Loma Linda University

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Michael Ing, MD
Associate Professor, Medicine
School of Medicine
Publications    Scholarly Journals--Published
  • Goetz MB, Morreale AP, Rhew DC, Berman S, Ing M, Eldridge D, Justis JC, and Lott E. "Effectiveness of Highly Active Antiretroviral Therapy on Outcomes ." AIDS 15.4 (2001): 530-532. ( 1/2001 ) Link...
  • Kedlaya I, Ing MB, Wong SS. "Rhodococcus equi Infections in Immunocompetent Hosts: Case Report and Review." Clinical Infectious Diseases 32.3 (2001): e39-e47. ( 1/2001 )
    Rhodococcus equi is an unusual cause of infection in humans. Infection in immunocompetent patients is extremely rare-only 19 cases in immunocompetent hosts have been reported. Localized infections represent nearly 50% of reported cases. Pulmonary infections account for only 42% of infections in immunocompetent hosts, compared with 84% of infections in immunocompromised hosts. The mortality rate among immunocompetent patients is approximately 11%, compared with rates of 50%-55% among human immunodeficiency virus (HIV)-infected patients and 20%-25% among non-HIV-infected immunocompromised patients. Treatment of infections in immunocompetent hosts depends on the site of infection. Serious infections need to be treated with combinations of parenteral antibiotics, followed by combinations of oral antibiotics. Surgical treatment is necessary for certain types of local infections. We report a pulmonary infection due to R. equi in an immunocompetent patient, and we review all reported cases of R. equi infection in immunocompetent hosts. [References: 30]
  • Ing MB, Schantz PM, Turner JA. "Human Coenurosis in North America: Case Reports and Review." Clinical Infectious Diseases 27.3 (1998): 519-523. ( 1/1998 )
    Coenurosis is a zoonotic disease of humans caused by the larval stage of Taenia (Multiceps) species. In North America, the adult tapeworm of Taenia (Multiceps) serialis is found in canids. The cystic larval forms (coenuri) are found in hares, rabbits, squirrels, and, rarely, in humans. We review in clinical detail the fifth case reported from North America, involving a child with extensive central nervous system involvement. We also report a sixth case, involving an adult with an intramuscular coenurus. The latter case was diagnosed by needle aspiration of the cyst. Although praziquantel administration may have been effective in killing the parasite in both patients, we are concerned about the production of marked inflammation as a result of treatment. The four other North American cases are reviewed, and the epidemiology of the infection in animals is discussed. [References: 26]
  • Bayer AS, Li C, Ing M. "Efficacy of Trovafloxacin, A New Quinolone Antibiotic, in Experimental Staphylococcal Endocarditis due to Oxacillin-Resistant Strains." Antimicrobial Agents and Chemotherapy 42.7 (1998): 1837-1841. ( 1/1998 )
    Therapeutic options for severe infections caused by strains of oxacillin-resistant Staphylococcus aureus (ORSA) and coagulase-negative staphylococci (ORSE) are very limited. With the increasing resistance of such strains to aminoglycosides, rifampin, and currently available quinolone agents, as well as the recent documentation of increasing resistance of ORSA to vancomycin (VANCO), new treatment alternatives are imperative. The in vivo efficacy of trovafloxacin (TROVA), a new quinolone agent with excellent antistaphylococcal activity in vitro, against experimental endocarditis (IE) due to beta-lactamase-producing ORSA and ORSE strains (ORSA and ORSE IE) was evaluated. TROVA (25 mg/kg of body weight intravenously [i.v.] twice daily [b.i.d]) was compared to VANCO (20 mg/kg i.v. b.i.d.) and two regimens of ampicillin-sulbactam (AMP-SUL; 200 mg/kg intramuscularly [i.m.] three times a day [t.i.d.] and 20 mg/kg i.m. b.i.d.), with all agents given for 3 or 6 days. AMP-SUL was included as a comparative treatment regimen because of its proven efficacy against experimental ORSA and ORSE IE. For both ORSA and ORSE IE, TROVA, AMP-SUL, and VANCO each reduced staphylococcal densities in vegetations compared to untreated controls (P < 0.01). For ORSA IE, TROVA was the most rapidly bactericidal agent--although not to a statistically significant degree--correlating with its superior bactericidal effect in vitro compared to those of VANCO and AMP-SUL.
  • Ramos MC, Ing M, Kim E, Witt MD, Bayer AS. "Ampicillin-Sulbactam is Effective in Prevention and Therapy of Experimental Endocarditis Caused by Beta-Lactamase-Producing Coagulase-Negative Staphylococci." Antimicrobial Agents and Chemotherapy 40.1 (1996): 97-101. ( 1/1996 )
    Optimal strategies for the prophylaxis and therapy of endocarditis caused by oxacillin-resistant, coagulase-negative staphylococci in patients with native or prosthetic valvular heart disease are not well defined. We compared the in vivo efficacies of ampicillin-sulbactam-based regimens with those of vancomycin-based oxacillin-resistant, beta-lactamase-producing coagulase-negative staphylococcal isolate (Staphylococcus haemolyticus SE220). Ampicillin-sulbactam (100 and 20 mg/kg of body weight, respectively, given intramuscularly in a two-dose regimen) was equivalent to vancomycin (30 mg/kg given intravenously in a two-dose regimen) in its prophylactic efficacy against the coagulase-negative staphylococcal strain (93 and 80%, respectively). The combination of ampicillin-sulbactam plus either rifampin or vancomycin did not enhance the prophylactic efficacy compared with that of ampicillin-sulbactam or vancomycin alone. In the therapy of established aortic valve endocarditis in rabbits caused by this same coagulase-negative staphylococcal strain, animals received 7-day ampicillin-sulbactam-based or vancomycin-based regimens with or without rifampin. All treatment regimens were effective at lowering intravegetation coagulase-negative staphylococcal densities and rendering vegetations culture negative compared with the coagulase-negative staphylococcal densities and vegetations of untreated controls, with ampicillin-sulbactam in combination with rifampin or vancomycin being the most active regimen. However, only the regimen of ampicillin-sulbactam in combination with vancomycin effectively prevented relapse of endocarditis posttherapy after a 5-day antibiotic-free period. For animals receiving rifampin-containing regimens, relapses of endocarditis were associated with the in vivo development of rifampin resistance among coagulase-negative staphylococcal isolates in the vegetation. Ampicillin-sulbactam was highly effective in the prevention of experimental endocarditis caused by a beta-lactamase-producing, oxacillin-resistant coagulase-negative staphylococcal strain. Ampicillin-sulbactam was also efficacious for the therapy of coagulase-negative staphylococcal endocarditis, especially when it was combined with vancomycin to prevent posttherapeutic relapses.
  Books and Chapters
  • Ing MB, Baddour LM, Bayer AS. Bacteremia and Infective Endocarditis: Pathogenesis, Diagnosis, and Complications. In Archer GL, Crossley KB (eds). The Staphylococci in Human Disease. New York: Churchill Livingstone, 1997. 331 - 354 ( 1/1997 )