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A 40 year patient presented with pyrexia of one month duration. Routine work up for fever of unknown origin (FUO) was negative. Bone marrow aspiration and culture done yielded Brucella. Bone marrow cultures are recommended for patients for FUO for whom the routine workup turns out to be negative. Serological tests for brucellosis can be false-negative in some cases of brucellosis due to prozone phenomena.
Group B streptococcus (GBS) is an important cause of neonatal infection. Early-onset diseases are due to perinatal contamination. The epidemiology of late-onset infections is poorly known. Maternal colonization may be responsible for some of them. The relationships between neonatal colonization and late disease could be a colonization of the gut. The purpose of this 3 year-prospective study was to analyse the kinetics of gut colonization in neonates and the influence of antibiotherapy. One hundred and nineteen infants less than one month of age were included because of the presence of GBS in their gastric aspirates or GBS infection. Depending on the therapeutic strategy, the infants were separated into 3 groups: 1) amoxicillin plus aminoside greater than or equal to 10 days because of neonatal infection (28 infants), 2) same combination less than or equal to 5 days because a GBS infection was suspected but not confirmed (17 infants), 3) no antibiotics (77 infants). Fecal flora was regularly analysed by differential count. Antibiotics caused rapid disappearance of GBS from the gut. However, the same strain reappeared after stopping the antibiotics at a rate of 13.5%. Without antibiotics, GBS was implanted in 33% of cases. This difference of implantation rate is statistically significant (p less than 0.05). No GBS infection was observed in any infant after a follow-up examination of 6 months to 2 years. Among the clinical and bacteriological factors studied, adhesion only was correlated with the GBS implantation. These results allow to discuss therapeutic abstention in colonized infants without any signs of infection.
AIM: A feverish high temperature is the symptom that most frequently leads families to take their children to a Pediatric First Aid unit. In the differential diagnosis of the causes of hyperpyrexia the presence of infections of the genito-urinary tract have to be excluded. Infections of the urinary ways are often the cause of high temperatures in infancy, particularly during the 1st year of life; early identification at the moment of examination at the Paediatric First Aid clinic of patients with infections of the urinary ways makes it possible to prevent the onset of renal complications. We carried out a retrospective study with the purpose of evaluating the incidence of infections of the urinary ways and their complications in paediatric patients who had come to the First Aid unit for hyperpirexia and were later hospitalised after examination of the urine revealed and infection of the urinary ways. METHODS: The study was carried out by consulting the registers listing arrivals at the First Aid unit and the subsequent discharge diagnosis. We then consulted the clinical records of patients who required admission to our Paediatrics Clinic arter the first aid examination. RESULTS: Re-reading the registers of examination carried out and the clinica records of hospitalised patients there emerged an increase in the observation of this pathology, diagnosed at the moment of the First Aid examination by means of rapid tests and thereafter assessed by haematochemical and radiological tests. CONCLUSIONS: In our opinion this increase could be attributed to the greater attention paid to diagnosing the causes of fever of apparently unknown origin.
OBJECTIVE: To evaluate the stability of gentamicin, tobramycin, netilmycin, vancomycin, cefazolin, unfractionated heparin, and low molecular weight heparin when added to four different peritoneal dialysis (PD) solutions [Extraneal (Baxter Healthcare, Castlebar, Ireland); Physioneal, Nutrineal, and Dianeal (Baxter Healthcare, Grosotto, Italy)] in new, non-PVC Clear-Flex containers. MEASUREMENTS: Gentamicin, tobramycin, netilmycin, vancomycin, cefazolin, unfractionated heparin, and low molecular weight heparin were injected into separate bags of PD solution. Samples were withdrawn at predefined sampling times and the concentration of each drug was analyzed using high-performance liquid chromatography (for gentamicin, tobramycin, vancomycin, and cefazolin), or bioassay (for netilmycin, gentamicin, and tobramycin in Nutrineal), or coagulation methods (heparins). RESULTS: Netilmycin, vancomycin, cefazolin, and heparin in Physioneal, Nutrineal, Extraneal, and Dianeal were stable for at least 24 hours at 25 degrees C and for an additional 4 hours at 37 degrees C. Gentamicin in Nutrineal, Extraneal, and Dianeal was stable for at least 24 hours at 25 degrees C and for an additional 4 hours at 37 degrees C; gentamicin in Physioneal was stable for less than 24 hours at 25 degrees C. Tobramycin in Nutrineal and Extraneal was stable for at least 24 hours at 25 degrees C and for an additional 4 hours at 37 degrees C; tobramycin in Physioneal and Dianeal was stable for less than 24 hours at 25 degrees C.
This study was undertaken to evaluate: 1. The efficacy of netilmycin and vancomycin as combined first line antimicrobial regime, compared to cefuroxime, in the treatment of peritonitis. 2. To measure the levels of netilmycin and vancomycin in the serum and dialysate. 3. To report on the use of this combination over a one year period and compare it with that of cefuroxime used during the previous one year.
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A randomized trial was conducted to examine the influence of initial lavage on treatment of CAPD peritonitis. Patients with hypotension and shock were excluded from the trial. Thirty-six CAPD patients with acute peritonitis were randomized to treatment with intraperitoneal antibiotics including either initial 24 hours lavage before resumption of routine CAPD schedule (prior standard approach) or continued prolonged exchanges as in routine CAPD schedule. Median time to solved infection (normalization of white cell count in dialysis effluent) was identical (3 days) in the two groups. Treatment success rate was found to be 72% in the group with initial lavage and 89% in the group with prolonged exchanges. The difference in treatment success (17%) in favour of continued CAPD schedule was not found significant (95% confidence limits--1% to 35%). The results suggest lavage to be of no clinical benefit in treatment of CAPD peritonitis in patients without profound hypotension and shock.
A study of the post-antibiotic effect (PAE) and letality curves of different concentrations of clavulanic acid, amoxycillin, amoxycillin + clavulanic acid, netilmycin and ofloxacin on mixed cultures of S. aureus and E. coli. The post-antibiotic effect was measured after one hour of exposure of bacteria to antimicrobial and the elimination of the latter by the dilution method. Amoxycillin did not induce PAE on the association. PAE only appeared at high concentrations on S. aureus when evaluated alone. Clavulanic acid induced a greater PAE than amoxycillin. The association clavulanic acid + amoxycillin was synergistic and induced a greater PAE than its components. Netilmycin and ofloxacin were the drugs that induced the greatest PAE on the bacterial association and on its strains independently evaluated.
A case of extensive skin necrosis following intramuscular injections of sisomycin is described. Eight cases of necrosis following subcutaneous injections of aminoside antibiotics have been reported in elderly females under anticoagulant theray, but the pathogenic mechanisms of these lesions have not been investigated. Defective fibrinolysis and abnormalities of oxidative metabolism of neutrophils were noted in our patient. Four major mechanisms are discussed: an Arthus reaction, a thrombotic process, a direct toxicity of aminosides for subcutaneous tissue, or a pyoderma-like neutrophilic reaction. Subjects with a tendency to thrombosis and/or abnormalities of neutrophil functions may be predisposed to these skin necroses.
Thrombotic obstruction is rare in bacterial endocarditis involving prosthetic heart valves. A 45-year-old man who had three intracardiac, ball-cage-type prosthetic valves, presented with streptococcal septicemia. Major obstruction of the tricuspid Smeloff-Cutter valve and normal function of the two other prostheses were documented by Doppler echocardiography. Emergency replacement of the tricuspid valve alone was decided on the one basis of this echocardiographic diagnosis, and successfully performed. Operative findings confirmed the noninvasive findings.
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Acute metabolic acidosis potentiates the nephrotoxicity of aminoglycosides by impairing the adequate excretion of ammonium and titratable acidity. The present study assesses distal tubular function after aminoglycoside administration in the rat. Two aminoglycosides, gentamicin and netilmycin were given to rats either in low doses equivalent to those used clinically (BG4 and BN5 groups) or in doses ten times higher (BG40 and BN50). The rats were subjected to acute metabolic alkalosis and the pCO2 of urine was continuously evaluated. The regression lines obtained by plotting the differences between urine and blood pCO2 as a function of urinary HCO3- in low dose models were similar to those obtained for the control group. However, the slopes obtained for BG40 and BN50 were significantly different from the control, suggesting an impairment of H+ secretion.
Cefotetan is a semi-synthetic cephamycin antibiotic. It has combined activity against aerobes and anaerobes which makes it of particular use in the treatment and prevention of intra-abdominal infections in the surgical patient. In the course of 3 years we have evaluated the therapeutic use of cefotetan in 107 patients. Early in the evaluation of this antibiotic we used cefotetan in combination with aminoglycosides in 35 severely ill patients with intra-abdominal infections. These patients were generally in poor condition. Good results were obtained in this high risk group. A further 72 patients received cefotetan monotherapy, usually at a dose of 2 g twice daily. The majority of these patients presented with intra-abdominal infections. Overall a successful clinical response of 94% was obtained with antibiotic therapy. In conclusion the results obtained support the therapeutic use of cefotetan in the treatment of moderate to severe intra-abdominal infection.
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