Isabel Gasser

Value of differential quantitative blood cultures in the diagnosis of catheter-related sepsis

A prospective study was performed to assess the value of differential quantitative blood cultures in the diagnosis of catheter-related sepsis when this condition is suspected on clinical grounds and to establish a reliable discriminative value for application without removal of the inserted catheter. A total of 107 central venous catheters from 64 patients were used for the study. Blood was obtained simultaneously through the suspected infected device and from a peripheral venipuncture. The catheter was removed and its tip cultured semiquantitatively. Catheter-related sepsis occurred in 17 patients. Using as cut-off value a colony count fourfold higher in blood drawn through the catheter than in simultaneously drawn peripheral blood, a sensitivity of 94 %, specificity of 100 % and positive predictive value of 100 % were obtained. A single bacterial count > 100 cfu/ml in the quantitative culture of the catheter blood specimen in the presence of a positive qualitative peripheral blood culture of the same organism was also highly suggestive of catheter-related sepsis. Differential quantitative blood culture is a reliable method for the diagnosis of catheter-associated sepsis without catheter removal.

Prophylaxis of visceral leishmaniasis in human immunodeficiency virus-infected patients

OBJECTIVE To assess the effectiveness of two regimens with allopurinol or pentavalent antimony as secondary prophylaxis for visceral leishmaniasis (VL) in human immunodeficiency virus (HIV)-infected patients. DESIGN Retrospective, nonrandomized, open trial. SETTING A 1,000-bed academic tertiary institutional hospital in Barcelona. PATIENTS Forty-six individuals over 14 years old with HIV infection, who recovered from an episode of VL between January 1988 and February 1995. INTERVENTIONS Twenty patients did not receive any prophylaxis, nine received 300 mg/8 h of allopurinol, and 17 received 850 mg once-a-month of pentavalent antimony. Patients were followed-up every 3 months, and the endpoint of study was relapse of VL. RESULTS Twenty-one patients had recurrent VL: 13 of 20 in the control group (65%), 5 of 9 in the allopurinol group (56%), and 3 of 17 in the antimonial group (18%). Kaplan-Meier estimates of the probability of remaining relapse-free at 12 months were 9% without prophylaxis (95% CI, 0-22%), 21% with allopurinol (95% CI, 0-51%), and 93% with antimonials (95% CI, 82-100%) (P < 0.001). Multivariate analysis showed that the only significant variables related to relapsing course of VL were assignment to the antimonial group, and the fact that the patient had experienced a previous episode of VL. CONCLUSIONS Pentavalent antimony given once a month is effective in the prevention of VL relapses in HIV-infected individuals. It is a low-cost treatment that proved to be well tolerated. Therefore, pentavalent antimony should be considered a suitable agent for secondary prophylaxis against VL.

Bilateral mammary abscess and uveitis caused by Brucella melitensis--report of a case.

Soft tissue locations ofBrucella are a rare finding. We report the isolation ofBrucella melitensis from a suspected breast tumour of a woman who also showed signs of uveitis. Three weeks after surgical drainage and despite antimicrobial therapy a new abscess developed on the other breast whose culture also yieldedBrucella. As observed, unusual localization of brucellosis without previous penetrating injury may be the only manifestation of chronic infection. Weichteilaffektionen durchBrucella sind selten. Wir berichten über eine Frau mit Verdacht auf Mammatumor und Uveitis, bei derBrucella melitensis aus der entzündlichen Schwellung isoliert wurde. Trotz antimikrobieller Therapie und chirurgischer Ausräumung des entzündlichen Gewebes entstand auf der anderen Seite ebenfalls ein Abszeß, aus demBrucella isoliert wurde. Der Fall zeigt, daß ohne penetrierendes Trauma als einzige Manifestation einer chronischen Brucella-Infektion ein Brucelloseherd mit ungewöhnlicher Lokalisation auftreten kann.SummarySoft tissue locations ofBrucella are a rare finding. We report the isolation ofBrucella melitensis from a suspected breast tumour of a woman who also showed signs of uveitis. Three weeks after surgical drainage and despite antimicrobial therapy a new abscess developed on the other breast whose culture also yieldedBrucella. As observed, unusual localization of brucellosis without previous penetrating injury may be the only manifestation of chronic infection.ZusammenfassungWeichteilaffektionen durchBrucella sind selten. Wir berichten über eine Frau mit Verdacht auf Mammatumor und Uveitis, bei derBrucella melitensis aus der entzündlichen Schwellung isoliert wurde. Trotz antimikrobieller Therapie und chirurgischer Ausräumung des entzündlichen Gewebes entstand auf der anderen Seite ebenfalls ein Abszeß, aus demBrucella isoliert wurde. Der Fall zeigt, daß ohne penetrierendes Trauma als einzige Manifestation einer chronischen Brucella-Infektion ein Brucelloseherd mit ungewöhnlicher Lokalisation auftreten kann.

Osteomielitis vertebral por Candida spp.

Introduccion La osteomielitis vertebral por Candida spp. es una rara entidad que requiere de un alto indice de sospecha para su diagnostico. Metodos Descripcion de 3 casos de osteomielitis vertebral por Candida spp. diagnosticados durante un periodo de 17 anos. Resultados De 110 episodios de osteomielitis, tres fueron causadas por Candida spp. Los 3 pacientes presentaban factores predisponentes: diabetes mellitus (2/3), inmunosupresion (2/3), cateteres centrales (3/3), antibioticoterapia (2/3) y nutricion parenteral (2/3). El diagnostico se establecio mediante tecnicas de imagen y cultivo de la lesion vertebral en 2 casos y en el tercero, afectado de endocarditis aortica, por la presencia de hemocultivos positivos. En 2 pacientes la evolucion fue favorable con tratamiento medico y el tercero recidivo tras 6 meses de tratamiento con fluconazol. Conclusion La osteomielitis por Candida spp. es poco frecuente y debe sospecharse en pacientes con factores de riesgo para desarrollar una candidemia.

Sternotomy infection due toMycoplasma hominis andUreaplasma urealyticum

Mycoplasma hominis infections outside the urogenital tract are uncommon. An unusual case of sternal infection caused by bothMycoplasma hominis andUreaplasma urealyticum is described. This is the first report found in the literature of mixed infection due to these microorganisms at this site. The outcome was favourable after drainage of the surgical wound and antibiotic therapy with clindamycin, gentamicin and doxycycline.