To review the clinical practice and complications of the home intravenous antimicrobial service at Christchurch Hospital after twelve months of full operation.
Clinical and microbiological diagnoses, ...antimicrobial therapy, and complications of home intravenous antimicrobial therapy were entered prospectively on an Excel data base.
Of the 153 patients, 113 (74%) suffered from skin, soft tissue or bone and joint disease. A bacteriological diagnosis was made in 108 patients (71%). 119 patients were treated with the narrow spectrum agents--penicillin 20 (13%), flucloxacillin 55 (36%) and cephazolin 44 (29%). Ceftriaxone was used for treatment in fifteen (10%) patients. Peripherally inserted central catheters (PICC's) were used in 129 patients, midlines fifteen, peripheral angiocaths in eight, and a Portacath in one. An elastomeric infusion device was used in 80 patients and an infusion pump in 34. Complications developed in 31 (20%) patients including three infections and one jugular vein thrombosis. Fifteen patients (10%) were readmitted within one month of discharge.
The home intravenous therapy programme successfully used first line narrow spectrum agents initiated in hospital with avoidance of unnecessary broad spectrum agents. Complication rates were acceptable and likely to improve with experience in patient selection and provision of support services.
HIV-associated tuberculosis is increasingly seen in Zimbabwe and other developing countries. The clinical and radiological features are often atypical, and diagnostic confusion may arise when sputum ...smears are negative. Patients with suspected intrathoracic tuberculosis frequently have palpable extrathoracic lymph nodes. In this study, Ziehl-Neelsen staining of aspirates from extrathoracic lymph nodes revealed acid-fast bacilli in 20 (71 %) of 28 patients with suspected tuberculosis, and 20 (87%) of 23 patients in whom a final diagnosis of tuberculosis was made Aspiration is simple, rapid, and cheap and may be of value in the diagnosis of tuberculosis, especially in developing countries with limited diagnostic and therapeutic resources.
HIV-associated tuberculosis is increasingly seen in Zimbabwe and other developing countries. The clinical and radiological features are often atypical, and diagnostic confusion may arise when sputum ...smears are negative. Patients with suspected intrathoracic tuberculosis frequently have palpable extrathoracic lymph nodes. In this study, Ziehl-Neelsen staining of aspirates from extrathoracic lymph nodes revealed acid-fast bacilli in 20 (71%) of 28 patients with suspected tuberculosis, and 20 (87%) of 23 patients in whom a final diagnosis of tuberculosis was made Aspiration is simple, rapid, and cheap and may be of value in the diagnosis of tuberculosis, especially in developing countries with limited diagnostic and therapeutic resources.
In order to assess the efficacy of 70% ethanol locks in addition to antibiotic therapy to treat tunnelled central venous catheter-associated bloodstream infections, a pilot study of 19 patients was ...performed prospectively using ethanol locks for 5 d in addition to antibiotic therapy to treat tunnelled central venous catheter-associated bacteraemia. 12 patients had mono-microbial infections and 7 had polymicrobial isolates. 17 of 19 patients completed ethanol lock therapy. 15 of 17 patients completing ethanol lock therapy had no recurrence of the original organism and retained their catheter for a median of 36 and an average of 47 d following initiation of ethanol lock therapy. These results demonstrate the safety and potential efficacy of this technique against a broad range of potentially virulent organisms. The intervention was acceptable to both staff and patients with no significant side-effects. These preliminary results from our prospective pilot study suggest that ethanol lock therapy is safe and easily integrated into clinical practice, and may have utility in treating central venous catheter-associated infections, avoiding removal of catheters in patients requiring long-term venous access.
To audit New Zealand's HIV infected population currently under active follow-up.
Multiple sources were used to determine anonymously the demographic and management characteristics of HIV infected ...individuals being monitored with HIV viral load measurements and/or receiving antiretroviral therapy during 2000.
593 people (480 males and 113 females) were under active follow-up. The most common transmission risk was male homosexual contact (56%) followed by heterosexual contact (28%), injecting drug use (3%) and mother to infant transmission (1%). Ethnicity data showed a disproportionate number of Africans (13%) compared to recent census figures. Anti-retroviral therapy was used in 71% of the cohort of whom 62% had HIV viral load measurements below 400 copies/mL. An upper estimate of diagnosed HIV individuals living in New Zealand at 30/9/2000 was 801.
This is the first time that the demographic and clinical state of HIV infected individuals has been assessed throughout New Zealand. The results suggest a slightly lower number of HIV infected individuals currently living in New Zealand than previously estimated. Anti-retroviral therapy is being used effectively within the HIV infected population. The changing demographics, with a higher proportion of people under care from Africa, increasing numbers of females, and an increase in the proportion with heterosexual risk factors are particular challenges.
The purpose of this study was to examine the effect of preceding fluconazole treatment on the oral mycologic flora and on the sensitivity of oral
Candida albicans isolates to fluconazole. Saline oral ...rinses were collected from 89 HIV-positive patients, of whom 48 had been exposed to fluconazole and 41 were fluconazole-naive. The rinses were cultured on Sabouraud's and Pagano Levin agars, and yeasts were identified by standard methods. Fluconazole sensitivity of
C. albicans isolates was measured by disk diffusion assay.
C. albicans was isolated from 69% of patients who had received fluconazole and from 93% of the patients who were fluconazole-naive (
p < 0.05). Nine other species of yeasts were also isolated, most commonly
C. glabrata. Five patients previously exposed to fluconazole harbored fluconazole-resistant
C. albicans, whereas no resistance was detected among the patients who were fluconazole-naive (
p < 0.01). Sixteen of the patients who were fluconazole-exposed carried yeasts other than
C. albicans, compared with only five patients in the fluconazole-naive group (
p < 0.01). All of the fluconazole-resistant strains were isolated from patients with low CD4 counts (less than 100 cells/ml) and after lengthy fluconazole exposures. Nevertheless, patients in Charlotte, N.C., who had a greater mean fluconazole exposure time (10.25 ± 1.41 months) than patients in Glasgow, UK, (0.65 ± 0.18 months;
p < 0.005), did not develop significantly more in vitro resistance or species diversity. This study indicates that long-term fluconazole treatment can have significant effects on the yeast flora of the mouth, particularly in a patient with a CD4 count of less than 100 cells/ml.
A 35 year old man developed paraplegia due to an epidural mass 15 months after completion of a full chemotherapy course for pulmonary and lymph node Mycobacterium bovis infection. His cellular immune ...function was normal after treatment. It is suggested that the lesion was a granulomatous healing response rather than bacteriological recurrence.
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