Frequency of small-colony variants and antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus in cystic fibrosis patients

Background

Small-colony variants (SCVs) are a distinct phenotype of Staphylococcus aureus, known for their role in chronic, difficult to treat infections, including cystic fibrosis (CF) lung disease. The goal of this study was to characterize SCV MRSA infection in an adult and pediatric CF population and to identify antibiotic susceptibility patterns unique to SCV MRSA.

Comparison of Five Chromogenic Media for Recovery of Vancomycin-Resistant Enterococci from Fecal Samples

Five chromogenic agars, evaluated using 400 stool specimens, were found to be superior in sensitivity (range, 89.9 to 93.9%) to bile esculin azide agar with vancomycin (BEAV) agar (84.8%) for detecting vancomycin-resistant enterococci (VRE), and the results were available 24 to 48 h sooner. The time to detection, need for supplemental testing, color distinction, and breakthrough of non-VRE organisms vary among the chromogenic media tested and may factor into the decision to use a particular medium.     

Atypical presentations of methemoglobinemia from benzocaine spray

Widely used for local anesthesia, especially prior to endoscopic procedures, benzocaine spray is one of the most common causes of iatrogenic methemoglobinemia. The authors report an atypical case of methemoglobinemia in a woman presenting with pale skin and severe hypoxemia, after a delayed repeat exposure to benzocaine spray. Early recognition and prompt management of methemoglobinemia is needed in order to lessen morbidity and mortality from this entity.     

Fecal Bacteriotherapy for Recurrent Clostridium difficile Infection: What’s Old Is New Again?

In recent years, effective management of recurrent Clostridium difficile infection (CDI) has emerged as an important issue for those clinicians who treat patients with CDI. In addition to antibiotic-based therapies, including alternating use, chaser, and tapering protocols, interest has increased in the potential utility of a variety of nonantibiotic forms of adjunctive therapy. Among these alternative forms of treatment, the concept of transferring extracts of a stool from donors to patients with CDI has been met with great interest among researchers, clinicians, and patients alike. Fecal bacteriotherapy, or so-called fecal microbiota transplantation, for therapy of CDI is a procedure that dates back to the 1950s. Recently, however, a variety of studies have garnered attention in the lay press, in addition to the standard scientific-reporting community. Although no well-controlled trials have been published as yet and the details of the procedures used have varied widely between institutions, the available evidence suggests that for selected patients, fecal bacteriotherapy appears to be generally safe and effective. Concerns about true efficacy and the theoretical potential for infectious complications have prevented widespread adoption of this concept as standard therapy, but its use in academic and community practices is on the rise.     

Changes in Fasting Plasma Glucose Levels with Ribavirin and Pegylated Interferon Treatment in Normal and Impaired Glucose Tolerant Patients with Chronic Hepatitis C

Background

Patients with Hepatitis C Virus (HCV) infection have increased rates of glucose intolerance, and studies have shown the improvement of fasting plasma glucose (FPG) levels after clearance of HCV infection with standard ribavirin plus pegylated interferon treatment. The purpose of this study was to examine glycemic changes with standard HCV treatment in patients with impaired fasting glucose (IFG) and normal fasting glucose (NFG).

Methods

A retrospective study of FPG changes in HCV patients with IFG and NFG treated with standard HCV therapy was conducted. Baseline characteristics and viral responses were assessed; FPG levels before treatment, at the end of treatment, and more than one-month post treatment were compared.

Results

The mean FPG levels increased by 8.68 mg/dl at the end of treatment in the NFG group but decreased by 9.0 mg/dl in the IFG group, a statistically significant difference (P=0.019). The change in FPG levels remained significantly different after adjusting for weight change (P=0.009) and weight changes and initial weight (P=0.039). FPG change from baseline at more than one month after treatment were similar in both groups (P=0.145). The change in FPG levels was not associated with sustained viral response.

Conclusions

In HCV-infected patients, standard ribavirin plus pegylated interferon treatment reduced FPG levels in patients with IFG and increased FPG levels in NFG individuals; independent of initial weight, weight change, or viral response. Standard HCV treatment modulates fasting plasma glucose levels which supports the need for a prospective study to determine the clinical significance of this finding.     

Atypical Presentations of Methemoglobinemia from Benzocaine Spray

Widely used for local anesthesia, especially prior to endoscopic procedures, benzocaine spray is one of the most common causes of iatrogenic methemoglobinemia. The authors report an atypical case of methemoglobinemia in a woman presenting with pale skin and severe hypoxemia, after a delayed repeat exposure to benzocaine spray. Early recognition and prompt management of methemoglobinemia is needed in order to lessen morbidity and mortality from this entity.