Initial Antibiotic Therapy For Patients Research Articles

РЕЗУЛЬТАТЫ МИКРОБИОЛОГИЧЕСКОГО ОБСЛЕДОВАНИЯ ПАЦИЕНТОВ С ОБШИРНЫМИ ОЖОГАМИ В ДИНАМИКЕ ТЕЧЕНИЯ ОЖОГОВОЙ БОЛЕЗНИ И АЛГОРИТМ ИХ ИНТЕРПРЕТАЦИИ

The results of a dynamic microbiological study of the samples of 195 patients with extensive burns are presented. Depending on the order of hospitalization of patients, differences were found in the structure of the microbiota, the level of resistance to antibiotics and the manifestation of pathogenic properties (biofilm formation, secretion of protective proteases and aggression factors, adhesive activity, the presence of virulence genes). There was an increase in the frequency of matches of the species composition, especially for isolates of P. aeruginosa, K. pneumoniae, A. baumannii, in 2 or more types of samples, depending on the length of stay in the intensive care unit. The results obtained determine a differentiated approach to microbiological examination and empirical initial antibiotic therapy in patients with extensive burns with the need to take into account the order of hospitalization. An algorithm for interpreting the results of sowing discharge from extensive burns is presented, taking into account the timing of the study, the number of bacteria, the level of resistance, markers of pathogenic potential, the coincidence of the species composition in biomaterials.

Effect of Initial Antibiotic Therapy in Patients with Blunt Abdominal Trauma

Background: Practising the use of antibiotics in emergency surgeries drastically reduces the incidence of post-operative systemic and surgical site infections. There are very few articles about the details of use of antibiotics in abdominal trauma. We studied the effect of preliminary drugs therapy against bacteria in patients with abdominal trauma.
 Methods: From Ma y 2020 to May 2021, we looked back and surveyed the medical files of patients with abdominal trauma in our institution, Krishna institute of medical sciences deemed to be university, Karad. Blunt and piercing abdominal injuries were included in our study
 Results: Data of the 432 patients were accumulated. Antibiotic was initiated in 96.4% of penetrating injury and 79.7% with blunt injury. Initial antibiotics therapy was provided to 78.2% of patients with solid organ injury and 97.5% with hollow viscus injury. On an average of 6 days, antibiotics were given in solid organ injuries, 6.2 days in hollow viscus. Infection within 2 weeks of admission occurred in 50 cases. Infection linked severity of injury, surgery performed and blood transfused. Time for which the antibiotic was given did not affect the rate of infection.
 Conclusion: It was inferred that the antibiotics were used in massive numbers (84.2%) and for prolonged time (6.2 days) in these patients in Karad.

Effect of Antibiotic Resistance of Pathogens on Initial Antibiotic Therapy for Patients With Cholangitis.

ObjectivesConsidering that pathogens resistant to initial antibiotic therapies for cholangitis can affect mortality rates, appropriate initial empiric antibiotic therapy is important. However, evidence regarding the influence of pathogens resistant to initial antibiotics in patients with cholangitis who have undergone early endoscopic retrograde cholangiopancreatography (ERCP) is limited, and the conditions in several cases can improve with early ERCP even when pathogens resistant to initial antibiotics are detected on time. Therefore, this study aimed to assess the influence of pathogens resistant to initial antibiotics on the course of cholangitis in patients undergoing early ERCP.Materials and methodsPatients (n=266) with positive blood or bile culture results treated with early ERCP were divided into those with cultures that were resistant to the initial antibiotics (antibiotic-resistant group; n=66; 24.8%) and those with cultures that were sensitive to the initial antibiotics (antibiotic-sensitive group; n=200; 75.2%). The duration of hospitalization, in-hospital mortality rates due to cholangitis, rates of increased disease severity, and complications during hospitalization were studied.ResultsEnterococcus, Enterobacter, Citrobacter, and Pseudomonas species showed high resistance to several antibiotics. No significant between-group differences were found in the duration of hospitalization, in-hospital mortality rates due to cholangitis, and rates of increased disease severity. However, the rate of post-ERCP cholecystitis was significantly higher in the antibiotic-resistant group than in the antibiotic-sensitive group (p=0.0245).ConclusionsEven if the initial antibiotics were ineffective, the rate of fatal outcomes did not increase among patients with cholangitis who had undergone early ERCP. However, when initial antibiotics were ineffective, the frequency of post-ERCP cholecystitis increased even after early bile duct decompression.

Current status of initial antibiotic therapy and analysis of infections in patients with solitary abdominal trauma: a multicenter trial in Korea.

PurposeProper use of antibiotics during emergency abdominal surgery is essential in reducing the incidence of surgical site infection. However, no studies have investigated the type of antibiotics and duration of therapy in individuals with abdominal trauma in Korea. We aimed to investigate the status of initial antibiotic therapy in patients with solitary abdominal trauma.MethodsFrom January 2015 to December 2015, we retrospectively analyzed the medical records of patients with solitary abdominal trauma from 17 institutions including regional trauma centers in South Korea. Both blunt and penetrating abdominal injuries were included. Time from arrival to initial antibiotic therapy, rate of antibiotic use upon injury mechanism, injured organ, type, and duration of antibiotic use, and postoperative infection were investigated.ResultsData of the 311 patients were collected. The use of antibiotic was initiated in 96.4% of patients with penetrating injury and 79.7% with blunt injury. Initial antibiotics therapy was provided to 78.2% of patients with solid organ injury and 97.5% with hollow viscus injury. The mean day of using antibiotics was 6 days in solid organ injuries, 6.2 days in hollow viscus. Infection within 2 weeks of admission occurred in 36 cases. Infection was related to injury severity (Abbreviated Injury Scale of >3), hollow viscus injury, operation, open abdomen, colon perforation, and RBC transfusion. There was no infection in cases with laparoscopic operation. Duration of antibiotics did not affect the infection rate.ConclusionAntibiotics are used extensively (84.2%) and for long duration (6.2 days) in patients with abdominal injury in Korea.

Pediatric Febrile Neutropenia: Change in Etiology of Bacteremia, Empiric Choice of Therapy and Clinical Outcomes.

The optimal choice of initial antibiotic therapy for patients with high-risk febrile neutropenia (FN) in children is unclear and varies by the institution on the basis of local antibiograms and epidemiology of specific pathogens. The authors evaluated the appropriateness of antibiotics for the empiric treatment of FN in pediatric patients with cancer in our institution on the basis of changes in the epidemiology of organisms isolated from blood cultures (BCx). The authors conducted a retrospective medical record review of pediatric patients who received any oncology care (including patients with cancer and patients who had stem cell transplant) at University of Chicago Medicine Comer Children's Hospitals (March 2009 to December 2016) with a diagnosis of FN who had at least 1 BCx obtained. They reviewed pathogens isolated from BCx and determined whether they were pathogens or contaminants using the Infectious Diseases Society of America (IDSA) guidelines and the team's decision to treat. They investigated the microbiologic spectrum and susceptibility patterns of pathogens causing bacteremia in pediatric FN and whether the empiric therapy chosen may have affected clinical outcomes. A total of 667 FN episodes were identified in 268 patients. BCx were negative in 497 (74.5%) and were determined to be contaminants in 27 (4%). In 143 episodes (21.5%), the BCx were positive for a pathogenic species. Polymicrobial bacteremia was identified in 25 episodes; a total of 176 pathogens were isolated. The majority of pathogens (95/176, 54%) were Gram-positive (GP), whereas 64 of 162 (36%) were Gram-negative (GN), 5 were fungal, and 4 were mycobacterial. The most common GP pathogens were viridans group streptococci (VGS) (n=34, 19.3%), coagulase-negative staphylococci (n=25, 14%), and methicillin-susceptible Staphylococcus aureus (n=12, 6.8%). Of aerobic GN bacilli, 15 (8.5%) were AmpC producers and 3 (1.7%) carried extended-spectrum beta-lactamases. There was no increase in the prevalence of multidrug-resistant GN isolates during the study period. Patients with VGS and multidrug-resistant GN bacteremia were more likely to be admitted to the pediatric intensive care unit [odds ratio (OR), 3.24; P=0.017; and OR, 2.8; P=0.07, respectively]. There were trends toward a higher prevalence of GP pathogens causing bacteremia and the emergence of VGS with decreased penicillin sensitivity. The prevalence of bacteremia with VGS was higher in acute myelogenous leukemia and neuroblastoma (OR, 2.3; P<0.01) than in patients with other solid tumors. Empiric antibiotic treatment should be tailored to patients' risk for VGS and multidrug-resistant organisms. Individual hospitals should monitor the pathogens causing FN among patients with cancer to guide choice of empiric therapy.

2270. Initial Treatment Selection Among Patients with Recurrent Pseudomonas aeruginosa (PSA) Infections (Infxs): Does Prior PSA Antibiotic Susceptibility Results Effect Subsequent Empiric Treatment Decisions?

BackgroundResistance to commonly used anti-pseudomonal β-lactams (AP-BLs) like piperacillin/tazobactam (TZP), meropenem (MER) and cefepime (CEF) among patients (patients) with PSA infx is increasing. To minimize receipt of DAT among patients with PSA infxs, clinicians need to consider the patient’s risk of having a PSA infx that is NS to commonly used AP-BLs. A well-described risk factor for having a NS AP-BL PSA infx is recent history of an NS AP PSA infx. This study evaluates the likelihood that a patient with a PSA infx receives an AP-BL that was found to be NS on a prior PSA culture.MethodsThis was a multi-center (n = 239), retrospective cohort analysis using the 2018 data from the BD Insights Research Database (Becton, Dickinson and Company). Inclusion criteria: age ≥ 18 years; hospitalized; PSA infx (index PSA infx); occurrence of a PSA infx ≤ 1 year of index PSA infx (post-index PSA infx); and received treatment for the post-index PSA infx for ≥ 24 hours. Frequency of NS to ≥ 1 AP-BL (MER, TZP, or CEF) for the index PSA infxs was calculated. Among patients with an index PSA infx that was NS ≥ 1 AP-BL, the number of patients who received an AP-BL for the post-index PSA infx that was NS on the index PSA infx was determined.ResultsDuring study period, 16,062 patients had a PSA infx and 2,386 (14.9%) of patients had a post-index PsA infx. The most common culture sites for the index and post-index PSA infxs were respiratory and urine. The most commonly prescribed AP-BL for the post-index PSA infx were TZP (41.9%), CEF (40.3%), and MER (30.8%). In total, 1,026 (43%) of patients had an index PSA infx that was NS to ≥1 AP-BL. Among the 1,026 patients with an index PSA infx that was NS to ≥1 AP-BL, 902 (88%) patients received an AP-BL as initial therapy for the post-index PSA infx and 558 (62%) patients received an AP-BL that was reported as NS on the index PSA culture.ConclusionThe findings highlight the importance of considering prior PSA culture and susceptibility data when selecting initial antibiotic therapy for patients who present with a suspected or documented PSA infx and have a history of a prior PSA infx. Patients with history of a PsA infx that was NS to ≥1 AP-BL may benefit from initial use of novel AP-BL therapies.Disclosures All authors: No reported disclosures.

Clinical and economic consequences of failure of initial antibiotic therapy for patients with community-onset complicated intra-abdominal infections.

ObjectivesComplicated intra-abdominal infection (cIAI) is infection that extends beyond the hollow viscus of origin into the peritoneal space, and is associated with either abscess formation or peritonitis. There are few studies that have assessed the actual costs and outcomes associated with failure of initial antibiotic therapy for cIAI. The aims of this study were to evaluate risk factors and impact on costs and outcomes of failure of initial antibiotic therapy for community-onset cIAI.MethodsA retrospective study was performed at eleven tertiary-care hospitals. Hospitalized adults with community-onset cIAI who underwent an appropriate source control procedure between August 2008 and September 2011 were included. Failure of initial antibiotic therapy was defined as a change of antibiotics due to a lack of improvement of the clinical symptoms and signs associated with cIAI in the first week.ResultsA total of 514 patients hospitalized for community-onset cIAI were included in the analysis. The mean age of the patients was 53.3 ± 17.6 years, 72 patients (14%) had health care-associated infection, and 48 (9%) experienced failure of initial antibiotic therapy. Failure of initial antibiotic therapy was associated with increased costs and morbidity. After adjustment for covariates, patients with unsuccessful initial therapy received an additional 2.9 days of parenteral antibiotic therapy, were hospitalized for an additional 5.3 days, and incurred $3,287 in additional inpatient charges. Independent risk factors for failure of initial antibiotic therapy were health care-associated infection, solid cancer, and APACHE II ≥13.ConclusionsTo improve outcomes and costs in patients with community-onset cIAI, rapid assessment of health care-associated risk factors and severity of disease, selection of an appropriate antibiotic regimen accordingly, and early infection source control should be performed.

Absence of Evidence for Enhanced Benefit of Antibiotic Therapy on Recurrent Acute Rhinosinusitis Episodes: A Systematic Review of the Evidence Base

To systematically review the evidence base on the effectiveness of short-course antibiotic therapy in adult patients with a recurrent episode of acute rhinosinusitis as part of a disease pattern on severity and duration of symptoms and recurrences. PubMed, EMBASE, and the Cochrane Library. A comprehensive search was performed up to March 21, 2013. Articles reporting studies on the effects of short-course antibiotic therapy compared with placebo in patients with recurrent acute rhinosinusitis were included. For included articles, the design of reported studies was assessed for directness of evidence and risk of bias. In total, 3473 unique publications were retrieved, of which 30 were considered eligible based on title and abstract screening. In addition, 8 eligible articles were retrieved using cross-reference checking. Based on full-text evaluation, none of the retrieved 38 articles satisfied our predefined selection criteria. They did not compare antibiotic treatment with placebo, excluded patients with recurrent acute rhinosinusitis, or did not report findings for a subgroup of patients with recurrent acute rhinosinusitis. To date, there is no evidence available on differences in effect of antibiotic therapy in primary or sporadic and recurrent episodes of acute rhinosinusitis. As such, decisions for or against initial antibiotic therapy in patients with recurring episodes of acute rhinosinusitis should be based on the same criteria used in managing primary or sporadic episodes of uncomplicated acute rhinosinusitis.

Fever-based antibiotic therapy for acute cholangitis following successful endoscopic biliary drainage

The current management of acute cholangitis consists of antibiotic therapy in combination with biliary drainage. However, the optimal duration of antibiotic therapy after the resolution of clinical symptoms by biliary drainage is unclear. We aimed to evaluate whether discontinuing antibiotic therapy for acute cholangitis immediately after the resolution of clinical symptoms, achieved by endoscopic biliary drainage, was safe and effective. This prospective study included patients with moderate and severe acute cholangitis. Cefmetazole sodium and meropenem hydrate were used as initial antibiotic therapy for patients with moderate and severe acute cholangitis, respectively. All patients underwent endoscopic biliary drainage within 24 h of diagnosis. When the body temperature of < 37 ° C was maintained for 24 h, administration of antibiotics was stopped. The primary endpoint was the recurrence of acute cholangitis within 3 days after the withdrawal of antibiotic therapy. Eighteen patients were subjected to the final analysis. The causes of cholangitis were bile duct stone (n = 17) and bile duct cancer (n = 1). The severity of acute cholangitis was moderate in 14 patients and severe in 4. Body temperature of < 37 ° C was achieved in all patients after a median of 2 days (range 1-6) following endoscopic biliary drainage. Antibiotic therapy was administered for a median duration of 3 days (range 2-7). None of the patients developed recurrent cholangitis within 3 days after the withdrawal of antibiotics. Fever-based antibiotic therapy for acute cholangitis is safe and effective when resolution of fever is achieved following endoscopic biliary drainage.

Effect of an emergency department sepsis protocol on time to antibiotics in severe sepsis

We sought to evaluate the time to antibiotics for emergency department (ED) patients meeting criteria for severe sepsis before and after the implementation of an ED sepsis protocol. Compliance with published guidelines for time to antibiotics and initial empiric therapy in sepsis was also assessed. A retrospective chart review was conducted. Emergency department patient encounters with International Classification of Diseases codes related to severe infections were screened during a 3-month period before and after the implementation of a sepsis protocol. Encounters meeting criteria for severe sepsis were further assessed. The time to initiation of antibiotics was determined as well as the initial choice of antimicrobial therapy based on the presumed source of infection. We reviewed 213 unique ED patient encounters meeting criteria for severe sepsis. Analysis of the period before implementation showed a median time from the time criteria for severe sepsis were met to delivery of antibiotics of 163 minutes (95% confidence interval [CI] 124 to 210 min). Analysis of the period after implementation of the protocol revealed a median time of 79 minutes (95% CI 64 to 94 min), representing an overall reduction of 84 minutes (95% CI 42 to 126 min). Before the implementation of the protocol, 47% of patients received correct antibiotic coverage for the presumed source of infection in compliance with locally published guidelines. After the initiation of the protocol, 73% received appropriate initial antibiotics, for an overall improvement of 26%. A guideline-based ED sepsis protocol for the evaluation and treatment of the septic patient appears to improve the time to administration of antibiotics as well as the appropriateness of initial antibiotic therapy in patients with severe sepsis.

Risk factors and outcome of community‐acquired pneumonia due to Gram‐negative bacilli

Several sets of guidelines have advocated initial antibiotic treatment for community-acquired pneumonia due to Gram-negative bacilli in patients with specific risk factors. However, evidence to support this recommendation is scarce. We sought to identify risk factors for community-acquired pneumonia due to Gram-negative bacilli, including Pseudomonas aeruginosa, and to assess outcomes. An observational analysis was carried out on prospectively collected data for immunocompetent adults hospitalized for community-acquired pneumonia in two acute-care hospitals. Cases of pneumonia due to Gram-negative bacilli were compared with those of non-Gram-negative bacilli causes. Sixty-one (2%) of 3272 episodes of community-acquired pneumonia were due to Gram-negative bacilli. COPD (odds ratio (OR) 2.4, 95% confidence interval (CI): 1.2-5.1), current use of corticosteroids (OR 2.8, 95% CI: 1.2-6.3), prior antibiotic therapy (OR 2.6, 95% CI: 1.4-4.8), tachypnoea >or=30 cycles/min (OR 2.1, 95% CI: 1.1-4.2) and septic shock at presentation (OR 6.1, 95% CI: 2.5-14.6) were independently associated with Gram-negative bacilli pneumonia. Initial antibiotic therapy in patients with pneumonia due to Gram-negative bacilli was often inappropriate. These patients were also more likely to require admission to the intensive care unit, had longer hospital stays, and higher early (<48 h) (21% vs 2%; P < 0.001) and overall mortality (36% vs 7%; P < 0.001). These results suggest that community-acquired pneumonia due to Gram-negative bacilli is uncommon, but is associated with a poor outcome. The risk factors identified in this study should be considered when selecting initial antibiotic therapy for patients with community-acquired pneumonia.

Clinical and Economic Consequences of Failure of Initial Antibiotic Therapy for Hospitalized Patients With Complicated Skin and Skin-Structure Infections

To estimate the consequences of failure of initial antibiotic therapy for patients with complicated skin and skin-structure infections. Retrospective cohort study. Large US multihospital database. We identified a total of 47,219 patients (age 18 years or older) who were admitted to the hospital for complicated skin and skin-structure infections from April 1, 2003, through March 31, 2004, and who received intravenous antibiotics during the first 2 hospital-days (ie, initial antibiotic therapy). Failure of therapy was defined as drainage, debridement, or receipt of other intravenous antibiotics at any subsequent time (except for changes to narrower-spectrum agents or any therapy change immediately before discharge). Predictors of failure of antibiotic therapy and mortality were examined using multivariate logistic regression. Analysis of covariance was used to estimate the impact of treatment failure on duration of intravenous antibiotic therapy, length of stay, and total inpatient charges. For 10,782 admitted patients (22.8%), there was evidence of failure of initial antibiotic therapy. In multivariate analyses, treatment failure was associated with receipt of vasoactive medications during the first 2 hospital-days (odds ratio [OR], 1.66 [95% confidence interval {CI}, 1.19-2.31]), initiation of antibiotic therapy in the intensive care unit (OR, 1.53 [95% CI, 1.28-1.84]), and the patient's Charlson comorbidity index (OR per 1-point increase, 1.06 [95% CI, 1.04-1.08]); treatment failure was also was associated with a 3-fold increase in mortality (OR, 2.91 [95% CI, 2.34-3.62]). Compared with patients for whom initial treatment was successful, patients who experienced treatment failure received intravenous antibiotic therapy for a mean of 5.7 additional days, were hospitalized for a mean of 5.4 additional days, and incurred a mean of $5,285 (in 2003 dollars) in additional inpatient charges (all P<.01). Failure of initial antibiotic therapy in the treatment of complicated skin and skin-structure infections is associated with significantly worse clinical and economic outcomes.

Severe community-acquired pneumonia: what's in a name?

Purpose of review Formerly, patients with community-acquired pneumonia admitted to an intensive care unit were considered as having the severe form of the disease. Recently, guidelines have distinguished severe and non-severe community-acquired pneumonia based on clinical definitions. In this review, we describe the different definitions of severe community-acquired pneumonia, and whether a differentiation based on these definitions reflects variation in etiology, risk factors, diagnostic approaches and treatment. Recent findings New definitions do not seem to accurately identify patients with high risks of mortality; patients not admitted to an intensive care unit could also be diagnosed as having severe community-acquired pneumonia. Host-factors, such as genetic factors and underlying diseases, can influence severity of presentation of community-acquired pneumonia. Distribution of pathogens in severe and non-severe disease forms is comparable. Initial antibiotic therapy in patients with severe disease should provide coverage of Streptococcus pneumoniae and Legionella pneumophila, as delay is associated with worse outcomes. However, recent studies also suggested an additional benefit of atypical coverage in non-severe disease. As a result, initial therapy with a beta-lactam plus a macrolide or an anti-pneumococcal fluoroquinolone is recommended for all patients with community-acquired pneumonia. Furthermore, the value of vaccination against pneumococci to prevent episodes of severe disease is yet unknown. Summary As current guidelines do not adequately identify patients with high risk of mortality and intensive care unit admittance, clinical judgment remains important. Based on distribution of pathogens, investigational procedures and therapy recommended in recent guidelines, differentiation between severe and non-severe community-acquired pneumonia does not seem useful. Whether atypical coverage indeed has additional value in non-severe or pneumococcal CAP, however, remains to be determined. In addition, the preventive benefit of influenza and pneumococcal vaccination for development of SCAP awaits further evidence.

Severe community-acquired pneumonia: what's in a name?

Formerly, patients with community-acquired pneumonia admitted to an intensive care unit were considered as having the severe form of the disease. Recently, guidelines have distinguished severe and non-severe community-acquired pneumonia based on clinical definitions. In this review, we describe the different definitions of severe community-acquired pneumonia, and whether a differentiation based on these definitions reflects variation in etiology, risk factors, diagnostic approaches and treatment. New definitions do not seem to accurately identify patients with high risks of mortality; patients not admitted to an intensive care unit could also be diagnosed as having severe community-acquired pneumonia. Host-factors, such as genetic factors and underlying diseases, can influence severity of presentation of community-acquired pneumonia. Distribution of pathogens in severe and non-severe disease forms is comparable. Initial antibiotic therapy in patients with severe disease should provide coverage of Streptococcus pneumoniae and Legionella pneumophila, as delay is associated with worse outcomes. However, recent studies also suggested an additional benefit of atypical coverage in non-severe disease. As a result, initial therapy with a beta-lactam plus a macrolide or an anti-pneumococcal fluoroquinolone is recommended for all patients with community-acquired pneumonia. Furthermore, the value of vaccination against pneumococci to prevent episodes of severe disease is yet unknown. As current guidelines do not adequately identify patients with high risk of mortality and intensive care unit admittance, clinical judgment remains important. Based on distribution of pathogens, investigational procedures and therapy recommended in recent guidelines, differentiation between severe and non-severe community-acquired pneumonia does not seem useful. Whether atypical coverage indeed has additional value in non-severe or pneumococcal CAP, however, remains to be determined. In addition, the preventive benefit of influenza and pneumococcal vaccination for development of SCAP awaits further evidence.

Apport du kit Servitex Staphylocoque MRSA ® dans le diagnostic rapide des souches de Staphylococcus aureus résistantes à la méticilline

Objective – An efficient initial antibiotic therapy for patients infected by methicillin resistant Staphylococcus aureus (MRSA) improves the health prognostic in term of morbidity and mortality. The authors wanted to assess the Servitex Staphylocoque MRSA test ®: a rapid (30 min) slide latex agglutination test used to determine methicillin resistance by detecting PBP 2a in Staphylococcus aureus. Method – Sixty five Staphylococcus aureus clinical isolates (53 heterogeneous methicillin resistant S. aureus, nine homogeneous methicillin resistant S. aureus, three methicillin susceptible strains), and two control strains (ATCC 25923, CIP 6525) were studied. These strains were tested by various methods: agar diffusion with 5 μg oxacillin disk tested both at 30°C on Mueller-Hinton medium and at 37°C and on Mueller-Hinton plus 4% NaCl; latex test Servitex MRSA ® tested with two inocula (5 and 10 cfu); and dot blot hybridization with the mecA probe. Results – The methods used to detect methicillin resistance were of similar sensitivity except for the latex test Servitex MRSA ® with a 5 cfu inoculum which detected resistance in only 87% of the cases. A 100% accuracy was restored if a 10 cfu inoculum was used for the latex test Servitex MRSA ®. Comments – Standardization of the initial inoculum appears to be necessary for the reliable detection of methicillin resistance by the latex test. In a clinical laboratory, the use of the latex test is thus restricted to very specific cases if results are to be obtained in less than 48 hours.

Legionella: An infrequent cause of adult community acquired pneumonia in Dublin

The commonest infectious agents identified in community acquired pneumonia (CAP) amongst 50 patients admitted to a Dublin hospital were Streptococcus pneumoniae and Haemophilis influenzae. Legionella pneumophila pneumonia occurred in only one patient who acquired infection abroad. A serological screen of blood bank donors and renal transplant recipients failed to detect antibody to Legionella pneumophila supporting the clinical findings of a low prevalence of infection in this community. It is concluded that initial antibiotic therapy for patients with CAP need not routinely include cover for Legionella.