Tracking drug-resistant Streptococcus pneumoniae in Oregon: an alternative surveillance method.

With the emergence of drug-resistant Streptococcus pneumoniae, community-specific antimicrobial susceptibility patterns have become valuable determinants of empiric therapy for S. pneumoniae infections. Traditionally, these patterns are tracked by active surveillance for invasive disease, collection of isolates, and centralized susceptibility testing. We investigated whether a simpler and less expensive method aggregating existing hospital antibiograms--could provide community-specific antimicrobial susceptibility data. We compared 1996 active surveillance data with antibiogram data from hospital laboratories in Portland, Oregon. Of the 178 S. pneumoniae active surveillance isolates, 153 (86% [95% confidence interval (CI) = 80% to 91%]) were susceptible to penicillin. Of the 1,092 aggregated isolates used by hospitals to generate antibiograms, 921 (84% [95% CI = 82%-87%]) were susceptible to penicillin. With the exception of one hospital's erythromycin susceptibility results, hospital-specific S. pneumoniae susceptibilities to penicillin, cefotaxime, trimethoprim-sulfamethoxazole, and erythromycin from the two methods were statistically comparable. Although yielding fewer data than active surveillance, antibiograms provided accurate, community-specific drug-resistant S. pneumoniae data in Oregon.

Legalized physician-assisted suicide in Oregon--the first year's experience.

BACKGROUND AND METHODS: On October 27, 1997, Oregon legalized physician-assisted suicide. We collected data on all terminally ill Oregon residents who received prescriptions for lethal medications under the Oregon Death with Dignity Act and who died in 1998. The data were obtained from physicians' reports, death certificates, and interviews with physicians. We compared persons who took lethal medications prescribed under the act with those who died from similar illnesses but did not receive prescriptions for lethal medications. RESULTS: Information on 23 persons who received prescriptions for lethal medications was reported to the Oregon Health Division; 15 died after taking the lethal medications, 6 died from underlying illnesses, and 2 were alive as of January 1, 1999. The median age of the 15 patients who died after taking lethal medications was 69 years; 8 were male, and all 15 were white. Thirteen of the 15 patients had cancer. The case patients and controls were similar with regard to sex, race, urban or rural residence, level of education, health insurance coverage, and hospice enrollment. No case patients or controls expressed concern about the financial impact of their illness. One case patient and 15 controls expressed concern about inadequate control of pain (P=0.10). The case patients were more likely than the controls to have never married (P=0.04) and were more likely to be concerned about loss of autonomy due to illness (P=0.01) and loss of control of bodily functions (P=0.02). At death, 21 percent of the case patients and 84 percent of the controls were completely disabled (P<0.001). CONCLUSIONS: During the first year of legalized physician-assisted suicide in Oregon, the decision to request and use a prescription for lethal medication was associated with concern about loss of autonomy or control of bodily functions, not with fear of intractable pain or concern about financial loss. In addition, we found that the choice of physician-assisted suicide was not associated with level of education or health insurance coverage.

Gonococcal septic arthritis of the hip.

We describe a patient with a Neisseria gonorrhoeae monoarthritis of the hip. Treatment with intravenous ceftriaxone, oral doxycycline, and repeated fluoroscopic needle aspirations resulted in a complete recovery of function without residual deficit. Gonococcal monoarthritis of the hip is rare. Gonococcal hip infections appear to respond well to antibiotics and drainage by arthrocentesis. This differs from hip infections caused by other bacteria where joint damage is common and where the recommended initial treatment is open surgical drainage.

Metabolic and peroxisome proliferation studies with di(2-ethylhexyl)phthalate in rats and monkeys.

Male Fischer 344 rats and cynomolgus monkeys were treated with various doses of di(2-ethylhexyl)phthalate (DEHP) for at least 21 days. There was metabolic, biochemical, and morphological evidence for peroxisomal proliferation in rats that consumed diets containing 1000 ppm DEHP and above. These diets were estimated to provide average daily doses of about 100 mg/kg of DEHP. In contrast, peroxisomal proliferation was not observed in monkeys that received up to 500 mg/kg/day of DEHP by gavage. The results of this study suggest that rats do not provide a good model for predicting the results of DEHP exposure on peroxisomal proliferation in higher primates.

Development, evaluation and use of a pharmacokinetic model for hexachlorobenzene.

This study discusses the background, biological basis, development characteristics, application and evaluation of six physiologically based multicompartment models that describe the absorption, distribution and elimination of hexachlorobenzene (HCB) in growing rats and growing humans. The models for rats and for humans have similar structures but differ in specific physiological parameters. The goal of the modelling effort was to obtain toxicological information about HCB based on its pharmacokinetics. Comparisons were made between estimated tissue concentrations based on the rat models and observed tissue distributions based on pharmacokinetic animal studies with HCB, using both chronic and single-dose studies. The estimates from the female model agreed reasonably well with experimental results, and estimated a long half-life of approximately 180 days in all tissues; it did not, however, duplicate the biphasic tissue efflux of HCB that has been reported in the literature. The male model estimated a half-life of approximately 55 days in all tissues, shorter than that observed experimentally. The estimated yield of metabolites agreed well with values reported in the literature. A pregnancy and offspring model predicted minimal transfer of HCB to the fetal compartment during gestation and extensive mobilization of HCB to the offspring during lactation. This agrees with results reported in the literature. Correlations were obtained between experimentally observed liver toxicity and estimated yield of metabolites; between experimentally observed effects on the central nervous system and estimated HCB concentrations in the brain; and between experimentally observed offspring mortality and estimated extent of lactational HCB transfer. This paper also discusses the effects on tissue concentrations and half-lives of trapping HCB in the intestines by sequestering a large portion of it there. Various characteristics of the human models are discussed. The female model has a biphasic elimination pattern, the second elimination phase having a half-life of greater than 200 days. The pregnancy and offspring model projects extensive transfer of HCB via the milk to the nursing offspring, which correlates with the greater mortality of nursing infants whose mothers were exposed to HCB in Turkey.