Cerebrospinal fluid monocytes in bacterial meningitis, viral meningitis, and neuroborreliosis.

OBJECTIVE: Cerebrospinal fluid (CSF) leukocytes analysis is commonly used to diagnose meningitis and to differentiate bacterial from viral meningitis. Interpreting CSF monocytes can be difficult for physicians, especially in France where lymphocytes and monocytes results are sometimes pooled. PATIENTS AND METHODS: We assessed SF monocytes in patients presenting with microbiologically confirmed meningitis (CSF leukocyte count>10/mm3 for adults or >30/mm3 for children<2 months), i.e. bacterial meningitis (BM), viral meningitis (VM), and neuroborreliosis (NB). RESULTS: Two-hundred patients (82 BM, 86 VM, and 32 NB) were included. The proportions of monocytes were higher in VM (median 8%; range 0-57%) than in BM (median 5%; range 0-60%, P=0.03) or NB (median 5%; range 0-53%, P=0.46), with a high value overlap between conditions. CONCLUSION: CSF monocytes should not be used to discriminate BM from VM and NB because of value overlaps.

Appropriate use of carbapenems in the Besançon university hospital.

INTRODUCTION: The excessive and inappropriate use of carbapenems is responsible for the development of resistance. The scientific community has been requiring caution and using these agents in specific cases only. OBJECTIVES: The authors had for aim to evaluate the appropriate use of carbapenems in a French university hospital. DESIGN: A retrospective survey was made over two months as a clinical audit to assess professional practices. The evaluation criteria for this audit were: the appropriateness of the indication, the possibility of alternative therapeutic strategies, the choice of an antibiotic combination, duration of treatment and dosage. RESULTS: During the audit period, 103 carbapenem prescriptions were included. Ninety-nine cases were analyzed. Among the carbapenem prescriptions, 28.3% (28/99) did not meet the criterion "appropriateness of the indication". Carbapenems were mostly prescribed empirically (60/99 [60%]) and most often for lung infections or nosocomial urinary tract infections. Finally, 66.7% (66/99) of all prescriptions were considered inappropriate for at least one criterion. The rate of inappropriateness ranged around 30% for each criterion. CONCLUSIONS: This study allowed us to assess professional practices for carbapenem prescriptions. The overall rate of inappropriateness was quite important. Carbapenems were not always used appropriately. These findings highlight the need of new regional guidelines and regular updating of local best practices recommendations. Finally, a stricter validation of carbapenem prescriptions will be implemented at the hospital pharmacy level.

Complementary therapies in HIV disease.

This study was designed to determine whether a standardized program of complementary therapies combined with appropriate standard medical care would have a measurable influence on the course of HIV disease when compared with data from other groups. All 10 participants began this study in 1988 with a diagnosis of asymptomatic HIV-positive. They received a 1-month orientation to the program and were then seen at 3-month intervals for follow-up data collection. Data were compared with two groups that had not been trained in the comprehensive treatment program. After 30 months, the mean CD4 cell count of our study group declined by 4% (406 to 391). The mean red and white blood cell counts remained stable at 96% and 105% of baseline, respectively. The mean CD8 cell number rose by 28%. No mortality occurred. One opportunistic infection (pneumocystis carinii pneumonia) developed in the study group. No other significant symptoms, serious infections, or disease progression developed in the other 9 participants during the study period. At long-term follow-up 8 of the 10 study participants remained alive 7 years after beginning the study protocol. These data suggest that patients who are presented counseling on good nutrition, vitamin supplementation, stress reduction, exercising, and involving oneself in community potentially can continue to live asymptomatic lives that in quality and length exceed the lives of those HIV-positive individuals not presented such counseling.