A retrospective review of all episodes of bloodstream infection (BSI) in HIV-positive patients admitted to the Infectious Diseases Unit at the Pisa General Hospital from 1991 to 1994 was performed. Sixty-eight episodes of BSI were recorded in 61 patients (5.8% of all patients admitted for HIV infection). BSI was community-acquired in 64.7% of cases. The patients were mainly male and i.v. drug abusers with a mean age of 33.8 yrs +/- 5.6 S.D. Sixty-four episodes occurred in AIDS patients (CDC criteria). CD4 count was less than 100 in 49 patients. The most frequent isolates were coagulase-negative staphylococci 33, S. aureus 7, Pseudomonas spp 7, fungi 1, non-typhoidal Salmonella 4. The most common sources of BSI were the skin or subcutaneous tissue infections and intravascular catheters. The overall mortality associated with BSI was 27.3%. Vancomycin and teicoplanin were active in vitro against all but one of the staphylococcal isolates.

A 42-year old Italian male with type 2 diabetes and HCV-related chronic hepatitis spent 6 months in Thailand. After his return in June 2002 he was admitted to the Infectious Diseases Unit of the Hospital of Livorno (Italy) because of fever, chest pain and skin abscesses in the legs. Chest X-rays and CT scan revealed multiple bilateral cavitary lesions in the lungs. Ultrasonography and CT scan showed numerous subcentimetric spleen abscesses. Burkholderia pseudomallei was isolated from the cutaneous lesions and sputum and thus melioidosis was diagnosed. A 6-week course of i.v. ceftazidime plus oral doxycycline was given during the acute phase of the illness. The in vitro susceptibility testing showed that long-term (20 weeks) antimicrobial therapy with doxycycline and moxifloxacin was required. Complete resolution of pulmonary and spleen lesions was obtained within 6 weeks of therapy and of cutaneous abscesses in 10 weeks. No significant side effects were noted during the follow-up period using this scheme of antimicrobial therapy.

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The in vitro antibacterial activity of ciprofloxacin and 13 other antimicrobial drugs was evaluated with respect to 569 pathogens, mainly isolated from urine. Ciprofloxacin was found active in 96.1% of all of the Gram-positive and Gram-negative strains tested, amikacin in 90.6%, ceftazidime in 89.8%, ceftriaxone in 85.3%, piperacillin in 82.7%, tobramycin in 82.6%, gentamicin in 81.5%, aztreonam in 78.3%, nitrofurantoin in 72.6%, cotrimoxazole in 71.6%, cinoxacin in 71.0%, pipemidic acid in 70.6%, nalidixic acid in 66.7%, ampicillin in 50.1%. Ciprofloxacin was found to be the most active of the drugs studied against the bacterial strains which cause urinary, respiratory and other infections.