Does Nasal Colonization or Mupirocin Treatment Affect Recurrence of Methicillin-Resistant Staphylococcus aureus Skin and Skin Structure Infections?

Some patients with community-associated methicillin-resistant Staphylococcus aureus skin and skin structure infections have experienced frequent recurrences. We performed a retrospective study and determined that the presence of nasal colonization did not affect recurrence and nasal mupirocin treatment marginally decreased recurrence

Evaluation of Treatment Courses When Vancomycin Is Given Every 8 Hours in Adult Patients

BACKGROUND

Several nomograms include recommendations to give intravenous (IV) vancomycin at 8-hour dosing intervals (Q8H). However, there is a lack of detailed data regarding this dosing recommendation.

METHODS

A retrospective chart review of 100 patients who received 107 treatment courses of vancomycin Q8H for at least 5 days was performed. Distribution of vancomycin trough levels and rate of nephrotoxicity were evaluated.

RESULTS

Median patient age was 38 years (interquartile range [IQR] 27-50 years), median weight was 67 kg (IQR 55-79 kg), and median creatinine clearance was 124 mL/min (IQR 101-147 mL/min). Median duration of Q8H dosing was 9 days (IQR 7-12 days). Within the initial 96 hours, only 7% (7 of 104) of maximum trough concentrations were >20 mg/L (median dose 15 mg/kg [IQR 15-18 mg/kg]). After 96 hours of Q8H dosing, 34% (30 of 89) of maximum troughs were >20 mg/L (median dose 17 mg/kg [IQR 15-20 mg/kg]), P = .0005. The rate of nephrotoxicity was 4%.

CONCLUSION

We observed an increase in the percentage of trough levels >20 mg/L later during treatment courses of vancomycin IV Q8H with a relatively small corresponding increase in vancomycin dose. Close monitoring of trough levels (eg, every 3 days) with prolonged courses of vancomycin IV Q8H is warranted.

Infection with panresistant Klebsiella pneumoniae: a report of 2 cases and a brief review of the literature

Infections caused by carbapenemase-producing Klebsiella pneumoniae have been reported with increasing frequency, thereby limiting the choice of effective antimicrobial agents available to clinicians. This has prompted the increased use of polymyxins and tigecycline, but resistance to these agents is already emerging. We report 2 cases of infection with panresistant K. pneumoniae.

Identification of novel hsp65 RFLPs for Mycobacterium leprae

Leprosy or Hansen's disease is a chronic infectious disease caused by an acid-fast bacillus, Mycobacterium leprae (M. leprae). The bacilli proliferate in macrophages infiltrating the skin and gain entry to the dermal nerves via the laminar surface of Schwann cells where they replicate. After entry, the Schwann cells proliferate and then die. Conclusive identification of M. leprae DNA in a sample can be obtained by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for the heat shock 65 gene (hsp65). Molecular epidemiology will make it possible to study the global distributions of M. leprae, explore the relationship between genotypes-incidence rates, mode of transmission, and the type of disease (tuberculoid vs. lepromatous). We amplified DNA using PCR for the hsp65 gene from 24 skin lesions from patients diagnosed with various types of leprosy. Fifteen out of 24 were positive for the hsp65 gene. Digestion with HaeIII-PAGE for the RFLP confirmation of the presence of M. leprae DNA showed the typical pattern in 5 out of 24 and 2 novel patterns in 10 out of 24 patients. We confirmed the presence of M. leprae DNA by sequencing the genes for gyraseA or B and folP, which contained only M. leprae specific single nucleotide polymorphisms (SNPs). Thus, we describe novel hsp65 RFLPs for M. leprae found in a high frequency making them ideal for future epidemiology and transmission studies.

Bartonella quintana endocarditis with positive serology for Coxiella burnetii

Both Bartonella quintana and Coxiella burnetii are known to cause of blood culture negative endocarditis. In such case, the diagnosis is usually established by serology. A case of Bartonella quintana endocarditis is described where the serology was falsely positive for Coxiella burnetii. This case demonstrates the difficulty in distinguishing these two etiologic agents by routine serologic testing.