A 47 Year Old Woman Who Had Undergone Kidney Transplantation

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Vaccines are available for typhoid fever and bubonic plague; however, neither is routinely recommended in

ible 22-5 Therapy for Gastrointestinal Infections Caused by Enterobacteriaceae

p 1 Organisms

Therapeutic Strategies

Giterotoxlgenlc £ co//(ETEC) êfleroînvasive £ coli (BEC) ïnteropathogenic £ coli (EPEC) jBiterohemorrhaglc £ coff(EHEC) 1; aggregative £ co//(EAEC)

Supportive therapy, such as oral rehydration, Is indicated In cases of severe diarrhea; for life-threatening infections, such as hemolytic-uremic syndrome associated with EHEC, transfusion and hemodialysis may be necessary. Antimicrobial therapy may shorten duration of gastrointestinal illness, but many of these Infections will resolve without such therapy. Because these organisms may develop resistance (see Table 22-6), antimicrobial drug therapy for non-life-threatening infections may be contraindicated


Oral rehydration; antimicrobial drug therapy may be used to shorten the period of fecal excretion and perhaps limit the clinical course of the Infection. However, because of the risk of resistance, using antimicrobial drug therapy for less serious infections may be questioned

iiftawHaspp. 1

For enteric fevers (e.g„ typhoid fever) and extraintestinal infections (e.g., bacteremia, etc.) antimicrobial agents play an Important rale In therapy. Potentially effective agents for typhoid Include qulnolanes, chloramphenicol, trimethoprim/sulfamethoxazole, and advance-generation cephalosporins, such as ceftriaxone; however, first- and second-generation cephalosporins and aminoglycosides are not effective. For nontyphoidal Sa/moneZ/a bacteremia, a third-generation cephalosporin (e.g., ceftriaxone) is frequently used. For gastroenteritis, replacement of fluids is most important Antimicrobial therapy generally is not recommended for either treatment of the clinical infection c decreasing the time that a patient excretes the organism

0n via enterocolitlca and Yersinia pseudotuberculosis i^Bfc ■r t»-

The need for antimicrobial therapy for enterocolitis and mesenteric lymphadenitis is not clear. In cases of bacteremia, piperacillin, third-generation cephalosporins, aminoglycosides, and trimethoprim/sulfamethoxazole are potentially' effective agents. Y. enterocolitica is frequently resistant to ampicillin and first-generation cephalosporins, whereas Y. pseudotuberculosis isolates are generally susceptible

Table 22-6 Antimicrobial Therapy and Susceptibility Testing of Clinically Relevant Enterobacteriaceae

Table 22-6 Antimicrobial Therapy and Susceptibility Testing of Clinically Relevant Enterobacteriaceae


Therapeutic Options

Potential Resistance to Therapeutic Options

Testa'ng Methods*

Comments ffi cotl, Citrobacterspp.,

Providencia spp.,

Several agents from each major class of antimicrobials, including aminoglycosides, beta-laclams,and qulnolones have activity. See Table 12-6 for listing of specific agents that should be selected for in vitro testing. For urinary tract infections, single agents may be used; for systemic Infections, potent beta-lactams are used, frequently in combination with an aminoglycoside of expressing resistance to one or more antimicrobials belonging to each drug class

As documented in Chapter 12; disk diffusion, broth dilution, agar dilution, and commercial systems

In vitro susceptibility testing results are important for guiding therapy

Streptomycin is the therapy of choice; tetracycline or chloramphenicol are effective alternatives

Yes, but rare

See CLSl document M100-515, testing must only be performed in a licensed reference laboratory

Manipulation of cultures for dangerous for laboratory personnel and is not necessary and Drug Administration (FDA).

the United States. An oral multiple-dose vaccine prepared against S. typhi strain iy2la or a parenteral singledose vaccine containing Vi antigen is available lor people traveling to an endemic area or for household contacts of a documented S. typhi carrier.1

An inactivated multiple-dose, whole-cell bacterial vaccine is available for bubonic plague for people traveling to an endemic area. However, this vaccine will not provide protection against pneumonic plague.1 Individuals exposed to pneumonic plague should be given chemoprophylaxis with doxycycline (adults) or trimethoprim/sulfamethoxazole (children younger than 8 years of age).1

A 47-year-old woman who had undergone kidney transplantation 2 years earlier presented to the hospital with fever and confusion. Blood cultures obtained on admission were positive with a gramnegative rod. A direct identification strip was inoculated from the blood culture that keyed out as Shigella spp., with very few positive reactions. It did not type with Shigella antisera. The test was repeated from a colony the next day, with the same low number of positive reactions. However, the technologist noticed that the original strip had been incubating on the counter and was now positive for urease and a number of sugar fermentation reactions. A new code was determined adding the additional reactions, and the organism keyed out as Yersinia pseudotuberculosis. When the patient was questioned, she admitted that she had been eating unpasteurized imported goat cheese.

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Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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