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Introduction: Acute obstructive kidney failure can occur during sulfadiazine treatment of cerebral toxoplasmosis in immunocompromised patients., Case: Six days after the patient began sulfadiazine treatment for toxoplasmosis, he developed low back pain radiating into the abdomen and kidney failure with obstructive uropathy, followed by anuria. Abdominal computed tomography found bilateral pyelocaliceal distention. Six hours after a hemodialysis session, the pain stopped abruptly and abundant diuresis resumed., Discussion: During acute renal failure due to sulfadiazine, simply stopping the drug treatment does not suffice. The massive alkalinization induced by hemodialysis, however, is effective.

Objectives: Multiresistant bacteria are regularly isolated in nosocomial infections occurring in intensive care units due to wide use of antibiotics. We evaluated the impact of systematic infectiology consultations on the quality of antibiotic prescriptions in an intensive care unit., Patients and Methods: Infectiology consultations (3 per week) were initiated mid February 1999. The infectiologist gave oral advice to be implemented (or not) by the intensive care unit according to ongoing therapeutic options. The hospital pharmacy recorded antibiotic use for March and April 1999 for comparison with use recorded in 1998 for a similar period. We retrospectively reviewed the files of patients hospitalized during these periods and who had received antibiotics to determine the modalities of antibiotic use. The 4 antibiotics used for the longest period for each patient were recorded., Results: Thirty-one patients in 1999 and 30 in 1998 were given antibiotics. The SAPS score was similar for the two groups. Mean duration of antibiotic treatment was lower during the March-April 1999 period than during the corresponding period in 1998: 13 +/- 9 days/patient versus 23 +/- 21 days/patient respectively, p = 0.037. In 1998, there were 596 antibiotic-days and in 1999 there were 455 (-24%). The cost of antibiotic therapy in 1998 was 70,342 FrF compared with 56,804 FrF in 1999 (-19%)., Conclusion: Infectiology consultation, in association with the opinion of the intensive care physician, is a simple way to limit antibiotic use.