title: [Resistance of staphylococci to intracellular killing by macrophages--a new pathophysiologic concept of acute hematogenous osteomyelitis in childhood and its therapeutic consequences].
abstract: The pathophysiologic mechanism of acute hematogenous osteomyelitis in children has been further elucidated. Investigations revealed, that certain strains of staphylococcus aureus, responsible for the majority of infections, can resist intracellular killing after phagocytosis. Beta-lactam-antibiotics don't penetrate well into phagocytes and are unable to eradicate staphylococci surviving intracellularly. Fosfomycin, clindamycin and combinations of these antibiotics with beta-lactam-antibiotics are able to eradicate staphylococci also in phagocytic vacuoles. In a therapeutic investigation 36 patients have been treated with fosfomycin in combination with cefamandole intravenously for 10-14 days followed by clindamycin orally for 3-6 weeks. With this treatment schedule the therapeutic outcome was superior to previously employed therapeutic regimen.
authors.affiliation: Universitäts-Kinderklinik, Innsbruck.
authors.forename: J P
authors.initials: JP
authors.lastname: Guggenbichler
authors.forename: H
authors.initials: H
authors.lastname: Bonatti
authors.forename: F
authors.initials: F
authors.lastname: Rottensteiner
mesh_terms: D002435:Cefamandole / Q000627:therapeutic use; D002648:Child; D002981:Clindamycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005578:Fosfomycin / Q000627:therapeutic use; D006801:Humans; D008264:Macrophages / Q000187:drug effects* / Q000276:immunology; D010019:Osteomyelitis / Q000188:drug therapy* / Q000276:immunology; D010068:Oxacillin / Q000627:therapeutic use; D010587:Phagocytosis / Q000187:drug effects*; D018805:Sepsis / Q000188:drug therapy* / Q000276:immunology; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000276:immunology
chemical_list: D005578:Fosfomycin; D002981:Clindamycin; D002435:Cefamandole; D010068:Oxacillin
vernacular_title: Resistenz der Staphylokokken gegen intrazelluläre Abtötung durch Makrophagen--ein neues pathophysiologisches Konzept der akuten hämatogenen Osteomyelitis im Kindesalter und seine therapeutischen Konsequenzen.