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Andersen HV, Jørgensen VRL, Steensen M, Pedersen FM, Helleberg M. Superinfections in COVID-19 patients receiving extracorporeal membrane oxygenation support. Acta Anaesthesiol Scand 2023; 67:755-761. [PMID: 36906734 DOI: 10.1111/aas.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND The risk of superinfections and associations with mortality among patients with corona virus disease 2019 (COVID-19) receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) is poorly elucidated. METHOD We identified all patients with COVID-19 treated with VV-ECMO >24 h at Rigshospitalet, Denmark from March 2020 to December 2021. Data were obtained by review of medical files. Associations between superinfections and mortality were assessed by logistic regression analyses adjusted for sex and age. RESULTS Fifty patients, median age 53 years (interquartile range [IQR] 45-59), 66% male, were included. Median time on VV-ECMO was 14.5 days (IQR 6.3-23.5), 42% were discharged from hospital alive. Bacteremia, ventilator associated pneumonia (VAP), invasive candidiasis, pulmonary aspergillosis, herpes simplex virus, and cytomegalovirus (CMV) were detected in 38%, 42%, 12%, 12%, 14%, and 20% of patients, respectively. No patients with pulmonary aspergillosis survived. CMV was associated with increased risk of death, odds ratio 12.6 (95% confidence interval 1.9-257, p = .05), whereas we found no associations between other superinfections and risk of death. CONCLUSION Bacteremia and VAP are common but does not seem to affect mortality, whereas pulmonary aspergillosis and CMV are associated with poor prognosis among COVID-19 patients treated with VV-ECMO.
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Affiliation(s)
| | - Vibeke R L Jørgensen
- Department of Thoracic Anesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Steensen
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn M Pedersen
- Department of Thoracic Anesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marie Helleberg
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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2
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Søvik S, Barrat-Due A, Kåsine T, Olasveengen T, Strand MW, Tveita AA, Berdal JE, Lehre MA, Lorentsen T, Heggelund L, Stenstad T, Ringstad J, Müller F, Aukrust P, Holter JC, Nordøy I. Corticosteroids and superinfections in COVID-19 patients on invasive mechanical ventilation. J Infect 2022; 85:57-63. [PMID: 35605805 PMCID: PMC9122884 DOI: 10.1016/j.jinf.2022.05.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/03/2022] [Accepted: 05/17/2022] [Indexed: 12/15/2022]
Abstract
Objectives To determine the incidence and characteristics of superinfections in mechanically ventilated COVID-19 patients, and the impact of dexamethasone as standard therapy. Methods This multicentre, observational, retrospective study included patients ≥ 18 years admitted from March 1st 2020 to January 31st 2021 with COVID-19 infection who received mechanical ventilation. Patient characteristics, clinical characteristics, therapy and survival were examined. Results 155/156 patients (115 men, mean age 62 years, range 26-84 years) were included. 67 patients (43%) had 90 superinfections, pneumonia dominated (78%). Superinfections were associated with receiving dexamethasone (66% vs 32%, p<0.0001), autoimmune disease (18% vs 5.7%, p<0.016) and with longer ICU stays (26 vs 17 days, p<0,001). Invasive fungal infections were reported exclusively in dexamethasone-treated patients [8/67 (12%) vs 0/88 (0%), p<0.0001]. Unadjusted 90-day survival did not differ between patients with or without superinfections (64% vs 73%, p=0.25), but was lower in patients receiving dexamethasone versus not (58% vs 78%, p=0.007). In multiple regression analysis, superinfection was associated with dexamethasone use [OR 3.7 (1.80–7.61), p<0.001], pre-existing autoimmune disease [OR 3.82 (1.13–12.9), p=0.031] and length of ICU stay [OR 1.05 p<0.001]. Conclusions In critically ill COVID-19 patients, dexamethasone as standard of care was strongly and independently associated with superinfections.
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Affiliation(s)
- Signe Søvik
- Dept. of Anesthesiology and Intensive Care, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Andreas Barrat-Due
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Dept. of Immunology, Oslo University Hospital, Oslo, Norway.
| | - Trine Kåsine
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
| | - Theresa Olasveengen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
| | | | - Anders Aune Tveita
- Dept. of Internal Medicine, Vestre Viken Hospital Trust, Bærum, Norway; Dept. of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway.
| | - Jan Erik Berdal
- Dept. of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Martin Andreas Lehre
- Dept. of Anesthesiology and Intensive Care, Akershus University Hospital, Lørenskog, Norway.
| | - Torleif Lorentsen
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
| | - Lars Heggelund
- Dept. of Internal Medicine, Vestre Viken Hospital Trust, Drammen, Drammen, Norway; Dept. of Clinical Science, Faculty of Medicine, University of Bergen, Norway.
| | - Tore Stenstad
- Dept. of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Jetmund Ringstad
- Dept. of Internal Medicine, Vestre Viken Hospital Trust, Bærum, Norway.
| | - Fredrik Müller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Microbiology, Oslo University Hospital, Oslo, Norway.
| | - Pål Aukrust
- Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway; Research Institute for Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Jan Cato Holter
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Microbiology, Oslo University Hospital, Oslo, Norway.
| | - Ingvild Nordøy
- Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway; Research Institute for Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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Lahmer T, Kriescher S, Herner A, Rothe K, Spinner CD, Schneider J, Mayer U, Neuenhahn M, Hoffmann D, Geisler F, Heim M, Schneider G, Schmid RM, Huber W, Rasch S. Invasive pulmonary aspergillosis in critically ill patients with severe COVID-19 pneumonia: Results from the prospective AspCOVID-19 study. PLoS One 2021; 16:e0238825. [PMID: 33730058 PMCID: PMC7968651 DOI: 10.1371/journal.pone.0238825] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023] Open
Abstract
Background Superinfections, including invasive pulmonary aspergillosis (IPA), are well-known complications of critically ill patients with severe viral pneumonia. Aim of this study was to evaluate the incidence, risk factors and outcome of IPA in critically ill patients with severe COVID-19 pneumonia. Methods We prospectively screened 32 critically ill patients with severe COVID-19 pneumonia for a time period of 28 days using a standardized study protocol for oberservation of developement of COVID-19 associated invasive pulmonary aspergillosis (CAPA). We collected laboratory, microbiological, virological and clinical parameters at defined timepoints in combination with galactomannan-antigen-detection from nondirected bronchial lavage (NBL). We used logistic regression analyses to assess if COVID-19 was independently associated with IPA and compared it with matched controls. Findings CAPA was diagnosed at a median of 4 days after ICU admission in 11/32 (34%) of critically ill patients with severe COVID-19 pneumonia as compared to 8% in the control cohort. In the COVID-19 cohort, mean age, APACHE II score and ICU mortality were higher in patients with CAPA than in patients without CAPA (36% versus 9.5%; p<0.001). ICU stay (21 versus 17 days; p = 0.340) and days of mechanical ventilation (20 versus 15 days; p = 0.570) were not different between both groups. In regression analysis COVID-19 and APACHE II score were independently associated with IPA. Interpretation CAPA is highly prevalent and associated with a high mortality rate. COVID-19 is independently associated with invasive pulmonary aspergillosis. A standardized screening and diagnostic approach as presented in our study can help to identify affected patients at an early stage.
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Affiliation(s)
- Tobias Lahmer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
- * E-mail:
| | - Silja Kriescher
- Klinik und Poliklinik für Aneasthesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Alexander Herner
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Kathrin Rothe
- Institut für Mikrobiologie, Immunologie und Hygiene, Technische Universität München, Munich, Germany
| | - Christoph D. Spinner
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Jochen Schneider
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Ulrich Mayer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Michael Neuenhahn
- Institut für Mikrobiologie, Immunologie und Hygiene, Technische Universität München, Munich, Germany
| | - Dieter Hoffmann
- Institut für Virologie, Technische Universität München, Munich, Germany
| | - Fabian Geisler
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Markus Heim
- Klinik und Poliklinik für Aneasthesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Gerhard Schneider
- Klinik und Poliklinik für Aneasthesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Roland M. Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Wolfgang Huber
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Sebastian Rasch
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Bonny TS, Kirby C, Martens C, Rose R, Desai N, Seisa M, Petropoulos C, Florman S, Friedman-Moraco RJ, Turgeon NA, Brown D, Segev DL, Durand CM, Tobian AAR, Redd AD. Outcomes of donor-derived superinfection screening in HIV-positive to HIV-positive kidney and liver transplantation: a multicentre, prospective, observational study. Lancet HIV 2020; 7:e611-e619. [PMID: 32730756 PMCID: PMC8073978 DOI: 10.1016/s2352-3018(20)30200-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/23/2020] [Accepted: 05/04/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND One of the primary risks of HIV-positive to HIV-positive organ transplantation is loss of virological control because of donor-derived HIV superinfection, which occurs when an HIV-positive individual becomes infected with a new distinct HIV strain. In this study, as part of the larger HIV Organ Policy Equity pilot study, HIV-positive to HIV-positive kidney and liver transplant recipients in the USA were examined for evidence of sustained donor-derived HIV superinfection. METHODS In this multicentre, prospective, observational study, HIV-positive to HIV-positive kidney and liver transplant recipients were followed in three hospitals in the USA. Candidates with well controlled HIV infection on ART, no active opportunistic infections, and minimum CD4 T-cell counts (>100 cells per μL for liver and >200 cells per μL for kidney per federal guidelines) were eligible to receive a kidney or liver from deceased HIV-positive donors without active infections or neoplasm. Peripheral blood mononuclear cells were collected from donor-recipient pairs at the time of transplantation, and from recipients at several timepoints up to 3 years after transplantation. Donor samples were assessed for HIV RNA viral load, CD4 cell count, and antiretroviral drug-resistant mutations. Donor and recipient HIV proviral DNA, and viral RNA from the viraemic timepoint were sequenced using a site-directed next-generation sequencing assay for the reverse transcriptase and gp41 genes. Neighbour-joining phylogenetic trees and direct sequence comparison were used to detect the presence of HIV superinfection. This study is registered with ClinicalTrials.gov, NCT02602262. FINDINGS 14 HIV-positive to HIV-positive kidney and eight liver transplant recipients were followed from March, 2016, to July, 2019. 17 recipients had adequate viral sequences allowing for HIV superinfection assessment. Eight donors were suppressed (viral load <400 copies per mL), and none had multiclass drug-resistant mutations detected. None of the recipients examined had evidence of HIV superinfection. One recipient had a viraemic episode (viral load of 2 080 000 copies per mL) 3 years after transplantation as a result of non-adherence to ART. Only recipient viral sequences were detected during the viraemic episode, suggesting that the donor virus, if present, was not reactivated despite temporary withdrawal of ART. INTERPRETATION These findings suggest that loss of HIV suppression due to donor-derived HIV superinfection might not be a significant clinical concern in carefully monitored ART suppressed HIV-positive organ recipients. FUNDING US National Institute of Allergy and Infectious Diseases and National Cancer Institute.
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Affiliation(s)
- Tania S Bonny
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Kirby
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Craig Martens
- Genomic Unit, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Rebecca Rose
- Bioinfoexperts, Shreveport, Los Angeles, CA, USA
| | - Niraj Desai
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Seisa
- Laboratory Corporation of America (LabCorp), South San Francisco, CA, USA
| | | | - Sander Florman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Diane Brown
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Andrew D Redd
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; International HIV Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, MD, USA.
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5
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Abstract
L’unité d’enseignement « Immunopathologie » qui propose les brèves de ce numéro est suivie par des étudiants des sept parcours recherche du Master Biologie Santé de l’Université de Montpellier. On y étudie les bases physiopathologiques des maladies immunologiques, les cibles thérapeutiques et les mécanismes d’échappement des microorganismes et des tumeurs. Ce Master rassemble des étudiants issus du domaine des sciences et technologies et de celui de la santé. Les articles présentés ont été choisis par les étudiants selon leur domaine de prédilection.
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6
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Castiglioni M, Pelosi G, Meroni A, Tagliabue M, Uslenghi E, Salaris D, Incarbone M. Surgical Resections of Superinfected Pneumatoceles in a COVID-19 Patient. Ann Thorac Surg 2020; 111:e23-e25. [PMID: 32603707 PMCID: PMC7320852 DOI: 10.1016/j.athoracsur.2020.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 01/01/2023]
Abstract
Emerging studies on radiologic findings in patients with coronavirus disease 2019 (COVID-19) report a high incidence of bilateral lung involvement, with ground-glass opacities imaging being the most common pattern on computed tomography. Cystic lesions, such as pneumatoceles, are rare, although they may occur in 10% of cases. Cyst formation may be explained by a focal pulmonary trauma caused by mechanical ventilation or infection-related damage to the alveolar walls leading to pneumatoceles. The superinfection of pneumatoceles is a potential life-threatening condition for which no standardized therapeutic algorithm has been accepted. We report a case of a COVID-19 patient successfully treated by lung resections for infected pneumatoceles.
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Affiliation(s)
- Massimo Castiglioni
- Thoracic Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico MultiMedica, Milan, Italy.
| | - Giuseppe Pelosi
- Oncology and Hemato-Oncology Department, University of Milan, and Inter-Hospital Pathology Division, Istituto di Ricovero e Cura a Carattere Scientifico MultiMedica, Milan, Italy
| | - Alberto Meroni
- Thoracic Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico MultiMedica, Milan, Italy
| | - Marta Tagliabue
- General Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico MultiMedica, Milan, Italy
| | - Elisabetta Uslenghi
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico MultiMedica, Milan, Italy
| | - Davide Salaris
- Anesthesiology and Resuscitation Department, Istituto di Ricovero e Cura a Carattere Scientifico MultiMedica, Milan, Italy
| | - Matteo Incarbone
- Thoracic Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico MultiMedica, Milan, Italy
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7
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Fux CA, Uehlinger D, Bodmer T, Droz S, Zellweger C, Mühlemann K. Dynamics of Hemodialysis Catheter Colonization by Coagulase-Negative Staphylococci. Infect Control Hosp Epidemiol 2016; 26:567-74. [PMID: 16018433 DOI: 10.1086/502586] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjectives:Catheter colonization is a necessary but poorly characterized step in the pathogenesis of catheter-related infections. Colonization dynamics of central venous hemodialysis catheters were studied with emphasis on coagulase-negative staphylococci (CoNS) and their population genetics, antibiotic resistance, and biofilm formation. The homogeneity of CoNS colony morphotypes was evaluated.Design:Prospective, longitudinal study during 1,158 catheter-days with microbiological analysis of skin swabs, weekly catheter blood and brush samples, and catheter tips.Setting:Hemodialysis unit of a university hospital.Patients:Twenty-six patients with 24 non-tunneled and 5 tunneled catheters.Results:Nineteen (65.5%) of the catheters became colonized, 17 by CoNS. CoNS colonization of the inner lumen was observed in 17.2% of the catheters and was first detectable after 3 weeks. Colonization of the outer surface occurred in 44.8% of the catheters within a minimum of 2 weeks. PFGE of 53 CoNS revealed 10 clones and 20 unique isolates. Isolates from clones were more frequent in catheter blood and brush cultures than were unique isolates (41% vs 15%), were resistant to more antibiotics (median, 7 vs 2), and tended to more often carry theicaAgene (64.1% vs 40%). Four (23.5%) of the catheters showed colonization with a mixture of CoNS based on PFGE. The time from catheter insertion to such mixed CoNS colonization was longer than that for colonization with one CoNS PFGE pattern only (42 vs 25 days).Conclusions:Colonization of hemodialysis catheters is dominated by multidrug-resistant,icaA-positive CoNS clones. Mixed CoNS colonization occurs, but is delayed, suggesting a process of sequential superinfection (Infect Control Hosp Epidemiol2005;26:567-574).
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Bacteremia/etiology
- Biofilms/growth & development
- Catheterization, Central Venous/adverse effects
- Catheterization, Central Venous/instrumentation
- Catheters, Indwelling/microbiology
- Coagulase
- Cross Infection/etiology
- DNA, Bacterial/analysis
- DNA, Bacterial/genetics
- Drug Resistance, Multiple, Bacterial
- Electrophoresis, Gel, Pulsed-Field
- Equipment Contamination/statistics & numerical data
- Equipment Design
- Female
- Hospitals, University
- Humans
- Male
- Microbial Sensitivity Tests
- Middle Aged
- Prospective Studies
- Renal Dialysis/adverse effects
- Renal Dialysis/instrumentation
- Staphylococcal Infections/etiology
- Staphylococcus/genetics
- Staphylococcus/growth & development
- Superinfection/etiology
- Switzerland
- Time Factors
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Affiliation(s)
- Christoph A Fux
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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Nagsuk P, Moore R, Lopez L. A case report of crusted scabies in an adult patient with Down syndrome. Dermatol Online J 2015; 21:13030/qt4kc74256. [PMID: 26437167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 06/05/2023] Open
Abstract
IMPORTANCE Crusted (Norwegian) scabies is a severe manifestation of the contagious skin infection caused by Sarcoptes scabiei. Crusted scabies has been well described in patients with known immunocompromised states. Treatment may be complicated by delayed diagnosis and/or inadequate treatment. This infection may not rank highly on one's differential diagnosis in the absence of an immunocompromised state, highlighting the uniqueness of the case being presented. Several papers describe immunocompromised children with Down syndrome who are infected with crusted scabies. We present a case of infection in an adult with Down syndrome without evidence of an immunocompromised state. OBSERVATIONS Our patient came to us with a 13-month history of progressively worsening symptoms, the last 4-6 weeks of that time period being most dramatic, despite various treatments. We performed tissue biopsy, culture, and laboratory evaluations, which revealed numerous mites and bacterial superinfection. CONCLUSIONS AND RELEVANCE Crusted scabies infection may occur in adult age individuals with Down syndrome regardless of immune status, leading us to encourage practitioners to consider this condition when presented with patients of this population. We also highlight the need for further exploration of disease prevalence in this patient population.
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Seminario-Vidal L, Sami N, Miller J, Theos A. Mycophenolate mofetil therapy for pediatric bullous pemphigoid. Dermatol Online J 2015; 21:13030/qt3x5585zn. [PMID: 26437160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 06/05/2023] Open
Abstract
Bullous pemphigoid (BP) is a common autoimmune blistering disease in the adult population, but extremely rare in the pediatric population. Childhood BP usually has a favorable prognosis and responds well to topical and oral steroids. However, for patients that do not respond to corticosteroids, therapeutic alternatives are scarce. We report a case of a toddler with recalcitrant BP who was successfully treated with mycophenolate mofetil (MMF).
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Affiliation(s)
| | | | | | - Amy Theos
- Department of Dermatology, University of Alabama at Birmingham.
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10
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Epperla N, Kattamanchi S, Fritsche TR. Appearances are Deceptive: Staphylococcus Superinfection of Clavicular Tuberculous Osteomyelitis. Clin Med Res 2015; 13:85-8. [PMID: 25487239 PMCID: PMC4504661 DOI: 10.3121/cmr.2014.1247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/24/2014] [Indexed: 11/18/2022]
Abstract
A man, aged 25 years, presented with pain, swelling, and drainage from the right clavicular area. He had a past history of abscess at the sternoclavicular joint. The cultures from the drainage site grew methicillin-sensitive Staphylococcus aureus, and he was placed on appropriate antibiotics. As S. aureus infection of the clavicle is often secondary in nature, particularly in adults, a thorough workup was done to identify the underlying cause. Quantiferon gold, done as a part of the workup, came back positive, while the bone cultures grew S. aureus and Mycobacterium tuberculosis. He was placed on 9 months of combination therapy for tuberculosis osteomyelitis with a good clinical outcome.
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Affiliation(s)
- Narendranath Epperla
- Department of Internal Medicine, Marshfield Clinic, Marshfield WI, USA Department of Laboratory Medicine, Marshfield Clinic, Marshfield WI, USA
| | | | - Thomas R Fritsche
- Department of Laboratory Medicine, Marshfield Clinic, Marshfield WI, USA
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11
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Bernardo Cofiño J, Trapiella Martínez L. Superinfected calcinosis cutis as a presentation of a limited form systemic sclerosis. Reumatol Clin 2014; 10:187-188. [PMID: 24051207 DOI: 10.1016/j.reuma.2013.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 05/27/2013] [Accepted: 07/03/2013] [Indexed: 06/02/2023]
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12
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Koticha A, Kuyare S, Nair J, Athvale A, Mehta P. Strongyloides stercoralis hyperinfection syndrome in patients on prolonged steroid treatment: two case reports. J Indian Med Assoc 2013; 111:272-274. [PMID: 24475564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Two cases of Strongyloides hyperinfection have been reported who were on prolonged steroid therapy for frequent exacerbations of respiratory problems. One patient presenting with acute respiratory distress, rapidly deteriorated, did not give any time for management and died whereas the second patient survived because of early diagnosis of hyperinfection due to Strongyloides stercoralis.
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Affiliation(s)
- Avani Koticha
- Department of Microbiology, Seth GS Medical College and KEM Hospital, Mumbai
| | - Sunil Kuyare
- Department of Microbiology, Seth GS Medical College and KEM Hospital, Mumbai
| | - Jairaj Nair
- Department of Microbiology, Seth GS Medical College and KEM Hospital, Mumbai
| | - Amita Athvale
- Department of Chest Medicine and Environmental Pollution Research Centre
| | - Preeti Mehta
- Department of Chest Medicine and Environmental Pollution Research Centre
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13
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Scheier E, Aviner S. Septicemia following rotavirus gastroenteritis. Isr Med Assoc J 2013; 15:166-169. [PMID: 23662380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Rotavirus gastroenteritis is a prevalent childhood illness rarely complicated by secondary bacterial sepsis. Although there are case reports of septicemia after rotavirus infection, there are no recent reviews on this topic. OBJECTIVES To add new cases of septicemia after rotavirus to the literature, review the few cases of septicemia after rotavirus that have been reported, calculate the incidence of septicemia in children hospitalized for rotavirus gastroenteritis, and discuss the characteristics of septicemia after rotavirus infection and implications for current pediatric practice. METHODS We identified children whose illness was complicated by septicemia from among all hospitalizations at our facility for rotavirus gastroenteritis from May 1999 through May 2010. We also review the few cases reported in the English literature. RESULTS We identified two cases of septicemia from among 632 hospitalizations for rotavirus gastroenteritis in this time period, for an incidence rate of 0.32%, which is comparable to other estimates in the English literature. The typical course for cases of bacterial superinfection involves a second peak of high fever; other clinical signs are variable. CONCLUSIONS Septicemia after rotavirus gastroenteritis is a rare but dangerous entity. Early identification of a child developing bacterial superinfection after rotavirus, as in any case of sepsis, is of the utmost importance, as is obtaining blood cultures in a child with a rotavirus infection and a second fever spike.
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Affiliation(s)
- Eric Scheier
- Department of Pediatrics, Barzilai Medical Center, Ashkelon, Israel.
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Cutler SJ. Dangerous liaisons--our expanding appreciation of microbial synergism. Clin Microbiol Infect 2013; 19:105-6. [PMID: 23398404 DOI: 10.1111/1469-0691.12066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Palma-Barrio R, Torres-de Rueda Á, Pizarro-León JL. Infection due to Pneumocystis jirovecii in haemodialysis. Nefrologia 2013; 33:742-743. [PMID: 24089172 DOI: 10.3265/nefrologia.pre2013.apr.12027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2013] [Indexed: 06/02/2023] Open
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Salem B, Ichrak K, Hanène N, Safouane C, Maher B. Ulcère de jambe récidivant et surinfecté au cours de la maladie de Behçet. Pan Afr Med J 2013; 14:139. [PMID: 23785544 PMCID: PMC3683515 DOI: 10.11604/pamj.2013.14.139.1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 08/02/2012] [Indexed: 11/11/2022] Open
Abstract
Parmi les manifestations cutanées de la maladie de Behçet, les ulcères de jambes sont exceptionnels mais gardent une implication pronostique fonctionnelle importante surtout dans les formes récidivantes et surinfectées. Nous rapportons l'observation d'un patient âgé de 42 ans porteur de maladie de Behçet depuis l’âge de 27 ans qui fût exploré pour ulcères de jambes bilatéraux, récidivants et invalidants nécessitant l'hospitalisation à plusieurs reprises. A chaque fois les récidives de l'ulcère s'associaient à une poussée cutanéo-muqueuse de la maladie avec notion d'arrêt intempestif de traitement. Il a présenté plusieurs épisodes de surinfection nécessitant le recours aux antibiotiques. Le doppler veineux et artériel ne montraient ni signes d'insuffisance veineuse ni d'artériopathie sous-jacentes. Sous antibiothérapie, en plus des soins locaux et la reprise de la colchicine et des corticostéroïdes, l’évolution se faisait vers la cicatrisation complète des ulcérations mais les récidives étaient fréquentes.
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Affiliation(s)
- Bouomrani Salem
- Service de Médecine Interne. Hôpital Militaire de Gabes 6000, Tunisie
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Martin-Loeches I, Valles J. Overtreating or underdiagnosing invasive pulmonary aspergillosis (IPA) in critically ill H1N1 patients: who is right? Intensive Care Med 2012; 38:1733-5. [PMID: 22895827 DOI: 10.1007/s00134-012-2677-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 07/23/2012] [Indexed: 01/05/2023]
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Gallach Sanchis D, Doñate Pérez F, Jiménez Ortega P. Multifocal bacterial osteomyelitis after varicella infection: a rare but dreaded complication of chickenpox. Musculoskelet Surg 2012; 98:61-5. [PMID: 22707015 DOI: 10.1007/s12306-012-0185-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 03/08/2012] [Indexed: 11/25/2022]
Abstract
Chickenpox is an infectious disease common in children, which in most cases is benign toward the self-limited resolution. There are, however, serious systemic and musculoskeletal complications, especially in patients with immunosuppression. We report a case of multifocal skeletal muscle involvement, as a complication of chickenpox by Streptococcus pyogenes.
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Affiliation(s)
- David Gallach Sanchis
- Department of Traumatology and Orthopaedic Surgery, Complejo Hospitalario Universitario de Albacete, Calle Hermanos Falcó sn, 02006, Albacete, Spain,
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Bruno P, Ricci A, Pezzuto A, Martone L, Gencarelli G, Mariotta S. Severe pneumonia caused by Nocardia farcinica and complicated by Staphylococcus haemoliticus superinfection. Eur Rev Med Pharmacol Sci 2011; 15:401-405. [PMID: 21608435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
It is reported the case of a subject 54 years old, painter, drinker and smoker who after an episode of cooling and the occurrence of widespread pain was taking its own initiative, cortisone and analgesics from approximately 30 days. The symptoms worsened and the patient was hospitalized. Chest X-ray and CT scan showed an extensive opacity in the left upper lobe with excavations in the context and also some nodular opacities excavated in the contralateral lung. In the first eight days after admission, the clinical picture despite empirical antibiotic therapy worsened towards adult respiratory distress syndrome (ARDS). On the ninth day after the admission, strains of Nocardia farcinica and Staphylococcus haemoliticus were isolated from the sputum. The targeted therapy (trimethoprim-sulfamethoxazole, amikacin, etc.) induced a rapid improvement of the clinical picture that was resolved in 6 months. Pneumonia caused by Nocardia farcinica is rare but its identification is necessary to set an appropriate therapy.
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Affiliation(s)
- P Bruno
- Department of Clinical and Molecular Medicine, Sapienza University, Pneumology UOC, Sant'Andrea Hospital, Rome, Italy.
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Sigusch HH, Zimmermann B, Lessig F, Thalwitzer J, Franke UFW. [Unusual cause of Staphylococcus aureus septicemia in a 79-year-old male patient]. Internist (Berl) 2010; 51:1313-4, 1316-7. [PMID: 20521017 DOI: 10.1007/s00108-010-2616-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
High grade fever in the context of Staphylococcus aureus bacteremia led to hospital admission of a 79 year old male patient. A covered perforation of the ascending aorta resulted in the formation of a pseudoaneurysm which was complicated by superinfection caused by hematogenic spread of Staphylococcus aureus. The infected pseudoaneurysm found per continuitatem contact to the pericardium and resulted in bacterial pericarditis. Antibiotic pretreatment was followed by operation with a complex procedure including resection of pseudoaneurysm and suture closure of the perforation site.
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MESH Headings
- Aged
- Aged, 80 and over
- Aneurysm, False/complications
- Aneurysm, False/diagnosis
- Aneurysm, False/therapy
- Aneurysm, Infected/complications
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Aorta, Thoracic/surgery
- Aortic Aneurysm, Thoracic/complications
- Aortic Aneurysm, Thoracic/diagnosis
- Aortic Aneurysm, Thoracic/therapy
- Aortic Rupture/complications
- Aortic Rupture/diagnosis
- Aortic Rupture/therapy
- Bacteremia/diagnosis
- Bacteremia/etiology
- Bacteremia/therapy
- Cardiac Tamponade/diagnosis
- Cardiac Tamponade/etiology
- Cardiac Tamponade/therapy
- Combined Modality Therapy
- Diagnosis, Differential
- Echocardiography, Transesophageal
- Humans
- Male
- Pericardiocentesis
- Pericarditis/diagnosis
- Pericarditis/etiology
- Pericarditis/therapy
- Staphylococcal Infections/diagnosis
- Staphylococcal Infections/etiology
- Staphylococcal Infections/therapy
- Superinfection/diagnosis
- Superinfection/etiology
- Superinfection/therapy
- Tomography, X-Ray Computed
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Affiliation(s)
- H H Sigusch
- Klinik für Innere Medizin I, Heinrich-Braun-Klinikum Zwickau gGmbH, Zwickau, Deutschland.
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Razonable R. Direct and indirect effects of cytomegalovirus: can we prevent them? Enferm Infecc Microbiol Clin 2009; 28:1-5. [PMID: 20022410 DOI: 10.1016/j.eimc.2009.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 07/06/2009] [Indexed: 12/22/2022]
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22
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Santiago M, Leitão B. Prevention of strongyloides hyperinfection syndrome: a rheumatological point of view. Eur J Intern Med 2009; 20:744-8. [PMID: 19892301 DOI: 10.1016/j.ejim.2009.09.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 08/30/2009] [Accepted: 09/04/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Strongyloides stercoralis (S.stercoralis) is a parasite that infects humans and in conditions of immunodeficiency may disseminate, causing the potentially fatal strongyloides hyperinfection syndrome (SHS). The aim of this review was to investigate the literature evidence on the prophylaxis of SHS in immunosuppressed patients with rheumatological disorders. MATERIAL AND METHODS The MEDLINE database (from 1966 to 2008) was searched using the following terms: "strongyloidiasis", "disseminated strongyloidiasis", "Strongyloides stercoralis", "Strongyloides stercoralis dissemination", "strongyloides hyperinfection syndrome", "treatment", "prophylaxis", "prevention", "immunocompromised", "immunodepression", "immunosuppressed", "immunosuppression", "corticosteroids", "glucocorticoids", "lupus erythematosus", "rheumatoid arthritis", "rheumatic diseases". A search of the therapeutic studies using the same set of terms was carried out. RESULTS No study on the prophylaxis of SHS restricted to rheumatic immunosuppressed patients was identified. However, two articles have been published on the prophylaxis of strongyloidiasis in other immunosuppressed patients. Additionally, 13 studies dealing with different therapeutical options for strongyloidiasis were identified and presented. CONCLUSIONS Since there is no evidence on the prophylaxis of SHS in immunosuppressed rheumatic patients, the suggested regimen for that prophylaxis may rely on the results obtained from therapeutical studies. Ivermectin has the best safety profile, lower cost and best efficacy and should be the drug of choice for the prophylaxis of SHS in such patients. Although a definitive prophylactic regimen has not been defined, the option for 200 microg/kg/day for 2 days, repeated within 2 weeks, seems to be a reasonable approach. Such regimen should be repeated every 6 months in case of persisting immunosuppression in permanent residents of endemic areas.
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Granizo JJ, Aguilar L, Gimenez MJ, Coronel P, Gimeno M, Prieto J. Safety profile of cefditoren. A pooled analysis of data from clinical trials in community-acquired respiratory tract infections. Rev Esp Quimioter 2009; 22:57-61. [PMID: 19544097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION A high number of individuals in the population are exposed to antibiotics for the treatment of respiratory tract infections. It is important to review the adverse events profile related to antibiotic exposure during the clinical development of drugs that are or have been recently included in the therapeutic armamentarium. MATERIAL AND METHODS Safety data from all 13 clinical trials of cefditoren on community acquired respiratory infections were reviewed. Safety population was defined as all randomized patients with at least one dose intake. Adverse events considered by investigators as related during antibiotic exposure were considered. RESULTS The overall safety population consisted in 4,592 patients for cefditoren and 2,784 for comparators. Overall reported diarrhoea related to cefditoren administration was significantly higher (p < or = 0.001) than comparators (9.9% vs 6.9%) due to the significant difference in the pooled pharyngotonsillitis studies (8.3% vs 3.2%), while no significant differences in others pathologies were found, with 9.4% (with cefditoren) vs 10.3% (with comparators) in the case of community-acquired pneumonia (CAP). Dyspepsia and abdominal pain were reported as adverse events in < 2.7% patients regardless the treated disease. In females population lower related vaginosis rate was found in cefditoren vs comparators, mainly due to differences among patients treated for sinusitis (4.5% vs 8.1%) and CAP (2.3% vs 5.5%) although differences were not significant (p = 0.017 and p = 0.008, respectively). CONCLUSION This study analysing reported adverse events from clinical trials showed an adverse events profile of cefditoren similar to those of standard antibiotics used in the treatment of respiratory tract infections.
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Affiliation(s)
- J J Granizo
- Granadatos Pozuelo de Alarcón, Madrid, Spain.
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25
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Abstract
Gram-positive infections have become prevalent among neutropenic patients with cancer. A prospective, randomized, double-blind trial of teicoplanin, 6 mg/kg every 12 h for three doses then every 24 h, versus vancomycin hydrochloride, 15 mg/kg every 12 h, in the empirical treatment of febrile neutropenic patients was undertaken among 50 consecutive patients with haematological malignancy. The patients also received piperacillin sodium, 3 g every 4 h, and tobramycin sulphate, 1.5-2 mg/kg every 8 h. Both groups (25 teicoplanin and 25 vancomycin) were comparable in age, sex, renal function, underlying disease and concurrent therapy. Among 22 patients (44%) with culture-proven infection, Gram-positive organisms were isolated in 15 (9 with bacteraemia) and Gram-negative in 11 (4 with bacteraemia). Mixed or polymicrobial infection occurred in 8 patients. Serum 1-h peak and trough levels at steady state were 41 +/- 15 and 12 +/- 3 mg/l for teicoplanin (at 14 +/- 4 days), and 40 +/- 10 and 8 +/- 5 mg/l for vancomycin (at 0.9 +/- 0.6 days). Mean elimination half-life and apparent volume of distribution at steady state were 80.5 +/- 21.5 h and 1.4 +/- 0.8 l/kg for teicoplanin, and 5.6 +/- 1.8 h and 0.6 +/- 0.2 l/kg for vancomycin. Empirical antimicrobial therapy was successful in 23 teicoplanin and 21 vancomycin patients, respectively (p = 0.67; two-tailed Fisher's exact test). Nephrotoxicity (serum creatinine > 110 mmol/l), however, was more common among vancomycin patients (10 versus 2; p = 0.02), while termination of treatment due to adverse effects was also more common among vancomycin patients (10 versus 2; p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A W Chow
- Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
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Vilela EG, Clemente WT, Mira RRL, Torres HOG, Veloso LF, Fonseca LP, de Carvalho E Fonseca LR, Franca MDC, Lima AS. Strongyloides stercoralis hyperinfection syndrome after liver transplantation: case report and literature review. Transpl Infect Dis 2009; 11:132-6. [PMID: 18983416 DOI: 10.1111/j.1399-3062.2008.00350.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Strongyloides stercoralis is an intestinal nematode that causes human infections and whose life cycle has special features, including autoinfection. Strongyloides infection may be asymptomatic for years, owing to a low parasite load. During immunosuppressive therapy, however, if cellular immunity is depressed, autoinfection can occur at a higher rate, resulting in hyperinfection syndrome. In this specific circumstance, it can become a fatal illness. We describe a case of hyperinfection syndrome in a liver transplant recipient and also review the literature.
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Affiliation(s)
- E G Vilela
- Transplant Unit, Alfa Institute of Gastroenterology, Clinic Hospital, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Kulenovic A. [Diabetic foot, mechanisms, complications and management]. Soins Gerontol 2009:28-32. [PMID: 19366022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Alma Kulenovic
- Département de médecine diabétologique-vasculaire et d'appareillage, Hôpital Villers-Saint-Denis.
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Abstract
A large system of N strains of parasite and a single host is analyzed as a function of the degree of virulence in the strains when there is super-infection between hosts (more virulent strains can infect hosts that are already infected) and within-host transition between strains that is neutral. When this small amount of local switching is allowed, steady-state solutions converge to a continuous distribution as the number of strains increases. The resulting nonlinear-nonautonomous integro-differential equation is reduced to a fourth order boundary value problem (BVP) and the existence of positive solutions is proven. The methods here and associated BVP allow for a thorough exploration of parameter space for this class of models.
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Affiliation(s)
- Bard Ermentrout
- Department of Mathematics, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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Araco A, Zaccheddu R, Araco F, Gravante G. Methicillin-resistant superinfection of the wound after body-contouring abdominal surgery. Aesthetic Plast Surg 2008; 32:681-3. [PMID: 18491177 DOI: 10.1007/s00266-008-9177-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 09/11/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND This report presents the case of a patient who underwent abdominal body-contouring surgery, then later experienced a severe deep infection and a methicillin-resistant (MRSA) superinfection. CASE REPORT A 56-year-old female ex-smoker presented, after massive weight loss, with skin excesses on the abdomen and flanks. She underwent an abdominoplasty with muscle plication and flank liposuction. On postoperative day 14, the woman presented with a deep wound infection, then 1 week later with MRSA superinfection. Since then, two surgical debridements and specific intravenous antibiotics have been necessary for a cure and to avoid septicemic complications. Complete wound closure was achieved only after 3 months of therapy, but a massive retractile and painful scar remained. CONCLUSION Concomitant risk factors for wound infections (obesity, smoking, flap undermining) determined a rare but potentially fatal wound complication after body-contouring abdominoplasty. This complication was presented to alert plastic and general surgeons to such postoperative infections and to the possibility of a nonconservative approach.
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Affiliation(s)
- A Araco
- Dolan Park Hospital, Bromsgrove, United Kingdom
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31
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Bollaert PE. Corticosteroids for septic shock. N Engl J Med 2008; 358:2069; author reply 2070-1. [PMID: 18467977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Marcos LA, Terashima A, Dupont HL, Gotuzzo E. Strongyloides hyperinfection syndrome: an emerging global infectious disease. Trans R Soc Trop Med Hyg 2008; 102:314-8. [PMID: 18321548 DOI: 10.1016/j.trstmh.2008.01.020] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 01/24/2008] [Accepted: 01/25/2008] [Indexed: 11/26/2022] Open
Abstract
The hyperinfection syndrome (HS) caused by Strongyloides stercoralis has a high mortality rate (15% to 87%). A variety of risk factors and predisposing conditions have been described, including new immunosuppressive therapies; HTLV-1 infection; cadaveric transplantation; immune reconstitution syndrome; haematological malignancies (especially lymphoma); tuberculosis; malnutrition secondary to chronic Strongyloides diarrhoea; international travel and immigration. Inhibition of Th2 cell-mediated, humoral or mucosal immunity is associated with HS. HS is more frequently seen in HTLV-1 than HIV patients. In AIDS, there is an increase in Th2 cytokines, while in HTLV-1 infection there is a decrease in the Th2 response, leading to an increased risk of autoinfection. Corticosteroid use remains the most frequent risk factor for HS. A number of ELISAs are useful for diagnosis and post-treatment evaluation. Once diagnosed, the disease may be managed effectively with anthelminthic drugs, including ivermectin. HS causes diverse symptoms and signs, with unusual manifestations leading to misdiagnosis and medical errors related to healthcare providers' lack of familiarity with the condition. HS is an example of an emerging tropical infection migrating to developed countries and requiring greater clinician awareness.
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Affiliation(s)
- Luis A Marcos
- Internal Medicine Department, University of Texas Health Science, 6431 Fannin Street, Suite 1.150, Houston, TX 77030, USA.
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Oliveira L, Graham J, Lok C, MacFarlane S, Zimmerman D. Risk factors for yeast superinfection in the treatment of suspected exit site infections: a case-control study. J Vasc Access 2008; 9:35-38. [PMID: 18379978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
PURPOSE The risk of infection can be reduced in hemodialysis (HD) patients with central venous catheters (CVCs) by using prophylactic intranasal mupirocin or polysporin at the exit site. However, there are concerns about the potential emergence of resistant microorganisms. The purpose of our study was to determine if the use of polysporin double in the treatment of exit site infections was associated with the emergence of yeast positive exit site cultures. METHODS In this case control study, we evaluated the risk of developing yeast positive exit site cultures after introducing a polysporin medical directive for the treatment of presumed exit site infections in our HD units. All HD patients using a CVC for blood access at the Ottawa Hospital were eligible for study. Demographic variables, use of polysporin, antibiotics and immunosuppressive medications were compared between those patients with yeast positive exit site cultures and controls. RESULTS There was no differences in age, gender or diabetic status between the cases and controls. However, the use of polysporin, antibiotics and immunocompromised status were associated with an increased risk of yeast positive exit site cultures. The relative importance of each of these factors could not be determined using this study design and requires future prospective study. CONCLUSIONS The emergence of yeast positive exit site cultures after the introduction of a new medical directive at a tertiary care hospital highlights the difference between medications used for prophylaxis and those used for treatment of CVC infections in high risk dialysis patients.
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Affiliation(s)
- L Oliveira
- Department of Medicine, University of Ottawa, Ottawa Hospital, Ottawa, Ontario, Canada
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Predari SC, de Paulis AN, Verón D, Zucchini A, Santoianni JE. Fungal peritonitis in patients on peritoneal dialysis: twenty five years of experience in a teaching hospital in Argentina. Rev Argent Microbiol 2007; 39:213-217. [PMID: 18390154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Fungal peritonitis is a rare but serious complication of peritoneal dialysis. The aim of this study was to analyze peritonitis rates, associated factors, clinical course, microbiological aspects, therapeutic regimens, and outcome of patients with fungal peritonitis in the dialysis center of a teaching hospital over the last 25 years. A hundred and eighty three episodes of peritonitis were detected and microbiologically documented in 57 patients. Fungi were identified in eight episodes (4.37%) occurring in seven female patients. The fungal peritonitis rate was 0.06 episodes/patient-year. Gram and Giemsa stains were positive in five out of eight dialysate fluids. The causative microorganisms were: Candida albicans in five episodes, and Candida parapsilosis, Candida glabrata, and Neosartorya hiratsukae in the remaining three. Antibiotics were administered to all but one patient, within 3 months before fungal peritonitis was detected. All patients required hospitalization, and antifungal therapy was administered in all episodes. The Tenckhoff catheter was removed in seven out of eight fungal peritonitis. All patients recovered from the fungal episodes. In the group of patients studied, it is concluded that recent exposure to antibiotics and female sex, were strongly associated with the development of fungal peritonitis by yeasts. The peritonitis caused by the environmental filamentous fungus did not require antibiotic pressure. Direct microscopy of the dialysate pellet was extremely useful for the prompt management of the fungal episode. Fungal peritonitis preceded by multiple episodes of bacterial peritonitis always determined the definitive dropout of the patient from the peritoneal dialysis program. Patients with de novo yeast-related peritonitis could continue on the program.
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Affiliation(s)
- S C Predari
- Department of Microbiology, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Argentina.
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Vaiphei K, Bhalla A, Kohli HS. Ischemic colitis with superadded infection by unusual organisms. Indian J Gastroenterol 2007; 25:298-301. [PMID: 17264430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Kim Vaiphei
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh 160 012, India.
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Abstract
Emphasis in VAP management is now shifting to the effectiveness of antibiotic therapy and its effect on subsequent mortality. As many as 62% of patients with VAP meet a set of objective criteria for failure to respond. The predominant microorganisms associated with failure of therapy are Pseudomonas aeruginosa and methicillin-resistant S. aureus (MRSA). Multiple causes of failure to respond in VAP exist: compromised host immunity, occult antibiotic resistance, inadequate antibiotic dosing, and concomitant or subsequent superinfections. The diagnosis of antibiotic failure and distinguishing failure from superinfection or noninfectious mimics is difficult because clinical criteria alone are inadequate. Microbiologic response is accurate only if quantitative cultures are used. Biochemical markers may be more accurate than clinical but still don't discriminate between causes. The appropriate diagnostic strategy and treatment algorithms have not been fully addressed and more research is clearly needed.
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Affiliation(s)
- Richard G Wunderink
- Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine. Chicago, Illinois, USA.
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38
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Cotten CM, McDonald S, Stoll B, Goldberg RN, Poole K, Benjamin DK. The association of third-generation cephalosporin use and invasive candidiasis in extremely low birth-weight infants. Pediatrics 2006; 118:717-22. [PMID: 16882828 DOI: 10.1542/peds.2005-2677] [Citation(s) in RCA: 211] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Previous studies have shown that incidence of invasive candidiasis varies substantially among centers, and previous use of broad-spectrum antibiotics is a risk factor for candidiasis in extremely low birth-weight infants. Differences in center practices, such as antibiotic strategies and the effects of these strategies on center incidence of candidiasis, are not reflected in assessments of an individual's risk of candidiasis. We evaluated the relationship between empirical antibiotic practices for extremely low birth-weight infants and center incidence of candidiasis. METHODS We studied a cohort of extremely low birth-weight infants who survived > or = 72 hours and were admitted to 1 of 12 tertiary centers between 1998 and 2001. Multivariable logistic regression was used to validate previous broad-spectrum antibiotics use as a risk factor for subsequent candidiasis in individual infants. We calculated correlation coefficients to assess the relationship between center incidence of candidiasis with antibiotic practice patterns. RESULTS There were 3702 infants from 12 centers included, and 284 (7.7%) developed invasive candidiasis. Broad-spectrum antibiotics use was associated with candidiasis for individual infants. Center candidiasis incidence ranged from 2.4% to 20.4%. Center incidence of candidiasis was correlated with average broad-spectrum antibiotics use per infant and average use of broad-spectrum antibiotics with negative cultures per infant. CONCLUSIONS Center incidences of invasive candidiasis differ substantially, and antibiotic practice differences are possible contributors to center variation in candidiasis risk.
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Affiliation(s)
- C Michael Cotten
- Duke University Department of Pediatrics, Durham, North Carolina 27710, USA.
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Masmoudi A, Maalej N, Boudaya S, Turki H, Zahaf A. [Adverse effects of intralesional Glucantime in the treatment of cutaneous leishmaniosis]. Med Mal Infect 2006; 36:226-8. [PMID: 16600554 DOI: 10.1016/j.medmal.2005.11.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 11/21/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The treatment of cutaneous leishmaniasis used in Tunisia is Glucantime. The aim of this retrospective study was to determine the adverse effects of intralesional Glucantime and to calculate the risk/benefit rate of this treatment. RESULTS Adverse effects were observed in 14 cases (5%). For facial lesions, we observed facial staphylococci in 2 cases, stibio-intolerance in 1 case, and a palpebral subcutaneous nodule in 1 case. In limb lesions the complications were: sporotrichoid nodules in 5 cases, vagal malaise (1 case), pyodermitis (1 case), erysipelas (1 case), necrosis (1 case), and urticaria (1 case). COMMENTARY The adverse effects of intralesional Glucantime are mostly infections, mainly observed in cephalic localization, and stibio-intolerance. For this reason, intralesional injection of Glucantime must be avoided in the cephalic region.
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Affiliation(s)
- A Masmoudi
- Service de Dermatologie, EPS Hédi-Chaker, CHU Hédi-Chaker, 3029 Sfax, Tunisie.
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40
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Bodet D, Bartralot R, Mollet J, Heras C, García-Patos V. Aportación a las erupciones acneiformes por inhibidores del receptor del factor de crecimiento epidérmico. Actas Dermo-Sifiliográficas 2006; 97:148-9. [PMID: 16595122 DOI: 10.1016/s0001-7310(06)73371-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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41
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Kumar CPG, Sundararajan T, Menon T, Venkatadesikalu M. Candidosis in children with onco-hematological diseases in Chennai, south India. Jpn J Infect Dis 2005; 58:218-21. [PMID: 16116254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Candida spp. are recognized as a leading contributor to mortality and morbidity in patients with onco-hematological malignancies. The rates and risk factors for mycotic infections in pediatric oncology patients are undetermined, particularly for those treated at centers in developing countries. The objective of the present study was to prospectively evaluate the species stratification and antifungal susceptibility profile of Candida spp. associated with superficial and systemic infection in children with onco-hematological diseases. Acute lymphoblastic leukemia was the most common underlying disease (71.4%) among the 91 children under study. Candida albicans was the predominant species, with 17/29 isolates (58.6%); followed by C. tropicalis, with 10/29 isolates (34.5%). The drug susceptibility data analysis for the clinical isolates of Candida revealed 17.2% (5/29) resistance to fluconazole. This study reinforces the need for the systematic surveillance of candidosis for the correct management of such life-threatening infections.
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42
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Affiliation(s)
- R J W Knight
- Department of Plastic and Reconstructive Surgery, Pinderfields General Hospital, Aberford Road, Wakefield, West Yorkshire WF1 4DG, UK.
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43
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López-Medrano F, San Juan R, Serrano O, Chaves F, Lumbreras C, Lizasoaín M, Herreros de Tejada A, Aguado JM. [Impact of a non-compulsory antibiotic control program (PACTA): cost reductions and decreases in some nosocomial infections]. Enferm Infecc Microbiol Clin 2005; 23:186-90. [PMID: 15826540 DOI: 10.1157/13073141] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Antibiotics account for 30% of hospital pharmacy expenses. More than 50% of the prescriptions are considered inappropriate; hence, programs devoted to optimizing the prescription of antibiotics should be developed. We present the results of a non-compulsory program for the assessment and control of antibiotic treatment in the University Hospital 12 de Octubre in Madrid. METHODS The program was applied in the hospitalization units of six medical and surgical departments. Treatments in all patients were checked daily and recommendations were made in writing, according to previously established criteria. The program was used for 12 months and the results were compared with those of the previous 12 months. RESULTS 1,280 treatments were reviewed and 524 recommendations were made (80% of them were accepted). There was a 13.82% reduction in the number of defined daily doses of antibiotics/100 inpatient-days. Antibiotic expenditure decreased by 65,352 euros (5,446 euros/month), implying a reduction of 1.21 euros/hospitalization-bed/day. There were no statistically significant differences in length of hospital stay or mortality between the two periods. A reduction in the incidence of Clostridium difficile diarrhea (p < 0.0001) and Candida spp. isolations (p < 0.05) was observed. CONCLUSIONS Following application of a non-compulsory control program, antibiotic prescription improved and expenditure decreased, with no change in length of hospital stay or mortality. There was a reduction in the incidence of some nosocomial infections. Acceptation of the program by the physicians of the departments implicated was favorable.
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44
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Abstract
Confidence intervals represent a routinely used standard method to document the uncertainty of estimated effects. In most cases, for the calculation of confidence intervals the conventional fixed 95% confidence level is used. Confidence curves represent a graphical illustration of confidence intervals for confidence levels varying between 0 and 100%. Although such graphs have been repeatedly proposed under different names during the last 40 years, confidence curves are rarely used in medical research. In this paper, we introduce confidence curves and present a short historical review. We draw attention to the different interpretation of one- and two-sided statistical inference. It is shown that these two options also have influence on the plotting of appropriate confidence curves. We illustrate the use of one- and two-sided confidence curves and explain their correct interpretation. In medical research more emphasis on the choice between the one- and two-sided approaches should be given. One- and two-sided confidence curves are useful complements to the conventional methods of presenting study results.
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Affiliation(s)
- Ralf Bender
- Institute for Quality and Efficiency in Health Care, Cologne, Germany.
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45
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Okamoto S, Kawabata S, Fujitaka H, Uehira T, Okuno Y, Hamada S. Vaccination with formalin-inactivated influenza vaccine protects mice against lethal influenza Streptococcus pyogenes superinfection. Vaccine 2004; 22:2887-93. [PMID: 15246625 DOI: 10.1016/j.vaccine.2003.12.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2003] [Accepted: 12/15/2003] [Indexed: 11/16/2022]
Abstract
Intranasal infection with non-lethal influenza A virus (IAV) followed by infection with group A streptococci (GAS) induces invasive, lethal GAS infections, including necrotizing fasciitis, in mice. We demonstrate that subcutaneous immunization of formalin-inactivated IAV vaccine or intranasal immunization of IAV vaccine and cholera toxin protected more than 75% of mice from death by lethal IAV-GAS superinfection. The increased survival rate correlates with increase in IAV neutralizing activity and the levels of serum anti-IAV IgG. Moreover, elimination of IAV from the lungs of vaccinated mice led to depletion of GAS associated with alveolar epithelial cells. These findings suggest that formalin-inactivated IAV vaccine may be useful for prevention of secondary bacterial infections following prior IAV exposure.
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Affiliation(s)
- Shigefumi Okamoto
- Department of Oral and Molecular Microbiology, Osaka University Graduate School of Dentistry, 1-8 Yamada-oka Suita, 565-0871, Japan
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46
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Apel D, Jakobs R, Lugauer J, Höffler U, Bohrer MH, Riemann JF. [Heavy diarrhea by low malignant B cell lymphoma]. Internist (Berl) 2004; 45:1043-6. [PMID: 15252712 DOI: 10.1007/s00108-004-1233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A 52-year old female presented with a low, malignant centroblastic-centrocytic lymphoma. After splenectomy and under steroid therapy it came to the eruption of a latent Strongyloides stercoralis infection, which the patient had presumably been suffering from for several years. Due to the immunodeficient condition and under continued steroid therapy even three courses of high dose anthelmintic therapy could not eradicate the parasites. The patient died of fulminant sepsis.
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Affiliation(s)
- D Apel
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen gGmbH.
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47
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[Especially in patients with diabetes, onychomycosis is not a harmless illness]. MMW Fortschr Med 2004; 146:45. [PMID: 15347086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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48
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Ledoux JM. Hypothesis of interference to superinfection between bovine spastic paresis and bovine spongiform encephalopathy; suggestions for experimentation, theoretical and practical interest. Med Hypotheses 2004; 62:346-53. [PMID: 14975501 DOI: 10.1016/j.mehy.2003.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Accepted: 11/21/2003] [Indexed: 11/16/2022]
Abstract
Sub-acute transmissible spongiform encephalopathies (TSEs) or prion diseases are diseases of little known etiology. The origin of these diseases would appear to be an abnormal protease-resistant prion protein (PrP(res)) which would be infectious by directly inducing its defective conformation to the normal native protein (PrP(C)). This hypothesis does not account for certain aspects of TSEs, such as interference to superinfection: in laboratory animals, inoculation by means of an attenuated strain with a long incubation period protects against later infection by a very virulent strain with a short incubation period. The hypothesis is put forward that there exists a possibility of interference to superinfection between neurodegenerative diseases of unknown origin, thought to be similar to TSEs, and a later infection by a TSE. The study of this interference between bovine spastic paresis (BSP) and bovine spongiform encephalopathy (BSE) could be used as a model for this hypothesis. BSP is a very rare disease among cattle, of unknown etiology; it is curable, in the very early stages, by using tryptophan and especially lithium, potentiated by copper and manganese. An etiology close to that of TSEs has been suggested on several occasions. If interference could be demonstrated between BSP and BSE, interesting data would be provided concerning the etiology, the pathogenesis and possibly the treatment and prevention of these diseases. Notably, such data could lead to the development of a treatment and a prevention with lithium and amino acids precursors of neuromediators (tryptophan, tyrosine, glutamic acid, etc.), as well as the developing of a vaccine to combat TSEs, especially BSE and scrapie.
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49
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Letonturier D. [Influenza can hide other infections]. Soins Gerontol 2004:42-5. [PMID: 15074246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Daniel Letonturier
- Unité de court séjour gériatrique, Fondation Chantepie-Mancier, L'Isle-Adam
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50
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Ivushkina LV, Mitrokhin SD, Moroz AM. [Role of some representatives of opportunistic microflora in development of secondary infection in patients with pulmonary tuberculosis]. Antibiot Khimioter 2004; 49:7-9. [PMID: 15850051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The results of the laboratory diagnosis of secondary (mixed) infection of the respiratory tracts in patients with respiratory tract tuberculosis were summarized. The study was performed for 12 months in a Tuberculosis Clinic. The species of the pathogens and the frequency of their detection in various clinical specimens from pulmonary tuberculosis patients were determined. The data on resistance of the strains of Streptococcus viridans group isolated from the pulmonary tuberculosis patients to various antimicrobials including new fluoroquinolones are presented.
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