Antibiotic management of native mitral valve infectious endocarditis in patient with unaffected prosthetic aortic valve: A case report

Infectious endocarditis is a rare but feared condition, most frequently caused by Staphylococcus aureus. We describe the case of an 81-year-old male patient presenting with intermittent fever and dyspnea. Cardiac evaluation with transthoracic echocardiogram showed the presence of heart failure with suspicion of endocarditis. Consequently, a transesophageal echocardiogram demonstrated vegetation on the native mitral valve with an unaffected prosthetic aortic valve. Blood cultures were positive for S. aureus. Literature concerning endocarditis originating from a native valve in patients with a prosthetic valve is limited. We applied a new treatment scheme consisting of intravenous floxapen 12 g/24 h in a continuous infusion combined with intravenous rifampicin 2×300 mg daily for a duration of 6 weeks resulting in complete regression of the vegetation. In addition, we were successful in preventing disease propagation to the prosthetic valve. There is a need for more adequate research to prove the prophylactic benefit of this treatment.valve

Mycoplasma maculosum and Mycoplasma spumans associated with fertility disorders in dogs from a Bernese Mountain dog kennel / Mycoplasma maculosum y Mycoplasma spumans asociados con desórdenes defertilidad en perros de un criadero de boyero de Berna

Abstract The aim of this short communication is to describe a case of subfertility and otheranomalies associated with the presence of Mycoplasma spumans and Mycoplasma maculosumin a Bernese Mountain Dog kennel. After the arrival of two dogs from abroad, some fertilitydisorders, such as unsuccessful mating, pregnancy losses and abnormal sperm analysis results,were observed. Two consecutive samplings (vaginal swabs) of three and two bitches with prob-lems, respectively, were performed and M. spumans and M. maculosum were identified by PCRand sequencing. After treatment for 15 days with doxycycline and 9 days with azithromycin,successful pregnancies were achieved and the results of the sperm analyses were reversed.Considering that no other infectious agents causing subfertility problems were detected andthat no management measures or other medication apart from these antibiotics were applied,it was concluded that fertility problems were due to the presence of these two Mycoplasmaspecies.

Effects of antibiotic treatment and antibiotics combined with surgery treatment on the prognosis of patients with infective endocarditis / 中华传染病杂志

Objective:To investigate the effects of antibiotic treatment and antibiotics combined with surgery treatment on the prognosis of patients with infective endocarditis (IE).Methods:The clinical data and prognosis of all patients diagnosed as IE discharged from Shanghai Jiao Tong University Affiliated Sixth People′s Hospital from June 2011 to May 2021 were collected. There were 240 IE patients, divided into antibiotic treatment group and the antibiotics combined with surgery group according to the treatment methods. The clinical characteristics and prognosis of the IE patients were compared between the two groups, so as to investigate the timing of surgery for IE patients and to analyze the effects of the two treatment methods on the prognosis of IE patients.Statistical analysis methods including Wilcoxon rank sum test, chi-square test, Kaplan-Meier survival analysis and Cox regression analysis were used when appropriate.Results:Of the 240 patients with IE, 63 cases were only treated with antibiotics and 177 cases were treated with antibiotics combined with surgery. After propensity score matching (PSM), one-year mortality rate of the IE patients in the antibiotics combined with surgery group was 11.1%(4/36), which was significantly lower than that in the antibiotic treatment group (33.3%(12/36), χ2=5.14, P=0.023). The median values of left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD) and left ventricular fractional shortening (LVFS) in the antibiotics combined with surgery group were 59%, 47 mm and 31%, respectively, which were significantly lower than those before surgery (63%, 54 mm and 34%, respectively, Z=6.19, 9.36 and 6.11, respectively, all P<0.001). The most common surgical indication was moderate to severe heart failure, and there was no significant difference between the early operation group and the late operation group (both P>0.050). The one-year cumulative survival rate of antibiotics combined with surgery group was 94.9%, which was significantly higher than that in the antibiotic treatment group (83.2%, χ2=7.38, P=0.007). Heart failure and Pitt bacteremia scores≥4 were the independent risk factors for one-year all-cause death of the IE patients (hazard ratio ( HR)=5.668 and 19.392, respectively, both P<0.050). Hospital days and antibiotics combined with surgery were independent related factors for reducing the risks of one-year all-cause death ( HR=0.931 and 0.299, respectively, both P<0.050). Pitt bacteremia scores≥4 had the greatest impact on one-year prognosis of the IE patients. Conclusions:Surgery could significantly improve cardiac function and one-year prognosis of the IE patients. IE patients with heart failure and Pitt bacteremia score≥4 should be actively treated.

Terapia antibiótica postoperatoria en pacientes sanos sometidos a cirugía de terceros molares impactados / Postoperative antibiotic therapy in healthy patients who underwent impacted third molar surgery

RESUMEN: Introducción: La adición de tratamiento antibiótico al tratamiento analgésico en el manejo postoperatorio de cirugía de terceros molares en pacientes sanos, ha sido propuesta principalmente para prevenir complicaciones postoperatorias. Sin embargo, es una terapia controvertida en la actualidad. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos siete revisiones sistemáticas que en conjunto incluyeron ocho estudios primarios, de los cuales siete corresponden a ensayos aleatorizados. Concluimos que la adición del tratamiento antibiótico postoperatorio en cirugía de terceros molares en pacientes sanos, disminuye la incidencia de fiebre y probablemente disminuye el desarrollo de infección. Además, podría disminuir la inflamación, pero la certeza de la evidencia es baja. Finalmente, no existe claridad de que la adición de un tratamiento antibiótico postoperatorio en cirugía de terceros molares disminuya el dolor y otros efectos adversos ya que la certeza de la evidencia ha sido evaluada como muy baja.

ABSTRACT: Introduction: Postoperative antibiotic therapy in addition to analgesics for impacted third molar surgery in healthy patients has been proposed to prevent postoperative complications. However, antibiotic use in healthy patients is still controversial. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified seven systematic reviews including eight studies overall, of which seven were randomized trials. We conclude that postoperative antibiotic therapy compared with no antibiotic treatment in healthy patients who underwent third molar surgery reduces the risk of fever and probably reduces the risk of infection. Also, it may reduce inflammation, but the certainty of the evidence has been assessed as low. Finally, we are uncertain whether the addition of a postoperative antibiotic in third molar surgery reduces pain and other adverse events, as the certainty of the evidence has been assessed as very low.

Infección por Salmonella enteritidis en pacientes con lupus eritematoso sistémico / Salmonella enteritidis infection in patients with systemic lupus erythematosus

RESUMEN La infección por Salmonella enteritidis (ISE) es rara en pacientes con lupus eritematoso sistémico (LES), y comúnmente se confunde con exacerbaciones del LES. ISE en pacientes con LES se ha relacionado con malos desenlaces. Este artículo describe los hallazgos clínicos y desenlaces de 5 pacientes con LES y diagnóstico de ISE, en una cohorte de 325 pacientes (1,53%). Todos los pacientes fueron mujeres, con una edad promedio de 28,2 (14 a 37 años). La duración promedio del LES antes de la ISE clínica fue de 3,2 años (1 a 7 años). No hubo evidencia de infección recurrente. Los pacientes fueron tratados con ciprofloxacino o ceftriaxona, con resolución de las manifestaciones clínicas en 4 pacientes. Un paciente murió debido a falla orgánica multisistémica. Nuestro reporte remarca las manifestaciones clínicas inespecíficas de la ISE que asemeja actividad lúpica. Un adecuado diagnóstico y una terapia antibiótica temprana son esenciales para mejorar los desenlaces de estos pacientes.

ABSTRACT Salmonella enteritidis infection (SEI) is rare in systemic lupus erythematosus (SLE) patients, and it is often mistaken with SLE flares. SEI in SLE patients has been associated with a poor outcome. A description is presented of the clinical features and outcomes of five patients with an SEI from a cohort of 325 patients with SLE (1.53%). All patients were women, with a mean age of 28.2 years (14 to 37 years). Mean duration of SLE before clinical SEI was 3.2 years (1 to 7 years). There was no evidence of recurrent infection. The patients were treated with ciprofloxacin and/or ceftriaxone, with resolution of clinical manifestations in four of them. One patient died due to multisystem organ failure. Our report highlights the unspecific clinical manifestations of SEI that resembles lupus flare-up. An accurate diagnosis and early antibiotic treatment are essential to improve their outcomes.

Efectividad de una nueva propuesta en el tratamiento antimicrobiano de la infección del pie diabético / Effectiveness of a new proposal for antibiotic treatment of the diabetic foot infection

Introducción: Las úlceras del pie diabético son asiento de infecciones que pueden poner en peligro tanto la extremidad como la vida del paciente. Su adecuado diagnóstico es necesario para efectuar un tratamiento antimicrobiano apropiado. Objetivo: Evaluar la correlación entre el uso de un nuevo protocolo de antibiótico-terapia y la respuesta favorable de las infecciones del pie diabético, según procederes quirúrgicos y tiempo de estadía hospitalaria. Métodos: Se realizó un estudio experimental en el Hospital Provincial "Dr. Antonio Luaces Iraola", de Ciego de Ávila desde octubre de 2012 a septiembre de 2015. La muestra de 100 pacientes obtenida de forma aleatoria se dividió en dos grupos, uno control, al cual se le aplicó el esquema propuesto en el Programa de Atención Integral al paciente con ulcera de pie diabético, y otro experimental, al que se le aplicó un esquema basado en el mapa microbiológico local. Se caracterizó la muestra según edad, sexo, tiempo de evolución como diabético, clasificación según Wagner, y severidad de la infección. Se aplicaron las pruebas chi cuadrado, t de Student y de U de Mann-Whitney para demostrar igualdad entre los grupos. Resultados: Los procederes quirúrgicos requeridos en el grupo control, resultaron significativamente más invasivos que en el grupo experimental; y los pacientes del primero precisaron de más días de ingreso hospitalario que los del segundo. Conclusiones: La aplicación de un esquema antimicrobiano basado en las características microbiológicas locales propicia la realización de menos amputaciones y se acorta la estadía hospitalaria de los pacientes tratados por pie diabético(AU)

Introduction: The diabetic foot ulcers are common locations for serious infections that can affect both the limb and the patient´s life. Early appropriate diagnosis is necessary to establish a correct antibiotic treatment. Objective: To assess the correlation between the use of a new protocol for antibiotic treatment and the favorable response of the diabetic foot infections, depending on surgical procedures and length of stay at hospital. Methods: An experimental study has been conducted in "Dr. Antonio Luaces Iraola" hospital in Ciego de Ávila province from October 2012 to September 2015. A random sample of 100 patients was divided into two groups, one was treated with the comprehensive care program for patients with diabetic foot ulcers and the other with the new proposed protocol based on the local microbiological map. The sample was characterized by age, gender, length of time with diabetes, Wagner classification and severity of infection. Chi square, T student and U Mann-Whitney tests were applied to prove equality between groups. Results: Surgical procedures needed in the control group were more invasive than in the experimental group and patients from the former group had a longer stay at hospital than the latter. Conclusions: The use of an antibiotic protocol based on the local microbiological characteristics favor the reduction of the number of amputations and shorter stay at hospital in patients with diabetic foot(AU)

Pyogenic Vertebral Osteomyelitis: Clinical Features, Diagnosis, and Treatment

Pyogenic vertebral osteomyelitis (PVO) may result in neurological deficits and sequelae, so early diagnosis and appropriate treatment are critical. Many previous studies on PVO exist, but our paper has aimed to comprehensively summarize the clinical aspects of PVO. Through review of the vast literature on the clinical research of PVO an overview of the clinical characteristics, diagnostic methods, treatment and prognosis is provided.

Apendicitis aguda / Acute appendicitis

Con el uso de las imágenes de creciente sensibilidad, el número de pacientes con diagnóstico de apendicitis ha aumentado, y una significativa proporción de ellos puede no progresar a apendicitis clínicamente relevante o puede resolver espontáneamente y evitar la apendicectomía. Existen reglas de predicción clínica que, sumadas a la tomografía computarizada o la ecografía, pueden tener una sensibilidad y especificidad significativamente altas tanto para descartar como para confirmar el diagnóstico. Los antibióticos deben ser considerados una válida opción terapéutica y su uso, discutido con los pacientes. (AU)

With the use of images of increasing sensitivity, the number of patients diagnosed with appendicitis has increased and a significant proportion of them could not progress to clinically relevant appendicitis or resolve spontaneously and avoid appendectomy. There are clinical prediction rules which combined with computed tomography or ultrasound may have a significantly higher sensitivity and specificity both to rule out as to confirm the diagnosis. Antibiotics should be considered a valid treatment option and its use discussed with patients. (AU)

The Clinical Courses of Patients with Congenital Cystic Adenomatoid Malformation Complicated by Pneumonia

PURPOSE: We evaluated the clinical characteristics and courses of patients with congenital cystic adenomatoid malformation (CCAM) complicated by pneumonia. MATERIALS AND METHODS: We retrospectively reviewed the records of 19 adult patients with surgically confirmed CCAM between March 2005 and July 2013. RESULTS: Eighteen of nineteen patients presented with acute pneumonia symptoms and signs, and inflammatory markers were elevated. On chest computed tomography, all 18 patients had parenchymal infiltration around cystic lesions, 17 (94%) had an air-fluid level, and 2 (11%) had pleural effusion. After antibiotics treatment for a median of 22 days prior to surgery, all acute pneumonia symptoms and signs disappeared in 17 (94%) patients at a median of 10 days. Improvements and normalization of inflammatory marker levels, occurred in 17 (94%) and 9 (50%) patients at medians of 8 and 17 days, respectively. Radiological improvement was evident in 11 (61%) patients, at a median of 18 days, of these patients, partial radiological improvement occurred in 10 (56%) and complete radiological resolution in only 1 (6%). One patient (6%) did not improve in terms of clinical, laboratory, or radiological findings despite antibiotic treatment for 13 days. Consequently, after 17 (94%) elective and 1 (6%) emergency surgeries, all patients improved without development of complications. CONCLUSION: We described the clinical characteristics and courses of patients with CCAM complicated by pneumonia, and showed that surgery may be performed safely after clinicolaboratory improvement is attained upon antibiotic treatment, even in the absence of complete radiological resolution.

Evaluation the clinical significance of procalcitonin levels detection on the diagnosis and treatment for elderly patients with severe pulmonary infection / 中国基层医药

Objective To evaluate the diagnostic and prognostic evaluation of Procalcitonin (PCT)levels detection for elderly patients with severe pulmonary infection.Methods 60 elderly patients with severe pulmonary infection were selected,as the infected group,wherein 45 cases with bacterial infection,15 cases with non -bacterial infections.Another 60 cases elderly patients excluded infectious diseases were selected as the control group.PCT,CRP and WBC levels in two groups were detected and compared.The infection group was randomly divided into two groups,each of 30 cases,the control group received conventional anti -infection treatment,while the observation group developed solutions to optimize antimicrobial drugs by detecting changes in PCT and CRP.Antibiotic course,antimi-crobial drug costs,superinfection and adverse reaction rates in two groups were recorded and compared.Results PCT,CRP levels and WBC in the infected group were (17.4 ±11.3)ng/mL,(43.5 ±18.7)mg/L and (10.4 ± 7.3)×109 /L,which in the control group were (0.4 ±0.2)ng/mL,(6.3 ±3.6)mg/L and (5.4 ±1.4)×109 /L,the difference was statistically significance (t =7.369,9.570,3.295,all P <0.05 ).PCT levels of bacterial infection group was (27.2 ±14.7)ng/mL,which in non -bacterial infection group was (8.2 ±2.7)ng/mL,the difference was statistically significant (t =7.369,9.570,3.295,all P <0.05).Antibiotic course,antimicrobial drug costs,superin-fection and adverse reactions in the observation group were significantly lower than those in the control group,the difference statistically significant (t =6.994,27.71,χ2 =6.171,6.984,all P <0.05).Conclusion PCT detection has an important value of infection diagnosis especially in elderly patients with severe pulmonary infection,and can be used as the basis for antibiotic treatment.

Successful antibiotic treatment of Pseudomonas stutzeri-induced peritonitis without peritoneal dialysis catheter removal in continuous ambulatory peritoneal dialysis

Pseudomonas stutzeri is a Gram-negative, rod-shaped, motile, single polar-flagellated, soil bacterium that was first isolated from human spinal fluid and is widely distributed in the environment. It was isolated as an uncommon opportunistic pathogen from humans, and a few cases of P. stutzeri-induced peritonitis have been reported in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Catheter removal with antibiotic treatment is generally recommended because peritonitis by Pseudomonas species is commonly associated with catheter-related infection. Here, we describe the first case of P. stutzeri-induced peritonitis in an 82-year-old woman in Korea. She had received two antipseudomonal antibiotics, an aminoglycoside (isepamicin, Yuhan corporation, Seoul, Korea) and a fluoroquinolone (ciprofloxacin), and was successfully treated without removal of the CAPD catheter.

Mortality of therapeutic fish Garra rufa caused by Aeromonas sobria

<p><b>OBJECTIVE</b>To investigate a case of mass mortality of Garra rufa (G. rufa) from a fish hatchery farm in Slovakia.</p><p><b>METHODS</b>Causative bacterial agent was swabbing out of affected fish skin area and subsequently identified using commercial test system. Antibiotic susceptibility was determined by the disk diffusion method.</p><p><b>RESULTS</b>Infected G. rufa was characterized by abnormal swimming behaviour, bleeding of skin lesions and local haemorrhages. Despite of using recommended aquatic antibiotic treatment no improvement was achieved and Aeromonas sobria (A. sobria) was identified as a causative agent of fish mortality. Due to massive fish mortality, antibiotic susceptibility of pure isolated culture of A. sobria was evaluated employing eight antibiotics against human infections. A. sobria was resistant only against one antibiotic, namely ampicilin.</p><p><b>CONCLUSIONS</b>These results indicate that A. sobria can act as a primary pathogen of G. rufa and may be a potential risk factor for immunodeficient or immunoincompetent patients during the ichthyotherapy.</p>

Effectiveness of antibiotic treatment given to patients for an abnormal prostate specific antigen before prostate biopsy / 中华泌尿外科杂志

Objective To analyze the effect of antibiotic treatment on prostate specific antigen (PSA) derivations in patients with and without prostate cancer and to further determine if the changes of PSA values after antibiotic treatment could help to exclude inflammation in the differential diagnosis of an abnormal PSA.MethodsA total of 100 patients with lower urinary tract symptoms,a PSA level of 4 to 10 μg/L,free PSA/total PSA (fPSA/tPSA) ratio ＜ 0.25,and a negative digital rectal examination and transrectal ultrasonography were enrolled in this study.All patients received 500 mg of ciprofloxacin twice a day for 3 weeks.Free and total PSA values were measured before and after antibiotic treatment.All the patients were then scheduled for 12-core prostate biopsy.Results The mean tPSA value was (6.5 ± 1.2) and (5.1 ± 1.2) μg/L respectively before and after antibiotic treatment ( P ＜ 0.01 ).Ninety-one patients (91.0％) showed tPSA reduction after antibiotic therapy,of which 13 ( 14.3％ ) had prostate cancer on biopsy.In 17 cases (18.7％) post-treatment tPSA was less than 4 μg/L.Three of the 17 cases (17.6％)had prostate cancer on biopsy.In 6 of the 100 men post-treatment tPSA was between 4 and 10 μg/L and the fPSA/tPSA ratio was above 0.25.One of these cases had prostate cancer on biopsy.Seven cases had a ＞50％ reduction in PSA levels with no positive biopsy results.Although mean total PSA and PSAD decreased after treatment in both groups,the reductions within these parameters were not significantly different between patients with and without prostate cancer (P ＞ 0.05).Furthermore,no differences emerged in terms of the changes of other PSA derivations including fPSA and fPSA/tPSA ( P ＞ 0.05 ).ConclusionsThe PSA levels may change with long-term antibiotic treatment in patients with elevated PSA values.A decrease in PSA after antibiotic treatment does not rule out the presence of prostate cancer even if PSA decreases to a normal level.But a ＞ 50％ reduction in PSA levels may be associated with a decreasing risk of prostate cancer,which may allow a postponement of prostate biopsy in selected patients.

Mortality of therapeutic fish Garra rufa caused by Aeromonas sobria

Objective:To investigate a case of mass mortality of Garra rufa (G. rufa) from a fish hatchery farm in Slovakia. Methods: Causative bacterial agent was swabbing out of affected fish skin area and subsequently identified using commercial test system. Antibiotic susceptibility was determined by the disk diffusion method. Results: Infected G. rufa was characterized by abnormal swimming behaviour, bleeding of skin lesions and local haemorrhages. Despite of using recommended aquatic antibiotic treatment no improvement was achieved and Aeromonas sobria (A. sobria) was identified as a causative agent of fish mortality. Due to massive fish mortality, antibiotic susceptibility of pure isolated culture of A. sobria was evaluated employing eight antibiotics against human infections. A. sobria was resistant only against one antibiotic, namely ampicilin. Conclusions: These results indicate that A. sobria can act as a primary pathogen of G. rufa and may be a potential risk factor for immunodeficient or immunoincompetent patients during the ichthyotherapy.

Tratamiento sin antibióticos en recién nacidos febriles con pleocitosis del líquido cefalorraquídeo y presunta meningitis viral / Treatment without antibiotics in febrile infants presenting with cerebrospinal fluid pleocytosis and supposed viral meningitis

INTRODUCCIÓN. El objetivo de esta investigación fue presentar la experiencia en antibioticoterapia en recién nacidos (RN) febriles con pleocitosis del líquido cefalorraquídeo (LCR) y presunción médica de meningitis viral. MÉTODOS. Se realizó un estudio retrospectivo con 310 RN con diagnóstico de meningitis aséptica, ingresados en el Servicio de Neonatología del Hospital Pediátrico Universitario Juan Manuel Márquez entre 1992 y 2009. Se determinó, utilizando estadística descriptiva, la indicación o no de tratamiento antibiótico, momento y motivos de la indicación. RESULTADOS. Hubo 204 RN (65,8 por ciento) con meningitis aséptica que egresaron favorablemente sin haber recibido tratamiento antibiótico. En 106 RN (34,2 por ciento) se indicaron antibióticos (en 76 inmediatamente al diagnóstico de meningitis y en 30 casos, mediatamente por diversos motivos). Los motivos para tratamiento inmediato fueron principalmente los resultados del examen citoquímico del LCR muy semejantes a los de una meningitis de causa bacteriana y los antecedentes de fiebre elevada o persistente. En la indicación mediata el principal motivo fue la concurrencia de infección del tracto urinario. En los pacientes que nunca recibieron tratamiento antibiótico, la mediana de estadía hospitalaria fue de 4 días (intervalo intercuartil 3-5 días) y para los que sí lo recibieron fue de 5 días (intervalo intercuartil 4-7 días) (p < 0,0001). CONCLUSIONES. Es aconsejable revisar el enfoque de utilizar tratamiento antibiótico ante todo RN proveniente de la comunidad cuando se encuentra pleocitosis del LCR y se presume la existencia de una meningitis viral, siempre y cuando existan condiciones de vigilancia profesional calificada y continua, y un laboratorio de microbiología con recursos suficientes para respaldar una estrategia de tratamiento con uso racional de la antibioticoterapia

INTRODUCTION. The aim of present research was to present the antibiotic-therapy experience in febrile newborn (NB) presenting with cerebrospinal fluid pleocytosis (CSFP) and supposed viral meningitis. METHODS. A retrospective study was conducted in 310 NB diagnosed with aseptic meningitis admitted in the Neonatology Service of the Juan Manuel Márquez Children University Hospital between 1992 and 2009. Using the descriptive statistic method the indication or not of antibiotic treatment, moment and indication reasons were determined. RESULTS. There were 204 NB (65,8 percent) presenting with aseptic meningitis favorably discharged without antibiotic treatment. In 106 NB (34,2 percent) antibiotics were prescribed (in 76 immediately to be diagnosed with meningitis and in 30 cases, due to different reasons. The reasons for immediate treatment were mainly the results of cytochemical examination of CSF very similar to that of bacterial meningitis and backgrounds of a high or persistent fever. In mediate indication the main reason was the concurrence urinary tract infection. In patients that never were received antibiotic treatment, the hospital stay mean was of 4 days (inter-quartile interval 3-5 days), and for those that received treatment it was of 5 days (inter-quartile 3-7 days) (p < 0,0001). CONCLUSIONS. It is advisable to review the approach to use the antibiotic treatment in the case of a NB from the community when there is CSF pleocytosis and the supposed existence of viral meningitis provided that there are conditions of qualified and continuous professional surveillance and a laboratory with enough resources to support a treatment strategy with a rational use of the antibiotic therapy

Oral Agents for the Treatment of Orthopedic Infections Caused by Methicillin-resistant Staphylococci / 감염과화학요법

Orthopedic infections, especially implant-associated infections, are difficult to treat. Long-term oral antibiotic, along with appropriate surgery, is often needed to eradicate infections. The question still remains which antibiotic regimen is best in this setting because of a paucity of large comparative clinical trials. I reviewed in vitro and in vivo studies evaluating the effectiveness of various oral antibiotic regimens of monotherapy or combination therapy for orthopedic infections caused by methicillin-resistant staphylococci.

Antibiotic Resistance and Treatment Update of Community-Acquired Pneumonia / 대한내과학회지

The emergence of penicillin-resistant S. pneumoniae has issued in the management of community-acquired pneumonia (CAP). However, the clinical outcome did not match with penicillin resistance. Thus, recent (Jan/2008) change of penicillin breakpoints for nonmeningeal strain was done and this made prevalence of penicillin resistance under 5% worldwide. Macrolide resistance of S. pneumoniae in Korea is prevalent (70-80%). Thus, the Korean CAP guideline did not include macrolide monotherapy as empiric therapy. Fluoroquinolone resistance of pneumococcus is very low, however, concerning of the increase of resistance is present.Some new antibiotics for the multidrug resistant S. pneumoniae should be reserved for the future. Macrolide resistance of Mycoplasma pneumoniae is reported in various regions in the world, however, data of the clinical significance is rare. Increased beta-lactamase production of Haemophilus influenzae urges us to use beta-lactam/beta-lactamase or 3rd generation cephalosporin if Haemophilus is pathogen. Pneumococcal vaccine usage is an effective way to prevent invasive diseases by S. pneumoniae (including resistant pathogen). The rate of pneumococcal vaccination in Korea is very low (0.8% in adult). Strategies to control resistance that include effective antimicrobial treatment, vaccination, infection control, appropriate policies and regulations, 'antibiotic stewardship' and education of appropriate antibiotic use, are greatly in need.

Antibiotic Resistance and Treatment Update of Community-Acquired Pneumonia / 대한내과학회지

The emergence of penicillin-resistant S. pneumoniae has issued in the management of community-acquired pneumonia (CAP). However, the clinical outcome did not match with penicillin resistance. Thus, recent (Jan/2008) change of penicillin breakpoints for nonmeningeal strain was done and this made prevalence of penicillin resistance under 5% worldwide. Macrolide resistance of S. pneumoniae in Korea is prevalent (70-80%). Thus, the Korean CAP guideline did not include macrolide monotherapy as empiric therapy. Fluoroquinolone resistance of pneumococcus is very low, however, concerning of the increase of resistance is present.Some new antibiotics for the multidrug resistant S. pneumoniae should be reserved for the future. Macrolide resistance of Mycoplasma pneumoniae is reported in various regions in the world, however, data of the clinical significance is rare. Increased beta-lactamase production of Haemophilus influenzae urges us to use beta-lactam/beta-lactamase or 3rd generation cephalosporin if Haemophilus is pathogen. Pneumococcal vaccine usage is an effective way to prevent invasive diseases by S. pneumoniae (including resistant pathogen). The rate of pneumococcal vaccination in Korea is very low (0.8% in adult). Strategies to control resistance that include effective antimicrobial treatment, vaccination, infection control, appropriate policies and regulations, 'antibiotic stewardship' and education of appropriate antibiotic use, are greatly in need.

Extensive, Non-Healing Scalp Ulcer Associated with Trauma-Induced Chronic Osteomyelitis

A 77-year-old woman presented with a trauma to the scalp caused from the blade of a windmill. The condition was persistent from the past 50 years. At the initial examination, a deep, foul-smelling and well-circumscribed ulcer was apparent on the head region, involving the majority of the cranium. Skin biopsy specimens of the lesion were nonspecific. The bone biopsy showed extensive necrotic areas of bone and soft tissues, with lymphocytic exudate foci. A computed tomography scan of the head revealed bone destruction principally involving both the parietal bones, and parts of the frontal and occipital bones. Streptococcus parasanguis was isolated from the skin culture, and Proteus mirabilis and Peptostreptococcus sp. were identified in the cultures from the bone. A long-term treatment with amoxicillin-clavulanic acid (1 g/12 h) and levofloxacin (500 mg/day) was prescribed, but even after 6 months, the lesion remained unchanged. The frequency of occurrence of scalp ulcers in dermatological patients is less, principally because of the rich blood supply to this area. We have not found any similar case report of a scalp ulcer secondary to chronic osteomyelitis discovered more than 50 years after the causal trauma. We want to highlight the importance of complete cutaneous evaluation including skin and bone biopsies, when scalp osteomyelitis is suspected.

Eficacia clínica de los macrólidos como parte del tratamiento empírico en neumonía de la comunidad que se interna: estudio piloto, aleatorizado, a doble-ciego / Clinical efficacy of macrolides as part of a combination therapy of community-acquired pneumonia: a pilot study

Introducción: A la fecha no se ha publicado un estudio aleatorizado que soporte las recomendaciones de tratamiento combinado en neumonía de la comunidad (NAC). El objetivo de este ensayo piloto fue evaluar los efectos clínicos de la adición de un macrólidoa la terapia empírica en pacientes con NAC. Materiales y métodos: Se aleatorizaron sesenta y dos pacientes hospitalizados por NAC a recibir ampicilina/sulbactam IV más azitromicina oral (n=32) versus ampicilina/sulbactam IV más placebo (n=30) a doble ciego. El punto final principal fue la cura precoz, evaluada al 5to día, definida como alta médica antes del 5to día ó estabilización clínica sin necesidad de cambios terapéuticos. Los puntos finales secundarios fueronestadía hospitalaria, fallo terapéutico y mortalidad. Resultados: La cura precoz fue mayor en el grupo macrólidos (81% vs 53%) (p=0.02), con una reducción de riesgo relativa de 60% (95% CI: 10-82%), una reducción absoluta de riesgo de 28% (95% CI: 5-50%) y un número necesario a tratar de 3 pacientes (95%CI: 2-18). La estadía hospitalaria fue menor en el grupo macrólidos (6,5 ± 2,3 vs 8,5 ±4,5 días, p=0.027). No hubo diferencias en cuanto a fallo terapéutico (3 versus 6 pacientes) ni mortalidad entre ambos grupos. Conclusiones: En este estudio piloto, el uso de azitromicina oral en combinación conbetalactámicos se asoció a una mayor tasa de cura precoz y menor estadía hospitalaria, sugiriendo una resolución clínica acelerada de la neumonía.

Background and objectives: To date, no randomized trials support the recommendation of combination therapy for community-acquired pneumonia (CAP). The aim of the pilot study was to determine the clinical efficacy of the addition of a macrolide as part of anempirical therapy of patients with CAP.Methods: Sixty-two patients admitted for non-severe CAP were randomized into two double-blind groups: intravenous ampicillin/sulbactam plus oral azithromycin (n=32) versusintravenous ampicillin/sulbactam plus placebo (n=30). The primary end point was early cure, evaluated at 5th day, and defined as 1) discharge before 5th day; or 2) clinical stability without changes in the antibiotic therapy. The secondary end points were lengthof stay, treatment failure and mortality. Results: The early cure rate was higher in the macrolide group than in the placebo group (81% vs 53%) (p = 0.02), with a relative risk reduction of 60% (95% CI: 10 - 82%), anabsolute risk reduction of 28% (95% CI: 5 - 50%) and a needed number of 3 patients to be treated (95% CI: 2 - 18). The length of stay was shorter in the macrolide group (6.5 ±2.3 vs 8.5 ± 4.5 days, p = 0.027), and there were no differences in treatment failure (3 vs6 patients) or mortality. Conclusion: The use of oral azithromycin in combination with ampicillin/sulbactam wasassociated with a higher early cure rate and a shorter length of stay, suggesting an accelerated clinical resolution of CAP.