Audit of treatment of Staphylococcus aureus bacteraemia.

Staphylococcus aureus bacteraemia remains a significant cause of morbidity and mortality. National guidelines recommend that a minimum of 14 days of antibiotics should be used to treat uncomplicated bacteraemia. Five hospitals in the East Midlands region conducted a retrospective audit to assess compliance to these guidelines before and after the introduction of extra text to laboratory reports of S. aureus bacteraemia advising clinicians on the minimum length of treatment. Introduction of this extra text resulted in an increase in compliance with the national recommendation from 44% to 60%. This increase in compliance was noted in both methicillin-sensitive S. aureus (45% versus 58%) and methicillin-resistant S. aureus (42% versus 62%) bacteraemia. This audit demonstrated a simple and effective intervention that has improved the treatment of this potentially life-threatening condition.

Investigation and control of a cluster of penicillin non-susceptible Streptococcus pneumoniae infections in a care home.

Two elderly residents of a care home were hospitalised with pneumonia over a period of one month. They had bacteraemia with penicillin non-susceptible Streptococcus pneumoniae (PNSP) and both died. All residents and staff of the care home were screened for PNSP using nasopharyngeal swabs, with one resident and one member of staff found to be asymptomatic carriers. Oral rifampicin was given to the carriers. All four strains were found to be serotype 14, and multilocus sequence typing (MLST) showed ST2652, not previously detected in Scotland. Review of care home residents showed that pneumococcal vaccination coverage was low (63%). This is similar to rates found in those aged > or =65 years in the general population and needs to be improved upon.

Successful treatment of Candida krusei fungemia with amphotericin B and caspofungin.

We report a leukemic patient with C. krusei fungemia who failed to respond to liposomal amphotericin B therapy alone. The addition of caspofungin eradicated infection and was well tolerated. Our report is the first to describe successful treatment of a patient with invasive C. krusei infection using this combination of antifungals. Combination therapy could be a useful treatment option for invasive candidosis, particularly when caused by more resistant species such as C. krusei.

A survey of the antibiotic treatment of febrile neutropenia in haematology units in the United Kingdom.

We performed a nationwide survey to define the different practices in managing febrile neutropenia in haematology units. A questionnaire was sent out to a named haematologist in each of 220 haematology units in the UK. Questions were asked regarding antibiotics of choice in managing febrile neutropenia and the use of antibiotic prophylaxis. Responses were received from 167 (76%) haematology units. Combination therapy with piperacillin-tazobactam and gentamicin is used first-line in febrile neutropenia by 72% of units. Piperacillin-tazobactam monotherapy is used first-line by 5% of units. When response to initial empirical therapy does not occur after 24-48 h, 32% of haematology units add a glycopeptide (vancomycin or teicoplanin) and 31% change to a carbapenem and a glycopeptide. Seventy-one percent of units use oral fluoroquinolone prophylaxis for all neutropenic patients. The antibiotic treatment of febrile neutropenia in haematology patients, and the use of antibiotic prophylaxis, vary significantly across the UK. This survey is the first to examine the prescribing of UK haematology units in this area, and could help in the formulation of practice guidelines.

Nosocomial transmission of Saccharomyces cerevisiae in bone marrow transplant patients.

Saccharomyces cerevisiae is an unusual cause of clinical infection. We describe three bone marrow transplant patients on a haematology unit who developed possible invasive disease with the organism. Two patients died and both these patients appeared to have a related strain of S. cerevisiae. Screening for S. cerevisiae from throat and stool samples revealed four further patients who were carriers. Genotyping of the invasive and carriage strains demonstrated an indistinguishable strain from patients who had been on the unit at the same time, suggesting cross-infection.

Comparison of Candida ID medium with sabouraud-chloramphenicol agar for the isolation of yeasts from clinical haematology surveillance specimens.

Candida ID is a new chromogenic medium for the identification of yeasts from clinical specimens. C. albicans produces blue pigmentation, whereas pink pigmentation is produced by C. tropicalis, C lusitaniae, C. guilliermondii and C. kefyr; other Candida species appear white. In this study, 240 clinical samples (throat swabs and stool samples) from haematology patients were inoculated on to Candida ID and Sabouraud-chloramphenicol agar in parallel, yielding a total of 105 yeasts; the media had overall detection rates of 85.7% and 86.7% respectively. The sensitivity of Candida ID for identification of C. albicans by blue pigmentation was 52.9% at 24 h and 94.1% at 48 h. Specificity of the blue pigmentation was 100% at 48 h. Two strains of C. tropicalis were identified, one produced pink pigmentation at 72 h, the other strain did not produce any pigmentation after 5 days. Candida ID was superior in detecting mixtures of yeasts compared with Sabouraud-chloramphenicol agar. Candida ID is a suitable primary isolation medium for yeasts from clinical specimens, providing rapid direct identification of C. albicans and enhanced detection of mixtures.

Neonatal group B streptococcal disease associated with infected breast milk.

Premature triplets each developed late onset group B streptococcal disease over a period of nine weeks. The source of the organism appeared to be expressed maternal breast milk, in the absence of clinical mastitis. Asymptomatic excretion of group B streptococcus in breast milk may be an under-recognised cause of neonatal infection.