Continuous versus intermittent infusion of vancomycin in severe Staphylococcal infections: prospective multicenter randomized study

A continuous infusion of vancomycin (CIV) may provide an alternative mode of infusion in severe hospital-acquired methicillin-resistant staphylococcal (MRS) infections. A multicenter, prospective, randomized study was designed to compare CIV (targeted plateau drug serum concentrations of 20 to 25 mg/liter) and intermittent infusions of vancomycin (IIV; targeted trough drug serum concentrations of 10 to 15 mg/liter) in 119 critically ill patients with MRS infections (bacteremic infections, 35%; pneumonia, 45%). Microbiological and clinical outcomes, safety, pharmacokinetics, ease of treatment adjustment, and cost were compared. Microbiological and clinical outcomes and safety were similar. CIV patients reached the targeted concentrations faster (36 +/- 31 versus 51 +/- 39 h, P = 0.029) and fewer samples were required for treatment monitoring than with IIV patients (7.7 +/- 2.2 versus 11.8 +/- 3.9 per treatment, P < 0.0001). The variability between patients in both the area under the serum concentration-time curve (AUC(24h)) and the daily dose given over 10 days of treatment was lower with CIV than with IIV (variances, 14,621 versus 53,975 mg(2)/liter(2)/h(2) [P = 0.026] and 414 versus 818 g(2) [P = 0.057], respectively). The 10-day treatment cost per patient was $454 +/- 137 in the IIV group and was 23% lower in the CIV group ($321 +/- 81: P < 0.0001). In summary, for comparable efficacy and tolerance, CIV may be a cost-effective alternative to IIV.

[Enterobacteriaceae isolated in nine general hospitals of the Ile-de-France in 1988 and 1989: susceptibility to beta-lactam antibiotics according to the length of hospitalisation]

Susceptibility to beta-lactam antibiotics of strains of Enterobacteriaceae consecutively isolated in nine general hospitals during a period of 2 months (march and april) has been studied by the disk-agar diffusion method. The separation between susceptible and resistant strains was based on the measure of the inhibition zones centered by 2 disks: cephalothin and ticarcillin. Enterobacteriaceae were divided in 2 groups: strains isolated during the first 48 h of hospitalisation or isolated after. Fifty one per cent of the strains were isolated during the first 48 h: they did not belong to the residential flora of these hospitals. Klebsiella, Proteus indole positive, Providencia, Enterobacter, Serratia were more frequently isolated after 48 h of hospitalisation. Susceptible strains of Klebsiella, Proteus indole positive, Providencia, Serratia were more rarely isolated after 48 h of hospitalisation. E. coli whatever the duration of hospitalisation, is the less frequent susceptible bacterium.

[Characteristics of penicillinase-producing strains of Neisseria gonorrhoeae isolated in France, 1979-1986]

Penicillinase producing Neisseria gonorrhoeae PPNG, had been first isolated in France in 1979. Since, they regularly increased if we considered France on the whole. From 1979 to 1986, 284 strains had been collected by a multicentric group. The frequency of isolation was strongly different in France, unknown in some region they rose 12% in specific areas in Paris. The PPNG strains were more frequently isolated from male than female (sex ratio was higher with PPNG than for non producing strain). They were more often responsible of complicated infections in female than male at the same rate than the non producing strains. Auxotype distribution was different between producing and non producing strains. Plasmidic content from african type (Af) was almost the same than from asian type (As). Strains with Af type associated with the conjugative plasmid were increasing.

[Incidence of acquired infection in the surgical departments of 5 hospitals]

A program for monitoring nosocomial infections was implemented in the surgical units of five hospitals. The overall incidence of infections after clean surgery varied from 6.6% to 15% depending on the units. Surgical wound infections were in the 2.8 to 5% range, which corresponded to 30-66% of nosocomial infections. The main septic complication of surgery in 2 of the 5 units was urinary tract infection, with an incidence of 1.6 to 7.8%. Bacteriaemia complicating urinary tract infections and intravenous catheter infections accounted for 4% to 16% of all infections. Staphylococcus aureus was responsible for 40 to 77% of surgical wound infections and Escherichia coli for 30 to 50% of urinary tract infections. After a 4-5 months period of monitoring, the incidence of nosocomial infections was reduced by 32 to 68% depending on individual units.

Stable serum resistance of Neisseria gonorrhoeae as an epidemiological marker

Using a simple and rapid microassay, we tested 100 strains of Neisseria gonorrhoeae isolated from 81 patients (41 men and 40 women) for their sensitivity to killing by normal human serum (NHS). The reproducibility of the test was good when the bactericidal end points were taken as the dilution of fresh NHS that killed more than 95% of the test organisms. The bactericidal end points of strains isolated either from different anatomical sites or from sexual partners correlated well with the levels of sensitivity to serum of corresponding isolates, as well as with auxotypes. When the strains were not highly resistant to killing by NHS, this marker gave a precise definition of each strain and permitted the differentiation of isolates belonging to common auxotypes.