Archive for August 27, 2009
Immunization Programs for Infants, Children, Adolescents, and Adults: Clinical Practice Guidelines by the Infectious Diseases Society of America
Clinical Infectious Diseases 15 September 2009 V.49 N.6 p.817–840
Larry K. Pickering,1 Carol J. Baker, Gary L. Freed, Stanley A. Gall, Stanley E. Grogg, Gregory A. Poland, Lance E. Rodewald, William Schaffner, Patricia Stinchfield, Litjen Tan, Richard K. Zimmerman, and Walter A. Orenstein
1National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Evidence‐based guidelines for immunization of infants, children, adolescents, and adults have been prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). These updated guidelines replace the previous immunization guidelines published in 2002. These guidelines are prepared for health care professionals who care for either immunocompetent or immunocompromised people of all ages. Since 2002, the capacity to prevent more infectious diseases has increased markedly for several reasons: new vaccines have been licensed (human papillomavirus vaccine; live, attenuated influenza vaccine; meningococcal conjugate vaccine; rotavirus vaccine; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis [Tdap] vaccine; and zoster vaccine), new combination vaccines have become available (measles, mumps, rubella and varicella vaccine; tetanus, diphtheria, and pertussis and inactivated polio vaccine; and tetanus, diphtheria, and pertussis and inactivated polio/Haemophilus influenzae type b vaccine), hepatitis A vaccines are now recommended universally for young children, influenza vaccines are recommended annually for all children aged 6 months through 18 years and for adults aged 50 years, and a second dose of varicella vaccine has been added to the routine childhood and adolescent immunization schedule. Many of these changes have resulted in expansion of the adolescent and adult immunization schedules. In addition, increased emphasis has been placed on removing barriers to immunization, eliminating racial/ethnic disparities, addressing vaccine safety issues, financing recommended vaccines, and immunizing specific groups, including health care providers, immunocompromised people, pregnant women, international travelers, and internationally adopted children. This document includes 46 standards that, if followed, should lead to optimal disease prevention through vaccination in multiple population groups while maintaining high levels of safety.
Impact of Quinolone Restriction on Resistance Patterns of Escherichia coli Isolated from Urine by Culture in a Community Setting
Clinical Infectious Diseases 15 September 2009 V.49 N.6 p.869-875
Bat Sheva Gottesman,1,2 Yehuda Carmeli,2,3 Pnina Shitrit,1,2 and Michal Chowers1,2
1Infectious Diseases Unit, Meir Medical Center, Kfar Saba, and 2Sackler Medical School, Tel Aviv University, and 3Division of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Background.Decreased antimicrobial susceptibility after increased antibiotic use is a known phenomenon. Restoration of susceptibility once antimicrobial use is decreased is not self‐evident. Our objective was to evaluate, in a community setting, the impact of quinolone restriction on the antimicrobial resistance of E. coli urine isolates.
Methods.We conducted a retrospective, quasi‐experimental ecological study to assess the proportion of quinolone‐susceptible E. coli urine isolates in the periods before, during, and after a nationwide restriction on ciprofloxacin use was implemented. We used an interrupted time interval analysis for outcome evaluation.
Results.We found a significant decline in quinolone consumption, measured as defined daily doses (DDDs) per month, between the preintervention and intervention periods (point estimate, −1827.3 DDDs per month; 95% confidence interval [CI], −2248.8 to −1405.9 DDDs per month; ). This decline resulted in a significant decrease in E. coli nonsusceptibility to quinolones, from a mean of 12% in the preintervention period to a mean of 9% in the intervention period (odds ratio, 1.35; ). The improved susceptibility pattern reversed immediately when quinolone consumption rose. Moreover, a highly significant inverse relationship was found between the level of quinolone use (regardless of intervention period) and the susceptibility of E. coli urine isolates to quinolone (odds ratio, 1.70; 95% CI, 1.26–2.28). During the months of highest quinolone use (8321 DDDs per month), the proportion of nonsusceptibility was 14%, whereas during the months of lowest quinolone use (4027 DDDs per month), the proportion of nonsusceptibility was 9%. An average decrease in resistance of 1.16% was observed for each decrease of 1000 DDDs.
Conclusion.Reducing quinolone consumption can lead to an immediate increase in the susceptibility of E. coli urine isolates to quinolones.
Use of Peroxisome Proliferator‐Activated Receptor γ Agonists as Adjunctive Treatment for Plasmodium falciparum Malaria: A Randomized, Double‐Blind, Placebo‐Controlled Trial
Clinical Infectious Diseases 15 September 2009 V.49 N.6 p.841–849
Andrea K. Boggild,1,a Srivicha Krudsood,6,a Samir N. Patel,2,3 Lena Serghides,3,4 Noppadon Tangpukdee,6 Kevin Katz,5 Polrat Wilairatana,6 W. Conrad Liles,1,2,3,4 Sornchai Looareesuwan,6,b and Kevin C. Kain1,2,3,4
1Tropical Disease Unit, Toronto General Hospital of the University Health Network, 2Department of Laboratory Medicine and Pathobiology and 3Division of Infectious Diseases, Department of Medicine, University of Toronto, and 4McLaughlin‐Rotman Centre for Global Health, Toronto General Hospital, McLaughlin Centre for Molecular Medicine, University of Toronto, and 5North York General Hospital, Toronto, Ontario, Canada; 6Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Background.Despite the use of potent antimalarial drugs, the fatality rate associated with severe malaria remains high. Adjunctive therapies that target the immunopathological responses to infection may decrease mortality associated with severe malaria. We hypothesized that peroxisome proliferator‐activated receptor γ agonists (eg, rosiglitazone) would modulate the host’s innate immune response to malaria and improve outcome.
Methods.In a randomized, double‐blind, placebo‐controlled, phase I/II trial of treatment for malaria acquired in Thailand, we investigated the safety, tolerability, and efficacy of rosiglitazone use for parasite clearance and for reducing malaria‐induced inflammation. Sequential patients with uncomplicated Plasmodium falciparum malaria were randomly assigned to 1 of 2 groups: 70 patients received rosiglitazone 4 mg twice daily for 4 days, and 70 patients received a placebo twice daily for 4 days. Both groups also received standard antimalarial therapy (ie, a fixed combination of 1000 mg of atovaquone per day for 3 days and 400 mg of proguanil per day for 3 days). Primary efficacy outcomes were 50% and 90% parasite clearance times (PCTs). Secondary outcomes were fever clearance time, levels of inflammatory mediators, blood glucose measurements, aminotransferase levels, admission to intensive care, and subjective tolerability of study drug.
Results.For the 70 patients who received rosiglitazone, parasite clearance from peripheral blood was significantly enhanced, compared with the 70 patients who received a placebo (mean 50% PCT, 19.0 h vs. 24.6 h [ ]; mean 90% PCT, 30.9 h vs. 40.4 h [ ]). Also, the patients who received rosiglitazone had reduced inflammatory responses to infection, compared with the patients who received a placebo (ie, interleukin‐6 levels at 24 h [ ] and at 48 h [ ] and monocyte chemoattractant protein–1 level at 48 h [ ]). There were no significant differences between the 2 groups with regard to safety and tolerability of treatment, and there were no admissions the intensive care unit or deaths.
Conclusions.The use of rosiglitazone is a well‐tolerated adjunct to standard therapy for nonsevere P. falciparum malaria. Treatment with rosiglitazone increased parasite clearance and decreased inflammatory biomarkers associated with adverse malaria outcomes.