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Background: Bacterial pneumonia is a very common cause of morbidity and mortality among persons with human immunodeficiency virus; however, the microbiologic characteristics (including antibiotic resistance) of bacterial pathogens causing community-acquired pneumonia in this population have not been well characterized or correlated with potentially predictive clinical presentation characteristics. Methods: We conducted a retrospective cohort study of all adults known to have or to be at high risk for human immunodeficiency virus infection and hospitalized at San Francisco (Calif) General Hospital from May 1990 through April 1991, with a hospital discharge diagnosis of community-acquired bacterial pneumonia and for whom a medical records review confirmed that this diagnosis met a uniform case definition. Results: Two hundred sixteen eligible patients had one or more hospital admissions meeting the case definition. One or more etiologic pathogens were definitively identified in 75% of cases, with Streptococcus pneumoniae, Haemophilus species, Staphylococcus aureus, and gram-negative bacilli most frequently identified. In patients who had a bacteriologic diagnosis made, 18.6%, 6.8%, and 4.3% had pneumonia caused by pathogens resistant to ampicillin sodium, cefuroxime sodium, or trimethoprim-sulfamethoxazole, respectively. One hundred percent of pathogens isolated were susceptible to ceftazidime. Anemia and use of antibacterial medication at the time of hospital admission were the only independent predictors of ampicillin and cefuroxime resistance. Conclusion: Nearly one fifth of human immunodeficiency virus - associated community-acquired bacterial pneumonias requiring hospitalization were caused by ampicillin-resistant pathogens, and presenting clinical characteristics did not consistently define a subset of patients at lower risk for resistance. In the absence of a diagnostic sputum Gram's stain and pending definitive microbiologic diagnosis, initial empiric therapy should be with a second- or third-generation cephalosporin or possibly trimethoprim-sulfamethoxazole.

Significantly more HIV-positive men surveyed in San Francisco used antiviral therapy and preventative anti-Pneumocystis carinii pneumonia (PCP) therapy in 1991 than in 1987-89. Of 42 men with AIDS, 93% had used antiretroviral drugs at some time, up from 58% in 1989, and 71% were currently using them. Also, 81% had used anti-PCP therapy before, up from 44% in 1989, and 67% were currently undergoing anti-PCP therapy. Of 313 HIV-positive men without AIDS, 57% had used antiretroviral drugs and 46% were currently taking them. Only 32% of them had ever undergone preventative anti-PCP therapy and 26% were currently undergoing anti-PCP therapy. The San Francisco HIV-positive population is more educated, has a higher socioeconomic status and greater awareness of and access to HIV treatment than does most of the HIV-infected population in the US. These finding suggest that in areas where both patients and doctors are well-informed of treatments available, high use of HIV therapy can be achieved.

NEW ORLEANS -- Patients taking warfarin should use trimethoprim-sulfamethoxazole only as a last resort antibiotic and should be closely monitored for increased anticoagulant activity while on the antibiotic, Dr. Douglas [...]

Synopsis: The days may be numbered when trimethoprim/sulfamethoxazole should be used for empiric therapy for uncomplicated UTI. Source: Gupta K, et al. JAMA 1999;281:736-738. PREVALENCE AND TRENDS IN ANTIMICROBIAL RESISTANCE [...]

WASHINGTON -- The prevalence of urinary tract infections in women resistant to standard treatment has been increasing, but there are indications that the increase has begun to level off, Patricia [...]

As medical director for Homeless Health Care Los Angeles, where I run a clinic at a needle exchange on Skid Row, and as a staff physician at the free Venice [...]