Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America
Clinical Infectious Diseases 1 March 2010 V.50 N.5 p.625-663
IDSA GUIDELINES
Thomas M. Hooton,1 Suzanne F. Bradley,3 Diana D. Cardenas,2 Richard Colgan,4 Suzanne E. Geerlings,7 James C. Rice,5,a Sanjay Saint,3 Anthony J. Schaeffer,6 Paul A. Tambayh,8 Peter Tenke,9 and Lindsay E. Nicolle10,11
Departments of 1Medicine and 2Rehabilitation Medicine, University of Miami, Miami, Florida; 3Department of Internal Medicine, Ann Arbor Veterans Affairs Medical Center and the University of Michigan, Ann Arbor, Michigan; 4Department of Family and Community Medicine, University of Maryland, Baltimore; 5Department of Medicine, University of Texas, Galveston; 6Department of Urology, Northwestern University, Chicago, Illinois; 7Department of Infectious Diseases, Tropical Medicine, and AIDS, University of Amsterdam, Amsterdam, The Netherlands; 8Department of Medicine, National University of Singapore, Singapore; 9Department of Urology, Jahn Ference Del‐Pesti Korhaz, Budapest, Hungary; and Departments of 10Internal Medicine and 11Medical Microbiology, University of Manitoba, Winnipeg, Canada
Guidelines for the diagnosis, prevention, and management of persons with catheter-associated urinary tract infection (CA‐UTI), both symptomatic and asymptomatic, were prepared by an Expert Panel of the Infectious Diseases Society of America. The evidence-based guidelines encompass diagnostic criteria, strategies to reduce the risk of CA‐UTIs, strategies that have not been found to reduce the incidence of urinary infections, and management strategies for patients with catheter-associated asymptomatic bacteriuria or symptomatic urinary tract infection. These guidelines are intended for use by physicians in all medical specialties who perform direct patient care, with an emphasis on the care of patients in hospitals and long-term care facilities.
abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/650482
1 comment February 7, 2010
Two Cases of Daptomycin-Induced Eosinophilic Pneumonia and Chronic Pneumonitis
Clinical Infectious Diseases 1 March 2010 V.50 N.5 p.737–740
BRIEF REPORT
Yasir Lal and Aristides P. Assimacopoulos
Academic Assistant Professor, Sanford School of Medicine of the University of South Dakota, Sioux Falls
We present 2 elderly patients who developed lung infiltrates associated with eosinophilia during intravenous daptomycin treatment. Both patients improved quickly after daptomycin was stopped and steroid treatment was initiated. However, complete recovery did not occur, and both patients became chronically steroid dependent.
abstract
Add comment February 7, 2010
Pegylated Interferon-α for Treating Chronic Hepatitis E Virus Infection after Liver Transplantation
Clinical Infectious Diseases 1 March 2010 V.50 N.5 e30–e33
BRIEF REPORT
Nassim Kamar,1,4 Lionel Rostaing,1,5 Florence Abravanel,5,6 Cyril Garrouste,1 Laure Esposito,1 Isabelle Cardeau-Desangles,1 Jean Michel Mansuy,4 Janick Selves,7 Jean Marie Peron,8 Philippe Otal,2 Fabrice Muscari,3 and Jacques Izopet5,6
Departments of 1Nephrology, Dialysis and Organ Transplantation, 2Radiology, and 3Liver Transplantation and 4Institut National de la Santé et de la Recherche Médicale (INSERM) U858, IFR –BMT, Centre Hospitalier Universitaire (CHU) Rangueil, and 5INSERM U563, IFR–BMT, and Departments of 6Virology, 7Histopathology, and 8Hepatology, CHU Purpan, Toulouse, France
This study assessed the effect of a 3-month course of pegylated interferon-α-2a (Peg-IFN-α-2a) in 3 liver transplant patients with chronic active hepatitis E. A virological response was sustained for 6 and 5 months in 2 patients after Peg-IFN-α-2a therapy was completed. A relapse was observed in the third patient.
abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/650488
Add comment February 7, 2010
MRSA as a cause of lung infection including airway infection, community-acquired pneumonia and hospital-acquired pneumonia
European Respiratory Journal 1 Dec 2009 V.34 N.6 p.1470-1476
S. Defres1, C. Marwick2 and D. Nathwani1
1 Infection Unit, Ninewells Hospital and Medical School, and 2 MacKenzie Building, University of Dundee, Dundee, UK.
Staphylococcus aureus has been recognised as a cause of community-acquired pneumonia, albeit uncommon, and an important cause of healthcare-associated (HA) pneumonia, including ventilator-associated pneumonia. Resistance of S. aureus to methicillin developed shortly after its introduction into clinical practice. Since then, methicillin-resistant S. aureus (MRSA) has predominantly been a feature of hospital-acquired, or latterly HA, infections as the boundaries became more blurred between the community and hospital environments.
However, more recently true community-acquired (CA)-MRSA infections have been detected and are becoming increasingly common, especially in the USA. Europe has not been immune to the development of MRSA in healthcare settings and although the prevalence of CA-MRSA is currently relatively low, there is the risk of wider spread. These new CA-MRSA strains appear to behave differently to HA-MRSA strains. Although predominantly causing skin and soft tissue infections, mainly as boils and abscesses requiring drainage, life threatening invasive infections including necrotising pneumonia can also occur. This article summarises the pathogenesis and clinical presentations of MRSA-related lung infections.
abstract
Add comment February 7, 2010
Multicenter Study Evaluating the Role of Enterococci in Secondary Bacterial Peritonitis
Journal of Clinical Microbiology 1 Feb 2010 V.48 N.2 p.456-459
Emilia Cercenado,1 Luis Torroba,2 Rafael Cantón,3 Luis Martínez-Martínez,4 Fernando Chaves,5 Jose Angel García-Rodríguez,6 Carmen Lopez-Garcia,7 Lorenzo Aguilar,8* César García-Rey,9 Nuria García-Escribano,9 and Emilio Bouza1
Microbiology Department, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo 46, Madrid 28007, Spain,1 Microbiology Department, Hospital Virgen del Camino, Irunlarrea 4, Pamplona 31008, Spain,2 Microbiology Department, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km. 9.100, Madrid 28034, Spain,3 Microbiology Department, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, Santander 39008, Spain,4 Microbiology Department, Hospital 12 de Octubre, Avda. de Córdoba s/n, Madrid 28041, Spain,5 Microbiology Department, Hospital Clínico Universitario de Salamanca, Paseo San Vicente 58-182, Salamanca 37007, Spain,6 Microbiology Department, Hospital Universitario Puerta del Mar, Avda. Ana de Viya, 21, Cádiz 11009, Spain,7 Microbiology Department, School of Medicine, Universidad Complutense, Avda. Complutense s/n, Madrid 28040, Spain,8 Medical Department, Wyeth Farma S.A., Ctra. N-I, km. 23 Desvío Algete Km. 1, San Sebastián de los Reyes, Madrid, Spain9
A 1-year prospective multicenter study was performed to explore the significance of the presence of enterococci in cultures of peritoneal fluid from patients with secondary bacterial peritonitis in seven Spanish hospitals. The clinical records of patients with positive peritoneal fluid cultures were reviewed and distributed into cases (patients with cultures yielding enterococci) and controls (patients with cultures not yielding enterococci). Of a total of 158 records, 38 (24.1%) were cases and 120 (75.9%) were controls. The percentages or the scores (cases versus controls) for the variables included in the multivariate analysis were as follows: age of >50 years, 89.5% versus 68.3%; malignancy, 39.5% versus 18.3%; chronic obstructive pulmonary disease (COPD), 15.8% versus 4.2%; postoperative peritonitis, 55.3% versus 30.1%; nosocomial onset, 57.9% versus 34.2%; a higher Charlson comorbidity index, 3.29 ± 3.38 versus 1.84 ± 2.31; APACHE II score, 10.71 ± 4.37 versus 8.76 ± 5.49; ultimately or rapidly fatal disease, 63.2% versus 34.8%; need for surgical reintervention, 36.1% versus 15.1%; and admission to an intensive care unit, 45.9% versus 30.8%. In the multivariate analysis, enterococci were associated only with postoperative peritonitis (P = 0.009; odds ratio [OR] = 5.0; 95% confidence interval [CI] = 1.49 to 16.80), a higher Charlson comorbidity index (P = 0.002; OR = 1.30; 95% CI = 1.11 to 1.54), and COPD (P = 0.046; OR = 6.50; 95% CI = 1.04 to 40.73). The results of this study showed that enterococci were associated with comorbidity. An association with mortality could not be demonstrated.
abstract
Add comment February 7, 2010
Characterization of Streptococcus milleri Group Isolates from Expectorated Sputum of Adult Patients with Cystic Fibrosis
Journal of Clinical Microbiology 1 Feb 2010 V.48 N.2 p.395-401
Margot E. Grinwis,1 Christopher D. Sibley,1 Michael D. Parkins,2,4 Christina S. Eshaghurshan,1 Harvey R. Rabin,2,4 and Michael G. Surette1,3*
Department of Microbiology and Infectious Diseases,1 Department of Medicine,2 Department of Biochemistry and Molecular Biology,3 Adult Cystic Fibrosis Clinic, University of Calgary, Calgary, Alberta, Canada T2N 4N14
With the recent insights into the Streptococcus milleri group (SMG) as pulmonary pathogens in patients with cystic fibrosis (CF), we sought to characterize 128 isolates from the sputum of adults with CF, along with 45 isolates from patients with invasive diseases for comparison. The tests performed included Lancefield grouping; tests for hemolysis; tests for the production of hyaluronidase, chondroitin sulfatase, DNase, proteases, and hydrogen peroxide; and PCR for the detection of the intermedilysin gene (ily). We also generated biochemical profiles with the Rapid ID Strep 32 API system and tested cell-free supernatants for the presence of the signal molecule autoinducer-2 (AI-2) using a Vibrio harveyi bioassay with a subset of CF strains. The S. intermedius isolates from both strain collections were similar, while the S. constellatus and S. anginosus isolates yielded several biotypes that differed in prevalence between the two strain collections. Beta-hemolytic, Lancefield group C S. constellatus comprised 74.4% of the S. constellatus isolates from patients with CF but only 13.3% of the corresponding isolates from patients with invasive infections. This was the only S. constellatus biotype associated with pulmonary exacerbations. Hyaluronidase-positive S. anginosus was detected only among the isolates from patients with CF. Strain-to-strain variability in AI-2 expression was evident, with the mean values being the highest for S. anginosus, followed by S. constellatus and then S. intermedius. Cluster analysis and 16S rRNA sequencing revealed that the species of SMG could be accurately determined with a minimum of three phenotypic tests: tests for the Lancefield group, hyaluronidase production, and chondroitin sulfatase production. Furthermore, isolates from patients with invasive infections clustered with isolates from the sputum of patients with CF, suggesting that the respiratory tract isolates were equally pathogenic.
abstract
Add comment February 7, 2010
Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial
Lancet Feb 06, 2010 V.375 N.9713 p.463 – 474
Original TextLila Bouadma MD a, Charles-Edouard Luyt MD e, Florence Tubach MD b, Christophe Cracco MD f, Antonio Alvarez MD g, Carole Schwebel MD h, Frédérique Schortgen MD i, Sigismond Lasocki MD c, Prof Benoît Veber MD j, Monique Dehoux MD d, Maguy Bernard MD k, Blandine Pasquet MS b, Prof Bernard Régnier MD a, Prof Christian Brun-Buisson MD i, Prof Jean Chastre MD e *, Prof Michel Wolff MD a *, for the PRORATA trial group†
Background
Reduced duration of antibiotic treatment might contain the emergence of multidrug-resistant bacteria in intensive care units. We aimed to establish the effectiveness of an algorithm based on the biomarker procalcitonin to reduce antibiotic exposure in this setting.
Methods
In this multicentre, prospective, parallel-group, open-label trial, we used an independent, computer-generated randomisation sequence to randomly assign patients in a 1:1 ratio to procalcitonin (n=311 patients) or control (n=319) groups; investigators were masked to assignment before, but not after, randomisation. For the procalcitonin group, antibiotics were started or stopped based on predefined cut-off ranges of procalcitonin concentrations; the control group received antibiotics according to present guidelines. Drug selection and the final decision to start or stop antibiotics were at the discretion of the physician. Patients were expected to stay in the intensive care unit for more than 3 days, had suspected bacterial infections, and were aged 18 years or older. Primary endpoints were mortality at days 28 and 60 (non-inferiority analysis), and number of days without antibiotics by day 28 (superiority analysis). Analyses were by intention to treat. The margin of non-inferiority was 10%. This trial is registered with ClinicalTrials.gov, number NCT00472667.
Findings
Nine patients were excluded from the study; 307 patients in the procalcitonin group and 314 in the control group were included in analyses. Mortality of patients in the procalcitonin group seemed to be non-inferior to those in the control group at day 28 (21·2% [65/307] vs 20·4% [64/314]; absolute difference 0·8%, 90% CI −4·6 to 6·2) and day 60 (30·0% [92/307] vs 26·1% [82/314]; 3·8%, −2·1 to 9·7). Patients in the procalcitonin group had significantly more days without antibiotics than did those in the control group (14·3 days [SD 9·1] vs 11·6 days [SD 8·2]; absolute difference 2·7 days, 95% CI 1·4 to 4·1, p<0·0001).
Interpretation
A procalcitonin-guided strategy to treat suspected bacterial infections in non-surgical patients in intensive care units could reduce antibiotic exposure and selective pressure with no apparent adverse outcomes.
Funding
Assistance Publique-Hôpitaux de Paris, France, and Brahms, Germany.
abstract
Lancet Feb 06, 2010 V.375 N.9713 p.435 – 436
Comment
Will procalcitonin reduce antibiotic use in intensive care?
Marin H Kollef
In The Lancet today, Lila Bouadma and colleagues 1 report the results of the PRORATA trial. These investigators assessed the effect of a procalcitonin-guided algorithm on the duration of antimicrobial therapy in critically ill patients. The main findings were that patients in the procalcitonin group had significantly more antibiotic-free days than did those in the control group, who were managed according to present practices. Mortality, relapsing infection, and days free of mechanical ventilation d …
abstract
Add comment February 6, 2010
Investigating an Airborne Tularemia Outbreak, Germany
Emerging Infectious Diseases Feb 2010 V.16 N.2
Anja M. Hauri, Iris Hofstetter, Erik Seibold, Philip Kaysser, Juergen Eckert, Heinrich Neubauer, and Wolf D. Splettstoesser1
Hesse State Health Office, Dillenburg, Germany (A.M. Hauri); Public Health Authority Darmstadt-Dieburg, Darmstadt, Germany (I. Hofstetter, J. Eckert); National Reference Laboratory for Tularemia, Munich, Germany (E. Seibold, P. Kaysser, W.D. Splettstoesser); and Institute of Bacterial Zoonoses, Jena, Germany (H. Neubauer)
Abstract
In November 2005, an outbreak of tularemia occurred among 39 participants in a hare hunt in Hesse, Germany. Previously reported tularemia outbreaks in Germany dated back to the 1950s. We conducted a retrospective cohort study among participants and investigated the environment to identify risk factors for infection. Ten participants had serologic evidence of acute Francisella tularensis infection; 1 other participant died before laboratory confirmation was obtained. Presence within 5 meters of the place where disemboweled hares were rinsed with a water hose was the risk factor most strongly associated with infection (risk ratio 22.1; 95% confidence interval 13.2–154.3). Swabs taken at the game chamber and water samples were PCR negative for F. tularensis. Eleven of 14 hare parts showed low-level concentrations of F. tularensis, compatible with cross-contamination. More than half of case-patients may have acquired infection through inhalation of aerosolized droplets containing F. tularensis generated during rinsing of infected hares.
Full Text
http://www.cdc.gov/eid/content/16/2/238.htm
Add comment February 2, 2010
Detection of Pandemic (H1N1) 2009 Virus in Patients Treated with Oseltamivir
Emerging Infectious Diseases Feb 2010 V.16 N.2
Letter
David Boutolleau, Nadhira Houhou, Claire Deback, Henri Agut, and Françoise Brun-Vézinet
Université Pierre et Marie Curie 6, Paris, France; (D. Boutolleau, C. Deback, H. Agut); Pitié-Salpêtrière University Hospitals, Paris (D. Boutolleau, C. Deback, H. Agut); and Bichat-Claude Bernard University Hospital, Paris (N. Houhou, F. Brun-Vézinet)
To the Editor: In April 2009, an influenza outbreak caused by a novel strain of influenza virus A (H1N1) was identified in Mexico. The rapid spread of this new virus among humans led the World Health Organization to raise the phase of pandemic alert to 6. We report results from the 2 virology laboratories from university hospitals that were involved in the surveillance network of pandemic (H1N1) 2009 in Paris at the beginning of the outbreak in France….
Full Text
http://www.cdc.gov/eid/content/16/2/351.htm
Add comment February 2, 2010
