Lower respiratory tract infections in the intensive care unit: consequences of antibiotic resistance for choice of antibiotic

BACKGROUND: The glomus tumor is an uncommon tumor of the hand, which presents with much pain. It is a benign neoplasm composed of a glomus body, which is located in the dermis. Glomus tumors present a classic clinical picture of pain, sensitivity to cold and local tenderness over the lesion. METHODS: Twelve patients underwent surgical removal for glomus tumors of the upper extremity from 1983 to 1992. There were three males and nine females; their average age was 37 years (25 to 60 years). The clinical manifestations were pain and local tenderness in 12 patients, and cold intolerance in 6 patients. RESULTS: There was a difference in gender in the anatomical site of the tumor. In three male patients, only one tumor was found in the digit. In female patients, all nine tumors were located in the digits. The average tumor size was 0.6 cm in diameter. After follow-up of 4.5 years (average), no recurrence, no residual pain or cold intolerance was noted. CONCLUSIONS: The treatment of glomus tumor consisted of local excision or curettage, with or without reconstruction of the nail bed. Recurrence is not a problem after complete removal of the tumor tissue. Permanent nail deformity is still a problem. Efforts to prevent this sequelae are worth trying.     

High percentage of antibiotic resistance in Shigella infections in children in Cura?ao

OBJECTIVE: To evaluate antimicrobial treatment and resistance in clinical childhood shigellosis. DESIGN: Retrospective. SETTING: St. Elisabeth Hospital, Willemstad, Cura?ao, Dutch Antilles. METHOD: From September 1991 through August 1995 shigellosis was diagnosed in 93 children out of 456 hospitalised with gastroenteritis (S. flexneri in 60, S. sonnei in 32, S. dysenteriae in 1). From hospital and laboratory records, the clinical presentation, antibiotic treatment and duration of hospitalization were indexed as well as the antibacterial resistance pattern of shigellae. RESULTS: Of the hospitalised children 52 (56%) were treated with antibiotics. Ampicillin was given most frequently (71%), followed by the combination trimethoprim-sulfamethoxazole (25%). Isolated shigellae were resistant to ampicillin in 52% and to trimethoprim-sulfamethoxazole in 34%; 42% of the antibiotic treatments were in accordance with susceptibility of the isolated Shigella. CONCLUSION: A high percentage of shigellae isolated on Cura?ao was resistant to the most frequently used antibiotics ampicillin and trimethoprim-sulfamethoxazole.     

Approaches to antiviral chemotherapy for acute respiratory infections

This paper describes a telemedicine system for diabetic patients management, presenting its architecture, the technical solutions adopted and the methodologies on which it is based. The system, designed to provide decision support in a distributed environment, is composed of two modules, a Patient Unit and a Medical Unit, connected by telecommunication services. We outline how the two modules can interact to perform an effective monitoring and a cooperative control of glucose metabolism. In particular, we detail the data analysis tasks performed by the two units and how the results are exploited to assist patients and physicians in revising and adjusting the therapeutic protocol. We will finally describe the current prototypical implementation of the system that uses HTTP as the communication protocol and HTML pages as the graphical user interface.     

Selection of drugs for chemotherapy based on drug resistance marker

There is no appropriate tumor marker for the selection of anti cancer drug. Some agents can be selected for the reversal of anti cancer drug resistance. For example, verapamil or cyclosporin A may be useful for p-glycoprotein related multidrug resistance, and amphotericin B, docosahexaenoic acid or 8-chloro cAMP can be used for the modification of cisplatin-resistance. Recently, bcl-2 or mutated p53 gene are demonstrated to be important markers for drug resistance. More studies are necessary to identify an appropriate markers for drug resistance and overcome it.     

Recent advances in antibiotic regimens for the treatment of obstetric-gynecologic infections

This paper reviews new information on antimicrobial agents for the treatment of obstetric-gynecologic infections. The bacteriology of these infections is complex, reflecting the bacteria that usually colonize the vagina and cervix. In general, these infections are polymicrobial in nature: the most frequently isolated microorganisms are gram-negative facultative aerobes, anaerobes, Chlamydia trachomatis, and Neisseria gonorrhoeae. Antibiotic regimens that do provide coverage of these pathogens showed unacceptably high failure rates. A review of the studies recently published confirmed the recommendations of the US Centers for Disease Control and Prevention for severe (inpatients) and mild-to-moderate (outpatients) pelvic inflammatory disease infections. In the case of severe infections, two regimens are recommended: a second-generation cephalosporin like cefoxitin or cefotetan, plus doxycycline or clindamycin/gentamicin. In the case of mild-to-moderate infection, a second- or third-generation cephalosporin plus doxycycline, or oral clindamycin plus an oral quinolone are recommended. Such studies produce high bacteriologic and clinical success rates. New studies indicate that gentamicin may be replaced with a monobactam such as aztreonam; this regimen leads to slightly better efficacy and less toxicity. The possibility of using clindamycin and a quinolone antibiotic is also discussed.     

Epidemiology of emerging pneumococcal drug resistance: implications for treatment and prevention

Drug-resistant Streptococcus pneumoniae infection are becoming increasingly common throughout the world. These strains pose new challenges in the treatment of suspected pneumococcal infections, and they highlight the importance of limiting selection for resistant strains through judicious antibiotic use and preventing infection by immunization of persons at high risk. The clinical impact of drug-resistant S. pneumoniae infection has not been fully defined, but anecdotal reports suggest that outcome is poor for persons with drug-resistant pneumococcal meningitis. The American Academy of Pediatrics has recommended adding vancomycin to the treatment of suspected pneumococcal meningitis cases until the results of culture and susceptibility testing are available. Additional data are needed to determine the optimal empiric antibiotic regimen for nonmeningeal invasive pneumococcal infections. A 23-valent pneumococcal capsular polysaccharide vaccine can prevent many drug-resistant and susceptible invasive pneumococcal infections. The vaccine is recommended in the United States for persons at increased risk of pneumococcal infection due to certain medical conditions and for all persons > or = 65 years old. Vaccine efficacy for immunocompetent persons > or = 65 years is 75%. However, the vaccine is underutilized, and a substantial reduction in the morbidity and mortality associated with invasive pneumococcal infections is unlikely until the vaccine is used more widely among persons at risk for disease.     

Continuation of antibiotic therapy for serious bacterial infections outside of the hospital

Many children hospitalized with serious bacterial infections are candidates for either home oral antibiotic therapy or outpatient parenteral antibiotic therapy. Outpatient antibiotic therapy offers the potential for excellent medical treatment, reduced costs, and improved quality of life for ill children. However, cost considerations must not override good medical judgment. Certain children simply are not candidates for outpatient therapy because of the seriousness of their infection, poor compliance, lack of intravenous access, or poor social situation. In addition, although the few published studies to date all show that outpatient antibiotic therapy is effective, there is further need for properly designed clinical trials to evaluate the efficacy and safety of outpatient antibiotic therapy for serious bacterial infections in children.     

Prevention of respiratory infections in adults. Influenza and pneumococcal vaccines

Influenza and pneumococcal infections are important causes of hospitalization and death among individuals who are elderly or who have chronic illnesses. Influenza and pneumococcal vaccines may prevent these infections and their complications, but most high-risk patients have not received them. Doubts about their effectiveness, fears of side effects, and the lack of programs to promote their use contribute to the underuse of these vaccines. Although adequate controlled trials in high-risk patients are lacking, there is observational evidence that they are moderately effective, reducing serious complications of influenza and pneumococcal infections by about one-half. They are cost-effective compared with other preventive interventions and may be cost saving. Their safety has been demonstrated in numerous studies. Health care providers should promote influenza and pneumococcal vaccination. Strategies that have been shown to be successful in increasing the use of these vaccines include provider education and feedback, flagging charts of vaccination candidates, mailed reminders to patients without fall appointments, standing orders for nurses to administer the vaccines, walk-in vaccination clinics, and vaccination of hospitalized patients at discharge.     

Impact of genetics on disease resistance

PURPOSE: To evaluate the safety and efficacy of phacoemulsification, primary posterior capsulorhexis (PCCC), and primary intraocular lens (IOL) implantation for uveitic cataracts. SETTING: Institutional practice. METHODS: Fifteen consecutive eyes of 13 patients with various causes of uveitis received anterior capsulorhexis, phacoemulsification, PCCC, and in-the-bag implantation of a heparin-surface-modified IOL for visually disabling cataract. The safety and efficacy of the combined operation were studied prospectively. RESULTS: At a mean follow-up of 16.9 months (range 8 to 30 months), all eyes had a clear central visual area. Fourteen of 15 eyes (93.3%) had good visual improvement after surgery. Eight eyes (53%) achieved a best corrected visual acuity (BCVA) of 20/30 or better and 6 (40%), 20/20 or better. Seventy-three percent of eyes attained a BCVA of 20/80 or better. The mean improvement in visual acuity was 5.2 Snellen lines (range 0 to 11 lines). No cases of uveitis flare-up or other major complications related to the cataract surgery occurred. CONCLUSIONS: The study's preliminary results are encouraging and indicate that phacoemulsification, PCCC, and IOL implantation can be considered in patients with visually disabling uveitic cataract.     

Multiple antibiotic resistance in Stenotrophomonas maltophilia

A cryptic multidrug resistance (MDR) system in Stenotrophomonas maltophilia, the expression of which is selectable by tetracycline, is described. Tetracycline resistance was the consequence of active efflux of the antibiotic, and it was associated with resistance to quinolones and chloramphenicol, but not to aminoglycosides or beta-lactam antibiotics. MDR is linked to the expression of an outer membrane protein (OMP54) both in a model system and in multidrug-resistant clinical isolates.     

抗生素的耐药性与抗生素的应用

细菌对抗生素产生耐药性是一种自然生物现象,抗生素的广泛应用与滥用加速了耐药性过程.现就抗生素的耐药机理进行讨论,期望有助于进一步合理应用抗生素.     

Multiple antibiotic resistance in Streptococcus pneumoniae

A 40-year-old Libyan male was admitted to the intensive therapy unit of Zliten Central Hospital, Libya after a road traffic accident in which he had been the driver. On physical examination he was irritable, dyspnoeic, cyanotic, had contusions and abrasions on his chest and abdomen (mainly on the left side), a lacerated wound on the forehead, a large haematoma over the left thigh and tenderness over the left side of the chest and abdomen.