Chapter 140. Infections Due to the HACEK Group and Miscellaneous Gram-Negative Bacteria (Part 2)

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Kingella kingae Because of improved microbiologic methodology, isolation of K. kingae is increasingly common. Inoculation of clinical specimens (e.g., synovial fluid) into aerobic blood culture bottles enhances recovery of this organism. In recent series, K. kingae has been the third most common cause of septic arthritis in children

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Nội dung Text: Chapter 140. Infections Due to the HACEK Group and Miscellaneous Gram-Negative Bacteria (Part 2)

Chapter 140. Infections Due to the HACEK Group and Miscellaneous Gram-Negative Bacteria (Part 2) Kingella kingae Because of improved microbiologic methodology, isolation of K. kingae is increasingly common. Inoculation of clinical specimens (e.g., synovial fluid) into aerobic blood culture bottles enhances recovery of this organism. In recent series, K. kingae has been the third most common cause of septic arthritis in children
cerebrovascular accidents, tricuspid insufficiency, and congestive heart failure with cardiovascular collapse. Endocarditis Caused by HACEK Organisms: Treatment See Table 140-1. Native-valve endocarditis should be treated for 4 weeks with antibiotics, whereas prosthetic-valve endocarditis requires 6 weeks of therapy. The cure rates for HACEK prosthetic-valve endocarditis appear to be high. Unlike prosthetic-valve endocarditis caused by other gram-negative organisms, HACEK endocarditis is often cured with antibiotic treatment alone— i.e., without surgical intervention. Table 140-1 Treatment of Endocarditis Caused by HACEK Group Organismsa Organism Initial Alternative Agents Commen Therapy ts Haemophilus Ceftriaxo Ampicillin/sulbact Ampicill species, ne (2 g/d) am (3 g of ampicillin in ± an Actinobacillus q6h) or aminoglycoside actinomycetemcomita fluoroquinolonesb can be used if
ns the organism does not produce β- lactamase. c Cardiobacteriu Penicillin Ceftriaxone (2 An m hominis (16–18 mU/d in g/d) or aminoglycoside 6 divided doses) ampicillin/sulbactam (3 g (gentamicin, 3 or ampicillin (2 of ampicillin q6h) mg/kg per day g q4h) in 3 divided doses) may be added, but its value has not been proven. The organism is usually pansensitive, but high-level penicillin resistance has
been reported. Eikenella Ampicilli Ceftriaxone (2 The corrodens n (2 g q4h) g/d) or fluoroquinolonesb organism is typically resistant to clindamycin, metronidazole, and aminoglycoside s. Kingella Ceftriaxo Fluoroquinolonesb The kingae ne (2 g/d) or prevalence of ampicillin (3 g β-lactamase- q6h) producing strains is increasing. Efficacy for invasive infections is
best demonstrated for first-line treatments. a Susceptibility testing should be performed in all cases to guide therapy. b Fluoroquinolones are not recommended for treatment of children