Antimicrobial resistance of Streptococcus pneumoniae isolates in Athens, Greece.

In order to determine the current antibiotic susceptibility of Streptococcus pneumoniae strains in Greece, the present study was performed on 282 clinical isolates collected from patients at the Sotiria Chest Hospital of Athens, Greece, during the years 1997-2003. Susceptibility testing revealed that 52 (18.4%) isolates were not susceptible to penicillin, with 13.1% demonstrating intermediate and 5.3% high-level resistance. One of the penicillin-non-susceptible isolates was also resistant to cefotaxime. Comparison with results of a previous study conducted at the same hospital during the period 1992-1993 showed that penicillin resistance had increased by 4.5%. The results of this study indicate the antimicrobial susceptibility of Streptococcus pneumoniae continues to change in Greece and continuous surveillance remains important for guiding empirical antibiotic therapy.

Accelerated ventricular rhythm in the neonatal period: a review and two new cases in asymptomatic infants with an apparently normal heart.

UNLABELLED: Accelerated ventricular rhythm (AVR) was observed in two newborn infants. In the first case, arrhythmia was noted during the foetal period. Both neonates were asymptomatic and had no evidence of cardiac disease. The arrhythmia eventually disappeared when the infants were 4 mo and 24 d old, respectively. AVR in the neonatal period is reviewed in this report and recent information regarding appropriate diagnostic evaluation, differentiation from ventricular tachycardia and treatment is outlined. CONCLUSION: Accelerated ventricular rhythm is a benign and self-limited arrhythmia in the neonatal period. However, it is important to differentiate it from other serious rhythm disorders, mainly ventricular tachycardia, in order to avoid unnecessary and potentially harmful treatment and to relieve parental anxiety.

Bloodstream infections in patients with solid tumors: associated factors, microbial spectrum and outcome.

BACKGROUND: Although patients with malignant diseases are at increased risk for bloodstream infections (BSIs), limited data are available for those with solid tumors. PATIENTS AND METHODS: The etiology, clinical features and outcome of BSIs were retrospectively studied in patients with solid tumors treated at the Department of Medical Oncology at the University Hospital of Heraklion, Greece, from November 1995 through June 2000. RESULTS: A total of 157 episodes of BSIs was identified among 137 patients over the study period. The majority of the episodes (128; 82%) occurred in non-neutropenic patients. 80 of 157 (51%) of the episodes were healthcare-associated, 35% (55 of 157) were nosocomial and 14% (22 of 157) were community acquired. A single pathogen was isolated in 86% of the episodes. A total of 184 pathogens was isolated (51% gram-negative rods, 44% gram-positive cocci, 3% anaerobes and 3% fungi), while the portal of entry was identified in 104 of 157 (66%) of the episodes. The site of the primary tumor or the metastases were the source of BSI in 39 of 104 (37.5%) of the episodes with an identified source. The overall infectious mortality was 20% and was significantly higher when the initial empirical antibiotic therapy was inappropriate (39%; p < 0.001) and in the presence of shock (63%; p < 0.001). CONCLUSION: BSIs in patients with solid tumors are frequently healthcare associated and in a large percentage the portal of entry can be identified. Neutropenia is not as common as in patients with hematologic malignancies. Inappropriate initial empirical antibiotic therapy and shock are clinical factors associated with worse outcomes.

Congenital rickets due to maternal vitamin D deficiency in a sunny island of Greece.

UNLABELLED: A full-term male infant presented with clinical and biochemical findings consistent with the diagnosis of congenital rickets: weak muscle tone, craniotabes, episodes of tremor, hypocalcaemia, elevated serum alkaline phosphatase, secondary hyperparathyroidism, decreased 25-hydroxyvitamin D and normal 1,25-dihydroxyvitamin D serum levels. The mother's history and biochemical findings suggested nutritional vitamin D deficiency. Treatment with calcium and vitamin D resulted in the disappearance of clinical findings of rickets, normalization of the baby's biochemical profile and normal growth. It is surprising that this case occurred in an affluent setting, in the Mediterranean island of Crete, with an abundance of sunlight throughout the year. CONCLUSION: We report this case in order to emphasize the continuing occurrence of congenital rickets even in populations not considered at risk for hypovitaminosis D. A high index of suspicion is required for prompt diagnosis and treatment, thus preventing complications.

Environmental surveillance of filamentous fungi in three tertiary care hospitals in Greece.

The environmental fungal load (FL) of three hospitals was studied in representative regions in Greece (Thessalonika, Northern Greece, Athens, Central Greece and Heraklion, Southern Greece). Air, surfaces and tap water from high-risk departments were sampled monthly during one year. Air FL was [median (range)] 10.6 (1.2-37), 5.5 (3-28.8) and 7.7 (3.1-12.1) cfu/m(3) at Thessalonika, Athens and Heraklion, respectively. Air FL was lower in winter and higher in summer and autumn but seldom above acceptable levels. Aspergillus spp. constituted 70.5% of the filamentous fungi isolated. Aspergillus niger was the most prevalent species in the air of all the hospitals followed by Aspergillus flavus and Aspergillus fumigatus. The least contaminated departments were the intensive care units, whilst most contaminated were the solid organ transplantation in Athens and haematology departments in Thessalonika. No correlation between fungal species, season, hospital or departments was observed. Sixty per cent of all surfaces examined yielded filamentous fungi and/or blastomycetes. While no fungi were recovered from water in Thessalonika and Athens, one-third of the samples in Heraklion (apart from those of ICU) yielded multiple fungal species. The higher air FL in Thessalonika and Athens was recorded in departments located close to renovation works. These findings suggest that the air and surface FL fluctuates over the year, is due to varying fungal species, but does not differ greatly among hospitals. The variation among hospitals, as well as the role of hospital water fungal contamination and appropriate measures to eliminate it, need further study.

Effects of erythromycin, clarithromycin, roxithromycin and azithromycin on murine gut colonization by Candida albicans.

Male Crl:CD1(ICR) BR mice were fed either chow containing Candida albicans or regular chow. The gastrointestinal tract of the C. albicans-fed mice was permanently colonized by the yeast. Groups of C. albicans-colonized mice were subsequently treated either with a macrolide (erythromycin, clarithromycin, roxithromycin or azithromycin) for 10 days or a normal saline solution (controls). Other controls included non-colonized mice receiving the same antibiotics or a saline solution. Our data are as follows: (i) C. albicans-colonized mice treated with each macrolide had highly significant increase in colony counts of C. albicans in their stools compared to C. albicans-colonized mice treated with saline only; (ii) discontinuation of macrolide treatment showed a trend towards lower colony counts, which was not statistically significant (colony counts were sustained even after discontinuation of antibiotic treatment); (iii) dissemination of C. albicans did not occur; (iv) mice fed regular chow treated with the study drugs or saline did not have any yeasts in their stools. In conclusion, oral erythromycin, clarithromycin, roxithromycin and azithromycin cause a modest increase of the C. albicans concentration of the gastrointestinal tract. This increase is not associated with a higher risk of disseminated candidiasis.

Fatal septicemia and meningitis due to Morganella morganii in a patient with Hodgkin's disease.

A unique case of spontaneous Morganella morganii meningitis in a patient with stage IV Hodgkin's disease, following hematogenous spread from the urinary tract, is described. Late initiation of appropriate antibiotic treatment was probably responsible for the fatal outcome. This case illustrates the pathogenic potential of M. morganii in immunocompromised hosts.

Transient fungemia due to Rhodotorula rubra in a cancer patient: case report and review of the literature.

A unique case of Rhodotorula rubra transient fungemia in a post-chemotherapy, febrile neutropenic patient with colon cancer, suffering from gastrointestinal mucositis, is described. The fungus was isolated repeatedly from his blood. However, all signs and symptoms of the infection disappeared, without antifungal treatment, as soon as neutropenia and mucositis, both of short duration, resolved. Restoration of the patient's defense mechanisms was adequate for disappearance of the fungus from the patient's blood and full recovery.