Archive for August 17, 2015

Community-Acquired Pyelonephritis in Pregnancy Caused by KPC-Producing Klebsiella pneumoniae

Antimicrobial Agents and Chemotherapy AUG. 2015 V.59 N.8 P.4375-4378

Asma Khatri, Nina Naeger Murphy, Peter Wiest, Melissa Osborn, Kathleen Garber, Michelle Hecker, Kelly Hurless, Susan D. Rudin, Michael R. Jacobs, Robert C. Kalayjian, Robert A. Salata, David van Duin, Federico Perez, Robert A. Bonomo, David L. Paterson, and Patrick N. A. Harris

aMetroHealth Medical Center, Cleveland, Ohio, USA

bCase Western Reserve University, Cleveland, Ohio, USA

cUniversity of North Carolina, Chapel Hill, North Carolina, USA

dUniversity Hospitals Case Medical Center, Cleveland, Ohio, USA

eLouis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA

fUniversity of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Brisbane, Australia

Carbapenem-resistant Enterobacteriaceae (CRE) usually infect patients with significant comorbidities and health care exposures.

We present a case of a pregnant woman who developed community-acquired pyelonephritis caused by KPC-producing Klebsiella pneumoniae.

Despite antibiotic treatment, she experienced spontaneous prolonged rupture of membranes, with eventual delivery of a healthy infant.

This report demonstrates the challenge that CRE may pose to the effective treatment of common infections in obstetric patients, with potentially harmful consequences to maternal and neonatal health.

PDF

http://aac.asm.org/content/59/8/4375.full.pdf

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August 17, 2015 at 10:12 pm

In Vitro Activity of Dalbavancin against Drug-Resistant Staphylococcus aureus Isolates from a Global Surveillance Program

Antimicrobial Agents and Chemotherapy AUG. 2015 V.59 N.8 P.5007-5009

Sandra P. McCurdy, Ronald N. Jones, Rodrigo E. Mendes, Sailaja Puttagunta, and Michael W. Dunne

aDurata Therapeutics, Branford, Connecticut, USA

bJMI Laboratories, North Liberty, Iowa, USA

In over a decade (2002 to 2012) of Staphylococcus aureus surveillance testing on 62,195 isolates, dalbavancin was demonstrated to be active against isolates that were either susceptible or nonsusceptible to daptomycin, linezolid, or tigecycline.

Nearly all (99.8%) multidrug-resistant methicillin-resistant S. aureus isolates were inhibited by dalbavancin at ≤0.12 μg/ml (MIC50/90, 0.06/0.06 μg/ml), the current U.S. Food and Drug Administration (U.S. FDA) breakpoint.

Overall, only 0.35% of the monitored S. aureus isolates had a dalbavancin MIC of either 0.25 or 0.5 μg/ml (i.e., were nonsusceptible).

PDF

http://aac.asm.org/content/59/8/5007.full.pdf

August 17, 2015 at 10:10 pm

Editor’s Choice: Nitrofurantoin revisited: a systematic review and meta-analysis of controlled trials

Journal of Antimicrobial Chemotherapy Sept 2015 V.70 N.9 P.2456-2464

1 Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland

2 Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, The Netherlands

3 Department of Medical Microbiology, Medical Centre Haaglanden, The Hague, The Netherlands

4 Center for Anti-infective Agents, Eckpergasse 13, Vienna, Austria

5 Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands

6 Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands

*Corresponding author. Tel: +41-79-553-3396; Fax: +41-22-372-3987; Email: angela.huttner@hcuge.ch

Objectives

Nitrofurantoin’s use has increased exponentially since recent guidelines repositioned it as first-line therapy for uncomplicated lower urinary tract infection (UTI). We conducted a systematic review and meta-analysis to assess nitrofurantoin’s efficacy and toxicity in the treatment of lower UTI.

Methods

We performed a systematic review of all human controlled clinical trials published from 1946 to 2014 and assessing short-term (≤14 days) nitrofurantoin for lower UTI. Meta-analyses assessing efficacy and adverse events were conducted on randomized trials.

Results

Twenty-seven controlled trials including 4807 patients fulfilled entry criteria; most were conducted between the 1970s and 1990s and were at increased risk for various biases. Nitrofurantoin appears to have good clinical and microbiological efficacy for UTI caused by common uropathogens, with clinical cure rates varying between 79% and 92%. The most methodologically robust studies surveyed indicate overall equivalence between nitrofurantoin when given for 5 or 7 days and trimethoprim/sulfamethoxazole, ciprofloxacin and amoxicillin. Meta-analyses of randomized controlled trials confirmed equivalence in clinical cure, but indicated a slight advantage to comparator drugs in microbiological efficacy (risk ratio 0.93, 95% CI 0.89–0.97). If given for only 3 days, nitrofurantoin’s clinical efficacy was diminished (61%–70%). Toxicity was infrequent (5%–16% in the 17 reporting studies), mild, reversible and predominantly gastrointestinal; meta-analyses confirmed no difference between nitrofurantoin and comparators. Hypersensitivity reactions such as pulmonary fibrosis and hepatotoxicity were not observed. Acquisition of resistance to nitrofurantoin is still relatively rare.

Conclusions

When given short term for lower UTI, nitrofurantoin has good clinical and microbiological efficacy; toxicity is mild and predominantly gastrointestinal.

PDF

http://jac.oxfordjournals.org/content/70/9/2456.full.pdf

August 17, 2015 at 9:43 pm


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