Neurotoxicity in patients treated with intravenous polymyxin B: Two case reports.

PURPOSE: Two cases of reversible neurotoxicity associated with the administration of intravenous polymyxin B are described. SUMMARY: In the first case, a 60-year-old, obese, white woman with a medical history of recurring urinary tract infections, nephrolithiasis, and chronic renal insufficiency was admitted for parenteral antibiotics for dysuria and hematuria despite outpatient management with oral antibiotics. Her urinalysis revealed pyuria and large blood content. The corresponding urine culture contained >or=100,000 colony-forming units/mL of multidrug-resistant (MDR) Klebsiella pneumoniae. The patient was treated with polymyxin B at 20,000 units/kg i.v. as a loading dose and then 10,000 units/kg i.v. daily based on her renal function. The patient experienced oral paresthesia that resolved upon discontinuation of the infusion with no further complications. In the second case, a 57-year-old white man with hypertension and ascending cholangitis was admitted. He required percutaneous drainage of an infected pancreatic cyst and received polymyxin B at 25,000 units/kg i.v. as a loading dose and then 15,000 units/kg i.v. daily in addition to imipenem-cilastatin based on the sensitivities of two organisms (Escherichia coli and MDR K. pneumoniae) isolated from the abdominal drainage. For his pancreatic abscess, the patient received a prolonged course of polymyxin B, which was well tolerated for the first four weeks. On day 30 of the polymyxin B, the patient reported oral and lower extremity paresthesias. The symptoms resolved upon discontinuation of the polymyxin B. CONCLUSION: Two patients developed symptoms of neurotoxicity after receiving intravenous polymyxin B for the treatment of MDR gram-negative infections.

Cervical osteomyelitis caused by Burkholderia cepacia after rhinoplasty.

Burkholderia cepacia, previously known as Pseudomonas cepacia, has been implicated in vertebral osteomyelitis in patients who are intravenous drug abusers. We report a case of acute vertebral osteomyelitis in a non-intravenous drug user, following an elective rhinoplasty.

True incidence and clinical significance of pneumoperitoneum after PEG placement: a prospective study.

BACKGROUND: PEG is a widely used method for providing nutritional support. Although pneumoperitoneum is a known finding after PEG placement, its true incidence is subject to debate. Small retrospective studies have found varied rates of free air after PEG placement. PATIENTS: There were a total of 65 patients. OBJECTIVE: To assess the true incidence of pneumoperitoneum and its clinical significance. DESIGN: Prospective study. SETTING: Long Island Jewish Medical Center. INTERVENTIONS: We obtained upright and anterior-posterior chest radiographs of 65 patients within 3 hours after PEG placement. Type of PEG tube, gauge of the needle used, number of sticks, and indications were recorded. The presence of pneumoperitoneum on the initial chest film was considered to be a positive finding. After a positive result, a repeat chest film was obtained 72 hours later to determine whether there was progression or resolution of the free air. Patients enrolled in the study were also monitored clinically for evidence of peritonitis. MAIN OUTCOME: Of the 65 patients who underwent PEG placement, 13 developed a pneumoperitoneum on the initial chest radiograph; there was complete resolution of pneumoperitoneum at 72 hours in 10 of the 13 patients. In 3 patients, the free air persisted but was of no clinical significance. MEASUREMENTS: The free air was quantified by measuring the height of the air column under the diaphragm and was graded with a scoring system (0, no air; 1, small; 2, moderate; 3, large). RESULTS: Eleven patients who underwent PEG died during the hospitalization; none of the deaths were related to the PEG placement or pneumoperitoneum. The other 54 patients were discharged to a skilled nursing facility. No patients in the study had clinical evidence of peritonitis. There were no adverse events, ie, infection or bleeding, associated with the PEG placement in any of the patients. CONCLUSIONS: Our data suggest that pneumoperitoneum after PEG placement is common and, in the absence of clinical symptoms, is of no clinical significance and does not warrant any further intervention.