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Ceftazidime and Ceftazidime–Avibactam
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
The addition of avibactam to ceftazidime expands the Gram-negative spectrum of activity to include many Enterobacteriaceae resistant to ceftazidime alone (Table 30.7). Large-scale studies conducted in multiple regions globally have demonstrated high susceptibility rates for Enterobacteriaceae to ceftazidime–avibactam (Sader et al., 2014; Flamm et al., 2014a; Castanheira et al., 2015; Flamm et al., 2014b; Levasseur et al., 2015; Aktas et al., 2012; Wang et al., 2014; Walkty et al., 2011; Denisuik et al., 2015). A study of 20,709 clinical isolates from US hospitals between 2011 and 2013 showed nearly all of the Enterobacteriaceae strains tested were susceptible (20,698 of 20,709 [99.9%]). The addition of avibactam greatly improves (4-to 1,024-fold reduction in MIC) the activity of ceftazidime against most Enterobacteriaceae species, including Escherichia coli, Klebsiella spp., Enterobacter spp., Morganella morganii, and Citrobacter spp. This includes activity against ESBL-producing organisms and ceftazidime and carbapenem nonsusceptible isolates. In vitro susceptibility data of the activity of ceftazidime–avibactam against organisms producing characterized beta-lactamases demonstrate reliable activity against class A (CTX-M-14-like producers, CTX-M-15-like producers, sulfhydryl variable [SHV]–ESBLs) and class C (CMY-2-like producers, AmpC) beta-lactamases, essentially restoring wild-type MICs (Flamm et al., 2014c). Ceftazidime–avibactam has potent In vitro activity against KPC-producing Klebsiella pneumoniae (Li et al., 2015; Endimiani et al., PMID:19528274), though cases identifying resistance have already been reported (see section 2b, Emerging resistance and cross-resistance). Its potent activity against KPC-producing K. pneumonia was also shown in two In vivo murine models of infection (Endimiani et al., PMID:21041503) Among 177 carbapenemase-producing Gram-negative bacilli, ceftazidime was found to be active against 93% of isolates, including all KPC-producing and most OXA-48-group-producing isolates, but not metallo-beta lactamase producers (Vasoo et al., 2015). In gentamicin-and fluoroquinolone-nonsusceptible isolates ceftazidime–avibactam has been shown to significantly improve activity (Denisuik et al., 2015; Pitart et al., 2015). Ceftazidime–avibactam MIC90 values were 0.5 μg/ml (MIC < 8 μg/ml for 100% of isolates) and 16 μg/ml (MIC < 8 μg/ml for 87.8% of isolates) against gentamicin-nonsusceptible Enterobacteriaceae and P. aeruginosa isolates, respectively.
Naja atra snakebite in Taiwan
Published in Clinical Toxicology, 2018
Yan-Chiao Mao, Po-Yu Liu, Liao-Chun Chiang, Chih-Sheng Lai, Kuo-Lung Lai, Cheng-Hsuan Ho, Te-Huo Wang, Chen-Chang Yang
Rhabdomyolysis occurred in 3.8% of patients, skin necrosis in 65.6%, bullae or blisters in 17.5%, local numbness in 29%, lymphadenitis or lymphangitis in 1.6%, fever in 32.2%, wound infection in 80.9%, with positive bacterial cultures in 73 of 90 patients from whom cultures were obtained, NSTI in 42.1%, gastrointestinal effects, such as nausea or vomiting in 20.8% and abdominal upset or diarrhea in 19.1%, and neurological effects, such as partial ptosis or equivocal, barely detectable weakness (grade 5−) in 4.9%. No deaths were observed during the study period. Deep tissue or biopsy culture was performed in 27 of the 77 patients with NSTI. Among the 27 patients, 22 had positive cultures: 13 bacterial species were isolated and 13 patients had polymicrobial infections. The most common pathogens were Morganella morganii and Enterococcus spp., which also contributed to polymicrobial infections (Tables 1 and 2).
Impact of antibiotic susceptibility reporting on broad spectrum antibiotic use in serratia and morganella bacteremia
Published in Journal of Chemotherapy, 2022
Wendy Hui Wen Ng, Ka Lip Chew, Joy Hui Yan Yong, Janice Xuanhui Li
In addition, our study findings contribute to the paucity of literature evaluating the treatment outcomes of 3rd generation cephalosporins for Serratia marcescens and Morganella morganii. Choi et al reported use of 3rd generation cephalosporins for infections due to Serratia marcescens (n = 37) and Morganella morganii (n = 21) for which no treatment failure was reported [10]. Similarly, all patients in our study with Serratia marcescens and Morganella morganii bacteraemia treated with 3rd generation cephalosporins survived. Our study thus lends support to the use of these agents in infections caused by Serratia marcescens and Morganella morganii.
A Rare Case of Fulminant Acute Postoperative Morganella morganii Endophthalmitis
Published in Ocular Immunology and Inflammation, 2023
Kushal Umeshbhai Agrawal, Kashmira Limaye Joshi, Maikel Gad
Morganella morganii is a rare human pathogen. There are very few reported cases of acute post-operative endophthalmitis related to it. The majority of reported cases have shown poor anatomical and functional outcomes due to this fulminant disease. Here, we report a case of acute post-operative endophthalmitis due to Morganella morganii. This patient had presented with very poor vision and fulminant disease. We are pleased to report the successful management of this patient and their favorable outcome.