Bacillomycin D and its combination with amphotericin B: promising antifungal compounds with powerful antibiofilm activity and wound-healing potency

AIMS

In this study, we evaluated the ability of the lipopeptide bacillomycin D and the antifungal drug amphotericin B as well as their combination, to inhibit Candida albicans biofilm formation and to accelerate keratinocyte cell migration.

METHODS AND RESULTS

The antibiofilm activity of bacillomycin D and its combination with amphotericin B was carried out by crystal violet colorimetric method. Our results have shown that, when combined together at low concentrations nontoxic to mammalian cells, corresponding to 1/32 MIC (0·39 μg ml(-1) ) and 1/4 MIC (0·06 μg ml(-1) ) for bacillomycin D and amphotericin B, respectively, a clear antibiofilm activity is manifested (95% inhibition of biofilm formation) along with a clear inhibition of germ tube formation. Moreover, the effect of both drugs on preformed biofilm of C. albicans strain was determined using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) reduction assay. The combination of the two antifungal compounds at 0·39 and 1 μg ml(-1) for bacillomycin D and amphotericin B, respectively, resulted in a clear enhancement of biofilm eradication compared to the results obtained with each drug alone. Furthermore, this combination was found to promote the closure of a gap produced in a monolayer of human keratinocytes.

CONCLUSIONS

Bacillomycin D and its combination with amphotericin B display impressive anti-biofilm and wound-healing activities.

SIGNIFICANCE AND IMPACT OF THE STUDY

Application of the lipopeptide bacillomycin D and the antifungal drug amphotericin B in medical devices may offer a promising alternative for topical treatment of Candida-associated infections in the setting of a wound.

Outcome in excised thymomas: role of prognostic factors and impact of additional malignancies on survival

Background and aims:

Although the management of thymomas has been extensively evaluated, the value of prognostic factors in the outcome of these patients remains unclear.

Methods and results:

The medical records of all patients who underwent resection of thymoma between January 1985 and September 2010 at a single thoracic unit were reviewed. Patients were followed up with reference to disease recurrence and development of additional malignancies (AM). Total thymectomy was performed in all 68 cases. Mean follow-up time was four years. Mean survival was 63.9 months. Mean disease-free interval was 13 months. Factors affecting prognosis were Masaoka staging and WHO histological sub-type. Patients with thymomas had a higher risk of developing AM when compared with a control population of individuals with other tumours ( p = 0.0002). Among thymomas, the cortical subtype was associated with a higher risk of AM ( p = 0.047) and mortality ( p = 0.001).

Conclusions:

This data confirms that Masaoka staging and WHO histologic sub-type are the most important prognostic factors in patients with thymoma. Moreover, thymomas predominantly arising from the thymic cortex are associated with a higher risk of developing other malignancies and with poorer survival. The cortical origin of thymoma could therefore be considered as a significant prognostic factor.

[Epidemiology and clinical features in diabetic patients with invasive infections treated at the Clinical Hospital of Infectious Diseases of Iaşi, Romania, between 2008-2010]

Infections in the diabetic population can be severe and life threatning at least for two reasons: clinical signs are often torpid, masqued by chronical complications of diabetes leading to late recognition and medical adresability and also because of the inability to control established infection due to complex cell-mediated and humoral immunity deffects. The aim of the study was to evaluate the etiology, clinical features and outcome in diabetic patients with invazive disease.

MATERIAL AND METHODS

A retrospective study was conducted between January 2008 and December 2010 at The Clinical Hospital of Infectious Diseases Iaşi among 75 diabetic patients with sepsis of microbiologically confirmed etiology (positive cultures from normally sterile sites) and sepsis with clinically suspected etiology (positive cultures from pus). Cases with positive urocultures and coprocultures only, were excluded.

RESULTS

From 75 diabetics, 56% were males, 90,7% being over 50 years. Severe cases of sepsis (33/75, 44%) were associated more often with insulin-treated diabetes than non-insulin treated group (40% vs. 4%, p<0,005) probably because of multiple comorbidities associated as suggested by a high Charlson score (6,09 vs. 4,09, p<0,05). There were 64 cases with confirmed etiology and 11 cases with clinically suspected etiology. Staphylococcus aureus and Escherichia coli were the most common agents isolated, being involved in 16 (21,3%) cases each, followed by coagulase negative Staphylococci (14/18,66%), Enterococcus spp.(6/8%), group B Streptococcus (3/4%), Streptococcus pneumoniae, Enterobacter spp., Salmonella spp. (2/2,66% each), Aerococcus viridans, Streptococcus equi, Klebsiella pneumoniae, Neisseria meningitidis, Sphyngomonas paucimobilis, Pseudomonas aeruginosa, Proteus mirabilis (1/1,33%). Multiple septic disseminations occured in 17(22,6%) cases and meningeal involvment was doccumented in 10(15,6%) cases. Meticillin resistance was noted in 53,3% for invasive isolates of S. aureus. Among 16 invazive strains of E. coli, 25% were resistant to 3rd generation cephalosporins, 17% to ciprofloxacin and 6,6% to aminoglycosides and colimycin. There were no E. coli strains resistant to imipenem, piperacillin-tazobactam and aztreonam. The mean mortality rate was 14,66%.

CONCLUSIONS

The high level of resistance of S. aureus and E. coli to commonly used antibiotics and meningeal involvement imposes a multidisciplinary approach of the diabetic patient. Proper knowledge of the pathogers involved in the potential invazive diseases is an important tool for successful treatment with appropriate empirical broad-spectrum antimicrobial agents.

[Aspects of the antimicrobial resistence profile in infections with Escherichia coli and Klebsiella pneumoniae in diabetic patients]

Infections in diabetic patient remains an important cause of morbidity and mortality, triggering and maintaining a prolonged metabolic imbalance. Emergence of extented spectrum beta-lactmase (ESBL) in Escherichia coli and Klebsiella pneumoniae is a major concern, because of the atypical manner infection acts in this group of imunodepressed patients and also for the limited therapeutic solutions. For this reason we have evaluated the profile of antimicrobial resistance of these pathogens in both diabetic and non diabetic patients.

MATERIAL AND METHOD

The aim of this study was to evaluate, in a retrospective case control study, the antibiotic susceptibility pattern in isolates of E. coli and Klebsiella spp. from different biological products in 49 diabetics and 150 non-diabetics admitted in The Clinical Hospital of Infectious Diseases Iaşi over a period of two years.

RESULTS

Most of strains of E. coli and Klebsiella spp. ESBL positive were found in uroculture. Significant differences in E. coli resistance rate between diabetics and nondiabetics were noted for amoxicillin-clavulanic acid and ciprofloxacin (31,4% vs.13,98%, p=0,04, respectively 52,9% vs. 24,46%, p=0,004). More isolates of ESBL positive K. pneumoniae were found in diabetic patients (50% vs. 24%). Ciprofloxacin resistance of K. pneumoniae was significantly higher in diabetics (75% vs 39%; p=0,05). There was no resistance in E. coli and K. pneumoniae isolates to imipenem in the diabetic group.

CONCLUSIONS

The high resistance rate to quinolones and 3rd generation cefalosporins limits their use for the treatment of Escherichia coli and K. pneumoniae infections. Other alternatives for empiric therapy in community and nosocomial-acquired infections in diabetic patient remains carbapenems, aminoglycosides and colimycin.

[Clinical and epidemiological aspects of patients with acute viral hepatitis in Bacau county, from 1996 TO 2005]

The purpose of the study is to emphasize the clinical and epidemiological peculiarities of acute viral hepatitis in the last decade.

MATERIAL AND METHOD

We studied retrospectively the files of 2014 patients, hospitalized with the diagnosis of acute viral hepatitis in the Bacău County Hospital, from 1996 to 2005.

RESULTS

We saw that the only type the incidence of which lowered in time was the B-type hepatitis. The A acute hepatitis witnessed two epidemic peaks. The clinical cases of the male young patients prevailed. In 91.6% of cases, the infection source could not be established. The average incubation period was 21 days for viral hepatitis A, 65 for B and 80 for C. Hospitalized anicteric forms represented 2.8% of total. Extended forms were recorded with 3.6% patients (50.9% of them with B virus) and severe forms with 10.3% (among these, 66.7% with B virus). A fulminate evolution was noticed with 0.65% of cases. The global mortality was 0.4% and 0.95% for B type.

CONCLUSIONS

We noticed several peculiarities and changes regarding the clinical and epidemiological aspects of acute viral hepatitis in the last

[Features of clinical evolution of severe acute viral hepatitis. Series of 72 cases]

The fulminant hepatic failure is a dramatic complication of acute viral hepatitis. Despite therapeutical efforts, the mortality of these forms of acute hepatitis is rated in most studies from 60 to 90%.

MATERIAL AND METHOD

We made a retrospective study that included 2014 patients hospitalized at the Bacau County Hospital from January 1996 to December 2005 with the diagnosis of acute viral hepatitis. Among these, 72 patients presented severe forms of hepatitis.

RESULTS

13 patients presented fulminant hepatic failure. In most cases, etiology was represented by the B-type virus (66.7%). Defining for the fulminant form of hepatitis are the Quick index under 50%, the increase of total serum bilirubine and the leucocitosis associated with neutrophilia.

CONCLUSIONS

Mortality in fulminant forms of hepatitis was of 61.5%, respectively 75% in the case of the B-type viral hepatitis. Key words: SEVERE

[Community acquired acute bacterial meningitis--a 10 year review]

Bacterial meningitis is still an important topic for the infectious diseases specialist, due to it's high incidence, severity and it's high mortality rate.

MATERIAL AND METHOD

We retrospectively studied 679 patients diagnosed with community acquired bacterial meningitis in the Infectious Diseases Hospital Iaşi, Romania between 1998 and 2007.

RESULTS

The annual number of admissions slightly decreased in the last years. Most patients were males (62.1%). Predisposing factors were present in 34.9% of cases. Seizures were described in 19.6% of cases, more frequent in children. The CSF was purulent only in 69.4% of patients, 29.6% of them receiving antibiotics prior to admission; the albumin level in the CSF of pneumococcal meningitis was higher than in other meningitis. The etiology was established in 51.6% of cases, more frequent in sucklings (68.1%). N. meningitidis was the most common cause of community acquired acute bacterial meningitis (CABM) (28.5%) followed by S. pneumoniae (14%). S. pneumoniae was susceptible to penicillin in 79% of cases. The mean mortality rate was 13.1%.

CONCLUSION

Factors associated with a poor prognosis were: pneumococcal etiology, age over 60, and the presence of seizures or coma at admission.

[Sepsis with Staphylococcus aureus in immunocompromised patients]

The aim of our study was to analyze clinical and biological characteristics of immunocompromised patients with staphylococcal sepsis and to compare with the same data in non-immunocompromised patients.

MATERIAL AND METHOD

The diagnosis of sepsis was made based on Bone criteria. MiniAPI system ID 32 STAPH was used for identification and antibiotic susceptibility was assessed by ATB STAPH method and by E-test for oxacillin and vancomycin.

RESULTS

Among the 147 patients with Staphylococcus aureus sepsis--66.67% had concomitant immunosuppressive conditions (diabetes mellitus, liver diseases, renal failure, corticotherapy, etc). We have found a significant correlation between the immunosuppressed status and MRSA (methicillin-resistant Staphylococcus aureus) involvement (p = 0.0018) and also, between this group of patients and treatment failure (p = 0.0012).

CONCLUSION

Because of the high rate of MRSA involvement in systemic infections in the Eastern region of Romania first intention treatment of patients with staphylococcal infections and conditions of immunosuppression must include antibiotics effective against methicillin-resistant strains.

[Clinical and microbiological characteristics of Staphylococcus aureus infections in infectious diseases hospital Iaşi]

We assessed clinical and microbiological characteristics of Staphylococcus aureus (SA) infections in hospitalized patients during a period of three years (October 2005 - October 2008) in the Clinic Hospital of Infectious Diseases Iaşi.

MATERIAL AND METHODS

The study included 169 patients with SA infections (sepsis, meningitis, skin infections and urinary tract infections). MiniAPI system ID 32 STAPH was used for identification and antibiotic susceptibility was assessed by ATB STAPH method and by E-test for oxacillin and vancomycin.

RESULTS

The rate of methicillin resistance (MR) was 48%, all strains being susceptible to linezolid, vancomycin, teicoplanin. In our study MRSA was susceptible in approximately 94% of cases to clindamycin and cotrimoxazole. Infections were defined as nosocomial in 51% of patients with a rate of MR of 52% and community-acquired in 49% with a rate of MR of 23% (p = 0.001). Clinical profile was: localized infection in 41% of patients with MRSA and systemic infection (sepsis with at least one organ involvement or bacteremia) in 59% of patients with MRSA infections (p = 0.53). Initial treatment was inadequate in 46% of MRSA infections. One third of strains had MIC of vancomycin 2 mg/mL.

CONCLUSIONS

The high level of methicillin resistance of S. aureus straints isolated from infections (48 %) justifies a particular approach of initial antistaphylococcal therapy.

[Cross-sectional study of leptospirosis cases admitted to the Iaşi Clinic of Infectious Diseases over a 5-years period]

Leptospirosis is a zooantroponosis manifested as an infection with a severe evolution, with liver and renal failure and haemoragic manifestation. The aim of the study was to present the epidemiologic, clinic and therapeutical aspects of 100 cases of leptospirosis admitted in the clinic of Infectious Diseases of Iaşi, during 5 years (2002-2006).

MATERIAL AND METHOD

The diagnostic was based on the clinical-biologic study and risk factors with febrile syndrome, mialgic syndrome, headache, meningial, liver and renal failure and hematological syndromes, with the serologic evidence of serotypes of leptospirosis.

RESULTS

All the patients were serologic confirmed with leptospirosis. Leptospirosis is an emergent disease with the possibility of severe evolution in some forms, with lever and renal failure.

[A severe case of infectious mononucleosis associated with ciprofloxacin and salazopyrin administration]

We report a case of rash probably induced by ciprofloxacin and/or salazopyrin administration in a patient with infectious mononucleosis. A 22 year woman developed a maculopapular and petechial eruption in the 3-rd day of ciprofloxacin (given for a genital tract infection) and the 32-nd day of salazopyrin (for a spondylodiscitis). Subsequently she developed a severe hepatitis, shock, and very severe leucocytosis (88 000/mmc) that occasioned haematological investigations for a lymphoproliferative syndrome.

[Antimicrobial resistance profile of E. coli and Klebsiella spp. from urine in the Infectious Diseases Hospital Iaşi]

The increasing frequency of extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae among nosocomial and community-acquired infections is an important problem for both microbiologists and clinicians, because of the difficulty in correctly detecting, reporting and treating such infections.

RESULTS

In the Clinical Hospital of Infectious Diseases Iaşi the most frequent etiological agents of urinary tract infections were: E. coli - 64%, Klebsiella spp. 11% and Enterococcus spp - 5%. The resistance rate of E. coli and Klebsiella spp. was 41% and 60%, respectively to amoxicillin-clavulanic acid, 29.6% and 72.5%, respectively to third generation cephalosporins, 26% and 24%, respectively to ciprofloxacin. The most active antimicrobial agents against cephalosporins resistant strains of E. coli and Klebsiella spp were carbapenems (susceptibility rate 99% and 94%, respectively) and colimycin (susceptibility rate 89% and 83%, respectively).

[Cryptococcus meningitis, five years of experience and literature review]

The aim of this study was to determine the distribution and antifungal susceptibility profile of Cryptococcus spp. isolated from patients in northeast Romania.

MATERIAL AND METHOD

Fungi isolated from blood and cerebrospinal fluid (CSF) cultures were identified by ID32C strips (bioMerieux, France). Susceptibility testing was performed using ATB FUNGUS2 strips (bioMerieux, France).

RESULTS

A total of 20 significant strains have been isolated. Overall, Cryptococcus neoformans was the most frequent isolate (95%). We mention the first Cryptococcus albidus meningitis in Romania (strain with multiple resistance). All cryptococci tested were susceptible to amphotericin B with minimal inhibitory concentration (MIC) =1 microg/mL; 90% strains were susceptible to flucytosine. Resistance to fluconazole and itraconazole was observed in 2 and 1 case, respectively. Most of the patients had an associated infection, tuberculosis in 37.5% cases. Despite appropriate therapy 4 patients died (21%).

CONCLUSION

First choice induction therapy with amphotericin B plus flucytosine followed by fluconazole is highly recommended since resistance to antifungal agents is still very low.

[Gamma interferon testing in blood and cerebrospinal fluid--rapid method for the diagnosis of tuberculous meningitis]

AIM

To evaluate the benefit of this early method of diagnosis of tuberculous meningitis, gamma-interferon levels comparatively in blood and cerebrospinal fluid (CSF).

MATERIAL AND METHOD

We have studied 50 patients with tuberculous meningitis admitted in the Clinic of Infectious Diseases Iaşi between 2006-2007, from the epidemiological, clinical, diagnosis and therapeutical points of view.

RESULTS

Tuberculous meningitis was more frequent in males, with a mean ration of 2.5. The age of patients varied between 2 and 78 years of age, with a mean value of 30.5 years. 35.6% of patients were children. In 32 cases the meningeal infection was secondary, disseminated from a primary site, most frequently from the lungs (68,7%). The bacteriologic confirmation was through culture in 13.3%, with an average of 23.4 days of incubation. In whole blood the sensitivity Quantiferon TB Gold assay (QTF) was 78.57%. In CSF the specificity was higher than in blood (96.1 vs. 88.4%), having a positive prediction value over 90%. Antituberculous therapy prior to QTF testing had a negative impact, 50 to 6 cases having negative QTF results.

CONCLUSION

The performance indicators of TB Gold Quantiferon Test in serum or CSF are high, being more sensitive and rapid than the direct exam of CSF or BK culture.

[Leptospirosis in children. Clinico-biological and therapeutic aspects for the cases hospitalised between 1992-2005]

The aim of the study is that of showing the prevalence of the disease in childhood in our county.

MATERIAL AND METHOD

We studied the observation files of the patients admitted in our unit in between 1992 and 2005 comprised in the 0-15 year old age bracket, noticing all the epidemiological, clinical and therapeutic aspects.

RESULTS

In the above mentioned period, 16 patients from the 0-15 year old group (3.12% of all the patients suffering from leptospirosis) were admitted in our clinic. Male (93.75%) and suburban area (60%) were dominant; 11-15 year old group was represented in 87.5% cases; the prevalence was observed during the summer (11 cases) and during 1999 (6 cases); the meningeal signs were noticed in 5 cases and jaundice for 3 children; the most frequent agent was L. icterohaemorrhagiae--7 cases. The etiological treatment was performed for 14 cases with betalactamines for 7.4 days in average; no lethal cases were noticed.

CONCLUSIONS

In the case of Iaşi County, leptospirosis is a clinico-biological entity considered in the diagnosis of the jaundice, meningeal and febrile syndromes in children.

[The co-infection with hepatitis virus B and D--cases admitted in the infectious diseases hospital from Iaşi, Romania (2003-2005)]

Despite the major medical advance, over 350 million people worldwide still have chronic infection with hepatitis B virus and HBV-associated liver disease remains a major cause of morbidity and mortality. 15-50% of patient VHB infected have serological markers for VHD co-infection. We retrospectively studied 252 cases of acute hepatitis B (AHB) admitted in our hospital between 2003-2005; 12 of them (4.76%) had a co-infection with hepatitis D virus. Most of the patients were young males with an urban origin. The route of transmission was unknown in 8/12 cases. Abdominal pain was more frequent during the onset of the disease than in AHB (p < 0.05). A cholestatic pattern was noted in 9 cases. The frequency of severe/ fulminant cases was greater then in AHB. The HBsAg was absent in 3 patients, and the HBV-DNA was present at low levels in 3/12 patients tested. Two patients had HBsAg present 6 month later.

[Varicella-zoster infection--extreme clinical aspects]

Infections with the varicella-zoster (VZ) virus are a constant of our everyday practice. The aim of the present study is that of underlining unusual aspects of the infection with the VZ virus--primary infection in adults and herpes zoster in children. If varicella, or chickenpox, has been traditionally considered a childhood disease, nowadays, an increased number of adults are affected by primary infections. On the contrary, more and more children present the secondary form of the infection, which appears as herpes zoster, a disease usually diagnosed in adults.

MATERIAL AND METHODS

We studied the observation papers of adult patients with varicella, hospitalized in our clinic during 2004-2005 and we analyzed the herpes zoster manifestations in non-HIV children, diagnosed with the disease during the same period of time.

RESULTS

During 2004-2005, 34 adult patients were diagnosed with varicella, while 10 children presented herpes zoster. 16 of the adults with varicella were 25-34 years old. One of the children with herpes zoster was less than one year old. All the adults with varicella were treated with acyclovir; in 14 cases, the therapy was supplemented with rifampicin. All the children with herpes zoster came from rural areas. The pathology that determined the decrease of general immunity was represented by neoplasia (3 cases), malnutrition and rickets (2 cases), associated infectious pathologies--bronchopneumonia (3 cases).

CONCLUSIONS

Varicella in adults has an increased incidence, which is underestimated, in our opinion. Its loud clinical manifestations impose the therapy with acyclovir. Herpes zoster in children reveals significant subsidiary pathologies and a depressed immune system that impose special medical care and many days of hospitalization.

Invasive amebiasis

Digestive amoebiasis with his invasive form is an unusual pathology encountered in the temperate zone. This could lead to a life threatening complication: systemic amoebiasis. A 55-year-old male was treated successfully of systemic amoebiasis in a third referral hospital. The diagnosis was established based on epidemiology data and microscopical identification of trophozoites of Entamoeba histolytica. The amoebicidal, antibiotic and supportive treatments was firstly administrated. The clinical picture of intestinal amoebiasis raised from dysenteric syndrome to necrotizing enteritis. The bowel perforation with localized peritonitis was followed by chronic enteric fistula. Amoebic liver abscess, as the most frequent extraintestinal complication, was concomitantly diagnosed and treated. Urinary amoebiasis was considered as complication in the context of systemic dissemination: any other location could become a site of an amoebic abscess. Multidisciplinary approach was the successful key in the management of the patient, including antiparasitic therapy and antibiotic prophylaxis, intensive care and multiple surgical approaches. The diagnosis of digestive amoebiasis and systemic complication may be delayed in nonendemic areas, leading to advanced and complicated stages of the disease. The surgical approach is most efficiently to treat a large liver amoebic abscess and intraperitoneal collections.

Antimicrobial susceptibility of Staphylococcus aureus isolated from colonized hospital personnel

The present study was performed to investigate the in vitro activity of oxacillin and other antimicrobial agents against S. aureus strains obtained from nursing personnel. We tested 127 S. aureus colonizing nasal mucous and hand skin and isolated from nursing personnel of University Hospital Department of Infectious Diseases, Iaşi, during June 2005 period. Minimum inhibitory concentrations (MICs) were determined by the dilution method in Mueller-Hinton agar. Most of the S. aureus strains were susceptible to tested agents excepted erythromycin and azithromycin. Erythromycin and azithromycin resistance was observed among 29.1% respectively 22% of S. aureus strains. Vancomycin was active against all isolates. Teicoplanin was active against against all MRSA excepted one of the strain, with an reduced susceptibility. Linezolid has very good in vitro activity against staphylococci, with an MIC 90 of 2 mcg/ml and only 0.8% resistance. The MIC values range was between 0.5-2 mcg/ml. In conclusion, the usually hygienic methods (disposable gowns, hygienic hand disinfection after each patients contact, masks use when is a risk of aerosolization of MRSA) are indicate for significantly reducing of these strains.

[Erysipelothrix rhusiopathiae--rare etiology of persistent febrile syndrome]

Erysipelothrix rhusiopathiae is a Gram-positive rod, carried by many domestic and pet animals and very resistant in the environmental habitat, causing an anthropo-zoonosis infection in humans. It can determine, most frequently, a skin infection and may cause also septic arthritis or systemic infection, usually associated with aortic endocarditis. Bacteremia without endocarditis is a very rare presentation, generally seen in immunocompromised patients. We report such an unexpected diagnosis in a 75-years old woman, with mitral regurgitation, who was investigated for a persistent febrile syndrome, with no evidence of vegetation on repeated echo examinations and no evidence of the entry portal and who recovered successfully from an E. rhusiopathiae bacteremia with Ampicillin iv. therapy for 14 days.

Incidence and etiological agents of bacterial meningitis among children <5 years of age in two districts of Romania

To expand upon the limited comprehensive population-based data for childhood bacterial meningitis in Eastern Europe, the present study was conducted in the Iasi and Constanta districts of Romania. From March 2000 through March 2002, children <5 years of age hospitalized for bacterial meningitis were enrolled in a prospective surveillance study. A total of 56 cases of bacterial meningitis were identified, including 37 due to Neisseria meningitidis (22 per 100,000 per year), 13 due to Haemophilus influenzae type b (7.6 per 100,000 per year), and six due to Streptococcus pneumoniae (3.5 per 100,000 per year). Of the 31 meningococcal isolates that were serotyped, 12 were serogroup A, eight were serogroup B, and 11 were serogroup C. Among all cases of bacterial meningitis, 25 occurred in children <1 year of age, including those due to meningococci (n=14), H. influenzae type b (n=7), pneumococci (n=3), and Klebsiella pneumoniae (n=1). In Romania the incidence of H. influenzae type b meningitis is similar to that found in other areas of Southern and Eastern Europe during the pre-vaccination era, and the incidence of meningococcal meningitis is one of the highest yet found in Europe. An unexpectedly high proportion of these meningococcal meningitis cases is due to serogroup A. Disease burden could be substantially reduced through the introduction of H. influenzae type b conjugate vaccine and, when available, meningococcal conjugate vaccine protective against serogroups A, B and C.

[Tetanus in childhood--experience at the Infectious Disease Hospital Iaşi, January 1980-October 2003]

The aim of our study is to present the tetanus pediatric cases for almost 24 year period. We analyzed epidemiologically, clinico-biologically and the treatment from the patients' files. In above mentioned period were admitted 8 children with tetanus, 4 cases in 1980-1990; 5 patients were female, mainly came from suburban area; 12-15 year old group of age was mainly involved-3 cases. A point of entry was certified in 7 cases, the mean incubation period was 9.2 days, all the cases had a typical form of the disease. The complications were: bronchopneumonia, ileus (1 case). The performed treatment--antitetanic serum, antibiotics, sedatives, curare for 3 patients; no patient died. A rare disease for the pediatric age, tetanus could be a severe disease, with severe complications.

[Lamivudine and alpha-IFN treatment of a severe case of acute hepatitis B]

In order to enhance the viral clearance we used a combined antiviral therapy in an 18 year old patient, hospitalized in the Infectious Diseases Hospital-Iaşi, in June 2002. The evolution under standard therapy was unsatisfactory, with the aggravation of the icteric syndrome and a constant cytolytic syndrome. At this point we used the combination of Lamivudine (Zeffix) 100 mg/24 h + alpha-IFN 3 milUI x 3/week for the duration of 8 weeks. The improvement in both clinical and biochemical condition of the patient was obvious. At the end of the treatment (8 weeks) none of the signs or symptoms were present, the patient became AgHBs negative, AgHBe negative and anti-HBe positive. The combined antiviral therapy was useful (with the clearance of the HBs antigen) in a severe case of acute hepatitis B.

[Side effects of antiretroviral therapy]

Highly active antiretroviral therapy (HAART) has changed the natural history of HIV infection, but the presence of adverse events may limit its efficacy. Nucleoside reverse transcriptase inhibitors can cause mitochondrial toxicity and anemia, non-nucleoside reverse transcriptase inhibitors are associated with rash and central nervous system disturbance; protease inhibitors elicit gastrointestinal adverse effects and metabolic abnormalities including lipodystrophy syndrome, hyperlipidemia and insulin resistance. These complications have the potential to increase morbidity and mortality significantly in those requiring long-term treatment of HIV-infection. The presence of such abnormalities also has an impact on adherence to treatment. Besides providing health benefits, HAART may have a negative impact on patients' quality of life. Identifying and treating these complications has important implications for patient survival.

[Acute viral encephalitis. Experience of the Iaşi Infectious Disease Clinic between January 2000 and March 2003]

We analyzed the patients files suffered from acute viral encephalitis in 39 months period: January 2000-march 2003. According to our data there was a total of 33 patients; one of them died. The most involved patients were male and of the 8-14 year group of age; for the first three month in 2003 were admitted 11 patients. Coma and seizures were the most frequent clinical signs. LCR had the usual abnormalities for the above mentioned disease; the treatment was mainly performed with corticosteroids; 28 cases were admitted more than 8 days period. The evolution of the clinical status was satisfactory for all 32 patients.

[Cutaneous and oral manifestations in HIV-infected children and adults--169 cases]

The aim of the study was to evaluate cutaneous and oral manifestations in infected HIV patients.

MATERIALS AND METHODS

We retrospectively analyzed 169 cases admitted in Infectiouse Disease Department of Iaşi in 2001-2002 period.

RESULTS

Cutaneous and oral manifestations were: candidiasis (99 cases), herpes virus infectious (36 cases), scabies and straphylococcal/streptococcal skin disease (26 cases), prurigo nodularis, psoriasis and verruca vulgaris (9 cases). Children of 0-13 year old group was 75.73 percent. Classification of HIV infection was related with CD4 count for 166 cases. Twelve cases with oral pharyngitis candidiasis, scabies and streptococcal skin diseases was 2-3 recurrent episodes of manifestations. Etiotrop treatment was associated with HAART therapy.

CONCLUSIONS

Cutaneous and oral manifestations are occurred frequently in HIV infected patients, with a various etiology, but the severity, persistence and its evolution did not evaluate.

[Activity of fourth generation cephalosporins against clinical isolates of Enterobacteriaceae]

Cefpirome and cefepime are a novel group of cephalosporins which contain a positively charged quaternary ammonium at carbon 3 of the dihidrothiazone ring. The antimicrobial agents cefpirome, cefepime, cefotaxime, ceftriaxone, ceftazidime, cefoperazone and imipenem were tested against clinical isolates of Escherichia coli (n = 302) and Klebsiella spp. (n = 62) obtained during september-december 2002 from patients of Galaţi Emergency Hospital. The fourth generation cephalosporins cefpirome and cefepime have similar in vitro activities to the third generation cephalosporins. E. coli showed the comparable resistance rates for all cephalosporins. Against Klebsiella spp. strains cefpirome was less active (35.5% resistance) than cefepime (25.8% resistance). As expected, imipenem had excellent activity (100% susceptibility).

[Digestive implications of human immunodeficiency virus infection]

AIDS, still present with severe prognosis at the beginning of the 3rd Millennium, may present gastrointestinal and hepatic involvement. Even they have not a fatal prognosis, in order to improve the quality of life of AIDS patients we need a broad knowledge of and to treat the gastrointestinal and hepatic manifestation of the disease.

[Possibilities and limits of antiretroviral actual therapy]

The therapies now approved for HIV-infection inhibit one of two viral-specific enzymes, reversetranscriptase or protease. Combining this drugs into regimes based on at least three individual drugs--so-called HAART--has resulted in a remarkable reduction in HIV-associated morbidity and mortality. Despite these therapeutic advances, many patients are either intolerant of available agents or develop virologic failure. Problems of adherence, drug-resistance, latent reservoirs and drug-induced toxic effects that compromise effective viral control point to need for new strategies (e.g. structured treatment interruptions--STIs) and new classes of anti-HIV drugs with different modes of action (e.g. blocking HIV entry into human cells or fusion process). The use of adjunctive immune-based therapy such as IL-2 may permit more extensive immune restoration.

[Hemophilus influenzae meningitis- the experience of infectious diseases department between 1984-2001]

Our paper presents a clinico-biological and therapeutical study of the cases admitted in Infectious Diseases Hospital between January 1984-December 2001. We studied the records of all the patients that suffered from meningitis with Haemophilus influenzae. In above mentioned period 40 cases of Haemophilus influenzae meningitis was admitted; 6 patients (15%) died. A number of 13 cases was registered for the first five years, mainly in the childhood-32 cases (80%) for infants. Bacteriological diagnosis was made by bacterioscopia for 16 patients, bacteriological cultures-30 patients, latex test, performed in the last five years, in 8 cases. In patients who died, the bacteriologic culture was positive in 5 cases and bacterioscopia in 4 cases. The therapy was performed in resonance with antibiograme results for the involved strains. The Haemophilus influenzae meningitis is an acute and severe disease of the childhood, with an important risk of death, despite the rigorous therapeutical measures.

[Leptospirosis-clinico-biological and therapeutical aspects-study of 256 cases]

Leptospirosis is a zooantroponosis manifested as an infectious disease with a severe evolution, with liver and renal failure and hemorrhagic manifestation. The aim of this study was to present the clinico-biological investigation and the therapeutical aspects of 256 cases of leptospirosis admitted in the Infectious Diseases Hospital Iasi during 4 years (1998-2001). The diagnosis was based on the study of clinico-biological and therapeutical parameters (risk factors, fever, mialgia, headache, algic, eruptive, meningeal, hepatorenal, hemorrhagic syndromes with the serological evidence of the serotypes of leptospirosis); most of the cases were registered in 1998 (23% cases), in adults (31.2%) and male (75.22%). All the patients were serologic confirmed with leptospirosis (RAL and RFC), and L. icterohaemorhagiae was isolated most frequently. The standard anti-leptospirosis treatment was administered with favorable evolution; 6 deaths were registered from the severe forms of the disease. The leptospirosis is an emergent disease with the possibility of severe evolution in some forms, with liver and renal failure.

Hepatitis C virus serotypes in Romanian patients with chronic hepatitis and cirrhosis

OBJECTIVES

To determine the prevalence of hepatitis C virus (HCV) serotypes in Romanian patients with chronic hepatitis infections and the association between them and disease's severity.

PATIENTS AND METHODS

Anti-HCV antibodies were first investigated by an indirect ELISA (Murex IIIrd generation). From 55 patients positive for anti-HCV, 22 patients (11 female and 11 male) with chronic active hepatitis (CAH--6 cases), chronic persistent hepatitis (CPH--11 cases) and cirrhosis (C--5 cases) were tested for HCV serotypes using an indirect ELISA (Murex HCV Serotypes 1-6 Assay). The average age for the selected group was 47.2 years (range 27 divided by 68).

RESULTS

In the first study from our region concerning this subject we have found the following serotypes distribution: serotype 1--68.18% (6/11--CPH; 4/6--CAH; 5/5--C); serotypes 2, 3, 4, and 6--4.54% for each of them (all were CPH cases); untypable--13.65% (2 with CAH and 1 CPH respectively).

CONCLUSIONS

(1) The serotype 1 seems to be predominant in our region in patients with chronic HCV infections and it is associated with the most severe cases. (2) The diversity of serotypes is higher compared with previous study group results (e.g. in haemodialized patients the serotype 1 was determined in almost 100% cases--unpublished data). (3) Untypable strains (13.65%) require the sequence analysis for HCV genome characterization.

[Fungal infection in AIDS patients. Consideration for 10 cases]

Clinic, etiologic and therapeutic study of fungic infection in AIDS patients. The retrospective clinical study of the 10 AIDS patients admitted between 01.01.1994 and 31.12.2000 in Infectious Diseases Clinical Hospital of Iaşi. The majority of the cases (7) were registered in the last 3 years: 4 children and 6 adults. HIV infection was known only for 4 patients according to their history, and for the other 6 patients this diagnosis was made concomitantly of fungic infection diagnosis. The disease onset was insidious in 7 cases (2 children and 5 adults) being characterized by manifestations of nervous system involvement and consciousness disturbances (6 cases). The etiological diagnosis was established for alive patients by cerebrospinal fluid culture and hemocultures and Cryptococcus neoformans was isolated for 9 patients and Candida to another one. Fungic infection lead to meningeal injuries to 6 patients and the systemic one in for 4 patients. Although, under antifungical and antiretroviral therapy, the disease was lethal for 4 patients. The fungic infection recrudesces in AIDS patients, possessing systemic or/and meningeal manifestation, long evolution that can be lethal for a lot of them.

Sensitivity and resistance to antibiotics of Streptococcus pneumoniae involved in severe infections (1990-2000)

S. pneumoniae implicated in severe infections presents now a high frequency of the resistant strains to Penicillin G or multiresistance in the whole world. Our study on 136 strains of invasive pneumococcus isolated in the last 10 years showed a medium resistance to penicillin of 22.8% with yearly variations. The resistance to Rifampin, Cloramphenicol and Eritromycin was of 4.4%, 7.8% and 8.0%. The treatment of pneumococcal infections must be adapted to actual antibiotypes. These results present therapeutic implications.

Spinal epidural abscess

In a retrospective study, 68 patients with Spinal Epidural Abscess (SEA) were reviewed. Of these, 66% had different predisposing factors such as staphylococcal skin infections, surgical procedures, rachicentesis, trauma, spondilodiscitis. Abscess had a lumbar region location in 53% of cases. Staphylococcus aureus was the most frequent etiological agent (81%). The overall rate of mortality in SEA patients was 13.2%.

[Bartonella infection]

Bartonella species have been recently recognized as an important human pathogen associated with a wide spectrum of diseases. Four members of the genus are known to cause human infection: Bartonella baciliformis, B. henselae, B. quintana and B. elizabethae. B. baciliformis, the first identified Bartonella species, is the agent of two disease entities, Oroya fever and verruga peruana., B. henselae and B. quintana are two species involved in producing bacteremic syndromes (relapsing fever, trench fever, endocarditis), chronic lymphadenopathy in immunocompetent patients (cat-scrath disease) and chronic vascular lesions in immunocompromised hosts (bacillary angiomatosis and bacillary peliosis hepatis-recognized as new opportunistic infections in HIV-infected patients).

[Clinical and biological study of acute diarrhea with mixed etiology in 48 patients]

OBJECTIVES

The study of incidence, clinical manifestation and treatment of acute diarrhea with mixed etiology.

MATERIAL AND METHOD

Study of 48 patients with acute diarrhea with mixed etiology admitted in the Hospital of Infectious Diseases of Iaşi during 1995-1998.

RESULTS

12 cases (24%) were mixed bacterial infections with the following microorganisms associations: Salmonella + Shigella (10 cazuri); Salmonella + Yersinia enterocolitica (1 case); Salmonella + Rotavirus (1 case). 16 cases (44%) had mixed digestive infections with parasites, in double or triple associations: Giardia intestinalis + Ascaris lumbricoides (10 cases); Giardia intestinalis + Ascaris lumbricoides + Entamoeba coli (1 case); Giardia intestinalis + Enterobius vermicularis (3 cases); Ascaris lumbricoides + Trichiuris trichiura (2 cases). The rest of 20 cases presented mixed infections with bacteria and parasites: Salmonella + Rotavirus + Giardia (2 cases), Salmonella + Shigella + Giardia intestinalis or Ascaris lumbricoides (6 cases), Salmonella + Giardia intestinalis (8 cases); Salmonella + Entamoeba coli (3 cases); Shigella + Trichiura trichiuris + Entamoeba coli (1 case). The majority was male patients from rural areas with age between 5 month and 56 years, the majority being children, 4 cases were found in immunosupressed patients. The clinical symptomatology was dominated by diarrheal syndrome (100%) and the diagnosis was established by clinical characters and confirmed by coproculture and parasitologic exam. The ethiological therapy was guided by antibiogram, in the majority of cases we used fluorochinolones (associated with ceftriaxone in severe cases), together with antiparasitic medications.

CONCLUSIONS

In this study predominated the bacterial and parasitic infections, most frequently being isolated Salmonella, Shigella and Giardia intestinalis; the therapy associated fluorochinolones with antiparasitic medication.

The prevalence of the owner of serologic markers for the hepatitis C virus, in a north-eastern territory of Romania

The paper describes aspects in the natural evolution of hepatitis C virus (HCV) infection with severe outcomes induced by the typical or atypical clinical manifestations or chronic carrier state. In the interval 1995-1999 in the Iasi district morbidity from all types of viral hepatitis ranged from 153.4 cases per 100,000 inhabitants in 1995 to 66.6 in 1999. The features of A viral hepatitis epidemiological process was the multiannual cyclic pattern. From estimating the circulation of HCV in the population of Iasi district, several population categories have been screened for the presence of HCV antibodies (anti-HCV). Testing 87,894 blood samples assessed the prevalence of anti-HCV in blood donors. Different annual values resulted: 1.5% in 1997 and as a result of routine screening, only 0.3% in 1999. The cases of posttransfusion hepatitis (PTH) admitted to the Clinic of Infectious Diseases of Iasi, the diagnosis of which was supported by epidemiological history and confirmed serologically by the presence of anti-HCV were of 12 in 1995 (36.4% of all PTH), 20 in the interval 1996-1999, with an average for the 4 study years of 7.5%. Anti-HCV was found in 24.4% of series of 4,594 patients with viral hepatitis, in 32.1% of 582 individuals with various disorders or at risk, of which those with liver cirrhosis accounted for 37%, and in 9.6% of 94 patients with neurological disorders. Of the 1083 tested physicians and nurses working in health care settings at risk 6.6% were anti-HCV-positive.

[Difficulties in the diagnosis of prolonged fever in infants]

We report the case of an infant with cytomegalovirus (CMV) infection who developed a nosocomial sepsis of mixed etiology. Fever failed to decrease despite long-time and sustained antibiotic therapy. Treatment with an antiviral agent following the detection of CMV antibody of the IgM class resulted in clinical improvement and subsequent full recovery. We suggest that the diagnosis of CMV infection should be considered even in immunocompetent patients in whom antibiotic therapy fails.

[Neurologic manifestation in mumps virus infection]

OBJECTIVE

To study the incidence, clinical manifestations and treatment of mumps virus meningitis.

MATERIAL AND METHOD

Study of 64 patients with mumps virus meningitis, admitted to the Clinic of Infectious Diseases of Iaşi during 1996-1999.

RESULTS

The mumps virus meningitis had a high prevalence în 1998 (39%) most patients being males (62.5%) from the urban areas. 39.06% of cases were on the age group of 5-6 years old, 25% were in the age group 10-14 years old and 18.75% were adults patients. The clinical manifestation were dominated by headache (100%), fever (100%), vomiting (89%), photophobia (43.75%) and meningeal syndrome of contracture. The laboratory diagnosis was established by the cerebro-spinal fluid exam, together with the peripheric blood exam. The treatment was in all the cases with pathogenic (corticotherapy) and symptomatics with a very good evolution.

CONCLUSIONS

All the cases with diagnosis mumps virus meningitis were well going, having good evolution and complete healing under symptomatic and pathogenic therapy.

[Hanover intensive score. Study on 218 cases ]

We have performed a prospective study (1990-1996) in our intensive care unit in Hospital "C.I. Parhon" Iassy. Our study has 218 critical patients with ARDS and MSOD. For all of them we have used a new scoring system HIS (Hanover Intensive Score) for: the evaluation of patients with ARDS that have the risk to develop MSOD; determine the prognosis in different moments of evolution. In our opinion this score has the following advantages: it is easy to apply; it can determine the prognosis and the probable status of the patient at the moment of outcome; it can be used in our country with the technical that we have and we propose this score for his performances.

[Nosocomial staphylococcal meningitis]

OBJECTIVE

Clinical, bacteriological and therapeutically study on iatrogenic staphylococcal meningitis.

METHOD

Retrospective analysis of 33 cases of iatrogenic staphylococcal meningitis admitted to the Hospital of Infectious Diseases of Iaşi in the interval 1988-1997.

RESULTS

In the interval under study the recorded incidence was 1-5 cases per year. The predisposing factors were neurosurgical procedures for endocranial processes (12 cases), operated chronic otomastoiditis (11 cases), ventriculoatrial or peritoneal shunt (5 cases) and neurosurgical assessment (5 cases). The onset was slow, with persisting and mild headache persistence recurrence of fever, vomiting and convulsions followed by meningeal contracture and encephalitic phenomena. In 24 patients cerebrospinal fluid was typical for purulent meningitis. The causal agents were isolated in 25 cases being Staphylococcus aureus (20 cases) and Staphylococcus epidermidis sensitive to usual antistaphylococcal agents. Three therapeutically schemes were used the association cefotaxim î gentamycin proving to be the most effective vancomycin was required in but 2 cases. Three deaths were recorded.

CONCLUSIONS

The symptoms of iatrogenic staphylococcal meningitis are mild marked by the underlying disease the most effective treatment being the association of cefotaxim with an aminoglycoside.

[The clinical picture, treatment and prognosis of meningitis due to anaerobic and nonfermentative bacteria]

OBJECTIVES

The study of incidence, clinical manifestations and prognosis of meningitis with anaerobic and non-fermentative bacteria.

MATERIAL AND METHOD

Retrospective study of 10 patients with severe forms of purulent meningitis admitted in the Hospital of Infectious Diseases of Iaşi, during 1.01.1990-31.12.1998.

RESULTS

3 of them were diagnosed with etiology with polymicrobial flora and the rest had etiology with: Peptostreptococcus (2 cases), Acinetobacter calcoaceticus (4 cases), Eikenella corrodens (1 case). The majority were male sex (8 cases), and from rural area (9 cases). The age of patients ranged from 2.5 to 59 years (the majority being adults of group of age 50-60 years). The gate of entrance was: iatrogenic in the majority of cases (6 cases), posttraumatic (2 cases) and othogen (2 cases); 3 cases being with cerebrospinal fluid fistula and 8 patients being in coma. The factors associated with poor prognosis were: the immunosuppression (chronic etilism--4 cases; bronchopneumonia--2 cases, pulmonary cancer--1 case) and the presence of the focal neurological findings on the noser of illness. The diagnosis was established by clinical characters and confirmed by isolating germs from cerebrospinal fluid. The treatment was done at the beginning with first intervention antibiotic association with a high spectrum and then according to the antibiogramme. The evolution was severe even under treatment with 3 deaths, the mortality being of 30.0%.

CONCLUSIONS

We wished to present these cases as a general remark on the severity of illness, generally appeared on a suppressed ground, together with the rarity of those germs implicated in the etiology of purulent meningitis.

Hepatic artery hemodynamics in acute viral hepatitis

In order to evaluate the effect of the acute viral hepatitis on arterial blood flow we performed duplex Doppler US on 30 patients with acute viral hepatitis (AVH) and compared the results with those obtained on 20 normal volunteers. Hepatic artery flow (HAF) was significantly increased with the patients suffering from acute viral hepatitis. The data obtained show that the increase of arterial blood flow is not always associated with the increase of arterial velocities. We could put in evidence the presence of the hepatic artery response to altered portal blood flow (arterial buffer) during a AVH. If the increase of HAF is absolutely necessary for recovery from hepatitis, excessive increase of HAF seems to increase the time of recovery. In our study, the evolution of acute viral hepatitis was good when the HAF values did not exceed 65% of liver supply. The increase of arterial blood flow over 65% seems to limit the portal supply of the liver and in this way the amounts of regenerating substances which bathe the liver cells. The HAF value plays an important role in acute viral hepatitis evolution, so that the exploration of HAF and hepatic artery velocities may be a reliable examination in order to monitor the evolution of this disease.

[The epidemiological aspects and prevalence of markers in those with viral hepatitis C in some population categories in 1994-1997 in Iaşi County]

The results of the epidemiological, clinical and laboratory investigations, carried out in the 1994-1997 interval in the Iaşi district, on various populational groups, to indicate the prevalence of the antibodies anti-HVC possessors are presented. In 3611 patients with clinical-epidemiological HCV diagnosis, it was recorded a prevalence of the anti-HCV antibodies (AcHCV) presence of 22.7%. Posttransfusional hepatitis, epidemiologically diagnosed in 205 hospitalised patients was attributed to HCV in 11.6% of the cases, and in 94 patients with neurological diseases, AcHCV were identified in 9.6%. The presence of AcHCV at 825 persons in medico-sanitary staff, from risk domains, has recorded a prevalence of 8.0%. In the January 1997-September 1997 interval, the investigation by IIIrd generation ELISA of 51,149 blood samples of donors from various areas indicated the presence of AcHCV with an interval average of 2.6%.

[The clinico-evolutionary considerations of 492 cases of measles hospitalized in the Infectious Disease Clinic Iaşi in 1997]

Between 01.01.1997-31.12.1997 in the Infections Diseases Clinical Hospital of Iaşi were admitted 492 patients suffering from measles. The above mentioned number of patients represents 4.92% of all the patients (10097) who were admitted during this period of time. More than half of the patients (56.9%) are residents in suburban arias. Teen-agers and young adults (15-24 years) were involved in most of the cases, followed by new born babies (0-11 months). The clinical signs were prevalent minor and the atypical exanthema was found in 1/4 of all cases. The most frequent complications were pneumonia, bronchopneumonia and otitis media. Of all the patients, two children (average age 1-4 years) died.

[Postoperative and posttraumatic meningitis. Comments on 87 cases]

Iatrogenic and traumatic cerebromeningitis infections are increasing in frequency in the last two decades. Retrospective analysis of 87 patients iatrogenic and traumatic bacterial meningitis were admitted in the Clinic of Infectious Diseases from Iaşi between 1, 01, 1990-31, 12, 1994. Head trauma, lumbar punctures and iatrogenic meningitis infections were the causes cerebromeningitis infections. The diagnosis is usually difficult because of the poor specificity of the clinical signs. Predominant pathogens were gram-negative bacteria and Staphylococcus in iatrogenic meningitis and gram-positive bacteria (S. pneumoniae) in traumatic meningitis. The treatment was based on the use penicillin G + chloramphenicol, 3rd generation cephalosporins and sometimes 2nd generation quinolones. Ten of the 87 patients with iatrogenic and traumatic cerebromeningitis infections died (10.3%).