Changes in epidemiology, clinical features and severity of influenza A (H1N1) 2009 pneumonia in the first post-pandemic influenza season.

Although the influenza A (H1N1) 2009 virus is expected to circulate as a seasonal virus for some years after the pandemic period, its behaviour cannot be predicted. We analysed a prospective cohort study of hospitalized adults with influenza A (H1N1) 2009 pneumonia at 14 teaching hospitals in Spain to compare the epidemiology, clinical features and outcomes of influenza A (H1N1) 2009 pneumonia between the pandemic period and the first post-pandemic influenza season. A total of 348 patients were included: 234 during the pandemic period and 114 during the first post-pandemic influenza season. Patients during the post-pandemic period were older and more likely to have chronic obstructive pulmonary disease, chronic kidney disease and cancer than the others. Septic shock, altered mental status and respiratory failure on arrival at hospital were significantly more common during the post-pandemic period. Time from illness onset to receipt of antiviral therapy was also longer during this period. Early antiviral therapy was less frequently administered to patients during the post-pandemic period (22.9% versus 10.9%; p 0.009). In addition, length of stay was longer, and need for mechanical ventilation and intensive-care unit admission were significantly higher during the post-pandemic period. In-hospital mortality (5.1% versus 21.2%; p <0.001) was also greater during this period. In conclusion, significant epidemiological changes and an increased severity of influenza A (H1N1) 2009 pneumonia were found in the first post-pandemic influenza season. Physicians should consider influenza A (H1N1) 2009 when selecting microbiological testing and treatment in patients with pneumonia in the upcoming influenza season.

Acrophialophora fusispora brain abscess in a child with acute lymphoblastic leukemia: review of cases and taxonomy.

A 12-year-old girl with acute lymphoblastic leukemia was referred to King Faisal Specialist Hospital and Research Center. The diagnosis without central nervous system (CNS) involvement was confirmed on admission, and chemotherapy was initiated according to the Children Cancer Group (CCG) 1882 protocol for high-risk-group leukemia. During neutropenia amphotericin B (AMB) (1 mg/kg of body weight/day) was initiated for presumed fungal infection when a computed tomography (CT) scan of the chest revealed multiple nodular densities. After 3 weeks of AMB therapy, a follow-up chest CT revealed progression of the pulmonary nodules. The patient subsequently suffered a seizure, and a CT scan of the brain was consistent with infarction or hemorrhage. Because of progression of pulmonary lesions while receiving AMB, antifungal therapy was changed to liposomal AMB (LAMB) (6 mg/kg/day). Despite 26 days of LAMB, the patient continued to have intermittent fever, and CT and magnetic resonance imaging of the brain demonstrated findings consistent with a brain abscess. Aspiration of brain abscess was performed and the Gomori methenamine silver stain was positive for hyphal elements. Culture of this material grew Acrophialophora fusispora. Lung biopsy showed necrotizing fungal pneumonia with negative culture. The dosage of LAMB was increased, and itraconazole (ITRA) was added; subsequently LAMB was discontinued and therapy was continued with ITRA alone. The patient demonstrated clinical and radiological improvement. In vitro, the isolate was susceptible to low concentrations of AMB and ITRA. A. fusispora is a thermotolerant, fast-growing fungus with neurotropic potential. We report the first case of human infection involving the CNS. Acrophialophora resembles Paecilomyces but differs in having colonies that become dark and in the development of phialides along the sides or at the tips of echinulate brown conidiophores. Conidia are borne in long chains and are smooth or ornamented with fine-to-coarse echinulations, sometimes in spiral bands. The taxonomy of the genus Acrophialophora is reviewed, and Acrophialophora nainiana and Acrophialophora levis are considered as synonyms of A. fusispora.

In vitro activity of sparfloxacin against Salmonella typhi.

Comparative in vitro activity of sparfloxacin was determined by the broth dilution method against 104 clinical isolates of Salmonella typhi. All of the isolates were inhibited by < or = 0.12 mg/l of this fluoroquinolone. Its inhibitory activity was slightly superior or comparable to that of other fluoroquinolones tested, namely ciprofloxain and norfloxain, and significantly greater than the conventional drugs, such as amikacin, ampicillin, Augmentin, ceftazidime, clindamycin, tetracycline and trimethoprim-sulfamethoxazole, used in the treatment of typhoid fever.

The use of 25% glutaraldehyde solution to strengthen the aorta of patients with annuloaortic ectasia, ascending and aortic arch aneurysms.

Aortic friability is a problem of great concern and frustration for those performing operations on patients with ascending and arch aortic aneurysms, and particularly, on patients with annuloaortic ectasia. We have used 25% glutaraldehyde to successfully strengthen the distal aorta of three such patients. After the application, the aorta wall held sutures without tearing. Postoperative bleeding was minimal in each case. No neurological events were noticed, and all of the patients were discharged home within 2 weeks. The application of this tanning solution to such a friable aortic tissue should be considered as a helpful alternative to reduce postoperative bleeding, which is the most common complication after this type of surgery.

Coronary artery bypass grafting in patients with systemic lupus erythematosus. Report of 2 cases.

Systemic lupus erythematosus is an autoimmune disease that often involves the cardiovascular system. Coronary artery narrowing in patients with lupus erythematosus is severe, progressive, and related to the duration of the disease rather than to the age of the patient. Steroid use in such patients has improved their life expectancy but seems to be increasing the incidence of coronary involvement. Consequently, a larger number of systemic lupus erythematosus patients may be candidates for myocardial revascularization in the future. We report our experience with myocardial revascularization in 2 women with severe systemic lupus erythematosus, incapacitating angina, and severe obstructive coronary artery disease. One of the women required balloon angioplasty 19 months after coronary artery bypass grafting and remains asymptomatic nearly 3 years later. The other patient is free of symptoms 9 months after surgery. Our results with these 2 patients are encouraging. Long-term follow-up should yield further information regarding the benefits of myocardial revascularization and coronary angioplasty in patients with systemic lupus erythematosus.

Rapid detection of methicillin-resistant Staphylococcus aureus by Crystal MRSA ID System.

A commercially available method for the rapid detection of methicillin-resistant Staphylococcus aureus (BBL Crystal MRSA ID System) was evaluated and compared with conventional methods. All 52 isolates of methicillin-susceptible and 142 isolates of intrinsic methicillin-resistant S. aureus were correctly identified in 4 h by the test method, whereas correct identification took 11 to 24 h by conventional methods. The test is simple, rapid, and easy to perform and the results are easy to interpret.

In vitro activity of sparfloxacin (CI-978), a new broad-spectrum fluoroquinolone.

The in vitro activity of sparfloxacin (CI-978, AT-4140), a new fluoroquinolone, was compared with ciprofloxacin, norfloxacin and other commonly used antimicrobial agents against 650 strains of Enterobacteriaceae, 237 isolates of other gram-negative bacilli and 318 strains of gram-positive cocci. The MICs of sparfloxacin against 90% of the members of Enterobacteriaceae were between 0.12 and 0.5 microgram/ml. All the 48 isolates of notoriously drug-resistant Serratia marcescens were inhibited by less than 0.03-4.0 micrograms/ml of sparfloxacin. All the 90 isolates of Acinetobacter, 80 of the 88 strains of Pseudomonas aeruginosa and all the 28 isolates of Xanthomonas maltophilia were susceptible to sparfloxacin. The MIC90 for all the cocci tested ranged between 0.5 and 4.0 micrograms/ml of sparfloxacin. It inhibited 92% of enterococci as compared with 27% for ciprofloxacin and 22% for norfloxacin. It was better or comparable in activity to other fluoroquinolones and superior to penicillins, cephalosporins and aminoglycosides tested. There was cross-resistance between ciprofloxacin, norfloxacin and sparfloxacin.

Susceptibility of recent clinical isolates to temafloxacin (A-63004) and other antimicrobial agents.

In vitro susceptibility of 1008 strains of recent clinical isolates was determined against the new aryl fluoroquinolone temafloxacin (T-167, A-63004) ciprofloxacin, norfloxacin, ampicillin, piperacillin, cephalothin, cefoxitin, ceftazidime, gentamicin, amikacin, oxacillin and vancomycin. The minimum inhibitory concentrations (MICs) of temafloxacin in micrograms/ml required for > or = 90% isolates were 0.13-0.5 for enterobacter, 0.03-0.25 for Escherichia coli, 0.12-0.5 for Klebsiella, 0.5-1.0 for Proteus mirabilis, 0.12-0.5 for Morganella morganii, 0.03-0.12 for Salmonella, 0.25-1.0 for Serratia marcescens, 0.03-0.12 for Shigella, 0.06-4.0 for Pseudomonas aeruginosa, 0.06-0.12 for Aeromonas hydrophila, 0.12-0.5 for Staphylococcus aureus, 0.12-1.0 for coagulase negative staphylococci and 4.0-8.0 for enterococci. The antibacterial activity of temafloxacin was comparable or superior to other drugs tested against most organisms. However, Xanthomonas malthophilia was relatively more susceptible to ciprofloxacin and norfloxacin, and temafloxacin had significantly high antibacterial activity against enterococci as compared to other fluoroquinolones.

Evaluation of BRL 42715, a beta-lactamase-inhibiting penem.

BRL 42715 is a new penem which inhibits a wide range of plasmid as well as chromosomally mediated bacterial beta-lactamases. We used a total of 902 recent clinical isolates, consisting of 455 Enterobacteriaceae, 247 staphylococci and 200 other gram-negative bacteria to evaluate its ability for potentiation of amoxycillin. MICs for all the 104 strains of methicillin-susceptible Staphylococcus aureus were reduced from 8-greater than 32.0 to less than or equal to 0.06 micrograms/ml in the presence of 1-5 micrograms/ml of this penem. It was also highly effective in inhibiting the beta-lactamase of a wide variety of gram-negative bacteria, thereby bringing their MIC values for amoxycillin from a 'resistant' range (greater than 32.0 micrograms/ml) to a 'susceptible' range (less than or equal to 8.0 micrograms/ml). Commonly resistant bacteria like Klebsiella, Enterobacter, Citrobacter, Morganella, Serratia, Acinetobacter and Aeromonas were rendered susceptible to amoxycillin in the presence of 1.0-5.0 micrograms/ml of BRL 42715.