BACKGROUND: A high proportion of currently isolated gram-negative bacilli are resistant to beta-lactams by producing beta-lactamases. beta-lactam and beta-lactamase inhibitor combinations have been successfully used to overcome the resistance. In this study, in vitro antimicrobial activity of a new combination, cefatrizine-clavulanic acid, was determined against gram-negative bacilli isolated from community-acquired urinary track infections. METHODS: Nonduplicate strains of Enterobacteriaceae, isolated in 2003 from urine specimens of outpatients and inpatients of less than 3 hospital days at Severance Hospital, were tested by the NCCLS agar dilution method. RESULTS: Of a total of 204 isolates, 144 (71%) were Escherichia coli and 30 (15%) were Klebsiella spp. MIC50 and MIC90 of cefatrizine for E. coli were 2 microgram/mL and 16 microgram/mL, respectively. MIC90s of both cefaclor and cefoxitin were also 16 g/mL. MIC50 and MIC90 of cefatrizine-clavulanic acid for E. coli were 1 microgram/mL and 4 microgram/mL, respectively, which were 1/2-1/4 of those of cefaclor and cefoxitin. For Klebsiella spp., MIC90 of cefatrizine was 4 microgram/mL with an MIC range of 1->128 microgram/mL, whereas that of cefatrizine-clavulanic acid was 2 microgram/mL with an MIC range of 0.5-32 microgram/mL. In vitro activity of cefatrizine-clavulanic acid was higher than that of cefatrizine. CONCLUSIONS: Improved in vitro activity of cefatrizine-clavulanic acid against isolates of E. coli and Klebsiella spp. from community-acquired urinary track infection suggested that the combination is useful for an empirical treatment of the infection.
Agar ; beta-Lactamases ; beta-Lactams ; Cefaclor ; Cefatrizine ; Cefoxitin ; Enterobacteriaceae ; Escherichia coli ; Humans ; Inpatients ; Klebsiella ; Outpatients

BACKGROUND: Recently Escherichia coli isolates with extended-spectrum beta-lactamase(ESBL) have been increased in Korea. ESBLs confer variable levels of resistance to cefotaxime, ceftazidime and other broad-spectrum cephalosporins as well as to monobactams such as aztreonam, but they have no detectable activity against cephamycins and carbapenems. The aim of this study was to characterize the ESBL produced by E. coli strains isolated from clinical specimens. METHODS: From March to July, 1998, a total of 93 clinical isolates of E. coli, which was produced ESBL, were collected from patients of the Asan Medical Center. The isolates flagged as ESBL producers by microbroth dilution antibiotic susceptibility test were confirmed by the double disk synergy test. Minimal inhibitory concentration(MIC) of beta-lactams were determined by agar dilution method. The presence of TEM, SHV or CMY-1 gene was determined by polymerase chain reaction. The types of beta-lactamase gene were determined by isoelectric focusing and nucleotide sequence analysis. RESULTS: Sixty-two strains carried plasmid-mediated TEM-52 gene, which sequence showed the substitution of 3 amino acids compared to that of TEM-1. Seventeen strains produced SHV-12, six strains produced SHV-2a, three strains produced TEM-52 and SHV-12, three strains produced TEM-52 and SHV-2a, and one strain produced SHV-2a and SHV-12. One out of twenty-seven strains of cefoxitin-resistant E. coli was confirmed to have CMY-1 beta-lactamase by PCR and nucleotide sequence analysis. CONCLUSIONS: TEM-52 was the most prevalent in E. coli isolates. The most common SHV-types of ESBL in Korea are SHV-12 and SHV-2a in E. coli isolates. In Korea, widespread use of oxyimino-cephalosporins in the hospitals has dramatically increased the prevalence of ESBL-producers in E. coli. Therefore, more prudent use of antibiotics is necessary to reduce the spread of these resistant organisms.
Agar ; Amino Acids ; Anti-Bacterial Agents ; Aztreonam ; Base Sequence ; beta-Lactamases* ; beta-Lactams ; Carbapenems ; Cefotaxime ; Ceftazidime ; Cephalosporins ; Cephamycins ; Chungcheongnam-do ; Escherichia coli* ; Escherichia* ; Humans ; Isoelectric Focusing ; Korea ; Monobactams ; Polymerase Chain Reaction ; Prevalence

Cephalosporines are the most important beta-lactams inducing IgE-mediated reactions such as urticaria, angioedema and anaphylaxis. There have been a few reports that describes assays of serum specific IgE for cephalosporins. We experienced a case of cefaclor-induced anaphylaxis and detected serum specific IgE to cefalor-human serum albumin (HSA) conjugate. A 40-year-old man was hospitalized due to sudden dyspnea. generalized urticaria, facial edema 30 minutes after taking cefaclor (250mg, po) for an upper respiratory infection. His systolic blood pressure dropped to 50 mmHg at admission. He had been treated with cefaclor for chronic osteomyelitis of the right heel for 1 year without adverse reactions. He had no personal or family history of allergic disease nor penicillin hypersensitivity. Skin prick test with cefaclor showed a positive response and serum specific IgE to cefaclor-HSA conjugate was detected by ELISA inhibition test showed significant inhibitions with additions of cefaclor-HSA conjugate and cefaclor in a dose-dependent manner. In conclusion, we confirmed that cefaclor-induced anaphylaxis in this patient was an IgE-mediated reation to cefaclor-HSA conjugate.
Adult ; Anaphylaxis ; Angioedema ; beta-Lactams ; Blood Pressure ; Cefaclor* ; Cephalosporins ; Dyspnea ; Edema ; Enzyme-Linked Immunosorbent Assay ; Heel ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate* ; Immunoglobulin E* ; Osteomyelitis ; Penicillins ; Serum Albumin ; Skin ; Urticaria

Effect of pivmecillinam hydrochloride was evaluated on 20 patients with cystitis and 13 patients with urethritis seen in urologic department of Kyungpook National University Hospital during past 4 months periods from April 1982 through August 1982. Pivmecillinam was given orally at a dose of 600mg (3 tablets) tid for 4 days (total 12 tablets) and following results were obtained. 1. In cystitis, effective result was observed in 19 out of 20 patients, giving therapeutic rate of 95%, and pivmecillinam was effective against all G (-) bacilli infections including E. coli except pseudomonas infection in 1. 2. In urethritis, effective result was noticed in 9 out of 13 patients, giving therapeutic rate of 70%, and pivmecillinam was effective against staphylococcus infection in 6 out of 7 patients, serratia infection in 1 out of 2 and G (-), bacilli infection in 1. However, it was ineffective against staphylococcus, serratia, enterococcus and unknown organism in 1 case, respectively. 3. As to the side effect, only diarrhea was observed in one of total 33 patients.
Amdinocillin Pivoxil* ; Anti-Bacterial Agents ; Cystitis ; Diarrhea ; Enterococcus ; Gyeongsangbuk-do ; Humans ; Pseudomonas Infections ; Serratia ; Serratia Infections ; Staphylococcus ; Urethritis ; Urinary Tract Infections* ; Urinary Tract*

Effect of pivmecillinam hydrochloride was evaluated on 20 patients with cystitis and 13 patients with urethritis seen in urologic department of Kyungpook National University Hospital during past 4 months periods from April 1982 through August 1982. Pivmecillinam was given orally at a dose of 600mg (3 tablets) tid for 4 days (total 12 tablets) and following results were obtained. 1. In cystitis, effective result was observed in 19 out of 20 patients, giving therapeutic rate of 95%, and pivmecillinam was effective against all G (-) bacilli infections including E. coli except pseudomonas infection in 1. 2. In urethritis, effective result was noticed in 9 out of 13 patients, giving therapeutic rate of 70%, and pivmecillinam was effective against staphylococcus infection in 6 out of 7 patients, serratia infection in 1 out of 2 and G (-), bacilli infection in 1. However, it was ineffective against staphylococcus, serratia, enterococcus and unknown organism in 1 case, respectively. 3. As to the side effect, only diarrhea was observed in one of total 33 patients.
Amdinocillin Pivoxil* ; Anti-Bacterial Agents ; Cystitis ; Diarrhea ; Enterococcus ; Gyeongsangbuk-do ; Humans ; Pseudomonas Infections ; Serratia ; Serratia Infections ; Staphylococcus ; Urethritis ; Urinary Tract Infections* ; Urinary Tract*

Antibiotics are prescribed to prevent infection and to treat established or presumptive infections. In choosing the appropriate antibiotics, a number of factors must be considered. First, the identity of the infecting organism must be known. Second, the information about the antibiotic susceptibility of the infecting organism must be as accurate as possible. Finally, host factors must be taken into consideration. The pharmacokinetics and pharmacodynamics of antibiotics in children are different from those in adults and are important host factors. The antibiotics may be classified into several groups : the beta-lactams (i.e., penicillins, cephalosporins, carbacephems, and monobactam), glycopeptides (i.e., vancomycin), aminoglycosides, macrolides, and quinolones. This article describes the clinical application of selected antibiotics to infectious diseases with newly available agents in children. The development of new oral agents prescribed as once or twice per day achieves enhanced compliance. These include cefprozil, cefpodoxime, loracarbef, azithromycin, clarithromycin, and fluoroquinolones. Meropenem is also a newly available carbacephem approved for use in children. Antibiotics available but not approved for use in children are imipenem-ci-lastatin, aztreonam, quinolones, and several cephalosporins including "fourth"-generation such as cefipime. Recently the use of once-daily dosing of aminoglycosides has been evaluated in pediatric populations, which appears to be safe and effective, although further studise are warranted. The emergence of antibiotic-resistant bacteria has generally been correlated with the rise of specific antibiotic use in clinical practice. Although the development of resistance may be inevitable, the rate at which it develops may be diminished by the rational use of antibiotics.
Adult ; Aminoglycosides ; Anti-Bacterial Agents ; Azithromycin ; Aztreonam ; Bacteria ; beta-Lactams ; Cephalosporins ; Child ; Clarithromycin ; Communicable Diseases ; Compliance ; Fluoroquinolones ; Glycopeptides ; Humans ; Macrolides ; Penicillins ; Pharmacokinetics ; Quinolones

BACKGROUND: Extended-spectrum beta-lactamases (ESBLs) confer resistance to extended-spectrum cephalosporin (e.g., cefotaxime, ceftazidime) and aztreonam. But the diversity of ESBLs results in various susceptibility profiles with different beta-lactams. To study the relative in vitro activities of various beta-lactams and non-beta-lactam antibiotics against the clinical isolates of ESBL-producing K. pneumoniae, we determined the MIC (minimum inhibitory concentration) of various antimicrobials. METHODS: Fifty-seven isolates of K. pneumoniae which produced ESBL and 63 isolates which did not produce ESBL from 3 university hospitals in Korea were tested. The MIC values of antimicrobials were determined by agar dilution method and detection of ESBL production was performed by double disk synergy test. RESULTS: The MIC values of beta-lactams against K. pneumoniae which produced ESBLs exhibited heterogeneous susceptability profiles. In differentiation of ESBL production, MIC value of 8 ug/mL (breakpoint of intermediate resistance) of ceftazidime was more sensitive and more specific than that of cefotaxime or aztreonam. MIC50 values of gentamicin, amikacin and ciprofloxacin against K. pneumoniae that produced ESBL were significantly higher than those against Non-ESBL producing isolates (P<0.001), suggesting that ESBL producing isolates are multi-drug resistant. CONCLUSION: The level of resistance to various beta-lactams of K. pneumoniae which produced ESBL was heterogeneous. ESBL-producing K. pneumoniae showed higher resistance to aminoglycoside and quinolone antibiotics. Ceftazidime was the most appropriate antibiotic to differentiate ESBL production.
Agar ; Amikacin ; Anti-Bacterial Agents* ; Aztreonam ; beta-Lactamases* ; beta-Lactams ; Cefotaxime ; Ceftazidime ; Ciprofloxacin ; Gentamicins ; Hospitals, University ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Pneumonia

PURPOSE: Pneumococcus is one of the most important causes of invasive infection through the childhood period. In January 2008, the Clinical and Laboratory Standards Institute (CLSI) published revised penicillin breakpoints for Streptococcus pneumoniae and penicillin susceptibility rates of S. pneumoniae increased in Korea. This study was performed to determine the probability of oral amoxicillin for the empirical treatment achieving bactericidal exposure against pneumococcus using pharmacodynamics model. METHODS: Twenty-three isolates of pneumococci were subjected to determine minimum inhibitory concentration (MIC) for beta-lactams and macrolide. For the beta-lactams, exposure of fT >MIC (time that free drug concentrations remain above the MIC) for 50% of the administration interval have determined the probability of target attainment (PTA), and regimens that had a PTA >90% were considered optimal. An analysis was performed by applying MIC of 23 isolates to a 5000-patient Monte Carlo simulation model. RESULTS: Among 23 isolates from healthy children, 7 (30.4%) isolates were MIC < or =1.0 microg/mL and 19 (82.6%) were MIC < or =2 microg/mL for amoxicillin. Amoxicillin 40 mg/kg/day achieved PTA >90% at MIC < or =1.0 microg/mL but PTA decreased to 52% at MIC 2 microg/mL, whereas amoxicillin 90 mg/kg/day can predict 97% of PTA at MIC 2 microg/mL. Overall, oral amoxicillin 90 mg/kg/day for the empirical treatment against pneumococcus can expect more successful response in Korean children. CONCLUSION: Considering the resistantce pattern of pneumococci in Korean children, we estimate that oral amoxicillin 90 mg/kg/day will provide a pharmacodynamic advantage for the empirical treatment against pneumococcus. And low dose amoxicillin or macrolide are expected to have higher chance of treatment failure than high dose oral amoxicillin.
Amoxicillin ; Anti-Bacterial Agents ; beta-Lactams ; Child ; Humans ; Imidazoles ; Korea ; Microbial Sensitivity Tests ; Nitro Compounds ; Penicillins ; Pharynx ; Pneumonia ; Streptococcus ; Streptococcus pneumoniae ; Treatment Failure

The study involved two groups: case group involved 65 patients with beta-lactam antibiotic allergy who were treating at B¹ch Mai Hospital during year 2000 and 25 healthy people were used a control group. Main findings: allergic symptoms onset rapidly within first 30 minutes in 43.07% of patients, onset after 1 hour of drug administration in 16.92% and after 1 day in 9.22%. 52.3% of patients have individual history and 13.84% have family history of allergy. Whole-body erythema occurred on 48.07% of patients, urticaria and Quinck edema on 27.69%, Stevens-Johnson syndrome on 18.46%, anaphylactic shock on 61.5% and drug-caused hepatitis on 4.61%. Levels of liver enzymes AST and ALT increase significantly in comparison with control group.
Drug Hypersensitivity ; Anti-Bacterial Agents ; beta-Lactams ; diagnosis

It is important to select appropriate antimicrobials for the treatment of infection according to the results of antimicrobial susceptibility tests (ASTs), yet the clinical isolates are sometimes susceptible to antibiotics that are clinically ineffective or this is due to technical error of the ASTs. So, interpretive reading of ASTs is needed and especially for the beta-lactams for treating Enterobacteriacae. This review describes the interpretive reading of ASTs according to natural antimicrobial resistance and the mechanisms of mechanisms, with giving special attention to the antibiotics phenotypes for Enterobacteriacae. Further, as all the diffent tissues have a different antimicrobial concentration for identical antimicrobials, more information is needed on the antimicrobial tissue distribution for the appropriate treatment of infection. (ED note: I hope you send me the paper.)
Anti-Bacterial Agents ; beta-Lactams ; Phenotype ; Tissue Distribution