ro13-9904 and Candidiasis

Skull base osteomyelitis (SBO) is a serious and rare condition most commonly seen in elderly diabetic or immunocompromised patients as a complication of otitis externa. We present the case of a previously healthy 3-year-old girl who presented to the paediatric emergency department with vomiting, fever, lethargy, headache and left-sided facial nerve palsy. The initial CT head revealed left-sided otitis media with otomastoiditis and she was managed with intravenous antibiotics and myringotomy with grommet insertion with initial improvement. Two weeks later she re-presented having deteriorated and a dedicated mastoid CT and temporal bone MRI showed SBO. She underwent urgent cortical mastoidectomy where microbiological analysis of the cultures and specimen grew

Topics: Administration, Intravenous; Anti-Bacterial Agents; Antifungal Agents; Candida albicans; Candidiasis; Ceftriaxone; Child, Preschool; Facial Paralysis; Female; Fluconazole; Humans; Magnetic Resonance Imaging; Mastoid; Mastoidectomy; Metronidazole; Osteomyelitis; Skull Base; Tomography, X-Ray Computed

Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat children at home, but studies in children are scarce. We aimed to describe the use, appropriateness and outcomes of OPAT in children.. This was a 12-month prospective observational study.. The hospital-in-the-home programme of The Royal Children's Hospital Melbourne.. All patients receiving OPAT.. Data were collected including demographics, diagnosis, type of venous access and antibiotic choice.. Length of stay, adverse events, readmission rate and appropriateness of antibiotic use.. 228 patients received OPAT in 251 episodes. The median age was 7.4 years (range 1 week to 21 years), with 22 patients (10%) under 1 year. The most frequent diagnoses were exacerbation of cystic fibrosis (17%), urinary tract infection (12%) and cellulitis (9%). Most patients were transferred from the ward, but 18% were transferred directly from the emergency department, the majority with skin and soft-tissue infection (66%). Venous access was most commonly peripherally inserted central catheter (29%) and peripheral cannula (29%). 309 parenteral antibiotics were prescribed, most frequently ceftriaxone (28%) and gentamicin (19%). The majority of antibiotics (72%) were prescribed appropriately. However, 6% were deemed an inappropriate choice for the indication and 26% had inappropriate dose or duration. The incidence of central line-associated bloodstream infections was 0.9%. The unplanned readmission rate was 4%, with low rates of OPAT-related adverse events. Three children (1%) had an inadequate clinical response.. OPAT is a safe and effective way of providing antibiotics to children. Despite high rates of appropriate antibiotic use, improvements can still be made.

Topics: Adolescent; Ambulatory Care; Anti-Infective Agents; Bacterial Infections; Candidiasis; Catheterization, Central Venous; Catheterization, Peripheral; Ceftriaxone; Cellulitis; Child; Child, Preschool; Cystic Fibrosis; Female; Gentamicins; Humans; Infant; Infant, Newborn; Infusions, Intravenous; Infusions, Parenteral; Length of Stay; Male; Patient Readmission; Prescription Drugs; Prospective Studies; Referral and Consultation; Treatment Outcome; Urinary Tract Infections; Young Adult

A 51-year-old previously fit and healthy gentleman sustained a circular saw injury to his right thumb with partial amputation and an open multifragmentary fracture of his distal phalanx. He underwent open reduction and internal fixation under the hand surgery team. He developed a postoperative infection discharging pus 2 weeks postoperatively, which later grew Candida parapsilosis. He underwent radical debridement and removal of a K-wire, then a further second debridement 2 days later. Ceftriaxone was started empirically while awaiting cultures. Tissue and bone biopsy samples obtained in theatre all grew C. parapsilosis and he was started on caspofungin for 1 week, and switched on to oral fluconazole to complete a 6-week course. He has progressed well and has regained function in his thumb after 3 months, without any sign of ongoing infection.

Topics: Amputation, Traumatic; Antifungal Agents; Candida; Candidiasis; Ceftriaxone; Debridement; Drug Therapy, Combination; Finger Phalanges; Fluconazole; Fracture Fixation, Internal; Fractures, Open; Humans; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Thumb

Candidiasis of the gallbladder is an uncommon cause of acute cholecystitis. Candidal cholecystitis is seen especially in patients with malignancies. In the present case, we report that acute calculous cholecystitis was caused by Candida lusitaniae in a 33-year-old patient without underlying malignancy. According to our review of the literature, this is the first report of acute cholecystitis caused by C. lusitaniae.

Topics: Adult; Anti-Bacterial Agents; Antifungal Agents; Candida; Candidiasis; Ceftriaxone; Cholecystitis; Female; Fluconazole; Gallbladder; Gallstones; Humans

This study studied the use of ERCP and nasobiliary tube in the diagnosis of fungal infection of biliary tract and the efficacy of combined use of local administration via nasobiliary tube and intravenous antifungal treatment for severe biliary tract fungal infection. 5 patients in our series, with age ranging from 47 to 68 y (mean 55.8), were diagnosed as having mixed bacterial and fungal infection of biliary tract as confirmed by smear or/and culture of bile obtained by ERCP and nasobiliary drainage. Besides routine anti-bacteria therapy, all patients received local application of fluconazole through nasobiliary tube and intravenous administration of fluconazole or itraconazole in terms of the results of in vitro sensitivity test. The mean duration of intravenous fluconazole or itraconazole was 30 days (24-40 days), and that of local application of fluconazole through nasobiliary drainage tube was 19 days (8-24 days). During a follow-up period of 3-42 months, all patient's fungal infection of biliary tract was cured. It is concluded that on the basis of typical clinical features of biliary tract infection, fungal detection of smear/culture of bile obtained by ERCP was the key for the diagnosis of fungal infection of biliary tract. Local application antifungal drug combined with intravenous anti-fungal drugs might be an effective and safe treatment for fungal infection of biliary tract.

Topics: Aged; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Biliary Tract Diseases; Candidiasis; Ceftriaxone; Cholangiopancreatography, Endoscopic Retrograde; Drainage; Female; Fluconazole; Humans; Male; Middle Aged; Staphylococcal Infections

In this retrospective study of the outcome of treatment of 245 patients (87 females and 158 males) with a diagnosis of Neisseria gonorrhoeae infection seen between 1996 and 2002, 81% (95% confidence interval (CI) 74%-86.8%) of the males and 88.5% (95% CI 79.9%-94.3%) of the females attended for a test of cure. At initial presentation, 93% (95% CI 87.9%-96.5%) and 94.3% (95% CI 89.5%-97.4%) of males respectively, had symptoms and signs of gonococcal infection compared with 48.3% (95% CI 37.4%-59.2%) and 44.8% (95% CI 34.1%-55.9%) of females, and this difference was statistically significant (P = 0.005). Initial diagnosis at first visit was made by Gram-stained smear in 88.6% (95% CI 82.6%-93.1%) of males and 32.2% (95% CI 22.6%-43.1%) of females, a statistically significant difference P = 0.001. There were 12 (4.9%) cases of reinfection that rebooked to attend after failing to attend for their test of cure in two females and 10 males. There were two (0.8%) treatment failures amongst the 245 episodes in two males who still had symptoms when they returned for their test of cure. One male had a ciprofloxacin-resistant strain (CRNG) acquired locally and the other one had a betalactamase-producing CRNG/penicillinase-producing N. gonorrhoeae (PPNG) isolate acquired abroad in South America. These patients would have sought to return, as they still had signs and symptoms of gonococcal infection, and they would have been recalled following receipt of the antimicrobial susceptibility report. Post-gonococcal urethritis occurred in 36.3% (95% CI 27.8%-45.4%) of the males who attended for their test of cure, 74.8% (95% CI 67.2%-81.5%) received anti-chlamydial therapy with their standard treatment. In men who received anti-chlamydial therapy the odds ratio of having post-gonococcal urethritis was 0.42 (95% CI 0.17-1.06), P = 0.04. Co-infection with Chlamydia trachomatis was more likely to occur amongst females (43.9%), odds ratio 3.97 (95% CI 2.07-7.67), P < 0.001 than males (16.5%). We have now discontinued routine attendance for a test of cure and encourage our patients to telephone for their results with recall only of patients whose antimicrobial susceptibility indicate inappropriate first line therapy or who are still symptomatic.

Topics: Adolescent; Adult; Ambulatory Care Facilities; Anti-Bacterial Agents; Candidiasis; Ceftriaxone; Chlamydia Infections; Cohort Studies; Contact Tracing; Drug Resistance, Microbial; Female; Gonorrhea; Herpes Simplex; Humans; Male; Middle Aged; Neisseria gonorrhoeae; Recurrence; Retrospective Studies; Sex Factors; Sexually Transmitted Diseases, Viral; United Kingdom; Urethritis; Vaginitis

Adult male Crl:CD1 (ICR) mice were fed chow containing Candida albicans to induce sustained gastrointestinal colonization by the yeast. Groups of mice were rendered neutropenic with cyclophosphamide and subsequently received ceftriaxone, while other groups received normal saline and served as controls. Stool cultures were obtained immediately before and at the end of treatment. The administration of cyclophosphamide substantially increased the C. albicans counts in the stools of mice. The addition of ceftriaxone to the cyclophosphamide regimen did not significantly increase the level of gastrointestinal colonization by C. albicans. There was no evidence of Candida dissemination to internal organs.

Topics: Alkylating Agents; Animals; Candida albicans; Candidiasis; Ceftriaxone; Cephalosporins; Cyclophosphamide; Digestive System; Feces; Male; Mice; Mice, Inbred ICR; Neutropenia

One hundred and one patients undergoing anticancer chemotherapy due to hematologic malignancy were retrospectively divided into two groups: 67 patients were treated with ceftriaxone plus amikacin, receiving once daily (od) 2-4 g ceftriaxone, 1-1.5 g amikacin (those without a peripheral or central venous catheter) and 34 patients with central or peripheral venous catheter (CPVC) receiving ceftizidime 2 g three times daily (tid) plus amikacin 0.5 g tid i.v. Both groups were similar as to their isolated pathogens, localization of infection, and basic diagnoses of hematologic malignancies. There was no significant difference in efficacy between ceftriaxone plus amikacin versus ceftazidime plus amikacin, but the toxicity was lower in once daily ceftriaxone plus amikacin group.

Topics: Amikacin; Antineoplastic Agents; Bacterial Infections; Candidiasis; Catheterization, Central Venous; Catheterization, Peripheral; Ceftazidime; Ceftriaxone; Drug Therapy, Combination; Hearing; Humans; Kidney; Leukemia; Lymphoma; Neutropenia; Retrospective Studies

The flora in the throat and the stools of 10 patients receiving chemotherapy for malignant diseases in a laminar air-flow room was studied during the prophylactic administration of ceftazidime. Ten percent of aerobic gram-negative bacilli, 41% of aerobic gram-positive organisms, 59% of anaerobes, and 70% of fungi persisted in stool specimens during ceftazidime administration. This drug had a less pronounced effect on the throat flora; 66% of organisms persisted during antibiotic administration. The throat and fecal flora of another eight patients were studied during the prophylactic administration of ceftriaxone. This antibiotic had a profound effect on the fecal flora; none of the gram-negative bacilli, only 24% of aerobic gram-positive organisms, and only 10% of anaerobes persisted during ceftriaxone administration. Like ceftazidime, ceftriaxone had a less marked effect on the throat flora; 59% of organisms persisted during antibiotic administration. The results show that new, expanded-spectrum cephalosporins can have a major suppressive effect on patients' endogenous microbial flora.

Topics: Adult; Aged; Bacterial Infections; Bacteroides; Candidiasis; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Enterobacteriaceae; Feces; Female; Humans; Male; Middle Aged; Neoplasms; Pharynx; Staphylococcus; Streptococcus