Treatment and Epidemiology of Third-Generation Cephalosporin-Resistant Urinary Tract Infections.

BACKGROUND AND OBJECTIVES: Limited data are available on the contemporary epidemiology, clinical management, and health care utilization for pediatric urinary tract infection (UTI) due to third-generation cephalosporin-resistant Enterobacterales (G3CR) in the United States. The objective is to describe the epidemiology, antimicrobial treatment and response, and health care utilization associated with G3CR UTI. METHODS: Multisite, matched cohort-control study including children with G3CR UTI versus non-G3CR UTI. UTI was defined as per American Academy of Pediatrics guidelines, and G3CR as resistance to ceftriaxone, cefotaxime, or ceftazidime. We collected data from the acute phase of illness to 6 months thereafter. RESULTS: Among 107 children with G3CR UTI and 206 non-G3CR UTI with documented assessment of response, the proportion with significant improvement on initial therapy was similar (52% vs 57%; odds ratio [OR], 0.81; 95% confidence interval [CI], 0.44-1.50). Patients with G3CR were more frequently hospitalized at presentation (38% vs 17%; OR, 3.03; 95% CI, 1.77-5.19). In the follow-up period, more patients with G3CR had urine cultures (75% vs 53%; OR, 2.61; 95% CI, 1.33-5.24), antimicrobial treatment of any indication (53% vs 29%; OR, 2.82; 95% CI, 1.47-5.39), and subspecialty consultation (23% vs 6%; OR, 4.52; 95% CI, 2.10-10.09). In multivariate analysis, previous systemic antimicrobial therapy remained a significant risk factor for G3CR UTI (adjusted OR, 1.91; 95% CI, 1.06-3.44). CONCLUSIONS: We did not observe a significant difference in response to therapy between G3CR and susceptible UTI, but subsequent health care utilization was significantly increased.

Being ready to treat Ebola virus disease patients.

As the outbreak of Ebola virus disease (EVD) in West Africa continues, clinical preparedness is needed in countries at risk for EVD (e.g., United States) and more fully equipped and supported clinical teams in those countries with epidemic spread of EVD in Africa. Clinical staff must approach the patient with a very deliberate focus on providing effective care while assuring personal safety. To do this, both individual health care providers and health systems must improve EVD care. Although formal guidance toward these goals exists from the World Health Organization, Medecin Sans Frontières, the Centers for Disease Control and Prevention, and other groups, some of the most critical lessons come from personal experience. In this narrative, clinicians deployed by the World Health Organization into a wide range of clinical settings in West Africa distill key, practical considerations for working safely and effectively with patients with EVD.

Atypical imaging appearance of toxoplasmosis in an HIV patient as a butterfly lesion.

In acquired immunodeficiency syndrome (AIDS) patients, differentiating toxoplasmosis and primary central nervous system (CNS) lymphoma remains a clinical and radiographic dilemma. The presence of butterfly lesions crossing the corpus callosum is customarily used to exclude the possibility of toxoplasmosis. We present an AIDS patient who had Epstein-Barr virus (EBV) polymerase chain reaction (PCR) -positive cerebrospinal fluid studies with a butterfly toxoplasmosis lesion confirmed by multiple methods signifying the importance of including toxoplasmosis in the differential diagnosis of butterfly lesions.

Salmonella spondylodiscitis associated with a mycotic abdominal aortic aneurysm and paravertebral abscess.

Each year, 1.4 million people in the United States are infected with Salmonella (Beneson et al. [23] Am J Med, 110:60-63, 2001). The most common clinical presentation of Salmonella infection is gastroenteritis which is usually self-limited, lasting between one to four days (Black et al. [24] N Engl J Med, 261:811-816, 1960). Although most infections are mild-to-moderate, serious disease, and death does occur (Voetsch et al. [25] CID, 38:S127-S132, 2004). A rare but increasing number of patients present with Salmonellosis spondylodiscitis resulting from contiguous spread of infection from the adjacent abdominal aorta. Concurrent infection of these structures exacerbates morbidity, necessitating an elevated clinical suspicion in patients with appropriate risk factors, clinical signs and symptoms. Furthermore, an overall mortality rate of 67% makes mycotic abdominal aortic aneurysms highly lethal (Gonda et al. [26] Radiology, 168:343-346, 1988). Thus, early diagnosis is crucial, allowing for prompt antibiotic and surgical management. Laboratory and imaging tests obtained at the initial suspicion for infection of the spine and aorta facilitates diagnosis while minimizing or preventing more serious complications like paresis and aortic rupture. We present a patient with a mycotic abdominal aortic aneurysm infected with Salmonella enteritides that spread to the adjacent lumbar vertebra and left psoas muscle.