Diffusion of a new beta-lactam (LY 127935) into cerebrospinal fluid. Implications for therapy of gram-negative bacillary meningitis

LY 127935, a new oxa beta-lactam with an expanded gram-negative spectrum, was administered intravenously to seven patients, including two patients with documented gram-negative bacillary meningitis. In the patients receiving continuous therapy (2 g intravenously every 8 hours) cerebrospinal fluid trough levels of LY were never less than 6 micrograms/ml. Peak cerebrospinal fluid levels of LY ranged from 25 to 39 micrograms/ml and occurred approximately 2.5 hours after the intravenous administration of the drug. Cerebrospinal fluid levels of LY were 19 per cent to greater than 100 per cent of simultaneous serum levels. Cerebrospinal fluid bactericidal activity was 1:4 to 1:256. Intravenous LY, because of its expanded gram-negative spectrum and excellent cerebrospinal fluid penetration, is a potentially useful antibiotic in the treatment of gram-negative bacillary meningitis.

Quantitative culture of intravenous catheters and other intravascular inserts

Quantitative cultures were done on 149 intravenous catheters and 40 additional intravascular inserts. Intradermal and intravascular segments of the insert were cultured separately. The inserts were immersed in broth and flushed. The number of colony-forming units (cfu) per insert was estimated by surface culture of serial dilution of the broth. Nonquantitative culture of undiluted broth was also done. Since all inserts associated with bacteremia had at least 10(3) cfu, inserts greater than 10(3) cfu were considered infected. Staphylococcus epidermidis was more likely than more virulent organisms to colonize an insert without causing bacteremia. The inserts in one bacteremic patient were infected from a distant bloodstream focus; however, in the majority of patients, quantitative intradermal cultures suggested that the insertion site was the portal of entry. In bacteremic patients, either a positive quantitative or a nonquantitative culture identified an infected insert. However, only 33% of positive nonquantitative insert cultures from nonbacteremic patients were confirmed by quantitative insert culture.

Subcutaneous infection with phialophora richardsiae and its susceptibility to 5-fluorocytosine, amphotericin B and miconazole

Two patients are described with subcutaneous infections due to Phialophora richardsiae. Both were diabetics and originally came from subtropical areas. One of the patients had a cystic lesion which was well encapsulated while the other had a large ulcerating lesion with draining sinus tracts. The organisms were found to be susceptible to cycloheximide but resistant to 5-fluorocytosine, miconazole and amphotericin B. There was some variability in the degree of resistance depending upon whether the primary or secondary phialoconidia were tested. While simple excision appears curative for the solitary cystic type of lesion, therapy of the ulcerating form of the disease remains problematic.

Non-type b Haemophilus influenzae infections in adults with reference to biotype

We report three cases of serious non-group b Haemophilus influenzae infections. The significance of these isolates with respect to both biotypes and serotypes is discussed.

Murocmycotic slough of nasal floor and palate in the anephric patient

A case of nasopalatine mucormycosis in a patient with chronic renal failure is reported. Early recognition is contingent on histopathological examination of tissue and culturing. Vigorous treatment with amphotericin B and surgical intervention averted possible orbital-cranial involvement and effected a cure. When a chronically debilitated patient has signs of intraoral necrosis or facial swelling and necrosis, or both, the clinician should be alert to the possibility of a mucormycotic infection.