Experience with ganciclovir treatment of life- or sight-threatening cytomegalovirus (CMV) infections in 22 heart and heart-lung transplant recipients at six medical centers was reviewed. All six heart-lung recipients and six of 16 heart recipients had CMV pneumonitis; five heart recipients had CMV gastrointestinal disease, three had retinitis, and two had infections in more than one organ system. Of the 18 patients (82%) surviving initial ganciclovir therapy, 16 improved, one stabilized, and one showed no change in clinical status. All cultures positive for CMV before treatment became negative during therapy. Six patients (33% of survivors) had recurrent episodes and received additional therapy. Four patients (18%) died during initial therapy; death was believed to be related to CMV infection in only two cases and to ganciclovir treatment in no case. Adverse reactions possibly attributable to ganciclovir included neutropenia (four patients), impaired renal function (one), thrombocytopenia (one), decreased blood pressure (one), and seizure (one). Ganciclovir appears to be well tolerated and to alter favorably the outcome of serious CMV infection in this patient population.

Acyclovir↗

PubMedDate not supplied

Anaerobic and aerobic bacteriology in head and neck cancer surgery.

A prospective study of wound infections following major head and neck cancer surgery was undertaken to define a rational approach to trials of antibiotic prophylaxis and initial therapy of these infections. Preoperative aerobic cultures were taken from the planned site of skin incision and from the oropharynx. Both aerobic and anaerobic cultures were obtained from all wound infections. Patients receiving prophylactic antibiotics were excluded from the study. The data indicate that preoperative cultures are not usually predictive of the bacteriology of subsequent wound infection. Mixed aerobic and anaerobic flora were cultured from most wound infections, and usually reflected normal anaerobic oropharyngeal flora, exogenously acquired Staphylococcus aureus, or both. Bacteroides fragilis was not cultured in this series. Antibiotics selected for trials of prophylaxis or initial treatment of these infections should cover both the resident oral aerobic and anaerobic flora and S aureus. Coverage for B fragilis does not appear necessary. Antibiotic choices might include penicillin G plus a penicillinase-resistant penicillin or a parenteral cephalosporin.

Anaerobiosis↗