Intravenous Streptomycin Use in a Patient Infected with High-Level, Gentamicin-Resistant Streptococcus Faecalis

1993 ◽  
Vol 27 (6) ◽  
pp. 712-714 ◽  
Author(s):  
Angela Kim-Sing ◽  
Michael B. Kays ◽  
Vivien E. James ◽  
C. Wayne Weart
Keyword(s):  
Renal Insufficiency ◽  
Chronic Renal Insufficiency ◽  
Enterobacter Aerogenes ◽  
Coagulase Negative Staphylococci ◽  
Streptococcus Faecalis ◽  
Susceptibility Data ◽  
History Of ◽  
Citrobacter Diversus ◽  
High Level ◽  
Gentamicin Therapy

OBJECTIVE: To report a case of intravenous streptomycin sulfate use in a patient infected with high-level, gentamicin-resistant Streptococcus faecalis. CASE SUMMARY: A 37-year-old woman with a history of schizoaffective disorder, diabetes insipidus possibly induced by lithium, chronic renal insufficiency, and anemia presented with a two-day history of decreased responsiveness, decreased verbalization, and tremulousness. Her hospital course was complicated by polymicrobial sepsis ( S. faecalis, coagulase-negative staphylococci, Citrobacter diversus, Enterobacter aerogenes, and unidentified gram-negative bacilli #2) requiring vancomycin and gentamicin therapy. Gentamicin was discontinued after two doses because she developed acute-on-chronic renal insufficiency. Subsequent susceptibility data showed the enterococcus to be highly resistant to gentamicin. The patient deteriorated clinically when treated only with vancomycin. She remained septic with a blood pressure of 80/40 mm Hg; streptomycin was added to her regimen. We were concerned that streptomycin concentrations obtained following intramuscular administration would not be adequate because of possible hypoperfusion. Based on limited published literature, streptomycin was administered intravenously via a central intravenous catheter. DISCUSSION: A review of high-level aminoglycoside-resistant S. faecalis and treatment with intravenous streptomycin therapy are discussed. The availability and monitoring of streptomycin therapy are also described. CONCLUSIONS: Streptomycin is an antimicrobial agent that must be used with vancomycin in serious infections to eradicate high-level, gentamicin-resistant S. faecalis. Its unique administration and monitoring concerns require individual patient assessment.

scholarly journals Natural History of Renal Function in Childhood Chronic Renal Insufficiency (CRI)

1999 ◽  
Vol 45 (4, Part 2 of 2) ◽  
pp. 328A-328A
Author(s):  
G L Ardissino ◽  
V Dacco ◽  
S Testa ◽  
A Claris Appiani ◽  
F Sereni
Keyword(s):  
Renal Function ◽  
Natural History ◽  
Renal Insufficiency ◽  
Chronic Renal Insufficiency ◽  
History Of

scholarly journals Is previous azithromycin treatment associated with azithromycin resistance in Neisseria gonorrhoeae? A cross-sectional study using national surveillance data in England

2018 ◽  
Vol 94 (6) ◽  
pp. 421-426 ◽  
Author(s):  
Soazig Clifton ◽  
Katy Town ◽  
Martina Furegato ◽  
Michelle Cole ◽  
Hamish Mohammed ◽  
...  
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Previous Treatment ◽  
Cross Sectional Study ◽  
Reference Laboratory ◽  
Electronic Patient Records ◽  
Cross Sectional ◽  
Susceptibility Data ◽  
History Of ◽  
High Level ◽  
Azithromycin Resistance

ObjectivesIt has been suggested that treatment of STIs with azithromycin may facilitate development of azithromycin resistance in Neisseria gonorrhoeae (NG) by exposing the organism to suboptimal doses. We investigated whether treatment history for non-rectal Chlamydia trachomatis (CT), non-gonococcal urethritis (NGU) or NG (proxies for azithromycin exposure) in sexual health (GUM) services was associated with susceptibility of NG to azithromycin.MethodsAzithromycin susceptibility data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP 2013–2015, n=4606) and additional high-level azithromycin-resistant isolates (HL-AziR) identified by the Public Health England reference laboratory (2013–2016, n=54) were matched to electronic patient records in the national GUMCAD STI surveillance dataset (2012–2016). Descriptive and regression analyses were conducted to examine associations between history of previous CT/NGU/NG and subsequent susceptibility of NG to azithromycin.ResultsModal azithromycin minimum inhibitory concentration (MIC) was 0.25 mg/L (one dilution below the resistance breakpoint) in those with and without history of previous CT/NGU/NG (previous 1 month/6 months). There were no differences in MIC distribution by history of CT/NGU (P=0.98) or NG (P=0.85) in the previous 1 month/6 months or in the odds of having an elevated azithromycin MIC (>0.25 mg/L) (Adjusted OR for CT/NGU 0.97 (95% CI 0.76 to 1.25); adjusted OR for NG 0.82 (95% CI: 0.65 to 1.04)) compared with those with no CT/NGU/NG in the previous 6 months. Among patients with HL-AziR NG, 3 (4%) were treated for CT/NGU and 2 (3%) for NG in the previous 6 months, compared with 6% and 8%, respectively for all GRASP patients.ConclusionsWe found no evidence of an association between previous treatment for CT/NGU or NG in GUM services and subsequent presentation with an azithromycin-resistant strain. As many CT diagnoses occur in non-GUM settings, further research is needed to determine whether azithromycin-resistant NG is associated with azithromycin exposure in other settings and for other conditions.

scholarly journals Is there something special about cardiovascular abnormalities and sudden unexpected death in epilepsy among patients with chronic renal insufficiency in regular hemodialysis program?

2009 ◽  
Vol 67 (2a) ◽  
pp. 209-213 ◽  
Author(s):  
Rui A. Gomes ◽  
Silvana Kesrouani ◽  
Jenner Cruz ◽  
Alexandre L. Silva ◽  
Tânia M.G. Henriques ◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Chronic Renal Insufficiency ◽  
Sudden Unexpected Death ◽  
Unexpected Death ◽  
Cardiovascular Abnormalities ◽  
History Of ◽  
Clonic Seizures ◽  
Convulsive Seizures ◽  
The Many ◽  
Regular Hemodialysis

Of the many risk factors suggested for sudden unexpected death in epilepsy (SUDEP), higher frequency of seizures is a very consistent issue. Following this reasoning, it has been established that hemodialysis-associated seizure is a complication of dialysis procedure. Based on these facts, this study investigated a possible association between cardiovascular abnormalities and SUDEP among patients with chronic renal insufficiency in regular hemodialysis program. For that, a retrospective medical history of 209 patients was reviewed to investigate the occurrence of convulsive seizures and EKG abnormalities during dialytic program. Three patients presented generalized tonic-clonic seizures, one had partial seizure with secondary generalization, and one presented unclassified seizure. Any EKG abnormalities and SUDEP event were found in all patients evaluated. In conclusion, the present findings demonstrated uncommon the occurrence of seizures and also SUDEP. Probably, the main justification to not allow us to demonstrated a direct relation between SUDEP and cardiovascular diseases in hemodialysis are the reduced number of cases examined.

Natural history of chronic renal insufficiency after partial and radical nephrectomy

Urology ◽  
2002 ◽  
Vol 59 (6) ◽  
pp. 816-820 ◽  
Author(s):  
James McKiernan ◽  
Rachel Simmons ◽  
Jared Katz ◽  
Paul Russo
Keyword(s):  
Natural History ◽  
Renal Insufficiency ◽  
Chronic Renal Insufficiency ◽  
Radical Nephrectomy ◽  
History Of

scholarly journals 194. Antimicrobial Susceptibility Data of Staphylococcus lugdunensis After the Implementation of Rapid Molecular Blood Culture Diagnostics (Verigene® Gram-Positive Blood Culture Nucleic Acid Test)

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S204-S205
Author(s):  
Kristin Constance ◽  
Alauna Hunt ◽  
Sam Karimaghaei ◽  
Juliet Chijioke ◽  
Violeta Chavez ◽  
...  
Keyword(s):  
Blood Culture ◽  
Multiplex Pcr ◽  
Large Scale ◽  
Meca Gene ◽  
Coagulase Negative Staphylococci ◽  
Hospital System ◽  
Susceptibility Data ◽  
Oxacillin Resistance ◽  
High Level ◽  
Resistance Rates

Abstract Background S. lugdunensis is a coagulase negative staphylococci (CoNS) demonstrating high level pathogenicity. In contrast to other CoNS, S. lugdunensis (SL) remains susceptible to most antibiotics. Prior to the implementation of Verigene®, SL was identified by provider request only. We sought to describe the susceptibility data of SL isolated from blood culture after the implementation of multiplex PCR, as well as to determine the correlation of the mecA gene provided by Verigene® and oxacillin resistance. Methods Retrospective review of all blood culture isolates positive for SL from two major hospital systems, Memorial Hermann Hospital System (14 hospitals) and HarrisHealth System (two acute care hospitals) identified on Verigene® PCR. Multiple isolates detected from the same patients were excluded from this analysis. Memorial Hermann utilized Microscan®, and HarrisHealth utilized BD Phoenix® for susceptibility testing. Results Between 2017 – 2021, 157 patients were identified with SL positive blood cultures. Of them, 141 isolates had susceptibility data collected, which is summarized in table 1. Resistance rates were highest amongst clindamycin 97/141 (68.8 %) susceptible, erythromycin 98/141 (69.5%) susceptible, and oxacillin 120/141 (85.1%) susceptible. 127/141 (90.1%) of isolates were tested for mecA on Verigene®. 13 of 21 oxacillin resistant isolates were from pure culture, of these isolates, none had mecA detected. Conclusion In our study, clindamycin and erythromycin demonstrated similar susceptibility compared to prior studies in the literature, however oxacillin susceptibility rate was lower than expected at 85.1%, compared to 95.3% in a prior large-scale United States based study in 2017. Absence of mecA gene detection on multiplex PCR did not correlate with oxacillin susceptibility suggesting that oxacillin susceptibility cannot be accurately predicted by the use of multiplex PCR systems, such as Verigene®, as demonstrated in Table 2. Our study also suggested that increased prevalence of oxacillin resistant SL isolates may be emerging. Disclosures All Authors: No reported disclosures

A Confrontation between Two Doctrines: The Birth of Struggle for Hegemony in Hebrew Children's Literature during the 1930s and 1940s

2008 ◽  
Vol 1 (2) ◽  
pp. 139-155 ◽  
Author(s):  
YAEL DARR
Keyword(s):  
Children's Literature ◽  
Educational System ◽  
Single Channel ◽  
Children’S Literature ◽  
The Political ◽  
Literary Creation ◽  
History Of ◽  
High Level ◽  
First Time ◽  
Literary Quality

This article describes a crucial and fundamental stage in the transformation of Hebrew children's literature, during the late 1930s and 1940s, from a single channel of expression to a multi-layered polyphony of models and voices. It claims that for the first time in the history of Hebrew children's literature there took place a doctrinal confrontation between two groups of taste-makers. The article outlines the pedagogical and ideological designs of traditionalist Zionist educators, and suggests how these were challenged by a group of prominent writers of adult poetry, members of the Modernist movement. These writers, it is argued, advocated autonomous literary creation, and insisted on a high level of literary quality. Their intervention not only dramatically changed the repertoire of Hebrew children's literature, but also the rules of literary discourse. The article suggests that, through the Modernists’ polemical efforts, Hebrew children's literature was able to free itself from its position as an apparatus controlled by the political-educational system and to become a dynamic and multi-layered field.

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