BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

Parvimonas micra is frequently associated with periodontal disease as well as respiratory, gastrointestinal, and female genitourinary tract infections, but only rarely has it been reported as a pathogenic agent of infectious spondylodiscitis. We describe the case of a 38-year-old woman with spondylodiscitis caused by P. micra. P. micra was cultured from the patient's blood and vertebral tissue. This case was treated with vertebral corpectomy followed by intravenous ampicillin-sulbactam for four weeks. Her symptoms and vital signs improved, and elevated inflammatory markers were normalized after treatment.
Adult ; Ampicillin ; Bacteria, Anaerobic ; Discitis ; Female ; Humans ; Periodontal Diseases ; Spondylitis ; Sulbactam ; Vital Signs

Anaphylaxis caused by beta-lactam antibiotics usually develops following the systemic administration of the drug, although it can also occur with trivial contact of the drug on the skin in extraordinarily sensitive individuals. Cefotiam is a second-generation cephalosporin developed in Japan, and cefotiam-induced contact urticaria and systemic symptoms (contact urticaria syndrome) have been reported in several nurses from Japan and Korea. Considering the serious nature of the systemic manifestations, such as hypotension, contact anaphylaxis is a more appropriate name for severe forms of the disease than contact urticaria syndrome. No previous study has reported a case involving contact urticaria syndrome to multiple drugs. We describe a case of cefotiam-induced contact anaphylactic shock combined with cefoperazone/sulbactam-induced contact urticaria syndrome in a 24-year-old nurse. She exhibited positive skin prick test responses to both cefotiam and cefoperazone/sulbactam.
Anaphylaxis ; Anti-Bacterial Agents ; Cefoperazone ; Cefotiam ; Humans ; Hypotension ; Japan ; Korea ; Skin ; Sulbactam ; Urticaria ; Young Adult

Parvimonas micra is frequently associated with periodontal disease as well as respiratory, gastrointestinal, and female genitourinary tract infections, but only rarely has it been reported as a pathogenic agent of infectious spondylodiscitis. We describe the case of a 38-year-old woman with spondylodiscitis caused by P. micra. P. micra was cultured from the patient's blood and vertebral tissue. This case was treated with vertebral corpectomy followed by intravenous ampicillin-sulbactam for four weeks. Her symptoms and vital signs improved, and elevated inflammatory markers were normalized after treatment.
Adult ; Ampicillin ; Bacteria, Anaerobic ; Discitis ; Female ; Humans ; Periodontal Diseases ; Spondylitis ; Sulbactam ; Vital Signs

BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii ; Acinetobacter ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated ; Sulbactam

Five hundred seventeen male patients with gonococcal urethritis at the VD clinic of Chocng-ku Public Health Center between Feb. 27 and Oct. 27, 1984 the were source cf this study. Forty-five of seventynine patients who had practiced cunnilingus were actual subjects of this study. Aeiss.ria gonorrhoeae were cultured from the pharynx of five patients: one was found to be PPNG. All 5 pharyngeal gonorrhea patients were asymptornatic and their throat appeared to be normal, except injection of the pharynx in one patient. Two patients infected by non-PPNG were administered an oral dose of 1. 0 gm probenecid plus 2 5 gm talampicillin and 2. Ogm Kanamycin sulfate, IM and one patient infected by non-PPNG was administred an oral dose of l. Ogm probenecid and, 3i) minutes later, 6. 0 m.u. fortified procaine penicillin G IM. One gatient infected by PPNG was administered an oral dose of 1, 0 gm probenecid and 30 minutes later, 1 vial of sulbactam sodium/ampicillin sodium, IM. All four pharyngeal gonorrgeal patients were cured, One patient was lost from further evaluation, We consider it important to have pharyngeal cultures done on all gonorrheal patients, at least on those who admit having had orogenital contact in recent episode, because pharyngeal gonococci may be the source of disseminated gonococcal disease and in rare circumstances, the source of mfection for sexual partners, and single lose spectinomycin and orally administered penciillin regimens that are effective against anogenital gonorrhea, had been known to have high rates of failure when used in the pharyngeal gonrorhea.
Gonorrhea* ; Humans ; Kanamycin ; Male ; Penicillin G Procaine ; Pharynx ; Probenecid ; Public Health ; Sexual Behavior ; Sexual Partners ; Sodium ; Spectinomycin ; Sulbactam ; Talampicillin ; Urethritis

A total of 90 Acinetobacter isolates from freshwater and seawater in Gangjin Bay of Korea was investigated for the distribution of genomic species, antimicrobial resistance patterns and clonal relatedness. By amplified ribosomal DNA restriction analysis, eighty-nine Acinetobacter isolates were classified into 11 Acinetobacter genomic species. A. johnsonii (n=23) was the most prevalent, followed by A. baumannii (n=13), A. calcoaceticus (n=13), Acinetobacter genomic species 11 (n=10), A. phenon 6/ct13TU (n=9), A. junii (n=5), A. venetianus (n=5), Acinetobacter genomic species 17 (n=4), 14BJ (n=3), A. phenon 10/1271 (n=2), Acinetobacter genomic species 3 (n=1), and ungrouped (n=1). The majority of Acinetobacter genomic species were isolated from the site A and B, and some known nosocomial pathogens in the clinical environment were observed among them. Of the 11 antimicrobial drugs tested, several A. johnsonii isolates exhibited high-frequency resistance to a wide variety of antimicrobial agents, including ampicillin-sulbactam, piperacillin, ceftazidime, cefotaxime, and sulfamethoxazole (p < 0.001). Some Acinetobacter genomic species were resistant to currently used antibiotics but all isolates were susceptible to imipenem, amikacin, and tetracycline. Based on the results of antimicrobial resistance pattern and phylogenetic analysis, 23 A. johnsonii isolates were classified into 19 pulsotypes. In conclusion, there was a significant difference in the distribution of Acinetobacter species between freshwater and seawater. Predominance of A. johnsonii strains was probably due to their ability to proliferate in the contaminated aquatic environment originated from local geographic features. Therefore, the waste effluent from animals and humans plays an important role in the distribution of Acinetobacter species in aquatic environment.
Acinetobacter ; Amikacin ; Ampicillin ; Animals ; Anti-Bacterial Agents ; Anti-Infective Agents ; Bays ; Cefotaxime ; Ceftazidime ; DNA, Ribosomal ; Fresh Water ; Humans ; Imipenem ; Korea ; Piperacillin ; Seawater ; Sulbactam ; Sulfamethoxazole ; Tetracycline

Simultaneous drug-induced immune hemolytic anemia (DIIHA) caused by multiple drugs is rare. We report a case of a patient who developed DIIHA caused by 2 drugs. The patient's serum exhibited agglutination of ceftizoxime- or sulbactam-coated red blood cells (RBCs; via a drug-adsorption mechanism) and of uncoated RBCs in the presence of sulbactam (via an immune-complex mechanism). Although ceftizoxime is known to exhibit a positive reaction by an immune-complex method with or without reactivity with drug-coated RBCs, this patient's antibodies were reactive only against drug-coated RBCs. On the other hand, sulbactam, which is known to cause hemolytic anemia by nonimmunologic protein adsorption, exhibited positive reactions in tests with both drug-coated RBCs and in the presence of sulbactam. This is the first report of DIIHA due to a sulbactam-cefoperazone combination and the fourth report of DIIHA due to ceftizoxime. Owing to the patient's complicated laboratory results, DIIHA was suspected only at a late stage. We propose that for the prompt diagnosis of DIIHA, tests for all possible causative drugs should be conducted by 2 methods.
Anemia, Hemolytic/chemically induced/*diagnosis/immunology ; Anti-Bacterial Agents/*adverse effects ; Cefoperazone/*adverse effects ; Ceftizoxime/*adverse effects ; Erythrocytes/chemistry/metabolism ; Female ; Humans ; Middle Aged ; Sulbactam/*adverse effects

BACKGROUND: Klebsiella pneumoniae is the second most common causative pathogen only next to Escherichia coli among the facultative Gram-negative rods causing both community-acquired and nosocomial bacteremia. METHODS: We have reviewed the clinical and laboratory data from all patients with community-acquired K. pneumoniae bacteremia and compared it with randomly selected community-acquired E. coli bacteremia in the patients who were admitted to Ajou University hospital between the period from 1997 to 1998. RESULTS: The incidence of K. pneumoniae bacteremia was 1.8/1,000 patient discharge. Of 51 patients with K. pneumoniae bacteremia, 27 were male and 24 were female. The mean age was 58.4 years. The primary foci of K. pneumoniae bacteremia were hepatobiliary tract (35%), urinary tract (22%), respiratory tract (16%) and 20% of patients had no primary focus identified. The attributable mortality of K. pneumoniae bacteremia was 20%. Patients with K. pneumoniae and E. coli bacteremia had common clinical features, but K. pneumoniae bacteremia had high incidence of diabetes mellitus as an underlying illness and there was a tendency to form abscess and neutropenia more frequently than in E. coli bacteremia. E. coli was found to be more resistant to antibiotics (ampicillin/ sulbactam, ciprofloxacin, gentamicin, cephalothin, co-trimoxazole, tetracycline and tobramycin) than K. pneumoniae. CONCLUSION: K. pneumoniae bacteremia occurred more frequently in diabetes mellitus and the major primary focus was hepatobiliary tract. K. pneumoniae bacteremia had a higher incidence of abscess formation and neutropenia than E. coli.
Abscess ; Anti-Bacterial Agents ; Bacteremia* ; Cephalothin ; Ciprofloxacin ; Diabetes Mellitus ; Escherichia coli* ; Escherichia* ; Female ; Gentamicins ; Humans ; Incidence ; Klebsiella pneumoniae* ; Klebsiella* ; Male ; Mortality ; Neutropenia ; Patient Discharge ; Pneumonia ; Respiratory System ; Sulbactam ; Tetracycline ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Tract

No abstract available.
Aged ; Anti-Bacterial Agents/therapeutic use ; Bursitis/*diagnosis/drug therapy/microbiology ; Cefoperazone/therapeutic use ; Diabetes Mellitus, Type 2/complications/*diagnosis ; Humans ; Male ; Nocardia/genetics/*isolation & purification ; Polymerase Chain Reaction ; RNA, Ribosomal, 16S/chemistry/genetics ; Sequence Analysis, RNA ; Sulbactam/therapeutic use