Gentamicin in neonates at risk for sepsis - peak serum concentrations are not necessary.

BACKGROUND: Serum gentamicin concentrations (GSCs) are frequently obtained before and after gentamicin administration to newborns with, or at high risk for, sepsis. OBJECTIVE: To determine whether performing a peak GSC assay when the trough GSC is within the guidelines for care would add clinically relevant information for health care workers. METHODS: A retrospective review of the IWK Health Centre (Halifax, Nova Scotia) laboratory database for peak and trough GSC for infants <28 days after birth was performed. RESULTS: Of 5253 paired samples of trough and peak GSCs, 3001 (57%) had trough GSCs ≤2 µg/mL. Of these, only nine (0.3%) had a peak GSC >10 µg/mL. CONCLUSIONS: Performing a peak GSC measurement does not provide further clinically important data and increases patient morbidity and hospital costs.

HISTORIQUE: On vérifie souvent les concentrations de gentamicine sérique avant et après l'administration de gentamicine aux nouveau-nés présentant une septicémie ou qui y sont très vulnérables. OBJECTIF: Déterminer si l'obtention de la valeur de pointe de la concentration de gentamicine sérique (CGS) lorsque la valeur seuil respecte les lignes directrices de soins ajoute de l'information pertinente sur le plan clinique pour les travailleurs de la santé. MÉTHODOLOGIE: Analyse rétrospective de la base de données du laboratoire de l'IWK Health Centre à l'égard des valeurs de pointe et des valeurs seuils du CGS obtenues chez des bébés de moins de 28 jours de vie. RÉSULTATS: Des 5 253 échantillons appariés, 3 001 (57 %) avaient une valeur seuil de la CGS égale ou inférieure à 2 µg/mL. De ce nombre, seulement neuf (0,3 %) avaient une valeur de pointe de la CGS supérieure à 10 µg/mL. CONCLUSIONS: L'obtention de la valeur de pointe de la CGS ne fournit pas de nouvelles données importantes sur le plan clinique, sans compter qu'elle accroît la morbidité des patients et les coûts pour l'hôpital.

Does sporadic Listeria gastroenteritis exist? A 2-year population-based survey in Nova Scotia, Canada.

BACKGROUND: Febrile gastroenteritis due to Listeria monocytogenes (LM) has been primarily described in foodborne outbreaks. We decided to determine the incidence of sporadic, febrile gastroenteritis due to LM in a large, well-defined North American population over a 2-year period and to compare these cases to sporadic cases of Campylobacter and Salmonella infections occurring concurrently in the community. METHODS: From 1 September 2002 through 31 August 2004, all stool specimens submitted for evaluation of diarrheal illness to a public health laboratory and to a children's hospital serving a population of approximately 350,000 were examined for the presence of Listeria species. Patients identified as having LM in their stool samples were matched with 2 temporally-matched patients with cultures positive for Campylobacter and Salmonella species. Patients with LM and control patients were contacted by telephone, and they answered a questionnaire that examined clinical features and risk factors for diarrheal illness. RESULTS: A total of 7775 stool specimens were submitted during the period 1 September 2002-31 August 2004. Thirty-nine Listeria species were recovered. Seventeen of the species were LM, 13 were Listeria innocua, 3 were Listeria welshimeri, 1 was Listeria grayi, and 4 were other species. Pulsed-field gel electrophoresis results demonstrated no temporal or other clusters, and no seasonality was noted for isolates of LM. Preexisting gastrointestinal problems were much more common in patients with LM (P=.001) than in patients with Campylobacter or Salmonella infections. CONCLUSIONS: Sporadic gastroenteritis due to LM appears to be an uncommon illness, and routine screening of stool samples for LM remains unwarranted. Preexisting gastrointestinal disease may be a risk factor for infection of the gastrointestinal tract with LM.

Francisella philomiragia adenitis and pulmonary nodules in a child with chronic granulomatous disease.

Francisella philomiragia is a rare and opportunistic pathogen capable of producing invasive infection in patients with compromised neutrophil function and in patients that have survived a near-drowning. A case of F philomiragia adenitis and lung nodules, refractory to cephalosporin therapy, is reported in a 10-year-old boy with chronic granulomatous disease following a facial abrasion from a saltwater crab. To the authors' knowledge, this is the first Canadian clinical isolate to be reported. Genus and species identification was confirmed via 16S ribosomal RNA sequence analysis. A literature review revealed three groups at risk of F philomiragia infection: young patients with chronic granulomatous disease; adults with hematogenous malignancy; and near-drowning patients. Pneumonia, fever without an apparent source and sepsis are the main clinical presentations. Invasive procedures may be required to isolate this organism and ensure appropriate antimicrobial therapy. Limited awareness of F philomiragia has led to delayed identification, patient death and misidentification as Francisella tularensis - a biosafety level three pathogen and potential bioterrorism agent.