1/18. Gemifloxacin: survival of the fittest.The incidence of penicillin resistance in pneumococci is increasing in the USA, having risen from <5% before 1989 to >35% in 1997. There has also been a shift in the ratio of intermediate to high-level resistance from 3 or 4:1 to 2 or 1:1. Multidrug resistance and resistance to macrolides and fluoroquinolones in pneumococci is also a matter of concern. The implications for empirical treatment of respiratory tract infections are considerable. The potential of quinolones with activity against respiratory pathogens including pneumococci must be preserved by careful antimicrobial prescribing.- - - - - - - - - - ranking = 1keywords = respiratory tract infection, tract infection, respiratory tract, tract (Clic here for more details about this article) |
2/18. Ototoxicity induced by gentamicin and furosemide.OBJECTIVE: To present a case of ototoxicity induced by furosemide and once-daily gentamicin therapy. CASE SUMMARY: A 60-year-old white woman presented to the hospital with community-acquired pneumonia and urinary tract infection. The antibiotic regimen included gentamicin and, after 5 doses, the patient reported profound bilateral hearing loss. A Pure Tone Audiogram suggested moderate to moderately severe sensorineural hearing loss bilaterally. The only risk factors present included her age, elevated temperature, and the use of furosemide. DISCUSSION: Several risk factors may predispose a patient to developing aminoglycoside ototoxicity: the 1555 chromosomal mutation, preexisting disorders of hearing and balance, hypovolemia, bacteremia, liver and renal dysfunction, and the simultaneous administration of other ototoxic medications. The cumulative dose and duration of aminoglycoside therapy are more important than serum concentrations. Administration of an aminoglycoside followed by furosemide may increase the risk of ototoxicity. The aminoglycoside interacts with the cell membranes in the inner ear, increasing their permeability. This theoretically allows the loop diuretic to penetrate into the cells in higher concentrations, causing more severe damage. CONCLUSIONS: Auditory toxicity occurred after only 5 days of gentamicin therapy and 1 dose of furosemide. An aminoglycoside followed by furosemide may increase the risk for ototoxicity. Clinicians need to be aware of the synergistic potential of ototoxic medications.- - - - - - - - - - ranking = 0.066506491069426keywords = tract infection, tract (Clic here for more details about this article) |
3/18. Fatal case of community-acquired pneumonia caused by legionella longbeachae in a patient with systemic lupus erythematosus.Reported here is a rare case of atypical pneumonia due to a non- pneumophila Legionella sp. that occurred in a young patient with systemic lupus erythematosus. In spite of aggressive treatment, the patient died 24 h following admission to the intensive care unit. legionella longbeachae was cultured from respiratory tract specimens and identified to the genus level by PCR and to the species level by an immunofluorescence test. Since most current laboratory tests for Legionella spp., including urinary antigen and serology, cannot detect infections caused by non- pneumophila Legionella spp., culture on legionella-selective media should be strongly considered when diagnosing immunosuppressed patients with pneumonia.- - - - - - - - - - ranking = 0.044666319657387keywords = respiratory tract, tract (Clic here for more details about this article) |
4/18. Lower respiratory tract infections and community acquired pneumonia in adults.BACKGROUND: Lower respiratory tract infections--acute bronchitis and community acquired pneumonia (CAP)--are important causes of morbidity in australia. Acute bronchitis is often treated with antibiotics, although the cause is usually viral. Community acquired pneumonia may be fatal, particularly in the elderly, therefore appropriate assessment and management is essential. OBJECTIVE: This article describes the aetiology, clinical assessment, investigations and management of acute bronchitis and CAP in the community. DISCUSSION: Clinical assessment is important for acute bronchitis and CAP, with investigations such as C reactive protein, serology, and chest X-ray informing diagnosis and management of the latter. Causative organisms are usually not identified, but are presumed to be viral for acute bronchitis, and streptococcus pneumoniae for CAP; although 'atypicals' are also important. Antibiotics should generally not be prescribed for acute bronchitis, however, there is some evidence they may provide limited benefits in patients who have chest signs, are very unwell, are older, have comorbidities, or smoke. In patients with CAP, treated outside of hospital, the combination of amoxycillin and doxycycline/roxithromycin is the treatment of choice.- - - - - - - - - - ranking = 5keywords = respiratory tract infection, tract infection, respiratory tract, tract (Clic here for more details about this article) |
5/18. Community-acquired methicillin-resistant staphylococcus aureus prostatic abscess.We present a 43-year-old man with a history of intravenous drug abuse who presented to the emergency department with a 5-week history of lower urinary tract symptoms. On digital rectal examination, a firm prostate with exquisite tenderness was noted. Computed tomography scan of the pelvis with contrast demonstrated a 4.4 by 2.7-cm prostatic abscess in the right lobe. Suppurative fluid was expressed from the right prostatic lobe during transurethral resection of the prostate. Cultures of blood and suppurative prostatic fluid grew methicillin-resistant staphylococcus aureus.- - - - - - - - - - ranking = 0.00022849918640241keywords = tract (Clic here for more details about this article) |
6/18. A case of legionnaires' disease with extensive concurrent deep vein thrombosis.A previously healthy 37-y-old male presented with community-acquired pneumonia and extensive upper limb deep vein thrombosis. The diagnosis of Legionella pneumonia was made based on a positive direct immunofluorescence of the bronchial wash. An extensive investigation for hypercoagulable states was negative. The possible association between Legionella infection and deep vein thrombosis is highlighted.- - - - - - - - - - ranking = 7.7100188207013E-6keywords = upper (Clic here for more details about this article) |
7/18. Community-acquired urinary tract infection caused by vancomycin-resistant enterococcus faecalis clinical isolate.We present a case of urinary tract infection caused by vancomycin-resistant enterococcus faecalis. The patient is a 62-year-old woman showing no recent admittances. The isolated microorganism was identified by MicroScan (DADE) and API (BioMerieux) and susceptibility was assessed by disk diffusion, E-test and broth microdilution. The isolate was identified as enterococcus faecalis and showed high MIC for vancomycin (>128 mg/l) and teicoplanin (8 mg/l) but was susceptible to ampicillin. The transmission routes of vancomycin-resistant enterococci in the community and their clinical implications remain uncertain. Healthy carriers have already been described in several countries but this case report represents an unusual finding.- - - - - - - - - - ranking = 0.33253245534713keywords = tract infection, tract (Clic here for more details about this article) |
8/18. Severe Staphylococcal sepsis in adolescents in the era of community-acquired methicillin-resistant staphylococcus aureus.OBJECTIVE: More than 70% of the community-acquired (CA) staphylococcal infections treated at texas Children's Hospital are caused by methicillin-resistant staphylococcus aureus (MRSA). Since September 2002, an increase in the number of severely ill patients with S aureus infections has occurred. This study provides a clinical description of severely ill adolescent patients and an analysis of their isolates using molecular methods. methods: We identified adolescent patients meeting criteria for severe sepsis requiring admission to the PICU. Patient records were reviewed, and isolates were obtained for susceptibility testing and DNA extraction. Isolates were tested for the presence of virulence genes (cna, tst, lukS-PV, and lukF-PV) and enterotoxin genes (sea, seb, sec, sed, seh, and sej) by polymerase chain reaction. Genomic fingerprints were determined by repetitive-element polymorphism polymerase chain reaction and pulse-field gel electrophoresis. SCCmec cassette type was determined. RESULTS: Fourteen adolescents with severe CA S aureus infections were identified between August 2002 and January 2004. All were admitted to the PICU with sepsis and coagulopathy. Twelve patients had CA-MRSA infections; 2 had CA methicillin-susceptible Staphylococcus aureus (MSSA) infections. The mean age was 12.9 years (range: 10-15 years). Thirteen patients had pulmonary involvement and/or bone and joint infection; 10 patients had > or =2 bones or joints infected (range: 2-10); 4 patients developed vascular complications (deep venous thrombosis); and 3 patients died. All isolates were identical or closely related to the previously reported predominant clone in Houston, texas (multilocus sequence type 8, USA300), and carried lukS-PV and lukF-PV genes as well as the SCCmec type IVa cassette (12 MRSA isolates) but did not contain cna or tst. Only 1 strain carried enterotoxin genes (sed and sej). CONCLUSIONS: Severe staphylococcal infections in previously healthy adolescents without predisposing risk factors have presented more frequently at texas Children's Hospital since September 2002. CA MRSA and clonally related CA MSSA characterized as USA300 and sequence type 8 have been isolated from these patients.- - - - - - - - - - ranking = 0.00022849918640241keywords = tract (Clic here for more details about this article) |
9/18. Chronic community-acquired Acinetobacter pneumonia that responded slowly to rifampicin in the anti-tuberculous regime.acinetobacter baumannii is a well-known cause of hospital-acquired pneumonia. Occasionally, it can present as an acute community-acquired pneumonia with a fulminant course. However, the occurrence of the chronic form of community-acquired Acinetobacter pneumonia is yet to be highlighted. We describe a 62-year-old, hiv negative, non-diabetic male, who was referred for evaluation of consolidation and cavitation in the apicoposterior segment of the left upper lobe for 4 months. For this, he had received anti-tuberculous therapy, which included rifampicin. On investigation, a diagnosis of chronic community-acquired pneumonia due to acinetobacter baumannii was made. The steady clinico-radiologic improvement observed was attributed to rifampicin in the anti-tuberculous regime. Subsequently, an aspergilloma formed in the cavity.- - - - - - - - - - ranking = 7.7100188207013E-6keywords = upper (Clic here for more details about this article) |
10/18. Failure of levofloxacin treatment in community-acquired pneumococcal pneumonia.BACKGROUND: streptococcus pneumoniae is the leading cause of community-acquired pneumonia (CAP). High global incidence of macrolide and penicillin resistance has been reported, whereas fluoroquinolone resistance is uncommon. Current guidelines for suspected CAP in patients with co-morbidity factors and recent antibiotic therapy recommend initial empiric therapy using one fluoroquinolone or one macrolide associated to other drugs (amoxicillin, amoxicillin/clavulanate, broad-spectrum cephalosporins). Resistance to fluoroquinolones is determined by efflux mechanisms and/or mutations in the parC and parE genes coding for topoisomerase IV and/or gyrA and gyrB genes coding for dna gyrase. No clinical cases due to fluoroquinolone-resistant S. pneumoniae strains have been yet reported from italy. CASE PRESENTATION: A 72-year-old patient with long history of chronic obstructive pulmonary disease and multiple fluoroquinolone treatments for recurrent lower respiratory tract infections developed fever, increased sputum production, and dyspnea. He was treated with oral levofloxacin (500 mg bid). Three days later, because of acute respiratory insufficiency, the patient was hospitalized. levofloxacin treatment was supplemented with piperacillin/tazobactam. Microbiological tests detected a S. pneumoniae strain intermediate to penicillin (MIC, 1 mg/L) and resistant to macrolides (MIC >256 mg/L) and fluoroquinolones (MIC >32 mg/L). Point mutations were detected in gyrA (Ser81-Phe), parE (Ile460-Val), and parC gene (Ser79-Phe; Lys137-Asn). Complete clinical response followed treatment with piperacillin/tazobactam. CONCLUSION: This is the first Italian case of community-acquired pneumonia due to a fluoroquinolone-resistant S. pneumoniae isolate where treatment failure of levofloxacin was documented. Molecular analysis showed a group of mutations that have not yet been reported from italy and has been detected only twice in europe. Treatment with piperacillin/tazobactam appears an effective means to inhibit fluoroquinolone-resistant strains of S. pneumoniae causing community-acquired pneumonia in seriously ill patients.- - - - - - - - - - ranking = 1keywords = respiratory tract infection, tract infection, respiratory tract, tract (Clic here for more details about this article) |
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