ABSTRACT
In the study presented here, data collected prospectively from 340 adult patients hospitalised in five countries with bacteremic pneumococcal CAP and treated with a ss-lactam +/- a macrolide were analysed retrospectively to evaluate the efficacy of this antimicrobial combination. Univariate and multivariate analyses revealed no significant effect on case fatality rate when a macrolide/ss-lactam regimen was used as initial therapy. Results were not affected by severity of illness, or by excluding patients who died within 2 days of admission. Identified predictors of death in a multivariate regression model were age >65 years (OR=2.6), two or more lung lobes affected (OR=2.2), and severity of disease as estimated using the acute physiology score (APS)>8.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Lactams/therapeutic use , Macrolides/therapeutic use , Pneumonia, Pneumococcal/drug therapy , Streptococcus pneumoniae , Adult , Bacteremia/drug therapy , Drug Therapy, Combination , Female , Humans , Male , Prospective Studies , Treatment OutcomeABSTRACT
We report here a case of meningitis caused by Salmonella virchow in a woman without signs or history of immunosuppression. Salmonella meningitis is a rare complication of human salmonellosis. The patient was successfully treated with ciprofloxacin. To our knowledge, this is the first reported case of confirmed meningitis in an adult caused by this serotype.
Subject(s)
Meningitis, Bacterial/etiology , Salmonella Infections/etiology , Ciprofloxacin/therapeutic use , Female , Humans , Meningitis, Bacterial/drug therapy , Middle Aged , Salmonella Infections/drug therapyABSTRACT
To define the influence of prognostic factors in patients with community-acquired pneumococcal bacteremia, a 2-year prospective study was performed in 5 centers in Canada, the United States, the United Kingdom, Spain, and Sweden. By multivariate analysis, the independent predictors of death among the 460 patients were age >65 years (odds ratio [OR], 2.2), living in a nursing home (OR, 2.8), presence of chronic pulmonary disease (OR, 2.5), high acute physiology score (OR for scores 9-14, 7.6; for scores 15-17, 22; and for scores >17, 41), and need for mechanical ventilation (OR, 4.4). Of patients with meningitis, 26% died. Of patients with pneumonia without meningitis, 19% of those with >/=2 lobes and 7% of those with only 1 lobe involved (P=.0016) died. The case-fatality rate differed significantly among the centers: 20% in the United States and Spain, 13% in the United Kingdom, 8% in Sweden, and 6% in Canada. Differences of disease severity and of frequencies and impact of underlying chronic conditions were factors of probable importance for different outcomes.
Subject(s)
Bacteremia/transmission , Community-Acquired Infections/microbiology , Pneumococcal Infections/transmission , Aged , Bacteremia/physiopathology , Canada , Community-Acquired Infections/physiopathology , Humans , Multivariate Analysis , Pneumococcal Infections/physiopathology , Prognosis , Spain , Sweden , United Kingdom , United StatesABSTRACT
Semiquantitative cultures were compared with blood cultures during one year in order to see if the routine use of a semiquantitative catheter culture method (SQC) in unselected patients can detect or predict infection associated with central venous catheters. Catheter infection, i.e. greater than or equal to 15 colony forming units (cfu) per plate, occurred in 137 of 542 catheter tips (25%), mainly with coagulase-negative staphylococci. Catheter-associated bacteremia occurred in 17 of 93 cases (18%) where blood cultures had been drawn. In 15 of these, the catheter tip grew greater than or equal to 15 cfu. The predictive value for bacteremia of a positive SQC was only 21%. SQC is not a suitable method for the detection of catheter-associated bacteremia, but may be an indicator of the standard of central venous catheter hygiene.
