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Volume 50, Issue 4
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TAKASHI FUKABORI, KAZUYA MIZOBUCHI, MITSUO NAKAMURA, HIROYUKI TAKIZAWA ...1997 Volume 50 Issue 4 Pages 299-305
Published: April 25, 1997
Released on J-STAGE: May 17, 2013
JOURNAL FREE ACCESSTherapeutic efficacy of the combined regimen, imipenem/cilastatin (IPM/CS) plus vancomycin (VCM), was examined in a total of 13 patients infected with MRSA (10 patients with pneumonia, 2 with sepsis and 1 with urinary tract infection). Based on the results of determination of FIC indices, in vitro combined effects were synergistic in 4 strains and additive in 3 strains.
There was, however, no apparent correlation between the in vitro combined effect in terms of FIC index and clinical outcome. No side effects or abnormal laboratory findings were observed. The average daily doses of IPM/CS and VCM were 1.2g and 1.25g and the average administration periods were 17.5 and 14.9 days, respectively. The present results suggested that simultaneous use of IPM/CS and VCM at the standard doses could yield an enhancement of both bacteriological and clinical efficacies in treatment of the patients with MRSA infection.View full abstractDownload PDF (2299K) -
III. DIFFERENCES IN SUSCEPTIBILITIES FROM PREVIOUS YEARSYOSHIAKI KUMAMOTO, TAIJI TSUKAMOTO, TAKAOKI HIROSE, AKIFUMI YOKOO, YOS ...1997 Volume 50 Issue 4 Pages 306-410
Published: April 25, 1997
Released on J-STAGE: May 17, 2013
JOURNAL FREE ACCESSSusceptibilities to various antimicrobial agents were examined for Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa that were isolated from patients with urinary tract infections (UTIs) in 11 hospitals during June, 1995 through May, 1996, and the results were compared with those obtained during the same period in earlier years.
1. Macrolide resistant E. faecalis isolated from uncomplicated UTIs during the latest study period appeared to have increased compared to those in previous study periods. More than 50% of the isolated E. faecalis during the latest study period were resistant to macrolide antibiotics, for the first time in our history.
2. No obvious changes were observed through the years for susceptibilities of S. aureus to various antimicrobial agents. Vancomycin (VCM) showed the highest activity against S. aureus, with MICs below 2μg/ml or below.
3. Among E. coli strains, those with low susceptibilities to quinolones appeared to have increased over the years with MIC90 changed from between 0.125μg/ml or below and 0.5μg/ml in the 1989-1990 period to between 8μg/ml and 128μg/ml in the latest study period.
4. Klebsiella spp. showed higher resistance to most antimicrobial agents during periods of 1993-1994 and 1994-1995, but somewhat lower resistance during period of 1995-1996. No resistant Klebsiella spp. were detected from uncomplicated UTIs during the latest study period.
5. Among P. aeruginosa isolates from complicated UTIs, resistance isolates to gentamicin appeared to be increasing over the years. Resistant strains to quinolones were isolated at lower frequencies during periods of 1991-1994, but higher frequency was observed in the latest period, and MIC50s were between 0.5 and 4μg/ml during 1991-1994, but were 16-32μg/ml during 1995-1996.
These susceptibility changes should be utilized in determining clinical treatments.View full abstractDownload PDF (7457K) -
TAKASHI FUKUOKA, HARUKI DOMON, MASAYO KAKUTA, CHIKA ISHII, AKIKO HIRAS ...1997 Volume 50 Issue 4 Pages 411-419
Published: April 25, 1997
Released on J-STAGE: May 17, 2013
JOURNAL FREE ACCESSWe investigated the in vitro and in vivo combination effects between panipenem (PAPM) and vancomycin (VCM) on highly methicillin-resistant strains of Staphylococcus aureus (MRSA) isolated from various clinical specimens.
Examination of combination between panipenem and vancomycin using checkerboard titration showed a good effect with mean fractional inhibitory index of 0.32±0.12 on 40 MRSA strains, and the effects were judged as synergistic against 33 strains (83%) and additive against 7 strains (17%). In the combination of PAPM and VCM at 1/4 MIC each against exponentially growing MRSA, bactericidal activity was found when PAPM was added at 1 hour or 2 hours prior to VCM-addition, and PAPM with VCM was added simultaneously, although bactericidal activity was scarcely demonstrated when VCM was added at 1 hour or 2 hours prior to PAPM-addition. Bactericidal activity was enhanced against MRSA in the combination of PAPM and VCM at 1/4 MIC each for MRSA than the bactericidal activity of VCM at 1 MIC alone, and the combination showed a strong bactericidal activity against P. aeruginosa. VCM alone, however, had no bactericidal activity in the in vitro mixed cultures of the two bacteria. Furthermore, the combination of PAPM and VCM induced a marked damage to cell surface and bacteriolysis against MRSA and P. aeruginosa in the mixed cultures, although VCM alone induced only slight morphological alterations. Penicillin-binding proteins (PBPs) including MRSA-specific PBP 2'were decreased greatly in the amounts in MRSA-cells with the increase of VCM-treated concentration. The combination therapy of PAPM and VCM showed a greater efficacy than the therapeutic efficacy of each antibiotic alone against mixed infection in burned mice caused by MRSA and P. aeruginosa, and the activity was judged as synergistic based on the FED index smaller than 0.34.View full abstractDownload PDF (2339K)
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