Time-to-positivity in patients with Escherichia coli bacteraemia.

The time from the start of incubation to a positive reading of blood cultures (time-to-positivity; TTP) is related to the concentration of bacteria in blood. Information concerning the correlation of TTP with clinical parameters, and its usefulness as a prognostic factor in patients with Escherichia coli bacteraemia, is limited. To investigate the relationship of TTP to clinical parameters, 459 cases of monomicrobial E. coli bloodstream infections from a single institution between 1997 and 2005 were reviewed. All cases involved patients who were not undergoing antibiotic treatment at the time of blood sampling. The in-hospital mortality rate was 6.3%. Median TTP was significantly shorter for patients who died than for those who survived (9.7 h, inter-quartile range 7.85-11.05 h vs. 11.2 h, inter-quartile range 10.1-11.4 h; p <0.001). Patients with TTP in the lowest quartile were more likely to be female, to have a non-urinary tract or an unknown origin of bacteraemia, to have severe sepsis or shock, and to subsequently die. In a multivariable Cox regression model, the hazard ratio for death from any cause for patients with a short TTP was 3.13 (95% CI 1.28-7.64; p 0.01). TTP in patients with E. coli bacteraemia provides prognostic information beyond that provided by the presence of haematological illness, a Charlson score > or =3, a non-urinary tract origin of bacteraemia, and the presence of severe sepsis or shock.

Risk factors for bacteremia in patients with limb cellulitis.

The aim of this study was to identify the risk factors for bacteremia in patients with limb cellulitis. Using the administrative and microbiology laboratory databases of a community teaching hospital, a review was conducted of all cases of community-acquired limb cellulitis that occurred during the period 1997-2004 and in which blood cultures had been performed. A comparison of demographical, clinical, and analytical data of patients with bacteremia versus patients without bacteremia was performed by univariate and multivariate analyses. Of 2,678 patients with cellulitis who presented to the hospital's emergency department, 308 were diagnosed with limb cellulitis and had blood cultures. Of these, 57 (18.5%) had bacteremia. In 24 of the 57 (42.1%) patients with bacteremia, the microorganism isolated in blood cultures was non-group-A beta-hemolytic Streptococcus, and in another 14 (24.6%), the microorganism identified was a gram-negative bacterium. Staphylococcus aureus was determined as the cause of bacteremia in just 6 (10.5%) patients and group A Streptococcus in 2 (3.5%). By logistic regression analysis, the following factors were associated with bacteremia: absence of previous antibiotic treatment (OR 5.3, 95% CI 1.4-20.3), presence of two or more comorbid factors simultaneously (OR 4.3, 95% CI 1.6-11.7), length of illness<2 days OR 2.44, 95% CI 1.07-5.56), and proximal limb involvement (OR 6, 95% CI 3.03-12.04). Patients with limb cellulitis who exhibit any of these characteristics are at increased risk of bacteremia. In such patients, it is imperative that blood cultures be performed.

Incidence of neutropenia during treatment of bone-related infections with piperacillin-tazobactam.

Of 41 patients with bone-related infections who were treated for > or =10 days with piperacillin-tazobactam, 14 (34%) developed neutropenia. Cumulative doses of piperacillin administered to neutropenic patients were higher than those administered to nonneutropenic ones (330 vs. 237 g; P=.008), and an inverse correlation was detected between the absolute neutrophil count at the end of treatment and the cumulative dose of piperacillin (r=-0.47, P=.002). Moreover, the incidence of piperacillin-tazobactam-induced neutropenia increased with an increase in the cumulative dose of piperacillin: 0% of patients in the first quartile of cumulative piperacillin doses, 33.3% in the second quartile, 40% in the third quartile, and 66.7% in the fourth quartile.

Acute bacterial arthritis caused by group C streptococci.

OBJECTIVES: To summarize the characteristics of and clinical experience with joint infection by group C streptococcus. METHODS: Two new cases of acute bacterial arthritis due to group C streptococci are reported, and a MEDLINE search was performed, which located 22 additional cases. RESULTS: Mean age (+/- standard deviation) of all 24 patients was 46 +/- 25 years, and most patients were men (75%). The species most frequently identified was Streptococcus equisimilis (12 cases). Eight patients (33%) had a general risk factor for infection, and the same percentage had some type of arthropathy. Only 3 patients had previous contact with animals. The infection was polyarticular in a third of cases, and the joint most frequently involved was the knee. The majority of patients showed a good response to the treatment with intravenous penicillin. However, 3 patients had functional sequelae, 2 more had residual radiological lesions, and 3 died. CONCLUSIONS: Acute bacterial arthritis due to group C streptococci is a serious but uncommon entity that can affect patients without risk factors. Rapid diagnosis and treatment may improve the outcome. Semin Arthritis Rheum 31:43-51.

Use of restriction fragment length polymorphism as a genetic marker for typing Mycobacterium avium strains.

Restriction fragment length polymorphism (RFLP) was used to study 75 clinical isolates identified as Mycobacterium avium. Two repetitive insertion sequences, IS1311 and IS900, were used as DNA probes. Although less than 25% of isolates showed RFLP patterns with IS900, all strains gave banding patterns with IS1311. M. avium strains isolated from patients with AIDS exhibited marked polymorphism with both probes.

Fluconazole in the management of endophthalmitis in disseminated candidosis of heroin addicts.

Seven heroin addicts were treated with fluconazole for endophthalmitis. All the patients had cutaneous lesions: deep-seated scalp nodules and/or pustulosis in hairy zones. One patient had an abscess at the venipuncture site. Candida albicans was isolated from all the extraocular sites in all the patients. Five patients were treated with 400 mg of intravenous fluconazole on the first day, followed by 200 mg (i.v.) for one week and finally 200 mg daily orally for a further two weeks. Two patients were treated exclusively with oral fluconazole (400 mg on the first day, followed by 200 mg daily for three consecutive weeks). Tolerance to fluconazole was good and it was not necessary to stop treatment for any patient. All the cutaneous lesions stabilized and healed. The eye lesions cleared completely in all cases, except in one patient in whom vitrectomy was indicated, and in whom there was a poor response to the exclusive treatment with fluconazole and associated corticosteroids.

[Combined chemotherapy (mebendazole plus praziquantel) in patients with hydatidosis]. / Quimioterapia combinada (mebendazol más prazicuantel) en pacientes con hidatidosis.

In February 1989 we began a combined treatment with mebendazole (3 g/day for 30 days) and praziquantel (1.8 g/day for 15 days) with variable rest periods, in a patients with hydatid disease who had been previously unsuccessful treated only with mebendazole. All the patients were monitored with serological techniques and radiography. Generally the treatment was without side-effects. According to radiography results, there was a reduction in the size of the cyst in 5 patients, in 2 there was no change and 1 patient, the cyst continued to increase in size. Results suggest that the combination of mebendazole more praziquantel could be a pharmacological alternative in the medical treatment of hydatid disease.