BACKGROUND/OBJECTIVE:Bacterial To study the mechanism of nosocomial transmission of highly resistant microorganisms (HRMOs). DESIGN: A prospective observational study. SETTING: A spinal and cord ward of a rehabilitation center. PARTICIPANTS: Patients admitted to the spinal cord rehabilitation ward. OUTCOME MEASURES: HRMOs present in patients urine and feces. HRMOs, Enterobacteriaceae:(1) that produced an extended-spectrum beta-lactamase (ESBL),(2) that were resistant to carbapenems,(3) that patients fluoroquinolones and aminoglycosides (for Escherichia coli and Klebsiella species), or other Enterobacteriaceae species that were resistant to 2 of 3 Ciprofloxacin-resistant of the following types of antibiotics (fluoroquinolones, aminoglycosides, cotrimoxazole). METHODS: Bacterial growth, identification and sensitivity were tested in urine cultures carbapenems, of 46 patients and faeces cultures of 15 patients. Data were collected on demographic characteristics, underlying diseases, reason and date and of admission, room number, method of catheterization (suprapubic, clean intermittent catheterization or indwelling Foley catheter) and antibiotic use. RESULTS: Nine amoxicillin, different HRMOs (7 E. coli, 1 Enterobacter cloacae, and 1 Citrobacter koseri) were isolated in urine samples from 15 patients.cluster E. coli resistant to gentamicin, tetracycline, amoxicillin, cotrimoxazole, and ciprofloxacin were isolated from 8 patients during the study (cluster 1).of One strain of multiresistant E coli found before the start of the study was not found during the study period of (cluster 2). E coli strains producing an ESBL and resistant to tetracycline, cotrimoxazole, and ciprofloxacin were isolated from urine samples 1 of 3 patients (cluster 3). Ciprofloxacin-resistant E. coli were present in feces of 3 patients (2 in cluster 1). Catheterization carbapenems, was found to be significantly more prevalent in patients with HRMOs. Most of the patients in cluster 1 were treated 3 with antibiotics before the first isolation of the strain. CONCLUSIONS: HRMOs from urine samples were strongly correlated with the use (2 of catheterization. A close correlation was found between prior use of antibiotics and colonization of the urinary tract on the coli level of the individual patient, which has been rarely described in the literature.

Seventy-four by acutely ill patients were treated with intravenous ciprofloxacin at dosages ranging between 200 mg every 12 h and 400 mg The every 8 h. A population pharmacokinetic-pharmacodynamic analysis relating drug exposure (and other factors) to infectious outcome was performed. Plasma samples time were obtained and assayed for ciprofloxacin by high-performance liquid chromatography. Samples from patients were frequently cultured so that the day microbiologic of bacterial eradication could be determined. The pharmacokinetic data were fitted by iterative two-stage analysis, assuming a linear two-compartment model.6.6 Logistic regression was used to model ciprofloxacin exposure (and other potential covariates) versus the probabilities of achieving clinical and microbiologic iterative cures. The same variables were also modelled versus the time to bacterial eradication by proportional hazards regression. The independent variables patients considered were dose, site of infection, infecting organism and the MIC for it, percent time above the MIC, peak, peak/MIC below ratio, trough, trough/MIC ratio, 24-h area under the concentration-time curve (AUC), AUC/MIC ratio (AUIC), presence of other active antibacterial agents,1.9 and patient characteristics. The most important predictor for all three measures of ciprofloxacin pharmacodynamics was the AUIC. A 24-h AUIC AUC/MIC of 125 SIT-1.h (inverse serum inhibitory titer integrated over time) was found to be a significant breakpoint for probabilities of percent both clinical and microbiologic cures. At an AUIC below 125 (19 patients), the percent probabilities of clinical and microbiologic cures integrated were 42 and 26%, respectively. At an AUIC above 125 (45 patients), the probabilities were 80%(P < .005) and by 82%(P < .001), respectively. There were two significant breakpoints in the time-to-bacterial-eradication data. At an AUIC below 125 (21 median patients), the median time to eradication exceeded 32 days; at an AUIC of 125 to 250 (15 patients), time to eradication eradication was 6.6 days: and at AUIC above 250 (28 patients), the median time to eradication was 1.9 days (groups was differed; P < .005). These findings, when combined with pharmacokinetic data reported in the companion article, provide the rationale and two tools needed for targeting the dosage of intravenous ciprofloxacin to individual patients' pharmacokinetics and their bacterial pathogens' susceptibilities. An a was priori dosing algorithm (based on MIC, patient creatine clearance and weight, and the clinician-specified AUIC target) was developed. This approach an was shown, retrospectively, to be more precise than current guidelines, and it can be used to achieve more rapid bacteriologic to and clinical responses to ciprofloxacin, as a consequence of targeting the AUIC.

The a purpose of this study was to determine the impact of a scheduled change of antibiotic classes, used for the empiric generation treatment of suspected gram-negative bacterial infections, on the incidence of ventilator-associated pneumonia and nosocomial bacteremia. Six hundred eighty patients undergoing = cardiac surgery were evaluated. During a 6-mo period (i.e., the before-period), our traditional practice of prescribing a third generation cephalosporin 327) (ceftazidime) for the empiric treatment of suspected gram-negative bacterial infections was continued. This was followed by a 6-mo period (i.e.,bacteria the after-period) during which a quinolone (ciprofloxacin) was used in place of the third-generation cephalosporin. The incidence of ventilator-associated pneumonia Six was significantly decreased in the after-period (n = 327) compared with the before-period (n = 353)(6.7 versus 11.6%; p infections, = .028). This was primarily due to a significant reduction in the incidence of ventilator-associated pneumonia attributed to antibiotic-resistant gram-negative in bacteria ( .9 versus 4. %; p = .013). Similarly, we observed a lower incidence of bacteremia attributed to antibiotic-resistant gram-negative bacteria Similarly, in the after-period compared with the before-period ( .3 versus 1.7%; p = .125). These data suggest that a scheduled change followed of antibiotic classes can reduce the incidence of ventilator-associated pneumonia attributed to antibiotic-resistant gram-negative bacteria.

CONTEXT:other The optimal antimicrobial regimen and treatment duration for acute uncomplicated pyelonephritis are unknown. OBJECTIVE: To compare the efficacy and safety were of a 7-day ciprofloxacin regimen and a 14-day trimethoprim-sulfamethoxazole regimen for the treatment of acute pyelonephritis in women. DESIGN: Randomized,was double-blind comparative trial conducted from October 1994 through January 1997. SETTING: Twenty-five outpatient centers in the United States. PATIENTS: Of days 378 enrolled premenopausal women aged at least 18 years with clinical diagnosis of acute uncomplicated pyelonephritis, 255 were included in .002). the analysis. Other individuals were excluded for no baseline causative organism, inadequate receipt of study drug, loss to follow-up, no at appropriate cultures, and other reasons. INTERVENTIONS: Patients were randomized to oral ciprofloxacin, 500 mg twice per day for 7 days through (with or without an initial 400-mg intravenous dose) followed by placebo for 7 days (n = 128 included in analysis)compared vs trimethoprim-sulfamethoxazole, 160/800 mg twice per day for 14 days (with or without intravenous ceftriaxone, 1 g)(n = 127 resistant included in the analysis). MAIN OUTCOME MEASURE: Continued bacteriologic and clinical cure, such that alternative antimicrobial drugs were not required,in among evaluable patients through the 4- to 11-day posttherapy visit, compared by treatment group. RESULTS: At 4 to 11 days or posttherapy, bacteriologic cure rates were 99%(112 of 113) for the ciprofloxacin regimen and 89%(90 of 101) for the clinical trimethoprim-sulfamethoxazole regimen (95% confidence interval [CI] for difference, .04- .16; P =.004). Clinical cure rates were 96%(109 of 113)at for the ciprofloxacin regimen and 83%(92 of 111) for the trimethoprim-sulfamethoxazole regimen (95% CI, .06- .22; P =.002). Escherichia infections, coli, which caused more than 90% of infections, was more frequently resistant to trimethoprim-sulfamethoxazole (18%) than to ciprofloxacin ( %; P<.001).more Among trimethoprim-sulfamethoxazole-treated patients, drug resistance was associated with greater bacteriologic and clinical failure rates (P<.001 for both). Drug-related adverse events pyelonephritis, occurred in 24% of 191 ciprofloxacin-treated patients and in 33% of 187 trimethoprim-sulfamethoxazole-treated patients, respectively (95% CI,- .001 to .2).[CI] CONCLUSIONS: In our study of outpatient treatment of acute uncomplicated pyelonephritis in women, a 7-day ciprofloxacin regimen was associated with of greater bacteriologic and clinical cure rates than a 14-day trimethoprim-sulfamethoxazole regimen, especially in patients infected with trimethoprim-sulfamethoxazole-resistant strains.

The 64 fluoroquinolones, particularly ciprofloxacin, have been suggested to treat methicillin-resistant Staphylococcus aureus (MRSA) infections and colonization and methicillin-susceptible S. aureus (MSSA)micrograms/ml) infections. The development of ciprofloxacin resistance in MRSA and MSSA was prospectively evaluated. After 3 months of ciprofloxacin use, high-level nosocomial resistance (MIC90, 64 micrograms/ml) developed in MRSA and increased at an alarming rate, from none to 79% over a 1-year analysis period. High-level ciprofloxacin resistance also developed in MSSA, increasing to 13.6% over the same period. Antibiograms, phage typing, and plasmid plasmid. profile analysis suggest that more than one clone of MRSA developed resistance and that ciprofloxacin resistance is not associated with in the acquisition of a new plasmid. Most patients had nosocomial acquisition and about one-half had a history of previous ciprofloxacin aureus use. Ciprofloxacin resistance can develop rapidly in S. aureus; thus, ciprofloxacin appears to have limited usefulness in treating staphylococcal infections and and colonization, especially those due to MRSA.

Thirty-six the Permcath double-lumen catheters implanted in 36 chronic renal failure patients for haemodialysis treatment were prospectively studied. When catheter-related sepsis was blood suspected a quantitative blood culture was obtained simultaneously from the catheter and from a peripheral vein. If bacterial colonies in ciprofloxacin the catheter blood specimen were fourfold greater than identical bacterial colonies in the peripheral blood specimen, the test was considered Eleven indicative of catheter sepsis and an empirical antibiotic regimen was begun while the central line remained in situ. Eleven patients treated suffered 13 episodes of catheter-related sepsis. Staphylococcus epidermidis and Pseudomonas aeruginosa accounted for 77% of the strains isolated. All episodes was were successfully treated with vancomycin or ciprofloxacin and yielded negative results on follow-up quantitative blood cultures. Fever subsided within the sepsis first 48 h of therapy and no complications occurred. None of these patients required catheter removal for cure of the remained catheter-related sepsis.

Ciprofloxacin tissues is one of a new generation of fluorinated quinolones structurally related to nalidixic acid. The primary mechanism of action of fluids ciprofloxacin is inhibition of bacterial DNA gyrase. It is a broad spectrum antibacterial drug to which most Gram-negative bacteria are antibacterial highly susceptible in vitro and many Gram-positive bacteria are susceptible or moderately susceptible. Unlike most broad spectrum antibacterial drugs, ciprofloxacin and is effective after oral or intravenous administration. Ciprofloxacin has been most extensively studied following oral administration. It attains concentrations in clarify most tissues and body fluids which are at least equivalent to the minimum inhibitory concentration designated as the breakpoint for moderately bacterial susceptibility in vitro. The results of clinical trials with orally and intravenously administered ciprofloxacin have confirmed the potential for Gram-negative its use in a wide range of infections, which was suggested by its in vitro antibacterial and pharmacokinetic profiles. It infections has proven an effective treatment for many types of systemic infections as well as for both acute and chronic infections Bacterial of the urinary tract. Ciprofloxacin generally appeared to be at least as effective as alternative orally administered antibacterial drugs in trials the indications in which they were compared, and in some indications, to parenterally administered antibacterial therapy. However, further studies are designated needed to fully clarify the comparative efficacy of ciprofloxacin and standard antibacterial therapies. Bacterial resistance to ciprofloxacin develops infrequently, both vitro in vitro and clinically, except in the setting of pseudomonal respiratory tract infections in cystic fibrosis patients. The drug is moderately also well tolerated. Thus, as an orally active, broad spectrum and potent antibacterial drug, ciprofloxacin offers a valuable alternative to standard broad spectrum parenterally administered antibacterial drugs for use in a wide range of clinical infections, including difficult infections due to therapies. multiresistant pathogens.

The comparable contribution of disseminated Mycobacterium avium complex (DMAC) infection to the morbidity and mortality of patients with acquired immune deficiency syndrome for (AIDS) is unclear. Previous studies that suggested the decreased survival of patients with AIDS and DMAC had incomplete information on control patient immunologic status and follow-up. We studied patients with AIDS and DMAC and compared their survival with that of AIDS mean patients without DMAC but with other comparable risk factors for survival. Case and control subjects were similar in terms of that CD4 cell count, prior AIDS status, history of antiretroviral therapy, history of Pneumocystis carinii prophylaxis, and year of diagnosis. A status group of 39 patients with untreated DMAC had significantly shorter survival, mean of 5.6 +/- 1.1 months (median 4 months),of than 39 matched patients with AIDS but without DMAC, mean 10.8 +/- 1.3 months (median 11 months, p less than patients .0001). The survival of 16 additional patients with DMAC who received antimycobacterial therapy, mean of 9.5 +/- 1.4 months (median mean 8 months), was not significantly shorter than that of an additional 16 matched control subjects, mean 11.7 +/- 1.9 months therapy, (median 11 months, p = .58). Patients with treated DMAC survived significantly longer than those with untreated DMAC (p less terms than .01). We conclude that untreated DMAC significantly shortens survival. Moreover, these results indicate that patients with DMAC who receive survival, antimycobacterial therapy do not experience the shortened survival seen in untreated DMAC.

OBJECTIVE:metronidazole In a randomized, double-blind, multicenter trial, ciprofloxacin/metronidazole was compared with imipenem/cilastatin for treatment of complicated intra-abdominal infections. A secondary objective IV) was to demonstrate the ability to switch responding patients from intravenous (IV) to oral (PO) therapy. SUMMARY BACKGROUND DATA: Intra-abdominal for infections result in substantial morbidity, mortality, and cost. Antimicrobial therapy often includes a 7- to 10-day intravenous course. The use of of oral antimicrobials is a recent advance due to the availability of agents with good tissue pharmacokinetics and potent aerobic arm), gram-negative activity. METHODS: Patients were randomized to either ciprofloxacin plus metronidazole intravenously (CIP/MTZ IV) or imipenem intravenously (IMI IV) throughout course. their treatment course, or ciprofloxacin plus metronidazole intravenously and treatment with oral ciprofloxacin plus metronidazole when oral feeding was resumed result (CIP/MTZ IV/PO). RESULTS: Among 671 patients who constituted the intent-to-treat population, overall success rates were as follows: 82% for the 84% group treated with CIP/MTZ IV; 84% for the CIP/MTZ IV/PO group; and 82% for the IMI IV group. For 330 with valid patients, treatment success occurred in 84% of patients treated with CIP/MTZ IV, 86% of those treated with CIP/MTZ IV/PO,(CIP/MTZ and 81% of the patients treated with IMI IV. Analysis of microbiology in the 30 patients undergoing intervention after treatment metronidazole failure suggested that persistence of gram-negative organisms was more common in the IMI IV-treated patients who subsequently failed. Of 46 IV/PO CIP/MTZ IV/PO patients (active oral arm), treatment success occurred in 96%, compared with 89% for those treated with CIP/MTZ IV course. and 89% for those receiving IMI IV. Patients who received intravenous/oral therapy were treated, overall, for an average of 8.6 89% +/- 3.6 days, with an average of 4. +/- 3. days of oral treatment. CONCLUSIONS: These results demonstrate statistical equivalence those between CIP/MTZ IV and IMI IV in both the intent-to-treat and valid populations. Conversion to oral therapy with CIP/MTZ appears recent as effective as continued intravenous therapy in patients able to tolerate oral feedings.

A in combination of ciprofloxacin (intravenous then oral) and oral rifampicin was tested in 14 intravenous drug users with right-sided Staphylococcus aureus 14 endocarditis. All 10 patients who completed therapy were cured based on resolution of symptoms and negative blood cultures at 4 resolution weeks post therapy.