Daptomycin versus teicoplanin in the treatment of osteomyelitis: Results of the Göztepe retrospective cohort study.

OBJECTIVES: Daptomycin is highly effective against Gram-positive multidrug-resistant bacteria. Publications on daptomycin in osteomyelitis treatment are limited. PATIENTS AND METHODS: In this multicenter retrospective cohort study, the aim was to evaluate the outcomes of osteomyelitis cases having received daptomycin or teicoplanin. This multicenter retrospective cohort study gathered data from seven centers located in five cities of Turkey. Study inclusion criteria were as follows: (a) magnetic resonance imaging and/or direct X-ray revealed osteomyelitis or biopsy pathologic examination results concomitant with osteomyelitis. Chi-squareand Student t-tests were used for statistical comparison. RESULTS: A total of 72 patients, 38 cases in the daptomycin group and 34 cases in the teicoplanin group diagnosed with osteomyelitis fulfilling the study inclusion criteria, were included in the study. Clinical success at the end of induction therapy was achieved in 32/38 cases in the daptomycin cohort vs. 30/34 cases in the teicoplanin cohort (p: 0.73). CONCLUSION: Although this is a limited experience in a small but well-defined cohort, our data suggest that daptomycin may be a safe alternative to glycopeptides in osteomyelitis treatment. A randomized controlled clinical study involving larger cohorts may increase the available evidence.

Colistin and tigecycline susceptibility among multidrug-resistant Acinetobacter baumannii isolated from ventilator-associated pneumonia.

Multidrug-resistant (MDR) Acinetobacter baumannii is one of the most important pathogens in intensive care units related to morbidity and mortality, especially in ventilator-associated pneumonia (VAP). In this study, 80.5% of isolates were MDR. The antimicrobial susceptibilities for 12 different antibiotics of MDR A. baumannii isolated from VAP were tested. Among the MDR A. baumannii isolates, resistance rates were found to be 95.5%, 72.7%, 80.3%, 71.2% and 68.2% for ciprofloxacin, cefepime, imipenem, meropenem and cefoperazone/sulbactam, respectively. Netilmicin resistance was detected in 30.3% of the isolates. Resistance rates for colistin and tigecycline were 0% and 25.8%, respectively. It is obvious that new alternative drugs are needed for the treatment of MDR A. baumannii-related VAP owing to high resistance to carbapenems, quinolones, aminoglycosides and cefoperazone/sulbactam. Although colistin appears to be a good choice, adverse reactions and unavailability of colistin limit its wide usage in Turkey. Tigecycline, which will shortly be introduced commercially in Turkey, is very effective against MDR A. baumannii isolates and shows promising results to solve the problem, however resistance rates should be monitored closely.

Saccharomyces cerevisiae fungemia after probiotic treatment in an intensive care unit patient.

Saccharomyces cerevisiae is a common colonizer of the human gastrointestinal system as a benign organism. Enteral supplementation of this yeast as a probiotic product is effective in the treatment of antibiotic associated diarrhae. In rare occasions it can cause invasive infections. We present two fungemia cases in an intensive care unit following probiotic treatment containing S. boulardii. We are warning the safety of probiotic treatment in critically ill patients.

In vitro activity of tigecycline, tetracycline and fluoroquinolones against Brucella melitensis.

Brucellosis is a major zoonotic disease of global importance. Forty years after active drug therapy was defined, there is no optimum antibiotic therapy for brucellosis due to relatively high rates of relapse and treatment failure. The aim of this study was to assess the in vitro susceptibility of 60 Brucella melitensis isolates obtained from blood and fluids to tigecycline, tetracycline and three quinolones (ciprofloxacin, levofloxacin, moxifloxacin). The minimum inhibitory concentrations (MICs) of these antibiotics were determined by E-test method. According to the MIC90, levofloxacin (MIC90 0.094 microg/mL) was found to be the most active agent, followed by tigecycline (MIC90 0.125 microg/mL), moxifloxacin (MIC90 0.125 microg/mL), ciprofloxacin (MIC 90 0.19 microg/mL) and tetracycline (MIC90 0.25 microg/mL). The results suggest that tigecycline can be a therapeutic alternative option for the treatment of brucellosis.

Burkholderia cepacia as a cause of ecthyma gangrenosum-like lesion.

Ecthyma gangrenosum (EG) is considered to be a pathognomonic sign of Pseudomonas aeruginosa septicemia and is predominantly seen in immunosuppressed patients. Although P. aeruginosa is the most recognized pathogen of EG, numerous other organisms have been reported to cause clinically identical lesions. We report a case of an EG-like eruption caused by Burkholderia cepacia, in an intensive care unit patient with multiple myeloma.

Age and duration of disease as factors affecting clinical findings and sacroiliitis in brucellosis.

OBJECTIVE: Brucellosis may be seen in any age group, but it still involves young and middle aged adults more frequently. Our aim was to investigate the relationship between age and the duration of disease on clinical findings of brucellosis in adults in this study. PATIENTS AND METHOD: One hundred and sixty-three patients with brucellosis, treated in our hospital, between 1997 and 2003, were evaluated retrospectively. RESULTS: Fever was found in 60.7% of the patients, and it was significantly higher when the duration of disease was less than one month (p = 0.03). Fever was significantly lower in the > or = 65 age group (p = 0.01). Sacroiliitis was detected in 44.1% of patients. Sacroiliitis was significantly higher in the 15-35 age group (p = 0.03). There were no differences between age groups and other clinical and laboratory findings. CONCLUSIONS: Sacroiliac involvement was noted particularly in young adults who manifested lumbar pain and fever, but this might not be a major symptom of brucellosis in the elderly, or in patients showing symptoms for more than a month.

The effect of osmotic pressure and salinity of the medium on the growth and sporulation of Aspergillus niger and Paecilomyces lilacinum species.

The effect of osmotic pressure and salinity on the production of conidia and growth of Aspergillus niger and Paecilomyces lilacinum, isolated from the soil, have been studied in this investigation. The maximum production of conidia in both species was observed in the nutrient medium containing 1% NaCl wheras maximum growth was recorded in the nutrient medium containing 3% NaCl. It has been thus observed that the salinity and the osmotic pressure related to it effect the reproductive as well as the vegetative development of both species, and these effects have been observed to be different. The sensitivity of both fungal species to the salt was also investigated. Conidia were not observed in the P. lilacinum species grown in nutrient medium with 5% NaCl whereas conidial development did take place in the case of Aspergillus niger grown in the nutrient medium containing 5% NaCl.