Ricardo Bolivar

Bacteremia caused by Campylobacter-like organisms in two male homosexuals.

Bacteremia caused by newly described Campylobacter-like organisms occurred in two immunosuppressed homosexual patients with tuberculosis. Although these organisms grow well in aerobic bottles using a radiometric blood culture system, they are not readily seen in gram-stained smears and are easily missed if routine subculture methods are used. Microscopic examination of wet preparations and subculture to brucella agar base supplemented with 10% sheep blood and incubated in microaerophilic conditions are useful for identification and isolation. The recovery of Campylobacter-like organisms from the blood suggests that these organisms, formerly known only to be associated with proctocolitis or asymptomatic rectal infection in homosexual men, can also cause systemic infection in these patients.

Piperacillin plus vancomycin in the therapy of febrile episodes in cancer patients.

Piperacillin and vancomycin were used as initial empirical therapy for 211 febrile episodes in cancer patients. The response rate in 95 episodes of documented infection was 72%. The response of bacteremias, soft tissue infections, and pneumonias was 78, 71, and 38%, respectively. The response in infections caused by gram-negative organisms was 73%. Only 6 of 10 Pseudomonas aeruginosa infections responded to therapy, although the organisms were sensitive in vitro to piperacillin. Of 14 infections caused by gram-positive organisms, 12 responded to this combination. No major side effects were observed with this regimen. Although the overall response rate with this antibiotic combination was comparable with other regimens used for neutropenic patients, superior results might be obtained by combining piperacillin with an extended-spectrum cephalosporin or an aminoglycoside.

Bacteremia Caused by a Previously Unidentified Species of Rapidly Growing Mycobacterium Successfully Treated with Vancomycin

Bacteremia caused by rapidly growing mycobacteria are usually due to Mycobacterium fortuitum or M. chelonei. Other rapidly growing mycobacteria generally are considered to be nonpathogenic. We report the case of a patient with bacteremia due to an unidentified, rapidly growing, scotochromogenic mycobacteria that was detected by a radiometric blood culture system. Results of in-vitro susceptibility testing indicated that the organism was susceptible to vancomycin and other antimicrobial agents, and the patient was successfully treated with vancomycin. We believe that this is the first report of successful use of vancomycin therapy for a mycobacterial infection.

Comparative in vitro study of temocillin (BRL 17421), a new penicillin.

The activity of temocillin (BRL 17421), a new penicillin, was tested in vitro against 653 isolates of gram-negative bacilli and gram-positive cocci. The drug was compared with other beta-lactam antibiotics and tobramycin. It inhibited the majority of gram-negative bacilli tested except for Pseudomonas aeruginosa and Acinetobacter calcoaceticus, which were highly resistant. It was active against more than 50% of the multiresistant strains tested. Temocillin was more active than mezlocillin against most gram-negative bacilli and more active than moxalactam, ceftriaxone, and ceftazidime against Enterobacter spp. In general, it was slightly less active than the other drugs tested and had no activity against the gram-positive cocci. There was no significant change in drug activity when pH and medium were varied, and the effect of serum binding was minimal. There was no significant inoculum effect when the size of the inoculum was increased from 10(4) to 10(6) organisms per ml.

Activity of β-lactamase inhibitors in combination with new β-lactam antibiotics against resistant gram-negative organisms

Abstract Thirty-eight isolates of gram-negative bacilli resistant to four new β-lactam antibiotics, aztreonam, moxalactam, ceftazidime, and cefoperazone, were tested in the presence of two β-lactam inhibitors, clavulanic acid and sulbactam. Microorganisms tested included 22 isolates of Pseudomonas species, 5 of Klebsiella species, and 11 of Enterobacter species. A 2- to 10-fold decrease in minimum inhibitory concentration was noted when antibiotics and β-lactamase inhibitors were combined compared to antibiotics alone. Four strains of Pseudomonas aeruginosa showed increased resistance to the combination of antibiotics and β-lactamase inhibitors.

Streptococcus bovis septicemia and meningitis associated with chronic radiation enterocolitis

We describe the first patient with simultaneous S bovis septicemia and meningitis associated with chronic radiation enterocolitis. This case underlines the value of a thorough gastrointestinal evaluation of all patients with S bovis infection, and the need for a neurologic investigation even with minor neurologic manifestations.