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Query: UMLS:C0519030 (Klebsiella)
 21,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During a 3-week period, nine babies in the neonatal unit of a large teaching hospital in Durban were infected or colonized with Klebsiella pneumoniae resistant to a range of antimicrobial agents including amikacin and cefotaxime. Resistance to cefotaxime was reduced by clavulanic acid in vitro suggesting production of extended-spectrum beta-lactamase activity. All the isolates had the same antibiotic resistance profile, belonged to the same serotype (K17), were non-typable with bacteriophages, and had identical plasmid profiles indicating that they belonged to the same strain. During a 1-day microbiological survey of the ward, the outbreak strain was isolated from the nose and hands of a doctor based in the nursery and from the hands of a nurse and the mother of an infected baby. The strain was also isolated from nine of 67 environmental samples. Investigation revealed that infection control practices which had been instituted following a previous outbreak in the nursery with multi-resistant methicillin-resistant Staphylococcus aureus (MRSA) were not being adhered to. The re-introduction and strict enforcement of these procedures under the supervision of an Infection Control Nurse resulted in the abrupt end of the outbreak.
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PMID:Multiresistant Klebsiella pneumoniae in a neonatal nursery: the importance of maintenance of infection control policies and procedures in the prevention of outbreaks. 136 37

Gram-negative bacteria are an important cause of invasive infection among neonates. In this study a novel fingerprinting method was used for the first time to assess the importance of various potential reservoirs of the major gram-negative enterobacteria that colonized 46 consecutive infants in three neonatal special care units during a three to four week period. Such bacteria were isolated from the oropharynx, umbilical cord and faeces in 24%, 33% and 100% of the infants, respectively. Klebsiella/Enterobacter spp. dominated over Escherichia coli and spreading (shared) over sporadic strains. Sixty-one percent of the neonates were colonized with at least one and up to six different strains shown to exist in the ward, mainly in other infants. Environmental reservoirs and the faecal flora of mothers and staff were of minor importance. Vertical transmission occurred in 12% of vaginally delivered infants and in 0% of those delivered by caesarean section.
Infection
PMID:Importance of the environment and the faecal flora of infants, nursing staff and parents as sources of gram-negative bacteria colonizing newborns in three neonatal wards. 142 81

New developments in case management presently afford cures to more than 60% of children with acute lymphoblastic leukemia (ALL). 287 children diagnosed with ALL were admitted to the All India Institute of Medical Sciences over the period January, 1982 - September, 1989, where they began chemotherapy. 50 died during initial or subsequent induction therapy and 5 died during the maintenance phase. All deaths were subsequently reviewed to identify the causes of mortality. Infection alone caused death in 47.3% of cases, hemorrhage was observed among 12.7%, and infection together with hemorrhage killed another 13 children. Septicemia, gastrointestinal, and pulmonary infections in 11, 15, and 10 cases, respectively, and meningitis in 2 cases were major sites or infection. Pseudomonas and Klebsiella in 6 cases each accounted for 54.5% of isolates. The gastrointestinal tract and pulmonary system were major sites of bleeding. While no definite cause of death was found for 5 cases, infections nonetheless either alone or combined with other factors caused 76.5% of deaths. To improve the long-term event free survival of children with ALL, practitioners must be knowledgeable about the potential spectrum of infections, begin treatment early with appropriate antibiotics, and seek to improve the availability of supportive facilities and modern antibiotics.
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PMID:Causes of mortality in children with acute lymphocytic leukemia. 150 Jan 28

The efficacy of cefodizime (CDZ) in upper urinary tract infections (UUTI) and complicated lower urinary tract infections (LUTI) was assessed by analysis of the combined results of five clinical trials. Doses of CDZ 1 g i.m. daily, 1 x 2 g i.v. or i.m. and 2 x 2 g i.v. were investigated; comparative agents were cefuroxime 3 x 1.5 g and ceftizoxime 1 x 2 g. Median duration of treatment was seven days. A total of 544 patients, 61% of whom had UUTI, entered the studies. Four hundred twenty-two patients were evaluable clinically and 375 bacteriologically. The most frequent pathogen at baseline was Escherichia coli, followed by Proteus mirabilis, Klebsiella spp. and Staphylococcus aureus. Both clinical and bacteriological cure rates were above 90% in all study groups. The dosage of 1 x 2 g CDZ is recommended for the treatment of UUTI and complicated LUTI.
Infection 1992
PMID:Cefodizime given once daily for the treatment of upper urinary tract infections and complicated lower urinary tract infections. 152 70

The efficacy of cefodizime (CDZ) in lower respiratory tract infections (LRTI) with parenchymal involvement was assessed by the analysis of data from 919 patients who participated in four controlled, randomized studies and three open studies. Sputum bacteriology and a chest x-ray were performed at baseline and after therapy. A total of 778 patients were evaluable for clinical efficacy and 451 for bacteriological efficacy. The most frequent pathogen was Streptococcus pneumoniae, followed by Staphylococcus aureus, Klebsiella pneumoniae and Haemophilus influenzae. CDZ 1 g b.i.d., 2 g b.i.d. and 2 g once daily achieved clinical and bacteriological cure rates above 90%, which matched those observed with the comparators (cefuroxime 1.5 g t.i.d. and cefotaxime 2 g b.i.d.). No significant differences in clinical and bacteriological outcome were detected when the various CDZ dosage regimens were compared. 1 g CDZ b.i.d. is therefore recommended as the regimen of choice for the treatment of LRTI with parenchymal involvement, with CDZ 2 g once daily as an alternative.
Infection 1992
PMID:Review of effectiveness of cefodizime in the treatment of lower respiratory tract infections with parenchymal involvement. 152 72

Cefodizime is a bactericidal cephem with the typical broad spectrum activity of an aminothiazolyl cephalosporin, including both gram-positive and gram-negative bacteria: its MIC90 is 0.125 mg/l for Streptococcus pneumoniae, Streptococcus pyogenes and other streptococci; and 0.05 mg/l for Haemophilus spp., Neisseria meningitidis, Neisseria gonorrhoeae and Moraxella catarrhalis; while beta-lactamase positive strains of M. catarrhalis require 1 mg/l. Less than 1 mg/l is needed for Escherichia coli, Klebsiella spp., Proteus spp. and Shigella spp. The MIC90 is 4 mg/l for methicillin-sensitive Staphylococcus aureus, Morganella morganii, Providencia spp. and most strains of Serratia marcescens, Citrobacter spp. and Enterobacter spp. Staphylococcus epidermidis, Enterococcus faecalis and most strains of Pseudomonas spp. and Acinetobacter spp. are considered cefodizime-resistant. Cefodizime is unaffected by plasmid-mediated beta-lactamases, but it is hydrolyzed by some chromosomally mediated enzymes, thus resembling other third-generation cephalosporins. Cefodizime has high affinity for PBP 3 and PBP IA and IB (Escherichia coli); in S. aureus it shows the highest affinity for PBP 1.
Infection 1992
PMID:In vitro activity of cefodizime. 152 73

After treatment of encapsulated Klebsiella pneumoniae with salicylate or bismuth compounds, phagocytic uptake by human peripheral white blood cells or rat alveolar macrophages was assessed. Without salicylate pretreatment of bacteria, a 30-60% net increase in viable bacteria resulted in phagocytic assays after a 1 hour incubation. With salicylate pretreatment, dose-related decreases in bacterial counts were seen, achieving a maximal reduction of 60% with 240 microM salicylate pretreatment. Bacterial variants producing less capsule were more serum sensitive and more readily phagocytosed. Micrographs of Giemsa-stained cells revealed phagocytic uptake of multiple bacteria after salicylate pretreatment, but virtually no uptake of untreated bacteria. Opsonization with polyclonal antiserum decreased bacterial cell counts by 20% without and by 90% with salicylate pretreatment of bacteria. Pretreatment of bacteria with bismuth salts also enhanced opsonophagocytosis of encapsulated bacteria. Thus, agents known to reduce capsule expression in K. pneumoniae also enhance phagocytic uptake of bacteria.
Infection
PMID:Salicylate or bismuth salts enhance opsonophagocytosis of Klebsiella pneumoniae. 158 86

Exposure to radiation damages the immune, hematopoietic, and gastrointestinal components of the host defense system. This may lead to serious endogenous or exogenous infections. When radiation injury is combined with other physical trauma, e.g., burn or wound, the resulting damage to these systems is synergistic, and treatment for infection requires multiple approaches. This paper reviews successful single and combined therapeutic modalities for infections in irradiated mice and irradiated mice inflicted with trauma that are currently conducted at the Armed Forces Radiobiology Research Institute. The models of endogenous and exogenous infection and combined injury are described. The management of wounds infected with bacteria, exogenous systemic infection due to gram-negative enteric bacteria, and the chemoprophylaxis of enteric-derived systemic infection with quinolones is described. Infections can be treated successfully with proper antimicrobial therapy. In gamma- and neutron-irradiated mice, the immunomodulator trehalose dimycolate (TDM) was effective in treating endogenous infection. TDM with the antimicrobial ceftriaxone was effective in treating exogenous infection due to Klebsiella pneumoniae. Improvement in managing infection in irradiated and injured hosts will require further research using these diagnostic and therapeutic modalities. Accurate biological dosimetry is critical in determining if victims are at risk of developing infection. We found that radiation induced changes in plasma diamine oxidase activity; monitoring these changes was a useful indicator of the severity of radiation injury.
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PMID:Therapies for radiation injuries: research perspectives. 160 4

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

Pyelonephritis emphysematous (PE) is a life threatening renal infection which is observed practically exclusively as a serious complication of diabetes mellitus. 95% of the 73 cases which have been reviewed were found in diabetic patients. The symptomatology resembles that of severe acute pyelonephritis but the disease differs from this in that, in PE, emphysema develops in the actual renal parenchyma and/or in the perirenal tissues. The most important single factor in the etiology appears to be ischaemia of the tissues which are employed as growth media for the microorganisms involved. Infections with E. coli, Klebsiella pneumoniae, Aerobacter and Proteus are the most commonly found. Isolated cases with Candida and Cryptococcus neoformans have been observed. The mortality in untreated cases of PE is 100%. With medical treatment alone, the mortality decreases to 73% while, when combined medical and surgical intervention is employed, the mortality can be reduced to 30%.
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PMID:[Emphysematous pyelonephritis. A serious complication of diabetes mellitus]. 163 68


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