatment of experimentally induced pneumonia caused by beta-lactam-resistant Klebsiella pneumoniae. Infection was experimentally induced in 18 healthy weanling foals that were randomly allocated to 3 treatment groups: sulbactam plus ampicillin (S/A, 3.3 and 6.6 mg/kg of body weight, respectively), ampicillin (6.6 mg/kg), or vehicle only. Foals were treated daily for 7 days; the observer was unaware of treatment status. Compared with ampicillin and vehicle, treatment with S/A resulted in a statistically significant (P less than 0.05) decrease in severity of pneumonia, with regard to bronchoalveolar lavage cytologic findings (decreased total cell and neutrophil numbers, and increased lymphocyte numbers) and extent of macroscopic lesions in lung tissue of the noninoculated regions. Marked trends toward improvement of S/A-treated foals were observed for quantitative results of bacteriologic culture of bronchoalveolar lavage fluid samples (P less than 0.07), macroscopic pathologic features of the whole lung (P less than 0.1), and histopathologic variables (P less than 0.07), compared with ampicillin- and vehicle-treated foals. Treatment effects were not observed for radiographic, hematologic, and blood gas abnormalities that resulted from infection. In conclusion, the combination of sulbactam plus ampicillin was found to have synergistic effects in vivo, to reduce the extent and severity of experimentally induced gram-negative lung infection in foals.
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PMID:Evaluation of sulbactam plus ampicillin for treatment of experimentally induced Klebsiella pneumoniae lung infection in foals. 162 75

Infection due to Staphylococcus aureus continues to be a source of significant morbidity and mortality. However, its treatment is increasingly complicated by the rising prevalence of resistance to antibiotics. Apart from the two recognized modes of staphylococcal resistance, namely, penicillinase production and intrinsic resistance, Sabath and associates have described a third type in which resistance is manifested by susceptibility to growth inhibition but tolerance to the lethal action of bactericidal agents. The mechanism of tolerance is attributed to a deficiency of autolytic enzyme activity in the part of bacteria, possibly secondary to an inhibition of autolysins in the tolerant staphylococcal strains. These strains are found in patients with infections responding poorly to treatment with cell-wall active antibiotics including vancomycin. Because of its unique mechanism of action and pharmacokinetic properties, rifampin has been reported to be the most active among 65 antistaphylococcal agents tested and have the capacity to kill intraleukocytic staphylococci. We present 2 cases who were cured following the addition of rifampin to previously established regimens. Case 1 was a 40-year-old male who had fever, cough, dyspnea, a right elbow abscess and left leg swelling for 2 weeks prior to admission. Culture of purulent material from the elbow abscess grew staphylococcus aureus. Chest X-ray showed bilateral septic embolism and phleborheography showed partial deep vein occlusion of the left ileofemoral vein. Case 2 was 22-year-old female with fever, chills and cough for 3 weeks. Blood culture grew staphylococcus aureus, and Chest X-ray revealed bilateral septic embolism with pneumonia. Neither of them responded to standard antibiotics which were judged adequate by in vitro sensitivity tests. Clinical cure was later obtained after rifampin was added to the regimens. These results suggest that rifampin may be a useful adjunct in the therapy of staphylococcal infections.
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PMID:[The use of rifampin in the treatment of infection due to Staphylococcus aureus]. 164 82

Serratia marcescens bacteremia has become ubiquitous recently. S. marcescens bacteremia, either hospital- or community-acquired, can no longer be treated as insignificant. We reviewed 23 episodes of S. marcescens bacteremia in 1985. Among them, 17 patients (74%) were hospital-acquired infections, while 6 (26%) were community-acquired. Nine patients died, and the case fatality rate was 39%. Eleven patients (48%) had no clinically apparent source of infection, 5 (22%) had urinary tract infection, 3 (13%) had pneumonia, 2 (9%) had biliary tract infection, 1 (4%) had intra-abdominal infection, and 1 (4%) had skin and soft-tissue infection. Nosocomial isolates are often resistant to many antibiotics. Amikacin and the beta-lactamase-stable (third generation) cephalosporins are superior to gentamicin in the treatment of nosocomial S. marcescens bacteremia. We here emphasize that the awareness and treatment of S. marcescens bacteremia in daily clinical practice is unequivocally critical.
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PMID:Serratia marcescens bacteremia. 167 15

Cefpodoxime proxetil is the orally absorbed ester of cefpodoxime, a new third generation cephalosporin. In the gastrointestinal tract, cefpodoxime proxetil is hydrolysed to cefpodoxime, which has potent antibacterial activity against the major bacterial pathogens involved in lower respiratory tract infections: Haemophilus influenzae, Moraxella (Branhamella) catarrhalis (including beta-lactamase-producing strains), and Streptococcus pneumoniae (including amoxicillin-resistant strains). Six randomised comparative studies in patients with lower respiratory tract infections, 5 of which were large (enrollment of more than 200 patients) and double-blind, examined the efficacy and safety of cefpodoxime proxetil. Cefpodoxime proxetil (at a dosage equivalent to 200mg of cefpodoxime) administered twice daily for 5 to 10 days was similar in clinical and bacteriological efficacy to the following: amoxicillin 500mg 3 times daily in the treatment of community-acquired pneumonia; intramuscular ceftriaxone Ig once daily in the treatment of pulmonary infections in hospitalised patients; and to amoxicillin/clavulanic acid 500/125mg 3 times daily in the treatment of acute exacerbations of chronic bronchitis (AECB). Additionally, a dosage equivalent to 100mg or 200mg of cefpodoxime twice daily was similar in clinical and bacteriological efficacy to amoxicillin 250mg 3 times daily in the treatment of bronchitis (acute or AECB). The adverse events noted with cefpodoxime proxetil administration were similar to those associated with other beta-lactam antibacterials and most commonly involved the gastrointestinal tract and skin or mucous membranes. Thus, cefpodoxime proxetil is a useful addition to the antibacterials available for the treatment of infections of the lower respiratory tract.
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PMID:Cefpodoxime proxetil in the treatment of lower respiratory tract infections. 172 6

The fluoroquinolones have excellent activity against a number of respiratory pathogens, especially gram-negative bacteria, including beta-lactamase-producing Hemophilus influenzae and Moraxella catarrhalis. Several studies have shown ciprofloxacin to be effective in the treatment of acute exacerbations of chronic bronchitis, some community-acquired and nosocomial pneumonia, and acute exacerbations of bronchopulmonary infections in cystic fibrosis. The fluoroquinolones have less activity against Streptococcus pneumoniae and limited anaerobic activity, which should limit the use of these drugs in empiric therapy of community-acquired pneumonia where the pneumococcus or anaerobes play a predominant role.
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PMID:Fluoroquinolones in respiratory infections. 175 33

Most empyemas occur as a complication of pneumonia or lung abscess, but 15% to 30% occur after thoracic surgery and 10% occur in association with an intraabdominal infection. The bacteriology of empyemas that occur in association with lung infections is often polymicrobial and mixed, containing multiple species of both aerobic and anaerobic bacteria, the latter found in up to 75% of cases. In contrast, empyema following thoracic surgery is more likely to be monomicrobial and caused by common nosocomial pathogens such as Staphylococcus aureus and aerobic gram-negative bacilli. Diffusion of antibiotics into both infected and uninfected pleural fluid is good, but certain agents (aminoglycosides and some beta-lactams) may be inactivated in the presence of pus, low pH, and beta-lactamase enzymes. Single antibiotic agents that are likely to be active against the wide spectrum of potential pathogens include imipenem-cilastatin and ticarcillin-clavulanic acid. Combinations of antibiotics should include an effective agent against anaerobic bacteria (clindamycin, metronidazole) coupled with an agent active against aerobic gram-positive cocci and gram-negative bacilli.
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PMID:Antibiotic therapy of pleural empyema. 177 8


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