Nightmare in the ward: difficult infection.

is a Gram-positive, anaerobic, spore-forming bacillus. It is isolated in 80% of the stools of children and infants and in 3% of healthy adults. It causes gastrointestinal tract infections and affects patients who make prolonged use of antibiotics.

Clostridium difficile infection in the elderly.

The incidence of C. difficile infections (CDI) in the elderly continues to rise and infection is associated with increased morbidity and mortality when compared to those affected in younger age-groups. Immunosenescence may be a contributory factor yet the exact immune responses that may protect against CDI are incompletely understood.

High rate of colistin resistance among patients with carbapenem-resistant Klebsiella pneumoniae infection accounts for an excess of mortality.

Carbapenem-resistant Klebsiella pneumoniae (CR-KP) is becoming a common cause of healthcare-associated infection in Italy, with high morbidity and mortality. Prevalent CR-KP clones and resistance mechanisms vary between regions and over time. Therapeutic approaches and their impact on mortality have to be investigated.

Case report: safety and efficacy of tocilizumab in a patient with rheumatoid arthritis and chronic hepatitis C.

Tocilizumab is a monoclonal humanized anti-IL-6-receptor antibody used for the treatment of rheumatoid arthritis. The safety of tocilizumab in HCV patients is an open question. We report on safety and efficacy of tocilizumab in a 71-year-old female with rheumatoid arthritis and chronic hepatitis C.

[Rheumatoid arthritis: a typical multifactorial genetic disease: review of the literature].

Environmental factors can be triggers for the clinical appearance of rheumatoid arthritis in subjects with genetic susceptibility. Genetic factors account for 60% of disease susceptibility. This review is focused on the genetic and environmental basis of the susceptibility to arthritis.

Molecular findings and antibiotic-resistance in an outbreak of Acinetobacter baumannii in an intensive care unit.

We investigated an outbreak of Acinetobacter baumannii in the intensive care unit (ICU) of a hospital in Rome, Italy. The outbreak involved 14 patients whose isolates were most frequently recovered from bronchoalveolar lavage. All isolates were multidrug-resistant and showed diminished susceptibility or resistance to carbapenems.

Activity of moxifloxacin in combination with vancomycin or teicoplanin against Staphylococcus aureus isolated from device-associated infections unresponsive to glycopeptide therapy.

We tested the in vitro bactericidal activity of moxifloxacin, a new 8-methoxyquinolone, alone and in combination with vancomycin or teicoplanin at different multiples of minimum inhibitory concentration (MIC) against 8 methicillin-ciprofloxacin-resistant Staphylococcus aureus (M-C-RSA) and 1 methicillin-ciprofloxacin susceptible S. aureus (M-C-SSA) recently isolated from device-associated infections unresponsive to or relapsing after glycopeptide therapy, despite device removal. MICs of vancomycin ranged from 1 to 4 microg/ml, MICs of teicoplanin ranged from 2 to 8 microg/ml; MICs of moxifloxacin were always 2 microg/ml against M-C-RSA isolates and 0.

Conservative medical therapy of infections following osteosynthesis: a retrospective analysis of a six-year experience.

The conventional therapeutic approach to bone infection associated with osteosynthesis is based on the idea that microbial eradication is most readily achieved by removal of the foreign material together with adequate antimicrobial therapy. This strategy usually requires implantation of external fixation devices with additional discomfort to the patient. We report our experience with conservative medical and antimicrobial therapy without removal of the osteosynthesis until adequate bone callus deposition is documented by bone radiography scan.

Prosthetic biologic valve endocarditis caused by a vancomycin-resistant (vanA) Enterococcus faecalis: case report.

We recently observed (February 1999) a 68-year old patient with endocarditis on a prosthetic biologic valve caused by a vancomycin-resistant Enterococcus faecalis. Broth dilution tests showed susceptibility to ampicillin (MIC=0.5 microg/ml), no high resistance to aminoglycosides (MIC for gentamicin <500 microg/ml) and resistance to vancomycin (MIC >256 microg/ml) and teicoplanin (MIC >16 microg/ml).

Antibiotic susceptibility and serotype distribution of Streptococcus pneumoniae causing meningitis in Italy, 1997-1999.

Because few data are available in Italy regarding antimicrobial susceptibility and serotype distribution of invasive Streptococcus pneumoniae strains, meningeal isolates collected at Italian hospitals during the years 1997-1999 were studied. The 12 most common serogroups, representing > 85% of the isolates, were 14, 23, 6, 4, 3, 9, 19, 8, 1, 12, 18, and 7 (in order of frequency). The serogroups identified in children < 5 years old were more limited in number: 80% are included in the 7-valent conjugate vaccines.

Antimicrobial susceptibility of invasive Streptococcus pneumoniae in Italy by agar dilution method and E test.

Few data on antimicrobial susceptibility of invasive Streptococcus pneumoniae isolated in Italy are available. Ninety-two invasive isolates from all over the country collected from January 1997 to April 1998 were tested for sensitivity to penicillin, erythromycin, ceftriaxone, chloramphenicol, tetracycline, and trimethoprim/sulfamethoxazole by the agar dilution method. Five (5.

Comparative in-vitro activity of moxifloxacin, penicillin, ceftriaxone and ciprofloxacin against pneumococci isolated from meningitis.

Minimum inhibitory concentrations of penicillin, ceftriaxone, ciprofloxacin, and moxifloxacin (BAY 12-8039), a new 8-methoxyquinolone, were determined for 60 cerebrospinal fluid isolates of Streptococcus pneumoniae collected during January 1997-April 1998 at Italian medical centres. Three reference isolates with predetermined MIC values (two penicillin- and multidrug-resistant isolates, one uniformly susceptible to all antibiotics) were also tested with the same antibiotics. The MIC90 of penicillin was < or = 0.

Susceptibility and genetic relatedness of invasive Haemophilus influenzae type b in Italy.

Haemophilus influenzae type b (Hib) still causes a large portion of meningitis in children less than 5 year old in Italy because vaccination against this agent has not been fully implemented in the country. We have studied 78 Hib strains and 4 nontypable H. influenzae (NTHi) isolated from the cerebrospinal fluid of subjects with meningitis for susceptibility to ampicillin, chloramphenicol, and ceftriaxone.

[Streptococcus bovis endocarditis. Clinical and microbiological observations and review of the literature].

Fourteen patients (11 men and 3 women) with Streptococcus bovis infective endocarditis have been observed by the Infectious Disease Section of our Department of Clinical Medicine between the years 1988-1998. The mean age was 63.2 years (range 35-85 years); 5 patients previously suffered valvular disease or had a valvular prosthesis, the infection involved the mitral valve in 6 patients, the aortic in 8, the prosthetic valve in 1.

Fatal suppurative mesenteric thrombophlebitis caused by an Enterococcus faecalis highly resistant to aminoglycosides: case report.

A 56-year old man with non-Hodgkin's lymphoma and biliary tract endoprosthesis, developed chronic bacteremia caused by Enterococcus faecalis with high-level resistance to gentamicin and streptomycin. The sources of bacteremia were a device-associated biliary tract infection, a suppurative thrombophlebitis of the confluence of the superior mesenteric vein with the splenic vein as well as multiple liver and pancreatic abscesses. Despite antibiotic therapy and multiple drainages of abscesses, the patient died due to overwhelming infection.

Teicoplanin in the treatment of enterococcal endocarditis: clinical and microbiological study.

Seven cases of enterococcal endocarditis treated with teicoplanin (7-10 mg/kg/day for 28-105 days) alone (one case) or in combination with aminoglycosides (six cases) were reviewed. All patients were cured. Serum bactericidal activity titres after intravenous gentamicin (5 mg/kg every 24 h) and teicoplanin (10 mg/kg every 24 h) were measured on day 7 of treatment in four patients against five enterococcal isolates: mean titres were 1:54 (range 1:16-64) and 1:22 (1:8-32) at 0.

Activity of quinupristin/dalfopristin against Streptococcus pneumoniae in vitro and in vivo in the rabbit model of experimental meningitis.

We tested the efficacy of quinupristin/dalfopristin, an antibiotic made up of dalfopristin (70%) and quinupristin (30%) against a large panel of Streptococcus pneumoniae strains. The pneumococcal isolates (217) included 200 penicillin-resistant and 17 penicillin-susceptible clinical isolates. Eighty-nine of the 200 resistant bacteria showed an intermediate level and 111/200 showed a high level of resistance to penicillin.

Spread of the serotype 23F multidrug-resistant Streptococcus pneumoniae clone to South Korea.

Thirty-eight antibiotic-resistant isolates of Streptococcus pneumoniae recovered in a hospital in Seoul, Korea, between February 1990 and March 1992 were analyzed for serotype, antibiotic susceptibility patterns, and chromosomal relatedness using pulsed-field gel electrophoretic (PFGE) analysis of SmaI chromosomal digests. Most of the isolates were from sputum samples, and a few strains were from otitis media and meningitis. The great majority of isolates (34 of 38, or 89%) were multiresistant, sharing virtually identical, elevated minimal inhibitory concentration (MIC) values (microgram/ml) for penicillin (1-2), chloramphenicol (12-25), tetracycline (25-30), and sulfamethoxazole/trimethoprim (> 100).

Penicillin-resistant and multidrug-resistant Streptococcus pneumoniae in a pediatric hospital in Zagreb, Croatia.

Sixty-four penicillin-resistant Streptococcus pneumoniae isolates [benzylpenicillin minimal inhibitory concentrations (MICs) between 0.05 and 1.6 micrograms/ml] recovered at the Pediatric Hospital "Dr.

Potential of clindamycin in addition to vancomycin for the treatment of oxacillin-resistant Staphylococcus aureus septicemia persisting under vancomycin therapy.

We observed seven patients with persistent fever and staphylococcemia under vancomycin-containing antimicrobial regimens who promptly improved as clindamycin was added to the initial antibiotics. Moreover, in all these patients a striking increase in peak and trough serum inhibitory activity (SIR) and serum bactericidal activity (SBA) levels was observed after addition of clindamycin. SIA and SBA levels after administration of a single dose of vancomycin (500 mg), clindamycin (600 mg) or vancomycin + clindamycin were also measured in three healthy volunteers against six ORSA isolates.

[The multiresistance of Streptococcus pneumoniae: a global danger].

S. pneumoniae causes several serious and potentially life-threatening community-acquired diseases, and there are 5 million deaths per year globally. In multidrug-resistant clones (those with resistance to erythromycin, tetracycline, chloramphenicol, penicillin, and trimethoprim-sulfamethoxazole), treatment of even relatively localized pneumococcal infection may require hospitalization because of the need to use parenteral vancomycin.