Ferbile neutropenia: Etiology of infection, empirical treatment and prophylaxis

Much has changed in the treatment of patients with fever and neutropenia, including the patterns of microbial flora and drug resistance, and the drugs used. Gram-positive organisms have overshadowed the gram-negative ones as causes of bacteremia. Changes in therapy may include antimicrobials directed against gram-positive bacteria, resistant gram-negative bacteria, or fungi. Due to the high risk for colonization by vancomycin resistant Enterococci, vancomycin use is restricted as first line empiric therapy unless the patient is at high-risk for serious gram-positive infection. Prophylactic antibiotic therapy may increase the selection of resistant strains and should be avoided. Therapy with colony stimulating factor is only considered for patients who remain severely neutropenic and have documented infections that do not respond to appropriate antibacterial therapy. Patients stratification for risk of infection-associated morbidity and mortality is essential to facilitate treatment decision

Urinary tract infection at a University Hospital in Saudi Arabia: incidence, microbiology, and antimicrobial susceptibility

Midstream and catheter stream specimens of urine from inpatients and outpatients at King Abdulaziz University in Jeddah, Saudi Arabia, were collected over a period of 12 months to determine prospectively the incidence of urinary tract infection, the predominant causative organisms, and their antimicrobial susceptibility. A total of 575 of 9845 specimens [5.8%] showed significant bacteriuria. The overall prevalence of urinary tract infection was 12.1%, 7.4% in inpatients and 4.7% n outpatients. Infection was found more frequently in females than males [2@1]. Four percent of the patients were catheterized at the time of the survey; 21% of catheterized patients and 6% of noncatheterized patients were infected. A knowledge of local organisms and their antimicrobial susceptibility pattern is invaluable for the empirical treatment of urinary tract infection. Guidelines for the use of the urethral catheter, when introduced and followed, can reduce hospital-acquired urinary tract infection