Archive for November, 2005

Originales – Estado clínico, adherencia al TARGA y calidad de vida en pacientes con infección por el VIH tratados con antirretrovirales*

Fuente: EI&MC 1 Dic 2005 Vol 23  N.10 p.581-585   

Isabel Ruiz-Péreza  Antonio Olry de Labry-Limaa  Miguel ?ngel López-Ruzb  Alfonso del Arco-Jiménezc  Jesús Rodríguez-Bañod  Manuel Causse-Pradose  Juan Pasquau-Liañof  Patricia Martín-Ricog  José Luis Prada-Pardalh  Javier de la Torre-Limah  Manuel López-Gómezi  Miguel Marcosj  Nuria Muñozk  Dolores Moralesl  Isabel Muñozm 

aDepartamento de Salud Pública. Escuela Andaluza de Salud Pública. Granada.
bServicio de Medicina Interna. Unidad de Enfermedades Infecciosas. Hospital Universitario Virgen de las Nieves. Granada.
cServicio de Enfermedades Infecciosas. Hospital Universitario Costa del Sol. Marbella.
dServicio de Enfermedades Infecciosas. Hospital Virgen Macarena. Sevilla.
eServicio de Medicina Interna. Unidad de Enfermedades Infecciosas. Hospital Universitario Carlos Haya. Málaga. España.
fServicio de Medicina Interna. Unidad de Enfermedades Infecciosas. Hospital Universitario Virgen de las Nieves. Granada.
gServicio de Medicina Interna. Unidad de Enfermedades Infecciosas. Hospital Universitario Carlos Haya. Málaga. España.
hServicio de Enfermedades Infecciosas. Hospital Universitario Costa del Sol. Marbella.
iServicio de Medicina Interna. Unidad de Enfermedades Infecciosas. Hospital Universitario Virgen de las Nieves. Granada.
jServicio de Enfermedades Infecciosas. Hospital Universitario Costa del Sol. Marbella.
kServicio de Medicina Interna. Unidad de Enfermedades Infecciosas. Hospital Universitario Carlos Haya. Málaga. España.
lServicio de Enfermedades Infecciosas. Hospital Virgen Macarena. Sevilla.
mServicio de Medicina Interna. Unidad de Enfermedades Infecciosas. Hospital Universitario Carlos Haya. Málaga. España.

Introducción. La calidad de vida es uno de los métodos de evaluación subjetiva más utilizados en enfermedades de carácter crónico. El objetivo de este estudio es analizar la asociación entre parámetros clínicos y terapéuticos y las 11 dimensiones de calidad de vida en pacientes infectados por el virus de la inmunodeficiencia humana (VIH).

Métodos. Se realizó un estudio transversal con 320 pacientes en tratamiento antirretroviral de 4 hospitales andaluces. Se utilizó un cuestionario semiestructurado administrado por personal sanitario. La calidad de vida relacionada con la salud se midió a través del cuestionario MOS-HIV (Medical Outcomes Study HIV Health Survey), que es un instrumento específico para pacientes con VIH.

Resultados. El 73,4% de los entrevistados eran varones, el 35,6% tenían sida y el 88,1% fue considerado adherente al tratamiento. Los pacientes con una mayor carga viral presentaron puntuaciones más bajas en todas las dimensiones de la calidad de vida, a excepción de la función cognitiva. Los pacientes con sida mostraron una peor calidad de vida en 10 de las 11 dimensiones. Aquéllos con una adherencia adecuada al tratamiento antirretroviral mostraron una mejor calidad de vida en 10 dimensiones. No se detectaron diferencias estadísticamente significativas en las medias de las dimensiones del cuestionario MOS-HIV entre pacientes cuya combinación farmacológica incluía inhibidores de la proteasa y aquellos que no, a excepción de la dimensión de calidad de vida.

Conclusión. El estado clínico y la adherencia del paciente no sólo afectan a su supervivencia, sino también a diferentes dimensiones de su calidad de vida.

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November 30, 2005 at 10:42 am Leave a comment

Documento de consenso – Tratamiento antifúngico empírico en pacientes seleccionados con fiebre persistente y neutropenia

Fuente: Enf Infecc & Microbiol Clin  1 Dic 2005 Vol 23 N.10 p.609-614   

José Miguel Cisnerosa  Ildefonso Espigadob  Antonio Riveroc  Fernando Lozano de Leónd  Jorge Parrae  Antonio Ramón Colladof  José Manuel Lomasg  Jerónimo Pachón (y Sociedad Andaluza de Enfermedades Infecciosas)h 

aUnidad de Gestión Clínica de Enfermedades Infecciosas. Hospitales Universitarios Virgen del Rocío. Sevilla.
bServicio de Hematología. Hospitales Universitarios Virgen del Rocío. Sevilla.
cUnidad de Enfermedades Infecciosas. Hospital Universitario Reina Sofía. Córdoba.
dUnidad de Enfermedades Infecciosas. Hospital Universitario Virgen de Valme. Sevilla.
eUnidad de Enfermedades Infecciosas. Hospital Clínico San Cecilio. Granada.
fUnidad de Enfermedades Infecciosas. Hospital Torrecárdenas. Almería
gServicio de Medicina Interna. Hospital Juan Ramón Jiménez. Huelva. España.
hUnidad de Gestión Clínica de Enfermedades Infecciosas. Hospitales Universitarios Virgen del Rocío. Sevilla.

El tratamiento antifúngico empírico (TAE) en los pacientes con neutropenia tiene como objetivo principal mejorar el mal pronóstico de los pacientes con infección fúngica invasora, mediante el tratamiento precoz de la misma. La Sociedad Americana de Enfermedades Infecciosas recomienda iniciar el TAE en los pacientes con fiebre después de 5-7 días de tratamiento antibacteriano y en los que la resolución de la neutropenia no es inminente. Sin embargo, el TAE no ha demostrado mayor eficacia que el placebo, no obtiene mejores resultados que el tratamiento antifúngico dirigido, su efectividad es mínima, no es inocuo y, con la mayoría de los antifúngicos, es muy poco eficiente. Por todas estas razones consideramos que la citada recomendación del TAE no está justificada. En su lugar proponemos la realización del TAE en pacientes seleccionados por criterios clínicos y factores de riesgo.

November 30, 2005 at 10:40 am Leave a comment

ORIGINAL ARTICLE – Effectiveness of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers at hospital admission to prevent hospital-acquired MRSA infections

Source: Clinical Microbiology & Infection Vol 11 N. 6 P.457 Jun  2005

M. H. Wernitz1, S. Swidsinski2, K. Weist3, D. Sohr3, W. Witte4, K-P. Franke1, D. Roloff1, H. Rüden3 and S. K. Veit1

Abstract

Screening of potential MRSA-positive patients at hospital admission is recommended in German and international guidelines. This policy has been shown to be effective in reducing the frequency of nosocomial MRSA transmissions in the event of an outbreak, but the influence of screening on reducing hospital-acquired MRSA infections in a hospital setting where MRSA is endemic is not yet well-documented. This study describes the effect of hospital-wide screening of defined risk groups in a 700-bed acute care hospital during a period of 19 months. In a cohort study with a 19-month control period, the frequencies of hospital-acquired MRSA infections were compared with and without screening. In the control period, there were 119 MRSA-positive patients, of whom 48 had a hospital-acquired MRSA infection. On the basis of this frequency, a predicted total of 73.2 hospital-acquired MRSA infections was calculated for the screening period, but only 52% of the expected number (38 hospital-acquired MRSA infections) were observed, i.e., 48% of the predicted number of hospital-acquired MRSA infections were prevented by the screening programme. The screening programme was performed with minimal effort and can therefore be recommended as an effective measure to help prevent hospital-acquired MRSA infections.

November 29, 2005 at 5:31 pm Leave a comment

ORIGINAL ARTICLE – Cost analysis of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers in the context of diagnosis related groups (DRG) payment

Source: Clinical Microbiology & Infection Vol 11 N.6 P.466 June 2005

M. H. Wernitz1, S. Keck2, S. Swidsinski1, S. Schulz2 and S. K. Veit1

Abstract

The costs of a hospital-wide selective screening programme were analysed for a period of 19 months. During this time, 539 inpatients were screened, of whom 111 were MRSA-positive. Based on microbiological costs (staff and materials) and the costs of preventive contact isolation for 2 days until microbiological results were available (including material costs for medical consumable goods and the costs of additional nursing time), a total of €26 241.51 was spent for the 539 patients screened. Based on cost units, the costs were €39.96 for a patient found to be MRSA-negative and €82.33 for a patient found to be MRSA-positive. Under the prospective diagnosis related groups (DRG) payment system in Germany, the costs of a prolonged hospital stay resulting from a hospital-acquired MRSA infection (HA-MRSA-I) are not reimbursed adequately by revenues, with a calculated average cost-revenue loss/patient with HA-MRSA-I of €5705.75. The screening programme was able to prevent 48% of predicted HA-MRSA-Is (35.2 patients with infection), thereby saving a predicted €200 782.73. After subtracting the screening costs, there was a net saving of €110 236.56 annually. A sensitivity analysis of the break-even points for different screening frequencies and different MRSA incidence rates indicated that the screening programme became cost-effective at a low MRSA incidence rate, meaning that it can be recommended for most hospitals with an MRSA problem.

November 29, 2005 at 5:30 pm Leave a comment

FOOD SAFETY – Human Health Consequences of Antimicrobial Drug Resistant Salmonella and Other Foodborne Pathogens

Source: Clinical Infectious Diseases 2005;41:1613-1620

INVITED ARTICLE
Frederick J. Angulo, Section Editor

Kåre Mølbak

Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark

There are several clinical and public health consequences associated with antimicrobial drug resistance in non-Typhi Salmonella species and other foodborne pathogens. If bacteria acquire resistance to clinically important antimicrobial drugs, early empirical treatment may fail, and there will be limitations in the choices of treatment after the establishment of microbial diagnosis. Drug-resistant gastrointestinal pathogens preferentially cause illness in persons receiving antimicrobial drugs for any medical condition. Consequently, emerging resistance in foodborne pathogens may result in increased burdens of illness and outbreaks in settings where patients are treated with antimicrobial drugs. Finally, resistance may be associated with increased virulence, and several epidemiological studies have demonstrated that infections with drug-resistant non-Typhi Salmonella serotypes and Campylobacter species are associated with excess mortality and morbidity. Mitigation of drug resistance in foodborne bacteria is likely to be of benefit for human health.

November 29, 2005 at 1:42 am Leave a comment

AGING AND INFECTIOUS DISEASES INVITED ARTICLE – Chronic Hepatitis C Virus Infection in Older Adults

Source: Clinical Infectious Diseases  2005;41:1606-1612

Kevin P. High, Section Editor

Esther-Lee Marcus1 and Ran Tur-Kaspa2,3

1Acute Geriatric Department, Herzog Hospital, The Hebrew University-Hadassah Medical School, Jerusalem, and 2Department of Medicine D and 3Liver Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Most of the older adults with chronic hepatitis C virus infection acquired the disease earlier in life. These patients often present with complications of liver disease, mainly cirrhosis and hepatocellular carcinoma. The burden of chronic hepatitis C virus infection in elderly persons is expected to increase significantly in the United States during the next 2 decades. It seems important that, for elderly patients with chronic hepatitis C, the risk-benefit of combination antiviral therapy consisting of pegylated interferon and ribavirin should be assessed on an individual basis. Assessment should be performed in all cases before considering treatment, and it should include evaluation of the degree of liver fibrosis by means of liver biopsy or, possibly, by means of noninvasive methods. Novel antiviral drugs that may have fewer adverse effects, such as protease inhibitors, may serve as potential alternatives. It is recommended that elderly patients (up to the age of 75 years) be included in randomized trials of chronic hepatitis C virus infection treatment.

November 29, 2005 at 1:40 am Leave a comment

HIV/AIDS MAJOR ARTICLE – Bacterial Diarrhea in Persons with HIV Infection, United States, 19922002

Source: Clinical Infectious Diseases 2005;41:1621-1627

Travis H. Sanchez,1 John T. Brooks,1 Patrick S. Sullivan,1 Marta Juhasz,1 Eric Mintz,2 Mark S. Dworkin,1 Jeffrey L. Jones,1 and the Adult/Adolescent Spectrum of HIV Disease Study Groupa

1Division of HIV/AIDS PreventionSurveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, and 2Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Disease, National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia

Background. To describe trends in bacterial diarrhea among human immunodeficiency virus (HIV)infected persons during 19922002, we examined data from a longitudinal record review study of persons with HIV infection who were receiving medical care in >100 medical facilities in 9 major United States cities.

Methods. An analysis was performed using data from 44,778 persons who were followed up for a mean of 2.6 years. We calculated incidence rates and rate ratios for bacterial diarrhea, by stage of HIV disease, and determined odds ratios (ORs) to compare bacterial diarrhea diagnosis in 2002 versus 1992.

Results. The mean annual incidence of bacterial diarrhea was 7.2 cases per 1000 person-years. The incidence of Clostridium difficileassociated diarrhea, the most common bacterial cause of diarrhea, was 4.1 cases per 1000 person-years. Compared with persons without AIDS, persons with AIDS were more likely to have bacterial diarrhea (incidence rate ratio, 1.39.9, varying by clinical versus immunologic AIDS and type of bacterial diarrhea). Between 1992 and 2002, the overall rate of bacterial diarrhea in persons with clinical AIDS decreased (OR, 0.4; 95% confidence interval, 0.20.6). During the same period, bacterial diarrhea rates among other persons in the analysis did not significantly change.

Conclusions. C. difficile is the most common recognized cause of bacterial diarrhea among persons infected with HIV. The risk for bacterial diarrhea increases with increased severity of HIV disease. Health care professionals should be aware that patients with AIDS are at increased risk for bacterial diarrhea, and they should reinforce recommendations for decreasing the chances of acquiring bacterial diarrhea.
 

 

     
 

November 29, 2005 at 1:36 am Leave a comment

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