George F. Thornton

Extrapulmonary tuberculosis. Experience of a community hospital and review of the literature

Extrapulmonary tuberculosis accounted for 37 percent of all new cases of active tuberculous infection identified at a 522-bed community hospital during an 11-year period. Forty-five foci of extrapulmonary infection were diagnosed in 38 patients. Involvement of the genitourinary system, lymphatic system, and respiratory system, other than the lung, was most common and accounted for 58 percent of all infections. Presenting symptoms were protean and often resulted in long delays between onset of symptoms and eventual diagnosis. Foreign birthplace, prior history of or exposure to tuberculosis, constitutional symptoms, febrile course, and anemia were important findings suggesting the diagnosis. Results of tuberculin skin tests were positive in 31 of 34 patients. Chest radiography demonstrated abnormalities in 25 of 38 patients. Cultures showed growth of Mycobacterium tuberculosis in 27 of 39 affected sites, and caseating granulomas were identified in 31 instances. It is concluded that extrapulmonary tuberculosis remains an important infectious disease problem despite the overall decrease in the national incidence of tuberculosis.

Cefoperazone versus combination antibiotic therapy of hospital-acquired pneumonia

Cefoperazone monotherapy was compared with combination antibiotic therapy in a randomized prospective evaluation of patients with hospital-acquired pneumonia. Cefoperazone was as effective as either clindamycin/gentamicin or cefazolin/gentamicin (cure rate: 45 of 52 cefoperazone-treated patients [87 percent], versus 44 of 61 combination-therapy patients [72 percent], p = 0.069). With the exception of hypoprothrombinemia in those patients who did not receive prophylactic vitamin K, there was no difference in the incidence of side effects. In addition, no difference was noted in the incidence of superinfections or secondary pneumonias. When antibiotic costs, administration costs, and laboratory costs were considered, cefoperazone monotherapy was the least expensive antibiotic regimen. Cefoperazone is a suitable alternative to combination antibiotic therapy for the treatment of hospital-acquired pneumonia.

Cefoperazone versus ceftazidime monotherapy of nosocomial pneumonia

Cefoperazone and ceftazidime monotherapy were compared in a randomized, prospective evaluation of patients with nosocomial pneumonia. These antibiotics were equally effective, with an overall successful treatment rate of 45 of 62 (73 percent) for cefoperazone-treated patients and 50 of 63 (79 percent) for ceftazidime-treated patients (p = 0.41). There was no difference in the incidence of side effects (including hypoprothrombinemia), superinfections, or colonization of the oropharynx with yeast, enterococcus, Staphylococcus aureus, or resistant gram-negative bacilli. When antibiotic administration, and laboratory costs are considered, cefoperazone is less expensive than ceftazidime. Both cefoperazone and ceftazidime are effective therapy for nosocomial pneumonia.

Cefoperazone versus ceftriaxone monotherapy of nosocomial pneumonia

Ceftriaxone and cefoperazone monotherapy was compared in a multicentered, randomized, nonblinded, prospective study of patients with nosocomial pneumonia. These antibiotics were equally effective, with an overall successful treatment rate of 48 (80%) of 60 for the cefoperazone-treated patients and 35 (70%) of 50 for the ceftriaxone-treated patients. Patients with nursing-home-acquired pneumonia had similar bacterial pathogens and an almost identical cure rate to those patients with hospital-acquired infection. There was no statistical difference in the incidence of side effects of superinfections. The development of secondary pneumonia with resistant bacteria was low, 3% with cefoperazone and 4% with ceftriaxone. When antibiotic, administrative, and laboratory costs were calculated, cefoperazone was slightly less expensive than ceftriaxone. Both cefoperazone and ceftriaxone are effective therapy for the treatment of nosocomial pneumonia.

TEMPERATE PYOMYOSITIS AT TWO COMMUNITY HOSPITALS

In a retrospective review of 430,000 hospital admission at two community hospitals from 1981 to 1996, 28 cases of primary temperate pyomyositis were identified the muscle most commonly affected was the iliopsoas (46%)staphylococcus aureus was the predominant organism (12 of 20 positive cultures yielded streptococcus species in several cases and various other organisms including Escherichia coli, proteus mirabilis, peptococcus magnus, salmonella, and mycobacterium tuberculosis all patients presented with muscle pain and fever. Patient characteristics included trauma (39%), injection drug use (25%), diabetes mellitus (21%), and human immunodeficiency virus–positive status (10%). The erythrocyte sedimentation rate and leukocyte count at admission were elevated in 81% and 79% of patients, respectively. No patient had eosinophilia. Blood cultures were positive for organisms in 64%. Computed tomography, magnetic resonance imaging radionuclide scanning, and ultrasonography were diagnostically helpful. Treatment consisted of antibiotic therapy with or without surgical or percutaneous drainage. In contrast to tropical pyomyositis, which occurs largely in immunocompetent Hosts and is due almost exclusively to s aureus, temperate pyomyositis is becoming more common in immunocompromised or chronically ill patients and is associated with a wide variety of organisms. Pyomyositis, which mimics many diseases, should be included in the differential diagnosis of all patients with localized pain and fever.