Synergistic interaction of cefotaxime and its metabolite desacetylcefotaxime demonstrated by drug-impregnated disks

Because no simple in vitro test for cefotaxime (CTX) and desacetylcefotaxime (dCTX) synergy exists, and, because no disk susceptibility data is available for dCTX, we investigated the potential of antibiotic impregnated disks as a test for positive in vitro interaction. Results of this study indicate that all strains of Staphylococcus aureus tested demonstrated additive interactions using disks that contained 30 micrograms of dCTX. In contrast, it was necessary to use much smaller concentrations of each cephalosporin to demonstrate additive effects against Gram-negative bacteria. Zones of inhibition were greater for disks containing the combination compared to either CTX or dCTX alone, among all the Gram-negative genera tested; however, these differences were statistically significant only for Klebsiella pneumoniae and Escherichia coli (P less than 0.05). These results demonstrate that disk susceptibility testing is reliable for the CTX metabolite, dCTX, and suggests that this technique using disks impregnated with CTX and dCTX singly and in combination is a simple method with which to evaluate positive antimicrobial interactions in the clinical laboratory.

A randomized clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants

To determine the safety, efficacy, and cost savings of early hospital discharge of very-low-birth-weight infants (less than or equal to 1500 g), we randomly assigned infants to one of two groups. Infants in the control group (n = 40) were discharged according to routine nursery criteria, which included a weight of about 2200 g. Those in the early-discharge group (n = 39) were discharged before they reached this weight if they met a standard set of conditions. For families of infants in the early-discharge group, instruction, counseling, home visits, and daily on-call availability of a hospital-based nurse specialist for 18 months were provided. Infants in the early-discharge group were discharged a mean of 11 days earlier, weighed 200 g less, and were two weeks younger at discharge than control infants. The mean hospital charge for the early-discharge group was 27 percent less than that for the control group ($47,520 vs. $64,940; P less than 0.01), and the mean physician's charge was 22 percent less ($5,933 vs. $7,649; P less than 0.01). The mean cost of the home follow-up care in the early-discharge group was $576, yielding a net saving of $18,560 for each infant. The two groups did not differ in the numbers of rehospitalizations and acute care visits, or in measures of physical and mental growth. We conclude that early discharge of very-low-birth-weight infants, with follow-up care in the home by a nurse specialist, is safe and cost effective.