Part I – Young Girls with Non-Refluxing Ureters

This paper is the study of 144 girls with histories of urinary tract infection followed at the Stanford Medical Center who were found to be free of ureterovesical reflux. The mean age at onset of infection for the entire group was about four years and ranged from the first few months of life to age 10. Ninety-two percent of the 505 infection episodes in these children presented with symptoms referable to the lower tract, and bacterial localization studies confirmed that 85 percent of the infections were limited to the bladder. Escherichia coli was the most common organism isolated and most infections were caused by a pure culture of a single bacteria.In only two of the 144 patients studied was there any evidence of upper tract damage related to infection. The possibility that these patients had reflux at an earlier age could not be discounted.In response to short-term antibacterial therapy in 66 of the patients followed closely for an average of 40 months each, 20 percent of the patients had no further infections and 80 percent went on to recurrence. With each succeeding treatment an additional 20 percent of the patients were “cured,” but the remainder experienced recurrent infections during the follow-up. This reinfection pattern supports the use of long-term antibacterial prophylaxis in all girls who have more than three or four recurrences of infections. Urethral dilation appeared to have no value in reducing the reinfection rate. While it appears that in the absence of ureterovesical reflux few, if any, of these children will go on to develop upper tract damage, long-term prophylactic suppressive medication can clearly be justified on the grounds of reducing patient morbidity.     

Use of a topical antibiotic spray in vaginal surgery.

During vaginal hysterectomy with or without colporrhaphy a topical aerosol spray containing neomycin sulfate, polymyxin B sulfate and zinc bacitracin was used in 50 patients to decrease the change of postoperative pelvic infection; a placebo spray was used in another 50 patients. All patients were treated preoperatively with povidone iodine and postoperatively with nitrofurantoin and an antibacterial irrigating solution for the bladder if catheter drainage was necessary. The frequency of postoperative pelvic infection was 16% in the group sprayed with the antibiotic combination and 34% in the group sprayed with the placebo, a significant difference (P less than 0.05).     

A clinical and microbiological study of venous catheterization

In a prospective study of 210 intravenous catheters and needles 31 (15%) swabs yielded 34 microbial isolates. Twenty-eight were “non-pathogenic” skin commensals and six were “pathogenic” organisms. Commensals were isolated predominantly from catheters left in situ for only a short time (up to two days) and pathogenic organisms most frequently from specimens left in situ for a longer time. Correlation was not confirmed between colonization and infection, antibiotic therapy or phlebitis. All samples of IV fluids were sterile on culture. Changing the IV catheter at least every two days is recommended.     

Gonococcal Ophthalmia Neonatorum Despite Treatment with Antibacterial Eye-drops

Over a five-year period, 1964-8, 48 cases of gonococcal ophthalmia neonatorum were notified to the department of venereology in Glasgow. Thirty-seven babies were born in hospital and 11 at home. The conjunctivitis, usually recorded as a “sticky eye,” developed between 1 and 13 days of birth, 36 by the fourth day.Diagnosis by culture of Neisseria gonorrhoeae was delayed in some cases up to 30 days after the appearance of the signs for those born in hospital and 15 days for those born at home, usually because of the blind use of antibacterial eye-drops which produced temporary alleviation of the signs without eradicating the infection; chloramphenicol was noteworthy in this respect.A “sticky eye” will resolve without the use of antibacterial agents, ophthalmia neonatorum will not. When it is decided to use an antibacterial agent pretreatment conjunctival smears for immediate staining and swabs for culture should be taken and the case notified to the medical officer of health.Gonococcal ophthalmia is a preventable disease. In view of the obstetricians'' already heavily committed clinical work load there is need for venereologists to collaborate, on consultation and within the maternity hospitals wherever possible, in the screening of antenatal patients for candidiasis and trichomoniasis as well as for gonorrhoea. Some target groups, those with a pathological vaginal discharge or with certain adverse social factors, warrant more thorough investigation, while all those treated require further examination to ensure cure.     

The dynamics of detecting group-A streptococci in an infectious disease clinic]

The study revealed that the isolation rate of group A streptococci in scarlet fever patients at the time of hospitalization did not exceed 68%. The isolation rate of these streptococci was greatly influenced by antibacterial therapy carried out before hospitalization. Under clinical conditions with intensive penicillin therapy group A streptococci were eliminated from the larynx on days 3-4. In 13% of children repeated streptococcal infection was observed 0.5-3 months after discharge from hospital.     

行政干预对Ⅰ类切口围术期预防性使用抗菌药物的影响

目的:探讨行政干预对I类切口围术期预防性使用抗菌药物的影响。方法:2011年4月～6月对全院手术科室进行行政干预,具体做法:卫生行政部门与医院一把手、医院与手术科室主任、科室主任与科室执业医生分别签订目标责任状;医院配合全国抗菌药物临床应用专项整治活动方案进行全员培训,并对医师进行抗菌药物临床应用培训并考核合格后,授予其相应级别的抗菌药物处方权,明确各级医师使用抗菌药物的处方权限;由医务科牵头与院感染科、药剂科、质控科联合对I类切口手术患者预防使用抗菌药物情况进行检查,定期实施目标奖罚,责任到科室主任和临床医生。然后抽取我院2010年7月～12月(行政干预前)和2011年7月～12月(行政干预后)I类切口手术病历各210份,参考《抗菌药物临床应用指导原则》、卫办医政发[2009]38号通知对420例I类切口手术患者预防使用抗菌药物情况进行回顾性分析。结果:行政干预前(2010年7月～12月)I类切口围手术期预防性抗菌药物的使用率达83.81%(176/210),术后抗菌药物使用时间在2～7天者占69.52%,大于7天者占6.67%;行政干预后(2011年7月～12月)210例患者预防使用抗菌药物使用率为30%(63/210),显著低于未使用行政干预的Ⅰ类切口术患者(P<0.05),围术期术后抗菌药物使用时间在2～7天者占16.67%,没有1例患者用药超过7天,抗菌药物的使用时间较未使用行政干预的Ⅰ类切口术患者显著缩短(P<0.05)。结论:有效的行政干预可以强化临床医生合理应用抗菌药物的意识,提高合理用药的水平,明显降低I类切口预防性抗菌药物的使用率,缩短抗菌药物的使用疗程。     

“Skid Row” Syndrome: A Medical Profile of the Chronic Drunkenness Offender

From skid row, 227 chronic “drunks”, inmates of the Toronto Jail, were studied to determine the physical features and illnesses of this group. Complete physical examinations, liver function tests, routine hematology, urinalysis, chest radiographs were carried out and previous hospital records were obtained for each man. The data were analyzed by IBM computer and reported in terms of body systems. Items that occurred in sufficient frequency were separated out and listed to compile a “skid row” syndrome. The men averaged 45 years of age, had been drinking heavily for 20 years and had four drunken convictions a year. Tuberculosis was found in 8.8%. Epilepsy was confirmed in 8%. Cirrhosis of the liver was definite in 3% of the group; 75% were under the Canadian average weight, and 25% had significant body deformities. It was estimated that, if necessary therapy was carried out, 90% of the men would be able to perform useful labour.     

PYOGENIC INFECTIONS IN ORTHOPEDIC SURGERY—Prevention and Management

A problem that confronts surgeons in clinical practice is that a patient may acquire new infections while in the hospital. When such infections occur they are predominantly staphylococcal and these bacteria are often, but not always resistant to penicillin, streptomycin and the tetracycline antibiotics. They are often but neither completely nor uniformly sensitive to the newer or less frequently used antimicrobial agents.The extension of antibiotic usage from proven situations to “routine” prophylaxis has been a widespread practice. There are many reasons to discourage and to reexamine the validity and purpose, as well as the safety of this practice. We now have sufficient background and experience to revert from widespread and indiscriminate use to a practice of discriminate prophylactic therapy.In general, soft tissue lacerations and clean wounds do not require operation under an “antibiotic umbrella.” Similarly, elective orthopedic surgical procedures of soft tissues such as muscle biopsy, tenorrhaphy and muscle and tendon transplants as well as plastic surgical procedures can be safely performed without antibiotic therapy if technique is good and operation not prolonged. Operations of major magnitude on the motor-skeletal system, such as open fractures, internal fixation of fractures with bone grafts, and major operations of joints are indication for antibiotic therapy for impending infection postoperatively for five days. Reliance is mainly on antistaphylococcal drugs to which hospital organisms are predominantly sensitive. The two remaining indications for antibiotic therapy against impending infection are: (1) major crush injury—for example, to the thigh—and (2) the need for a patient with a healing fracture to have other surgical procedures such as tooth extraction or excision of an infected area which might predispose to transient bacteremia and embolic infection in bone or joint.     

Pneumocystis Carinii Pneumonia—Problems in Diagnosis and Therapy in 24 Cases

Twenty-four instances of Pneumocystis carinii pneumonia were recognized in 23 patients at the Stanford University Hospitals between 1962 and 1970. The affected persons could be broadly characterized as “compromised” hosts. All but one were receiving immunosuppressive drug therapy for such underlying disease as hematopoietic malignant disease, collagen vascular disorder, and organ transplant rejection. The one patient not receiving immunosuppressant medication had congenital dysgammaglobulinemia and suffered two discrete bouts of pneumocystis pneumonia. Most of the patients were concomitantly infected with other “opportunistic” pathogens.Open lung biopsy remained the most reliable method of antemortem diagnosis of pneumocystis infection during this eight-year period. It resulted in little morbidity. Unfortunately, direct examination of appropriately stained sputum specimens for cysts was almost uniformly nonproductive.The majority of patients received specific antipneumocystis drug treatment (pentamidine isethionate or pyrimethamine and sulfadiazine). “Cure” was achieved when institution of therapy was prompt and duration of therapy approached the empirically recommended two-week course.The fact that pneumocystis pneumonia can be controlled if recognized early is compelling reason to pursue diagnosis of pneumocystosis in an appropriate clinical setting, namely, in patients with impaired host defenses who have pulmonary infection unresponsive to conventional therapy. There is hope that a noninvasive (serological) technique will be developed shortly to simplify identification of this not uncommon cause of diffuse interstitial pneumonitis.     

Effect of rIFN-gamma and IL-2 treatments in mouse and nude rat infections with Toxoplasma gondii.

Mice and nude rats lethally infected with T. gondii and treated with recombinant rat interferon-gamma (rIFN-gamma) or recombinant human interleukin-2 (rIL-2) were protected against death, when compared with untreated infected controls. In mice rIFN-gamma and rIL-2 played an important role in "prophylactic treatment", but not in "curative therapy". The survival rate was 42% in mice treated with 3 doses of 20,000 U of rIFN-gamma at days -2, -1, 0 before challenge and up to 66% in mice treated with 3 doses of 10,000 U of rIFN-gamma at days -2, 0, +2 before and after infection. Whereas the survival rate was 33% in mice that received 3 doses of 500 U rIL-2 at days -2, -1, 0 before infection, or -2, 0, +2 before and after infection respectively, up to 50% of the mice treated with 3 doses of 1,000 U rIL-2 at days -2, -1, 0 survived. In nude rats rIFN-gamma had a slight effect in "prophylactic treatment", whereas rIL-2 was active only in "curative treatment". The survival rate was 25% both in nude rats treated with doses of 400,000 U of rIFN-gamma at days -3, 0 before challenge, or with doses of 5,000 U of rIL-2 at days +2, +6, +9 after infection. These results lead us to hypothesise that the mechanism by which the lymphokine treatment exerts a protective effect on Toxoplasma infected mice is different from that on nu/nu rats. We conclude that these cytokines may play a notable role in modulating the host's immune defence against T. gondii infection.     

Long term management of duodenal ulcer in general practice: How best to use cimetidine?

Two hundred and sixty seven patients with duodenal ulceration were entered into a five year study of two strategies of treatment with cimetidine. Two thirds were treated continuously with 400 mg at bedtime supplemented by temporary increases in dosage if they had symptomatic relapses (group 1), and the remaining third were given intermittent “healing” doses for four to eight weeks if a symptomatic recurrence was judged to have occurred (group 2). Life table analysis showed that the probability of remaining free of clinically important symptoms five years after the start of treatment was 24% (95% confidence interval (CI) 15·5% to 32·6%) in group 1 compared with nil in group 2 (p<0·0001). The median values for the longest periods free from relapse for each patient were 108 weeks in group 1 and 32 weeks in group 2, respectively (p<0·0001; 95% CI of the median difference 36 to 76). Over the five years 10 patients suffered major complications, two requiring emergency surgery, while a further nine had elective surgery because of the failure of medical treatment. There were no deaths that could be attributed either to ulceration or to treatment with cimetidine.Medical management was therefore very satisfactory for most patients, though those treated continuously with cimetidine suffered considerably less from their ulcer symptoms. As 80% of patients studied relapsed during the two years after a healing course of cimetidine, continuous treatment will benefit many patients treated in general practice.     

Ectopic Pregnancy: A Review of 113 Selected Cases

One hundred and thirteen selected cases of ectopic pregnancy were analyzed to clarify the diagnostic and therapeutic factors. The incidence of this condition was higher in “ward” patients and in the Negro. Salpingitis was the commonest etiological factor. The common symptoms were pain, a missed period, vaginal bleeding, faintness, nausea and vomiting, and shoulder pain. The common signs were abdominal tenderness, a positive “chandelier sign”, rebound tenderness, a pelvic mass and pallor. Fertility of the women in this series was equal to that of women in the general population of the same age group. The frog (pregnancy) test was the only significant laboratory test. Colpocentesis proved very helpful, whereas dilatation and curettage did not. Conservative operation, consisting of salpingectomy plus a uterine wedge, was recommended for tubal pregnancy and was performed in 107 patients. The ovary was removed only if involved. Interstitial pregnancies were treated by removal of the corneal portion of the uterus and by salpingectomy, rather than hysterectomy; this procedure was successful in four out of four patients. Incidental appendectomy is not recommended.     

Infectious Complications in Head and Neck Cancer Patients Treated with Cetuximab: Propensity Score and Instrumental Variable Analysis

Background

To compare the infection rates between cetuximab-treated patients with head and neck cancers (HNC) and untreated patients.

Methodology

A national cohort of 1083 HNC patients identified in 2010 from the Taiwan National Health Insurance Research Database was established. After patients were followed for one year, propensity score analysis and instrumental variable analysis were performed to assess the association between cetuximab therapy and the infection rates.

Results

HNC patients receiving cetuximab (n = 158) were older, had lower SES, and resided more frequently in rural areas as compared to those without cetuximab therapy. 125 patients, 32 (20.3%) in the group using cetuximab and 93 (10.1%) in the group not using it presented infections. The propensity score analysis revealed a 2.3-fold (adjusted odds ratio [OR] = 2.27; 95% CI, 1.46–3.54; P = 0.001) increased risk for infection in HNC patients treated with cetuximab. However, using IVA, the average treatment effect of cetuximab was not statistically associated with increased risk of infection (OR, 0.87; 95% CI, 0.61–1.14).

Conclusions

Cetuximab therapy was not statistically associated with infection rate in HNC patients. However, older HNC patients using cetuximab may incur up to 33% infection rate during one year. Particular attention should be given to older HNC patients treated with cetuximab.     

HAY FEVER—A Comparative Clinical Evaluation of Treatment with Aqueous Pollen Extracts,Alum-Precipitated Pyridine Pollen Extracts and Aqueous Pollen in Oil Emulsions

Three different types of pollen extracts are currently being used in the prophylactic treatment of hay fever. A comparative clinical study of their efficacy reveals that all are about equally efficacious. The alum-precipitated pyridine pollen extracts may be slightly better. Since only 14 to 16 injections are required for prophylactic treatment, they may well replace the older aqueous pollen extracts, 20 to 35 injections of which are usually necessary to provide relief.The aqueous pollen in oil repository method of treatment needs only one to four injections for comparable results, but this so-called “one-shot” treatment can only be administered by one who is trained in emulsion therapy and has come to know by experience the proper maximum dose.     

High Systemic Levels of the Cytokine-Inducing HMGB1 Isoform Secreted in Severe Macrophage Activation Syndrome

Macrophage activation syndrome (MAS) is a potentially fatal complication of systemic inflammation. High mobility group box 1 (HMGB1) is a nuclear protein extensively leaked extracellularly during necrotic cell death or actively secreted by natural killer (NK) cells, macrophages and additional cells during infection or sterile injury. Extracellular HMGB1 orchestrates key events in inflammation as a prototypic alarmin. The redox states of its three cysteines render the molecule mutually exclusive functions: fully reduced “all-thiol HMGB1” exerts chemotactic activity; “disulfide HMGB1” has cytokine-inducing, toll-like receptor 4 (TLR4)-mediated effects—while terminally oxidized “sulfonyl HMGB1” lacks inflammatory activity. This study examines the kinetic pattern of systemic HMGB1 isoform expression during therapy in four children with severe MAS. Three of the four patients with underlying systemic rheumatic diseases were treated with biologics and two suffered from triggering herpes virus infections at the onset of MAS. All patients required intensive care unit therapy due to life-threatening illness. Tandem mass-spectrometric analysis revealed dramatically increased systemic levels of the cytokine-inducing HMGB1 isoform during early MAS. Disease control coincided with supplementary etoposide therapy initiated to boost apoptotic cell death, when systemic HMGB1 levels drastically declined and the molecule emerged mainly in its oxidized, noninflammatory isoform. Systemic interferon (IFN)-γ and ferritin peaked concomitantly with HMGB1, whereas interleukin (IL)-18 and monocyte chemotactic protein (MCP)-1 levels developed differently. In conclusion, this work provides new insights in HMGB1 biology, suggesting that the molecule is not merely a biomarker of inflammation, but most likely also contributes to the pathogenesis of MAS. These observations encourage further studies of disulfide HMGB1 antagonists to improve outcome of MAS.     

不同人群人工流产术围手术期预防用多西环素临床分析

目的:分析不同人群人工流产术围手术期预防用多西环素的临床疗效。方法:采用回顾性调查方法,抽取本院2012年要求行人工流产术的日间手术住院患者4073例,分为正常人群和高危人群。正常人群中预防用多西环素者(预防组)2007例,未预防用抗菌药物组(未预防组)688例,高危人群中预防组865例,未预防组513例。对比分析不同人群预防组和未预防组术后1个月的手术部位感染率和远期(1年)并发症发生率。结果:正常人群预防组的手术部位感染率及远期并发症发生率分别为2.14%、7.77%,均分别显著低于未预防组的6.54%、11.05%(P0.05),而高危人群预防组分别为4.62%、10.06%,与未预防组的4.68%、12.09%比较,差异均无统计学意义(P0.05)。结论:围手术期预防用多西环素可降低人工流产术中正常人群的手术部位感染率和远期并发症发生率,而对于高危人群的作用不明显,因此术前应对患者的高危感染因素进行积极治愈或纠正后,预防用药价值可能较大。     

Multicentre study of comparative efficacy of meropenem and combined regimens for empirical antibacterial therapy of severe nosocomial infections: results of clinical and pharmacoeconomic analysis]

Adequacy and effectiveness of empirical antibacterial therapy of severe nosocomial infections with meropenem vs. combined regimens of antibacterial therapy were investigated and the ratio of the cost and effectiveness of the compared regimens was evaluated. A prospective, randomized, open, comparative study of two initiative regimens of empirical antibacterial therapy of severe nosocomial infections was performed: meropenem in a daily dose of 1.5-3 g and the standard regimen with the use of betalactams and fluoroquinolones in combination with aminoglycosides and/or metronidazole. Patients with recorded diagnosis of nosocomial pneumonia (including the ventilator-associated one) or abdominal infection with the signs of severe sepsis and severity of APACHE II > 14 were enrolled. The patients were stratified into 2 groups subject to the disease severity, i.e. APACHE II 15-20 and APACHE II 21-25. One hundred thirty five out of 166 patients with recorded nosocomial infection were included into the final estimate of the therapy adequacy and effectiveness (Protocol Analysis): 62 patients were treated with meropenem and in the treatment of 73 patients the standard antibacterial therapy was used. In the group of the patients treated with meropenem there were stated significantly higher clinical effectiveness (recovery in 80.6% of the patients vs. the control of 46.6%, p < 0.01) and pathogen eradication (89.6 and 48.1% respectively, p < 0.01). The difference in the clinical and bacteriological effectiveness of meropenem and the standard therapy was more evident in the subgroups of more severe patients (APACHE > 20). With the use of meropenem the probability of recovery from nosocomial infection was significantly higher (RR 1.73-1.94, p < 0.001) vs. the control. Meropenem provided significantly higher eradication of the pathogens: P. aeruginosa (88 and 40% respectively, p = 0.007), E. coli (100 and 46.7%, p = 0.003), Acinetobacter spp. (90.9 and 40%, p = 0.02). The antibacterial therapy with the use of meropenem was assessed as adequate in 51 out of 56 patients (91.1%), that was 3 times as frequent as with the use of the standard antibacterial therapy (33.9%). The cost-effectiveness coefficient with the use of meropenem was 2.2 times lower vs. the control. Therefore, the empirical therapy of severe nosocomial infections with meropenem proved to be more adequate and from the economic viewpoint more advantageous vs. the standard combined regimens of antibacterial therapy, that was evident from significantly higher clinical and bacteriological efficacy of the treatment and decrease of the terms of the patients hospitalization in intensive care units (on the average by 5 days).     

Mycobacterium Ulcerans Treatment – Can Antibiotic Duration Be Reduced in Selected Patients?

Introduction

Mycobacterium ulcerans (M. ulcerans) is a necrotizing skin infection endemic to the Bellarine Peninsula, Australia. Current treatment recommendations include 8 weeks of combination antibiotics, with adjuvant surgery if necessary. However, antibiotic toxicity often results in early treatment cessation and local experience suggests that shorter antibiotic courses may be effective with concurrent surgery. We report the outcomes of patients in the Barwon Health M. ulcerans cohort who received shorter courses of antibiotic therapy than 8 weeks.

Methodology / Principal findings

A retrospective analysis was performed of all M. ulcerans infections treated at Barwon Health from March 1, 1998 to July 31, 2013. Sixty-two patients, with a median age of 65 years, received < 56 days of antibiotics and 51 (82%) of these patients underwent concurrent surgical excision. Most received a two-drug regimen of rifampicin combined with either ciprofloxacin or clarithromycin for a median 29 days (IQR 21–41days). Cessation rates were 55% for adverse events and 36% based on clinician decision. The overall success rate was 95% (98% with concurrent surgery; 82% with antibiotics alone) with a 50% success rate for those who received < 14 days of antibiotics increasing to 94% if they received 14–27 days and 100% for 28–55 days (p<0.01). A 100% success rate was seen for concurrent surgery and 14–27 days of antibiotics versus 67% for concurrent surgery and < 14 days of antibiotics (p = 0.12). No previously identified risk factors for treatment failure with surgery alone were associated with reduced treatment success rates with < 56 days of antibiotics.

Conclusion

In selected patients, antibiotic treatment durations for M. ulcerans shorter than the current WHO recommended 8 weeks duration may be associated with successful outcomes.     

Restrictive antibiotherapy after renal transplantation.

Forty-two patients were followed up after 44 renal transplantations in an effort to evaluate possible benefits from the following protocol: systematic microbiologic and clinical surveillance, early and aggressive research for the cause of suspected infections, refusal to use prophylactic antibiotherapy, and selection of treatment according to the established cause of the infection. During 18,030 days of follow-up 124 infections were recorded, of which 110 were bacterial, 11 viral and 3 protozoal. Eighty originated in the urinary tract, 17 in skin wounds and 10 in the lower respiratory tract. Septicemia occurred three times, and one death due to infection was recorded. In the treatment of bacterial infections patients received antibiotics for 2486 days. Ampicillin (given for 816 days) and "minor" drugs such as sulfonamides and urinary antiseptics (given for 1036 days) were used 74.5% of the time, whereas gentamicin was used only 2.6% of the time (64 days). Combined antibacterial therapy was needed 1.2% of the time (29 days). A restrictive policy regarding anti-biotherapy seems to be beneficial to renal transplant recipients.     

Improved Outcome with Early Rifampicin Combination Treatment in Methicillin-Sensitive Staphylococcus aureus Bacteraemia with a Deep Infection Focus – A Retrospective Cohort Study

Introduction

Rifampicin has been used as adjunctive therapy in Staphylococcus aureus bacteraemia (SAB) with a deep infection focus. However, data for prognostic impact of rifampicin therapy is unestablished including the optimal initiation time point. We studied the impact of rifampicin therapy and the optimal initiation time for rifampicin treatment on prognosis in methicillin-sensitive S. aureus bacteraemia with a deep infection.

Methods

Retrospective, multicentre study in Finland including 357 SAB patients with a deep infection focus. Patients with alcoholism, liver disease or patients who died within 3 days were excluded. Patients were categorised according to duration of rifampicin therapy and according to whether rifampicin was initiated early (within 7 days) or late (7 days after) after the positive blood cultures. Primary end point was 90 days mortality.

Results

Twenty-seven percent of patients received no rifampicin therapy, 14% received rifampicin for 1-13 days whereas 59% received rifampicin ≥14 days. The 90 day mortality was; 26% for patients treated without rifampicin, 16% for rifampicin therapy of any length and 10% for early onset rifampicin therapy ≥14 days. Lack of rifampicin therapy increased (OR 1.89, p=0.026), rifampicin of any duration decreased (OR 0.53, p=0.026) and rifampicin therapy ≥14 days with early onset lowered the risk for a fatal outcome (OR 0.33, p<0.01) during 90 days follow-up.

Conclusion

Rifampicin adjunctive therapy for at least 14 days and initiated within 7 days of positive blood culture associated with improved outcome among SAB patients with a deep infection.