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We report a low rate of adverse antibiotic related events in patients treated with percutaneous nephrolithotomy who received extended perioperative antibiotic therapy. Exposure to trimethoprim/sulfamethoxazole was the only identifiable risk factor for a complication. These findings should be considered when counseling patients on the risks of perioperative antimicrobial therapy at percutaneous nephrolithotomy.
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We report a now three year old male patient with ectodermal dysplasia and a polysaccharide specific humoral immunodeficiency. Immunological investigations showed compromised production of IgA, IgM, and IgG2. Isohaemagglutinins still were not detectable at the age of three years. Repeated vaccination with polyvalent pneumococcal polysaccharide vaccine did not result in production of specific antibodies. Two brothers showed clinical signs of ectodermal dysplasia. The elder brother died from pneumococcal sepsis at the age of 3 years. The younger brother suffers from chronic inflammatory gastrointestinal disease with ulcerations in all parts of the gastrointestinal system. Thus, a possible association between polysaccharide specific humoral immunodeficiency and ectodermal dysplasia may be considered.
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The new fluorinated quinolones norfloxacin, ciprofloxacin and pefloxacin were evaluated in urinary infections. Bacteriological cure rates in both uncomplicated and complicated urinary tract infections ranged from 85% to 99%. Clinical cure rates were often lower due to the underlying conditions in the urinary tract. Patients with neurological bladder disease were cured in a relatively high percentage of their Pseudomonas infection after three months treatment with norfloxacin. Pharmacokinetics of ciprofloxacin in prostatic tissue and fluid will probably offer an advance in the treatment of chronic urinary infections due to an infectious prostatic focus. Definitely drug related side effects (of gastro-intestinal, neurological or allergic nature) were mild in most cases. The new 4-quinolones should be followed with interest concerning their activity in urological infections in general as well as specifically. The minor influence on the natural human flora and the possibility to decrease plasmid-mediated resistance are of major importance.
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The blood examinations revealed high inflammation parameters and ruled out any immunodeficiency. Smouldering infiltrates in the upper lobes were found on the chest radiography. Sputum was free of acid fast bacilli and no mycobacterial DNA was detected by polymerase chain reaction. Bronchoscopy showed a normal endobronchal situation, Burkholderia pseudomallei were found to grow from specimens of bronchial mucus.
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To describe and report a case of multidrug-resistant Ewingella americana associated with exacerbation of chronic obstructive pulmonary disease (COPD).
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One hundred and fifty-seven (77.7%) of the isolates were confirmed as ESBL-producers. By univariate analysis, young age, stay in intensive care unit (ICU)/medical wards, recent stay in ICU, and number of days of ICU stay were found to be risk factors for acquisition of resistant bacteria (chi(2) and Mann-Whitney U tests, P < 0.05). However, binary logistic multivariate regression analysis confirmed that stay in ICU [Odds ratio (OR) 6.09, 95% confidence interval (CI) 2.36-15.72; P < 0.001] or medical wards [OR 3.72, 95% CI 1.42-9.75; P = 0.007] were significantly associated with ESBL production. Imipenem, ofloxacin, cefoxitin and norfloxacin (against urinary isolates) were found to be highly active against ESBL-producing isolates in vitro (100%, 75.2%, 69.4% and 66.7% susceptibility, respectively). In addition to most beta-lactams, they showed co-resistance with other antibiotics such as ciprofloxacin, aminoglycosides, trimethoprim/sulfamethoxazole and tetracycline.
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The first reported case of Whipple's disease in a female who was HLA-B27 positive and had asymptomatic sacroiliitis is discussed. She presented great difficulty in diagnosis as she had multi-system involvement without diarrhea. This case supports the hypothesis that Whipple's disease is a disorder related to HLA-B27.
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Pneumocystis jiroveci (formerly Pneumocystis carinii) pneumonia (PCP) is a major cause of mortality in human immunodeficiency virus (HIV)-infected infants in Africa, but the prevalence of mutations in the gene encoding dihydropteroate synthase (DHPS) in isolates from Africa has not been reported.
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The target gene was identified among genes encoding a unique trifunctional enzyme in which DHPS is combined with the 2 preceding enzymes of the folate biosynthesis pathway. Changes in the amino acid sequence of putative DHPS were detected in the case patient. Gene complementation showed that the gene encoding putative DHPS restored the folate biosynthesis pathway and susceptibility to sulfamethoxazole, whereas the mutated sequence was associated with sulfamethoxazole resistance.
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Chloramphenicol-resistant Salmonella typhi was detected in Saigon in September 1971. Subsequently, 163 strains of S typhi were isolated, 46 percent of which were resistant to choramphenicol by the agar-disk method. Sixty-two strains were studied by the broth-dilution method; 37 percent had minimal inhibitory concentrations for chloramphenicol greater than 250mug/ml, but all strains were susceptible to 0.4mug/ml of ampicillin and to a disk of a combination of trimethoprim and sulfamethoxazole (Bactrim). Persons infected with chloramphenicol-resistant strains of S typhi responded poorly to chloramphenicol alone, but ampicillin or the combination drug was effective.
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Randomised controlled trials (RCTs) and nonrandomised studies (NRSs) that examined the effectiveness of the three interventions were included.
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A total of 120 isolates of Klebsiella spp. and Proteus spp. collected from horses and small animals (dogs and cats) were screened for their susceptibility to 24 different antimicrobial agents. Klebsiella spp. were included from infections of the genital tract (GT) of horses (36 isolates) and the urinary/genital tract (UGT) from dogs and cats (17 isolates), while Proteus spp. were from small animal (dogs and cats) infections of the UGT (37 strains) and the skin (incl. ear/mouth) (30 isolates). In Klebsiella spp. resistance appeared most frequently to ampicillin (53-67%), sulfamethoxazole (19-29%) and potentiated sulfonamides (trimethoprim/sulfamethoxazole 1/19 combination) (19-24%). A further 29% of enrofloxacin resistant Klebsiella isolates were observed for the UGT of small animals. From the GT of horses for this antimicrobial agent there was no isolate detected with a comparably high minimum inhibitory concentration (MIC) value. In Proteus spp. highest percentages of resistance occurred against tetracycline (90-92%). Due to drug efflux proteins, high MIC values against this antimicrobial agent have been frequently reported in literature. In Proteus spp. relevant resistance percentages also occurred for potentiated sulfonamides (27-37%), sulfamethoxazole (24-37%) and chloramphenicol (24-37%).