The goal of this study was to assess the overtreatment of asymptomatic bacteriuria (ASB) in hospitalized patients, calculate the total costs of inappropriate treatment, and determine if a multi-faceted educational intervention was effective in reducing the overtreatment of ASB in a resource-limited community hospital. The study encompassed three phases: a retrospective pre-intervention assessment of the baseline cost and treatment of ASB, the implementation of a multi-faceted educational intervention, and a prospective post-intervention assessment of the efficacy of the intervention. A positive urine culture was defined by bacterial counts ≥105 cfu/mL. In the pre-intervention group, 64 (83%) of 109 patients were asymptomatic: 30 (47%) were treated. In the post-intervention group, 13 (17%) of 55 patients were asymptomatic: 2 (15%) were treated, (p=0.04). Fewer urine cultures were collected during the post-intervention period than the pre-intervention period (3,127 and 3,419, respectively) (p<0.001). The total cost of inappropriately treating ASB in the pre-intervention group was $1200 compared to $600 in the post-intervention group. The results demonstrated a significant decrease in the inappropriate treatment of ASB and the associated costs.
We evaluated the role of CD34+ bone marrow progenitor cells in vivo, in the pathogenesis of AIDS-related haematological abnormalities. The clonogenic activity of CD34+ cells from seven patients with HIV-1 infection, without bone marrow involving opportunistic infections or neoplasms, was assessed in semisolid cultures. The number of CFU-GM was significantly reduced as compared to the controls (P = 0.017), independently from myelotoxic therapy, while the number of BFU-E was not. The presence of retroviral sequences in CFU-GM colonies from four patients and in the total population of CD34+ cells from six patients with advanced stage HIV infection was investigated using the polymerase chain reaction. The presence of HIV-1 sequences was also searched for in a purified suspension of CD34+ cells after 3 weeks liquid culture. All these cells were always HIV-1 negative, while viral sequences were always detected in bone marrow mononuclear cells from these and other patients. The number of HIV-1 DNA copies decreased with increasing enrichment. At most 1:10,000 CD34+ cells are infected in vivo. Other mechanisms than direct viral infection of progenitor cells must account for the defective haemopoiesis in HIV-1 infected patients.
A 59-year-old man with prostatism, in otherwise good health, was treated with transurethral prostatectomy and ketoconazole. At microscopic examination of the prostatic tissue he had acute and chronic prostatitis with granulomatous lesions, in the center of which capsular-deficient cryptococcal organisms were demonstrated. The patient was well without evidence of systemic or local infection at 22 months. The differential diagnosis of granulomatous prostatitis is discussed.
The successful use of vancomycin is reported in two children with shunt infections due to Staphylococcus epidermidis which failed to respond to shunt removal. The previously reported experience with this drug is reviewed. The use of vancomycin should be considered in cases of shunt infections due to susceptible microorganisms and refractory to other therapeutic measures.
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