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)

Imipenem was registered for clinical use in Germany in 1985. It is recommended for initial treatment in either severe nosocomial infections or infections in ICU or immunocompromised patients. In this study, we evaluated 1,215 patients who were prescribed imipenem at our Zentrum der Inneren Medizin-a major tertiary care university hospital-over a 6 year period. 650 of 1,215 patients (53.5%) had rapidly fatal disease; and the main indication for imipenem was pneumonia and fever of unknown origin. 56.2% received 500 mg imipenem t.i.d., 40.4% 500 mg b.i.d., 0.9% 1000 mg b.i.d.; and 2.5% 1000 mg t.i.d. Average duration of treatment was 11 days. Lower dose (500 mg b.i.d.) was used in patients with renal insufficiency; highest dose was used in severe infections or infections caused by moderately sensitive organisms. Imipenem was used as a single initial antibacterial agent in the majority of the patients. Success was seen in 80% of the episodes, irrespective of the dosage used; 89% at 500 mg b.i.d., 74% at 500 mg t.i.d., 77% at 1,000 mg b.i.d.; and 69% at 1,000 mg t.i.d. We observed the highest favourable response (91.5%) in the episodes treated initially with imipenem monotherapy. Overall, imipenem was well tolerated. The majority of the patients with untoward effects was on multiple-drug regimens. The most frequent untoward event observed involved the gastrointestinal tract.
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PMID:Experience with imipenem in internal medicine--a postmarketing surveillance study. 911 96

We identified 17 cases of pneumococcal bacteremia among 340 neutropenic cancer patients with bacteremia. Pneumonia was more frequent in patients with pneumococcal bacteremia than in those with bacteremia due to other organisms: 12 (71%) of 17 patients with pneumococcal bacteremia had pneumonia, whereas only 23 (7%) of 323 patients with nonpneumococcal bacteremia had pneumonia (P < .001). Eight (47%) of the 17 episodes of pneumococcal bacteremia were caused by penicillin-resistant strains (MICs ranged from 0.12 microg/mL to 4 microg/mL); these penicillin-resistant pneumococci showed varying degrees of diminished susceptibility to all beta-lactams studied, especially ceftazidime (MICs of this drug ranged from 1 microg/mL to 64 microg/mL). Imipenem was the beta-lactam agent most active against these organisms (MICs ranged from 0.03 microg/mL to 0.25 microg/mL). Patients with penicillin-resistant pneumococcal bacteremia received inappropriate empirical antibiotic therapy more often than did patients with bacteremia due to susceptible strains (i.e., 4 (50%) of 8 patients vs. 0 of 9, respectively; P < .05). Eight (47%) of the 17 patients with pneumococcal bacteremia died. In areas where penicillin-resistant pneumococci are highly endemic, these findings should be considered in selecting empirical antibiotic therapy for neutropenic patients with cancer who are suspected of having pneumonia.
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PMID:Treatment of penicillin-resistant pneumococcal bacteremia in neutropenic patients with cancer. 911 39

Carbapenems are active beta-lactam antibiotics versus most of the gram positive and gram negative microorganisms and anaerobes although their activity is lacking in the case of Staphylococcus sp. resistant to methicillin, Enterococcus faecium and Streptococcus pneumoniae with high resistance to penicillin and some gram negative bacilli which naturally produce an methaloenzyme able to hydrolyze them such as Stenotrophomonas maltophilia. Imipenem, the first synthetized carbapenem requires administration with cilastatin to avoid inactivation by renal dehydropeptidase 1. Meropenem does not require being taken with the renal enzyme inhibitor, with its activity being similar to that of imipenem. In abdominal infection the carbapenems have shown to be the authentic monotherapy in this type of infections being as effective as the different schedules of antibiotic associations normally used. Treatment with carbapenems in bacterial meningitis should be currently limited to the cases produced by gram negative bacilli producers of wide spectrum beta-lactamases (WSBL), cases of meningitis by Pseudomonas aeruginosa or gram negative bacilli producers of inducible cephalosporinase. Meropenem is the carbapenem of choice probably in these cases because the carbapenems are often the only active antibiotics and meropenem, specifically, does not have the risk of convulsions observed with imipenem-cilastatin. The carbapenems have shown to be useful in skin and soft tissue infections as well as in obstetric and gynecologic infections as monotherapy similar to the schedules of the currently used antibiotic associations. In the case of nosocomial pneumonias, all the studies have evaluated the carbapenems in monotherapy as useful and effective, specially in the case of pneumonia by gram negative bacilli. Finally, in non filiated nosocomial sepsis and specially in the case of neutropenic patients, the use of carbapenems is particularly attractive in gram negative sepsis in intensive care units. The appearance in the last few years of strains of gram negative bacilli, producers of wide spectrum beta-lactamase or stable repressed hyperproducers of class I chromosomic cephalosporinase, as well as other multiresistant gram negative bacilli, such as Acinetobacter baumanii make the carbapenems, in many cases, the only effective antibiotic in this type of infections.
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PMID:[The role of carbapenems in the treatment of nosocomial infection]. 941 75

The number of nosocomial infections caused by Acinetobacter baumannii has increased in recent years. The purposes of this study are to discover the risk factors of transmission to prevent the nosocomial infection of A. baumannii. We retrospectively studied 36 patients with A. baumannii bacteremia at China Medical College Hospital from January 1996 to December 1997. There were 23 males and 13 females. All bacteremia were acquired nosocomially. Malignancy (n = 8) and intracranial hemorrhage (n = 6) were the most common underlying diseases. Only one patient on arterial line disclosed intraarterial catheter-related A. baumannii bacteremia and 3 patients had evidence of A. baumannii pneumonia. Twenty-one patients (58%) had central venous catheters in place at the onset of bacteremia, but none was proven to be catheter-related infection. There were 32 patients (89%) with unknown portal of entry. Multivariate logistic regression analysis revealed that potential risk factors related to A. baumannii bacteremia were prior antimicrobial therapy (P < 0.05). The most common clinical features of A. baumannii bacteremia were, in descending order, fever, leukocytosis, thrombocytopenia and hypotension. Eleven patients (30.6%) died directly from A. baumannii bacteremia. All isolates were resistant to ampicillin, cephalothin, cefonicid and moxalactam. The most alarming evidence was that 19% of isolates showed resistance to imipenem. Our findings emphasized that A. baumannii bacteremia had the following characteristics: usually acquired nosocomially, unknown portal of entry, and high multiresistance, especially the increasing resistance rate to imipenem. Imipenem must be reserved as a last-line agent to treat A. baumannii infections, so we want to suggest that the treatment of choice for A. baumannii is gentamicin, amikacin or ceftazidime.
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PMID:Acinetobacter baumannii bloodstream infection: clinical features and antimicrobial susceptibilities of isolates. 1046 22

Pneumatoceles are cystic lesions of the lungs often seen in children with staphylococcal pneumonia and positive-pressure ventilation. Acinetobacter calcoaceticus is an aerobic, short immobile gram-negative rod, or coccobacillus, which is an omnipresent saprophyte. The variant anitratus is the most clinically significant pathogen in this family, usually presenting as a lower respiratory tract infection. Acinetobacter has been demonstrated to be one of the most common organisms found in the ICU. We present three critically ill surgery patients with Acinetobacter pneumonia, high inspiratory pressures, and the subsequent development of pneumatoceles. One of these patients died from a ruptured pneumatocele, resulting in tension pneumothorax. Treatment of pneumatoceles should center on appropriate intravenous antimicrobial therapy. This should be culture directed but is most often accomplished with Imipenem. Percutaneous, computed tomographic-guided catheter placement or direct tube thoracostomy decompression of the pneumatocele may prevent subsequent rupture and potentially lethal tension pneumothorax.
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PMID:Acinetobacter calcoaceticus pneumonia and the formation of pneumatoceles. 1082 47

The treatment of life-threatening infections due to carbapenem-resistant Acinetobacter baumannii has become a serious challenge for physicians worldwide. Often, only colistin shows in general good in vitro activity against these carbapenem-resistant strains, but its antibacterial efficacy in comparison with the antibiotics most used in clinical practice is not well known. We studied the efficacy of colistin versus those of imipenem, sulbactam, tobramycin, and rifampin in an experimental pneumonia model with immunocompetent mice. We used three strains of A. baumannii corresponding to the main clones (A, D, and E) involved in the outbreaks of our hospital, with different grades of resistance to imipenem (imipenem MICs of 1, 8, and 512 microg/ml, respectively) and to the other antibiotics. The MIC of colistin was 0.5 microg/ml for the three strains. Reduction of log(10) CFU/g in lung bacterial counts, clearance of bacteremia, and survival versus results with controls were used as parameters of efficacy. Imipenem and sulbactam (Deltalung counts: -5.38 and -4.64 log(10) CFU/ml) showed the highest level of bactericidal efficacy in infections by susceptible and even intermediate strains. Tobramycin and rifampin (-4.16 and -5.15 log(10) CFU/ml) provided good results against intermediate or moderately resistant strains, in agreement with killing curves and pharmacodynamics. On the contrary, colistin showed the weakest antibacterial effect among the antibiotics tested, both in killing curves and in the in vivo model (-2.39 log(10) CFU/ml; P < 0.05). We conclude that colistin did not appear as a good option for treatment of patients with pneumonia due to carbapenem-resistant A. baumannii strains. Other alternatives, including combinations with rifampin, may offer better therapeutic profiles and thus should be studied.
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PMID:Efficacy of colistin versus beta-lactams, aminoglycosides, and rifampin as monotherapy in a mouse model of pneumonia caused by multiresistant Acinetobacter baumannii. 1201 13

Infection with Burkholderia mallei (formerly Pseudomonas mallei) can cause a subcutaneous infection known as "farcy" or can disseminate to condition known as Glanders. It is primarily a disease affecting horses, donkeys and mules. In humans, Glanders can produce four types of disease: localized form, pulmonary form, septicemia, and chronic form. Necrosis of the tracheobronchial tree and pustular skin lesions characterize acute infection with B. mallei. Other symptoms include febrile pneumonia, if the organism was inhaled, or signs of sepsis and multiple abscesses, if the skin was the port of entry. Glanders is endemic in Africa, Asia, the Middle East, and Central and South America. Glanders has low contiguous potential, but because of the efficacy of aerosolized dissemination and the lethal nature of the disease, B. mallei was considered a candidate for biological warfare. During World War I, Glanders was believed to have been spread to infect large numbers of Russian horses and mules on the Eastern front. The Japanese infected horses, civilians and prisoners of war during World War II. The USA and the Soviet Union have shown interest in B. mallei in their biological warfare program. The treatment is empiric and includes mono or poly-therapy with Ceftazidime, Sulfadiazine, Trimethoprim + Sulfamethoxazol, Gentamicin, Imipenem etc. Aggressive control measures essentially eliminated Glanders from the west. However, with the resurgent concern about biological warfare, B. mallei is now being studied in a few laboratories worldwide. This review provides an overview of the disease and presents the only case reported in the western world since 1949.
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PMID:[Glanders--a potential disease for biological warfare in humans and animals]. 1217 May 62

In spite of the recent medical advances, lower respiratory tract infections are still the most frequent infectious causes of mortality worldwide. The objective of this study was to determine the frequency of occurrence and antimicrobial susceptibility of bacterial isolates collected from hospitalized patients with pneumonia in Latin American medical centers during the first four years of the SENTRY Program. The five most frequently isolated species were (n/%): Pseudomonas aeruginosa (659/26.3%), Staphylococcus aureus (582/23.3%), Klebsiella pneumoniae (255/10.2%), Acinetobacter spp. (239/9.6%), and Enterobacter spp. (134/5.4%). P. aeruginosa demonstrated high rates of resistance to most of the antimicrobials tested. Against P. aeruginosa, the most active agents were meropenem (MIC(50), 1 microg/ml; 71.6% susceptible), amikacin (MIC(50), 4 microg/ml; 71.0% susceptible), and piperacillin/tazobactam (MIC(50), 16 microg/ml; 70.4% susceptible). Imipenem (MIC(50), 1 microg/ml; 84.1% susceptible) and meropenem (MIC(50), 2 microg/ml; 84.9% susceptible) were the most active agents against Acinetobacter spp. followed by tetracycline (MIC(50), </=4 microg/ml; 52.3% susceptible). Although the broad-spectrum cephalosporins had demonstrated excellent in vitro activity against Klebsiella pneumoniae isolates (MIC(50)s range, </= 0.12 to 0.25 microg/ml), elevated rates of resistance (46.3%-58.5%) were observed. Approximately 44.0% and 29.0% of K. pneumoniae and E. coli isolates were considered ESBL producers based on NCCLS criteria, respectively. Overall, the prevalence of methicillin-resistant S. aureus was 46.2%. The most active drugs against this pathogen were vancomycin, teicoplanin, linezolid and quinupristin/dalfopristin. In summary, the SENTRY Antimicrobial Surveillance Program has detected a high prevalence of methicillin-resistant S. aureus and multidrug resistant non-fermentative Gram-negative bacilli isolated from respiratory tract specimens of hospitalized patients with pneumonia in Latin America. Our results emphasize the importance of local surveillance programs in correctly guiding empiric therapy and local intervention programs in attempt to reduce antimicrobial resistance.
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PMID:Respiratory tract pathogens isolated from patients hospitalized with suspected pneumonia in Latin America: frequency of occurrence and antimicrobial susceptibility profile: results from the SENTRY Antimicrobial Surveillance Program (1997-2000). 1249 78

Acinetobacter spp. are predominantly nosocomial pathogens of growing importance. One of their important features is antimicrobial resistance that includes beta-lactams, aminoglycosides and quinolones. Imipenem, considered the most effective drug against Acinetobacter spp., is not universally active against clinical isolates and therapeutic options are necessary. In vitro studies demonstrate the activity of beta-lactamase inhibitors with direct antimicrobial activity, polymyxins, doxycycline and rifampin. Synergy of various combinations has been demonstrated in vitro. Experimental models of infection in mice and rabbits show the efficacy of rifampin and doxycycline. Colistin did not lead to good results in a mouse pneumonia model. There are no randomised, controlled studies on the treatment of Acinetobacter spp. infections. Retrospective comparative studies suggest that ampicillin-sulbactam may be comparable to imipenem in the treatment of pneumonia and bacteraemia. There are a few uncontrolled studies using ampicillin-sulbactam and one study with colistin with results that suggest that they may be acceptable options to treat multi-resistant infections.
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PMID:Treatment of Acinetobacter spp infections. 1287 37

Abstract Sub-inhibitory concentrations of imipenem and meropenem were evaluated for their ability to induce morphological changes with six strains of Acinetobacter baumannii isolated from patients with nosocomial pneumonia. Three strains were susceptible and three were resistant to carbapenems. The strains were grown in the presence of 0 (controls), 0.25x, 0.5x and 1x the MIC of both carbapenems for 4 h, and then examined after Gram's stain. Cells > or = 3 microm in size (spheroplasts) were considered to be altered. Both carbapenems induced significant numbers of spheroplasts compared to controls. Imipenem had more effect against susceptible strains, while meropenem had a greater effect against resistant strains.
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PMID:Morphological changes induced by imipenem and meropenem at sub-inhibitory concentrations in Acinetobacter baumannii. 1537 91


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