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Microbiological Assay of Antibiotics in Body Fluids and Tissues
Published in Adorjan Aszalos, Modern Analysis of Antibiotics, 2020
Other Body Fluids, Except Bile: Peritoneal, pleural, cerebrospinal, bronchial, and synovial fluids, as well as protein-free filtrate of serum and urine, can be assayed versus a standard curve in 1% phosphate buffer, pH 6.0, providing the samples are diluted 1:5 or greater in the buffer. Standard concentrations are 0.02, 0.03, 0.05 (reference concentration), 0.08, and 0.13 μg/ml of buffer. Store control fluids supplemented with aztreonam together with the samples at —70°C or lower until assayed. Determine recovery from these control fluids with each assay run for each of the fluids. Recoveries range from 80 to 90%, and the dose responses are parallel to those of the phosphate buffer curve. Control cerebrospinal fluid can be obtained commercially (Fisher Scientific). Protein-free filtrate of serum can be made in the laboratory by ultrafiltration (Amicon CF 50A Cones, Amicon Corp., Danvers, Massachusetts). Pleural and peritoneal fluids are produced by injecting saline into the appropriate cavities of cows and harvesting the fluid, after a period of hours, yield 10—20% (Agrilab, Bridgewater, New Jersey). Other fluids must be obtained from participating hospital laboratories. Nominal potencies found for the samples are normalized to 100% recovery using the recoveries of the appropriate control fluids.
Klebsiella spp. as Pathogens: Epidemiology, Pathogenesis, Identification, Treatment, and Prevention
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
Arumugam Kamaladevi, Shanmugaraj Gowrishankar, Krishnaswamy Balamurugan
Treatment for Klebsiella infection is site dependent. Local susceptibility patterns determine the choice of antimicrobial agents. Once the bacteremia in patients is confirmed, treatment may be enhanced with highly intrinsic antimicrobials against Klebsiella. Examples of such antimicrobial agents include third-generation cephalosporins (e.g., cefotaxime and ceftriaxone), carbapenems (e.g., imipenem/cilastatin), aminoglycosides (e.g., gentamicin and amikacin), and quinolones. These antimicrobials may be used as monotherapy or combination therapy. The combination therapy using aminoglycoside and third-generation cephalosporin is used to treat the non-ESBL-producing Klebsiella strains.29,30 In 2015, the U.S. Food and Drug Administration approved ceftazidime-avibactam, novel antibacterial agents to treat adults with severe intraabdominal infections and UTIs. The combination of ceftolozane/tazobactam and ceftazidime/avibactam may also be used to treat Klebsiella. Additionally, infection by carbapenem-resistant Klebsiella is treated with ceftazidime/avibactam.59 Aztreonam is used to treat the patients who are allergic to ß-lactam antibiotics. Likely, quinolones are used for patients allergic to carbapenems and ß-lactam. The antibiotics used to treat susceptible Klebsiella infection include ticarcillin/clavulanate, ampicillin/sulbactam, piperacillin/tazobactam, ceftazidime, cefepime, norfloxacin, levofloxacin, moxifloxacin, ertapenem, and meropenem.
Problematic Beta-Lactamases: An Update
Published in Robert C. Owens, Lautenbach Ebbing, Antimicrobial Resistance, 2007
Marion S. Helfand, Louis B. Rice
Metallo beta-lactamases (Class B Ambler designation) are typically identified in Pseudomonas and Acinetobacter isolates. They have become widely disseminated in Asia, South America, southern Europe, and parts of Canada, but remain rare in the United States with the exception of sporadic case reports. These beta-lactamases confer resistance to most beta-lactams including carbapenems. A minority are active against aztreonam, and they cannot be inhibited by our current clinical inhibitors. New methods to detect and report metallo-beta-lactamases are being developed and employed in the clinical microbiology laboratory. Class B enzymes are inhibited under conditions where their metal ions have been removed, e.g., by addition of a metal chelator like ethylene diamine tetraacetate or EDTA. Because the Class B enzymes are an unusual cause of beta-lactam resistance in U.S. hospitals, they are not discussed further in this chapter. The interested reader is referred to an excellent review by Walsh et al. (23).
The safety of antimicrobials for the treatment of community-acquired pneumonia
Published in Expert Opinion on Drug Safety, 2020
Carla Bastida, Dolors Soy, Antoni Torres
The estimated prevalence of allergic reactions is 3%–4% for cephalosporins and 3% for carbapenems [24,25]. Caution should be taken in patients with a history of penicillin allergies because both cephalosporins and carbapenems share a common beta-lactam ring, having the potential for allergic cross-reactivity. Among patients who report penicillin reactions, cross-allergy has been estimated at 4%–10% with cephalosporins and less than 1% with carbapenems. In the presence of a history of allergy to penicillin, the side chains of the cephalosporin constitutes the major determinant of allergic reactions and the risk of allergy decreases with increasing generations of cephalosporins [21]. Aztreonam is a safe option for patients with penicillin allergies and for most with cephalosporin allergies, excluding ceftazidime because it shares an identical R1 side chain [24–26].
Treatment of urinary tract infections in the era of antimicrobial resistance and new antimicrobial agents
Published in Postgraduate Medicine, 2020
Mazen S. Bader, Mark Loeb, Daniela Leto, Annie A. Brooks
Aztreonam is a β-lactam antibiotic and the only clinically available member of its monobactam class. Aztreonam remains an option for treating infections due to MBLs) producing gram-negative organisms that test susceptible to this agent. However, these carbapenemase-producing bacteria are often coupled with additional resistance mechanisms, such as ESBLs and AmpC-type enzymes, which confer resistance to aztreonam (Table 2) [104]. Therefore, aztreonam should not be used as empiric monotherapy for cUTIs or acute pyelonephritis due to high resistance and failure rate [114]. Combing aztreonam with other antibiotics (ceftazidime-avibactam, amoxicillin-clavulanic acid) or β -lactam inhibitors (avibactam, zidebactam, nacubactam, and WCK 5153) enhances activity against these resistant organisms [37,115–118].
Investigational inhaled therapies for non-CF bronchiectasis
Published in Expert Opinion on Investigational Drugs, 2018
Inhaled aztreonam was associated with a notable reduction in respiratory symptom burden compared to placebo at day 28 (p = 0.0005), with a significant improvement in lung function at day 28 (p < 0.0001), with a considerable reduction in sputum PA load (−1.38 log 10 CFU/mL compared to 0.069 log 10 CFU/mL, p < 0.0001). However, it did not display a significant therapeutic effect on the number of patients requiring systemic antibiotic therapy or on the number of patients requiring at least one hospital admission over 42 days including 28 days of active treatment. In terms of serious adverse events, intestinal obstruction, nausea, pyrexia, and peripheral edema had each an incidence of 1.25% in the aztreonam group.