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Diabetic Ketoacidosis and Necrotizing Soft Tissue Infection.

AUDIENCE: Emergency medicine (EM) residents at all levels of education and medical students on EM rotation. INTRODUCTION: Diabetes is a chr … al and myonecrosis and should be treated with: 1) vancomycin (or linezolid), 2) either piperacillin/tazobactam, ampicillin/sulbactam, or a carbapenem, 3) clindamycin to decrease toxin production.2,4Initial treatment of DKA is isotonic fluids, and insulin therapy should be withheld until serum potassium levels are obtained since prolonged serum acidosis can d …

Successful treatment and limb salvage of mucor necrotizing fasciitis after kidney transplantation with posaconazole.

This is a case of mucormycosis complicated by necrotizing fasciitis in a renal transplant recipient on immunosuppressive therapy treated with posaconazole. Mucormycosis occurs most commonly as an opportunistic infection in the immunocompromised host. This patient, with predisposing risk factors for infection, including diabetes mellitus status post cadaveric renal transplantation on immunosuppressive therapy, is the first reported case of successful treatment of Mucor involving an extremity which was neither fatal nor required extremity amputation.

Nutritionally variant streptococci bacteremia in cancer patients: a retrospective study, 1999-2014.

BackgroundNutritionally variant Streptococci (NVS), Abiotrophia and Granulicatella are implicated in causing endocarditis and blood stream infections more frequently than other sites of infection. Neutropenia and mucositis are the most common predisposing factors for infection with other pathogens in cancer patients. In this study, we investigated the clinical characteristics of NVS bacteremia in cancer patients and identified risk factors and outcomes associated with these infections.Materials and methodsWe retrospectively reviewed all cases of NVS bacteremia occurring from June 1999 to April

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… /tazobactam, Vancomycin | Survived 13 | 80 | M | AML | 1 | 2 | Vancomycin | Survived Figure 1 Type of Malignancy Associated with NVS Bacteremia Figure 2 Hematologic vs Non Hematologic Malignancies The non-hematologic malignancies included esophageal cancer(2) and bladder cancer(1). … Most patients were on empiric antimicrobial therapy with ciprofloxacin, levofloxacin or piperacillin/tazobactam at the time of breakthrough bacteremia. Almost all patients received vancomycin as definitive treatment. …

Empirical antimicrobial treatment in haemato-/oncological patients with neutropenic sepsis.

Neutropenic sepsis in haemato-/oncological patients is a medical emergency, as infections may show a fulminant clinical course. Early differentiation between sepsis and febrile neutropenic response often proves to be challenging. To assess the severity of the illness, different tools, which are discussed in this article, are available. Once the diagnosis has been established, the correct use of early empirical antibiotic and antifungal treatment is key in improving patient survival. Therefore, profound knowledge of local resistance patterns is mandatory and carefully designed antibiotic regime

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… For patients with limited previous antimicrobial exposure, that is, no antimicrobial therapy within the last months, a piperacillin/tazobactam therapy should be the first choice if local resistance profiles permit and no prior colonisation with resistant bacteria has been documented. … Antimicrob Agents Chemother 2017 ; 61 : e00537 – 17 . 10.1128/AAC.00537-17 28396547 PMC5444130 42. van Duin D , Bonomo RA Ceftazidime/avibactam and ceftolozane/tazobactam: second-generation β-lactam/β-lactamase inhibitor combinations . …

Evaluating the Use of Meropenem in Hematologic Patients with Febrile Neutropenia: A Retrospective Observational Single-Cohort Study.

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… Resistance to piperacillin/tazobactam was confirmed in only a single urine culture from one (1%) patient. … piperacillin/tazobactam) and cephalosporins for the treatment of infections with AmpC producers and susceptibility results for penicillins, and cephalosporins are not reported to the clinicians. …

Antibiotic resistance status and its costs in hematological patients: A two-year analysis.

BackgroundMost frequently, empirical antibiotic therapy is immediately administered for patients with febrile neutropenia (FN). In this study, its aim was to assess the antibiotic resistance status and the cost of antibacterial agents in FN patients associated with hematological malignancies.MethodsThe cost of antibacterial agents used in FN episodes in patients with hematologic neoplasms followed-up at the Department of Hematology from November 2010 to November 2012 were analyzed retrospectively.ResultsIn the study period, 15 of 141 patients who were admitted to the hematology ward and inelig

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… The therapeutic regimens which are active against Pseudomonas aeruginosa, were piperacillin-tazobactam (PIP-TAZ), cefoperazone-sulbactam (CEP-SUL) and PIP-TAZ in combination with ciprofloxacin (CIP), in accordance with local antibiotic resistance status as fist line antibacterial therapy. … Piperacillin/tazobactam was used less than cefoperazone/sulbactam, thus its cost was less than the cefoperazone/sulbactam. Nonetheless, piperacillin/ tazobactam is used four times per day as 4x4.5 gr/iv, and cefoperazone/sulbactam is used three times daily as 3x2 gr/iv. …

Successful Management of Neutropenic Sepsis Is Key to Better Survival of Patients With Blood Cancer in Sri Lanka: Real-World Data From the Resource-Limited Setting.

PurposeSepsis is the main cause of nonrelapse mortality, and there are no published data on applicability of supportive care protocols from high-income countries such as Sri Lanka. The aim of the study was to investigate management and mortality of neutropenic episodes among Hemato-Oncology patients.Materials and methodsRetrospective analysis of clinical characteristics, management, morbidity, and mortality of neutropenic Hemato-Oncology patients presented to the Lanka Hospital Blood Cancer Centre from January 1, 2019 to December 31, 2019 was performed.ResultsA total of 169 neutropenic episode

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… Blood | 2 | 2 | 4 Urine | 4 | 1 | 5 Sputum | 1 | 3 | 4 Other | 1 | | 1 TABLE 5 Source, Organism, and Antibiotic Sensitivity of Culture-Positive Episodes During the Study Period Abbreviations: ICD, intercostal drain; pip + taz, piperacillin + tazobactam. … They have used single-agent cefepime or piperacillin-tazobactam/tigecycline combination as empirical agents. Thirty seven percent of neutropenic episodes in our cohort ended up as inpatients because of sepsis. …

Short Course of Antibiotic Therapy for Gram-Negative Bacilli Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation: Less Is Possible.

Data about short courses of antibiotic therapy for Gram-negative bacilli (GNB) bacteremia in immunosuppressed patients are limited. This is a prospective observational study performed on adult patients with cancer and hematopoietic stem cell transplant (HSCT) who developed GNB bacteremia and received appropriate empirical antibiotic therapy (EAT), had a clinical response within 7 days and survived 48 h after the end of therapy. They received antibiotic therapy in the range of 7-15 days and were divided into short course, with a median of 7 days (SC), or long course, with a median of 14 days (L

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… The EATs prescribed as monotherapy in both groups were mainly piperacillin-tazobactam and meropenem, while those prescribed as combined therapy were meropenem + colistin or amikacin. … MDR-GNB was defined as a GNB resistant to three or more of the following categories of antibiotics: carbapenems, piperacillin/tazobactam, third and fourth-generation cephalosporins, aztreonam, fluoroquinolones, or aminoglycosides [ 33 , 34 ]. …

[Chinese expert consensus on the management of lower respiratory tract infections of Pseudomonas aeruginosa in adults(2022)].

Pseudomonas aeruginosa (PA) is the second common Gram-negative bacterium for hospital acquired pneumonia (HAP) in China (16.9%-22.0%). The p … difficult-to-treat resistance PA (DTR-PA), if an agent of new enzyme inhibitor, such as ceftolozane/tazobactam, ceftazidime/avibactam, and imipenem/cilastatin/relebactam shows in vitro sensitivity, it is recommended as the first-line choice; cefiderocol may serve as the second-line treatment. Combination therapy based on polymyxins may also be considered. Ot …

Imipenem-Relebactam and Meropenem-Vaborbactam: Two Novel Carbapenem-β-Lactamase Inhibitor Combinations.

Relebactam (formerly known as MK-7655) is a non-β-lactam, bicyclic diazabicyclooctane, β-lactamase inhibitor that is structurally related to … BP). A phase III clinical trial has reported superiority of meropenem-vaborbactam over piperacillin-tazobactam for the treatment of complicated urinary tract infections, including acute pyelonephritis. Meropenem-vaborbactam has recently demonstrated higher clinical cure rates versus best available therapy for the treatment of carbapenem-resistant Enterobacte …

C-Reactive Protein Monitoring and Clinical Presentation of Fever as Predictive Factors of Prolonged Febrile Neutropenia and Blood Culture Positivity after Autologous Hematopoietic Stem Cell Transplantation-Single-Center Real-Life Experience.

BackgroundFebrile neutropenia (FN) is a medical emergency that requires urgent evaluation, timely administration of empiric broad-spectrum antibiotics and careful monitoring in order to optimize the patient's outcome, especially in the setting of both allogeneic and autologous hematopoietic stem cell transplant (ASCT).MethodsIn this real-life retrospective study, a total of 49 consecutive episodes of FN were evaluated in 40 adult patients affected by either multiple myeloma (thirty-eight) or lymphoma (eleven), following ASCT, with nine patients having fever in both of the tandem transplantatio

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… As for the empirical antibiotic treatment following FN, prophylaxis with levofloxacin or ceftriaxone was suspended and piperacillin/tazobactam or ampicillin/sulbactam was started in around 90% of the patients. … One third of patients initiated novel antibiotic treatment with ceftozolane/tazobactam based on admission isolation of XDR germs or persistently high fever without benefit from prior antibiotic treatment ( Table 3 ). …

Treatment of community-onset pneumonia in neutropenic cancer patients: β-lactam monotherapy versus combination antibiotic regimens.

BackgroundAlthough β-lactam monotherapy may be sufficient in non-critically ill patients with community-acquired pneumonia, the value of combination antibiotic regimens in community-onset neutropenic pneumonia remains unclear.MethodsA retrospective cohort study was conducted to compare the effects of combination antibiotic regimens to those of β-lactam monotherapy in cancer patients with community-onset neutropenic pneumonia. Electronic medical records of patients diagnosed with community-onset neutropenic pneumonia between March 1995 and February 2015 at a tertiary care center were reviewed.R

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… Ceftazidime was used more frequently in the β-lactam group, while piperacillin-tazobactam was used more in the combination group. … Cardiovascular diseases 5 (6.9%) 2 (2.2%) 0.130 Chronic lung diseases 3 (4.2%) 6 (6.5%) 0.733 Chronic liver diseases 3 (4.2%) 3 (3.2%) 1.000 Chronic renal diseases 0 (0.0%) 6 (6.5%) 0.036 Types of β-lactams Cefepime 40 (55.6%) 64 (68.8%) 0.080 Ceftazidime a 20 (27.8%) 2 (2.2%) < 0.001 Piperacillin/tazobactam …

Understanding and Managing Sepsis in Patients With Cancer in the Era of Antimicrobial Resistance.

Sepsis is a frequent complication in immunosuppressed cancer patients and hematopoietic stem cell transplant recipients that is associated with high morbidity and mortality rates. The worldwide emergence of antimicrobial resistance is of special concern in this population because any delay in starting adequate empirical antibiotic therapy can lead to poor outcomes. In this review, we aim to address: (1) the mechanisms involved in the development of sepsis and septic shock in these patients; (2) the risk factors associated with a worse prognosis; (3) the impact of adequate initial empirical ant

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… Table 3 Summary of the main clinical and microbiological characteristics of the published case series and case reports on the use of ceftazidime/avibactam and ceftolozane/tazobactam in high-risk hematologic cancer patients. … Studies should also continue to clarify the role of new antibiotics, such as ceftolozane/tazobactam and ceftazidime/avibactam, in cancer patients with sepsis, particularly when used empirically. …

Antimicrobial resistance phenotypes, disinfectant susceptibility, and resistance-associated gene detection in carbapenem-resistant Pseudomonas aeruginosa from two tertiary hospitals in Urumqi, China.

OBJECTIVE: To characterise antimicrobial resistance phenotypes, in vitro susceptibility to four commonly used disinfectants, and the distrib … and no isolate was susceptible to either agent. Overall resistance rates to aztreonam, piperacillin/tazobactam, levofloxacin, ceftazidime, cefepime, amikacin, and tobramycin were 37.50%, 30.00%, 26.30%, 25.00%, 21.30%, 12.50%, and 6.30% respectively. The expected oprD amplicon failed to amplify in 55 isolates (68.75%). mCIM was positive in 23 isolates (28.75 …

Infections Caused by Acinetobacter baumannii in Recipients of Hematopoietic Stem Cell Transplantation.

Acinetobacter baumannii (A. baumannii) is a Gram-negative, strictly aerobic, non-fermentative coccobacillus, which is widely distributed in nature. Recently, it has emerged as a major cause of health care-associated infections (HCAIs) in addition to its capacity to cause community-acquired infections. Risk factors for A. baumannii infections and bacteremia in recipients of hematopoietic stem cell transplantation include: severe underlying illness such as hematological malignancy, prolonged use of broad-spectrum antibiotics, invasive instrumentation such as central venous catheters or endotrach

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… Treatment of complicated infections in severely ill and septic patients having A. baumannii is usually in the form of combination therapies that include: piperacillin–tazobactam and amikacin, piperacillin–tazobactam and colistin, or colistin and rifampicin ( 10 ). … The best therapeutic approach for CRAB infection is to use colistin in combination with tigecycline or cefoperazone–sulbactam or piperacillin–tazobactam ( 38 ). …

Ceftazidime-Avibactam Improves Outcomes in High-Risk Neutropenic Patients with Klebsiella pneumoniae Carbapenemase-Producing Enterobacterales Bacteremia.

Few studies have evaluated the efficacy of ceftazidime-avibactam (CA) for Klebsiella pneumoniae carbapenemase-producing Enterobacterales bacteremia (KPC-PEB) in high-risk neutropenic patients. This is a prospective multicenter observational study in high-risk neutropenic patients with multi-drug resistant Enterobacterales bacteremia. They were compared according to the resistance mechanism and definitive treatment provided: KPC-CPE treated with CA (G1), KPC-CPE treated with other antibiotics (G2), and patients with ESBL-producing Enterobacterales bacteremia who received appropriate definitive

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… In patients with ESBL-producing Enterobacterales, empirical or definitive antibiotic therapy with piperacillin/tazobactam or cefepime monotherapy was considered inappropriate [ 29 ]. … Empirical antibiotic therapy was combined in 42.8% of cases, with carbapenems (61.3%), colistin (28.5%), piperacillin–tazobactam (24.3%), and aminoglycosides (24.3%) being the antibiotics most commonly used. …

PB2584: EXPLOSIVE GROWTH ANTIMICROBIAL RESISTANCE IN CENTRAL KAZAKHSTAN IN ONCOHEMATOLOGICAL PATIENTS IN POST COVID PERIOD

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… In the structure of line 1 antibacterial therapy in 2021, ceftazidime and piperacillin tazobactam occupied the same proportion - 44.4% each, in 2022 - the appointment of piperacillin tazobactam increased to 76.6%. …

Case Report: Uremia secondary to acute pyelonephritis in a patient with type 2 diabetes mellitus.

We report a 58-year-old male patient with acute kidney injury (AKI), who eventually developed anuria secondary to acute tubulointerstitial nephritis (ATIN) following acute pyelonephritis. Our patient had a 10-year history of type 2 diabetes mellitus, with an admission glycated hemoglobin (HbA1c) level of 6.3% and no prior history of renal disease. Before admission, he presented with painless gross hematuria and fever. Escherichia coli was detected in the urine culture at the local hospital, and anti-infective normalized his temperature, but urine output progressively decreased to anuria. After

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… He received empirical anti-infective treatment with piperacillin/tazobactam 4.5 g every 12 h, and his body temperature returned to normal, but his urine output progressively decreased to anuria. … The patient received empirical anti-infective treatment with piperacillin/tazobactam 4.5 g every 12 h, hemodialysis, and hypoglycemic therapy. The infection was gradually controlled, but the patient remained anuric ( Figure 1 ). …

A Case Series of Elizabethkingia meningosepticum Bacteremia in the Cancer Population.

Elizabethkingia meningosepticum (E. meningosepticum) is a ubiquitous microorganism previously known as Chryseobacterium meningosepticum. It is emerging as a pathogen responsible for bacteremia in the immunocompromised population, particularly in cancer patients and those with a history of prolonged hospital stay and frequent instrumentations. A retrospective chart review of all cases over 10 years at the Moffitt Cancer Center showed a total of three patients with E. meningosepticum infection. The first patient (history of multiple myeloma) underwent endoscopy complicated by aspiration pneumoni

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… He was empirically started on piperacillin-tazobactam, which was later changed to meropenem after isolation of Gram-negative rods from blood cultures. … E. meningosepticum shows varied degrees of susceptibility to antibiotics used to treat Gram-positive infections including piperacillin-tazobactam, fluoroquinolones, trimethoprim-sulfamethoxazole (TMP-SMX), vancomycin, and rifampicin [ 17 ]. …

Pseudomonas aeruginosa ExoU-associated virulence in HCT recipients and patients with hematologic malignancies.

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… Cefepime is the first-line agent for the empirical treatment of febrile neutropenia, with piperacillin-tazobactam and meropenem being second- and third-line agents, respectively. … | 15 (26) Meropenem | 3 (5.2) Ceftolozane-tazobactam | 3 (5.2) Adjunctive empirical tobramycin ¶ | 11 (19) Antipseudomonal antibiotic susceptibility | Cefepime | 54 (93.1) Piperacillin-tazobactam | 50 (86.2) Meropenem | 19 (34) MDR P. aeruginosa | 8 (13.8) AEAT | 51(87.9) Pneumonia | 18 (31.0) Copathogen …