Antimicrobial therapy in the pregnant woman has to consider the potential risks of antibacterial agents for the devoloping foetus and the mother. Extensive clinical experience shows that penicillins, cephalosporins and erythromycin (except erythromycin estolate) can be considered safe for the developing foetus and for the pregnant woman. Nitrofurantoin is a valid antibacterial option in pregnancy, except in the latter stages. Isoniazid and ethambutol are the safest drugs for the treatment of tuberculosis in pregnancy, but attention must be paid to the potential toxicity of isoniazid for the mother. For several other antimicrobial agents (aminoglycosides, fluoroquinolones, newer macrolides, metronidazole, rifampicin, vancomycin) a potential teratogenic or toxic risk has been documented in animal or human studies: however, their use during pregnancy is justified when there is no safer alternative. A few antibacterials should be absolutely avoided in pregnancy: tetracyclines, cotrimoxazole and chloramphenicol according to a teratogenic risk or a toxic risk for the foetus or the mother, and clindamycin according to its high risk/benefits ratio. The safety data in pregnancy of many other antibacterials, including carbapenems, ketolides and streptogramines, are very limited or lacking. More data on the risks of antibacterial agents are needed for an optimal therapy of bacterial infections in pregnancy.

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Beta-lactams represent one of the most important class of antibiotics for the treatment of infectious diseases due to pathogenic bacteria. The selective pressure exerted from the wide spread use of third generation cephalosporins generated mutant b-lactamases belonging mainly to the TEM or SHV family that are able to extend the activity spectrum of hydrolysis. Moreover, extended spectrum cephalosporins are often a good choice in clinical practice towards Enterobacteriaceae. Here we report a comparative analysis of stability between cefotaxime, desacetyl-cefotaxime and ceftazidime with some common TEM-derivatives extended spectrum b-lactamases.

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Wound infection and secondary meningitis represent important complications for patients undergoing acoustic neuroma surgery. The aim of this paper is to evaluate the efficacy of a short-term protocol with vancomycin and netilmicin. We studied 434 patients submitted to acoustic neuroma surgery in the Otorhinolaryngology Division, A.O. Ospedali Riuniti di Bergamo, during the years 1987-1997. The utility of this protocol was evaluated on the basis of the occurrence of infective episodes during the first ten-day follow-up.

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Background: The aim of the research was to isolate and to identify the methicillin-resistant Staphylococcus aureus (MRSA) strains from cattle and human and to determine their genetic relatedness comparing the DNA restriction patterns. Methods: Strains of Staphylococcus aureus were isolated from animals (223 strains) and humans (83). The E-test was applied to determine methicillin-resistance. The restriction patterns of DNA were carried out with pulsed field gel electrophoresis (PFGE). Results: Thirty two (14.34%) from animals and 53 (63.8%) from men strains of S. aureus showed resistance to methicillin. PFGE demonstrated that the strains from human and veterinary pathology are different. The microrganisms isolated from men revealed, among them, an high similarity while only two strains, from animals, were considered identical. Conclusions: The resistance to methicillin involved both human and veterinary pathology. The human MRSA strains were higher than the animals ones. The strains isolated from animals showed a large genomic variability while in man the number of indistinguishable microrganisms, induces to suppose the existence of a prevalent clone. PFGE could be considered the gold standard for molecular characterisation of MRSA isolates.

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Objectives: Candidal vulvovaginitis is a frequent infectious process in adult women that assumes particular clinical, epidemiological and social importance in prostitutes due to its possible sexual transmission. The aim of the study was to evaluate the frequency of symptomatic or non-symptomatic vulvovaginitis caused by Candida spp and its possible relationship to behavioural risk factors, by a prospective study carried on 153 immigrant prostitutes from various African countries. Patients and methods: All subjects (average age 27 yrs; range 18-50 yrs) coming from sub-Saharan areas (Nigeria, Ghana, Benin, Senegal) and resident in the coastal area northwest of Naples (southern Italy) underwent a microbiological investigation to detect the possible presence of Candida in vaginal, rectal and pharyngeal swabs. Agar Sabouraud with the addition of chloramphenicol was used for cultures and the mycotube system for identification; in vitro sensitivity tests with amphotericin, nystatin, 5-fluorocytosine, econazole, and fluconazole were also performed according to the Kirby Bauer technique. Results: The rate of Candida detection from vaginal swabs was 45% (69/153) with the following distribution by specie: C. albicans 75.4%, C. glabrata 7.2%, C. krusei 2.9%, C. tropicalis 1.4%, Candida spp 13%. The incidence of Candida from pharyngeal and rectal swabs was 18.3% and 26.1%, respectively. The overall resistance of Candida was comprised between 6% for fluconazole and 27% for econazole. No strain was resistant to 5-fluorocytosine, nystatin and amphotericin. Conclusions: The incidence of Candida in this particular population of immigrates was very high and correlated to many well-identified risk factors.

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The Authors examined the case mix of patients with tuberculosis who were hospitalised from 1996 to the first 6 months of 2001 at the Infectious Disease Department. The patient population comprises two groups with different epidemiological characteristics. The first group consists of Italians [62] and the second of Non-EU patients [28]. The Italians have an older average age and their epidemiological and clinical risks are more serious in comparison to Non-EU’s. Moreover, among Italian patients the number of subjects with HIV infection is greater. The presence of tuberculosis at the lymph nodes appears to be related to patients with HIV, whereas for HIV-negative patients the most frequent sites are the lungs and pleura. Some of the patients underwent biopsy in the sites affected by the pathology and the histopathological findings are very similar to the typical data. There does not seem to be any difference between the results of the X-rays of the lung X-rays for the Italians and the Non-EU’s, whereas in general there are very few patients who show the typical location of tuberculosis at the apex of the lungs.

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Objectives: to study the effectiveness of low dose sultamicillin in the treatment of acute sinusitis. Methods: a total of 108 patients, between 16-56 years of age (mean 32.8), suffering from acute sinusitis took part in the trial. Patients received orally 2x375 mg sultamicillin, and compared with patients receiving 3x500 mg amoxicillin. The first control was made between the 5th and 7th days. A patient was considered clinically cured when all pretreatment signs and symptoms of infection were eliminated. Clinical improvement was defined as the partial disappearance of pretreatment signs and symptoms. In either result, study drugs were reconstituted for additional 5 days. Failure was defined as no change or worsening of signs and symptoms; and study drug was changed. The second control was made between 10-12th days, and the third was four weeks later. Results: The clinical success (improvement + cure) rate was (17+11)/42 (66.6%) and (28+21)/66 (74.2%) for amoxicillin and sultamicillin respectively, at first control. All improved patients were cured at the second control. No significant side-effects were noted in either amoxicillin or sultamicillin treated patients. All side effects were gastrointestinal, 11.9% and 3.0% in the same order. Conclusions: Low dose sultamicillin was comparable to amoxicillin; sultamicillin has fewer side effects than amoxicillin (p>0.05).

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Authors describe a case of dengue fever, accidentally seen for appearance of purple at the lower limbs, fever and fatigue. They want to signal this case not for the difficulty of the diagnosis, because the patient was just arrived from Venezuela and he went, during his travel, in endemic zones for dengue, but because this illness is very uncommon in our Country. Diagnosis was confirmed with the presence of antibody in the serum of the patient and treatment was limited to a careful monitoring of laboratory examination and at an hydratation. Recovery with return to normal value of renal and hepatic function was obtained after 15 days.

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