To assess the clinical importance of emergence of beta-lactam resistance caused by stable derepression of chromosomal beta-lactamases, sequential cultures from patients treated with expanded-spectrum cephalosporins were monitored for the persistence of bacteria possessing these enzymes. Antibiotic susceptibilities and beta-lactamase production before and after cefoxitin induction were determined in sequential isolates of individual bacterial strains. Of 49 strains isolated from 44 patients, 25 strains (51%) were eradicated by cephalosporin therapy, 17 strains (35%) persisted with unchanged susceptibility in sequential cultures, and 7 strains (14%) from 7 patients developed multiple beta-lactam resistance during cephalosporin therapy. In 6 of the 7 strains, resistance was associated with stable derepression of beta-lactamases. In the patient group whose strains developed resistance, subsequent use of non-beta-lactam antibiotics was more frequent and mortality was higher.
A man was hospitalized with bacteremic Achromobacter xylosoxidans type IIIa pneumonia. The authors are aware of no previously reported similar infections caused by this bacterium. A clinical cure was achieved with a combination of carbenicillin and kanamycin therapy. Microtiter susceptibility testing revealed that carbenicillin was the antibiotic to which A. xylosoxidans IIIa was most sensitive (minimal inhibitory concentration, 1.6 microgram/ml) and that synergy between carbenicillin and kanamycin existed. During the patient's hospitalization, deficiency of IgM (21 mg/dl) was found. Specific serum activity against A. xylosoxidans IIIa was detected by the agglutination method. Specific anti-A. xylosoxidans IIIa IgG, but not IgM, was detected by indirect immunofluorescence. It appears that a defect in immunologic recognition of A. xylosoxidans IIIa as an invasive bacterium, a defect in synthesis of specific IgM, or both, contributed to this patient's infection.
The plasma and urine concentrations of cefaclor were measured after oral administration of single and multiple doses to volunteers. Cefaclor was rapidly absorbed, rapidly excreted in the urine, well tolerated without toxicity, and failed to accumulate in the plasma with chronic dosing.
Distinctive lesions occurred in the brainstem of a 59-year-old patient who had had recent Pseudomonas aeruginosa meningitis treated with parenteral and intrathecal gentamicin sulfate. The lesions were multiple, minute, and discrete, and were characterized by loss of axons, spongiosis, axonal swelling with frequent calcification, loss of astroglia and oligodendroglia, and slight inflammatory response. These lesions were restricted to the myelinated fiber bundles of the pons and mesencephalon. Because similar lesions can occur with other intrathecally administered medications and emboli to the brain, an experimental study in rabbits was done. Similar lesions were produced in normal adult rabbits after a single intracisternal injection of gentamicin sulfate with or without preservative at doses equivalent to 50 and 100 times the human therapeutic dose. Lesions were not seen after injection of normal saline, preservative, or gentamicin sulfate with preservative at doses equivalent to 1 and 10 times the human therapeutic dose. A direct relationship was observed between the cerebrospinal fluid concentrations of gentamicin, brain tissue concentrations of gentamicin, and occurrence of the lesions.
The ability of a single oral 750-mg dose of ciprofloxacin to eradicate Neisseria meningiidis from persistent nasopharyngeal carriers was prospectively evaluated in a placebo-controlled, randomized, double-blinded study. Cultures of specimens taken from all 23 ciprofloxacin-dosed subjects 1 day postdose were negative; cultures from 96% of these subjects were negative at 7 and 21 days postdose, including a specimen from a subject colonized with a minocydine-resistant strain. Of 22 placebo recipients, 20 (91%) remained culture positive. Single-dose ciprofloxacin appears efficacious for meningococcal prophylaxis.Rifampin and minocycline are currently recommended prophylactic antimicrobial agents for Neisseria meningitidis infections. Although both drugs are effective, their use entails multidose regimens, as well as a risk of toxicity or occasional emergence ofresistance (7, 10). The carboxyquinolone ciprofloxacin has excellent in vitro activity against N. meningitidis (3). In previous placebo-controlled studies, multidose regimens of ciprofloxacin have been shown to be effective in eradicating N. meningitidis from chronic nasopharyngeal carriers up to 2 weeks after dosing (13). Furthermore, in an uncontrolled study, 11 of 12 N. meningitidis carriers given a single oral 750-mg dose of ciprofloxacin remained culture negative for 2 weeks after the dose (14). We report here the results of a placebo-controlled, randomized, double-blinded study of single-dose ciprofloxacin in persistent N. meningitidis carriers.Written informed consent was obtained from 620 healthy young volunteers, who were then evaluated for persistent nasopharyngeal carriage of N. meningitidis by means of two cultures taken 1 week apart, followed by a third culture taken 9 days later. Forty-six subjects whose cultures grew N. meningitidis on all three occasions were identified. These subjects provided a medical history and underwent a physical examination. They were tested for pregnancy by means of a qualitative test for human P-choriogonadotropin in urine; pregnant individuals were excluded from the trial. No subjects were allergic to quinolone drugs, had used antibiotics within 2 weeks of ciprofloxacin dosing, or had a symptomatic infection.Subjects were randomly assigned to take a single 750-mg oral dose of ciprofloxacin or a placebo tablet with an identical appearance. Nasopharyngeal cultures were taken 1, 7, and 21 days after dosing. All tablets were administered under supervision, and subjects were requested to report all adverse effects. At the time of the 7-day-postdose culture, a repeat physical examination was performed.Nasopharyngeal swabs were streaked onto modified Thayer-Martin agar and incubated at 37°C in 10% C02-90% air for 48 h. Colonies that resembled N. meningitidis were identified by Gram stain, positive oxidase reaction, and fermentation of glucose and maltose but not sucrose and lactose. Serogroups were determined by the slide agglutination technique with the cells suspended in physiological * Corresponding author.saline. Antise...
We report a case of actinomycosis of the prostate with symptoms of acute prostatitis. Laparotomy was required to establish an etiological diagnosis. Long-term therapy with erythromycin resulted in a clinical cure.
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