Ciprofloxacin in the treatment of infections in oncology patients

Treatment of infectious complications with ciprofloxacin in 65 patients provided good and satisfactory results in 67.7 and 20.0 per cent of the cases, respectively. The drug was efficient in sepsis, urogenital infections, respiratory infections and postoperative purulent complications. Ciprofloxacin showed a broad antibacterial spectrum. 96.3 per cent of the isolates belonging to aerobic organisms causing purulent inflammatory processes, including those with high antibiotic resistance levels, such as Pseudomonas spp., Proteus spp., Klebsiella tribe and Staphylococcus aureus were sensitive to the drug. In its antibacterial spectrum ciprofloxacin was similar to ofloxacin. The advantage of ciprofloxacin is its possible use not only orally but also intravenously. Adverse reactions to ciprofloxacin were observed in 5 (7.7 per cent) out of the 65 patients. In two cases discontinuation of the drug use was required. The use of ciprofloxacin in treatment of infectious complications in oncological patients is promising.     

Clinical evaluation of antibiotic therapy of NAG-infection]

It is not concluded yet whether it is expedient to use antibiotic therapy with respect to patients and vibrio-carries with NAG-infection. Observation of a group of patients with acute gastro-intestinal infections caused by NAG-vibrio and carriers of NAG-vibrioes showed that the rate of vibrio isolation after a course of antibiotic therapy (tetracycline, levomycetin) significantly decreased as compared to that in the group of the patients subjected only to symptomatic therapy. The data of the study provided recommendation of antibacterial therapy with respect to patients with NAG-infection especially in cases with accompanying infections or invasions. As for "asymptomic" carriers antibiotic therapy is required only with respect to persons with repeated vibrio isolation.     

Antibiotic Therapy in Current Surgical Practice

The clinical surgeon is required to assume important responsibilities in the management of microbial infections. To be effective, antibiotics should be used against sensitive organisms, the lesion should be infused adequately, and, ideally, the antibiotic should be bactericidal and compatible with other antibiotic agents in combination. A survey of commonly used antibiotics disclosed that penicillin in its synthetic and natural forms is still the drug of choice in most cases, particularly since, in its different forms, it may be used in combination with other agents to give a wide antibacterial spectrum. As a major surgical problem, Gram-positive septicemia has been superseded by Gram-negative septicemia and attendant endotoxin shock. Most authorities advocate a combination of bactericidal and bacteriostatic antibiotics in the treatment of endotoxin shock. However, while antibiotic therapy is considered crucial in the treatment of this condition, the mortality rate is still high and no uniform regimen of antibiotic therapy has been accepted.     

Side effects of antibiotics in patients with thermal burns]

The possibilities of antibacterial therapy in the clinics of burn diseases has at present decreased because of increasing microflora resistance to antibiotics. This phenomenon is one of the most often causes of antibacterial drug side effects in burn patients. For control of infections complications in burn patients which are most often lethal it is necessary to use biologically active subtance, such as prodigiozan and lysozime in addition to the directed antibiotic therapy. The use of specific antitoxic antistaphylococcal drugs, such as antistaphylococcal plasma and antistaphylococcal gamma-globulin in combination with the antibiotics of the direct action provided effective control of infectious complications and sepsis of staphylococcal genesis in burn patients. Decamine proved to be effective along with the usual use of nystatin in cases with dysbacteriosis as a result of the antibiotic side effects. In the patients treated with decamine the sings of candidosis disappeared by the 5th--7th day. Therefore, for decreasing the side effects of antibiotics in the clinics of burn patients it is expedient to use antibiotics in combination with the biologically active and immune preparations which increases the efficacy of antibiotic therapy, impfoves the treatment results and decreases the antibiotic side effects.     

Results of 10 years of use of lincomycin (1966-1976) in the clinics of the N. N. Priorov Central Research Institute of Traumatology and Orthopedics]

During 10 years 1063 patients were treated with lincomycin used parentally or orally at the N. N. Priorov Central Research Institute of Traumatology and Orthopedy. The doses and the rate of its use depended on the state of the patient, its age and weight. Lincomycin was used for the treatment of patients with osteomyelitis or purulent wound infection, as well as for prophylaxis of suppuration. The drug was used for a long period of time under conditions of the same hospital, and it was shown that it remained up to the present days highly effective in therapy of infections and especially bone infections caused by staphylococci sensitive to it. The 10-year study of staphylococcal sensitivity to lincomycin revealed an insignificant increase in the development of resistance to it. The paper presents data on the importance of adequate surgical interventions in addition to the antibiotic therapy in cases with bone infections. A possibility of lincomycin combined use with other antibiotics and gentamicin or kanamycin in particular was shown. Complications, such as diarrhea and urticaria were registered in 11 patients.     

Antibiotic therapy of angiogenic sepsis

Introduction to medical practice of new penicillins, cephalosporins and aminoglycosides is one of the chief reserves for increasing efficacy of antibacterial therapy. The main schemes of antibiotic use in treatment of sepsis and individual regimens controlled by laboratory findings are discussed. Optimization of antibiotic therapy schemes is based on pharmacokinetic studies, quantitative assay of antibiotic sensitivity and determination of antibacterial activity of serum and other biosubstrates at definite periods after antibiotic administration. In vitro time course investigation of the bactericidal effect of gentamicin, azlocillin and cefotaxime on pathogens of purulent infections at various sizes of the inoculum provided prediction of the antibiotic therapy efficacy in various purulent septic infections. It is indicated that rational use of antibiotics markedly increases efficacy of sepsis therapy and improves social and economic indices of the treatment.     

Use of live Saccharomyces cerevisiae cells as a biological response modifier in experimental infections

A short-term oral administration of live Saccharomyces cerevisiae cells, strain Sillix Hansen DSM 1883, resulted in enhanced resistance of mice toward infections with K. pneumoniae. S. pneumoniae and S. pyogenes A produced by intranasal inoculation. Yeast pre-treatment also increased the efficacy of antibiotic therapy in bacterial infections and of antiviral drugs in viral infections. Yeast treatment of animals stimulated phagocytosis, activated the complement system and induced interferon which are likely to represent the main mechanisms of action whereby pretreatment of mice with live S. cerevisiae cells increases resistance to infection. It is concluded that preventive administration of live Saccharomyces cerevisiae cells should be used for increasing resistance to bacterial infections, in particular of the respiratory tract, or to viral infections, as well as an adjunct to antibiotic and antiviral drug therapy.     

Use of live Saccharomyces cerevisiae cells as a biological response modifier in experimental infections

Abstract A short-term oral administration of live Saccharomyces cerevisiae cells, strain Sillix Hansen DSM 1883, resulted in enhanced resistance of mice toward infections with K. pneumoniae, S. pneumoniae and S. pyogenes A produced by intranasal inoculation. Yeast pre-treatment also increased the efficacy of antibiotic therapy in bacterial infections and of antiviral drugs in viral infections. Yeast treatment of animals stimulated phagocytosis, activated the complement system and induced interferon which are likely to represent the main mechanisms of action whereby pretreatment of mice with live S. cerevisiae cells increases resistance to infection. It is concluded that preventive administration of live Saccharomyces cerevisiae cells should be used for increasing resistance to bacterial infections, in particular of the respiratory tract, or to viral infections, as well as an adjunct to antibiotic and antiviral drug therapy.     

Rational use of antibiotics is the basis of their effectiveness and safety]

Many-year studies on the use of antibiotics in the general medical practice are summarized in the paper. The present trends in further improvement of the rational use of antibiotics are presented. It is shown that the present rational and safe antibiotic therapy is determined by 3 main factors: (1) choice of the drug with due regard for its pharmacological properties and spectrum, (2) isolation, identification and determination of the bacterial flora sensitivity to the antibiotic, (3) revealing or prevention of high sensitivity of the patients to the antibiotics chosen.     

Antibiotic resistance dynamics and isolation rate of staphylococci and enterococci from patients of reconstructive surgery units

The dynamics of isolation of staphylococci and enterococci from clinical material of patients and their antibiotic susceptibility within a 5-year period (2005-2009) was analysed. 5990 isolates were tested: 1250 isolates of Staphylococcus aureus, 3268 isolates of S. epidermidis, 1005 isolates of Enterococcus faecalis and 467 isolates of E. faecium. Grampositive infections were shown to be prevailing within the last 2-3 years, the nosocomial epidermal staphylococci more and more replacing S. aureus (the ratio of S. epidermidis and S. aureus in 2009 was 3.3). The isolation rate of E. faecalis significantly increased (by 3.5 times) and the ratio of E. faecalis and E. faecium in 2009 was 4.3. The microflora composition with respect to the isolation source was analysed and its clinical significance was estimated. The study of the antibiotic susceptibility showed that oxacillin had its own specific niche, while antibiotics active against resistant grampositive cocci, such as rifampicin, fusidic acid, fluoroquinolones (moxifloxacin), cefoxitin, as well as amoxicillin/clavulane in infections due to E. faecalis, might be considered as the drugs of choice. In the treatment of nosocomial infections, when the etiological role of MRSA or VRE is suspected or confirmed, the complex therapy should obligatory include the most active antibiotics (vancomycin or linezolid among them).     

Prophylaxis and treatment of bacterial infections: do we need new strategies?

Bacterial infections in patients with hematologic malignancies still represent a severe and life-treating problem. Several observational studies during the last decade have revealed that neutropenic patients with fever are a heterogeneous population with various differences regarding response to initial therapy, development of serious complications and mortality. The role of neutropenia as main risk factor for infections in hematologic patients and the definition of different level of risk related to neutrophils count and duration of neutropenia have been extensively studied and different categories of patients based on the risk of infection, mostly the condition of neutropenia, have been clearly defined. The strategies on antimicrobial therapy and supportive care in hematologic patients need to be continuously assessed, in fact new conditions favouring the occurrence of infectious complications in patients with hematologic malignancies have progressively emerged. The use of oral prophylactic antibiotics in neutropenic cancer patients is still a matter of debate. Before 2005, several trials showed how the prevention of infection can be extremely important in this setting of patients but none was conclusive. In 2005 two meta-analysis and two large randomized clinical trials gave new evidence that antibacterial prophylaxis can reduce in neutropenic patients several important outcomes including mortality. The use of the empiric antibacterial therapy represents the cornerstone of the antimicrobial strategies in the febrile neutropenic patients leading, over the span of 20 years, to a dramatic decrease of deaths: Actually beta-lactam monotherapy is commonly used for the empiric treatment of febrile neutropenia. Recently, large randomized clinical trials and meta-analysis showed that the addition of an aminoglycoside and/or a glycopeptides results in a more favourable outcome only in selected severe infections. The use of antibiotics should be prudent and safe also in neutropenic hematologic patients to prevent emergence of microbial resistance, to save costs, to reduce toxicity. For this reasons, according to the evidence, antibacterial prophylaxis should be restricted to high risk hematologic patients and empiric parenteral antibiotic monotherapy should be recommended in case of febrile neutropenia limiting the use of amynoglicosides and glycopeptides. In the next future, a major effort should be made to state in hematologic patients new risk factors which could more accurately define subgroups for targeted anti-infective strategies.     

Evidence-based antibiotic therapy of diabetic foot infections

In addition to proper cleansing, debridement and local wound care, foot infections in diabetic patients require carefully selected antibiotic therapy. Serious infections necessitate hospitalization for initial parenteral broad-spectrum antibiotic therapy. Appropriately selected patients with mild infections can be treated as outpatients with oral (or even topical) therapy. Initial antibiotic selection is usually empirical, but definitive therapy may be modified based on culture results and the clinical response. Therapy should nearly always be active against staphylococci and streptococci, with broader-spectrum agents indicated if Gram-negative or anaerobic organisms are likely. In infected foot tissues levels of most antibiotics, except fluoroquinolones, are often subtherapeutic. The duration of therapy ranges from a week (for mild soft tissue infections) to over 6 weeks (for osteomyelitis). Recent antibiotic trials have shown that several intravenously or orally administered agents are effective in treating these infections, with no one agent or combination emerging as optimal. Suggested regimens based on the severity of infection are provided.     

ICU下呼吸道多重耐药菌医院感染的病原学临床特征及易感因素分析

摘要 目的：研究ICU下呼吸道多重耐药菌医院感染的病原学临床特征及易感因素。方法：选择2020年1月到2022年12月于我院ICU住院治疗的216例下呼吸道感染者,按照是否发生多重耐药菌感染分为研究组113例,对照组103例。分析两组患者感染相关因素的数量分布情况,通过Logistic回归分析多重耐药菌医院感染的危险因素。采用全自动细菌鉴定仪对菌种进行鉴定,采用K-B纸片法进行药敏试验,并分析多重耐药菌感染的病原学分布及对常用抗菌药物的耐药性。结果：（1）与对照组相比,研究组患者感染相关因素的分布率更高;（2）住院时间>3个月、使用糖皮质激素治疗、应用机械通气治疗、其他细菌感染、血红蛋白含量<100 g/L、抗菌药物使用时间>15 d、抗菌药物使用种类>4种、使用免疫抑制剂是ICU下呼吸道多重耐药菌感染的危险因素;（3）113例研究组共培养出细菌菌株93株,其中革兰氏阴性菌52株（55.91%）,革兰氏阳性菌25株（26.88%）,革兰氏阴性菌中较多的是铜绿假单胞菌（22株）、鲍曼不动杆菌（13株）、肺炎克雷伯菌（12株）;革兰氏阳性菌中最多的是肺炎链球菌（11株）和金黄色葡萄球菌（11株）;（4）耐药情况：铜绿假单胞菌对莫西沙星耐药率较低（15.83%）,肺炎克雷伯菌对亚胺培南耐药率较低（17.56%）,鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率较低（16.37%）,金黄色葡萄球菌、肺炎链球菌对万古霉素无耐药性。结论：住院时间>3个月、使用糖皮质激素治疗、应用机械通气治疗、其他细菌感染、血红蛋白含量<100 g/L、抗菌药物使用时间>15 d、抗菌药物使用种类>4种、使用免疫抑制剂是多重耐药感染的独立危险因素。本院ICU下呼吸道感染以革兰氏阴性杆菌为主,应根据病原菌选择耐药性低的药物,并针对危险因素采取有效措施。     

Correlation of in vitro and in vivo resistance development to antimicrobial agents

Preclinical in vitro and in vivo determinations of the likelihood of an antibiotic to develop resistance can and has proven predictive of their likelihood of resistance development in patients. Problematic antibiotic/bacterial species combinations are often associated with high frequencies of single-step resistance development in that species. Thus, treatment of organisms with rapid in vitro emergence of drug resistance should be monitored carefully. In vitro studies, however, are limited in predicting resistance mediated through acquisition of a resistance plasmid.The frequency of resistance development to a drug is dependent on factors such as the drug used for selections, the concentration (i.e., dosing) of the drug, the bacterium, and the site of infection. Organisms intrinsically less susceptible to an antibiotic develop resistance rapidly due to their low therapeutic ratios. Since cross-resistance often occurs within an antibiotic class, it may be desirable to initiate therapy with a drug with low resistance-selecting potential. Optimal dosing regimens are especially critical when treating bacterial species likely to develop drug resistance. Though combination drug therapies have proven affective in experimental animal infections and in man, they do not prevent resistant variants from emerging. Understanding of drug-resistance development will contribute to our management of infectious diseases.     

The antibiotic prophylaxis of postoperative complications in breast cancer patients

The studies showed that infectious complications in patients operated for breast cancer (BC) most frequently developed after removal of the drainage tube resulting in poorer discharge favourable for development of infections. The causative agents in such cases are usually exogenous bacteria differing from endogenous ones (Staphylococcus epidermidis) inhabiting the human skin and sometimes contaminating the operative field. The endogenous bacteria are detectable bacteriologically in 60 per cent of the cases. Still, since the operation wound contains humoral and tissue immunity factors (specifically active against the host microflora) such bacteria rarely grow on artificial media (18 per cent) and even more rarely cause infections. Therefore, to prevent postoperative infections in patients with BC it should be recognized rational to use broad-spectrum antibacterial drugs such as ampiox, ampicillin, doxycycline, cephalosporins of the 2nd and 3rd generations, etc. for 5 to 6 days after the drainage removal. If an infection develops the preventive therapy should be replaced by an adequate therapy in accordance with the pathogen sensitivity.     

Drug susceptibility of Pseudomonas aeruginosa strains isolated from patients of a hospital and specialistic outpatients clinics of the SP ZOZ in Nidzica

The aim of this study was to evaluate a frequency of isolation and antimicrobial susceptibility testing (AST) of Pseudomonas aeruginosa strains cultured from clinical specimens collected from patients hospitalized in wards and specialistic outpatients clinics of a hospital in Nidzica (01. 09. 2000 -31. 12. 2003). During over three years 392 Pseudomonas aeruginosa strains were cultured from 16346 clinical samples provided to bacteriological laboratory. P. aeruginosa strains were isolated from 2.5% of examined specimens. Susceptibility of Pseudomonas aeruginosa strains to antimicrobial agents was tested. The highest in vitro activity against clinical P. aeruginosa strains demonstrated imipenem. One strain was resistant to imipenem. This strain was isolated from a patient of a surgical department. Metalo-beta-lactamase was not detected (MBL-negative strain).Twenty nine strains were ESBL producer (7.4% of all strains). The contribution of Pseudomonas aeruginosa strains to the etiology of nosoconial and ambulatory infections increases. In vitro activity of antibacterial agents against P. aeruginosa strains should be monitored during therapy of infections. Resistance to antibiotics/chemothe-rapeutics may be acquired during treatment with antibacterial agent to which P. aeruginosa strain was susceptible according to the antibiogram.     

Clinical Importance of Infections due to Bacteroides fragilis and Role of Antibiotic Therapy

Out of 200 infections due to Bacteroides fragilis occurring over a period of three years 133 were related to the intestinal tract, 55 to the genitourinary tract, and the remainder were in bedsores and ulcers; 56% occurred in patients undergoing major intestinal surgery.B. fragilis was isolated in pure culture from 56% of the infections. In mixed culture it was most commonly associated with Klebsiella and Enterobacter species. Other anaerobic bacteria were isolated in 9% of the mixed cultures.Altogether 131 (65·5%) of the patients recovered without antibiotic therapy or further surgery, but 59 (29·5%) developed complications and 10 (5%) died. The commonest complication was abscess formation, and the incidence was highest with infections associated with malignancy (44%) and lowest with obstetric infections (5%). The mortality was 5% overall but in the presence of bacteraemia it rose to 33%.Only 43 patients received appropriate chemotherapy. Clindamycin was the most effective antibiotic, having a recovery rate of 78%, but this rate was little better than in untreated patients (65%). The role of prophylactic antibiotic therapy in preventing bacteroides infection remains to be studied.The incidence of the isolation of bacteroides from wound infections after major intestinal surgery rose from 13% in 1970 to 81% in 1973. This increase was due to both the accurate collection and care of specimens while in transit to the laboratory and the use of selective media for the isolation of bacteroides in laboratory culture. The importance of these precautions is emphasized.     

Results of using an accelerated method of determining microbial flora sensitivity to antibacterial preparations in the surgical clinic]

Express diagnosis using 2,3,5-triphenyltetrasolium chloride as the redox indicator provided in most tests rapid and sufficiently precise determination of the microbial flora sensitivity to antibacterial drugs permitting to start in time the antibiotic therapy of the patients. For rapid response it proved to be useful to incubate beforehand the test material taken from surgical patients within 16 to 18 hours and to increase the indicator concentration up to 2--3 per cent.     

呼吸道感染患者多重耐药菌肺炎克雷伯菌的耐药及危险因素分析

摘要 目的：探讨与分析呼吸道感染患者多重耐药菌肺炎克雷伯菌的耐药及危险因素。方法：选择2015年1月到2020年2月本院诊治的呼吸道感染患者65例作为研究对象,收集患者的临床样本进行细菌分离与耐药分析,调查患者的临床资料并进行危险因素分析。结果：在呼吸道感染患者65例中,分离出多重耐药菌肺炎克雷伯菌32株,占比49.2 %,其中下呼吸道、上呼吸道、灌洗液、血液标本分别占50.0 %、9.4 %、25.0 %、6.3 %。32株多重耐药菌肺炎克雷伯菌对头孢曲松、头孢呋辛、氨苄西林、头孢吡肟、头孢噻肟的耐药率分别为71.9 %、87.5 %、96.9 %、84.4 %、81.3 %,对阿米卡星、头孢替坦、左氧氟沙星、亚胺培南、环丙沙星的敏感率分别为59.4 %、68.8 %、81.3 %、75.0 %、81.3 %。非条件 Logistic回归分析显示血型A型、碳青霉烯类抗菌药物使用、引流、机械通气、糖尿病等为导致多重耐药菌肺炎克雷伯菌感染的独立危险因素(P<0.05)。结论：多重耐药菌肺炎克雷伯菌感染在呼吸道感染患者中比较常见,对头孢呋辛、氨苄西林的耐药率比较高,对左氧氟沙星、环丙沙星的敏感率比较高,血型A型、碳青霉烯类抗菌药物使用、引流、机械通气、糖尿病等为导致多重耐药菌肺炎克雷伯菌感染的独立危险因素。     

Effectiveness of the antibacterial therapy of patients with various forms of dysentery]

The analysis of the efficacy of various methods of antibacterial therapy in 1382 patients with obliterated, light and moderately severe forms of dysentery as compared to the patients subjected only to patholgenic therapy showed that broad spectrum antibiotics lost their role in treatment of such patients. Furazolidon proved to be one of the most active drugs. The authors suppose that treatment of patients with obliterated forms of dysentery with antibacterial drugs is not obligatory and is indicated only in cases with repeated isolation of the causative agent.