Most of Bartholin's gland abscesses have been thought to be caused bymicroorganisms found in opportunistic infections. However, we have encountered two very interesting cases of Bartholin's gland abscesses caused by Streptococcus pneumoniae and Haemophilus influenzae, two major pathogdns of respiratory tract infections. In the first case, since abscess formation was not observed due to disintegration, cefdinir (CFDN), 300 mg/day, t.i.d. for 5 days was administered. The treatment improved clinical symptoms, but relapse occurred 3 days after the administration was discontinued. Microbiological examination of pus revealed the presence of Streptococcus pneumoniae and Finegoldia magna, and it also showed that the isolated S. pneumoniae was penicillin-resistant S.pneumoniae (PRSP). After an incision and drainage of abscess, cefteram pivoxil (CFTM-PI), 300 mg/day t.i.d. for 7 days, was administered, and the cure was confirmed. In the second case, after an incision and drainage of Bartholin's gland abscess, amoxicillin (AMPC), 750 mg/day, t.i.d. for 5 days, was administered. The treatment improved clinical symptoms temporarily. However, the symptoms deteriorated 7 days after the operation, and the patient was diagnosed with relapse. Microbiological examination of pus revealed the presence of Haemophilus influenzae and Peptostreptococcus anaerobius, and it also showed that the isolated H. influenzae was μ-lactamase-nonproducing ampicillin-resistant H. influenzae (BLNAR). After performing additional incision and drainage of abscess again, CFTM-PI, 300 mg/day, t.i.d. for 7 days, was administered, and the cure was confirmed. In addition, the analysis of these two cases using PK/PD theory revealed that the time above MIC reached 100% with administration of CFTM-PI 300mg, t.i.d. suggesting that the dosage is sufficient for treating these infections. There are other cases of external genitalia infections caused by microorganisms usually associated with respiratory tract infections like cases that we are reporting here. Therefore, it is necessary to consider a possible infection by drug-resistant bacteria even for a case of external genitalia infection. In addition, it was thought that adjusting dosage and method for administration of antibacterial agents based on PK/PD theory would help to provide efficient treatment.

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Patients with hematological malignancies and aplastic anemia become complicated by critical infections, which are one of the common causes of death in many cases. This is a retrospective investigation of the factors that affect the efficacy of antibiotic treatment of febrile neutropenia (FN). The subjects consisted of 98 cases that developed FN during their hospitalization in this department and received antibiotics as a first-line treatment. Parameters evaluated were age, gender, with or without administration of granulocyte-colony stimulating factor (G-CSF), with or without hematopoietic transplantation, the number of antibiotics, the type of antibiotics, the highest level of C-reactive protein (CRP), with or without antifungal prophylaxis, the duration of neutropenia, and the number of neutrophils before and after the administration of antibiotics. Logistic analysis was used for statistical evaluation. With univariate analysis, significant clinical efficacy was observed with the use of carbapenems (p=0.0009, Odds;4.58) when the number of neutrophils was not less than 500/μL (P<0.0001, Odds: 14.1) after administration of antibiotics. Furthermore, even when multivariate analysis was performed, 3ignificant clinical efficacy was observed independently in the use of carbapenems (P=0.02, Odds: 3.73) and when the number of neutrophils was not less than 500/μL (P<0.0001, Odds: 10.4) after administration of antibiotics. In this investigation, as a first-line treatment of FN, carbapenem antibiotic is recommended as a primary chaice, when the number of neutrophils was expected to decrease after administration.

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[in Japanese]

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