Blood stream infections after allogeneic stem cell transplantation: a single-center experience with the use of levofloxacin prophylaxis.

Blood stream infections (BSIs) remain one of the major causes of morbidity and mortality for patients receiving an allogeneic hematopoietic stem cell transplantation (HSCT). In the present study, we evaluated the incidence and characteristics of BSI within 1 year after allogeneic HSCT in 269 consecutive adult patients who received antibacterial prophylaxis with levofloxacin. Cumulative incidence of BSI was 12% (95% confidence interval, 8-16%). Bacteria were responsible for 30 out of the 32 BSI, while fungi were responsible for 2 episodes of BSI. The median onset of BSI was day 8 (range 1-328 days) post transplant, and 66% of BSI occurred before neutrophil recovery. Gram-positive organisms accounted for 60% (n=18) of bacteremia, and gram-negative isolates for 40% (n=12) of the cases. Coagulase-negative staphylococci were the most commonly isolated gram-positive pathogens (53% of the cases), while Escherichia coli was the most commonly isolated gram-negative bacteria (58% of the cases). Candida albicans and Candida guillermondii were isolated from patients with candidemia. Resistance to fluoroquinolones (FQ) was common with 13% of gram-positive isolates being susceptible to FQ, while 50% of the gram-negative rods were susceptible to FQ. Crude mortality and mortality attributable to BSI were both 3% (1 of 32). In conclusion, our data suggest that despite the emergence of antibiotic resistance, FQ prophylaxis may be considered an appealing approach in allogeneic HSCT recipients and is also worth evaluating in randomized studies.

In vitro compared activity of telithromycin and azithromycin against northwest Italian isolates of Streptococcus pyogenes and Streptococcus pneumoniae with different erythromycin susceptibility.

AIMS: This study compared the in vitro activity of telithromycin with that of azithromycin against 438 Streptococcus pyogenes and 198 Streptococcus pneumoniae, isolated over the period 2005-2007 from specimens of different human origin obtained in three Piemonte Region's hospitals. METHODS AND RESULTS: The determination of antimicrobial activity was evaluated by the microdilution broth method and the erythromycin-resistant (Ery-R) phenotypes by the triple-disc test. Exactly 78.8% of S. pyogenes and 69.2% of S. pneumoniae were erythromycin-susceptible (Ery-S). Concerning S. pyogenes, telithromycin was active against M and inducible MLS(B), subtype-C, phenotypes but not against constitutive MLS(B) strains. Telithromycin acted well against all S. pneumoniae, irrespective of their mechanism of macrolide-resistance. On the contrary, the Ery-R isolates, both S. pyogenes and S. pneumoniae, were resistant to azithromycin. CONCLUSIONS: Our results indicate that macrolide resistance in streptococci still persist in northwest Italy (21.2% of S. pyogenes and 308% of S. pneumoniae) and that telithromycin is confirmed as being extremely active even against recent clinical Ery-R streptococcal isolates. SIGNIFICANCE AND IMPACT OF THE STUDY: The present study emphasizes that an active surveillance of the phenotype distribution and antibacterial resistance in streptococci is essential in guiding the effective use of empirical treatment option for streptococcal infections, also at regional level.

[Bacterial and fungal colonization in indwelling total laryngectomy phonatory prostheses: identification of microbial agents, treatment protocol and prevention]. / Colonizzazione, batterica e micotica, di protesi fonatorie fisse in pazienti laringectomizzati: identificazione degli agenti microbici, protocollo terapeutico e preventivo.

Today, after the erygmophonic voice, the application of phonatory prostheses is the rehabilitation strategy of choice in patients who had undergone laryngectomy. This is because the surgical procedure is simple and because they are highly successful. The main cause of complications is infection or biofouling. The present study examined the results of cultures taken from phonatory prostheses in 15 laryngectomy patients. The dominating strains of the bacteria and fungi were tested to determine their sensitivity to various pharmacological treatments. By working up and applying a preventive and treatment protocol to reduce prosthetic infections, the average duration of these devices, and thus their functionality, has been increased by approximately 50% bringing it from 6 to 9 months.

[Evaluation of the antibody response and antigenemia in anti-HIV positive subjects with or without candidiasis]. / Valutazione della risposta anticorpale e dell'antigenemia in soggetti anti-HIV positivi con o senza candidosi.

As a diagnostic tool in infectious diseases by CANDIDA species, two different commercial kits have been tested. A LATEX agglutination-test for CANDIDA circulating antigens and an E.L.I.S.A. for detecting specific antibodies. We have examined 107 sets of anti-HIV + subjects (63 with positive culture and 44 negative) against 44 health controls. All controls were negative for circulating antigens, where as 27% resulted positive for specific antibodies. In the group of anti-HIV +, with positive culture for CANDIDA the 45% proved positive for CANDIDA circulating antigens, whereas only the 9.5% resulted negative. The results, shown in the present work, suggests the weight of LATEX test for its diagnostic reliability, its simplicity, while the E.L.I.S.A. for detection of specific antibodies turns out of difficult interpretation in distinguishing between common colonization and infection by CANDIDA species.

[Evaluation of a rapid agglutination method for the identification of Staphylococcus aureus]. / Valutazione di un metodo rapido di agglutinazione per l'identificazione dello Stafilococco aureo.

It has been valued a new quick latex method (Staphaurex Wellcome) for the identification of the aureus Staphylococcus. This shown simultaneously the Clumping Factor (CF) and the A protein; the production of the free Coagulase (CL) and the Thermonuclease (TNase), has been utilized as methods of remarking. On 120 bacterial stocks isolated by many biological materials, belonging to the family of the Micrococcaceae, 56 stocks was identified as aureus. St. and 64 as not aureus St. For what concerns the quick Staphaurex method, it has shown a sensitivity of 83.4, with 8 false negatives on 120 cases, while it proved very satisfactory as specification with one false positive.

[Serologic diagnosis of streptococcal diseases. Ulterior data on the comparison of 2 methods (streptozyme and antistreptolysin O]. / In tema di diagnostica sierologica delle malattie streptococciche. Ulteriori dati sul confronto tra due metodologie (Streptozyme e ASLO).

Increasingly thorough analysis of the antigen structures of Group A beta-haemolytic streptococci has revealed the presence of antigen components with differentiated immune responses in relation to common streptococcal conditions. It is therefore extremely useful in laboratory practice to have a multiple antigen that reveals the immune response to a streptococcal infection so that we can study the serological behaviour of individual streptococcal pictures with their complications and sequelae. Research conducted to date indicates that the streptozyme test can explore the five main streptococcal isoenzymes both for rapid screening and for the quantification of the degree of antibody response. This is confirmed by the results obtained by numerous Authors over the past 15 years, results that demonstrate the high sensitivity of STZ (Streptozyme) at antibody level that single antibody reactions are apparently not capable of revealing. The polyvalent antigen represented by STZ seems to be the best tool for the demonstration of responses to the individual isoenzymes of the very numerous streptococcal strains in circulation (Group A, C and G beta-haemolytics). The possibility of using microtiter techniques for serum assays is also emphasised. These techniques have given repeatable results and are also easy to read.