Stenotrophomonas maltophilia infections: Clinical characteristics in a military trauma population.

Stenotrophomonas maltophilia is a pathogen with unique resistance patterns. We assessed 70 combat casualties with S. maltophilia clinical isolates to examine its role as a nosocomial pathogen in critically-ill trauma patients. Incidence density was 0.36 S. maltophilia infections per 100 patient-days (95% CI: 0.29-0.44). Patients predominantly had blast trauma (97%) and were critically injured (injury severity score [ISS] >25; 80%). Restricting to patients with ISS >15, 50 patients with S. maltophilia infections were compared to 441 patients with infections attributed to other gram-negative bacilli. Patients with S. maltophilia infections had significantly more operating room visits prior to isolation, traumatic or early surgical amputations, longer hospitalization (median 71 vs 47 days), and higher overall mortality (10% vs 2%; P = 0.01). Initial and serial (≥7 days between initial and subsequent isolation) S. maltophilia isolates had high susceptibility to trimethoprim-sulfamethoxazole and minocycline. Evaluation of newer agents awaiting CLSI breakpoints, including moxifloxacin, showed promising results.

Evaluation of extragenital screening for gonorrhea and chlamydia in HIV-infected active duty Air Force members.

This study evaluated the hypothesis that detection of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infections among HIV-infected active duty members of the U.S. Air Force would increase after expanding screening to include extragenital infections. Before and after the start of extragenital screening, urethral screening was positive for GC/CT in 2.9% and 1.9% of HIV-infected service members. Much higher proportions of rectal (11.1%) and pharyngeal (21.9%) specimens were found to be positive for GC or CT after starting extragenital screening. Only 5.9% of the extragenital positive specimens were associated with positive urethra specimens. Circumstances that warrant routine extragenital screening and the potential benefits are discussed.

Delayed-type hypersensitivity and hepatitis B vaccine responses, in vivo markers of cellular and humoral immune function, and the risk of AIDS or death.

BACKGROUND: Delayed-type hypersensitivity (DTH) test responsiveness is associated with HIV disease progression; however it is unknown whether other immune markers, such as hepatitis B virus (HBV) vaccine seroresponse, also predict HIV outcomes. METHODS: Eligible participants received HBV vaccine after HIV diagnosis, had non-anergic DTH testing at the time of last HBV vaccination, and available post-vaccine HBV antibody responses. The risk of progression to AIDS or death from the time of last HBV vaccination was evaluated. RESULTS: Of 369 eligible participants with non-anergic DTH responses, 148 (40%) were HBV vaccine responders. In a multivariate model adjusted for age, CD4 count, viral load, and number of vaccinations, HBV vaccine non-responders had an increased risk of progression to AIDS or death (HR 1.81; 95% CI, 1.03-3.19). CONCLUSIONS: HBV vaccine seroresponses were independent of DTH responses which suggest that non-response to HBV vaccine is not solely due to cell-mediated immune dysfunction in HIV-infected persons.