Eikenella Corrodens, a Recently Recognized Pathogen

We studied the comparative in vitro activities of 10 oral antimicrobial agents against 147 aerobic and 61 anaerobic bacteria making up species in 13 genera (Staphylococcus aureus, streptococci, Eikenella corrodens, Pasteurella multocida, Haemophilus-Actinobacillus spp., M-5, EF-4, Moraxella spp., Flavobacterium Ilb, Bacteroides melaninogenicus, Bacteroides spp., Fusobacterium spp., and Peptostreptococcus spp.) that were isolated from bite wounds. Cefuroxime was generally >fourfold more active than cephalexin and cefadroxil against all aerobic isolates, including Pasteurella multocida. The fluoroquinolones were highly active against most aerobic isolates but were less active against anaerobic isolates. Ciprofloxacin was generally more active than either enoxacin or ofloxacin. Discrepancies of >30% in the interpretation of susceptibilities between break points suggested by the National Committee for Clinical Laboratory Standards and those related to oral dose peak levels (one-half to one-quarter of maximum achievable concentrations) were noted in 14% (18 of 130) of the instances.The choice of an appropriate antimicrobial regimen for infections caused by animal and human bites poses a dilemma for clinicians. Approximately 80% of bite wounds harbor potential pathogens, including many unusual and fastidious aerobic and anaerobic bacteria (10). Anaerobic bacteria can be isolated from approximately 30 and 60% of animal and human bite wounds, respectively (2, 6, 7, 10), and their isolation has been associated with more severe clinical infections (11). Yet, in an era of cost-consciousness, these wounds are often not cultured aerobically and are rarely cultured anaerobically except in research studies. To compound these problems, most clinical laboratories are unable to determine the in vitro susceptibilities of fastidious aerobic and anaerobic bacteria that are frequently isolated from bite wounds.Consequently, clinicians must sometimes rely on the medical literature to guide therapeutic choices, both empiric and specific. Only two systematic susceptibility studies with large numbers and varieties of bite pathogens exist in the English language literature (2, 9). In these studies both a high percentage of 3-lactamase-producing bacteria (2) and the emergence of bacteria that are resistant to commonly used antimicrobial agents have been noted in several genera of isolates obtained from bite wounds (9). Information about newer alternative therapeutic agents and their in vitro activities against the full spectrum of species isolated from bite wounds is therefore needed to help guide clinicians.Cefuroxime axetil, the new orally administered, esterified formulation of cefuroxime, and ciprofloxacin, an oral fluoroquinolone antibacterial agent, have recently been approved for use in skin and soft tissue infections. Ofloxacin and enoxacin are two other oral fluoroquinolones under investigation that have potential use in skin and soft tissue infections. Since these agents can be used to treat animal and human bite wound infections...

Section: Methodsmentioning

confidence: 99%

Comparative activities of cefuroxime, amoxicillin-clavulanic acid, ciprofloxacin, enoxacin, and ofloxacin against aerobic and anaerobic bacteria isolated from bite wounds

Goldstein¹,

Citron²

1988

“…E. corrodens is susceptible to penicillin and resistant to penicillinase-resistant penicillins, clindamycin, and the aminoglycosides (1, 10). The in vitro activity of the cephalosporins has been inconsistent (1,5,6). In addition to its poor activity against E. corrodens, cephalothin has led to clinical therapeutic failures (1,4,13 The E. corrodens strains were taken from frozen stock culture and grown on brucella agar supplemented with 5% sheep blood and vitamin K1 (10 ,ug/ml) in 5 to 10% CO2 for 48 h. After a transfer to ensure purity, the strains were transferred to tubes containing Mueller-Hinton broth (CalScott Laboratories, Carson, Calif.) supplemented with Fildes enrichment (Difco Laboratories, Detroit, Mich.) and incubated overnight in 5 to 10% CO2.…”

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confidence: 99%

“…Although it has been isolated as the sole pathogen in dental infections, pulmonary infections, brain abscesses, meningitis, osteomyelitis, and endocarditis (2-4, 7-9, 12, 13), it is usually isolated in mixed culture. E. corrodens is susceptible to penicillin and resistant to penicillinase-resistant penicillins, clindamycin, and the aminoglycosides (1,10). The in vitro activity of the cephalosporins has been inconsistent (1,5,6).…”

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confidence: 99%

“…Clinical evidence of therapeutic failure has been correlated with in vitro findings that the E. corrodens strain was resistant to the antibiotic used (1, 4, 13). Brooks et al (1) noted that patients receiving cephalothin therapy developed infections with E. corrodens. It was recently reported that patients with hand infections from which E. corrodens was isolated who were not given effective therapy against E. corrodens (usually a cephalosporin or a penicillinase-resistant penicillin) had a higher incidence of complications and residual disability (4).…”

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confidence: 99%

See 1 more Smart Citation

Susceptibility of Eikenella corrodens to penicillin, apalcillin, and twelve new cephalosporins

Goldstein¹,

Citron²

1984

The susceptibility of 29 strains of Eikenella corrodens to penicillin, apalcillin, and 12 new cephalosporins was determined by the agar dilution method. Most strains were resistant to cefsulodin, and some were resistant to apalcillin and cefpiramide. Although all strains were susceptible to the other cephalosporins tested, most of those drugs were as active as or less active than penicillin. Susceptibility testing of isolates should be performed whenever a cephalosporin is used to treat infections involving E. corrodens.Eikenella corrodens has been implicated as a pathogen in a wide variety of clinical infections. Although it has been isolated as the sole pathogen in dental infections, pulmonary infections, brain abscesses, meningitis, osteomyelitis, and endocarditis (2-4, 7-9, 12, 13), it is usually isolated in mixed culture. E. corrodens is susceptible to penicillin and resistant to penicillinase-resistant penicillins, clindamycin, and the aminoglycosides (1, 10). The in vitro activity of the cephalosporins has been inconsistent (1,5,6). In addition to its poor activity against E. corrodens, cephalothin has led to clinical therapeutic failures (1,4,13 The E. corrodens strains were taken from frozen stock culture and grown on brucella agar supplemented with 5% sheep blood and vitamin K1 (10 ,ug/ml) in 5 to 10% CO2 for 48 h. After a transfer to ensure purity, the strains were transferred to tubes containing Mueller-Hinton broth (CalScott Laboratories, Carson, Calif.) supplemented with Fildes enrichment (Difco Laboratories, Detroit, Mich.) and incubated overnight in 5 to 10% CO2. The turbidity was adjusted to one-half of a McFarland standard no. 1. Mueller-Hinton agar plates supplemented with 5% sheep blood and antimicrobial agents at concentrations from 128 to 0.06 ,ug/ml were inoculated with a Steers replicator (Craft Machine Inc., Chester, * Corresponding author. t Address reprint requests to Ellie J. C. Goldstein, 11980 San Vicente Boulevard no. 103, Los Angeles, CA 90049. Pa.). Antibiotic solutions were freshly prepared for each test by the manufacturer's instructions. Control plates without antibiotics were inoculated before and after each series of antibiotic-containing plates were inoculated. All plates were incubated in 5 to 10% CO2 for 48 h and then examined. Control strains (Staphylococcus aureus ATCC 25923 and Escherichia coli ATCC 25922) were tested simultaneously on each plate.The activities of 12 new cephalosporins, apalcillin, and penicillin against 29 strains of E. corrodens is shown in Table 1. All strains tested were uniformly susceptible to ceftriaxone (<2 1±g/ml), cefotetan (<4 jig/ml), HR-810 (<4 ,ug/ml), cefmenoxime (<8 p.g/ml), cefuroxime (<8 j±g/ml), penicillin (<8 IU/ml), cefbuperazone (<16 ,ug/ml), ceforanide (<16 jxg/ml), and ceftizoxime (<16 ,ug/ml). Susceptibility to the other agents was variable. Ceftazidime showed relatively poor activity (MIC, 0.06 to 32 ,ug/ml); the activity of apalcillin and cefpiramide was also relatively poor, and some strains were resistant to these drugs. W...

“…Eikenella corrodens, a fastidious, slow-growing, facultatively anaerobic gram-negative rod that is part of the normal oral and fecal flora of humans (2) has been increasingly recognized as a pathogen in human infections (1)(2)(3)(4)(5)(6)(7)(8)(9)11 The activity of the 13 antimicrobial agents tested against the 28 strains of E. corrodens is shown in Table 1. All strains of E. corrodens tested were uniformly susceptible to cefoxitin (-1 ,ug/ml), cefotaxime (sl ,ug/ml), moxalactam ('1 ,ug/ml), N-fomiimidoyl thienamycin (c 0.25 ,ug/ml), ticarcillin (c4 ,ug/ml), and penicillin G ('4 ,ug/ml) and resistant to clindamycin.…”

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confidence: 99%

Susceptibility of Eikenella corrodens to newer beta-lactam antibiotics

Goldstein¹,

Gombert²,

Agyare³

1980

In vitro susceptibility testing of 28 strains of Eikenella corrodens by the agar dilution technique showed that all strains were uniformly susceptible to penicillin, ticarcillin, cefoxitin, cefotaxime, N-formimidoyl thienamycin, and moxalactam and resistant to clindamycin and cefadroxil. Cefoperazone, piperacillin, and mezlocillin showed good activity, with some strains relatively resistant. Bacampicillin and cefamandole showed relatively poor activity.Eikenella corrodens, a fastidious, slow-growing, facultatively anaerobic gram-negative rod that is part of the normal oral and fecal flora of humans (2) has been increasingly recognized as a pathogen in human infections (1-9, 11). It is variably susceptible to beta-lactam and aminoglycoside antibiotics; it is uniformly susceptible to penicillin and ampicillin and resistant to penicillinase-resistant penicillins, clindamycin, and metronidazole (1, 2, 10, 11). We determined the in vitro susceptibility, by the agar dilution technique, of 28 strains of E. corrodens, all clinical isolates, to the newer beta-lactam antibiotics and to penicillin and clindamycin.All isolates were identified by standard criteria (1, 2). The sources and numbers of the isolates were as follows: abscesses, eight; transtrachial aspirates, five; human bite wounds, five; other wounds, five; bile, one; blood, one; urine, one; and sputum, two. Laboratory powders were kindly supplied by the following: cefoxitin and N-formimidoyl thienamycin, Merck & Co., Inc., Rahway, N. The activity of the 13 antimicrobial agents tested against the 28 strains of E. corrodens is shown in Table 1. All strains of E. corrodens tested were uniformly susceptible to cefoxitin (-1 ,ug/ml), cefotaxime (sl ,ug/ml), moxalactam ('1 ,ug/ml), N-fomiimidoyl thienamycin (c 0.25 ,ug/ml), ticarcillin (c4 ,ug/ml), and penicillin G ('4 ,ug/ml) and resistant to clindamycin. Susceptibility to the other agents was variable. Cefoperazone, piperacillin, and mezlocillin showed good activity, with some strains relatively resistant. Cefadroxil showed poor activity (32 to 128 ,ug/ml); the activity of cefamandole was relatively poor (4 to 16 ,ug/ml), as was that of bacampicillin (2 to 8 ,ug/ml).The extended-spectrum beta-lactam antibiotics are frequently used as initial empiric therapy for a wide variety of clinical situations in which E. corrodens is a potential pathogen. Consequently, the susceptibility pattem of E. corrodens must be considered when a therapeutic reginen is chosen.Our data are in agreement with prior reports that E. corrodens is susceptible to penicillin and cefoxitin but resistant to clindamycin (1, 2, 10, 11). On a weight basis, cefoxitin, cefotaxime, moxalactam, and N-formimidoyl thienamycin showed better activity than did penicillin against all strains tested. Ticarcillin showed comparable activity. Cefoperazone, piperacillin, and mezlocillin showed good activity, but some strains were relatively resistant.