The cost and safety of multidose use of palivizumab vials.

Palivizumab is an antirespiratory syncytial virus humanized murine monoclonal antibody that has been shown to reduce the frequency of hospitalization rates of preterm infants infected with respiratory syncytial virus. The United States Food and Drug Administration has approved palivizumab for single-vial dosage; however, if multidose use of single-use vials is proven safe, significant cost savings for respiratory syncytial virus prophylaxis would result. A total of 446 palivizumab vials administered to patients during the respiratory syncytial virus seasons of 2004-2006 were examined for bacterial contamination. One single-use vial showed growth of multiple organisms, and all multidose-use vials were culture negative. The cost benefits of multidose palivizumab vials netted a potential average savings of $37 410 per year in this institution. This study suggests that multidose distribution is a possible solution for cost savings with no increased risk to patients. Secondary to the low incidence of complications, the safety of this practice will require a larger study.

Gastroenteritis caused by Edwardsiella tarda in a pediatric renal transplant recipient.

Edwardsiella tarda, a member of the family Enterobacteriaceae, is a Gram-negative bacillus that is most often pathogenic in aquatic environments. Human infections with Edwardsiella are rare, with most occurring in immunocompromised or immunosuppressed hosts. Reported infections include meningitis, cholecystitis, endocarditis, osteomyelitis, soft tissue infections, bacteremia and septicemia, dysentery, and gastroenteritis. This report describes a case of E. tarda gastroenteritis in a renal transplant patient receiving immunosuppressive therapy. The epidemiology, diagnosis, clinical presentation, and treatment options pertaining to E. tarda infections are examined.

Group A Streptococcus: another resistant pathogen.

OBJECTIVES: In Greenville, South Carolina in 1992, erythromycin resistance in GAS was less than 5%, and there were no fully resistant strains. With a large increase in macrolide and azalide usage within the Greenville area, we again examined susceptibility patterns of pharyngeal GAS isolates in 2002 to 2003. METHODS: Community pediatric offices supplied 106 GAS isolates for study. Screening for macrolide resistance was done via Kirby-Bauer disk diffusion testing. Zones of inhibition from 16 to 20 mm were interpreted as intermediately resistant, and those 15 mm or less were interpreted as resistant per National Committee for Clinical Laboratory Standards guidelines. RESULTS: A total of 106 GAS isolates were tested; 0.9% of isolates were intermediately resistant to erythromycin and 11% were fully resistant. CONCLUSIONS: The rate of erythromycin resistance among GAS isolates has increased in the past 10 years in the Greenville community. This pattern has paralleled the increased utilization of macrolides in the same community. Continued monitoring of resistance rates will be needed to alert practitioners of possible treatment failures due to macrolide resistance.