Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0519030 (Klebsiella)
 21,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Since the combination of ticarcillin with clavulanic acid is active against many otherwise resistant organisms that commonly affect patients with cancer, a therapeutic trial with ticarcillin disodium plus clavulanate potassium for treating infections in cancer patients was conducted. A total of 127 evaluable patients were treated with this antibiotic. Of these, 63 percent were women with breast carcinoma, 28 percent were patients with leukemia, and the remainder were patients with sarcomas and lung cancer. The median duration of therapy was 7.7 days. There were 63 documented infections, with bacteriologic documentation in 39 episodes. Because of the high incidence of gram-positive infections and after the failure of ticarcillin plus clavulanate potassium in two of these episodes, vancomycin was added to the regimen. The overall response rate was 75 percent. In microbiologically proved infections, the response rate was 79 percent. Thirteen of 17 gram-negative infections responded (76 percent), including four of four episodes caused by Pseudomonas aeruginosa. The only failures in this group were two episodes with Klebsiella species, one episode with Escherichia coli, and one episode with Enterobacter species. Of the gram-positive infections treated without vancomycin, five of eight (63 percent) responded and only two episodes due to Staphylococcus aureus and one due to JK diphtheroid bacteria failed. All episodes treated with the combination of ticarcillin plus clavulanate potassium and vancomycin responded. Seven of eight (88 percent) polymicrobial infections and 73 percent of those infections without identified organisms responded as well. The overall response rates for septicemia, pneumonia, soft tissue infections, and urinary tract infections were 71, 50, 71, and 83 percent, respectively. Of five microbiologically proved superinfections, three were fungal, and one each was due to Klebsiella species and S. aureus. No toxicity was observed. For 12 organisms, the minimal inhibitory concentration was lower for ticarcillin plus clavulanate potassium than for ticarcillin alone; in six it was identical. Five organisms were resistant to both, and three that were resistant to ticarcillin were sensitive to ticarcillin plus clavulanate potassium. Ticarcillin plus clavulanate potassium is a safe drug with an expanded spectrum of activity. More therapeutic trials need to be conducted to better define its role in the therapy of serious infections in cancer patients.
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PMID:Ticarcillin plus clavulanic acid in the treatment of patients with cancer. 407 96

Attempting to explain the predominance of Pseudomonas in leukemic patients, five of the most common gram-negative organisms isolated from sites of infection in cancer patients were exposed to several of the chemotherapeutic agents used in the treatment of this disease (methotrexate, cytosine arabinoside, cyclophosphamide, and 6-mercaptopurine). At concentrations of 125 mug/ml or higher, methotrexate inhibited all organisms except Pseudomonas. Cytosine arabinoside inhibited Escherichia and Klebsiella but appeared to stimulate the growth of Pseudomonas slightly at the higher concentrations. Thus, significant differences existed in individual susceptibilities to these agents. Clinical isolates were more resistant than the corresponding laboratory strains not previously exposed to these compounds. The resistance of Escherichia coli to cyclophosphamide was decreased 26% when it was grown in mixed culture with Pseudomonas. Only Pseudomonas was resistant to all of these compounds whether in pure or mixed culture. These observations may help to explain, in part, the predominant role that Pseudomonas plays as an infectious agent in leukemic patients.
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PMID:Effect of chemotherapeutic agents upon microorganisms isolated from cancer patients. 420 99

Out of 200 infections due to Bacteroides fragilis occurring over a period of three years 133 were related to the intestinal tract, 55 to the genitourinary tract, and the remainder were in bedsores and ulcers; 56% occurred in patients undergoing major intestinal surgery.B. fragilis was isolated in pure culture from 56% of the infections. In mixed culture it was most commonly associated with Klebsiella and Enterobacter species. Other anaerobic bacteria were isolated in 9% of the mixed cultures.Altogether 131 (65.5%) of the patients recovered without antibiotic therapy or further surgery, but 59 (29.5%) developed complications and 10 (5%) died. The commonest complication was abscess formation, and the incidence was highest with infections associated with malignancy (44%) and lowest with obstetric infections (5%). The mortality was 5% overall but in the presence of bacteraemia it rose to 33%.Only 43 patients received appropriate chemotherapy. Clindamycin was the most effective antibiotic, having a recovery rate of 78%, but this rate was little better than in untreated patients (65%). The role of prophylactic antibiotic therapy in preventing bacteroides infection remains to be studied.The incidence of the isolation of bacteroides from wound infections after major intestinal surgery rose from 13% in 1970 to 81% in 1973. This increase was due to both the accurate collection and care of specimens while in transit to the laboratory and the use of selective media for the isolation of bacteroides in laboratory culture. The importance of these precautions is emphasized.
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PMID:Clinical importance of infections due to Bacteroides fragilis and role of antibiotic therapy. 484 65

We determined the serum bactericidal activity 1 h after the end of 2 g, 30 min infusions of latamoxef, cefoperazone and cefotaxime in six volunteers against six strains each of Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa. All produced excellent serum bactericidal activity against E. coli. Latamoxef and cefotaxime were superior for K. pneumoniae. Cefoperazone produced the highest titres against Staph. aureus. None of these agents produced sufficient bactericidal activity against Ps. aeruginosa to be useful in initial single agent therapy for the septic, granulocytopenic cancer patient.
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PMID:The serum bactericidal activity of latamoxef (moxalactam), cefoperazone and cefotaxime. 609 48

Moxalactam is a new cephalosporin with a broad spectrum of activity which includes Pseudomonas aeruginosa in addition to Klebsiella species Escherichia coli, and Staphylococcus aureus. Moxalactam was combined with amikacin (M + A) compared to ticarcillin plus amikacin (T + A) in a prospective, randomized double-blind trial of empiric therapy for febrile episodes among granulocytopenic cancer patients. One hundred and ninety-one epidoses were evaluated; T + A, 93 episodes and M + A, 98 episodes. Median granulocyte count of initiation of therapy was less than 100/microliters. Overall response rates were good. In the T + A group, 21 of 29 (72 percent) microbiologically documented infections, including seven of 14 (50 percent) bacteremias, and 24 of 27 (89 percent) clinically documented infections improved. In the M + A group, 20 of 28 (71 percent) microbiologically documented infections, including 11 of 18 (61 percent) bacteremias, and 25 of 25 (96 percent) clinically documented infections resolved. Adverse effects were minimal and equivalent in both groups. Hypokalemia (decrease in serum potassium of greater than 11 mEq/liter from baseline) occurred in 14 of the 93 episodes in the T + A group and in 10 of the 98 episodes in the M + A group with decline in mean serum potassium level of 0.5 and 0.4 mEq/liter respectively. Nephrotoxicity (increase in serum creatinine greater than 0.04 mg/dl) occurred in only one patient in the T + A group and in two patients in the M + A group. Moxalactam plus amikacin has a broader in vitro spectrum, is as effective, and is no more toxic than ticarcillin plus amikacin as empiric therapy for febrile granulocytopenic cancer patients.
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PMID:Empiric antibiotic therapy for suspected infection in granulocytopenic cancer patients: a comparison between the combination of moxalactam plus amikacin and ticarcillin plus amikacin. 621 81

C 1821 is a purified glycoprotein extract from Klebsiella pneumoniae serotype 2 with a molecular weight of about 350,000. It enhances immune responses in animals when given orally and the oral route of administration is devoided of any toxicity even in humans. The present controlled trial showed that C 1821 given per os at the single daily dose of 4 mg for 14 days in untreated cancer patients (mostly lymphomas) significantly enhanced delayed cutaneous hypersensitivity to recall antigens using the Multitest system (7 antigens). It also increased basal levels of lymphocyte cAMP and particularly of cGMP which were decreased in these patients. When incubated in vitro with lymphocytes from either normal controls or patients, C 1821 showed a dose-dependent stimulation of cAMP synthesis which was more pronounced in patients than in controls.
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PMID:Immunomodulating effects of a short-term oral treatment with C 1821 in untreated cancer patients: a controlled study. 631 64

It is well known that patients with granulocytopenia due either to bone marrow failure, acute leukemia or its treatment, or as a result of other intensive chemotherapy are at enhanced risk of serious infection. Several approaches have been designed to minimize the risk of infection in these patients by means of suppression of gastrointestinal flora. A retrospective review of infection in febrile neutropenic patients revealed a significant decrease in bacteremia in patients who had received some oral antimicrobial regimen compared with those who did not. In one large series, infection due to the four most common infecting organisms in neutropenic patients (Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Klebsiella species) occurred in 28% of 380 patients receiving some oral antibiotic regimen compared with 44% of 426 receiving no oral prophylaxis. Aminoglycosides alone or in combination with vancomycin or polymyxin and bacitracin and other agents have been utilized in gut decontaminating regimens. More recently, selective decontamination with a variety of oral agents including nalidixic acid, cotrimoxazole, colistin, etc. have been shown to be effective in some trials. Although cotrimoxazole initially was thought to be beneficial in reducing infection and bacteremia in neutropenic patients, the recently completed EORTC trial did not show a significant difference in incidence of infection or bacteremia in acute leukemia patients attendant upon the use of oral trimethoprim-sulfamethoxazole. There was a significant reduction in infections and bacteremia in patients with malignancies other than acute non-lymphocytic leukemia. Thus, there is a need for infection prevention in neutropenic patients but the optimal method for achieving this goal remains to be determined.
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PMID:Prophylaxis of bacterial infections with oral antibiotics in neutropenic patients. Lessons from the last two EORTC trials and prospects for the future. 636 95

Moxalactam disodium in combination with ticarcillin disodium or tobramycin sulfate was used to treat 445 episodes of suspected or confirmed infection in patients with cancer. The majority had leukemia and neutropenia. The rate of cures during the 231 confirmed infections was 65% for moxalactam and ticarcillin and 64% for moxalactam and tobramycin. Both regimens were comparable against aerobic gram-negative and polymicrobial infections. In gram-positive infections, the response rate for moxalactam and ticarcillin was 73% and for moxalactam and tobramycin, 53%. Only three of nine enterococcal infections responded to treatment. Thirteen percent of all organisms recovered were resistant to moxalactam. Side effects occurred infrequently; the most important was coagulopathy due to moxalactam. Nephrotoxic effects occurred in six patients receiving moxalactam and tobramycin and in none of those receiving moxalactam and ticarcillin. In 39 patients, a superinfection was confirmed. Fourteen were fungal, three were due to enterococcus, and one due to Klebsiella species. Eleven of the 14 fungal episodes occurred in the moxalactam-ticarcillin group. Moxalactam with ticarcillin and moxalactam with tobramycin are equally active for the initial treatment of presumed infection in patients with neutropenia.
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PMID:Moxalactam plus ticarcillin or tobramycin for treatment of febrile episodes in neutropenic cancer patients. 638 46

A one-year prospective study of bacteremia was carried out at a Swedish university hospital. Blood cultures were taken in 6.3% of all patients admitted to the hospital. 148 episodes of bacteremia were recorded in 142 patients, 59% of whom were males. The mean incidence of bacteremia was 4.3 episodes per 1,000 admissions. The incidence of contamination was 1.3%. Malignancy and urinary tract disorders were the most common diagnoses and surgical intervention, central venous catheters and cytostatic drugs the most common predisposing factors. The ratio of hospital to community-acquired bacteremia was 1.3:1. The fatality rate was 12.7%. Gram-negative rods belonging to the Enterobacteriaceae were the most common pathogens, followed by Staphylococcus aureus and Staphylococcus epidermidis. The antibiotic sensitivity pattern of the causative bacteria was quite favorable. No S. aureus strains were resistant to isoxazolyl penicillins or gentamicin. No Klebsiella strain and only one Escherichia coli strain was resistant to gentamicin. The results were compared to a one-year retrospective study carried out in the same hospital five years ago. The incidence of bacteremia had not increased between the two studies.
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PMID:Bacteremia in a Swedish university hospital: a one-year prospective study in 1981 and a comparison with 1975-76. 638 92

Mezlocillin, at a dose of 3 g intravenously over a 2-h period every 4 h, was used for the treatment of 92 episodes of documented infections in 75 myelosuppressed cancer patients. The response rate in 59 evaluable bacterial infections was 46%. Eight of 23 patients with septicemia (35%) responded. The response rates for Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli, the three most common gram-negative infections, were 42, 64, and 70%, respectively. Mezlocillin was well tolerated; the only toxicity attributable to this antibiotic was a skin rash in one patient. The formation of a false-positive urine protein reaction by mezlocillin was noted. This study demonstrated that mezlocillin administered as a single agent was effective against some infections in myelosuppressed cancer patients. The response rate for Klebsiella sp. infections was especially encouraging. However, because it had limited or little activity against many infections, especially those caused by P. aeruginosa and Staphylococcus aureus, the general use of mezlocillin as a single agent for treatment of infections in immunocompromised cancer patients cannot be recommended.
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PMID:Mezlocillin for treatment of infections in cancer patients. 644 74


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