The emergence of a clonal group of gonococci showing decreased susceptibility to cefixime in England and Wales highlights the need for continued surveillance.

We report, for the first time, that automated minimum retesting interval rejection rules as a stand-alone strategy are a cheap and sustainable method for reducing unnecessary repeat CRP tests, resulting in small laboratory cash savings, more efficient use of laboratory resources and standardisation of patient care pathways. The minimum retesting interval rejection rule also altered clinician test-requesting behaviour towards more appropriate requesting.

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Summary:Patients who undergo splenectomy and recipients of allogeneic marrow (alloBMT) or peripheral stem cell transplantation are at increased risk of overwhelming infection from encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae and Neiserria meningitidis. As prophylaxis against these pathogens splenectomised patients are immunised and may also receive antibiotics for life. We report relapsing overwhelming sepsis caused by penicillin-resistant pneumococcus in a patient who was immunised and received prophylactic phenoxymethylpenicillin for 8 months following splenectomy and matched unrelated donor (MUD) marrow transplantation for refractory T cell lymphoma. No obvious focus of sepsis was found during any of the three episodes and S. pneumoniae serogroup 6, subtype 6B was isolated from blood cultures on each occasion. He was treated with i.v. cephalosporins, as the organisms were resistant to penicillin with a minimum inhibitory concentration (MIC) of 2.0, and there was complete resolution of symptoms each time. In the light of recurrent sepsis with this penicillin-resistant organism the decision was made to give prophylactic levofloxacin for the next 12 months. This case illustrates that the choice of prophylactic regimen and the treatment of sepsis in immunocompromised patients remain difficult and challenging issues. 5 They are also immunised with 23-valent polysaccharide pneumococcal vaccine but the ability to generate an adequate antigen-specific immune response in recipients of alloBMT is time-dependent and may not be consistent. 6,7 To highlight the challenges in the primary prevention of sepsis with encapsulated bacteria in this group of patients, we report on the recurrence of serious penicillin-resistant pneumococcal sepsis in a patient, 8 months post-MUD transplantation for refractory T cell lymphoma. Case reportA 27-year-old man presented with splenomegaly and pancytopenia. A diagnosis of T cell NHL was made on trephine biopsy. He was treated with nine courses of CHOP chemotherapy. A splenectomy was performed 5 months after the initial diagnosis and nodular collections of small lymphocytic cells with slightly irregular nuclei and low mitotic rate, were detected on splenic sections. The cells expressed CD3, CD5 and CD43, thus confirming a diagnosis of lowgrade peripheral T cell lymphoma. Prior to the splenectomy he was immunised with 23-polyvalent polysaccharide pneumococcal vaccine, H. influenza type b (Hib) conjugate vaccine and meningococcal type A and C polysaccharide vaccine. He was subsequently treated with more chemotherapy (miniBEAM and subsequently a combination of idarubicin and cytosine arabinoside). However, marrow examination after completing chemotherapy continued to show infiltration with lymphoma, indicating refractory disease.Since the patient's sister was not HLA compatible, matched unrelated donor transplantation was performed 17 months after the initial diagnosis. The pretransplant conditioning regimen consisted of fractionated total body irradiation 1...

Breast abscess is a common clinical condition mostly caused by Staphylococcus aureus. However, infections due to mixed organisms are observed in non-lactational women, mostly in smokers. Salmonella infection causing breast abscess is extremely rare in developed countries. We report a case of Salmonella enterica subsp enterica (I) serovar Enteritidis breast abscess in a 48-year-old woman, a UK citizen, who had recently travelled abroad. She was treated successfully with a combination of surgery and ciprofloxacin. Unusual causative organisms should be kept in mind in patients with recent travel abroad and pus should be sent for microbiology. Mastitis caused by Salmonella spp can present with a severely indurated area that may take a few weeks to resolve. Complete assessment with biopsy of the indurated area and breast imaging is mandatory to exclude malignancy.