Linezolid for treatment of vancomycin-resistant enterococcal peritonitis.

A 42-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) developed peritonitis secondary to vancomycin-resistant Enterococcus faecium and Candida albicans while hospitalized for pneumonia. She was treated successfully with intravenous linezolid, fluconazole given by nasogastric tube, and removal of the peritoneal catheter. A concentration of linezolid above the minimum inhibitory concentration for most gram-positive pathogens, including vancomycin-resistant E faecium, was achieved in the dialysate fluid after an oral loading dose of 1200 mg. Additional data are needed to establish the role of linezolid in treating CAPD-associated peritonitis.

Staphylococcus epidermidis with intermediate resistance to vancomycin: elusive phenotype or laboratory artifact?

The recent and troubling isolation of Staphylococcus aureus and coagulase-negative staphylococci that have increased resistance to glycopeptide antibiotics has prompted the use of aggressive surveillance measures in the clinical microbiology laboratory to aid in the recognition of these strains. Despite increasing awareness, the confirmation of glycopeptide resistance among staphylococci can be problematic; we present a case of catheter-associated peritonitis caused by Staphylococcus epidermidis to illustrate the dilemma.

Progressive multifocal leukoencephalopathy and idiopathic CD4+lymphocytopenia: a case report and review of reported cases.

Progressive multifocal leukoencephalopathy (PML) is a well recognized demyelinating neurological disorder caused by JC virus. Idiopathic CD4(+) lymphocytopenia (ICL) is a syndrome first described by the Centers for Disease Control and Prevention as a CD4(+) count <300 cells/mm(3) or a CD4(+) count that is <20% of the total T cell count on 2 occasions, with no evidence of human immunodeficiency virus (HIV) infection on testing, and absence of any defined immunodeficiency or therapy that depresses the levels of CD4(+) T cells. To the best of our knowledge, this is the third reported case of PML and ICL, and also the first reported case of the use of cidofovir to treat PML in a patient not infected with human immunodeficiency virus.

Infection control in ambulatory care.

This article provides a structured review of the English literature focusing on areas that theoretically pose the greatest risk for nosocomial infections in ambulatory care. The review describes variations in methods of surveillance and a general paucity of studies that provide reliable estimates of the risk for infections in the ambulatory environment.

Pneumonia due to Staphylococcus aureus infection.

Staphylococcus aureus is the second most common infectious agent of pneumonia in the ICU. The virulence of this organism is highlighted by toxins and enzymes that result in severe damage to lung tissue. Clinical features fail to distinguish Staphylococcus aureus pneumonias from other pathogens, and clinical diagnosis has the same limitations that beset other bacterial causes of pneumonia. Effective therapy is dictated by carefully performed susceptibility testing. First-line therapy is with a beta-lactam agent. If BRSA is detected or beta-lactam intolerance occurs, vancomycin should be administered. Despite agents active in vitro, the mortality of this disease remains high, especially if spread through hematogenous routes.

Attitudes of internal medicine residents regarding influenza vaccination.

OBJECTIVE: To survey the attitudes of internal medicine residents regarding the influenza vaccine and their reasons for accepting or refusing the vaccine during a hospitalwide immunization campaign. DESIGN AND PARTICIPANTS: Internal medicine residents responded to a written survey. SETTING: A university-owned, 891-bed, tertiary referral hospital and a 278-bed Veterans Administration hospital in Iowa. RESULTS: Immediately following the immunization campaign, 51% of residents had received the vaccine. Of those residents who were not vaccinated, 42% never had time to go to the vaccine clinic, but only 8% worried about side effects of the vaccine. Residents whose clinics were staffed by infectious disease subspecialists were significantly more likely to be vaccinated (odds ratio = 2.55; CI95 = 1.01 to 6.42) than residents working with general internists or other subspecialists. CONCLUSIONS: Knowledge, vaccine availability, and social pressure all increase the likelihood that residents will be vaccinated. Faculty, particularly those interested in infectious diseases, may influence residents to accept the vaccine.

Coagulase-negative staphylococci. Epidemiology, evaluation, and therapy.

More sophisticated speciation schemes and the application of a variety of epidemiology typing systems have helped to clarify the increasing frequency and changing patterns of nosocomial infections with coagulase-negative staphylococci. The presence of foreign bodies, compromised host defenses, and microbial factors such as slime production may all play important roles in the pathogenesis of these infections. Although coagulase-negative staphylococci are common contaminants in blood cultures, even a single isolation of these organisms warrants careful evaluation. Therapy of these infections may be difficult as phenotypes resistant to multiple antibiotics occur frequently. In the future, both prevention and the development of alternative antimicrobial agents will play important roles in limiting the morbidity and mortality of these infections.

Molecular forms of acetylcholinesterases in Alzheimer's disease.

In this study, we examined 26 cases of Alzheimer's disease (AD) and 14 age-matched controls. In Brodmann area 21 cerebral cortex of the AD cases, there was no change in soluble G1 and G4 acetylcholinesterase (AChE) (EC 3.1.1.7), a significant 40% decrease in membrane-associated G4 AChE, significant 342 and 406% increases in A12 and A8 AChE, and a significant 71% decrease in choline acetyltransferase (ChAT) (EC 2.3.1.6). Our working hypothesis to account for these changes postulates that soluble globular forms are unchanged because they are primarily associated with intrinsic cortical neurons that are relatively unaffected by AD, that ChAT and membrane-associated G4 AChE decrease because they are primarily associated with incoming axons of cholinergic neurons that are abnormal in AD, and that asymmetric forms of AChE increase because of an acrylamide-type impairment of fast axonal transport in diseased incoming cholinergic axons. In the nucleus basalis of Meynert (nbM) of the 26 AD cases, there was a significant 61% decrease in the number of cholinergic neurons, an insignificant 23% decrease in nbM ChAT, a significant 298% increase in nbM ChAT per cholinergic neuron, and a significant 7% increase in the area of cholinergic perikarya. To account for the increased ChAT in cholinergic neurons and the enlargement of cholinergic perikarya, we propose that slow axonal transport may be impaired in nbM cholinergic neurons in AD.