Severe pneumonia due to Legionella pneumophila: prognostic factors, impact of delayed appropriate antimicrobial therapy.

OBJECTIVE: To compare the outcome of patients with severe Legionella pneumonia (LP) according to the presence or absence of prognostic factors currently reported in the literature and delays in initiating fluoroquinolones and macrolides. DESIGN: Retrospective clinical investigation. SETTING: Intensive care unit (ICU) of an university hospital. PATIENTS: Forty-three consecutive cases with no previous treatment with a macrolide or a fluoroquinolone. MEASUREMENTS AND MAIN RESULTS: The 14 (33%) patients who died of LP were compared with the 29 survivors. Thirty-eight patients (88%) received a fluoroquinolone in combination with a macrolide agent, two patients erythromycin alone and three ofloxacin alone. In univariate analysis, SAPS II more than 46 ( p=0.006) and intubation requirement ( p=0.012) were associated with a higher mortality whereas the administration of fluoroquinolones ( p=0.011) or erythromycin ( p=0.044) within 8 h of arrival on the ICU was associated with better survival. By logistic regression analysis, SAPS II score more than 46 [odds ratio (OR) 8.69; 95% confidence interval (CI) 1.15-66.7; p=0.036], duration of symptoms prior to ICU admission longer than 5 days (OR 7.46; 95% CI 1.17-47.6) were independent risk factors for death. Fluoroquinolone administration within 8 h of ICU arrival (OR 0.16; 95% CI 0.03-0.96; p=0.035) was associated with a reduced mortality. CONCLUSIONS: SAPS II score higher than 46, duration of symptoms prior to ICU admission longer than 5 days and intubation were associated with increased mortality. Initiation of fluoroquinolone therapy within 8 h of ICU admission significantly reduced mortality.

Beware of dogs licking ears.

A patient with right-sided chronic purulent otorrhoea developed meningitis due to Pasteurella multocida transmitted by a dog that frequently licked his ear. We suggest that patients with a perforated tympanic membrane should avoid being licked on their ears by animals.

[Comparative study of the bacteriostatic and bactericidal activity of levofloxacin against Pasteurella strains isolated from man]. / Etude comparative de l'activité bactériostatique et bactéricide de la lévofloxacine vis-à-vis des souches de Pasteurella isolées chez l'homme.

The MICs of seven quinolones, nalidixic acid, pefloxacin, ofloxacin, d-ofloxacin, ciprofloxacin, sparfloxacin and levofloxacin, were determined by agar dilution method comparatively to those of amoxycillin, cefpodoxime, doxycyclin and clarithromycin against 75 clinical isolates of Pasteurella multocida, P. dagmatis and P. canis. Time-kill method was performed for three selected P. multocida isolates. Fluoroquinolones were the most active agents. At concentration of 0.016 mg/L of sparfloxacin or levofloxacin the 75 isolates were inhibited. The MICs of levofloxacin and sparfloxacin showed that the activity of these molecules was two to four times higher than that of the other quinolones studied. Time-kill studies showed a complete killing in six hours with the CMI x 2 of pefloxacin, ofloxacin, ciprofloxacin, sparfloxacin and levofloxacin. This result was obtained more rapidly with the quinolones than with amoxicillin or cefpodoxime. Doxycycline and clarithromycin were devoid of bactericidal activity.

[Antibiotics resistance of Streptococcus pneumoniae. Results from the Brittany registry for 1999]. / Etat de la résistance aux antibiotiques de Streptococcus pneumoniae dans la région Bretagne. Résultats de l'Observatoire Régional du Pneumocoque pour l'année 1999.

Throughout 1999, clinical microbiology laboratories of 13 hospitals in Brittany have recovered Streptococcus pneumoniae isolates in 832 patients, 312 (37.5%) female and 518 (62.2%) male. Two hundred fifty five of them (30.6%) were children. One hundred eighty eight isolates were recovered from blood cultures (22.6%), 16 from CSF (1.9%), 449 from lungs (54%), and 88 from ear exsudates (10.6%).A 5 microgram oxacillin-disk test was used to detect isolates with reduced susceptibility to penicillin G. Determination of MICs of penicillin G, amoxicillin and cefotaxime were then performed by agar dilution method on 402 strains previously categorized resistant or intermediate. Five hundred forty six isolates were PSDP, 33.5% of them were resistant to penicillin G, 2.2% to amoxicillin and 0.2% to cefotaxime. As expected, a decreased susceptibility to beta-lactamins was frequently associated with resistance to macrolides, cotrimoxazole and tetracycline. Among PSDP, the most prevalent serotypes were 23 (23.7%), 14 (23.5%) and 19 (19.1%). In Brittany, the constant rise of PSDP (1993-1994: 28.5%; 1997: 56.4%; 1999: 65.6 %) could be perhaps explain by analysis of social and demographic data.