Baranova, F.

Chervinko, V.

Kozhokar, Y.

Novozhenov, V.

Selkova, E.

Shilo, V.

Starchenko, A.

Stenina, I.

Taranov, V.

Zubkin, M.

International Journal of Infectious Diseases

Elsevier - Publisher Connector 

Abstracts of the 12th ISIIH 2327 
access. Thus, in this controlled trial, following induction 
with 14 days of IV ganciclovir (6mg/kg IV qd), CMV- 
seronegative liver transplant recipients with CMV-sero- 
positive donors were randomized to receive either 
oral ganciclovir (1000 I mg 18hrs, Mon-Sun) or IV 
ganciclovir (6 mg/kg qd, Mon-Fri) until day 100 after 
transplant. Patients were followed until time of death or 
12 months after transplant. CMV disease occurred in 
3/32 oral ganciclovir patients (9.3%) and in 4/32 IV 
ganciclovir patients (12S%).Types of CMV disease: oral 
ganciclovir (syndrome 2, hepatitis 1); IV ganciclovir 
(syndrome 3, hepatitis + colitis l).There were no deaths 
from CMV in either study group. All cases of CMV 
disease occurred > 90 days after transplant (median time 
of onset day+137 for oral ganciclovir and day+135 for 
IV ganciclovir). Both oral and IV ganciclovir were well- 
tolerated. Reversible leukopenia (WBC <3000/mm3) 
occurred in 9/32 oral ganciclovir patients (28.1%) and in 
12/32 IV ganciclovir patients (37.5%) but did not require 
withdrawal of any patient from the study. Emergence of 
ganciclovir-resistant strains of CMV was not found 
during the study. These results suggest that, following 
induction with 2 weeks of IV ganciclovir, oral ganciclovir 
can be as effective as IV ganciclovir for long-term CMV 
prophylaxis in high-risk CMV-seronegative liver 
transplant patients with CMV-seropositive donors and 
eliminate the need for prolonged IV access. 
Predictors of low efficacy of hepatitis B vaccination 
in hemodialysis (HD) patients 
M. Zubkin, E Baranova, E. Selkova, Y Kozhokar, 
I/: Chervinko, I/: Taranov, A. Starchenko, V Shilo, 
I. Stenina, V Novozhenov 
Moscow Nephrology Center, Russia 
Two hundred and sixteen HD patients (M:102, F:114, 
aged 4517212.84) received recombinant hepatitis B 
vaccine (Combiotech Ltd, Russia) or Engerix B. The 
protocol of vaccination scheduled 4 doses of 40 Kg at O- 
l-2-6 months. Before the end of vaccination 13 pts (6%) 
had acute hepatitis B. HBsAb levels in this group was 
~100 IU/L after the 3 mos. 27 pts (13%) at the end of 
vaccination had HBcoreAB. The efficacy of vaccination 
was evaluated by the determination HBsAb levels after 
3 and 7 mos from the beginning of immunization in 176 
pts.The frequency of seroconversion (HBsAb level from 
10 to 99 IU/L) after 3mos was 23% and it was 13% after 
7 mos. The rate of seroprotection (HBsAb level 2100 
IU/L) after 3 mos reached 50% and increased up to 70% 
after 7 mos. Relation between some factors involved in 
immune response and vaccination efficiency in 46 pts 
was studied. In patients with HBsAb level ~100 IU/l 
count CD3 lymphocytes were 0.84+0.1 109/1, CD20- 
0.36+0.04 109/1, and concentration of IL-l-2.78+0.63 
pmol/ml, IL-2 -13.36+ 1.97 pmol/ml, IgM - 0.84+0.14 g/l. 
In patients with HBsAb levels 2100 IU/l these values 
were significantly different (~~0.05) and were equal to 
0.9520.16 109/1, 0.41?0.05 109/1, 3.22kO.77 pmol/ml, 
15.9623.2 pmollml, 1.120.24 g/l, respectively. Logistic 
regression analysis and criteria tables method permitted 
to determine the predictors of low efficacy of 
vaccination in HD patients: amount CD20 lymphocytes 
<3.5(109/~, concentration IgM +0.95 rr/rr, IL-2 512 
pmol/ml, transferrin in blood >2.8 g/L. The presence of 
two and more from these parameters allows the 
prognosis of negative or low response to vaccination. 
Sensitivity and specificity of such prognosis equal 86% 
and 84%, respectively. 
BACTERIAL INFECTIONS 
Activity of 26 antimicrobial agents tested against 
Listeria monocytogenes: eighty-four isolates from 
patients with systemic listerosis at a comprehensive 
cancer center during the later half of the last century 
*Donald Armstrong and Amar Safdar 
Infectious Diseases Service, Departments of Medicine, 
Memorial Sloan-Kettering Cancer Center, and Weill 
Medical College of Cornell University, New York. 
*Present address: Division of Infectious Diseases, 
Department of Medicine, University of South Carolina 
School of Medicine, Columbia, South Carolina, USA 
Introduction: Systemic infections due to Listeria 
monocytogenes are infrequent but serious complications 
in patients with an underlying malignancy. Institution of 
appropriate therapy is critical in improving outcome 
especially in patients with profound defects in cellular 
immunity. 
Methods: In vitro antimicrobial susceptibility profiles of 
84 clinical isolates of L. monocytogenes from patients 
with listeric infections during 1955 to 1997 at Memorial 
Sloan-Kettering Cancer Center in New York were 
reviewed retrospectively. 
Results: The 84 L. monocytogenes isolates showed 
greater than ninety percent in vitro susceptibility to 
penicillin (97.6%) ampicillin (90.7%) erythromycin 
(98.8%) tetracycline (96.9%), and gentamicin (98.0%). 
No in vitro resistance was observed for trimethoprim- 
sulfamethoxazole (TMP-SMX), rifampin, amikacin, 
vancomycin, imipenem/cilastatin, and ciprofloxacin. 
High-level resistance to clindamycin (96.2%) and 
amoxicillin/clavulanate (100%) was unexpected. The 
MI& and MIC9o among 26 L. monocytogenes during 
1991 to 1997 for penicillin and ampicillin were 0.5 and 
1.0 kg/ml respectively. During this period MI&, for 
gentamicin, imipenem/cilastatin, and ciprofloxacin was 
5 1.0 Fg/ml. 
Conclusions: Since 1955, we observed no interval in- 
crease in resistance for penicillin, ampicillin, gentamicin 
and TMP-SMX among L. monocytogenes in our high- 
risk listeric patients. Amoxicillin/clavulanate does not 
appear to be an adequate choice for oral therapy in this 
setting. The newer antimicrobial compounds such as 


Predictors of low efficacy of hepatitis B vaccination in hemodialysis (HD) patients 

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Predictors of low efficacy of hepatitis B vaccination in hemodialysis (HD) patients

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