Page 18 - pest-POSTEN nr 4, 1995

-pest-POSTEN Side 18

Results: MecA positive strains: 118 pharmacokinetic behavior similar to modern
macrolides.
2%NaCl ___
Oxacillin 0.5 1.0 2.0 4.0 6.0
No 114 106 70 47 36 CYTOMEGALOVIRUS
INFECTION IN AIDS.
4%NaCl AB Brantsæter, O Dunlop, AK Goplen,
Oxacillin 0.5 1.0 2.0 4.0 6.0 G Størvold, JN Bruun. Ullevål University
No 115 113 91 60 48 Hospital, Oslo.

Mec negative strains : 114. All had oxacillin Background: Impairment of cell-mediated
MIC`s < 0.5 mg/l. immunity is associated with reactivation of
Conclusion: Cation supplemented Mueller- cytomegalovirus (CMV). CMV causes serious
Hinton agar with 4% NaCl and oxacillin 0.5 mg/l disease in AIDS patients with advanced immuno-
is recommended for routine use in the clinical suppressions as expressed by low CD4
microbiological laboratory for detection of lymphocyte counts. As a consequence of
oxacillin resistance in coagulase negative prolonged survival and reduction in mortality from
staphylococci. other causes one would expect increasing
___ incidence of CMV infection in AIDS patients.
Aims of the study: We sat out to answer the
SPIRAMYCIN IN LOWER RESPIRATORY following questions: 1. What is the incidence of
TRACT INFECTIONS: CMV infection in the Oslo AIDS population ? 2.
A PHARMACOKINETIC-PHARMACO- Is the incidence of CMV infection among AIDS
DYNAMIC EVALUATION. patients increasing ?
RA Walstad,E Thurmann-Nielsen,O Jetlund, Materials and methods: This material (n=217)
University of Trondheim. includes 89% of all adult AIDS patients in Oslo
during the period 1983-1994. 176 patients died
The penetration of spiramycin (S) - one of the and autopsy was performed in 75% of these cases.
early macrolides, - into epithelial lining fluid We registered all CMV infections diagnosed
(ELF), alveolar macrophages (AM), bronchial before death or at autopsy. CMV retinitis was
mucosa (BM) and serum (SE) was investigated in diagnosed by ophtalmoscopy. In other
24 patients with lower respiratory tract infection. manifestations of CMV infection we required
S was given as one single oral dose of 2 g (6 mill histopathological confirmation or positived CMV
IE) once daily for 7-12 days. Fibre broncoscopy culture in combination with clinical presentation,
was done on day 1-2 of therapy, and at 4, 6, 8,12 radiological findings and response to treatment
or 24 hrs after dosing, allowing 4 patients to be strongly suggestive of CMV infection.
examined at each point of time. Frequent blood Results: In the period 1983-1994 a total of 69
samples were also collected. S concentrations AIDS patients developed CMV infection. Of these
were analyzed by HPLC method. Bacterial only 6 patients were alive at the end of the period.
isolation and sensitivity testing was performed 176 AIDS patients died and 63 (36%) had CMV
concurrently from the broncheoalveolar lavage infection. This included 35 patients with retinitis
fluid and protected brush examination. Clinical and 46 patients with other end-organ disease. In
response, temperature, WBC, CRP and ESR was other words, many (18) patients presented both
recorded during treatment. The concentrations of manifestations of CMV infection. During the last
S in AM and ELF were closely similar, more 5 years of the period the annual number of HIV
sustained and significantly higher than in SE and positive patients has been fairly constant. Whereas
BM, mean AUC (0-24) being 354.6, 207.3, 13.6 there has been a sharp decrease in the incidence of
and 10.8 mg-h/l, respectively. In 11 patients pneumocystis carinnii infection due to the
common respiratory pathogens could be isolated, effective prophylaxis, the incidence of CMV
all sensitive to S. The clinical and laboratory infection has changed little.
parameter response to therapy correlated Conclusion: More than one third of the AIDS
significantly with the AUC (0-24)/MIC ratios, patients develop clinically significant CMV
ranging from 0.9 to 3550. Thus, S demonstrates a