Utility of blood cultures in the management of adults with community acquired pneumonia discharged from the emergency department.

STUDY OBJECTIVE: To assess the clinical value of blood cultures (BCs) in the management of adult patients discharged from the emergency department (ED) with a diagnosis of community acquired pneumonia (CAP). METHODS: The courses of antibiotic regimens and outcomes of patients with positive BC results were examined to assess their influence on BCs. RESULTS: BCs were obtained from 289 outpatients. Six clinically significant organisms were identified (a yield of 2.1%). Outpatients with CAP who had blood cultures performed had a 0.69% (2 of 289) chance of having a change of treatment directed by the results of the culture. CONCLUSION: BCs have little utility in the ambulatory management of CAP.

Efficacy and safety of oral levofloxacin compared with clarithromycin in the treatment of acute sinusitis in adults: a multicentre, double-blind, randomized study. The Canadian Sinusitis Study Group.

Adult patients with acute sinusitis (n = 236) were randomized in a double-blind study to levofloxacin 500 mg orally once daily (n = 119) or clarithromycin 500 mg orally twice daily (n = 117) for 10-14 days. Between 2 and 5 days after therapy participants were evaluated as cured (no symptoms), improved (symptoms improved, no further therapy required), or failed (further therapy required). Clinical response rates (cured plus improved) for clinically evaluable patients were 93.9% for levofloxacin (n = 98) and 93.5% for clarithromycin (n = 93). The proportion of patients evaluated as cured was higher in the levofloxacin (40.8%) than in the clarithromycin arm (29.0%) and individual symptoms showed higher rates of resolution. Of patients receiving levofloxacin and clarithromycin, 22.5% and 39.3%, respectively, experienced adverse events related or possibly related to the study therapy. This study showed that, in the treatment of acute sinusitis, daily levofloxacin therapy is as effective as twice-daily clarithromycin therapy with more complete clearing of symptoms and a more tolerable side-effect profile.

Laboratory and clinical evaluation of modified New York City medium (Henderson formulation) for the isolation of Neisseria gonorrhoeae.

The growth-promoting properties of several ingredients of New York City (NYC) medium were investigated by using 100 recently isolated clinical strains of Neisseria gonorrhoeae. Difco GC medium base promoted the growth of large colonies of gonococci significantly better than other commercial GC medium bases. A 1% agar concentration resulted in the growth of larger colonies than 2% agar, without affecting the stability of the gel. Neither replacement of horse plasma with horse serum nor reducing the concentration of added serum from 12 to 3% affected the growth of even the most fastidious strains tested. From these observations, a modified NYC medium (Henderson) has been formulated which is easy to prepare and less expensive than NYC or Thayer-Martin medium. In a direct clinical comparison with 1,275 specimens, an isolation rate of 6.5% was achieved with both NYC medium and the Henderson formulation.

Rapid identification of antibiotic-resistant corynebacteria with the API 20S system.

The API 20S system (Analytab Products, Plainview, N.Y.) was evaluated for the rapid identification of multiply antibiotic-resistant aerobic diphtheroids. Sixty-eight clinical isolates of multiply resistant Centers for Disease Control group JK and group D2 corynebacteria had API 20S profiles which were clearly different from those of a number of strains of other Corynebacterium species which were tested. The API 20S system allowed more rapid identification of antibiotic-resistant diphtheroids than conventional biochemical tests. Its use for corynebacteria other than group JK and group D2 is not recommended at this time.

Genetic meaning of zooecial chamber shapes in fossil bryozoans: fourier analysis.

Fourier harmonic amplitudes quantitatively characterize chamber shapes of fossil tubular bryozoans. The odd-numbered harmonics, particularly the seventh, carry evolutionary information. The phenotypically plastic second and sixth harmonics measure zooecial orientation and packing, respectively. As a measure of crowding, the sixth harmonic reflects mechanistic growth response to paleoenvironmental conditions.