ABSTRACT
Actinomyces cardiffensis is an anaerobic, Gram-positive, non-spore-forming rod that was first identified by Hall et al. (Hall V. et al. (2002) J Clin Microbiol 40:3427-31). Here we report a case of bacteremia with liver and lung abscesses associated with A. cardiffensis. A 67-year-old man was hospitalized with fever and headache for 20 days. Blood culture revealed an Actinomyces species, which was ultimately identified as A. cardiffensis by 16S rRNA gene sequencing. A computed tomography scan of his chest showed small abscesses in his lung and liver. After a 3-week course of intravenous ceftriaxone, the patient showed rapid improvement. The patient was transitioned to oral amoxicillin for the remainder of his antibiotic treatment.
Subject(s)
Actinomyces/isolation & purification , Actinomycosis/diagnosis , Sepsis/diagnosis , Actinomycosis/microbiology , Actinomycosis/pathology , Administration, Oral , Aged , Amoxicillin , Anti-Bacterial Agents/administration & dosage , Blood/microbiology , Ceftriaxone/administration & dosage , Cluster Analysis , DNA, Bacterial/chemistry , DNA, Bacterial/genetics , DNA, Ribosomal/chemistry , DNA, Ribosomal/genetics , Hospitalization , Humans , Infusions, Intravenous , Liver Abscess/complications , Liver Abscess/diagnosis , Liver Abscess/microbiology , Liver Abscess/pathology , Lung Abscess/complications , Lung Abscess/diagnosis , Lung Abscess/microbiology , Lung Abscess/pathology , Male , Phylogeny , RNA, Ribosomal, 16S/genetics , Radiography, Thoracic , Sepsis/complications , Sepsis/microbiology , Sepsis/pathology , Sequence Analysis, DNA , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND: To investigate the clinical results of sitagliptin (SITA) and the characteristics of the treatment failure group or of low responders to SITA. METHODS: A retrospective study of type 2 diabetic patients reviewed 99 cases, including 12 treatment failure cases, who stopped SITA because of worsening patients' condition, and 87 cases, who continued treatment over five visits (total 9.9±10.1 months) after receiving the prescription of SITA from December 2008 to June 2009. Subjects were classified as five groups administered SITA as an initial combination with metformin (MET), add-on to metformin or sulfonylurea, and switching from sulfonylurea or thiazolidinedione. The changes in HbA1c level from the first to last visit (ΔHbA1c) in treatment maintenance group were subanalyzed. RESULTS: The HbA1c level was significantly reduced in four groups, including initial coadministration of SITA with metformin (ΔHbA1c=-1.1%, P<0.001), add-on to MET (ΔHbA1c=-0.6%, P=0.017), add-on to sulfonylurea (ΔHbA1c=-0.5%, P<0.001), and switching from thiazolidinedione (ΔHbA1c=-0.3%, P=0.013). SITA was noninferior to sulfonlyurea (ΔHbA1c=-0.2%, P=0.63). There was no significant adverse effect. The treatment failure group had a longer diabeties duration (P=0.008), higher HbA1c (P=0.001) and fasting plasma glucose (P=0.003) compared to the maintenance group. Subanalysis on the tertiles of ΔHbA1c showed that low-response to SITA (tertile 1) was associated with a longer diabetes duration (P=0.009) and lower HbA1c (P<0.001). CONCLUSION: SITA was effective and safe for use in Korean type 2 diabetic patients. However, its clinical responses and long-term benefit-harm profile is yet to be established.
