ABSTRACT
A 27 year old, HIV positive, homosexual man was admitted for evaluation and treatment of acute oligoarticular arthritis. Gonococcal arthritis was found in a single hip and a single sternoclavicular joint, which is an unusual distribution for this bacterial pathogen.
Subject(s)
Arthritis, Infectious/etiology , Gonorrhea/complications , HIV Seropositivity/complications , Hip Joint/microbiology , Sternoclavicular Joint/microbiology , Acute Disease , Adult , Humans , Male , Neisseria gonorrhoeae/isolation & purification , Opportunistic Infections/complicationsABSTRACT
We investigated the mechanism of resistance to penicillin in two penicillin-resistant clinical isolates of viridans streptococci that caused life-threatening infections in two patients not receiving chronic penicillin therapy. The first was a strain of Streptococcus intermedius that was isolated from the cerebrospinal fluid of a patient with post-neurosurgical meningitis. The second was a strain of Streptococcus mitis recovered from the bloodstream of a leukemic patient with neutropenia. Both patients failed to respond to penicillin. The mechanism of resistance in these strains was associated with diminished affinity for penicillin of their penicillin-binding proteins, as compared with those of penicillin-susceptible control strains. We conclude that penicillin-resistant viridans streptococci may cause serious infections even in patients not receiving chronic penicillin therapy, that this resistance is clinically significant and may result in failure of penicillin therapy, and that the mechanism of resistance in these strains is associated with diminished affinity of the penicillin-binding proteins for penicillin.
Subject(s)
Bacterial Proteins , Carrier Proteins/physiology , Hexosyltransferases , Muramoylpentapeptide Carboxypeptidase/physiology , Penicillin Resistance , Peptidyl Transferases , Streptococcal Infections/microbiology , Streptococcus/drug effects , Adult , Electrophoresis, Polyacrylamide Gel , Female , Humans , Male , Meningitis/microbiology , Middle Aged , Penicillin-Binding Proteins , Sepsis/microbiologyABSTRACT
In a prospective randomized study, contamination rates of disposable pressure transducers changed every two days (n = 81) were compared with those changed at four (n = 26) or eight days (n = 50); the mean daily incidence of contamination was 3% for each group. After four days of use, the cumulative prevalences of contamination were similar. However, after eight days, the cumulative prevalence was significantly higher in transducers used without change (6.9%) than in those changed every two days (2.9%). Gram-negative bacilli were present in 63% of contaminated transducers; over half were from the patients' own flora. The only definite transducer-related bacteremia occurred on a day of initial contamination and should have been unaffected by the interval of change. Routine use of disposable transducers can be safely extended to four days, even in a busy intensive care unit.
