Aerococcus urinae is a pathogen that rarely causes severe or fatal infections. We describe four cases of severe A. urinae bloodstream infections. All patients had underlying urologic conditions. Urine cultures, however, were negative. CASE REPORTSPatient A, an 81-year-old man with a history of benign prostatic hyperplasia, was admitted to our department because of fever. He had been home for 4 days after a 2-week admission for Aerococcus urinae bacteremia for which no source could be identified. Transesophageal echocardiography (TEE) showed no vegetations. The fever responded well to a 10-day course of high-dose intravenous penicillin, and blood cultures were negative on the last day of admission. At readmission, the patient showed no clinical signs of heart failure and no heart murmurs were heard on auscultation. Electrocardiography (ECG) was normal. Laboratory findings showed an erythrocyte sedimentation rate of 54 mm/h, a white blood cell count of 15.4 ϫ 10 9 /liter, and a C-reactive protein (CRP) level of 138 mg/liter. Urinalysis did not show white blood cells or nitrite, and urine cultures performed before the initiation of antibiotic treatment were negative. The chest radiograph and ultrasound examination of the abdomen were normal. The blood cultures drawn on the day of admission showed growth with Gram-positive cocci resembling staphylococci, and intravenous flucloxacillin was subsequently started. However, subinoculation onto blood agar showed alpha-hemolytic colonies resembling viridans streptococci which were identified as A. urinae using the Vitek system (99% reliability; bioMérieux, France) and 16S rRNA PCR (97 to 99% reliability). The antibiotic treatment was switched to penicillin after sensitivity testing showed a MIC of 0.023 mg/liter. Repeated TEE demonstrated a vegetation on the mitral valve with regurgitation and prolapse. The patient was treated with 12 million IU/day intravenous penicillin for 6 weeks and 3 mg/kg of body weight gentamicin once a day for 2 weeks. He declined mitral valve surgery.Patient B, a 78-year-old man with a history of ischemic heart disease and polymyalgia rheumatica, was recently diagnosed with stage IV non-small cell lung carcinoma. After two courses of chemotherapy (carboplatin/gemcitabine), he refrained from further treatment. One day after suprapubic catheterization of the bladder, the patient became septicemic. His temperature was 39.6°C, and he was hypotensive, with a blood pressure of 65/40 mm Hg and a heart rate of 92 beats per minute (b/min). After performing blood and urine cultures, fluid resuscitation was immediately started, as well as intravenous cefuroxime administration on the presumptive diagnosis of a urinary tract infection. An ECG was normal. The laboratory findings showed a CRP level of 46 mg/liter, sodium 140 mmol/liter, potassium 3.5 mmol/liter, urea 9.0 mmol/liter, and creatinine 107 mol/liter. Cefuroxime was replaced with flucloxacillin when Gram-positive organisms, thought to be staphylococci, were identified in the blood cultures. However, ...

The variation in the rate of decline of plasma HIV-1 RNA between patients after the initiation of a quadruple drug regimen could be explained by differences in exposure to NFV or SQV. Determination of k could be used to optimise further antiretroviral drug therapy and may be a first tool to assess antiretroviral activities of new or increasing doses of drugs administered in combination regimens. Furthermore, our data suggest that exposure to antiretroviral drugs should be incorporated in mathematical models to describe HIV-1 dynamics in more detail.

Seventy-five consecutive HIV-infected patients, including 33 AIDS cases were examined. One or more oral mucosal lesions were observed in 57 (76%); candidiasis was the most common finding (52%). Others included hairy leukoplakia (16%), periodontal disease (16%) and Kaposi's sarcoma (4%). Diversity of study design and methods allowed no reliable comparison with other reports.

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BackgroundMedical residents are key figures in delivering health care and an important target group for patient safety education. Reporting incidents is an important patient safety domain, as awareness of vulnerabilities could be a starting point for improvements. This study examined effects of patient safety education for residents on knowledge, skills, attitudes, intentions and behavior concerning incident reporting.MethodsA controlled study with follow-up measurements was conducted. In 2007 and 2008 two patient safety courses for residents were organized. Residents from a comparable hospital acted as external controls. Data were collected in three ways: 1] questionnaires distributed before, immediately after and three months after the course, 2] incident reporting cards filled out by course participants during the course, and 3] residents' reporting data gathered from hospital incident reporting systems.ResultsForty-four residents attended the course and 32 were external controls. Positive changes in knowledge, skills and attitudes were found after the course. Residents' intentions to report incidents were positive at all measurements. Participants filled out 165 incident reporting cards, demonstrating the skills to notice incidents. Residents who had reported incidents before, reported more incidents after the course. However, the number of residents reporting incidents did not increase. An increase in reported incidents was registered by the reporting system of the intervention hospital.ConclusionsPatient safety education can have immediate and long-term positive effects on knowledge, skills and attitudes, and modestly influence the reporting behavior of residents.