Successful treatment with doripenem and tobramycin of ventriculitis due to imipenem- and meropenem-resistant Pseudomonas aeruginosa.

Inoculum suspensions were prepared from 7 to 14 day cultures on potato carrot agar, by slightly scraping the surface of mature colonies with a sterile cotton swab wetted with sterile saline including Tween 40 (0.05%). The super-natants were adjusted spectrophotometrically at a wavelength of 530 nm to an optical density (OD) that ranged from 0.25 to 0.3 (2Â10 4 –7Â10 4 cfu/mL). 3 Microdilution plates were incubated at 308C for 48 h (plates with insufficient growth were incubated for 72 h) and read visually after agitation. Table 1 summarizes the results of all in vitro activities of the eight antifungal drugs. Both environmental and clinical Alternaria isolates showed an MIC range from 0.125 to 1 mg/L for amphotericin B. We found the widest range and the highest MICs for fluconazole (range 4– 32 mg/L). Surprisingly, most isolates of A. infectoria and A. alternata had high MICs of voriconazole, although the environmental isolates of A. malorum (a non-human pathogenic species) had lower MICs. Isavuconazole had high MICs similar to voriconazole with complete inhibition endpoints exhibiting MIC 50 and MIC 90 values of 4 mg/L against all Alternaria isolates. Itraconazole demonstrated better in vitro activity than vori-conazole and isavuconazole with an MIC 90 of 1 mg/L. Posaconazole had the lowest MIC 90 (0.25 mg/L) of all the azoles. The echinocandin drugs caspofungin and anidulafungin both demonstrated in vitro activity against A. infectoria and A. alternata, with anidulafungin exhibiting the lowest MEC 90 (0.008 mg/L) compared with caspofungin (MEC 90 1 mg/L); MEC stands for minimal effective concentration. Both echino-candins had no activity against A. malorum (MEC 90 .8– 16 mg/L). More than 150 cases of infection have been described in the world literature, with the skin being the most involved organ. 1 Severe deep infections are rare complications and optimal treatment is not known. 2 Various antifungal drugs have been used in the treatment of Alternaria infection, such as amphotericin B, flucytosine, fluconazole, miconazole and nystatin. 1 There are few published data available concerning the in vitro antifungal susceptibility with microdilution techniques of Alternaria species; 4,5 the largest collection included just 13 strains. 4 Reported MIC 50 and MIC 90 values of posaco-nazole, itraconazole and amphotericin B are comparable to our results. Among the azoles, fluconazole showed uniform low activities against Alternaria species in this and previous studies. 4,5 Except one report involving 11 isolates, 5 itracona-zole, voriconazole and posaconazole had good …