Use of Doxycycline in a Renal Impaired Patient with Enteroccocal Sepsis

Aim: This report highlights the use of doxycycline therapy other than the more standard regimen that includes an aminoglycoside in the management of enterococcal infection in patients with renal impairment without causing further damages to the kidney due to aminoglycoside therapy. Presentation of Case: A case of enteroccocal septicemia in a 29-year-old woman who was admitted on account of acute kidney injury secondary to pregnancy induced hypertension in the setting of pre-eclampsia. She was referred from another centre where she had emergency caesarean section done on account of severe pre-eclampsia at 36 weeks gestational age. Blood culture yielded Enterococcus species. When other antibiotic regimen failed, she was started on doxycycline. Patient had good clinical response and was discharged 7 days after commencement of doxycycline. Discussion: Enteroccoci have emerged as important agent of human disease largely because of their resistance to antimicrobial agents. They are important nosocomial pathogens capable of causing serious and potentially life-threatening infections, including sepsis. The incidence of enteroccocal infections, mainly hospital-acquired, has increased over the past 2 decades and isolates with novel mechanism of resistance to antimicrobial agents are more and more frequent. Furthermore, they have great capacity for transmitting these resistances to other species and even to other genera. Conclusion: Doxycycline is a safe and effective alternative antibiotic for the treatment of enterococcal sepsis in patients with impaired renal status.

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Consultation with the Specialist

Pediatrics in Review ◽

10.1542/pir.14.5.202 ◽

1993 ◽

Vol 14 (5) ◽

pp. 202-203

Author(s):

Terry Yamauchi

Keyword(s):

Urinary Tract ◽

Antimicrobial Agents ◽

The United States ◽

Enterococcal Infection ◽

Surgical Wounds ◽

Serious Infections ◽

Patient At Risk ◽

Hospital Acquired ◽

Group D

Introduction The enterococci, normal inhabitants of the human and animal bowel flora, were considered for years to be nonvirulent microorganisms. Over the past decade, however, the role of enterococci in human disease has taken on new importance. Serious diseases, such as bacteremia, which is associated with significant mortality, and endocarditis, are prime examples of human enterococcal infections. More recently, the wide-spread use of antimicrobial agents has led to the emergence of multiresistant microorganisms, previously considered to be nonpathogenic, as significant agents in human diseases. Morphologically, enterococci are gram-positive cocci that grow in chains and resemble streptococci. Previously, enterococci were placed in the Lancefield Group D streptococci genus; currently, they are in a new bacterial genus classification Enterococcus (Table). Clinical Diseases Enterococci may cause serious infections in the hospitalized patient and have been reported as the third leading cause of nosocomial infections in the United States. The recovery of enterococci from the urinary tract, surgical wounds, and the blood documents the importance of these bacteria in hospital-acquired infections. [See table in the PDF file] The urinary tract is the most common site infected by enterococci. Surgical instrumentation, intervention, and catheterization are invasive procedures that place the patient at risk for enterococcal infection.

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The Evolution of Lead Extraction

European Cardiology Review ◽

10.15420/ecr.2009.5.1.32 ◽

2009 ◽

Vol 5 (1) ◽

pp. 32

Author(s):

Melanie Maytin ◽

Laurence M Epstein ◽

◽

Keyword(s):

Natural Selection ◽

Lead Extraction ◽

Significant Morbidity ◽

Extraction Techniques ◽

Extraction Technology ◽

Device Management ◽

Future Developments ◽

The Past ◽

New Methods ◽

Life Threatening

Prior to the introduction of successful intravascular countertraction techniques, options for lead extraction were limited and dedicated tools were non-existent. The significant morbidity and mortality associated with these early extraction techniques limited their application to life-threatening situations such as infection and sepsis. The past 30 years have witnessed significant advances in lead extraction technology, resulting in safer and more efficacious techniques and tools. This evolution occurred out of necessity, similar to the pressure of natural selection weeding out the ineffective and highly morbid techniques while fostering the development of safe, successful and more simple methods. Future developments in lead extraction are likely to focus on new tools that will allow us to provide comprehensive device management and the design of new leads conceived to facilitate future extraction. With the development of these new methods and novel tools, the technique of lead extraction will continue to require operators that are well versed in several methods of extraction. Garnering new skills while remembering the lessons of the past will enable extraction technologies to advance without repeating previous mistakes.

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Brain-eating Amoebae Infection: Challenges and Opportunities in Chemotherapy

Mini-Reviews in Medicinal Chemistry ◽

10.2174/1389557519666190313161854 ◽

2019 ◽

Vol 19 (12) ◽

pp. 980-987 ◽

Cited By ~ 9

Author(s):

Mohammad Ridwane Mungroo ◽

Ayaz Anwar ◽

Naveed Ahmed Khan ◽

Ruqaiyyah Siddiqui

Keyword(s):

Mortality Rate ◽

Free Living ◽

Outdoor Activities ◽

The Past ◽

Free Living Amoeba ◽

Challenges And Opportunities ◽

Life Threatening ◽

The Central Nervous System ◽

Living Nature ◽

Treatment And Diagnosis

Pathogenic free-living amoeba are known to cause a devastating infection of the central nervous system and are often referred to as “brain-eating amoebae”. The mortality rate of more than 90% and free-living nature of these amoebae is a cause for concern. It is distressing that the mortality rate has remained the same over the past few decades, highlighting the lack of interest by the pharmaceutical industry. With the threat of global warming and increased outdoor activities of public, there is a need for renewed interest in identifying potential anti-amoebic compounds for successful prognosis. Here, we discuss the available chemotherapeutic options and opportunities for potential strategies in the treatment and diagnosis of these life-threatening infections.

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2′FL and LNnT Exert Antipathogenic Effects against C. difficile ATCC 9689 In Vitro, Coinciding with Increased Levels of Bifidobacteriaceae and/or Secondary Bile Acids

Pathogens ◽

10.3390/pathogens10080927 ◽

2021 ◽

Vol 10 (8) ◽

pp. 927

Author(s):

Louise Kristine Vigsnaes ◽

Jonas Ghyselinck ◽

Pieter Van den Van den Abbeele ◽

Bruce McConnell ◽

Frédéric Moens ◽

...

Keyword(s):

Antimicrobial Effect ◽

Secondary Bile Acid ◽

Clostridioides Difficile ◽

Life Threatening ◽

Intermediate Time ◽

Indigenous Microbiota ◽

Hospital Acquired ◽

Gut Microbial Community ◽

Secondary Bile Acids

Clostridioides difficile (formerly Clostridium difficile) infection (CDI) is one of the most common hospital-acquired infections, which is often triggered by a dysbiosed indigenous gut microbiota (e.g., upon antibiotic therapy). Symptoms can be as severe as life-threatening colitis. The current study assessed the antipathogenic potential of human milk oligosaccharides (HMOs), i.e., 2′-O-fucosyllactose (2′FL), lacto-N-neotetraose (LNnT), and a combination thereof (MIX), against C. difficile ATCC 9689 using in vitro gut models that allowed the evaluation of both direct and, upon microbiota modulation, indirect effects. During a first 48 h fecal batch study, dysbiosis and CDI were induced by dilution of the fecal inoculum. For each of the three donors tested, C. difficile levels strongly decreased (with >4 log CFU/mL) upon treatment with 2′FL, LNnT and MIX versus untreated blanks, coinciding with increased acetate/Bifidobacteriaceae levels. Interindividual differences among donors at an intermediate time point suggested that the antimicrobial effect was microbiota-mediated rather than being a direct effect of the HMOs. During a subsequent 11 week study with the PathogutTM model (specific application of the Simulator of the Human Intestinal Microbial Ecosystem (SHIME®)), dysbiosis and CDI were induced by clindamycin (CLI) treatment. Vancomycin (VNC) treatment cured CDI, but the further dysbiosis of the indigenous microbiota likely contributed to CDI recurrence. Upon co-supplementation with VNC, both 2′FL and MIX boosted microbial activity (acetate and to lesser extent propionate/butyrate). Moreover, 2′FL avoided CDI recurrence, potentially because of increased secondary bile acid production. Overall, while not elucidating the exact antipathogenic mechanisms-of-action, the current study highlights the potential of HMOs to combat CDI recurrence, help the gut microbial community recover after antibiotic treatment, and hence counteract the adverse effects of antibiotic therapies.

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Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

Medicines ◽

10.3390/medicines8040016 ◽

2021 ◽

Vol 8 (4) ◽

pp. 16

Author(s):

Gabriele Savioli ◽

Iride Francesca Ceresa ◽

Luca Caneva ◽

Sebastiano Gerosa ◽

Giovanni Ricevuti

Keyword(s):

Major Trauma ◽

Management Strategies ◽

Medical Problem ◽

Current Evidence ◽

Potential Drug ◽

The Past ◽

Trauma Induced Coagulopathy ◽

Threatening Condition ◽

Life Threatening ◽

Trauma Mortality

Coagulopathy induced by major trauma is common, affecting approximately one-third of patients after trauma. It develops independently of iatrogenic, hypothermic, and dilutive causes (such as iatrogenic cause in case of fluid administration), which instead have a pejorative aspect on coagulopathy. Notwithstanding the continuous research conducted over the past decade on Trauma-Induced Coagulopathy (TIC), it remains a life-threatening condition with a significant impact on trauma mortality. We reviewed the current evidence regarding TIC diagnosis and pathophysiological mechanisms and summarized the different iterations of optimal TIC management strategies among which product resuscitation, potential drug administrations, and hemostatis-focused approaches. We have identified areas of ongoing investigation and controversy in TIC management.

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The association between neutrophil-to-lymphocyte ratio and contrast-induced acute kidney injury in patients with carotid artery stenting

Vascular ◽

10.1177/17085381211012562 ◽

2021 ◽

pp. 170853812110125

Author(s):

Altuğ Ösken ◽

Ahmet Öz ◽

Muhammed Keskin ◽

Evliya Akdeniz ◽

Hasan Şahan ◽

...

Keyword(s):

Acute Kidney Injury ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Kidney Injury ◽

Fold Increase ◽

Multivariate Regression Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Life Threatening ◽

Prolonged Hospital

Objectives Contrast-induced acute kidney injury (CI-AKI) is a life-threatening complication that leads to comorbidities and prolonged hospital stay lengths in the setting of peripheral interventions. The presence of some CI-AKI risk factors has already been investigated. In this study, we evaluated the predictors of CI-AKI after carotid artery stenting. Methods A total of 389 patients with 50% to 99% carotid artery stenosis who underwent carotid artery stenting were included in this study. Patients were grouped according to CI-AKI status. Results CI-AKI developed in 26 (6.6%) patients. Age, baseline creatinine level, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were higher and estimated glomerular filtration rate, haemoglobin and lymphocyte count were lower in CI-AKI patients. In the multivariate regression analysis, the neutrophil-to-lymphocyte ratio triggered a 1.39- to 2.63-fold increase in the risk of CI-AKI onset ( p < 0.001). Conclusions The neutrophil-to-lymphocyte ratio may be a significant predictor of CI-AKI in patients with carotid artery stenting and higher neutrophil-to-lymphocyte ratio values may be independently associated with CI-AKI.

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Drug Induced Pneumonitis Secondary to Treatment with Paritaprevir/Ritonavir/Ombitasvir and Dasabuvir (VIEKIRA PAK®) for Chronic Hepatitis C: Case Report of an Unexpected Life-Threatening Adverse Reaction

Case Reports in Medicine ◽

10.1155/2017/4895736 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Shih Yea Sylvia Wu ◽

Bridget Faire ◽

Edward Gane

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Kidney Injury ◽

Complete Recovery ◽

Final Diagnosis ◽

Community Acquired Pneumonia ◽

Drug Induced ◽

First Case ◽

Life Threatening

VIEKIRA PAK (ritonavir-boosted paritaprevir/ombitasvir and dasabuvir) is an approved treatment for compensated patients with genotype 1 (GT1) chronic hepatitis C virus (HCV) infection. This oral regimen has minimal adverse effects and is well tolerated. Cure rates are 97% in patients infected with HCV GT 1a and 99% in those with HCV GT 1b. We report the first case of life-threatening allergic pneumonitis associated with VIEKIRA PAK. This unexpected serious adverse event occurred in a 68-year-old Chinese female with genotype 1b chronic hepatitis C and Child-Pugh A cirrhosis. One week into treatment with VIEKIRA PAK without ribavirin, she was admitted to hospital with respiratory distress and acute kidney injury requiring intensive care input. She was initially diagnosed with community acquired pneumonia and improved promptly with intravenous antibiotics and supported care. No bacterial or viral pathogens were cultured. Following complete recovery, she recommenced VIEKIRA PAK but represented 5 days later with more rapidly progressive respiratory failure, requiring intubation and ventilation, inotropic support, and haemodialysis. The final diagnosis was drug induced pneumonitis.

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Neuroleptic malignant syndrome following catatonia: Vigilance is the price of antipsychotic prescription

SAGE Open Medical Case Reports ◽

10.1177/2050313x17695999 ◽

2017 ◽

Vol 5 ◽

pp. 2050313X1769599 ◽

Cited By ~ 2

Author(s):

Thomas J Reilly ◽

Sean Cross ◽

David M Taylor ◽

Richard Haslam ◽

Sophie C Tomlin ◽

...

Keyword(s):

Adverse Effect ◽

Adverse Drug Reaction ◽

Pulmonary Embolism ◽

Neuroleptic Malignant Syndrome ◽

Kidney Injury ◽

Clinical Suspicion ◽

Antipsychotic Treatment ◽

High Dose ◽

Intravenous Fluids ◽

Life Threatening

Objectives: To describe a case of neuroleptic malignant syndrome following antipsychotic treatment of catatonia, highlighting the potentially serious complications of this rare adverse drug reaction. Methods: We present a case report of a patient who developed this syndrome with various sequelae. Results: The patient developed neuroleptic after being treated with lorazepam and olanzapine for catatonia. He subsequently developed the complications of rhabdomyolysis, acute kidney injury, pulmonary embolism, urinary retention and ileus. He received high-dose lorazepam, anticoagulation and intravenous fluids. Antipsychotic medication in the form of haloperidol was reinstated with no adverse effect, and he went on to make a full recovery. Conclusions: This case illustrates the potential life-threatening complications of neuroleptic malignant syndrome and the need for a low index of clinical suspicion. It also highlights the lack of evidence for treatment of catatonia, including the use of antipsychotics.

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Determinants of pyelonephritis onset in patients with obstructive urolithiasis

Urologia Journal ◽

10.1177/03915603211035244 ◽

2021 ◽

pp. 039156032110352

Author(s):

Georges Abi Tayeh ◽

Ali Safa ◽

Julien Sarkis ◽

Marwan Alkassis ◽

Nour Khalil ◽

...

Keyword(s):

Emergency Department ◽

Renal Colic ◽

Demographic Data ◽

Vital Signs ◽

Kidney Injury ◽

Stone Size ◽

Positive Urine ◽

Life Threatening ◽

Fat Stranding ◽

Obstructive Pyelonephritis

Background: Acute obstructive pyelonephritis due to urolithiasis represents a medico-surgical emergency that can lead to life-threatening complications. There are still no established factors that reliably predict progression toward acute pyelonephritis in patients presenting with a simple renal colic. Objective: To investigate clinical and paraclinical factors that are associated with the onset of acute obstructive pyelonephritis. Methods: Patients presenting to the emergency department for renal colic with obstructive urolithiasis on imaging were enrolled in the study. Demographic data, vital signs, medical comorbidities, blood test results, urinalysis, and radiological findings were recorded. Obstructive pyelonephritis was defined by the presence of two or more of the following criteria: fever, flank pain or costovertebral angle tenderness, and a positive urine culture. Results: Seventeen patients out of 120 presenting with renal colic, were diagnosed with acute obstructive pyelonephritis (14%). Parameters that were associated with the onset of obstructive pyelonephritis were: diabetes ( p = 0.03), elevated CRP ( p = 0.01), stone size (>5 mm) ( p = 0.03), dilatation of renal pelvis ( p = 0.01), peri-renal fat stranding ( p = 0.02), and positive nitrites on urinalysis ( p < 0.01). Hyperleukocytosis, acute kidney injury, multiple stones, pyuria (>10/mm3), hypertension, and were not associated with the onset of obstructive pyelonephritis. Conclusion: This study showed that known diabetic status, elevated CRP, positive urine nitrites, stone size (>5 mm), pyelic dilatation, and peri-renal fat stranding were associated with the onset of pyelonephritis in patients presenting to the emergency department with obstructive urolithiasis.

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Rhabdomyolysis: An evidence-based approach

Journal of the Intensive Care Society ◽

10.1177/17511437211050782 ◽

2021 ◽

pp. 175114372110507

Author(s):

Sarah Burgess

Keyword(s):

Fluid Overload ◽

Kidney Injury ◽

Community Acquired Pneumonia ◽

Evidence Based ◽

Shortness Of Breath ◽

Past Medical History ◽

Urine Dipstick ◽

The Past ◽

Acting Insulin ◽

History Of

A 76-year-old lady was found on the floor following a fall at home. She was uninjured, but unable to get up, and had been lying on the floor for roughly 18 hours before her son arrived. She had been unwell for the past 3 days with a cough and shortness of breath. She had a past medical history of diabetes, hypertension, hypercholesterolaemia and atrial fibrillation (AF). On examination, she was alert but distressed, clinically dehydrated, febrile and tachycardic. She was treated for community acquired pneumonia with co-amoxiclav and was fluid resuscitated with Hartmann’s solution. Her hyperkalaemia was treated with 50 mL of 50% glucose containing 10 units of rapid-acting insulin. Her creatinine kinase (CK) on admission was 200,000, and she had an acute kidney injury (AKI). Urine dipstick was positive for blood. However, her renal function continued to deteriorate over the succeeding 48 h, when she required renal replacement therapy (RRT) due to fluid overload and anuria.

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