Mild nephrotoxicity associated with vancomycin use.

Nephrotoxicity related to vancomycin hydrochloride therapy has been reported at overall rates of 7% to 16% and as high as 35% when combined with an aminoglycoside antibiotic. We conducted a prospective study in older men. A group that received vancomycin was compared with a control group to determine the incidence of nephrotoxicity secondary to vancomycin therapy alone and in combination with aminoglycosides, to identify possible risk factors associated with nephrotoxicity, and to determine the incidence of other adverse effects associated with vancomycin use. Nephrotoxicity occurred in 11 (17%) of 66 patients receiving vancomycin and in 3 (5%) of 57 controls overall. Stepwise logistic-regression analysis failed to identify underlying illnesses or concurrent risks that may have contributed to the development of nephrotoxicity associated with vancomycin. Adverse effects, including phlebitis (14%), neutropenia (1%), rash (0%), and red neck syndrome (0%), occurred at rates similar to previous reports.

Successful nonsurgical treatment of tuberculous empyema in an irreducible pleural space.

A 78-year-old woman with empyema due to Mycobacterium tuberculosis in a chronic pleural space was successfully treated with a 24-month course of oral isoniazid, rifampin, ethambutol, and serial space-emptying thoracocenteses. Besides dramatic clinical improvement, follow-up pleural fluid analyses demonstrated gradual replacement of the empyema with a sterile pleural exudate, which has persisted 24 months after cessation of therapy. This case demonstrates a therapeutic program that was an effective alternative to decortication or thoracoplasty for tuberculous empyema in an irreducible pleural space.

Successful treatment of progressive disseminated histoplasmosis with amphotericin B methyl ester.

Amphotericin B methyl ester (AME) has been used to treat fungal infections, most often those caused by Coccidioides immitis. We describe the only patient with disseminated histoplasmosis who has been treated with AME. After having had alarming reactions to amphotericin B, the patient was treated and cured with AME without adverse drug effect or later relapse.

Nosocomial Hemophilus influenzae type C meningitis in an adult.

Hemophilus influenzae type C meningitis developed in a 68-yr-old man with a cerebrospinal fluid leak which occurred after craniotomy for an olfactory groove meningioma. Hemophilus influenzae is an uncommon cause of meningitis in adults, and most reported cases have been due to type B or nontypeable strains.

Haemophilus paraphrophilus brain abscess.

The clinical course of a patient with brain abscess due to Haemophilus paraphrophilus is described. The organism was recovered in pure culture from purulent material collected at surgery. The role of this organism as a human pathogen is reviewed.

Coagulase-negative staphylococci.

Coagulase-negative staphylococci, long considered to be harmless commensals or contaminants, have emerged as major pathogens as medical technology has advanced. They are a major cause of intravenous-catheter-associated bacteremia, endocarditis, otitis media, and infection of joint prostheses, vascular grafts, cardiac pacemakers, cerebrospinal fluid shunts, postoperative wounds, the urinary tract, and the eye. Therapy includes removal of infected foreign bodies and administration of appropriate antimicrobial agents.

Mycobacterium kansasii among patients infected with human immunodeficiency virus in Kansas City. Kansas City AIDS Research Consortium.

Previous reports of infection due to Mycobacterium kansasii among patients infected with human immunodeficiency virus (HIV) have conflicted with regard to the significance of the isolate; the clinical, radiographic, and laboratory features of the disease; and the response to therapy. To clarify the spectrum of M. kansasii infection in this population, we conducted a retrospective study of 35 patients. Twenty-eight of these patients were believed to have disease due to M. kansasii, while the remaining seven patients were probably colonized with the organism. All but two patients presented with advanced HIV infection; the median CD4 cell count was 12/microL. Most patients with pulmonary disease presented with fever, cough, and dyspnea, but only eight of these 22 patients had radiographic findings of either pulmonary cavitation or predominantly upper-lobe disease. Ten patients had M. kansasii isolated from blood or bone marrow. The majority of patients with pulmonary or disseminated disease responded to therapy. However, 11 patients died either before mycobacterial infection was diagnosed or early in the course of treatment, and two had a relapse of infection during therapy.