Microbiological Diagnosis of Fungal Infections
Nancy Khardori in Bench to Bedside, 2018
Galactomannan (GM) is a cell wall component of Aspergillus. Detection of galactomannan in serum and BAL fluid has been studied in patients with neutropenia and/or hematologic malignancy. Galactomannan is reported as an index of optical density (galactomannan index [GMI]; the index is considered to be positive when 2 aliquots from the same sample have an optical density > 0.5) (Miceli et al. 2008). The GM test is standardized, widely available and reproducible (Wheat and Walsh 2008). It has been accepted by regulatory agencies as a surrogate marker for the diagnosis of invasive aspergillosis in trials (Cornely et al. 2007, Ullmann et al. 2007). Serum GM testing can be used as a surrogate end point for aspergillosis outcome in patients with hematological malignancy (Anaissie 2007). Though earlier studies showed piperacillin/tazobactam antibiotic use may provide false positive reaction, recent kits have overcome this problem to a certain extent. Enteral feeding with soybean protein, gastrointestinal colonization with Bifidobacterium in neonates can also result in false-positives. Combining the BAL galactomannan assay with PCR may increase the detection rate of invasive aspergillosis in neutropenic patients, though PCR techniques are in the process of standardization.
Piperacillin–Tazobactam
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 in Kucers’ The Use of Antibiotics, 2017
Piperacillin–tazobactam is an effective antimicrobial for the treatment of complicated intraabdominal infections (IAIs), with clinical and microbiological response rates similar to imipenem, ertapenem, and moxifloxacin. A meta-analysis of 40 clinical trials in 5094 patients with secondary peritonitis demonstrated equivalence among various agents for efficacy and toxicity (Wong et al., 2005). No specific recommendations can be made for the first-line treatment of secondary peritonitis in adults with antibiotics because all regimens showed equivocal efficacy. Other factors such as local guidelines and preferences, ease of administration, costs, and availability must therefore be taken into consideration in deciding the antibiotic regimen of choice.
Nosocomial Pneumonia in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Piperacillin/tazobactam is an antipseudomonal penicillin that has been used for empiric monotherapy. However, the addition of tazobactam to piperacillin offers no increase in anti-P. aeruginosa activity for the treatment of NP. Piperacillin/tazobactam has only modest P. aeruginosa activity. If selected for NP/VAP, piperacillin/tazobactam should be used in “high dose”, e.g., 4.5 g (IV) q6h, and given more frequently and furthermore should be used in combination with amikacin 1 g (IV) q24h [1,2,6,31].
COVID-19 in a Patient with β-Thalassemia Major and Severe Pulmonary Arterial Hypertension
Published in Hemoglobin, 2020
Valeria M. Pinto, Giorgio E. Derchi, Lorenzo Bacigalupo, Emanuele Pontali, Gian Luca Forni
Supplemental oxygen through 50.0% Venturi mask maintained the SpO2 at 95.0%. Antibiotic therapy with piperacillin-tazobactam and azithromycin was started. According to our hospital’s guidelines treatment for COVID-19 at that time the following therapy was also given: hydroxychloroquine at a dosage of 200 mg orally every 12 hours, Ritonavir 100 mg once a day and Darunavir 800 mg once a day for 7 days. Due to the high potential for harmful drug–drug interactions with darunavir and ritonavir, Rivaroxaban was discontinued and replaced with enoxaparin 100 IU/Kg twice a day. During hospitalization renal function worsened to a minimum value of glomerular filtration rate (GFR) of 40 ml/min./1.73 m2 and increasing blood consumption was evident (four units of packed red cells were transfused in 10 days).
Synthesis and evaluation of polymeric micelle containing piperacillin/tazobactam for enhanced antibacterial activity
Published in Drug Delivery, 2019
Milani Morteza, Salehi Roya, Hamishehkar Hamed, Zarebkohan Amir, Akbarzadeh Abolfazl
Antibiotic treatment of this pathogen is extremely difficult due to multiple resistance mechanisms, such as b-lactamases, efflux pumps, and the impermeability of the outer membrane (Bassetti et al., 2018). In fact, this leads to a serious limitation of the options for the treatment of P. aeruginosa infections. Nowadays several antibiotics are used to treat P. aeruginosa infections. Piperacillin is a potent, broad-spectrum ureidopenicillin that is used against gram-negative, gram-positive and anaerobic bacteria. When combined with beta-lactamase inhibitors such as tazobactam, it demonstrates a broader spectrum of activity against lactamase-producing bacteria. For its spectrum of activity, Piperacillin/tazobactam is a β-lactam/β-lactamase inhibitor combination widely employed in first-line therapy, particularly for nosocomial infections (Grant et al., 2002; Fonseca et al., 2004; Lodise et al., 2007). Based on some studies, treatment with subinhibitory concentrations of antibiotics may be effective on bacterial virulence factors, such as adherence, motility and biofilm formation (Wolter & McCormack, 1998; Wilson et al., 2002; Fonseca et al., 2004). The emergence of multidrug-resistant pathogens including cephalosporins and fluoroquinolones has led to the use of Piperacillin/Tazobactam. On the other hand, Piperacillin/Tazobactam is considered a safe antimicrobial agent and has fewer side effects than penicillin derivatives.
Chlamydophila psittaci pneumonia associated to exposure to fulmar birds (Fulmaris glacialis) in the Faroe Islands
Published in Infectious Diseases, 2018
Marian Elsubeth Fossádal, Mansour Grand, Shahin Gaini
The first patient was a 75 years old man with chronic obstructive lung disease (COPD). He was hospitalized 18 September 2016 due to high fever with temperature of 40°C, impaired general condition, shortness of breath and elevated infection parameters including a CRP of 239 mg/l. He was initially treated with iv. cefuroxime at a local hospital. Chest X-ray showed bilateral diffuse infiltrative and interstitial changes (Figure 1). Cultures of blood and urine were negative. The antibiotic treatment was changed to iv. benzylpenicillin. The patient's respiratory condition deteriorated during the following 4 days. The antibiotic treatment was changed again to iv. piperacillin/tazobactam. After 8 days of hospitalization, the patient had increasing oxygen demands and was transferred to the intensive care unit at the National Hospital Faroe Islands. The patient was now treated with continuous positive airway pressure (CPAP) and iv. piperacillin/tazobactam and iv. ciprofloxacin. After another 2 days without significant clinical improvement, CP was identified in pleural fluid by PCR (Danish Reference Laboratory of Clinical Microbiology, Statens Serum Institut, SSI, Copenhagen, Denmark), (SSI). Treatment was now supplemented with oral doxycycline. The patient improved and was discharged the 3 October 2016 after 15 days of hospitalization with oral doxycycline planned for a total duration of 14 days. A control chest X-ray was taken 6 weeks after discharge and showed normalized conditions. The patient had been in contact with fulmar birds for 5 consecutive days in late August 2016.
Related Knowledge Centers
- Antibiotic
- Bacteria
- Combination Drug
- Pelvic Inflammatory Disease
- Piperacillin
- Pseudomonas Aeruginosa
- Β-Lactamase Inhibitor
- Tazobactam
- Gram-Positive Bacteria
- Gram-Negative Bacteria