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Intravenous ciprofloxacin and ceftazidime were compared for efficacy in the treatment of nosocomial pneumonia and urinary tract infection (UTI). Patients with nosocomial pneumonia were randomized to receive ciprofloxacin (as the lactate salt) 300 mg i.v. every 12 hours or ceftazidime (with sodium carbonate) 2 g i.v. every eight hours. Patients with UTI were randomized to receive ciprofloxacin 200 mg i.v. every 12 hours or ceftazidime 1 g i.v. every eight hours. Sputum and urine specimens were collected before, during, and after therapy. For patients with pneumonia, the organisms most frequently isolated before treatment began were Escherichia coli, Haemophilus influenzae, Klebsiella pneumoniae, and Proteus mirabilis. Of the 17 pneumonia patients who completed ciprofloxacin treatment, 15 (88%) had resolution of signs and symptoms or improvement. Of the 15 ceftazidime-treated pneumonia patients, 13 (87%) had resolution or improvement. Staphylococcus aureus, Streptococcus species, Acinetobacter species, and K. pneumoniae infections persisted for the ciprofloxacin treatment failures. Infections by Enterobacter cloacae and Acinetobacter species persisted for the ceftazidime treatment failures. For UTI patients, E. coli was the organism most frequently isolated before treatment. All 14 UTI patients who completed treatment showed resolution or improvement. In the ciprofloxacin group two patients were superinfected by Enterococcus species, and in the ceftazidime group there were two superinfections by Enterococcus species and one by Enterobacter cloacae. Intravenous ciprofloxacin was as effective as ceftazidime in the treatment of nosocomial pneumonia and urinary tract infection. Caution should be exercised when treating serious infections by streptococci or staphylococci.
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PMID:Intravenous ciprofloxacin versus ceftazidime for treatment of nosocomial pneumonia and urinary tract infection. 199 86

In a prospective, open clinical study, 50 urological patients with acute pyelonephritis were treated with the oral cephalosporin cefixime. The medication (2 x 200 mg/day) was given for seven to ten days. Clinical, bacteriological as well as hematological examinations were carried out prior to, during and immediately after therapy. A late check-up was performed five to nine days after the end of therapy. 46 of the 50 cases were evaluable for efficacy, and all 50 patients were included in safety evaluation. The most frequent pathogens isolated prior to therapy were Escherichia coli (34 times), Proteus mirabilis (six times), Klebsiella pneumoniae (twice) and coagulase-negative staphylococci (twice). Immediately after the end of therapy the pathogens were eradicated in 44 (97.5%) patients. At the late check-up the urine was sterile in 29 (63%) patients. A relapse was observed in 11 patients, a reinfection in four and the initially isolated pathogens had persisted in two. Immediately after the end of therapy 44 (95.7%) patients were clinically cured and two patients had improved. At the late check-up 41 patients were classified as clinically cured, three showed improvement, and two improvement with relapse. Adverse reactions (one case nausea and exanthem, and one case of meteorism) occurred in two patients. No changes in the blood counts or in the liver and kidney functions were observed. In the study described here cefixime proved to be an effective and well tolerated antibiotic for the treatment of upper urinary tract infections; it is of particular interest that 16 of the 50 patients presented with underlying disease favoring infection.
Infection 1990
PMID:[Effectiveness and tolerance of cefixime in the treatment of acute pyelonephritis]. 207 74

The in vitro activity of cefpirome was evaluated against strains that showed conflicting results for third generation cephalosporins. Against isolates with derepressed inducible chromosomal cephalosporinase (n = 40) cefpirome was the sole cephalosporin with an MIC90 in the susceptible range; Klebsiella spp. with plasmid-mediated beta-lactamases (broad spectrum SHV-2 or SHV-2 type) (n = 40) remained most susceptible to ceftizoxime and cefpirome; against aminoglycoside-resistant Pseudomonas aeruginosa (n = 50), cefpirome was as active as ceftazidime and cefoperazone; against oxacillin-susceptible and oxacillin-resistant Staphylococcus spp., (n = 40), cefpirome was more active than other third generation cephalosporins but killing was inadequate against both oxacillin-resistant staphylococci and enterococci.
Infection
PMID:In vitro activity of cefpirome compared with other third generation cephalosporins against nosocomial isolates in Argentina. 211 72

Infections of the chest and abdominal wall are rare but potentially fatal disorders that can occur spontaneously or in association with diabetes mellitus, immunosuppression, or trauma. The condition (either in the form of necrotizing fasciitis and/or pyomyositis) is difficult to diagnose clinically because of poor localizing signs. Prognosis depends on early recognition, extent of disease, and type of causative organism. Pathologically, the infections can manifest as cellulitis, abscess, and/or granulation tissue formation. To determine the value of MR imaging in the assessment of these infections, we compared the findings of MR with those of CT, sonography, scintigraphy, and plain radiography in 13 patients with proved thoracic and/or abdominal wall infection. The imaging findings were correlated with microbiological, pathologic, and/or surgical data. The isolated pathogens were Staphylococcus aureus (n = 6), Klebsiella pneumoniae (n = 1), Mycobacterium tuberculosis (n = 4), and Streptomyces somaliensis (n = 2). In 10 of 13 patients, MR imaging and CT were comparable and proved accurate in detecting the nature and extent of the inflammatory process. In seven of the patients, CT also was useful in guiding percutaneous biopsy and/or partial drainage procedures. Coronal and sagittal MR images were helpful for planning surgery. Rib osteomyelitis was missed with both techniques in one patient; in two other patients who did not have CT, MR imaging missed osteomyelitis of the ribs, the spinous process of a vertebral body, and the iliac bone. Sonography underestimated the extent of the disease in all 13 patients, but detected fluid collections in six. Findings on scintigraphy and plain radiography were the least contributory to the diagnosis and treatment of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:MR imaging of thoracic and abdominal wall infections: comparison with other imaging procedures. 213 43

Parainfluenza 1 (Sendai) and influenza A virus pneumonitis cause severe lung damage, which, upon resolution, is followed by persistent alveolitis and parenchymal changes characterized by patchy consolidation and collagen deposition in the affected areas. To determine whether these long-term sequelae of the virus pneumonias are cumulative, mice were infected by aerosol inhalation with Sendai virus, influenza A virus, or Sendai followed 30 days later by influenza virus infection. At 90 days after the initial infection, mice were killed for assay of long-term parenchymal changes as quantitated lung hydroxyproline (Hpr) content, morphometric analysis, and total and differential lavage cell counts. Sendai virus infection did not alter the proliferation of influenza virus in the lungs as quantitated by infectious virus titers on Day 1, 3, 5, 7, 9, and 11 of influenza infection. At Day 90, lung Hpr content was cumulative in dual-infected mice, with a concomitant increase in the persistent alveolitis. To determine whether bacterial infections played a similar role in these long-term pulmonary sequelae, mice were infected by aerosol inhalation with either Staphylococcus aureus or Klebsiella pneumoniae or, during the course of influenza virus infection, superinfected with each of the bacteria. Sixty days after infection with K. pneumoniae alone, lung Hpr levels were significantly increased over those in noninfected control mice. Infection with S. aureus had no effect on the quantitated parameters of long-term lung damage. In influenza-infected mice superinfected with K. pneumoniae, lung Hpr content was significantly increased over that of S. aureus did not elevate any quantitated parameter of lung damage when compared with the virus alone.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sequential virus infections, bacterial superinfections, and fibrogenesis. 216 56

New plasmidic beta-lactamases inactivating so far stable cephalosporins, aztreonam and cephamycins restrict the use of these antibiotics in therapy of infections, e.g., by Escherichia coli and Klebsiella. Thus, combinations of beta-lactamase inhibitors and beta-lactam antibiotics were investigated in vitro with regard to their therapeutic perspectives. Minimal inhibitory concentrations and the kinetics of killing in a pharmacodynamic model were determined. Extended broad spectrum beta-lactamases (EBS-beta-lactamases) representative both for the TEM- and SHV-type were included. None of the available fixed combinations of penicillins and beta-lactamase inhibitors appears useful for therapy of infections caused by producers of EBS-beta-lactamases. In contrast, combinations of piperacillin and tazobactam or sulbactam plus cephalosporins (cefoperazone, cefotaxime, ceftazidime) or aztreonam are highly active (both by their MICs and bactericidal activity) against TEM-type EBS-beta-lactamases, but less promising for the SHV-type EBS-beta-lactamases, and plasmidic cephamycinase. Of the beta-lactams available, the monobactam carumonam and the carbapenems (imipenem, meropenem) remain safe in infections caused by E. coli and Klebsiella EBSBase producers.
Infection
PMID:Perspectives of beta-lactamases inhibitors in therapy of infections caused by Escherichia coli or Klebsiella with plasmidic resistance to third generation cephalosporins. 217 38

Eighteen studies on Selective Decontamination of the Digestive Tract (SDD) have been published up to now. A statistically significant reduction of infection rate was found in fourteen out of the fifteen controlled studies. Although all the studies were designed to evaluate infection-related morbidity as the end point, ten centres have reported fatality rates. Six centres out of the ten showed a statistically significant reduction in mortality in patients receiving SDD versus control. A recent French study describes the eradication of an outbreak of a multi-resistant Klebsiella with SDD. The Paris trial suggests a major impact of the SDD maneuver on the ICU ecology. Emergence of resistance to the SDD agents among gram-positive cocci has been described, although the clinical impact of this antibiotic side effect has not been reported so far. There are three indications for SDD, as follows: (i) trauma patients; (ii) liver transplant recipients and (iii) outbreaks of multi-resistant organisms.
Infection 1990
PMID:Review of available trials of selective decontamination of the digestive tract (SDD). 219 22

Infection with potential bacterial enteropathogens was studied prospectively in 94 Swedish travellers. Three faecal samples were collected, regardless of diarrhoeal symptoms, after each of three 1-week stays in Singapore, Hong Kong and Japan. The specimens were analyzed for salmonella, shigella, yersinia, campylobacter and different enterotoxin-producing bacteria. A potential enteropathogen was identified in 30% (28/94) of the participants, i.e. in 26% of the healthy and in 39% of the travellers with diarrhoea. The most common isolates were enterotoxigenic bacteria of different species (14%), salmonella (11%) and campylobacter (7%). By performing enterotoxin-tests on six different colonies from the primary culture of each specimen enterotoxigenic Escherichia coli (ETEC) as well as enterotoxin-producing Klebsiella sp., Citrobacter sp. and Morganella morganii were identified. The latter strains were as prevalent as ETEC. In the 33 participants with diarrhoea enterotoxigenic bacteria (18%) and campylobacter (18%) were the most common isolates. Campylobacter-infected travellers developed symptomatic disease (6/7) significantly (P less than 0.02) more often than those infected with salmonella (3/10) or enterotoxigenic bacteria (6/13; 2 ETEC, 4 other species).
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PMID:Infection with bacterial enteropathogens in Swedish travellers to South-East Asia--a prospective study. 220 37

The efficacy of intravenous ofloxacin therapy (200 mg 12-hourly) followed, when appropriate, by oral administration of the same dose was evaluated in an open multicentre trial involving 185 patients in 31 French hospitals. Dosage adjustment was made for patients in renal failure. Infection was hospital-acquired in 35 cases, 53 patients required admission to an intensive care unit. The infections comprised septicaemia (n = 56), pneumonia (n = 18), bronchitis (n = 10), urinary tract (n = 78), female pelvis (n = 8), bone and joint (n = 5), skin and soft tissues (n = 10). The causative pathogens were: Staphylococcus spp. (n = 23), Streptococcus spp. (n = 11), Escherichia coli (n = 85), Haemophilus influenzae (n = 9), Klebsiella, Enterobacter or Serratia spp. (n = 21), Salmonella spp. (n = 22), Chlamydia spp. (n = 3), Legionella spp. (n = 1), Mycoplasma pneumoniae (n = 1) and miscellaneous Gram-negative bacilli (n = 17). All were ofloxacin-susceptible. Mean duration of therapy was 8.06 ( +/- 2.6) days for the i.v. and 14.8 ( +/- 14.39) days for the oral preparation. Clinical cure was achieved in 173 patients (93.5%). It is concluded that iv ofloxacin is an effective treatment for a range of infections due to susceptible organisms.
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PMID:Efficacy of intravenous ofloxacin: a French multicentre trial in 185 patients. 228 86

The pattern of illness in 60 consecutive children with homozygous sickle cell disease who attended the Paediatric Emergency Room of a busy Lagos hospital with acute illness was studied prospectively. Their ages ranged from 3 months to 13 years with a peak in the 2nd year. There were twice as many boys as girls. The commonest symptoms were fever, limb or abdominal pain and cough, and the commonest signs were pallor and hepatomegaly. Painful crises occurred in 27, anaemic crises in 11, and a combination of these in 12 children. Infection was detected in 76% of subjects in crises. Infection was found in 82% of all the children and was mainly bacterial. The commonest infections were pneumonia (35%), bacteraemia (32%), tonsillitis/pharyngitis (17%) and osteomyelitis (8%). The predominant bacteria isolated were Klebsiella spp (38%), E. coli (23%), Staph. aureus (23%), Staph. albus (23%) and Pseudomonas spp (23%). Some children had multiple isolates. Bacterial infection was a major cause of morbidity in very young children and merits appropriate control and preventive measures in this age group. The spectrum of bacteria isolated makes it unlikely that the specific anti-pneumococcal measures widely advocated in Europe and America for young children with SCA would be appropriate in Nigeria.
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PMID:Acute illness in Nigerian children with sickle cell anaemia. 244 66


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