Impact of implementing respiratory point-of-care testing in a regional haemato-oncology unit.

Respiratory point-of-care testing (POCT) for the detection of influenza A, influenza B and respiratory syncytial virus (RSV) was implemented in response to recent RSV outbreaks at a regional haemato-oncology unit in Glasgow. This descriptive study, undertaken pre- and post-POCT implementation, suggests that POCT reduces the time taken to receive results and increases diagnostic rates in outpatients. It is likely that the reduction in turnaround time afforded by POCT also leads to a faster time to antiviral treatment, prompt isolation and a reduction in the number of hospital-acquired infections.

[New Beta-lactam agent in the treatment of intra-abdominal sepsis: double blind and randomized stage III study of ertapenem versus piperacillin/tazobactam]. / Nuevo agents betalactámico en el manejo de la sepsis intra-abdominal: estudio de fase III, doble ciego y randomizado del ertapenem vs piperacilina/tazobactam.

The clinical and safety efficacy of a new wide spectrum beta-lactam agent for most pathogen intra-abdominal infection germs is evaluated herein. Its chemical name is Ertapenem (MK-0826). Its pharmacokinetic characteristics and the known antibacterial spectrum enable the potential use of one daily dose in the treatment of infections by aerobic and anaerobic bacteria. This is a sub-group of patients that have been treated within a multinational, prospective, randomized, controlled and double-blind study, to compare the safety and efficacy of ertapenem (100% vs 88%) with piperacillin/tazobactam in patients that have undergone surgery due to complicated intra-abdominal infection, from April 1998 to October 1999, pursuant to the IDSA/FDA standards. Twenty local patients were evaluated from a total of 623 patients in 17 countries. Acute perforated appendicitis was the most frequent pathology in both groups. The recovery ratio was slightly higher in the group, which was administered ertapenem, with no documented clinical failure. This study shows the efficacy of ertapenem in the treatment of intra-abdominal infections using a single 1-gr/day dose, equivalent to 3.375 gr of piperacillin/tazobactam every six hours. Tolerance and safety were similar in both groups. No side effects, or mortality cases were registered. The results of this study indicate that ertapenem might be the therapeutic option to discard the combination of antibiotics or the use of multiple doses in intra-abdominal infections.

Nuevo agente betalactámico en el manejo de la sepsis intra-abdominal: Estudio de fase III, doble ciego y randomizado del Ertapenem vs. Piperacilina/Tazobactam / New beta-lactam agent in the treatment of intra-abdominal sepsis: double blind and randomized stage III study of Ertapenem versus Piperacillin/Tazobactam

Se evalúa la eficacia clínica y de seguridad de un nuevo agente betalactámico de amplio espectro de nombre químico ertapenem (MK-0826) para la mayoría de gérmenes patógenos de infección intra-abdominal. Sus características farmacocinéticas y el espectro antimicrobiano conocido permite el uso potencial de dosis única diaria en el tratamiento de infecciones bacterianas aeróbicas y anaeróbicas. Este es un sub grupo de pacientes tratados en un estudio multinacional, prospectivo, randomizado, controlado y doble ciego para comparar la seguridad y eficacia del ertapenem con la piperacilina/tazobactam en pacientes operados por infección intraabdominal complicada de abril de 1998 a octubre de 1999, de acuerdo con las normas de la IDSA/FDA. 20 pacientes nacionales fueron evaluados de un total de 623 pacientes en 17 países. La apendicitis aguda perforada fue la patología más frecuente en ambos grupos. El índice de curación fue discretamente mayor en el grupo del ertapenem (100 por ciento vs 88 por ciento), sin haberse documentado ninguna falla clínica. El presente estudio nos muestra la eficacia del ertapenem, en dosis única de 1 gr/día, siendo equivalente a la piperacilina/tazobactam de 3.375 gr cada seis horas en el manejo de las infecciones intra-abdominales. La tolerancia y seguridad fueron similares en ambos grupos. No se presentaron efectos secundarios, ni hubo mortalidad. Los resultados de esta investigación indican que el ertapenem puede ser la opción terapeútica que permita descartar la necesidad de combinar antibióticos o el uso de multidosis en la sinfecciones intra-abdominales.

Clostridium innocuum bacteremia secondary to infected hematoma with gas formation in a kidney transplant recipient.

Clostridium innocuum is a relatively antimicrobial resistant, frequently misidentified anaerobe that has only rarely been associated with bacteremia. A 38-year-old female with chronic hepatitis C underwent a second kidney transplant operation. Two weeks after surgery a computed tomography scan of the abdomen showed a heterogeneous hematoma with pockets of gas adjacent to the allograft, which extended into the pelvis and left abdominal wall, associated with low-grade fever. An anaerobic blood culture grew a Clostridium initially identified as C. subterminale and later re-identified as C. innocuum. At abdominal exploration liquefied blood was evacuated, and the patient completed a course of antibiotics and recovered. C. innocuum should be considered as a cause of gas-producing anaerobic infection in transplant patients. Because C. innocuum is frequently misidentified by the use of commercial anaerobic identification kits, its true incidence in serious infections is likely underestimated.

Bilophila wadsworthia clinical isolates compared by polymerase chain reaction fingerprinting.

Bilophila wadsworthia isolates recovered from a right-ear cholesteatoma and brain abscess of the same patient were analyzed by means of polymerase chain reaction (PCR) fingerprinting with single primers (T3B and M13 core) to ascertain if they originated from the same clone. Their PCR fingerprint profiles were compared with those of three additional B. wadsworthia clinical isolates and the type strain (ATCC 49260). The two isolates from the same patient produced PCR fingerprint profiles identical to each other, regardless of which primer was used. All isolates' PCR fingerprint profiles, with use of either the T3B or M13 core primer, shared some major and minor bands. However, differences in additional major and minor bands distinguished each of the additional isolates, suggesting that there are different subgroups of B. wadsworthia.

Fatal sepsis due to a beta-lactamase-producing strain of Fusobacterium nucleatum subspecies polymorphum.

A patient with Waldenström's macroglobulinemia was treated empirically with imipenem for sepsis related to oropharyngeal infection and responded within 24 hours. When blood cultures yielded Streptococcus agalactiae, the regimen was changed to ampicillin and gentamicin. The patient's condition rapidly deteriorated, and she died 3 days later. After her death, a strain of Fusobacterium nucleatum subspecies polymorphum producing beta-lactamase (PEN-Y; group 2a) was isolated from blood cultures. A literature review revealed increasingly frequent isolation of beta-lactamase-producing strains of F. nucleatum. Thus strains of F. nucleatum isolated from blood and other specimens from patients with serious infections should be tested for beta-lactamase production.

Localized Mycobacterium avium-intracellulare mastitis in an immunocompetent woman with silicone breast implants.

While M. avium-intracellulare has received increasing recognition due to its association with AIDS, silicone breast implants have come under increased FDA scrutiny, requiring new safety and efficacy protocols. We report a case of localized M. avium-intracellulare mastitis associated with a breast implant in an immunocompetent, HIV-negative woman who was cured with implant removal and a long course (6 months) of clarithromycin. Serous exudates occurring in association with breast implants should be cultured for acid-fast organisms. Clarithromycin may be a therapeutic adjunct to effectively cure these infections.

Babesiosis: problems in diagnosis using autoanalyzers.

A 76-year-old white man previous diagnosed as having Waldenstrom's macroglobulinemia continued with persistent fevers and sweats for two and a half years. Recently, repeated automated differentials during 11 days of hospitalization failed to note any intracellular inclusions in the RBCs. Blood sent to the Microbiology Laboratory was noted to contain Babesia species. A review of the hematology slides revealed that Babesia species was present on all the slides the analyzer had screened. This failure to note infected RBCs may pose serious diagnostic problems.

Contrast enhancement of spontaneous animal CNS tumors with gadolinium DTPA: a correlation of MRI with x-ray CT.

A visual comparison was made between both pre-contrast and post-contrast x-ray computerized tomographic images (X-CT) and magnetic resonance tomographic images (MRI) of spontaneous CNS tumors in three animals. The contrast agents, HypaqueR-76 (X-CT) and Gadolinium DTPA (MRI), were administered as an intravenous bolus injection. The parameters for comparison of pre- and post-contrast features included: lesion discrimination, demarcation, and intensity and pattern of enhancement. Necropsy specimens were included to correlate the anatomic fidelity of scan appearances for each modality and to establish a final diagnosis. There was good visual correlation of the lesion site with both X-CT and MRI. The intensity of lesion enhancement with the contrast reagents was similar for each modality but there were subtle differences in the pattern of enhancement. Overall, MRI in conjunction with the contrast agent Gadolinium DTPA, was as good or better at delineating the presence and extent of CNS tumors than contrast enhanced X-CT. Contrast agents may be necessary to provide increased lesion detectability and delineation when imaging with magnetic resonance.

Cavitary Legionnaires' pneumonia: nosocomial infection in renal transplant recipients.

Cavitation is an unusual manifestation of legionnaires' pneumonia. Mortality rates range from 24 to 58 percent with effective therapy. Antibiotic therapy is not standardized and is largely based on anecdotal reports. This report has described nosocomially acquired cavitary legionnaires' pneumonia in five renal transplant recipients. The diagnosis was made by seroconversion and immunofluorescent staining of lung tissue or transtracheal aspirates. Frequently seen associated symptoms were not present. All patients were successfully treated with 2 to 4 g of erythromycin for at least 4 weeks.

Eikenella corrodens in hand infections.

Clinical and therapeutic information on 21 patients with hand infection due to Eikenella corrodens is reported. Patients given empiric therapy ineffective against E. corrodens had a high incidence of complications, while proper empiric therapy was associated with good recovery. All hand wounds should be cultured aerobically and anaerobically and empiric antibiotic therapy should include a penicillinase-resistant penicillin or cephalosporin in combination with penicillin G.

Prevalence of Eikenella corrodens in dental plaque.

The prevalence of Eikenella corrodens in dental plaque and saliva samples of 282 volunteers was determined by a semiquantitative method with a selective medium. E. corrodens was recovered in 58.9% of plaque samples and 0.3% of saliva samples. This prevalence rate was not significantly altered (P greater than 0.05) by variables of sex, race, smoking habits, clinic attended by the patient, general health status, or age; however, patients 7 to 14 years old had a significantly higher prevalence rate (90.5%; P less than 0.05). E. corrodens should be considered as a potential pathogen in infections associated with and wounds inoculated by the human gingival flora.

North American blastomycosis in an immunosuppressed patient.

A 49-year-old man with sarcoidosis presented with a large nonhealing verrucous and eroded lesion (of two years' duration) over the left flank. Biopsy of the lesion revealed granulomatous infiltration, and special fungal stains showed the typical broad-necked budding structure of Bastomyces dermatitidis. The patient underwent en masse surgical removal of the lesion followed by systemic administration of amphotericin B. This report emphasizes the need for skin biopsy for nonhealing ulcers of unknown etiology, reviews the natural history of North American blastomycosis, and speculates on its relationship to immunosuppression.

Infections caused by Actinomyces viscosus.

Two cases of Actinomyces viscosus infection of the lungs were seen in nonimmunosuppressed patients. One patient had a peripheral actinomycotic lung mass resembling a tumor. Both patients responded to a long course of penicillin therapy. Reports of A. viscosus infections are rare, although the organism colonizes the mouths of most adult humans. Only ten cases have previously been described. There is no characteristic of A. viscosus infection that can distinguish it from Actinomyces israelii or Actinomyces bovis infections. The illness usually manifests as a chronic disease weeks to months before the diagnosis, which can only be made by identification of the organism from a clinical specimen uncontaminated by sputum or mouth flora. Ignorance of the biochemical reactions and growth characteristics of this organism have in the past hindered its isolation and identification. At least three weeks of antibiotic therapy using agents to which A. viscosus is sensitive in vitro are required for cure.

Isolation of Eikenella corrodens from pulmonary infections.

Eikenella corrodens is a capnophilic gram-negative rod that is part of the normal human oral flora. We report the isolation of E. corrodens by transtracheal aspiration or percutaneous aspiration from 7 patients with pneumonia and/or lung abscess. Four of the 7 patients had an associated carcinoma of the lung. The susceptibilities of strains were tested to penicillin, dicloxacillin, clindamycin, and 10 cephalosporins. All strains were very susceptible to penicillin and cefoxitin and resistant to dicloxacillin and clindamycin. Susceptibilities of strains to the cephalosporins were variable. E. corrodens has been increasingly identified as a pathogen and should be recognized as an etiologic agent of pneumonia, especially in cases not responding to therapy with a penicillinase-resistant penicillin, clindamycin, or cephalosporin.

Infections following clenched-fist injury: a new perspective.

Fifteen cases of clenched-fist injury were studied by aerobic, anaerobic, and 10% CO2 cultures. Anaerobic bacteria and Eikenella corrodens were prominent pathogens, being recovered in 60% and 20% of cases, respectively. These organisms are more susceptible to penicillin than to penicillinase-resistant penicillins or cephalosporins. All clenched-fist injuries should be cultured in aerobic, anaerobic, and 10% CO2 atmospheres. We recommend the use of both penicillin and a penicillinase-resistant penicillin as initial empiric therapy.