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A woman infected by carbapenem-resistant Klebsiella pneumoniae is reported in this study. Tigecycline and meropenem combination was used, and indeed, in vitro checkerboard synergy test confirmed the antagonism between the two antibiotics. Thus, meropenem was ceased and single high-dose tigecycline was successful against the infection. Subsequent experiments showed that the isolates of the KPC-2-producing K. pneumoniae ST11 clone caused the infection. Therefore, tigecycline and meropenem combination should be used with caution.

We measured serum interferon (IFN) levels and leukocyte IFN productionin vitro in homosexual men with AIDS or generalized lymphadenopathy and in asymptomatic homosexual or heterosexual men. Acid-labile interferon alpha was detected in the serum of two patients with AIDS and in three out of nine patients with lymphadenopathy, but not in the sera of healthy homosexual or heterosexual controls. The presence of serum interferon in patients with AIDS or lymphadenopathy was correlated with a marked deficiency of their leukocytes to synthesize interferon alpha in response to viruses or tumor cells, but did not significantly interfere with the production of interferon gamma in response to lectin or bacterial enterotoxin. Our results suggest an inverse correlation between serum interferon alpha and the amount of interferon alpha produced in leukocyte cultures in male homosexuals with AIDS or generalized lymphadenopathy.

Six volunteers were given 600 mg clindamycin intravenously to investigate the serum bactericidal activity (SBA) against 50 methicillin susceptible (MSSA) and 50 methicillin resistantStaphylococcus aureus (MRSA) strains. Minimal inhibitory concentrations (MIC) against MSSA, MRSA and 50 methicillin resistant strains ofStaphylococcus epidermidis (MRSE), of which 50% were slime-producing, were determined. SBA of clindamycin against MSSA and MRSA was equally high (mean reciprocal SBA titer against MSSAvs MRSA 1h after application was 13.0vs 13.45), although MICs against MRSA were markedly higher than against MSSA (MIC 90 of MRSAvs MSSA: 0.06vs>32 mg/l). There was no difference in MICs between slime- and non-slime-producing MRSE.

The high cost of fidaxomicin has restricted its use despite the benefit of a lower Clostridioides difficile infection (CDI) recurrence rate at 4 weeks of follow-up. This short follow-up represents the main limitation of pivotal clinical trials of fidaxomicin, and some recent studies question its benefits over vancomycin. Moreover, the main risk factors of recurrence after treatment with fidaxomicin remain unknown. We designed a multicentre retrospective cohort study among four Spanish hospitals to assess the efficacy of fidaxomicin in real life and to investigate risk factors of fidaxomicin failure at weeks 8 and 12. Two-hundred forty-four patients were included. Fidaxomicin was used in 96 patients (39.3%) for a first episode of CDI, in 95 patients (38.9%) for a second episode, and in 53 patients (21.7%) for a third or subsequent episode. Patients treated with fidaxomicin in a first episode were younger (59.9 years vs 73.5 years), but they had more severe episodes (52.1% vs. 32.4%). The recurrence rates for patients treated in the first episode were 6.5% and 9.7% at weeks 8 and 12, respectively. Recurrence rates increased for patients treated at second or ulterior episodes (16.3% and 26.4% at week 8, respectively). Age greater than or equal to 85 years and having had a previous episode of CDI were identified as recurrence risk factors at weeks 8 and 12. We conclude that the outcomes with fidaxomicin in real life are at least as good as those observed in clinical trials despite a more demanding evaluation. Be it 85 years of age or older, and the use after a first episode appears to be independent factors of CDI recurrence after treatment with fidaxomicin.

The original version of this article unfortunately contained a mistake. The presentation of Fig. 1 was incorrect. The corrected figure is given below.

Cephacetril wurde in einer Dosierung von 8,0 g täglich als Kurzinfusion an drei aufeinanderfolgenden Tagen nierengesunden Probanden appliziert. Im 24-Stunden-Harn wurden die Aktivitäten der Alanin-Aminopeptidase, ein Leitenzym des proximalen Tubulus, bestimmt. Außerdem wurde versucht, dieses Membranenzym mit Hilfe eines Bürstensaum-Antiserums in Harnkonzentraten immunologisch nachzuweisen. Bei einem Teil der Probanden kam es unter Therapie zu einem geringen Anstieg der Aktivitäten im Harn. In diesen Fällen konnte auch immunologisch der Nachweis erbracht werden, daß dieses Membranenzym eliminiert wurde. Nach Absetzen der Medikation normalisierten sich diese Werte spontan. Enzymwerte, die als nephrotoxisch anzusehen wären, wurden in keinem Falle gemessen.

In an attempt to restore the colonization resistance we administered anaerobic microflora to prevent an abnormal colonization of the intestine after antibiotic treatment had been discontinued. After the antibiotics had been discontinued and before the donor flora had been administered and had colonized the intestine, microorganisms present were “unopposed” and expanded to a high density. A mouse model was used to investigate which antibiotics negatively influenced the donor flora and reduced the colonization resistance when administered intraperitoneally. Erythromycin, clindamycin and carbenicillin suppressed the donor flora permanently, as could be seen by the reduced colonization resistance. Benzylpenicillin, ampicillin, doxycycline and the combination gentamicin-cephalothin affected the colonization resistance as long as these agents were present. Gentamicin alone and cephalothin and oxytetracycline had no effect on the colonization resistance.