OBJECTIVETo investigate the concentration and pharmacokinetics changes of amikacin in the serum and blister fluid in severe burn patients at early stage.

METHODSTwenty severe burn patients during early postburn stage were divided into four groups with five patients in each group. Each patient was given a single dose of 400 mg amikacin in 30 minutes during 3-4 postburn hour (PBH) in A group, at 10 PBH in B group, at 20 PBH in C group, and at 30 PBH in D group. The concentration of amikacin in blister fluid was examined at 0.25, 0.5 min and 1, 2, 3, 4, 5, 6, 7 h after treatment by fluorescence polarization immunoassay, meanwhile, the venous blood of 9 patients among them was also collected to determine the concentration of amikacin at the same time points. Pharmacokinetics parameters of model were produced by program 3P97.

RESULTSAmong all groups, the concentration of amikacin in blister fluid in A group increased quickest and maintained longest, that of B group ranked second. The amikacin concentration of blister fluid in A, B groups were obviously higher than those in C, D groups at each time point (P <0.05 orP < 0.01), especially at 1PBH (12.53 +/- 1.76, 9.52 +/- 1.51 microg/mL vs 4.65 +/- 0.77, 3.10 +/- 0.41 microg/ml, P < 0.01). The serum concentration of amikacin in 9 patients were decreasing along with elapse of time. The amikacin concentration-time curves in blister fluid and serum were best fit in two compartment models. Compared with that in normal value, t1/2beta of amikacin from burn patient was shortened in serum and prolonged in blister fluid.

CONCLUSIONEarly administration of amikacin in burn patients (within 10 PBH) may form an effective and continuous antibiotics barrier around the wound to prevent bacterial infection.

Adult ; Amikacin ; pharmacokinetics ; therapeutic use ; Burns ; blood ; drug therapy ; Female ; Humans ; Male ; Serum ; chemistry

OBJECTIVETo analyze the use of antibiotics and the drug resistance of Pseudomonas aeruginosa in the burn ward of our hospital in the past 11 years, so as to optimize the use of antibiotics in the future.

METHODSBacterial epidemiology during 1991-2001 in our burn ward was investigated. The change of the drug resistance of Pseudomonas aeruginosa was observed by defined daily dose (DDD) of antibiotics in adult patients and by the ranking of antibiotic administration days.

RESULTS(1) Staphylococcus aureus (10.53%-34.40%) and Pseudomonas aeruginosa (75.66%-11.47%) were dominant in our burn ward. (2) Predominant antibiotics used included Penicillin, Amikacin, Vancomycin, Imipenem and Ceftazidime. (3) There was increasing drug resistance of Pseudomonas aeruginosa to the following antibiotics ranking in following order: Piperacillin (41.57%-100.00%), Imipenem (36.36%-98.46%), Ceftazidime (23.46%-97.85%), Amikacin (13.16%-100.00%) and ciprofloxacin (6.90%-100.00%).

CONCLUSIONThere was increasing drug resistance of Pseudomonas aeruginosa to all antibiotics, which might be related to antibiotic abuse.

Amikacin ; therapeutic use ; Anti-Bacterial Agents ; therapeutic use ; Burn Units ; Ceftazidime ; therapeutic use ; Drug Administration Schedule ; Drug Resistance, Bacterial ; drug effects ; Humans ; Imipenem ; therapeutic use ; Penicillins ; therapeutic use ; Pseudomonas aeruginosa ; drug effects ; Vancomycin ; therapeutic use

The treatment of infectious complications in cancer patients has evolved as a consequence of the developments in the chemotherapy of cancer patients. In this prospective, randomized study, we compared imipenem-cilastatin and sulbactam-cefoperazone with amikacin in the empiric therapy of febrile neutropenic (< 1000/mm3) patients with liquids and solid tumours. Of 30 evaluable episodes, 15 were treated with imipenem-cilastatin and 15 were treated with sulbactam-cefoperazone plus amikacin. 73% of episodes were culture-positive: gram-positive pathogens accounted for 62% of the isolates. Bacteremia was the most frequent site of infection. The initial clinical response rate for both regimens was 60% (p > 0.05). No major adverse effects occurred. This study demonstrated that imipenem-cilastatin monotherapy and combination therapy of sulbactam-cefoperazone plus amikacin were equally effective empiric therapy for febrile granulocytopenic cancer patients.
Adolescence ; Adult ; Aged ; Aged, 80 and over ; Amikacin/therapeutic use ; Antibiotics, Combined/therapeutic use* ; Bacteremia/drug therapy ; Bacteremia/complications ; Cefoperazone/therapeutic use ; Cilastatin/therapeutic use ; Female ; Fever/drug therapy* ; Fever/complications ; Human ; Imipenem/therapeutic use ; Male ; Middle Age ; Neoplasms/drug therapy* ; Neoplasms/complications ; Neutropenia/drug therapy* ; Neutropenia/complications ; Prospective Studies ; Sulbactam/therapeutic use

OBJECTIVETo determine the prevalence of Streptococcus suis and major pathogenic serotypes in middle part of Jiangsu province.

METHODSTonsillar specimens from 303 slaughtered pigs aged 6 to 8 months were investigated for the presence of Streptococcus suis and major pathogenic serotypes by polymerase chain reaction (PCR) method. Bacteriological examination compared with molecular genetics identification for three Streptococcus suis isolates were also done.

RESULTSThe overall carrier rate of Streptococcus suis was up to 88.0%, with the percentages of serotype 1(14), 2(1/2), 7 and 9 were 9.6%, 8.5%, 11.3% and 29.5% respectively in 2005. While in 2006, the prevalence of Streptococcus suis was 82.5%, with capsular types 1 (14), 2 (1/2), 7 and 9 were accounted for 17.6%, 2.4%, 25.8% and 20.0% of all the specimens. All the three isolates belonged to Streptococcus suis serotype 2,named 2a, 2f and 14e, which exhibiting the virulent phenotype cps2+/gdh+/mrp-/lepf-/sly-/fbps+/orf2+/89k-, cps2+/lgdh+/mrp-/epf-/sly-/fbps-/orf2-/89k- and cps2+/gdh+/mrp-/epf-/sly-/fbps/orf2-/ respectively. These isolates were all susceptible to amoxicillin, ampicillin, penicillin and resistant to amikacin and tetraycline. Clinical signs were not noted in BALB/c mice and rabbit.

CONCLUSIONPrevalence of the Streptococcus suis among the healthy herds in the areas was very high, with various capsule types of Streptococcus suis involved in the same herds, and the virulent phenotype of these 3 isolates were very different from those prevalent Streptococcus suis serotype 2 virulent isolates frequently discovered from the epidemic areas.

Amikacin ; therapeutic use ; Amoxicillin ; therapeutic use ; Ampicillin ; therapeutic use ; Animals ; China ; epidemiology ; Mice ; Mice, Inbred BALB C ; Molecular Epidemiology ; methods ; Penicillins ; therapeutic use ; Polymerase Chain Reaction ; Streptococcal Infections ; drug therapy ; epidemiology ; microbiology ; Streptococcus suis ; classification ; drug effects ; genetics ; pathogenicity ; Tetracycline ; therapeutic use ; Virulence

OBJECTIVETo establish the rat model of chronic bacterial prostatitis and investigate the penetrability of amikacin to chronic inflammatory prostatic tissues.

METHODSA total of 180 male rats were randomly divided into a normal control group (NC, n=48), a chronic bacterial prostatitis group (CBP, n = 84) and a CBP treatment group (CBPT, n = 48). The prostates of the animals were injected with Xiaozhiling and E. coli respectively to make CBP and CBPT models. The animals of the CBPT group were treated with amikacin by intramuscular injection, their prostate tissues and sera isolated at 1-150 min after the treatment and detected for antibiotic activities, bacteria counts and pathological changes.

RESULTSObvious chronic inflammatory pathological changes including leukocyte invasion and fibre hyperplasia were observed and E. coli isolated from the prostate tissues of the rats in the CBP and CBPT groups, but no pathological changes, antibiotic activity and bacteria were detected in the the NC group. The numbers of E. coli in the prostate tissues markedly decreased with the time in the two model groups, 30 CFU/mg in the CBP rats at 28 days and 0 CFU/mg in the CBPT group at 10 days after the treatment. Obvious antibiotic activities were found in both the prostate tissues and sera at 2-150 min after the injection. No antimicrobial activities were detected at 12 hours after the treatment either in the sera or in the prostate samples. With the increase of the treatment time and decrease of the bacteria counts, the chronic inflammatory pathological changes were obviously alleviated in the CBPT group.

CONCLUSIONRat models of CBP with chronic inflammatory pathological changes can be successfully established by direct injection of Xiaozhiling and E. coli into the prostate. Amikacin, given by intramuscular injection, can penetrate into the prostate of the CBP rat and produce an antibiotic activity equal to or higher than that of the sera, which may kill sensitive bacteria in the prostate and help to reduce the inflammatory pathological changes and repair the damage to the prostate tissues.

Amikacin ; blood ; pharmacokinetics ; therapeutic use ; Animals ; Anti-Bacterial Agents ; administration & dosage ; pharmacokinetics ; therapeutic use ; Disease Models, Animal ; Escherichia coli ; drug effects ; Injections, Intramuscular ; Male ; Prostate ; drug effects ; metabolism ; microbiology ; Prostatitis ; drug therapy ; metabolism ; microbiology ; Random Allocation ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo investigate the changes of pharmacokinetic parameters of amikacin in the subeschar tissue fluid (STF) in the early stage of severe burns.

METHODSAmikacin concentration in the STF of 10 severely burned patients were determined by fluorescence polarization immunoassay (FPIA) at different time points after intravenous amikacin infusion of the initial dose of 400 mg given within 60 min. The pharmacokinetic parameters of amikacin were measured using 3P97 program and statistically analyzed with SPSS10.0 software.

RESULTS AND CONCLUSIONAfter the initial dose of 400 mg of amikacin, the STF concentration-time curves of amikacin were fitted in two compartment model. The pharmacokinetic parameters of amikacin in the STF were: t(1/2alpha)=(4.35-/+1.66) h, t(1/2beta)= (80.04-/+9.52) h, Vc= (13.17-/+1.32) L, AUC= (1802.49-/+285.68) microg. h.ml(-1), and CLs= (0.2272-/+0.0383) L. h(-1), demonstrating significantly lower clearance and longer elimination half life of amikacin in the STF following amikacin administration in early stage of severe burns. Elimination half-life of amikacin in the STF in severely burned patients was 28.20-44.78 times longer than that in the serum of normal volunteers, and the effective inhibitory concentration of amikacin could maintain for at least 24 h, suggesting antibiotic retention in the third space after early and short-term use of potent antibiotics and formation of antibiotic barrier in the STF, which may help prevent bacterial infection of the wound.

Adult ; Amikacin ; administration & dosage ; pharmacokinetics ; therapeutic use ; Anti-Bacterial Agents ; administration & dosage ; pharmacokinetics ; therapeutic use ; Burns ; drug therapy ; metabolism ; Extracellular Space ; metabolism ; Exudates and Transudates ; metabolism ; Female ; Humans ; Infusions, Intravenous ; Male ; Skin ; drug effects ; metabolism ; pathology

PURPOSE: To report 2 cases of Comamonas acidovorans keratitis in immunocompromised cornea. METHODS: A complete review of the medical records of the two cases of Comamonas acidovorans keratitis. RESULTS: We found some similarities in clinical courses of two cases. Both of them showed development of keratitis during the management with corticosteroids, delayed onset, slow response to antibiotics, and relatively less affected corneal epithelium. CONCLUSIONS: Comamonas acidovorans is known as a less virulent organism. However it can cause an indolent infection that responds slowly even to adequate antibiotics therapy in immunocompromised corneas.
Amikacin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Ceftazidime/therapeutic use ; Ciprofloxacin/therapeutic use ; Corneal Ulcer/diagnosis/drug therapy/*microbiology ; Delftia acidovorans/*isolation & purification ; Drug Therapy, Combination ; Eye Infections, Bacterial/diagnosis/drug therapy/*microbiology ; Gram-Negative Bacterial Infections/diagnosis/drug therapy/*microbiology ; Humans ; *Immunocompromised Host ; Male ; Microbial Sensitivity Tests ; Middle Aged

PURPOSE: To report 2 cases of Comamonas acidovorans keratitis in immunocompromised cornea. METHODS: A complete review of the medical records of the two cases of Comamonas acidovorans keratitis. RESULTS: We found some similarities in clinical courses of two cases. Both of them showed development of keratitis during the management with corticosteroids, delayed onset, slow response to antibiotics, and relatively less affected corneal epithelium. CONCLUSIONS: Comamonas acidovorans is known as a less virulent organism. However it can cause an indolent infection that responds slowly even to adequate antibiotics therapy in immunocompromised corneas.
Amikacin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Ceftazidime/therapeutic use ; Ciprofloxacin/therapeutic use ; Corneal Ulcer/diagnosis/drug therapy/*microbiology ; Delftia acidovorans/*isolation & purification ; Drug Therapy, Combination ; Eye Infections, Bacterial/diagnosis/drug therapy/*microbiology ; Gram-Negative Bacterial Infections/diagnosis/drug therapy/*microbiology ; Humans ; *Immunocompromised Host ; Male ; Microbial Sensitivity Tests ; Middle Aged

BACKGROUNDAerosolized amikacin (AA) is a current option for the management of ventilator-associated pneumonia (VAP) caused by multidrug-resistant Gram-negative bacteria (MDR-GNB), as it is reported that AA could increase the alveolar level of the drug without increasing systemic toxicity. This study aimed to evaluate the efficacy and safety of AA as an adjunctive therapy for VAP caused by MDR-GNB.

METHODSIn this single-center, double-blind study conducted in a 36-bed general Intensive Care Unit (ICU) in a tertiary hospital from June 2014 to June 2016, 52 ICU patients with confirmed MDR-GNB VAP were randomized to two groups (AA group, n = 27 and placebo group, n = 25). Amikacin (400 mg, q8h) or saline placebo (4 ml, q8h) was aerosolized for 7 days. The attending physician determined the administration of systemic antibiotics for VAP. Patients were followed up for 28 days. Bacteriological eradication, clinical pulmonary infection score (CPIS), and serum creatinine were assessed on day 7 of therapy. New resistance to amikacin, cure rate of VAP, weaning rate, and mortality were assessed on day 28.

RESULTSThe baseline characteristics of patients in both groups were similar. At the end of the treatment, 13 of the 32 initially detected bacterial isolates were eradicated in AA group, compared to 4 of 28 in placebo group (41% vs. 14%, P= 0.024). As for patients, 11 of 27 patients treated with AA and 4 of 25 patients treated with placebo have eradication (41% vs. 16%, P= 0.049). The adjunction of AA reduced CPIS (4.2 ± 1.6 vs. 5.8 ± 2.1, P= 0.007). New drug resistance to amikacin and the change in serum creatinine were not detected in AA group. No significant differences in the clinical cure rate in survivors (48% vs. 35%, P= 0.444), weaning rate (48% vs. 32%, P= 0.236), and mortality (22% vs. 32%, P= 0.427) were detected between the two groups on day 28.

CONCLUSIONSAs an adjunctive therapy of MDR-GNB VAP, AA successfully eradicated existing MDR organisms without inducing new resistance to amikacin or change in serum creatinine. However, the improvement of mortality was not found.

Administration, Inhalation ; Aged ; Amikacin ; administration & dosage ; therapeutic use ; Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Colistin ; administration & dosage ; therapeutic use ; Double-Blind Method ; Drug Resistance, Multiple, Bacterial ; Female ; Gram-Negative Bacteria ; drug effects ; pathogenicity ; Humans ; Intensive Care Units ; statistics & numerical data ; Male ; Middle Aged ; Pneumonia, Ventilator-Associated ; drug therapy

BACKGROUND/AIMS: The number of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) is increasing. In an outpatient setting, there are limited therapeutic options to treat ESBL-producing pathogens. We evaluated the outcomes of amikacin outpatient parenteral antibiotic therapy (OPAT) for UTIs caused by ESBL-EC in patients not pre-treated with carbapenem. METHODS: We retrospectively evaluated the outcomes of amikacin OPAT for UTIs caused by ESBL-EC. RESULTS: From November 2011 to October 2012, eight females, who could not be hospitalized for carbapenem treatment, were treated with amikacin OPAT for nine episodes of non-bacteremic ESBL-EC UTIs. Seven of the eight patients had one or more comorbidities. Of the nine UTI cases, three had symptomatic lower UTIs and six had non-bacteremic upper UTIs. In all of the cases, symptomatic and laboratory improvements were observed following amikacin OPAT. One patient showed a delayed relapse with bilateral microabscesses 3 weeks after treatment cessation; however, a clinical and microbiological cure was eventually reached. All of the patients were able to tolerate amikacin OPAT without any significant nephrotoxicity or ototoxicity. CONCLUSIONS: Amikacin OPAT represents a feasible therapeutic option for non-bacteremic UTIs caused by ESBL-EC in settings with limited resources.
Adult ; Aged ; Aged, 80 and over ; Ambulatory Care ; Amikacin/administration & dosage/adverse effects/*therapeutic use ; Drug Administration Schedule ; Escherichia coli/*drug effects/enzymology/isolation & purification ; Escherichia coli Infections/diagnosis/*drug therapy/microbiology/urine ; Humans ; Microbial Sensitivity Tests ; Middle Aged ; Recurrence ; Remission Induction ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Urinalysis ; Urinary Tract Infections/diagnosis/*drug therapy/microbiology/urine ; Urine/microbiology ; beta-Lactamase Inhibitors/administration & dosage/adverse effects/*therapeutic use ; beta-Lactamases/*metabolism