ABSTRACT
We report a failure of pristinamycin treatment in a case of pneumonia caused by streptogramins B-type resistant pneumococcus. We suggest that (i) streptogramins therapy should be avoided, if a previous treatment failure has been observed with a macrolide and/or if the antibiogram shows the MLS(B) co-resistance phenotype, and (ii) beta-lactams should remain the first-line antibiotics used for treatment of pneumococcal respiratory infections.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Pneumonia, Pneumococcal/drug therapy , Pneumonia, Pneumococcal/microbiology , Streptococcus pneumoniae/drug effects , Virginiamycin/therapeutic use , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Drug Resistance, Microbial , Female , Humans , Treatment Failure , Virginiamycin/pharmacologyABSTRACT
OBJECTIVE: To determine in patients with systemic lupus erythematosus (SLE) or with primary antiphospholipid syndrome (PAPS) the prevalence of cerebral magnetic resonance imaging changes (MRI) and the relationship with antiphospholipid antibodies. METHODS: Twenty-nine consecutive SLE patients, 24 PAPS patients and 31 healthy controls were prospectively included in the study and underwent MRI Scan over a 1-year period. MRI scans were analyzed separately by a neuroradiologist for white matter changes [periventricular hyperintensity (PVH) (0-6 scale), deep white matter hyperintensity (WMH) (0-24 scale)], and one neurologist for cerebral atrophy (0-39 scale) and stroke subtypes. Statistical assessment consisted of a discriminant analysis performed with SAS-package with MRI data as dependent variables and, as independent variables, age, sex, arterial hypertension, diabetes mellitus, cardiopathy, migraine, neurological symptoms, antiphospholipid antibodies, SLE, steroid treatment. RESULTS: The prevalence of cerebral atrophy was increased in both SLE and PAPS groups relative to controls. PVH and WMH scores were significantly higher in SLE and PAPS than in controls. Focal infarct did not differ in the SLE group when compared with PAPS. PVH and WMH scores were significantly higher in patients with neurological symptoms. Using a correlation test we found a weak significant correlation between cerebral atrophy and lupus anticoagulant. The multivariate analysis found only three independent variables related to PVH and WMH: age, the diagnosis of SLE and cerebral atrophy. CONCLUSIONS: Age, presence of SLE and presence of neurological symptoms were independently related with WMH and PVH, but not antiphospholipid antibodies.
