Sepsis associated with transhepatic cholangiography.

A retrospective study was carried out of 74 elderly patients with obstructive jaundice undergoing percutaneous transhepatic cholangiography (PTC) and/or percutaneous biliary drainage (PBD) in order to assess the effect of prophylactic antibiotics on the incidence of fever and sepsis complicating these procedures. Seventeen patients underwent PTC alone, while 57 had both PTC and PBD. Fifty-three patients had either primary or metastatic malignancy. In the other patients with benign disease, choledocholithiasis was the most common reason for undertaking these procedures. Prophylactic antibiotics were given in 80% of cholangiographies and 93% of biliary drainage procedures. There was an overall incidence of sepsis of 13.5%. Enterobacter cloacae and Acinetobacter anitratus were the most common blood culture isolates in patients with malignant biliary obstruction. The incidence of fever was no different between patients who underwent PTC alone compared with those who had PTC and PBD. Of 24 patients who developed fever, two died secondary to sepsis. Although there was no difference in the rate of sepsis and febrile episodes between the two groups, the risk of septic episodes and mortality emphasizes the need for antibiotic prophylaxis and early therapy in elderly patients undergoing percutaneous biliary drainage procedures.

Haemophilus parainfluenzae bacteremia associated with a pacemaker wire localized by gallium scan.

A young woman with a history of sick sinus syndrome and placement of a permanent pacemaker 6 months before admission had fever and Haemophilus parainfluenzae bacteremia. A gallium scan localized the infection to the site of the pacemaker wire. Echocardiograms were negative for any vegetations. The patient responded to cefotaxime and trimethoprim-sulfamethoxazole therapy. We believe that this is the first case of H. parainfluenzae bacteremia associated with a pacemaker wire and localized by gallium scan.

Pseudomonas paucimobilis bacteraemia associated with haemodialysis.

We report a case of Pseudomonas paucimobilis bacteraemia where the source was presumed to be related to haemodialysis. Previous reports have identified this organism as a pathogen in a variety of disease states including bacteraemia of unknown origin and in patients undergoing peritoneal dialysis.

Listeria monocytogenes meningitis in a human immunodeficiency virus-positive patient undergoing hemodialysis.

Listeria monocytogenes bacteremia without meningitis has been reported in patients who have undergone long-term hemodialysis and have transfusional iron overload. On the other hand, cases of Listeria bacteremia without meningitis have occurred sporadically among the acquired immunodeficiency syndrome population, mostly homosexuals. There have been no reports of Listeria meningitis occurring among persons who are antibody positive to human immunodeficiency virus or are intravenous drug abusers having chronic renal failure and undergoing hemodialysis. This patient represents the first case of Listeria bacteremia and meningitis to occur in an intravenous drug abuser who is human immunodeficient antibody positive, is receiving hemodialysis, and has transfusional iron overload.

Thiamphenicol in the treatment of gonococcal infections: a comparative trial with penicillin and spectinomycin.

The efficacy of thiamphenicol for treatment of uncomplicated gonococcal infection was compared with that of penicillin and spectinomycin in 370 women confined in the clinic to preclude reinfection before evaluation of treatment. Thiamphenicol (2.5 g perorally) was highly effective against beta-lactamase-producing Neisseria gonorrhoeae, but the failure rate in infections with non-beta-lactamase-producing N. gonorrhoeae was high. This rate was not, however, significantly higher than that for beta-lactamase-producing strains. The failure rate with thiamphenicol was significantly higher than that with spectinomycin (2 g im) in the treatment of infections due to beta-lactamase-producing N. gonorrhoeae but was essentially similar to that observed with aqueous procaine penicillin G (4.8 X 10(6) units im) plus probenecid (1 g perorally) among non-beta-lactamase-producing N. gonorrhoeae. Therefore thiamphenicol may be used as an alternative therapy for gonorrhea, especially for infections due to beta-lactamase-producing strains.

Cefuroxime, thiamphenicol, spectinomycin, and penicillin G in uncomplicated infections due to penicillinase-producing strains of Neisseria gonorrhoeae.

The use of cefuroxime and thiamphenicol in uncomplicated gonococcal infection was studied in 562 women confined to a clinic to preclude reinfection before cultural confirmation of cure. Cefuroxime was as effective as spectinomycin in the treatment of infections due to penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) and was significantly more effective than 4.8 units of aqueous procaine penicillin G with probenecid among non-penicillinase-producing (non-PPNG) strains. Thiamphenicol was highly effective against PPNG, but the failure rate in infections with non-PPNG was high and appeared to be related to the minimum inhibitory concentrations of thiamphenicol. This rate was not, however, significantly higher than that for PPNG strains. Thiamphenicol might therefore be used as an alternative for infections due to PPNG strains. If, however, thiamphenicol is used widely, selection of more resistant strains and thus an increasing proportion of failures may be expected.

Treatment of uncomplicated gonorrhoea in women. Comparison of rosoxacin and spectinomycin.

A comparative study of the new antibacterial agent, rosoxacin, a quinoline derivative, with spectinomycin was made in women with uncomplicated cervical, urethral, pharyngeal, and rectal gonorrhoea. Rosoxacin was given in three oral regimens: 200 mg in a single dose, 300 mg in a single dose, and 300 mg in two doses of 150 mg four hours apart. All culture results 72 hours after administration were negative for Neisseria gonorrhoeae in all 81 women compared with 107 of 109 who received 2 g spectinomycin intramuscularly. Thirty-five of the women successfully treated with rosoxacin harboured penicillinase-producing strains of N gonorrhoeae (PPNG) and 46 non-penicillinase-producing (non-PPNG) strains. Fifty of the women treated with spectinomycin had PPNG strains and 59 non-PPNG strains. Mild self-limiting side effects, principally dizziness, occurred in varying frequency with rosoxacin, but these were difficult to evaluate owing to the characteristics of the patient population and the conditions under which the study was conducted.

Single oral dose of cefaclor for the treatment of infections with penicillinase-producing strains of Neisseria gonorrhoeae.

A single oral dose of 3 g cefaclor was effective in the treatment of uncomplicated gonococcal infection in women due to penicillinase-producing strains of Neisseria gonorrhoeae (PPNG). Cefaclor was equally active in vitro against both PPNG (MIC range, 0.01-1.0 microgram/ml) and non-PPNG strains (MIC range, 0.005-2.0 micrograms/ml). As empirical treatment cefaclor was effective in 53 of 57 (93%) patients compared with ampicillin, to which only 37 of 53 (69.8%) patients responded. This difference was attributed to the 40% incidence of PPNG in the patients studied; as expected, such patients responded poorly to ampicillin.