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We investigated the clinical efficiency and safety of ceftazidime for treatment of 33 episodes of infection in 30 patients (17 males and 13 females), whose ages ranged from 9 to 92 years (mean 52.5). Fourteen patients had ultimately fatal diseases and the remaining 16 had non-fatal diseases. The clinical condition of patients at the beginning of treatment was critical or poor in 16 cases.Episodes of infection treated were: 24 urinary tract infections (eight of them with concomitant bacteraemia), seven wound infections (one with concomitant bacteraemia and three with osteomyelitis), and two episodes of pneumonia.Twenty-nine episodes of infection were monomicrobial and the four remaining ones were polymicrobial. Significant organisms isolated were all aerobic or facultatively anaerobic Gram-negative rods and were responsible for the following episodes of infection: Escherichia coli (14), Pseudomonas aeruginosa (12), Pseudomonas cepacia (1), Proteus mirabilis (5), Serratia marcescens (2), Klebsiella (2), Enterobacter aerogenes (1) and Haemophilus influenzae (1).Total dosage of ceftazidime ranged from 28 to 240 g (mean 82.4 g), and mean duration of therapy was 17 days (range 8 to 44 days).The overall rate of clinical response to ceftazidime was 91%. Local and general tolerance to the drug was excellent. Enterococcal and/or candida colonization occurred in 12 episodes (36%) and superinfections by the same micro-organisms occurred in three episodes.Ceftazidime seems to be an effective and safe single agent for therapy of many bacterial infections, including those caused by Ps. aeruginosa. [ABSTRACT FROM PUBLISHER]

The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. Short peripheral catheters have been found to be associated with the risk of nosocomial bacteremia resulting in morbidity and mortality. Staphyloccus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been elaborated by a panel of experts of the Spanish Society of Cardiovascular Infections in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy and Spanish Society of Thoracic-Cardiovascular Surgery and aims at define and establish the norm for management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance and registry, diagnosis and treatment of infection, indications for removal and stresses on continuous education as a driver for quality. Implementation of this norm will allow uniformity in usage thus minimizing the risk of infection and its complications.

Objectives: To analyze the incidence trend of listeriosis, its present epidemiology and the potential benefit of aminoglycosides during the last two decades., Methods: We reviewed all cases of invasive listeriosis detected during a 22-year period in a large tertiary hospital. Two equal periods of 11 years were compared., Results: We detected 111 cases of listeriosis (32 during the first 11-year period and 79 during the second). Incidence of listeriosis increased significantly (from 4.66/10(6) inhabitants to 10.39/10(6) inhabitants; P = .001). In the second period, there were more patients >65 years (21.9%-45.6%; P = .02) and with no significant underlying diseases (0 vs. 16.5%; P = .02). Comparing clinical presentations between the two periods, primary bacteremia increased (40.6% vs. 55.7%), while central nervous system infections decreased (34.4% vs. 27.8%). Cotrimoxazole (SXT) use increased significantly in the second period (from 6.3% to 40.5%, P = .001) while the administration of aminoglycosides decreased (from 40.6% to 21.5%, P = .04). The use of combination therapy did not have any impact on mortality, however it did increase toxicity., Conclusions: Listeriosis should be considered an emerging health problem, especially among the elderly, including those with no underlying medical conditions. The use of aminoglycosides does not seem to be justified according to our data., (Copyright © 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)

Objective: To describe an outbreak of trimethoprim-sulfamethoxazole (cotrimoxazole)-resistant and methicillin-resistant Staphylococcus aureus (CMRSA) in a unit housing patients infected with the human immunodeficiency virus (HIV)., Design: Prospective study involving patients colonized or infected with CMRSA., Patients: 15 hospitalized patients with cultures positive for CMRSA., Methods: Isolates of CMRSA were collected and characterized. Molecular typing of the epidemic strains was carried out after total DNA extraction by restriction endonuclease analysis and random amplification of polymorphic DNA., Results: The epidemic was brought under control with the reinforcement of nosocomial transmission measures and with systematic nasal decontamination with mupirocin of all patients admitted to the HIV unit. Molecular typing techniques showed the existence of two epidemic strains: strain A was present in the 12 patients admitted to the HIV unit and strain B in the remaining 3 patients hospitalized elsewhere., Conclusions: Cotrimoxazole may no longer be a reliable and effective alternative for glycopeptides in patients with infection caused by MRSA strains, and HIV units should be particularly alert for CMRSA strains.

Severe infections caused by Pseudomonas aeruginosa are uncommon in patients infected with HIV. These infections are usually recurrent, bear a poor prognosis and their potential for nosocomial transmission is questioned. From May 1991 to December 1994, a total of 2,739 admissions were recorded at the VIH Unit in our hospital. Seven of those patients suffered 9 episodes of P. aeruginosa bacteremia (3.28 episodes/1,000 admissions). All cases were acquired nosocomially. The mean CD4 count was 30.7 cells/ml. Mortality associated with Pseudomonas aeruginosa bacteremia was 43%. With molecular typing techniques homologies over 98% were demonstrated for the two episodes in patient 4 and the episode in patient 3 (very close in time, 1993) and almost 99% between the isolate from patient 7 and the two isolates (identical) from patient 6. The other three isolates had relationship (to themselves and to the other isolates) lower than 97%. Our findings suggest that patient-to-patient transmission of severe infections caused by P. aeruginosa in patients with AIDS.

Objective: In recent years the incidence of gastroenteritis due to Aeromonas spp has increased significantly. The purpose of this study was to investigate the etiology and clinical manifestations of this disease., Patients and Methods: In the period between 1986 and 1992, we found Aeromonas spp in seventy patients (88 samples) between 0 and 16 years of age. We were able to analyze 53 of these samples., Results: Of all of the patients, 66% were males and 58.5% were younger than two years old. We found a pattern in the disease with 83% of the cases occurring in summer and autumn. The infection was polymicrobial in 43% of the patients. The clinical manifestations most often found were fever (71%), vomiting (62.5%) and abdominal pain (9.4%). Diarrhea was watery in 71.7% and 64% of the cases lasted less than a week. The number of stools was 5 to 10 per day in 58% of the patients. Forty patients (75.5%) required hospitalization, with the stay being longer than 10 days in 25%. There were 30% of the patients that required antibiotic therapy, mostly due to concomitant infections and not due to the diarrheic episodes, with all of them having a satisfactory evolution.