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ABSTRACTPostoperative or posttraumatic sepsis remains one of the leading causes of morbidity and mortality in hospital populations, especially in populations in intensive care units (ICUs). Central to the successful control of sepsis-associated infections is the ability to rapidly diagnose and treat disease. The ability to identify sepsis patients before they show any symptoms would have major benefits for the health care of ICU patients. For this study, 92 ICU patients who had undergone procedures that increased the risk of developing sepsis were recruited upon admission. Blood samples were taken daily until either a clinical diagnosis of sepsis was made or until the patient was discharged from the ICU. In addition to standard clinical and laboratory parameter testing, the levels of expression of interleukin-1ß (IL-1ß), IL-6, IL-8, and IL-10, tumor necrosis factor-a, FasL, and CCL2 mRNA were also measured by real-time reverse transcriptase PCR. The results of the analysis of the data using a nonlinear technique (neural network analysis) demonstrated discernible differences prior to the onset of overt sepsis. Neural networks using cytokine and chemokine data were able to correctly predict patient outcomes in an average of 83.09% of patient cases between 4 and 1 days before clinical diagnosis with high sensitivity and selectivity (91.43% and 80.20%, respectively). The neural network also had a predictive accuracy of 94.55% when data from 22 healthy volunteers was analyzed in conjunction with the ICU patient data. Our observations from this pilot study indicate that it may be possible to predict the onset of sepsis in a mixed patient population by using a panel of just seven biomarkers.

Elevated concentrations of atmospheric CO2(Ca) are believed to raise sorghum [Sorghum bicolor(L.) Moench] productivity by improving water relations. In ecosys, water relations are simulated by solving for the canopy water potential (ψC) at which water uptake from a model of soil–root–canopy water transfer equilibrates with transpiration from the canopy energy balance. Simulated water relations were tested with ψC, water uptake, and energy exchange measured under ambient (363 μmol mol−1) and elevated (566 μmol mol−1) Caand high vs. low irrigation in a free air CO2enrichment experiment during 1998 and 1999. Model results, corroborated by field measurements, showed that elevated Caraised ψCand lowered latent heat fluxes under high irrigation and delayed water stress under low irrigation. Changes in ψCmodeled under ambient vs. elevated Cavaried diurnally, with lower ψCcausing earlier midafternoon stomatal closure under ambient Ca. Modeled changes in sorghum water status caused elevated Cato raise seasonal water efficiency under high and low irrigation by 20 and 26% (vs. 20 and 13% measured) in 1998 and by 9 and 27% (vs. 6 and 26% measured) in 1999. Ecosyswas used to generate an irrigation response function for sorghum yield, which indicated that yields would rise by ≈13% for a range of irrigation rates if air temperatures were to rise by 3°C and Caby 50%. Current high sorghum yields could be achieved with ≈120 mm or ≈20% less irrigation water if these rises in temperature and Cawere to occur.

Objectives: To compare the fluoroquinolones gatifloxacin and moxifloxacin with ciprofloxacin for post-exposure prophylaxis of systemic anthrax in a BALB/c mouse model. Methods: Treated mice and controls were inoculated subcutaneously with 5×104 spores/mouse of Bacillus anthracis Ames strain and observed for 37 days after challenge. Treated mice were given 100 mg/kg of antibiotic orally twice daily for 14 days, starting at various times post-challenge. Results: Treatment starting 6 h post-challenge resulted in survival rates of 90%, 15% and 40% for gatifloxacin, moxifloxacin and ciprofloxacin, respectively. Treatment commencing 24 h post-challenge resulted in survival rates of 65%, 10% and 5%, respectively. Treatment starting more than 24 h after exposure had little effect on survival. Conclusions: Gatifloxacin appeared to be more effective than moxifloxacin or ciprofloxacin, at similar doses, for early post-exposure treatment of murine systemic anthrax. However, these results might be due to differences in potency or pharmacokinetic properties.

Plague is a re-emerging disease endemic in at least 24 countries. Non-endemic countries should be able to confirm plague to prevent outbreaks due to imported cases. We established a combination of a IgG/IgM screening ELISA and a confirmation immunoblot employing F1 capsular antigen (CA) for the serodiagnosis of plague in countries where yersiniosis is present. The ELISA and the immunoblot assay showed a specificity of 96·1% and 100% among sera from healthy German blood donors. This group had a seroprevalence of 39% of anti-yersinia outer protein (YOP) antibodies obviously caused by previous Y. enterocolitica infection. The ELISA detected anti-F1 CA antibodies in 22 and the immunoblot in 20 out of 26 sera of plague vaccinees. Five control sera from bacteriologically confirmed plague cases from Madagascar reacted positively. It can be concluded that anti-YOP antibodies do not affect assays based on purified F1 CA.

In order to evaluate prophylaxis and therapy for individuals infected with pathogens by the airborne route, we have designed and built a simple apparatus in which small laboratory animals may be exposed to aerosols of infectious microorganisms. Animals are kept in a chamber closed by a HEPA filter and exposed to the pathogen aerosolized using a Collison nebulizer. Air in the exposure chamber may be sampled to show that the infectious agent is present but the dose of agent must be expressed as 50% effective doses determined by titration. An effective dose may be defined by whatever criteria are chosen to judge disease. Using this apparatus we have shown that St Louis encephalitis (SLE) virus is infectious for mice by the airborne route. These data support the idea that there may be significant hazard to personnel exposed to aerosols of infectious SLE after a laboratory accident.

<it>Objectives</it>: The <it>in vivo</it> efficacy of ciprofloxacin, gatifloxacin and moxifloxacin were assessed in an experimental <it>Francisella tularensis</it> Schu S4 infection in the BALB/c mouse model. <it>Methods</it>: Mice were given 100 mg/kg of antibiotic by oral administration twice daily commencing at 6, 24 or 48 h post-exposure and continued for 14 days post-exposure. All mice were challenged subcutaneously with 1 × 106 cfu <it>F. tularensis</it> Schu S4 and observed for a period of 56 days. <it>Results</it>: Treatment initiated 6 h post-exposure resulted in 94, 100 and 100% survival for ciprofloxacin, gatifloxacin and moxifloxacin, respectively. When treatment was delayed until 24 h post-exposure the survival rates were ciprofloxacin 67%, gatifloxacin 96% and moxifloxacin 100%. Treatment initiated at 48 h post-exposure resulted in a significant reduction in the survival rate of the ciprofloxacin-treated mice, with 0% survival compared with 84 and 62% for gatifloxacin and moxifloxacin, respectively. Non-treated infected control mice died within 96 h post-exposure. Dexamethasone given at day 42 for 7 days to suppress the animals' immune system caused relapse in all of the treatment groups. <it>Conclusions</it>: Both gatifloxacin and moxifloxacin were more effective at preventing mortality than ciprofloxacin and could be considered as alternative antibiotics in the treatment of systemic <it>F. tularensis</it> infection.

<it>Objectives</it>: To compare the efficacy of moxifloxacin, gatifloxacin and ciprofloxacin for the post-exposure prophylaxis and treatment of experimental <it>Burkholderia pseudomallei</it> infection. The presence of persistent infection in treated animals and the rate of relapse following dexamethasone treatment were also investigated. <it>Methods</it>: BALB/c mice were inoculated subcutaneously with 1.75 × 106 cfu of <it>B. pseudomallei</it> strain 576. Gatifloxacin, moxifloxacin and ciprofloxacin (100 mg/kg) were given orally at 12 hourly intervals for 14 days starting at 6 h, 7 days or 12 days post-challenge. Control mice did not receive antibiotic therapy. <it>Results</it>: No regimen gave 100% protection. Prophylaxis was most effective when started 6 h post-challenge, with survival rates at 42 days for ciprofloxacin, gatifloxacin and moxifloxacin being 58%, 75% and 75%, respectively. For treatment started at day 7 post-challenge, survival rates were 17%, 11% and 44%, respectively. When antibiotic treatment was delayed until day 12 post-challenge, survival rates fell to 21%, 17% and 28%, respectively. Following dexamethasone treatment of survivors at 42 days post-challenge, relapses occurred in all treatment groups. <it>Conclusions</it>: Fluoroquinolones do not provide good post-exposure protection against infection with <it>B. pseudomallei</it>. The newer agents moxifloxacin and gatifloxacin are not significantly better than ciprofloxacin for this purpose.

Epidemiol. Infect. 118 (1997), 71–5 Figure 3, page 73: the horizontal x axis should be labelled ‘Spores/ml in spray fluid (log10)’. The corrected figure is shown below: