In vitro activity of colistin or sulbactam in combination with fosfomycin or imipenem against clinical isolates of carbapenem-resistant Acinetobacter baumannii producing OXA-23 carbapenemases.

This study investigated the in vitro activity of colistin or sulbactam in combination with fosfomycin or imipenem against eight strains of carbapenem-resistant A. baumannii (CRAB). The eight CRAB clinical isolates were collected from hospitalized patients admitted to Songklanagarind Hospital in southern Thailand during January-December 2008. The isolates were divided into 4 different patterns of clonal relationships using the Repetitive Extragenic Palindromic-Polymerase Chain Reaction method (REP-PCR). The in vitro activity of combination antibacterial agents against theses isolates were determined by chequerboard and time-kill methods. All isolates producing OXA-23 carbapenemases were universally susceptible to colistin but intermittently susceptible to other antimicrobial agents. A chequerboard assay showed the synergistic effects of sulbactam plus fosfomycin and colistin plus fosfomycin in 75% and 12.5% of isolates, respectively. Sulbactam at a concentration of 1 x MIC plus fosfomycin at 1 x MIC or at 1/4 x MIC showed synergism in 75% and 37.5% of clinical isolates, respectively. Bactericidal activity was observed for up to 12 hours of incubation. There was no synergism between colistin and sulbactam, sulbactam and imipenem, and colistin and imipenem, against the tested isolates. Combined use of sulbactam and fosfomycin may provide an alternative therapeutic option for CRAB infections.

Clinical outcomes of patients infected with carbapenem-resistant Acinetobacter baumannii treated with single or combination antibiotic therapy.

OBJECTIVE: To evaluate treatment outcomes in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) nosocomial infections treated with antimicrobial agent either alone or in combination. MATERIAL AND METHOD: Clinical data were retrospectively evaluated in patients with CRAB nosocomial infections admitted to Songklanagarind Hospital, Songkhla, Thailand from January-December 2008. RESULTS: One hundred ten patients with CRAB nosocomial infections were identified. Most patients (57.3%) had site of infection in the lower respiratory tract and the majority of them (61.8%) received a single antimicrobial agent. Crude mortality was 30%. The presumptive success rate was 60.3% (41/68) for patients given monotherapy and 81.0% (34/42) for patients given combination therapy (p = 0.024). Patients given combination therapy were more likely to have been given at least one antibiotic to which the organism was susceptible (p = 0.004). In multivariate analysis, renal impairment, bloodstream infection, and inappropriate antimicrobial regimen were independent predictors of treatment failure. CONCLUSION: The combination therapy regimen yielded more presumptive treatment success by increasing the likelihood of an appropriate antimicrobial therapy. Additionally, inappropriate antimicrobial treatment, renal impairment, and bloodstream infection were associated with poor treatment outcomes in patients with CRAB nosocomial infections.

Peripheral facial paralysis associated with HIV infection: A case series and literature review.

OBJECTIVE: The association between peripheral facial paralysis (PFP) and HIV infection has been scarcely explained. The authors aimed to describe the association between PFP and HIV infection status, along with the related co-morbidities and the outcomes of PFP, as well as the literature review on this topic. PATIENTS AND METHODS: All HIV-infected patients who experienced PFP, both before and after a positive HIV serology test, between January 2002 and June 2015 were retrospectively reviewed. The patients' demographic data, clinical characteristics, HIV co-morbidities and outcomes of PFP were summarized. A literature review of PFP in HIV infection was also performed. Descriptive statistics were used in the data analysis. The Mann-Whitney U test was performed to compare the parameters between the current case series and cases from literature review to determine statistical significant differences (p <  0.05). RESULTS: Sixteen patients (6 males and 10 females) were enrolled. Their median age was significantly higher than that of the cases in the literature review [46 (38, 49.75) vs. 33 (26, 41) years (p =  0.004)]. Nonetheless, a non-significant lower median CD4 count was observed [274 (134.5, 425.5) vs. 373 (265, 718) cells/µL (p =  0.058)]. In our series, unilateral PFP (UFP) was the most frequent, and it typically occurred long after a positive HIV serology test. However, bilateral PFP (BFP) was commonly found in the literature, and a simultaneous positive HIV serology test was reported in almost all cases. Consequently, most of our cases, except for those with HIV-related complications or co-morbidities, experienced a satisfactory recovery from PFP regardless of treatments received. CONCLUSIONS: Most of the cases in our series were UPF with a higher median age and a lower median CD4 count. Moreover, facial paralysis presented later in our series than in the previously reported cases in the literature. Most of our cases experienced satisfactory recovery of facial weakness.

Acute bacterial meningitis in adults: a 20 year review.

During the period Jaunuary 1982 to December 2001 (20 years), a retrospective study in patients 15 years or older with acute bacterial meningitis who were admitted to Songklanagarind Hospital was carried out. There were 180 episodes in 161 cases of acute bacterial meningitis with an increasing incidence of disease during the study. Fifty-nine percent of episodes were nosocomial infection. The classic triad of acute bacterial meningitis was found in 54% of cases. The most common pathogen was Streptococcus pneumoniae (11.7%) in which 19% of these strain were penicillin-resistant. Gram-negative bacilli were common organisms in nosocomial meningitis (32.1%). Twenty-five patients died from meningitis with a mortality rate of 15.5%. Risk factors for mortality older age were than 60 years, HIV infection, impaired mental status and shock.

Invasive streptococcal group A infection and toxic shock syndrome in Songklanagarind hospital.

BACKGROUND AND OBJECTIVES: Streptococcal group A infection is reported as a medical problem in several parts of the world. The most serious complication of this infection is streptococcal toxic shock syndrome (STSS) which is associated with a very high mortality rate. The present study aimed to determine the clinical manifestations, including underlying conditions, mortality and prognostic factors, of invasive streptococcal group A infection and STSS from southern Thailand (Songklanagarind Hospital). METHOD: The medical records of infected patients from January 1, 1995 to June 30, 1999 were reviewed retrospectively. Criteria for diagnosis of STSS were as follows (JAMA 1993). Prognostic factors were analyzed by logistic regression model. RESULT: 176 cases of STSS and streptococcal group A infection, 89.9 per cent were community acquired infections. About 70 per cent of the infected patients had previous underlying conditions, the most common was cancer. The commonest site of infection was the skin and soft tissue (80.1%). The total mortality rate from streptococcal group A infection was 9.1 per cent. STSS was identified in 12 patients (6.8%), with a 50 per cent mortality rate. Prognostic factors for mortality in this infection were diabetic mellitus (odds ratio 9.67, p<0.025), history of steroid use (odds ratio 11.17, p<0.017), STSS (odds ratio 22.16, p<0.005) and received cancer chemotherapy (odds ratio 115.19, p<0.003). Predictive factors for STSS couldn't be identified, while age >65 years and steroid use were suggested protective factors for this condition [odds ratio 0.02, p<0.0001 and odd ratio 0.07, p<0.027 respectively].

Varidans streptococci in the oral flora of the patients at risk for infective endocarditis: species and penicillin susceptibilities.

This study examined viridans streptococci (SV) in oral flora of patients at risk of infective endocarditis (IE) by obtaining 57 isolates from gum-tooth margin swabs of 3 groups of patients. Penicillin minimal inhibitory concentrations (MICs) were determined by E test. Group 1 was from 30 patients with prosthetic heart valves who did not receive antimicrobial agents within 3 months prior to recruitment. Group 2 consisted of 21 patients with known rheumatic heart diseases who regularly received penicillin prophylaxis. Group 3 was 2 patients with IE caused by SV in whom dental swabs were performed before and on the third day of treatment. Streptococcus mitis was found most frequently (49% among 51 oral isolates of SV from patients in group 1 and 2) and in both blood cultures of IE patients. Ninety-four per cent of the isolates were penicillin-susceptible and the rest were intermediate-resistant (IR) equally distributed in both groups 1 and 2. In 2 patients with IE, oral SV obtained after 3 days of penicillin therapy had MICs rising 3 and 5 folds of the baselines. It is suggested that surveillance of susceptibilities of oral SV in patients at risk for IE should be kept up since this will affect the dose and type of antimicrobial agents in IE prophylaxis.

Acute bacterial meningitis in adults: a 20 year review.

During the period Jaunuary 1982 to December 2001 (20 years), a retrospective study in patients 15 years or older with acute bacterial meningitis who were admitted to Songklanagarind Hospital was carried out. There were 180 episodes in 161 cases of acute bacterial meningitis with an increasing incidence of disease during the study. Fifty-nine percent of episodes were nosocomial infection. The classic triad of acute bacterial meningitis was found in 54% of cases. The most common pathogen was Streptococcus pneumoniae (11.7%) in which 19% of these strain were penicillin-resistant. Gram-negative bacilli were common organisms in nosocomial meningitis (32.1%). Twenty-five patients died from meningitis with a mortality rate of 15.5%. Risk factors for mortality older age were than 60 years, HIV infection, impaired mental status and shock.

Invasive streptococcal group A infection and toxic shock syndrome in Songklanagarind hospital.

BACKGROUND AND OBJECTIVES: Streptococcal group A infection is reported as a medical problem in several parts of the world. The most serious complication of this infection is streptococcal toxic shock syndrome (STSS) which is associated with a very high mortality rate. The present study aimed to determine the clinical manifestations, including underlying conditions, mortality and prognostic factors, of invasive streptococcal group A infection and STSS from southern Thailand (Songklanagarind Hospital). METHOD: The medical records of infected patients from January 1, 1995 to June 30, 1999 were reviewed retrospectively. Criteria for diagnosis of STSS were as follows (JAMA 1993). Prognostic factors were analyzed by logistic regression model. RESULT: 176 cases of STSS and streptococcal group A infection, 89.9 per cent were community acquired infections. About 70 per cent of the infected patients had previous underlying conditions, the most common was cancer. The commonest site of infection was the skin and soft tissue (80.1%). The total mortality rate from streptococcal group A infection was 9.1 per cent. STSS was identified in 12 patients (6.8%), with a 50 per cent mortality rate. Prognostic factors for mortality in this infection were diabetic mellitus (odds ratio 9.67, p<0.025), history of steroid use (odds ratio 11.17, p<0.017), STSS (odds ratio 22.16, p<0.005) and received cancer chemotherapy (odds ratio 115.19, p<0.003). Predictive factors for STSS couldn't be identified, while age >65 years and steroid use were suggested protective factors for this condition [odds ratio 0.02, p<0.0001 and odd ratio 0.07, p<0.027 respectively].

Local tetanus.

The diagnostic problem posed by local tetanus is illustrated by 2 cases of this disease. With lack of a reliable serologic test and often failure to isolate the tetanus bacilli, the identification of tetanus must depend largely on the clinical characteristics, and trismus is the characterisitic initial sign. The presence of localized muscle rigidity and of intermittent involuntary spasm should also suggest local tetanus. The clinical features are discussed and followed by a review of current concept in the pathophysiology of the disorder.

Varidans streptococci in the oral flora of the patients at risk for infective endocarditis: species and penicillin susceptibilities.

This study examined viridans streptococci (SV) in oral flora of patients at risk of infective endocarditis (IE) by obtaining 57 isolates from gum-tooth margin swabs of 3 groups of patients. Penicillin minimal inhibitory concentrations (MICs) were determined by E test. Group 1 was from 30 patients with prosthetic heart valves who did not receive antimicrobial agents within 3 months prior to recruitment. Group 2 consisted of 21 patients with known rheumatic heart diseases who regularly received penicillin prophylaxis. Group 3 was 2 patients with IE caused by SV in whom dental swabs were performed before and on the third day of treatment. Streptococcus mitis was found most frequently (49% among 51 oral isolates of SV from patients in group 1 and 2) and in both blood cultures of IE patients. Ninety-four per cent of the isolates were penicillin-susceptible and the rest were intermediate-resistant (IR) equally distributed in both groups 1 and 2. In 2 patients with IE, oral SV obtained after 3 days of penicillin therapy had MICs rising 3 and 5 folds of the baselines. It is suggested that surveillance of susceptibilities of oral SV in patients at risk for IE should be kept up since this will affect the dose and type of antimicrobial agents in IE prophylaxis.