Chemotherapy. 2001;47 Suppl 1:24-32.
Management of endocarditis: outpatient parenteral antibiotic treatment in Argentina.

Lopardo G.

Fundacion Centro de Estudios Infectologicos (FUNCEI), Buenos Aires, Argentina. glopardntramed.net.ar

Patients with infective endocarditis often face lengthy hospitalization for parenteral antibiotic therapy. Efforts to reduce medical costs have led to consideration of outpatient parenteral antibiotic treatment (OPAT) for these patients. However, concerns about outpatient management of complications, particularly congestive heart failure and emboli, exist. In Argentina, carefully selected patients with infective endocarditis, representing a low-risk population, have been successfully treated with OPAT. A retrospective analysis was conducted of 48 such patients. Three delivery models were used: at home with medications given by the visiting nurse, at infusion center, or at home with medications self-administered. Ten patients received OPAT only; 38 were initially hospitalized, then transferred to an OPAT program. Twenty-nine patients had streptococcal disease, 37 out of 48 patients were treated with ceftriaxone. Clinical and microbiologic cure was achieved in all patients. Three patients developed heart failure, 2 prior to starting antibiotic therapy. Four developed emboli, all prior to starting antibiotics. Surgery was required in 5 patients: 2 were treated with OPAT postoperatively and 3 had surgery after antibiotic therapy was completed. OPAT for infective endocarditis is safe in well selected patients.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11096186&dopt=Abstract antibiotic, antibiotics



J Infect. 2003 Apr;46(3):161-3.
Assessment of antibiotic prescription in hospitalised patients at a Chinese university hospital.

Hu S, Liu X, Peng Y.

Department of Respiratory Medicine, Renmin Hospital of Wuhan University, Wuhan, P. R. China. husuotmail.com

OBJECTIVE: To describe and understand antibiotic prescribing in hospitalised patients in a university hospital. METHODS: Retrospective study using clinical data on antibiotic prescriptions in 1025 inpatient cases chosen from 21,000 inpatients in our hospital in 1997 by systematic sampling. RESULTS: Antibiotics were prescribed to 77.8% of inpatients, among which 55.2% were prescribed two or more kinds of antibiotics. In 58.5% of cases, antibiotic prescriptions were given therapeutically. Only 39 specimens in 1025 cases were taken for microbiological investigation. CONCLUSIONS: Few microbiological investigations were undertaken prior to antibiotic prescribing. The main challenges in the antibiotic prescribing are to make rational choices for antibiotic use and recognise the potential problems of abuse of antibiotics.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12643864&dopt=Abstract antibiotic, antibiotics



J Bone Joint Surg Am. 2000 Nov;82-A(11):1552-7.
Evaluation of preoperative cultures before second-stage reimplantation of a total knee prosthesis complicated by infection. A comparison-group study.

Mont MA, Waldman BJ, Hungerford DS.

Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21239, USA.

BACKGROUND: Two-stage reimplantation has proven to be highly successful in the treatment of patients with infection at the site of a total knee arthroplasty. However, up to 20 percent of patients have a recurrence of infection following this treatment. The purpose of our study was to determine whether aspiration of the affected joint and culture of the specimen, performed before reimplantation and after discontinuation of antibiotic therapy, would help to identify patients who might have a recurrent infection. METHODS: We prospectively followed sixty-nine patients who were treated for a culture-proven deep infection at the site of a total knee arthroplasty. Group I consisted of thirty-five patients who were treated with removal of the prosthetic components and irrigation and debridement of the joint, followed by six weeks of antibiotic therapy and reimplantation of a prosthesis. Group II was composed of thirty-four patients who were treated with removal of the components and irrigation and debridement of the joint, six weeks of antibiotic therapy, and then repeat culture four weeks after the antibiotic course had ended. If the culture was negative, the patient was managed with a second-stage reimplantation of a prosthesis. If the culture was positive, the protocol was repeated, beginning with irrigation and debridement. The two groups were similar with regard to male-to-female ratio, age, preoperative Knee Society scores, time since primary surgery, types of infectious organisms, duration of symptoms, duration of follow-up, and number of previous revisions. All of the patients were evaluated clinically with use of the objective scoring system of the Knee Society and were followed with serial radiographs. Success was defined as no infection and a functional prosthesis, with a Knee Society score of at least 75 points at the last (thirty-six-month-minimum) follow-up evaluation. RESULTS: Of the thirty-five patients in Group I, five (14 percent) had recurrence of infection. One of the patients was managed with a successful second-stage revision, three were managed with arthrodesis of the knee, and one continued with chronic antibiotic suppressive treatment. Of the thirty-four patients in Group II, three (9 percent) had a positive culture after the course of antibiotics. The protocol was repeated for all three, and they subsequently had a successful second revision. One other patient (3 percent) in Group II, who had a negative culture, had a recurrent infection and was eventually managed with arthrodesis of the knee. CONCLUSIONS: Prerevision cultures, grown after discontinuation of antibiotic treatment and before reimplantation of the components, helped to identify the patients with infection at the site of a total knee arthroplasty in whom the infection might recur. The performance of aspiration and cultures resulted in a substantial improvement in the clinical outcome.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11097443&dopt=Abstract antibiotic, antibiotics



Appl Environ Microbiol. 2000 Dec;66(12):5406-9.
Long-term shifts in patterns of antibiotic resistance in enteric bacteria.

Houndt T, Ochman H.

Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, Arizona 85721, USA.

Several mechanisms are responsible for the ability of microorganisms to tolerate antibiotics, and the incidence of resistance to these compounds within bacterial species has increased since the commercial use of antibiotics became widespread. To establish the extent of and changes in the diversity of antibiotic resistance patterns in natural populations, we determined the MICs of five antibiotics for collections of enteric bacteria isolated from diverse hosts and geographic locations and during periods before and after commercial application of antibiotics began. All of the pre-antibiotic era strains were susceptible to high levels of these antibiotics, whereas 20% of strains from contemporary populations of Escherichia coli and Salmonella enterica displayed high-level resistance to at least one of the antibiotics. In addition to the increase in the frequency of high-level resistance, background levels, conferred by genes providing nonspecific low-level resistance to multiple antibiotics, were significantly higher among contemporary strains. Changes in the incidence and levels of antibiotic resistance are not confined to particular segments of the bacterial population and reflect responses to the increased exposure of bacteria to antimicrobial compounds over the past several decades.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11097921&dopt=Abstract antibiotic, antibiotics



FEMS Microbiol Lett. 2003 Mar 14;220(1):15-20.
Tylosin-resistant bacteria cultivated from agricultural soil.

Onan LJ, LaPara TM.

Department of Civil Engineering, University of Minnesota, 500 Pillsbury Drive SE, Minneapolis, MN 55455, USA.

In this study we analyzed the numbers and types of cultivable tylosin-resistant bacteria from six agricultural soils that differed with respect to their association with subtherapeutic antibiotic use. The proportion of tylosin-resistant bacteria to the total number of bacteria cultivated was significantly higher (7.2-16.5%) at three sites affected by subtherapeutic antibiotic use compared to three sites unaffected by subtherapeutic antibiotic use (0.7-2.5%). We also detected differences in the types of cultivable tylosin-resistant bacteria. At a site affected by subtherapeutic antibiotic use, we detected tylosin-resistant bacteria from the alpha- and beta-subdivisions of Proteobacteria. In contrast, at a site unaffected by subtherapeutic use, we detected only Streptomyces-like (high-G+C Gram-positive) tylosin-resistant bacteria. Our results suggest a link between subtherapeutic use of antibiotics and the numbers and types of antibiotic-resistant bacteria in nearby soil. However, other factors, such as soil type and temporal variation, may have also contributed to the differences observed.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12644222&dopt=Abstract antibiotic, antibiotics



J Chemother. 2000 Oct;12(5):379-84.
Postantibiotic effects and postantibiotic sub-MIC effects of amoxicillin on Streptococcus gordonii and Streptococcus sanguis.

Lee SY.

Department of Oral Microbiology, College of Dentistry, Kangnung National University, Korea. siyounnusun.kangnung.ac.kr

Amoxicillin is one of the most frequently recommended antibiotics for prophylaxis of infective endocarditis in dental/oral procedures. In this study, the postantibiotic effect (PAE), postantibiotic sub-MIC (PASME) and sub-MIC effect (SME) of amoxicillin on oral streptococci, Streptococcus gordonii and Streptococcus sanguis, which are two of the major etiological agents in infective endocarditis, were investigated. The PAE was induced by 10 x MIC of amoxicillin for 2 h and the antibiotic was eliminated by washing. The PASMEs were studied by addition of 0.1, 0.2 and 0.3 x MICs during the postantibiotic phase of the bacteria, and the SMEs were studied by exposing bacteria to amoxicillin at the sub-MICs only. The PAE of amoxicillin was 2.0 h with S. gordonii DL1 and 0.7 h with S. sanguis MPC1. The PASME and SME of amoxicillin were observed both for S. gordonii DL1 and for S. sanguis MPC1. However, the durations of effects for S. sanguis MPC1 were shorter than those for S. gordonii DL1. The PASME values for both strains increased as the concentration of amoxicillin increased. The PASME values for both strains were substantially longer than the SME values. The present study illustrates the existence of PAE, PASME and SME for amoxicillin against S. gordonii and S. sanguis, thereby extending the pharmacodynamic advantages of amoxicillin for these bacteria in the prophylaxis procedures of infective endocarditis.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11128556&dopt=Abstract antibiotic, antibiotics



J Gastroenterol Hepatol. 2000 Nov;15(11):1307-11.
Influence of intestinal flora on the development of fibrosis and cirrhosis in a rat model.

Plummer JL, Ossowicz CJ, Whibley C, Ilsley AH, Hall PD.

Department of Anesthesia, Flinders Medical Centre and The Flinders University of South Australia, Australia. john.plummelinders.edu.au

BACKGROUND AND AIMS: The gut flora play a significant role in the disposition of many foreign substances, as well as producing nutrients and toxins that may be absorbed and reach the liver. This study examines the influence of antibiotic-induced alterations in gut flora on the development of hepatic fibrosis in a rat model. METHODS: Thirty-six male Porton rats were fed alcohol (3.9 g/kg per day) in the drinking water and exposed to carbon tetrachloride (CCl4) vapor (80 p.p.m.) for 6 h each night, five nights per week. Half were also given neomycin (330 mg/kg per day) and polymyxin B (105 mg/kg per day) in the drinking water. Fecal cultures were carried out at 0, 3, 8 and 13 weeks; rats were killed at 14 weeks. Coded liver section were assessed for fibrosis using a graded scale (0, no abnormal fibrosis to 4, early or established cirrhosis). RESULTS: Rats that received antibiotics had significantly higher fibrosis scores than those that did not (mean score 2.4 vs 1.4, P < 0.01, ordinal logistic regression). Three rats, all of which were in the antibiotic group, were cirrhotic. Rats that had received antibiotics fell into three groups. Four had overgrowth of Proteus mirabilis; in these the fibrosis scores (mean 1.5) were similar to those in the rats that did not receive antibiotic. In six, no organisms could be cultured; fibrosis scores of these (mean 2.3) were slightly elevated (P = 0.03), but this was mainly because of a single rat in this subgroup being cirrhotic. The remaining eight had overgrowth of Morganella morganii; these had significantly (P < 0.001) elevated fibrosis scores. Furthermore, in this subgroup, fibrosis scores were significantly correlated (Spearman's r = 0.82, P = 0.01) with the number of weeks of Morganella colonization. CONCLUSIONS: Antibiotic treatment exacerbated fibrosis in the alcohol/CCl4 rat model; this effect appeared to be related to the type of gut flora and may be endotoxin-mediated.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11129226&dopt=Abstract antibiotic, antibiotics