Y. Van Laethem

Single-drug versus combination empirical therapy for gram-negative bacillary infections in febrile cancer patients with and without granulocytopenia.

Empirical therapy with cefoperazone was compared with cefoperazone plus amikacin in granulocytopenic and nongranulocytopenic febrile patients. In nonneutropenic patients the overall response rate to cefoperazone was 88%; 10 of 12 gram-negative bacteremic patients were cured. Cefoperazone plus amikacin resulted in an 88% overall response rate and cured 14 of 15 patients with bacteremia. In neutropenic patients the overall response rate was 77% with cefoperazone alone and 73% with cefoperazone plus amikacin; the cure rates for gram-negative bacteremias were 8 of 11 and 6 of 12 patients, respectively. Our findings support the concept of single-drug empirical therapy with cefoperazone in febrile cancer patients, whether granulocytopenic or not, especially when gram-negative bacteremias are predominantly caused by Escherichia coli or Klebsiella species. The issue of Pseudomonas spp. and other more resistant pathogens needs further assessment with a larger number of patients.

Serum bactericidal activity of ceftazidime and cefoperazone alone or in combination with amikacin against Pseudomonas aeruginosa and Klebsiella pneumoniae.

Sera of volunteers receiving ceftazidime (2 g) or amikacin (500 mg), alone or in combination, or cefoperazone (2, 4, or 6 g) or cefoperazone (2 g) with amikacin (500 mg) were evaluated for bactericidal activity against Klebsiella pneumoniae and Pseudomonas aeruginosa. Serum bactericidal activities were similar for ceftazidime and ceftazidime plus amikacin, but were definitely lower for amikacin alone. Against P. aeruginosa, a 6-g dose of cefoperazone resulted in a higher frequency of peak serum bactericidal activities greater than or equal to 1:8 than a 2-g dose of cefoperazone plus amikacin. Killing studies, performed in 1:8 diluted serum, demonstrated a higher killing rate for cefoperazone plus amikacin than for a 6-g dose of cefoperazone, the more resistant P. aeruginosa excepted. Emergence of resistance was found with a 2-g dose of cefoperazone for K. pneumoniae and with a 6-g dose of cefoperazone for P. aeruginosa, but not with cefoperazone plus amikacin.

Epidemiology and outcome of invasive pneumococcal disease among adults in Belgium, 2009–2011

This epidemiological study examined morbidity and case fatality of invasive pneumococcal disease (IPD) in adults in Belgium as well as distribution and antibiotic susceptibility of Streptococcus pneumoniae serotypes.Adults hospitalised with microbiologically proven IPD were prospectively enrolled. The study started in 2009 with patients aged ≥50 years, whereas in 2010 and 2011, patients aged ≥18 years were included. The clinical presentation, patient profile, treatment, outcome, and mortality were recorded during hospitalisation.Outcome was also assessed one month afterdischarge. Of the 1,875 patients with IPD identified, 1,332 were included in the analysis. Bacteraemic pneumonia, affecting 1,049 of the patients, was the most frequent IPD type (79%), and chronic obstructive pulmonary disease and cancer were the main comorbidities.One-third of patients required admission to intensive care unit. A total of 208 (16%) patients died during hospitalisation and an additional 21 (2%) within one month after discharge. Case fatality rates of ≥20%were observed in patients with chronic heart failure, hepatic disease, and renal insufficiency. Serotypes 7F, 1, 19A, and 3 were the most prevalent and together accounted for 47% (569/1,214) of all IPD cases and 42% (80/189) of mortality. Of the patient isolates, 21% (255/1,204) were resistant to erythromycin and 22% (264/1,204) to tetracycline. Penicillin non-susceptibility was mostly found in serotype 19A isolates. These baseline data are essential when assessing the impact of pneumococcal conjugate vaccination in adults in the future.

Serum bactericidal activity of aztreonam, cefoperazone, and amikacin, alone or in combination, against Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, and Pseudomonas aeruginosa.

Serum samples from volunteers receiving (per kilogram) 20 mg of aztreonam, 20 mg of cefoperazone, 7.5 mg of amikacin, 20 mg of cefoperazone plus 20 mg of aztreonam, or 20 mg of aztreonam plus 7.5 mg of amikacin were evaluated for bactericidal activity against Escherichia coli, Klebsiella pneumonia, Serratia marcescens, and Pseudomonas aeruginosa. Serum bactericidal activities were similar for aztreonam alone or in combination but were lower for amikacin and cefoperazone alone, especially against S. marcescens and P. aeruginosa. Killing studies, performed with serum samples diluted 1:8, demonstrated a high killing rate for aztreonam plus amikacin, especially against P. aeruginosa.

Use of ceftazidime in the therapy of serious infections, including those due to multiresistant organisms.

Ceftazidime was administered intravenously or intramuscularly or both in doses of 1 to 6 g per day to 33 patients with serious gram-negative bacillary infections (12 pulmonary, 10 urinary tract, 4 soft tissue, 4 intraabdominal, and 3 miscellaneous infections). Twenty-one patients were septicemic. We identified 20 isolates of members of the family Enterobacteriaceae and 13 isolates of Pseudomonas aeruginosa. Seventeen patients had failed to respond to previous antimicrobial therapy. A total of 23 patients were clinically cured, 7 patients improved, and 3 patients failed to respond to therapy. The selection or emergence of resistant organisms during treatment (mostly Candida spp., Staphylococcus aureus, and enterococci) was noted in 11 patients. Toxicity was minimal (reversible mild liver function abnormalities and eosinophilia). The results of this study suggest that ceftazidime is an effective and well-tolerated new cephalosporin for the therapy of serious infections due to susceptible gram-negative organisms.

RECOMMENDATIONS FOR THE USE OF THE 23-VALENT POLYSACCHARIDE PNEUMOCOCCAL VACCINE IN ADULTS: A BELGIAN CONSENSUS REPORT.

Abstract A multidisciplinary expert panel, appointed by the High Council for Public Health, evaluated the scientific evidence on which the recommendations for the appropriate use of the pneumococcal vaccine was based and reviewed the studies that became available since previous reports. The conclusions of the working group, presented in this manuscript, resulted in an update of the Belgian recommendations for pneumococcal vaccination.

Multidrug-resistant tuberculosis: A review of the 23 cases treated by the saint-pierre university hospital (brussels)

Abstract Introduction For about fifteen years, Belgium, as other developed countries, has been confronted with multidrug-resistant tuberculosis (MDR-TB). The treatment of MDR-TB is complex, associating several antibiotics and causing multiple adverse effects. The aim of this study is to report our experience with MDR-TB at the Saint-Pierre University Hospital in Brussels.

Prevention of pneumococcal disease: an update on the Belgian Consensus Report

An ad hoc working party on pneumococcal vaccine with representatives of the Belgian Society for Infectiology and Clinical Microbiology, the Belgian Society of Pulmonology and Scientific Societies of General Practitioners reviewed new data on the epidemiology of S. pneumoniae infections in Belgium, on the efficacy and the cost-effectiveness of the 23-valent capsular polysaccharide vaccine. We discuss recent data on vaccination with a new conjugate pneumococcal vaccine, shown to be highly effective in children. The Working Group of the Belgian Scientific Societies endorses the recommendations issued by the Hoge Gezondheidsraad in 1993 and described in a consensus report in 1996.

Natural History of HIV Infection in African Patients

To evaluate the natural history and clinical manifestations of human immunodeficiency virus (HIV) infection in Africa a cohort study was conducted of 174 HIV-infected Africans who travelled to Belgium for medical treatment. The study subjects were divided into 4 groups on the basis of their clinical status: stage 1 (26 cases) healthy asymptomatic seropositive patients; stage 2 (45 cases) patients with generalized lymphadenopathy of at least 3 months duration in the absence of any constitutional signs or symptoms; stage 3 (77 cases) subjects with acquired immunodeficiency syndrome (AIDS)-related complex (ARC); and stage 4 (26 cases) full blown AIDS. During the 3-42 month (mean 16 months) study period all of the 26 healthy seropositive patients remained symptom-free. 3 (10%) of the patients with lymphadenopathy and 26 (37%) of ARC patients developed AIDS after a mean evolution period of 33 months and 12 months respectively. The rate of progression from ARC to AIDS documented in this cohort of African patients is similar to that recorded among homosexuals and hemophiliacs in Western countries. Immunologic prognostic markers for evolution from stage 3 to stage 4 included decreased white blood cell count decreased lymphocytosis decreased T4 cells count decreased T4/T8 ratio decreased in vitro lymphocytes response to phytohemagglutinin and increased IgA blood level. Esophageal candidiasis cerebral toxoplasmosis crytococcal meningitis mucocutaneous herpes and extrapulmonary tuberculosis were the most frequent clinical manifestations among stage 3 and stage 4 patients. The natural history and immunological evolution of HIV infection appear to be similar in black and white African patients. The influence of environmental factors on opportunistic infections is suggested by the fact that Pneumocystis carinii pneumonia--the most frequent opportunistic infection among black AIDS patients in the US--is rare among African AIDS patients. 32 (60%) of the patients with AIDS in this study died after a mean time period of 10 months.

The Role Of Excess Iron In The Pathogenesis Of Disturbed Neutrophil Functions In Cirrhotic Patients (Neutrophil Functions In Cirrhotic Patients)

SummaryIn the purpose to specify polymorphonuclear neutrophils (PMN) abnormalities and increased susceptibility to infections in cirrhosis, PMN ‘unctions-NBT reduction, phagocytosis, killing rate. myeloperoxydase activity—and incidence of infections were investigated in 25 cirrhotic patients. The patients were classified in a group of decompensated cirrhosis (D.C.) and a group of non evolutive cirrhosis (N.E.C.) according to their plasma bilirubin level.Patients with D.C. had a ccllular phagocytosis defect for both yeast and E. coli in comparison with N.E.C.; a seric abnormality was also observed in the yeast phagocytosis test. Other PMN functions were normal.Iron overload (higher transferrin saturation and ferritin levels) was found in D.C. in comparison with N.E.C. Moreover. Perls’s staining of PMN revealed the presence of iron in PMN of D.C. and its absence in N.E.C.In vitro incubation of normal PMN with high iron concentrations altered their phagocytic functions while the Perls’s staining revealed the...