Archive for October, 2010

An International Prospective Study of Pneumococcal Bacteremia: Correlation with In Vitro Resistance, Antibiotics Administered, and Clinical Outcome

Clinical Infectious Diseases 15 July 2003  V.37 N.2 p.230-237

Victor L. Yu,1 Christine C. C. Chiou,5 Charles Feldman,8 Ake Ortqvist,10 Jordi Rello,11 Arthur J. Morris,15 Larry M. Baddour,2 Carlos M. Luna,13 David R. Snydman,3 Margaret Ip,7 Wen Chien Ko,6 M. Bernadete F. Chedid,14 Antoine Andremont,12 and Keith P. Klugman,4,9 for the International Pneumococcal Study Group

1Division of Infectious Disease, University of Pittsburgh, Pennsylvania; 2Mayo Clinic, Rochester, Minnesota; 3Division of Geographic Medicine and Infectious Diseases, Tufts–New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts; 4Department of International Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; 5Department of Pediatrics, Veterans General Hospital–Kaohsiung, National Yang Ming University, Taipei, and 6Division of Infectious Diseases, National Cheng Kung University Hospital, Tainan, Taiwan; 7Department of Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; 8Pulmonology Division, Department of Medicine, Johannesburg Hospital and University of the Witwaterstrand, and 9Wits/Medical Research Council/National Health Laboratory Service Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa; 10Unit of Infectious Diseases, Department of Communicable Diseases and Prevention, Karolinska Institute, Karolinska Hospital, Department of Communicable Diseases and Prevention, Stockholm, Sweden; 11University Hospital Joan XXIII, University Rovira and Virgili, Tarragona, Spain; 12Laboratorie de Bacteriologie, Hopital Bichat–Claude Bernard AP‐HP, Paris, France; 13Division of Pulmonary Medicine, Hospital de Clinicas, Universidad de Buenos Aires, Buenos Aires, Argentina; 14Postgraduate Program in Pulmonology, Federal University of Rio Grande do Sol, Hospital de Clinicas de Porto Alegre, Brazil; and 15Clinical Microbiology Laboratory, Auckland Hospital, Auckland, New Zealand

We performed a prospective, international, observational study of 844 hospitalized patients with blood cultures positive for Streptococcus pneumoniae. Fifteen percent of isolates had in vitro intermediate susceptibility to penicillin (minimum inhibitory concentration [MIC], 0.12–1 μg/mL), and 9.6% of isolates were resistant (MIC, 2 μg/mL). Age, severity of illness, and underlying disease with immunosuppression were significantly associated with mortality; penicillin resistance was not a risk factor for mortality. The impact of concordant antibiotic therapy (i.e., receipt of a single antibiotic with in vitro activity against S. pneumoniae) versus discordant therapy (inactive in vitro) on mortality was assessed at 14 days. Discordant therapy with penicillins, cefotaxime, and ceftriaxone (but not cefuroxime) did not result in a higher mortality rate. Similarly, time required for defervescence and frequency of suppurative complications were not associated with concordance of β-lactam antibiotic therapy. β-Lactam antibiotics should still be useful for treatment of pneumococcal infections that do not involve cerebrospinal fluid, regardless of in vitro susceptibility, as determined by current NCCLS breakpoints.



October 27, 2010 at 12:06 pm Leave a comment

Sexually Transmitted Diseases Treatment Guidelines, 2006

MMW Report Recommendations and Reports Aug 4, 2006  V.55  N. RR-11  p.1-100

Department of health and human services – Centers for Disease Control and Prevention (CDC)


October 26, 2010 at 3:31 pm Leave a comment

Pielonefritis enfisematosa aguda bilateral.

Medicina 05/2007  V.67  p.282-284

Un desafío terapéutico


1Unidad de Internación del Departamento de Medicina, 2División Terapia Intensiva, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires


La pielonefritis enfisematosa es una forma poco común de infección renal, caracterizada por la presencia de bacterias coliformes productoras de gas que afecta preferentemente a los pacientes diabéticos. Comunicamos el caso de una mujer diabética de 57 años de edad que ingresó en el hospital por un shock séptico, signos de pielonefritis enfisematosa aguda bilateral y cetoacidosis diabética. En los cultivos de las muestras de orina y sangre desarrolló Escherichia coli. La paciente fue tratada exitosamente con antibióticos de amplio espectro por un tiempo prolongado, control diabético y medidas de sostén solamente. No fue necesario el drenaje con catéteres o la nefrectomía para superar esta situación potencialmente letal.


October 26, 2010 at 12:12 pm Leave a comment


Actas Urológicas Españolas Oct 2003  V.27  N.9



Servicio de Urología. Hospital Universitario Juan Canalejo. La Coruña.


La pielonefritis enfisematosa es una infección necrotizante del parénquima renal que afecta especialmente a pacientes diabéticos con mal control de su enfermedad. Esta grave afección conlleva altas tasas de mortalidad aún a pesar del tratamiento agresivo. Lo más importante en el manejo de la misma es un precoz diagnóstico y agresivo tratamiento, casi siempre con nefrectomía.

Presentamos un caso clínico típico, haciendo especial hincapié en el diagnóstico clínico y por imagen, así como en el tratamiento, y en su evolución. Asimismo realizamos una revisión de la literatura intentando comprender mejor este proceso, y encontrar bases definidas para su abordaje terapéutico.


October 26, 2010 at 12:10 pm Leave a comment

Amodiaquine Dosage and Tolerability for Intermittent Preventive Treatment To Prevent Malaria in Children ,

Antimicrobial Agents and Chemother 1 March 2010  V.54  N.3  p.1265-1274

M. Cairns,1* B. Cisse,1,2 C. Sokhna,3 C. Cames,3 K. Simondon,3 E. H. Ba,3 J.-F. Trape,3 O. Gaye,2 B. M. Greenwood,1 and P. J. M. Milligan1

London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom,1 Department of Parasitology and Mycology, Universite Cheikh Anta Diop, Dakar, Senegal,2 Institut de Recherche pour le Developpement, Dakar, Senegal3

Sulfadoxine-pyrimethamine with amodiaquine (SP-AQ) is a highly efficacious regimen for intermittent preventive treatment to prevent malaria in children (IPTc), but the amodiaquine component is not always well tolerated. We determined the association between amodiaquine dosage by body weight and mild adverse events (AEs) and investigated whether alternative age-based regimens could improve dosing accuracy and tolerability, using data from two trials of IPTc in Senegal, one in which AQ dose was determined by age and the other in which it was determined by weight category. Both dosage strategies resulted in some children receiving AQ doses above the recommended therapeutic range. The odds of vomiting increased with increasing amodiaquine dosage. In one study, incidence of fever also increased with increasing dosage. Anthropometric data from 1,956 children were used to predict the dosing accuracy of existing and optimal alternative regimens. Logistic regression models describing the probability of AEs by dosage were used to predict the potential reductions in mild AEs for each regimen. Simple amendments to current AQ dosing schedules based on the child’s age could substantially increase dosing accuracy and thus improve the tolerability of IPTc using SP-amodiaquine in situations where weighing the child is impractical.



October 23, 2010 at 9:34 pm Leave a comment

Laninamivir Prodrug CS-8958, a Long-Acting Neuraminidase Inhibitor, Shows Superior Anti-Influenza Virus Activity after a Single Administration

Antimicrobial Agents and Chemother 1 March 2010  V.54  N.3  p.1256-1264

Shuku Kubo, Takanori Tomozawa, Masayo Kakuta, Akane Tokumitsu, and Makoto Yamashita*

Biological Research Laboratories IV, Daiichi Sankyo Co. Ltd., 1-2-58, Hiromachi, Shinagawa, Tokyo 140-8710, Japan

Two neuraminidase (NA) inhibitors, zanamivir (Relenza) and oseltamivir phosphate (Tamiflu), have been licensed for use for the treatment and prophylaxis of influenza. We have reported on laninamivir (code name, R-125489), a novel neuraminidase inhibitor, and have discovered that the laninamivir prodrug CS-8958 worked as a long-acting neuraminidase inhibitor in a mouse influenza virus infection model when it is intranasally administered. In this study, CS-8958 was administered just once 7 days before infection and showed significant efficacy in vivo. The efficacy of a single administration of CS-8958 after viral infection was then compared with that of repeated administrations of oseltamivir phosphate or zanamivir in mice and ferrets. CS-8958 showed efficacy superior or similar to the efficacies of the two licensed NA inhibitors. CS-8958 also significantly reduced the titers of an oseltamivir-resistant H1N1 virus with a neuraminidase H274Y substitution in a mouse infection model. These results suggest that since CS-8958 is characteristically long lasting in the lungs, it may be ideal for the prophylaxis and treatment of influenza.



October 23, 2010 at 9:32 pm Leave a comment

Epidemiology of Invasive Meningococcal Disease with Decreased Susceptibility to Penicillin in Ontario, Canada, 2000 to 2006

Antimicrobial Agents and Chemother 1 March 2010  V.54  N.3  p.1016-1021

Elizabeth M. Brown,1,2 David N. Fisman,1,2,3 Steven J. Drews,4 Sharon Dolman,5 Prasad Rawte,1 Shirley Brown,1 and Frances Jamieson1,2*

Ontario Agency for Health Protection and Promotion, Public Health Laboratories, 81 Resources Road, Toronto, Ontario, Canada M9P 3T1,1 University of Toronto, Department of Laboratory Medicine and Pathology, Toronto, Ontario, Canada,2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada M5G 1E2,3 Provincial Laboratory for Public Health Alberta, Calgary, Alberta, Canada,4 Ontario Ministry of Health and Long-Term Care, Infectious Diseases Branch, Toronto, Ontario, Canada5

Neisseria meningitidis has been relatively slow to acquire resistance to penicillin. We previously reported an increase in the incidence of invasive meningococcal disease (IMD) strains with decreased susceptibility to penicillin (DSP) in Ontario. Our objectives were to evaluate trends in IMD with DSP, to identify case-level predictors of IMD with DSP, and to evaluate the relationship among DSP, bacterial phenotype, and the likelihood of a fatal outcome. All IMD isolates received in Ontario between 2000 and 2006 were submitted to the Public Health Laboratories, Toronto, for confirmation of the species, serogroup determination, and susceptibility testing. Isolates were considered to be IMD strains with DSP if the penicillin MIC was 0.125 µg/ml. Temporal trends were evaluated using multivariable Poisson regression models. Correlates of diminished susceptibility and fatal outcome were evaluated with multivariable logistic regression models. The overall rate of IMD caused by strains with DSP in Ontario was approximately 1.20 cases per million population annually (95% confidence interval [95% CI], 0.99 to 1.46). Seventy-nine strains (21.7%) were IMD strains with DSP. There was no year-to-year trend in the incidence of IMD with DSP. IMD with DSP was strongly associated with strains of serogroups Y (odds ratio [OR], 6.3; 95% CI, 3.6 to 11.1) and W-135 (OR, 8.2; 95% CI, 4.0 to 16.7). Infection with serogroup B or C strains was associated with a marked increase in the risk of mortality (OR, 3.07; 95% CI, 1.39 to 6.75); however, no association between IMD with DSP and mortality was observed. In contrast to trends of the 1990s, the incidence of IMD with DSP was stable in Ontario between 2000 and 2006. In Ontario, the serogroup rather than the penicillin MIC is the microbiological parameter most predictive of mortality.


October 23, 2010 at 9:31 pm Leave a comment

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