1/8. vancomycin treatment failures in Staphylococcus aureus lower respiratory tract infections.We reviewed all patients with Staphylococcus aureus lower respiratory tract infections treated with vancomycin at our institution in 1998, to see how this antimicrobial is performing. We found that approximately 40% of evaluable patients were considered treatment failures, even though the S. aureus was still reported as being susceptible to vancomycin. We report in detail two example patients that failed to respond clinically to vancomycin and summarize the clinical characteristics of the 23 additional patients that failed. The first case was treated four times in the intensive care unit with vancomycin. Each course, after approximately 14 days therapy, the vancomycin was discontinued and his infection relapsed soon thereafter. The second was treated with vancomycin for 10 days initially. She relapsed, was restarted on vancomycin once more, but her condition deteriorated, and she died of refractory sepsis 20 days after admission. The cost of care for each patient ranged from $50,000 to over $100,000. With trends such as these, alternative therapies are needed to control resistant Gram-positive infections.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
2/8. treatment failure due to methicillin-resistant staphylococcus aureus (MRSA) with reduced susceptibility to vancomycin.We report the first instance in australia of treatment failure due to a strain of methicillin-resistant staphylococcus aureus (MRSA) with reduced susceptibility to vancomycin--heteroresistant vancomycin-intermediate S. aureus (hVISA). The infection occurred in a 41-year-old man with multiple risk factors. No transmission of the organism to other patients or the environment was detected. This case may herald the beginning of a new phase of staphylococcal resistance in australia.- - - - - - - - - - ranking = 0.2keywords = treatment failure (Clic here for more details about this article) |
3/8. endocarditis caused by methicillin-resistant staphylococcus aureus: treatment failure with linezolid.We describe 2 cases of endocarditis caused by methicillin-resistant staphylococcus aureus that failed to respond to intravenous linezolid therapy but were successfully treated with trimethoprim-sulfamethoxazole plus gentamicin and vancomycin plus rifampin.- - - - - - - - - - ranking = 0.8keywords = treatment failure (Clic here for more details about this article) |
4/8. vancomycin treatment failure associated with heterogeneous vancomycin-intermediate Staphylococcus aureus in a patient with endocarditis and in the rabbit model of endocarditis.Heterogeneous resistance to vancomycin is thought to precede emergence of intermediate susceptibility to vancomycin in Staphylococcus aureus, but the clinical significance of heterogeneous resistance is unknown. Paired S. aureus isolates from a patient with endocarditis who relapsed after vancomycin treatment were tested for heterogeneous resistance to vancomycin. The pretreatment and the relapse clinical isolates (strains SF1 and SF2, respectively) were genotyped by pulsed-field gel electrophoresis. Susceptibility to vancomycin was assessed by the broth dilution method, population analysis, and time-kill studies and in the rabbit model of endocarditis. Strains SF1 and SF2 had similar genotypes, and the vancomycin MICs for the strains were vancomycin. vancomycin eradicated SF1 in the rabbit model of endocarditis, while SF2 persisted at pretreatment levels. vancomycin treatment failure in this patient with endocarditis was attributable to heterogeneous resistance to vancomycin.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
5/8. daptomycin cure after cefazolin treatment failure of Methicillin-sensitive Staphylococcus aureus (MSSA) tricuspid valve acute bacterial endocarditis from a peripherally inserted central catheter (PICC) line.Right-sided acute bacterial endocarditis (ABE) is an infrequent complication of central intravenous (IV) lines. We report a case of methicillin-sensitive Staphylococcus aureus tricuspid valve (TV) ABE related to a peripherally inserted central catheter line (PICC). patients with right-sided ABE present with symptoms of fever and chills, and symptoms and signs of pulmonary emboli. In the patient presented, the PICC line was removed and high-dose cefazolin therapy, 2 g (IV) every 8 hours, was initiated. Although the patient's blood cultures became negative during the third week of cefazolin therapy, her erythrocyte sedimentation rate and teichoic acid antibody titers remained high. Pulmonary emboli developed. A large TV vegetation (1 x 2 cm) remained unchanged after 4 weeks of cefazolin therapy. For these reasons, cefazolin treatment was considered a treatment failure. Therapy with daptomycin was initiated at a dose of 6 mg/kg (IV) every 24 hours. During daptomycin therapy, the patient's erythrocyte sedimentation rate and teichoic acid antibody titers gradually returned to normal. Repeat transthoracic echocardiograph revealed the TV vegetation was gone and the methicillin-sensitive Staphylococcus aureus ABE was cured with daptomycin. We conclude daptomycin is a rapidly bactericidal antistaphylococcal antibiotic reliably effective even when other usually effective antistaphylococcal antibiotics have failed.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
6/8. Necrotizing 'malignant' external otitis caused by staphylococcus epidermidis.Necrotizing "malignant" external otitis is a life-threatening skull base infection that originates in the external auditory canal and is characterized by otalgia and purulent aural discharge with external auditory canal cellulitis and granulation. Necrotizing external otitis, seen almost exclusively in elderly diabetics, is almost always caused by pseudomonas aeruginosa. To our knowledge, there have been only six nonpseudomonal cases reported to date. We describe a 70-year-old diabetic man with necrotizing external otitis caused by staphylococcus epidermidis, confirmed by serial cultures. This case was characterized by otalgia, purulent otorrhea, preauricular swelling, bony external auditory canal erosion, and a conductive hearing loss. Despite prolonged intravenous antistaphylococcal antibiotic therapy and frequent local debridement, the patient's symptoms never completely resolved. As demonstrated by the treatment failure, S epidermidis necrotizing external otitis, may represent a more refractory form of this already virulent disease process. We believe this to be the first reported case of necrotizing external malignant otitis caused by S epidermidis.- - - - - - - - - - ranking = 0.2keywords = treatment failure (Clic here for more details about this article) |
7/8. Failure of treatment with teicoplanin at 6 milligrams/kilogram/day in patients with Staphylococcus aureus intravascular infection. The Infectious Diseases Consortium of oregon.patients with blood cultures positive for gram-positive cocci were enrolled in a prospective randomized double-blind comparative trial of vancomycin at 15 mg/kg every 12 h versus teicoplanin at 6 mg/kg every 12 h for three doses and then 6 mg/kg every 24 h. A total of 54 patients were randomized, and 40 were evaluable. Of the 40, 9 had infection of indwelling vascular catheters. Four infections were due to Staphylococcus aureus, and five were due to staphylococcus epidermidis. In concert with catheter removal, all patients were treated successfully, regardless of which drug they were taking. Of 31 patients without an indwelling catheter, 19 were infected with S. aureus, and 12 of the 19 had either endocarditis or mycotic aneurysm. Six of eight patients given teicoplanin failed treatment, as opposed to one of four patients given vancomycin (P = 0.14). Of greater concern, four of four patients with left-sided endocarditis or mycotic aneurysm failed to recover when given teicoplanin, as opposed to one of three patients given vancomycin (P = 0.07). Although not quite statistically significant, the unexpectedly high number of treatment failures with teicoplanin resulted in a decision to discontinue patient enrollment. It is suggested that future trials explore the efficacy of larger doses of teicoplanin.- - - - - - - - - - ranking = 0.2keywords = treatment failure (Clic here for more details about this article) |
8/8. Inappropriate breast secretions of possible bacterial etiology in the parous nonpuerperal female.This article presents two cases of spontaneous green breast secretions of parous nonpuerperal patients. To understand the nature of these secretions, bacterial evaluations and subsequent treatment were undertaken. Case 1 culture and sensitivity studies from breast secretions were commenced within 24 hours yielding an isolate identified as staphylococcus epidermidis, with sensitivity to cephalothin, erythromycin, and tetracycline but resistant to penicillin. cephalothin, 500 mg four times a day for 10 days, followed by erythromycin 100 mg twice a day for 10 days and doxycycline 100 mg twice a day for 10 days, did not alter the breast secretions. Four weeks later, ciprofloxacin HCI 500 mg twice a day for 6 weeks caused a 50% decrement in breast secretion at 4 weeks but increased clinical depression. At 6 weeks, no evidence of breast secretions persisted. Mental depression decreased within 2 weeks postciprofloxacin treatment. In Case 2, a total of 35 minutes elapsed between sample collection and initiation of culture and sensitivity studies. moraxella osloensis was identified and found sensitive to ampicillin and tetracycline but resistant to trimethoprim. ampicillin 500 mg four times a day for 10 days and doxycycline 100 mg twice a day by mouth for 10 days were administered at 2-week intervals with no effect on breast discharge. After 4 weeks of treatment failure, ciprofloxacin HCI 500 mg twice a day for 6 weeks caused a 50% decrease in discharge at 2 weeks and total elimination at 6 weeks. lethargy during treatment ceased with termination of therapy. These results support the importance of bacterial evaluation of breast secretions with subsequent antibiotic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.2keywords = treatment failure (Clic here for more details about this article) |