Erythromycin prophylaxis for Legionnaire's disease in immunosuppressed patients in a contaminated hospital environment.

Between January 1 and June 30, 1983, immunosuppressive drugs were administered in 20 renal transplant recipients undergoing 23 rejection episodes and in 3 patients with renal failure secondary to systemic disease. Legionella pneumophila, serogroup 1, pneumonia was diagnosed on 12/26 (47%) occasions. In an attempt to decrease this high rate, a program of erythromycin prophylaxis was instituted for every new patient who received immunosuppressive chemotherapy until eradication of the organism from the water supply could be realized. From July 1, 1983 to April 30, 1984, erythromycin prophylaxis (1.5-3 g/day by mouth) was administered during 39 episodes of high-dose immunosuppression (20 kidney graft recipients and 4 patients with systemic diseases); no cases of Legionnaire's disease were recorded. During the same period, erythromycin prophylaxis was withheld from 9 other high-dose immunosuppression episodes (7 kidney graft recipients and one patient with sarcoidosis); 5 cases of Legionnaire's disease occurred (56%) in this group. We conclude that erythromycin effectively protects immunocompromised patients in an environment contaminated with L pneumophila.

[Gas-phase chromatography in the rapid bacteriological diagnosis of infections. Contributions and limitations of this technic]. / Contribution de la chromtographie en phase gazeuse au diagnostic bactériologique rapide des infections. Les apports et les limites de cette technique.

Gas-liquid chromatography has been used directly on clinical specimens as a method for presumptive diagnosis of anaerobic infections. This technique proved to be valuable and reliable. Combined with a Gram stain, it offers the possibility to differentiate in less than 1 hour aerobic from anaerobic infections by means of detection of volatile fatty acids (short chain monocarboxylic acids) others than acetic acid.