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

Reliability of the cefamandole (CMD) disc susceptibility test in estimating approximate values of MICs was studied using various clinical isolates totaling 246 strains with Showa discs (8 mm diameter containing 30 micrograms of CMD). Clinical significance of a 4 category system for the interpretation of the CMD disc tests, which is normally used in Japan, was also evaluated to determine whether this system would be suitable or not for the evaluation of a proper dose of administration. The results obtained with the disc method were compared with MICs determined using the agar dilution method at an inoculum level of 10(6) CFU/ml. The results of the CMD disc susceptibility test were well correlated with MICs, showing the reliability of the disc method to estimate approximate values of MICs. Break points in MIC values proposed for the classification of bacteria into 4 categories of susceptibility are () MIC less than or equal to 3 micrograms/ml, (++) MIC greater than 3-15 micrograms/ml, (+) MIC greater than 15-60 micrograms/ml, (-) MIC greater than 60 micrograms/ml. Only 4 (1.6%) out the 246 strains tested showed false positive results and 11 (4.5%) showed false negative results, showing the excellent reliability of this test. In this study, approximately 90% of strains of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis isolated from clinical materials randomly were inhibited by CMD at concentrations less than 3.13 micrograms/ml. Proteus vulgaris and Enterobacter aerogenes were sensitive to CMD at 67 and 69% of strains, respectively, at concentrations below 6.25 micrograms/ml. CMD was not active against Pseudomonas aeruginosa, Serratia marcescens and Enterococcus faecalis. About 90% of Staphylococcus aureus were inhibited at dose levels smaller than 6.25 micrograms/ml and 70% of the strains at levels less than 3.13 micrograms/ml. Susceptibilities to 15 micrograms/ml CMD of highly methicillin-resistant strains (MIC greater than 30 micrograms/ml) of S. aureus were examined. Ten of 12 strains examined were found susceptible to CMD, but only 6 of the 12 to cefmetazole. Imipenem/cilastatin was effective to 5 of the 12 strains at levels lower than 3 micrograms/ml and to one at a level less than 15 micrograms/ml. Minocycline was effective against 11 strains at concentrations below 2 micrograms/ml.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Clinical laboratory approach in estimating the effective dosage of cefamandole]. 322 28

Cephalosporin and related antibiotics are highly effective bactericidal agents of relatively low toxicity. The spectrum of activity varies with the drug but is usually broad. The first-generation cephalosporins, and especially cefazolin, are most active against sensitive staphylococci and streptococci. Most second-generation (except cefoxitin) and third-generation cephalosporins show substantial activity against Haemophilus influenzae. All cephalosporins (except cefsulodin) are active against Klebsiella, Escherichia coli, and Proteus mirabilis, whereas only the third-generation agents have pronounced activity against the other Enterobacteriaceae. Imipenem (a carbapenem) is active against essentially all pathogenic organisms, but aztreonam (a monobactam) is active against only aerobic gram-negative bacilli. Advantages associated with some of the new cephalosporins are once-daily administration and high cerebrospinal fluid levels. With the development of new cephalosporins, however, new toxicities have become apparent, and superinfections and induction of resistance have become greater problems. The cephalosporins are among the most expensive antibiotics in use today; thus, use of these expensive agents must be justified by lower toxicity, greater efficacy, or both in comparison with drugs of more reasonable cost.
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PMID:Cephalosporin, carbapenem, and monobactam antibiotics. 330 82

Sixty-one hospitalized infants aged one day to six months were enrolled in an open, multicenter noncomparative clinical study of the efficacy and safety of imipenem/cilastatin. Patients weighing less than 1500 g (four males/ten females, Group 1) and those greater than or equal to 1500 g (31 males/16 females, Group 2) were analyzed separately. Total daily dose (divided into b.i.d. (27) or t.i.d. (34) regimens) ranged from 50 to 101.4 mg/kg given for 10.8 days (means, range 2 to 35 days) for Group 1 and 39.7 to 103 mg/kg given for 11.2 days (means, range 1 to 41 days) for Group 2. The investigators graded the intensity of signs and symptoms of infections as moderate or severe in 86 and 91% of patients in groups 1 and 2, respectively, and bacterial pathogens were isolated pretreatment in 43 and 32% of patients. Eighty-eight percent of all bacterial pathogens were susceptible to imipenem in vitro. The most commonly isolated pathogens were Pseudomonas aeruginosa and Klebsiella pneumoniae. Patients who had confirmed bacterial infections and who did not receive concomitant antibiotics were considered evaluable for efficacy, including 6 (43%) in Group 1 and 15 (32%) in Group 2. Infection sites were (Group 1) respiratory (100%), and (Group 2) skin and skin structures (33%), urinary (11%), gastrointestinal (11%), septicemia alone (11%) and meningitis or respiratory (28% and 6% with sepsis, respectively). Safety analysis included all patients. Imipenem/cilastatin was well tolerated in 93% of Group 1 and 85% of Group 2 patients. Three patients' treatments were discontinued due to rash, oliguria or poor local tolerability. Three patients in Group 1 and four in Group 2 died; deaths were considered unrelated to imipenem/cilastatin. Results are as follows: (table; see text) In summary, 81% (17 of 21) of evaluable patients were clinically cured or improved, among whom 3 of 21 patients (14%) had serious clinical or laboratory adverse experiences which were considered possibly related to imipenem/cilastatin. These results are comparable to results reported with other single or multiple antibiotic regimens.
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PMID:Imipenem/cilastatin therapy for serious infections in neonates and infants. 333 Oct 42

One hundred and four children who were hospitalized for documented or suspected non-CNS bacterial infections (56 males/48 females, 22 days to 15 years old) were treated with intravenous imipenem/cilastatin for 9.4 days (range 3 to 28 days). Children up to three years of age received 100 mg/kg/day and older children 60 mg/kg/day, administered in four divided doses. Bacterial pathogens were isolated before therapy in 85%. Diagnoses in the 74 evaluable patients included bronchopneumonia with or without empyema (20%), peritonitis complicating appendicitis (16%), skin/soft tissue abscesses (14%), septicemia (11%) and miscellaneous other infections (39%). Among evaluable patients, 95% were clinically cured or improved. One patients, a marasmic child with pneumonitis due to pseudomonas, died during therapy. One evaluable patient each with shigellosis, Klebsiella pneumoniae empyema and streptococcal pneumonia had bacteriologic eradication or suppression but, due partly to noninfectious complications, had no overall clinical improvement. Most bacterial isolates (101/108) were eradicated, including many gram-negative and gram-positive aerobes and anaerobes; three pathogens persisted (one Proteus mirabilis and one Salmonella typhi, one Staphylococcus aureus); and one Escherichia coli pyelonephritis recurred after therapy ended too early. Imipenem/cilastatin was well tolerated by 91% of children. Clinical adverse experiences (AEs), none serious except for the one death, occurred in 19%; 12% were judged possibly related to imipenem/cilastatin, but none probably or definitely related. No serious laboratory AEs occurred; the most common AEs were eosinophilia (11%), urine discoloration, and infusion site pain. Imipenem/cilastatin is well tolerated and has excellent clinical efficacy in a wide variety of pediatric infections.
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PMID:Imipenem/cilastatin for pediatric infections in hospitalized patients. 333 Oct 43

Twenty-two patients admitted to the ICU with a severe nosocomial infection caused by multi-resistant Gram-negative bacilli were treated with imipenem combined with cilastatin. We treated nine cases of meningo-ventriculitis, eight cases of septicaemia, four cases of mediastinitis, and one case of pneumonia. The bacteria responsible were Acinetobacter spp. (10), Pseudomonas aeruginosa (5), Enterobacter cloacae (5), Klebsiella pneumoniae (3), Proteus spp. (2), Streptococcus spp. (2), Serratia marcescens (1). More than one pathogen was isolated in five cases. The dosages ranged between 1.5 g to 4 g per day by intravenous infusion; the highest doses were used for the treatment of meningitis. The mean duration of treatment was 17 days. An aminoglycoside was combined with imipenem in 18 cases. Cure was obtained in 17 out of the 22 cases. Very rapid sterilization of the CSF in the cases of meningitis and ventriculitis was noted. Two patients died rapidly despite eradication of the bacteria. One case of meningitis relapsed but cure was subsequently obtained with continuation of the same treatment. In three cases of Ps. aeruginosa infection, resistant mutants were isolated from the sites of infection and were responsible for two failures and one colonization. Imipenem appears to be an antibiotic of choice in severe nosocomial infections including meningo-ventriculitis, especially those caused by Acinetobacter spp. and Ps. aeruginosa. It is also one of the few antibiotics active against both streptococci and multi-resistant Gram-negative bacilli. Careful bacteriological monitoring is recommended during treatment.
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PMID:Experience with imipenem/cilastatin in the intensive care unit. 346 88

Imipenem is a thienamycin antibiotic of the first generation with broad antibacterial activity. It covers all gram-positive organisms (including Streptococcus faecalis) and gram-negative bacteria (including Pseudomonas aeruginosa and Serratia spp.) as well as Bacteroides fragilis and other Bacteroides species. In this comparative study the antimicrobic effect against 1020 gram-negative, 927 gram-positive and 352 anaerobic strains from fresh clinical isolates was tested and compared with that of other frequently used antibiotics. The minimum inhibitory concentrations (MIC) were determined by means of a serial dilution test with micro standard plates. Within the group of gram-negative strains, imipenem was the most active antibiotic with a MIC90 of less than or equal to 0.25 mg/l for most isolates. Imipenem shows a broad spectrum of activity against gram-negative pathogenic bacteria including Escherichia coli, Klebsiella spp., Proteus spp, Enterobacter spp., Citrobacter spp. and Serratia spp., and also covers resistant strains of Pseudomonas aeruginosa, Acinetobacter spp. and Alcaligenes faecalis. Imipenem also shows high inhibiting activity against gram-positive strains and anaerobic pathogens.
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PMID:Antibacterial effect of imipenem in vitro against important aerobic and anaerobic strains isolated from clinical specimens. 347 32

The bactericidal effect (BE) of an antibiotic reduces the infective population, and its postantibiotic effect (PAE) assures a persistent inhibition of bacterial cells after a short exposure to the antimicrobial agent. Both effects prevent the early regrowth of the infecting organisms when the antibiotic tissue levels decrease to below the MIC value. The BE and the PAE of imipenem, cefotaxime, ceftazidime, piperacillin, gentamicin and ampicillin on Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa, Acinetobacter calcoaceticus, Staphylococcus aureus and Streptococcus faecalis were investigated with viable counts and continuous impedance monitoring of broth cultures. Imipenem and gentamicin gave similar high BE and PAE values at low concentrations and with short drug exposures in most strains tested. PAE is low or non-existent for Gram-negative strains with other beta-lactam antibiotics. These results suggest the possibility of future clinical studies with new experimental dosage schedules for imipenem.
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PMID:Postantibiotic effect of imipenem on gram-positive and gram-negative micro-organisms. 354 47

Infection remains a major cause of morbidity and mortality for the patient with cancer who experiences episodes of severe granulocytopenia. The search continues for new antimicrobial agents with improved efficacy and lower incidence of toxicity. Imipenem is a new carbapenem antibiotic which possesses a broad antibacterial spectrum with excellent activity against Pseudomonas aeruginosa and the other commonly recovered enteric gram-negative bacilli that infect the granulocytopenic patient with cancer. The combination of imipenem plus an aminoglycoside has shown in vitro synergy against P. aeruginosa and Staphylococcus aureus whereas the combination of imipenem plus piperacillin or the extended spectrum cephalosporins have frequently shown antagonism when tested against P. aeruginosa and Serratia marcescens. The use of a P. aeruginosa-infected neutropenic rat model has provided an in vivo system to evaluate the activity of new antibiotics or antibiotic combinations. Monotherapy with imipenem is as effective in this model as any of the currently available synergistic antibiotic combinations. This degree of activity has not been found with other broad-spectrum antibiotics when used alone. Imipenem provides serum bactericidal activity well above a 1:8 dilution for the four most commonly isolated pathogens: P. aeruginosa, Escherichia coli, Klebsiella species, and S. aureus. In addition, imipenem's post-antibiotic effect against P. aeruginosa may be pertinent. Imipenem is a unique antibiotic, with properties that make it well suited for study as monotherapy for fever and suspected infection in granulocytopenic patients with cancer. A prospective randomized, double-blind study comparing imipenem with a control regimen of piperacillin plus amikacin as empiric antibiotic therapy of febrile granulocytopenic patients with cancer is currently underway at the University of Maryland Cancer Center.
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PMID:Potential of imipenem as single-agent empiric antibiotic therapy of febrile neutropenic patients with cancer. 385 17

Imipenem/cilastatin was given to 243 evaluable patients with moderately severe to severe soft tissue infections. Cultures prior to therapy yielded Staphylococcus aureus (108 isolates), group D and non-group D enterococci (49), group A streptococci (42), other aerobic gram-positive cocci (72), Pseudomonas aeruginosa (54), Escherichia coli (32), Proteus mirabilis (31), Enterobacter (21), Klebsiella (20), other aerobic gram-negative rods (58), Bacteroides fragilis group (16), and other anaerobes (65). Overall, 95 percent (230 of 243) of the patients treated had clinical cure (137 of 243) or improvement (93 of 243). Of the 506 strains of etiologic bacterial pathogens isolated from these patients and tested against imipenem, 498 (98 percent) were susceptible to the antibiotic. Many were resistant to both older and newer penicillins and cephalosporins. Serial cultures of infection sites revealed that 426 of 498 (86 percent) of pre-therapy bacterial isolates were eradicated by imipenem/cilastatin therapy. Eight of 498 etiologic pathogens (1.6 percent) acquired resistance to imipenem (seven P. aeruginosa and one enterococcus). Such resistance acquisition was associated with clinical failure in two patients. Imipenem/cilastatin appears to be a highly effective, relatively safe therapy of soft tissue infections caused by a wide variety of gram-positive and gram-negative aerobes and anaerobes, both polymicrobial and monomicrobial in nature. Imipenem/cilastatin should be considered particularly when infection by the more antibiotic-resistant of these bacteria is suspected or proved.
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PMID:Role of imipenem/cilastatin in the treatment of soft tissue infections. 389 May 34

The in vitro activity of the novel monobactam antibiotic, Ro 17-2301 has been compared with those of aztreonam, imipenem, ceftazidime, cefotaxime and netilmicin. A total of 438 clinical isolates of aerobic gram-negative rods were employed and an agar dilution method was used for measurement of MIC. Ro 17-2301 was highly active against a wide variety of Enterobacteriaceae species (MIC range less than or equal to 0.03-8, MIC50 less than or equal to 0.03, MIC90 0.06 mg/l). The activity of aztreonam parallelled that of Ro 17-2301 although the latter seemed to have more uniformly high activity against Klebsiella sp. The other agents showed generally high activity against Enterobacteriaceae except netilmicin against Providencia stuartii (MIC50 4, MIC90 greater than or equal to 16 mg/l). Activity against Pseudomonas aeruginosa. was more variable. Ro 17-2301 and aztreonam were moderately active (MIC50 2, MIC90 8 and 16 mg/l, respectively). Imipenem was the most active agent against Acinetobacter, whereas Ro 17-2301 was moderately active. In conclusion, Ro 17-2301 shows impressive activity against Enterobacteriaceae and moderate activity against Acinetobacter and P. aeruginosa. Ro 17-2301 may well prove to be a useful agent in the treatment of gram-negative infections.
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PMID:Ro 17-2301: in vitro comparison with aztreonam, imipenem, ceftazidime, cefotaxime and netilmicin. 392 81


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