Volume 12, Issue 2, 2004
Original article
Management of severe bacterial infections and role of the infectious disease specialist: results of an interview-based survey
Esposito Silvano,
Leone Sebastiano,
Noviello Silvana,
Ianniello Filomena
Ascertainment of SBIs plays a central role in their management, which can affect the prognosis, hopefully avoiding an inappropriate antibacterial therapy concerning choice, dosing, timing, duration and route of administration of antibiotics. Different aspects of SBI management were evaluated by interviewing doctors practising in ICU, Surgery and Haematology wards.
In the period 16 June - 7 July 2003, 150 doctors, equally distributed by specialty and geographical location, experienced in the management of antibiotic therapy, were interviewed in order to acquire the following information: criteria adopted to define SBIs, presumed incidence, most frequent diagnosis, initial approach to antibiotic therapy (empirical or not, route of administration, mono- or combination therapy), ID consultation request.
In most cases generic and empirical criteria are used to define SBI, generally associated to the presence of co-morbidities, the highest rates being reported in ICUs (35.1%) and Haematology (34.7%) wards. Pneumonia is the top reported SBI in all the wards, followed by sepsis in ICUs and Haematology, and by intrabdominal infections in Surgery. Antibiotic therapy is often empirical (~90%), often performed i.v. with antibiotics given in combination. Following treatment failure, which occurs on average in 35.5% of cases, ID consultation and microbiological investigation are required. ID consultation is required in 20.2%, 26.1% and 28.1% of cases by haematologists, surgeons and ICU specialists, respectively.
SBIs frequently occur in all the wards where the interviews were conducted. Their management is generally empirical and either ID consultation or microbiological investigation is infrequently required especially as an initial approach. The use of appropriate guidelines and ID consultation, as proven in many controlled studies, could be efficacious in reducing the incidence of inappropriate therapies and increasing favourable outcome rates.
Mixed cryoglobulinemia in HCV mono-infected and HCV/HIV co-infected patients
Scotto Gaetano,
Cibelli Donatella Concetta,
Palumbo Emilio,
Saracino Annalisa,
Fazio Vincenzina,
Conte Pietro Elia,
Angarano Gioacchino
The aim of our study was to compare the prevalence of mixed cryoglobulinemia in a group of HCV positive/HIV- negative patients with respect to a group of HCV/HIV co-infected subjects. Between September 2002 and May 2003, 58 patients with proven HCV infection and 67 subjects with HIV/HCV co-infection were enrolled. Serum was assessed for detectable cryoglobulins, liver enzymes, HCV viral load and HCV genotypes. In HIV positive patients, plasma HIV RNA and CD4+ cell count were determined. A chi-square test was used to compare the prevalence of cryoglobulins in our two categories of patients. Cryoglobulinemia was detected in 14/58 HCV mono-infected patients (24.1%) and in 10/67 HCV/HIV co-infected patients (14.9%), without any significant statistical difference between the two groups (p=0.2). Only two HCV mono-infected patients complained of arthralgia. No significant correlation was found between the presence of cryoglobulinemia and ALT levels, HCV viremia and duration of HCV infection. In HIV patients circulating cryoglobulins were not correlated with plasma HIV viral load, CD4 cell count and with duration of HIV infection. In conclusion, mixed cryoglobulinemia may be detected in a similar rate in the two groups and HIV infection does not appear to play a significant role in cryoglobulin production.
Incidence of extended spectrum beta-lactamase (ESBL)-producing Enterobacteria in the area of Caltagirone (Sicily)
Bellissima Pietro,
Amato Rosalba
The authors report the incidence of extended spectrum -lactamases (ESBL)- producing strains in 1,602 enterobacteria consecutively isolated, from April 2002 to December 2003, in Caltagirone (CT) Hospital, and their in vitro susceptibility to several antimicrobial agents. The incidence of ESBL-producing Enterobacteria was equal to 1.5%, mainly among Escherichia coli, Klebsiella spp and Citrobacter koseri, isolated by emergency and medicine wards. In vitro, the enterobacteria were fully susceptible to carbapenems and highly susceptible to third-generation cephalosporin, aztreonam, piperacillin, amikacin, and ciprofloxacin.
Unusual manifestations of infections due to Mycoplasma pneumoniae in children
Timitilli Anna,
Di Rocco Maya,
Nattero Giovanni,
Tacchella Angela,
Giacchino Raffaella
Mycoplasma pneumoniae (Mp) is an important cause of pneumonia in paediatric age, but also other organs or systems can be affected even without pulmonary involvement. The purpose of this study is to stress the unusual clinical features of Mp infection in children. A review of children affected with Mp infection with peculiar pulmonary and/or extra-pulmonary forms is reported. Diagnosis of Mp infection was always confirmed by serum anti-Mp antibody assay. Two patients with infection of the lower airways showed severe respiratory distress; nine cases with only extra-pulmonary manifestations presented urticaria and arthralgia; three patients had severe neuromuscular impairment, one of these resulting in flaccid tetraparesis; one 2-year-old child had anicteric hepatitis, without any sequelae; one case of a 6-year-old child presented severe haemolytic anaemia, and a 5-year-old child with Schönlein-Henoch purpura. In conclusion, Mp infection, a frequent cause of pneumonia at all paediatric ages, may also give rise to extrapulmonary manifestations. Frequently, muscular-articular or neurological systems, skin or other organs are involved. Clinical suspicion of Mp infection is essential in severe cases and the outcome of all pulmonary and/or extra-pulmonary manifestations depends on early diagnosis and specific therapy.
The impact of automation on organizational changes in a community hospital clinical microbiology laboratory
Camporese Alessandro
The diagnosis of infectious diseases and the role of the microbiology laboratory are currently undergoing a process of change. The need for overall efficiency in providing results is now given the same importance as accuracy. This means that laboratories must be able to produce quality results in less time with the capacity to interpret the results clinically. To improve the clinical impact of microbiology results, the new challenge facing the microbiologist has become one of process management instead of pure analysis. A proper project management process designed to improve workflow, reduce analytical time, and provide the same high quality results without losing valuable time treating the patient, has become essential.
Our objective was to study the impact of introducing automation and computerization into the microbiology laboratory, and the reorganization of the laboratory workflow, i.e. scheduling personnel to work shifts covering both the entire day and the entire week. In our laboratory, the introduction of automation and computerization, as well as the reorganization of personnel, thus the workflow itself, has resulted in an improvement in response time and greater efficiency in diagnostic procedures.
Coryneform bacteria: their clinical significance and resistance patterns during a three-year study
Ubaldi Manuela,
D'Annibale Maria Letizia,
Medora Maria Chiara,
Crotti Daniele
We report data concerning our experience during three years (1998-2001) about isolation, identification and susceptibility towards antimicrobial agents of coryneform bacteria in infections of hospitalized/at risk patients. We isolated 54 Corynebacterium spp., with prevalence of C. striatum (8 strains) and C. amycolatum (7 strains), and 1 strain of Oerskovia spp. and 1 strain of Actinomyces neuii. 31 strains were isolated from the “exit-site” and 6 from peritoneal fluid of CAPD patients. Vancomycin and teicoplanin were always “in vitro” efficacious. Resistance rates towards other antibiotics were the following: 11% for minocycline, 12.5% for tetracycline, 20% for gentamicin and netilmicin, 61% for erythromycin and chloramphenicol, 66% for penicillin.
Antibiotic usage and costs in the community
Karatas Halil,
Yalcin Ata Nevzat,
Turgut Huseyin,
Cetin Banu
A prospective study was designed in order to determine to what extent antibiotics are used in treating community-acquired infections and their costs. Between February and July 2001 a total of 43,011 prescriptions from a representative sample of pharmacies in the city of Denizli (Turkey) were evaluated during the study period. Antibiotics accounted for 16.4 % of total prescriptions and 30.8% of the market value of drugs. Penicillins (49.7%), followed by cephalosporins (17.3%), macrolides (9.5%), and aminoglycosides (7.6%) were the most frequently prescribed antibiotics during the study period. The economic burden of antibiotic usage in the community is found higher than in developed countries. In order to reduce this cost the proper use of antibiotics is a matter of urgency.
Case report
Late onset opportunistic infections in a renal allograft recipient: a case report
Morosi Sabrina,
De Socio Giuseppe Vittorio Luigi,
Fiorio Maurizio,
Stagni Giuliano
In renal allograft recipients, infection disease complications remain an important cause of morbidity and mortality during the post-transplant period. This complication occurs more frequently from 1 to 6 months after transplant. The epidemiology of infection during the postoperative period is less well characterized, because recipients routinely reside at home. We describe a case of late onset Candida albicans and HSV-1 esophagitis, and Pneumocystis carinii pneumonia, that occurs 9 years after renal transplantation in a patient with severe CD4+ T-lymphocytopenia and hypogammaglobulinaemia. We underline the importance of monitoring immunosuppressive therapy in these patients and the usefulness of prophylaxis against P. carinii pneumonia.
Mediterranean visceral leishmaniasis in immunocompetent children. Report of two cases relapsed after specific therapy
Colomba Claudia,
Scarlata Francesco,
Salsa Ludovico,
Frasca Polara Valentina,
Titone Lucina
Visceral leishmaniasis (VL) is endemic in areas bordering the Mediterranean Sea (Spain, Italy, France, Greece, Morocco, Tunisia) where it is caused by Leishmania infantum and is transmitted by the bite of a hematophagous sandfly belonging to Phlebotomus spp.; the dog constitutes the main reservoir of infection. Two cases of VL in immunocompetent children are described. Both patients lived in endemic areas for leishmaniasis (Sicily) and at admission were febrile, pale and had splenomegaly. In both patients anti-leishmania antibodies were present and a definitive diagnosis was confirmed by demonstration of leishmania parasites by microscopy or polymerase chain reaction (PCR) in the bone marrow aspirates. The use of PCR performed on peripheral blood has been reported to be highly sensitive for the diagnosis and follow-up of children with VL. One patient was treated with N-dimethylglucamine, Glucantim, the other one with liposomal Amphotericin B (AmBisome). Both had symptomatic relapses 3 months later, and recovered following re-treatment with AmBisome administered intravenously at a dosage of 3 mg/Kg for ten consecutive days. The patients were monitored for one year after treatment was completed.
