An unforeseen complication of home parenteral antibiotic therapy.

Increasing pressure to cut the length of hospital stay has resulted in a large number of patients receiving home parenteral antibiotic therapy. We present a case of an immediate allergic reaction in a penicillin-sensitive spouse of a patient receiving parenteral mezlocillin sodium therapy. A seminal level of 42 micrograms/mL of mezlocillin was documented by bioassay.

The prevalence of hepatitis B serologic markers in suburban paramedics.

Urban emergency medical services personnel have documented hepatitis B virus (HBV) seropositivity rates ranging from 0.6% to 25%. We studied 85 suburban paramedics for Hepatitis B serologic markers. All paramedics answered a questionnaire describing age, race, duration of employment, known hepatitis exposure, blood transfusions, gamma globulin injections, and Hepatitis B vaccination. HBV surface antibodies (Anti-HBs) were present in 6/85 (7.1%) paramedics of whom one (1.2%) had reactive HBV core antibodies (Anti-HBc). No paramedic had HBV surface antigen (HBsAg). Seropositivity was not associated with duration of employment, or exposure to a patient with either jaundice (28.2%) or confirmed hepatitis B (20.0%) within the six months prior to testing. The 7.1% prevalence of HBV markers found in this group of suburban paramedics is intermediate between previously reported rates for urban paramedics. We conclude that prehospital personnel do not constitute a homogenous occupational category at risk for hepatitis B infection.

Infection following coronary artery surgery. Comparison of two antibiotic prophylaxis regimens.

A prospective randomized study was conducted in 200 patients undergoing coronary artery bypass surgery. All patients received intravenous (IV) cephalothin prophylaxis for 48 hours beginning with anesthetic induction. Group A (99 eligible patients) received cephalexin 500 mg po, qid for three extra days. Group B (94 eligible patients) received no oral therapy. The overall infection rate was 9.3 percent (18 patients). Six patients had multiple sites of involvement. There was no difference between group A (9.0 percent, nine patients) vs B (9.5 percent, nine patients) (p greater than 0.5). The median sternotomy infection rate, superficial or deep, was 2.6% (five patients). The surgical wound infection rate was 4.7 percent (nine patients). The overall infection rate compares favorably with that of high risk groups for clean surgical procedures defined in SENIC study. There was no advantage to prolonged oral cephalexin prophylaxis following coronary artery bypass (CAB) surgery.

Effects of erythromycin and ciprofloxacin on chronic fecal excretion of Campylobacter species in marmosets.

Ciprofloxacin was compared with erythromycin for the eradication of Campylobacter species that were chronically excreted in the stools of marmosets (Saguinus labiatus labiatus, Saguinus fuscicollis nigrifrons, and Saguinus fuscicollis illigeri). Stool cultures were negative within 48 h of the beginning of treatment with either agent. Within 10 days after the end of therapy, however, Campylobacter species were again isolated from the stools of six animals that had received erythromycin. During an 8-week follow-up period, no animal that had received ciprofloxacin relapsed. High levels of ciprofloxacin in the stool (mean, 49.2 micrograms/g) possibly contributed to the efficacy of this agent.

Comparative in vitro activities of twelve antimicrobial agents against Campylobacter species.

The in vitro susceptibility of 27 Campylobacter jejuni, 31 Campylobacter coli, and 30 Campylobacter fetus subsp. fetus strains to 12 antimicrobial agents was determined. Ciprofloxacin, a new quinoline derivative, was the most active agent tested. Antimicrobial susceptibility differed among the three species tested.

Comparative in vitro activity of ciprofloxacin against Campylobacter spp. and other bacterial enteric pathogens.

A comparison was made of the in vitro activity of ciprofloxacin (Bay o 9867) with nine other antibiotics against isolates of Campylobacter jejuni, Salmonella spp., Shigella spp., Yersinia enterocolitica, Clostridium difficile, Vibrio spp., and Escherichia coli. Minimum inhibitory concentrations of ciprofloxacin were the lowest of any compound tested for all organisms except C. difficile.

A pseudoepidemic due to Salmonella typhimurium.

A pseudoepidemic due to Salmonella typhimurium occurred in the clinical microbiology laboratory of a university hospital and involved 10 patients. One patient received "unnecessary" antibiotics. Investigation of the events implicated a contaminated rubber pipette bulb. Such bulbs should be considered as a possible source of false-positive cultures.

Ceftazidime in the therapy of serious Gram-negative bacillary infections.

Eighteen patients were evaluated after treatment with ceftazidime: these included nine nosocomial lower respiratory tract infections, four soft tissue infections, three bacteraemias and two bone infections. Thirty-five bacterial pathogens were isolated from these 18 patients. Two were resistant to ceftazidime and required alternative therapy. Sixteen of the 18 evaluable patients had a favourable response to ceftazidime. Seven of eight patients with Pseudomonas aeruginosa lower respiratory tract infections responded favourably. Fifteen possible complications were observed in ten of 23 patients who received ceftazidime. In three patients ceftazidime was discontinued due to possible complications of therapy. This trial provides preliminary support for the use of ceftazidime as an alternative to aminoglycosides in the treatment of serious infections caused by Gram-negative organisms, including Ps. aeruginosa.