Background-Intrauterine infection is a recognized cause of adverse pregnancy outcome but the source of infection is often undetermined. We report a case of stillbirth caused by Fusobacterium nucleatum that originated in the mother's mouth.

One case of primary Desulfovibrio desulfuricans bacteremia in an immunocompetent man is presented, and 15 other reported cases are reviewed. While most isolates have not been identified to the species level, Desulfovibrio fairfieldensis and D. desulfuricans have been associated with incidents of bacteremia and D. vulgaris has been associated with intra-abdominal infections. In vitro studies suggest that empirical therapy with either imipenem or metronidazole should be considered.Desulfovibrio organisms belong to a heterogeneous group of sulfate-reducing, motile, anaerobic bacteria with more than 30 proposed species, some of which infrequently cause a variety of human infections

After ertapenem was added to the formulary of a 344-bed community teaching hospital, we retrospectively studied its effect on antimicrobial utilization and on the in vitro susceptibility of various antimicrobial agents against Pseudomonas aeruginosa. Three study periods were defined as preintroduction (months 1 to 9), postintroduction but before the autosubstitution of ertapenem for ampicillin-sulbactam (months 10 to 18), and after the policy of autosubstitution (months 19 to 48) was initiated. Ertapenem usage rose slowly from introduction to a range of 36 to 48 defined daily doses/1,000 patient days (DDD) with a resultant decrease in ampicillinsulbactam usage due to autosubstitution. Imipenem usage peaked 6 months after the introduction of ertapenem and started to decline coincidently with the increased use of ertapenem. During the second period, imipenem usage decreased (slope ‫؍‬ ؊1.28; P ‫؍‬ 0.002). Prior to the introduction of ertapenem, the susceptibility of P. aeruginosa to imipenem increased from 61 to 81% at month 7 but then decreased slightly to 67% at month 9. After the introduction of ertapenem, susceptibility continued to increase; the increasing trend was significant (slope ‫؍‬ 1.74; P < 0.001). In the third period, the median susceptibility (interquartile range) was 88% (82 to 95%). This change appeared related to decreased imipenem usage. For every unit decrease in the monthly DDD of imipenem, there was an increase of 0.38% (P ‫؍‬ 0.008) in the susceptibility of P. aeruginosa to imipenem in the same month. Ertapenem was effective in our antimicrobial stewardship program and may have helped improve the P. aeruginosa antimicrobial susceptibility to imipenem by decreasing the unnecessary usage and selective pressure of antipseudomonal agents.

The importance of performing anaerobic blood cultures on a routine basis has been questioned in recent reports; this prompted us to review data on episodes of anaerobic bacteremia that have occurred in our 350-bed community hospital. In 1991, 771 of 7,397 blood cultures yielded bacteria or fungi; 569 (7.7%) were true positive cultures, 35 (6.2%) of which yielded 48 anaerobic isolates from 20 patients. The charts of these patients were reviewed, and it was determined that 16 of the patients had significant anaerobic bacteremia. The outcome was fatal for seven (44%) of these 16 patients, including two who died before results were reported. The results of blood culture led to a change of antimicrobial therapy for nine (56%) of the 16 patients. The source of infection was obvious for 11 of the 16 patients, and 50% of patients were receiving antimicrobial agents active against anaerobes before culture results were obtained. Although anaerobic bacteremia is uncommon in our hospital, positive culture results often resulted in a change in antimicrobial therapy.

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