[Economic impact of rationalized antibiotic therapy in a general hospital]

PURPOSE

To evaluate the economic impact and the bacterial resistance rates after 2 years of a rationalized antibiotic prescription program in a 502-bed hospital.

CURRENT KNOWLEDGE AND KEY POINTS

Prescribing protocols were established by consensus in 1998 and were reinforced a year later by nominative dispensing of the most costly antibiotics. The impact of the program was assessed in terms of changes in the overall cost of antibiotics and in the pattern of bacterial resistance among pathogens isolated in the institution, during the period prior to the onset of the program (1997) and its realization (1998 and 1999).

FUTURE AND PROJECTS

The expenses for antibiotic drugs decreased by 46% in 2 years. Resistance rates among the different pathogens studied have remained stable. No increase of mortality was observed. Our rational policy in antibiotic therapy had a positive economic impact. However, new additional measures should be encouraged to prevent antimicrobial resistance.

[Adult-onset Still's disease after hepatitis A and B vaccination?]

BACKGROUND

Hepatitis A and B vaccination are generally very well tolerated. However, exceptional cases of arthritis and systemic diseases have been reported after hepatitis B vaccination.

CASE REPORT

The authors report a case of adult Still's disease apparently triggered by hepatitis A and B vaccination. The patient was a 38-year-old woman who presented with fever, hepatitis, pneumonitis and neurologic symptoms, compatible with the diagnosis of adult Still's disease.

DISCUSSION

The authors discuss the rarity of systemic diseases triggered by such vaccination, the link between hepatitis B virus and some vasculitis, and the possibility for viral bacterial infections to trigger adult Still's disease.

[Chronic obstructive bronchopneumopathy after acute inhalation of sulfur anhydride. Apropos of a case]

We report on an acute accidental inhalation of sulfurous anhydride, by a man aged thirty in the course of his work. This intoxication, followed by acute respiratory distress, first showed an improvement, then re-aggravation 26 days after the accident. This episode has not been explained. The patient then developed a chronic obstructive bronchopathy. Ten years of regular observation allows us to maintain that the severe obstructive syndrome which the patient presents has never regressed (FEV1/FVC = 32%), and must be associated with a chronic toxic obstructive bronchopneumopathy.

Comparison of nested PCR for detection of DNA in plasma with pp65 leukocytic antigenemia procedure for diagnosis of human cytomegalovirus infection

A nested PCR was used for the detection of human cytomegalovirus (HCMV) DNA in plasma. The presence of HCMV DNA and its correlation to pp65 leukocytic antigenemia were investigated with 299 blood samples from 45 organ transplant recipients and 63 AIDS patients. Of the 53 samples positive by nested PCR, 52 (98%) were also positive for leukocytic antigenemia and 23 had high levels of antigenemia (> 50 positive cells per 2 x 10(5) leukocytes). Of the 246 samples negative in PCR, only 3 (1.2%) had highly positive antigenemia. For 15 patients having a high antigenemia level in the course of their disease, consecutive blood samples were studied and also assessed for viremia in culture. The extent to which HCMV DNA, detected by PCR, was present in plasma correlated with increased levels of HCMV leukocytic antigenemia for six of the eight AIDS patients and for all the organ transplant recipients. Positivity for HCMV DNA in PCR and for viremia in cell culture was usually restricted to the highest antigenemia levels. From a total of 69 blood samples, PCR and culture gave positive results, respectively, for 17 of 32 samples (53%) and 14 of 32 samples (43%) from transplant recipients and for 15 of 37 samples (40%) and 9 of 37 samples (24%) from AIDS patients. Our findings have shown a strong correlation between high levels of leukocytic antigenemia and HCMV DNA in plasma. The detection of HCMV DNA in plasma by this nested PCR can prove HCMV dissemination in blood, but it lacks the rapidity and simplicity of the leukocytic pp65 antigenemia procedure.

[Extrapulmonary and disseminated pneumocystosis in HIV infection]

Three cases of extrapulmonary disseminated Pneumocystis carinii infection are reported. All 3 patients had HIV infection with less than 50 CD4 lymphocytes per cubic millimeter and were having aerosols of pentamidine as prophylactic treatment of pneumocystosis. P. carinii may invade numerous organs and in particular the liver, spleen and bone marrow. Extrapulmonary lesions, often pan-symptomatic, are to be feared in deeply immunodepressed patients receiving prophylactic aerosols of pentamidine. Infection of the choroid can be detected by systematic ophthalmoscopy. An early diagnosis raises hopes of a good, if temporary, response to treatment.