Outcomes of Pseudomonas aeruginosa Bacteremia 

P. aeruginosa bacteremia is associated with grave clinical outcomes, and piperacillin-tazobactam is commonly used as first-line empirical therapy. However, various national regulatory agencies have identified different susceptibility threshold breakpoints for the drug. In this study, which involved 34 patients with bacteremia who had isolates with reduced piperacillin-tazobactam susceptibility (i.e, minimum inhibitory concentration (MIC) of 32 mg/L or 64 mg/L), seven patients received empirical piperacillin-tazobactam, and 27 patients received other appropriate therapy. Thirty-day mortality was found to be 86 percent in the piperacillin-tazobactam group and 22 percent in the other group. In contrast, patients with highly susceptible organisms (MIC ≤16 mg/L) had a mortality rate similar to that of controls. The authors suggest that further studies should examine the appropriateness of the CSLI resistance breakpoint for piperacillin-tazobactam. (Tam et al., Clin Infect Dis. 2008;46:862-867.)

Pandemic Influenza Planning in the United States

This review summarizes planning efforts for pandemic influenza based on proposals from the U.S. Department of Health and Human Services and assessment of these plans from authoritative nongovernmental sources. Despite a variety of substantial planning efforts that have been undertaken in recent years, the authors conclude that the United States needs to be better prepared, and they identify a number of issues that should be addressed. (Bartlett and Borio, Clin Infect Dis. 2008;46:919-925.)

Steroids for Hepatosplenic Candidiasis

Hepatosplenic candidiasis is observed in almost 5 percent of patients with acute leukemia treated with intensive chemotherapy. It occurs principally during neutrophil recovery. Treatment usually consists of several months of antifungal therapy and usually requires postponement of the antileukemic therapy. In this study, corticosteroids were given to patients whose symptoms continued despite antifungal therapy. The addition of corticosteroid therapy appeared to result in a more rapid resolution of symptoms and a shorter hospitalization than has been historically reported. (Legrand et al., Clin Infect Dis. 2008;46:696-702.)

HIV-1 Subtype Influences Disease Progression

In a group of 350 patients in Rakai, Uganda, those infected with HIV-1 subtype A took longer to progress to AIDS or die than those with subtype D, multiple subtypes, or recombinant subtypes. These findings suggest that HIV-1 subtype may need to be considered when deciding when to start treatment, and may have implications for vaccine research. (Kiwanuka et al., J Infect Dis. 2008;197:707-713; commentary by Kuritzkes, J Infect Dis. 2008;197:638-639.)

More from the literature…

Don’t miss a new feature to help you stay up to date on the infectious diseases literature: Each month, IDSA News will feature brief summaries of key infectious diseases studies in the previous month’s major journals chosen by the new IDSA Literature Review Panel.

In addition, the “In This Issue” section of each issue of Clinical Infectious Diseases highlights several important studies from that journal. (Click for April 1 or April 15.)

For a review of other recent research in the infectious diseases literature, see “In the Literature,” by Stanley Deresinski, MD, in each issue of Clinical Infectious Diseases.

April 1

• Influenza Takes Its Toll
• Oseltamivir Resistance Slams Europe
• Fish and Worms in Vietnam
• How Did Chikungunya Get That Way?

April 15

• Antiviral Therapy for Bell's Palsy?
• HIV and Haiti
• Candidemia and the Eye
• Ampicillin Susceptibility Testing Predicts Imipenem Susceptibility in Enterococci—But Not Always