Objective: To assess the efficacy and safety of polymyxin B in neutropenic patients with hematologic disorders who had refractory gram-negative bacterial bloodstream infection. Methods: From August 2021 to July 2022, we retrospectively analyzed neutropenic patients with refractory gram-negative bacterial bloodstream infection who were treated with polymyxin B in the Department of Hematology of the First Affiliated Hospital of the Soochow University between August 2021 to July 2022. The cumulative response rate was then computed. Results: The study included 27 neutropenic patients with refractory gram-negative bacterial bloodstream infections. Polymyxin B therapy was effective in 22 of 27 patients. The median time between the onset of fever and the delivery of polymyxin B was 3 days [interquartile range (IQR) : 2-5]. The median duration of polymyxin B treatment was 7 days (IQR: 5-11). Polymyxin B therapy had a median antipyretic time of 37 h (IQR: 32-70). The incidence of acute renal dysfunction was 14.8% (four out of 27 cases), all classified as "injury" according to RIFLE criteria. The incidence of hyperpigmentation was 59.3%. Conclusion: Polymyxin B is a viable treatment option for granulocytopenia patients with refractory gram-negative bacterial bloodstream infections.
Humans ; Polymyxin B/adverse effects* ; Retrospective Studies ; Gram-Negative Bacterial Infections/complications* ; Fever/drug therapy* ; Sepsis/drug therapy* ; Anti-Bacterial Agents/therapeutic use* ; Bacteremia/complications*

OBJECTIVETo observe the curative effect and side effect of tigecycline in the treatment of patients with infection caused by granulocytopenia.

METHODSThe clinical data of 107 patients who were treated with tigecycline for infection due to granulocytopenia were retrospectively reviewed. The tigecycline was administered by intravenously (30-60 min drip infusion)as the initial dose of 100 mg and maintenance does of 50 mg, every 12h. The whole treatment course kept for 5-7 d when the body temperature was normal and then the step-down treatment or discontinuation of the drug was adopted.

RESULTSA total of 104 strains of bacteria were isolated from 107 cases of hospitalized patient, including 60 multi-drug resistant strains (MDR) and 2 extensively-drug resistant strains (XDR). The total effective rate of tigecycline treatment was 62.6%, including 30 cases with tigecycline alone (63.3% of the effective rate), 21 cases with tigecycline as initial treatment followed by combination with other antibiotics (61.9% of the effective rate), and 56 cases with tigecycline in combination with other antibiotics from the beginning of the treatment (62.5% of the effective rate). There was no statistical significant difference between the 3 treatment groups (P=0.994). Among the 39 patients with MDR strains, 22 patients' temperature was controlled , 9 patients died, and 8 patients' temperature remained uncontrolled. The clinical effective rate of these patients was 56.4%. The median onset time of tigecycline treatment was 3 days. The adverse drug reactions of nausea (11.2% ) and vomiting (8.4% )were tolerable.

CONCLUSIONTigecycline is effective in treatment of resistant bacteria infection in patients with granulocytopenia. The side effects of tigecycline were few, safe and generally well tolerated.

Agranulocytosis ; complications ; microbiology ; Anti-Bacterial Agents ; therapeutic use ; Bacterial Infections ; drug therapy ; Body Temperature ; Drug Resistance, Multiple, Bacterial ; Humans ; Minocycline ; analogs & derivatives ; therapeutic use ; Retrospective Studies ; Treatment Outcome

Anti-Bacterial Agents ; therapeutic use ; Bacterial Infections ; complications ; drug therapy ; China ; Chronic Disease ; Humans ; Male ; Prostatitis ; drug therapy ; microbiology ; Treatment Outcome

OBJECTIVETo explore the penetrability and therapeutic effect of vancomycin to the prostates of rats with bacterial prostatitis (BP) or benign prostate hyperplasia (BPH)-BP.

METHODSThe experimental rats with BP or BPH-BP were injected with vancomycin through the tail vein. The prostate tissues and sera were isolated respectively from the rats at 10 min to approximately 24 h after treatment and the antibiotic activities of the samples were detected by serial dilution test and agar diffusion test. The rats with BP or BPH-BP were treated with vancomycin by intravenous injection daily for 5 days. The prostates were collected the second day after injection and bacteria were isolated and determined. One to five weeks after treatment, the prostates of the animals were isolated and pathologic tests were done.

RESULTSNo bacteria could be isolated from the prostates of the normal rats, but positive isolation was achieved from the prostates of the infected animals 28th day after infection. In the first 4 days after treatment, a decrease of bacteria could be detected in the prostate samples of the rats treated with BP or BPH-BP. After 5th day, no bacteria could be detected from 91.7% prostates of the treated groups. Obvious antibiotic activity in both sera and prostates could be detected 10 to approximately 150 min after the antibiotic injection. Antibiotic activity of the prostate tissues could be lower or higher than or equal to that of the sera in the same period. Pathologic tests detected obvious exudation and leukocyte invasion in the prostate tissues of the BP rats and gland proliferation in the BPH rats. Vancomycin treatment and the consequent reduction of bacteria obviously alleviated the inflammatory pathological changes in the prostates of the BP rats.

CONCLUSIONVancomycin given intravenously has more penetrability to the prostates of either BP or BPH-BP rats. The antibiotic concentration in the prostate tissues may be equal to or higher than that of the sera, so that the susceptive bacteria in the prostates will be killed and the alleviation of the inflammation and repair of the tissues accelerated effectively.

Animals ; Anti-Bacterial Agents ; pharmacokinetics ; therapeutic use ; Bacterial Infections ; complications ; drug therapy ; Male ; Prostate ; metabolism ; microbiology ; pathology ; Prostatic Hyperplasia ; complications ; drug therapy ; Prostatitis ; complications ; drug therapy ; microbiology ; Rats ; Rats, Sprague-Dawley ; Vancomycin ; pharmacokinetics ; therapeutic use

Actinomycosis ; complications ; drug therapy ; pathology ; Aged, 80 and over ; Amoxicillin-Potassium Clavulanate Combination ; therapeutic use ; Anti-Bacterial Agents ; therapeutic use ; Cephalexin ; therapeutic use ; Ciprofloxacin ; therapeutic use ; Clindamycin ; therapeutic use ; Coinfection ; drug therapy ; Drug Resistance, Bacterial ; Escherichia coli Infections ; complications ; drug therapy ; Humans ; Male ; Pseudomonas Infections ; complications ; drug therapy ; Skin Diseases, Bacterial ; complications ; drug therapy ; pathology ; Staphylococcal Skin Infections ; complications ; drug therapy ; Thigh ; Trimethoprim, Sulfamethoxazole Drug Combination ; therapeutic use

Aged ; Bacterial Infections ; drug therapy ; etiology ; Female ; Hepatitis, Chronic ; complications ; Humans ; Liver Cirrhosis ; complications ; Male ; Middle Aged ; Peritonitis ; drug therapy ; etiology

Ecthyma gangrenosum is a characteristic skin lesion of systemic infection due to Pseudomonas aeruginosa. It has a high incidence in patients with chronic disease and impaired defense mechanisms. Early diagnosis and appropriate systemic antibiotic therapy is crucial since its mortality rate is very high. We report a case of ecthyma gangrenosum in aplastic anemia.
Adult ; Anemia, Aplastic/*complications/pathology ; Case Report ; Female ; Human ; Opportunistic Infections/microbiology/pathology ; Pseudomonas Infections/*complications/microbiology/pathology ; Skin Diseases, Bacterial/drug therapy/*etiology/pathology

Ascites, hepatic encephalopathy and variceal hemorrhage are three major complications of portal hypertension. The diagnostic evaluation of ascites involves an assessment of its etiology by determining the serum-ascites albumin gradient and the exclusion of spontaneous bacterial peritonitis. Ascites is primarily related to an inability to excrete an adequate amount of sodium into urine, leading to a positive sodium balance. Sodium restriction and diuretic therapy are keys of ascites control. But, with the case of refractory ascites, large volume paracentesis and transjugular portosystemic shunts are required. In hepatorenal syndrome, splanchnic vasodilatation with reduction in effective arterial volume causes intense renal vasoconstriction. Splanchnic and/or peripheral vasoconstrictors with albumin infusion, and renal replacement therapy are only bridging therapy. Liver transplantation is the only definitive modality of improving the long term prognosis.
Anti-Bacterial Agents/therapeutic use ; Ascites/complications/*diagnosis/therapy ; Bacterial Infections/*diagnosis ; Hepatic Encephalopathy/complications ; Hepatorenal Syndrome/complications/*diagnosis/therapy ; Humans ; Hypertension, Portal/*complications ; Liver Transplantation ; Peritonitis/*diagnosis/drug therapy/etiology ; Serum Albumin/administration & dosage

To report a case of bilateral endophthalmitis as the initial presentation of bacterial meningitis in a young, immunocompetent Korean patient. A 35-year-old female with a one day history of bilateral swollen eyes, visual disturbance, headache, petechial skin rash, and nausea visited our clinic. She was diagnosed as having endogenous endophthalmitis associated with bacterial meningitis. Intravenous broad spectrum antibiotic therapy was initiated with cefotaxime 3 g and ubacillin 3 g, four times daily. Intravitreal antibiotic (vancomycin 1 mg/0.1 mL and ceftazidime 2 mg/0.1 mL) injections were performed in both eyes. Two weeks post presentation, the best corrected visual acuity in both eyes improved to 0.7, and inflammation of the anterior chamber and vitreous cavity was decreased. We recommend that when endogenous endophthalmitis is suspected along with meningitis, or if it is known to be present, intravitreal and intravenous antibiotics should be promptly administered to preserve vision.
Adult ; Anti-Bacterial Agents/therapeutic use ; Diagnosis, Differential ; Endophthalmitis/diagnosis/drug therapy/*etiology ; Eye Infections, Bacterial/diagnosis/drug therapy/*etiology ; Female ; Follow-Up Studies ; Humans ; Meningitis, Bacterial/*complications/diagnosis/drug therapy ; Ophthalmoscopy

OBJECTIVETo observe the clinical characteristics of infections in adult acute leukemia （AL）patients during chemotherapy in hospital, and identify the risk factors for infections.

METHODSA retrospective study of patients with AL who underwent chemotherapy between July 2010 and Dec 2014 in the First Affiliated Hospital of Xiamen University was conducted. Clinical features and risk factors for infections were analyzed.

RESULTS191 patients with AL received a total of 728 courses of chemotherapies. During these admissions, 385（52.9%) infections episodes occurred. The common infections sites were lower respiratory tract infection（36.3%，153/374）, bloodstream infection（17.1%, 64/374）, oral infection（13.6%，51/374）, and perianal infection（13.4%, 50/374）. 164 strains of pathogenic bacteria were detected. Gram- negative bacteria were recorded in 59.1% of documented pathogens, and Gram- positive bacteria were responsible for 32.9% of infections. Multivariate unconditioned logistic analysis of factors identified consistent independent risk factors for no completely remission（OR=0.142, P< 0.001）, duration of neutropenia longer than 7 days（OR=12.764, P<0.001）, general wards（OR=1.821, P< 0.001）, and hospitalization interval longer than 10 days（OR=0.720, P=0.039）.

CONCLUSIONInfections after chemotherapy for AL continues to be common. AL patients with induction chemotherapy or severe neutropenia faced an increased risk of infections by multivariate analysis. And patients with short-term stay or laminar flow wards seem to be less susceptible to infections.

Acute Disease ; Bacterial Infections ; complications ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Hospitals ; Humans ; Leukemia ; complications ; drug therapy ; microbiology ; Multivariate Analysis ; Neutropenia ; complications ; Remission Induction ; Retrospective Studies ; Risk Factors