Enterococcal Liver Abscess Associated With Moxalactam Therapy: Review of Literature on Enterococcal Superinfections in Association With Moxalactam Therapy

Moxalactam, a third-generation cephalosporin, has been demonstrated to have an ultrawide spectrum of antibacterial activity. One important gap in this impressive spectrum is the enterococcus. Superinfections and colonization with enterococci have been reported following moxalactam therapy. Sites involved have included the urinary tract, wounds, middle ear, and blood stream. To our knowledge, we report the first case of enterococcal liver abscess following moxalactam therapy. The abscess was localized by ultrasound examination and microbiologic diagnosis made by aspiration using a skinny needle. Without surgical drainage or therapeutic aspiration, institution of appropriate antibiotic therapy in optimum dosage resulted in complete resolution. The literature on enterococcal superinfections in association with moxalactam therapy and nonsurgical management of liver abscesses is reviewed

Gastric Microbial Flora in Patients with Gastrointestinal Disease

We designed a prospective study to test the hypothesis that the stomach may be a bacterial reservoir in some patients and function as a potential source of aspiration-induced bacterial pneumonia. Quantitative cultures of fasting gastric contents were obtained in 100 consecutive patients having fiberoptic endoscopy for evaluation of gastrointestinal disease. Culture results were correlated with gastric pH and gastrointestinal pathology. Patients with gastric ulcer disease had a significantly higher incidence of bacterial growth than those with duodenal ulcer. Patients who had had gastrectomy were more likely than any others to have gram-negative bacilli in their stomach. A somewhat high frequency of other common pneumonic pathogens in gastric contents was also noted. The significance of these findings in the production of pneumonia in the elderly is discussed