Archive for August 3, 2008

Nevirapine Resistance in Women and Infants after First versus Repeated Use of Single-Dose Nevirapine for Prevention of HIV-1 Vertical Transmission

The Journal of Infectious Diseases  15 Aug  2008  V.198  N.4  p.465-469

BRIEF REPORT

Tamara S. Flys,1 Michelle S. McConnell,2 Flavia Matovu,3 Jessica D. Church,1 Danstan Bagenda,3,4 Leila Khaki,1 Paul Bakaki,3,a Michael C. Thigpen,2 Chineta Eure,2 Mary Glenn Fowler,2,a and Susan H. Eshleman1

1Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; 2Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; 3Makerere University–Johns Hopkins University Research Collaboration and 4Makerere University School of Public Health, Kampala, Uganda

abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/590160

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August 3, 2008 at 6:00 pm Leave a comment

Cervical necrotizing fasciitis: 8-years’ experience of microbiology

European Journal of Clinical Microbiology & Infectious Diseases  Aug 2008  V.27  N.8  p.691 – 695

V. Fihman1 , L. Raskine1, F. Petitpas2, J. Mateo2, R. Kania3, J. Gravisse1, M. Resche-Rigon4, I. Farhat2, B. Berçot1, D. Payen2, M. J. Sanson-Le Pors1, P. Herman3 and A. Mebazaa2

(1)  Service de Bactériologie-Virologie, Université Paris 7—Denis Diderot, Groupe Hospitalier Lariboisière-Fernand Widal, GHU Nord, Assistance Publique—Hôpitaux de Paris, 2 rue Ambroise Paré, 75475 Paris Cedex 10 Paris, France
(2)  Département d’Anesthésie-Réanimation, Université Paris 7—Denis Diderot, Groupe Hospitalier Lariboisière-Fernand Widal, GHU Nord, Assistance Publique—Hôpitaux de Paris, Paris, France
(3)  Service d’Oto-Rhino-Laryngologie, Université Paris 7—Denis Diderot, Groupe Hospitalier Lariboisière-Fernand Widal, GHU Nord, Assistance Publique—Hôpitaux de Paris, Paris, France
(4)  Département de Biostatistique et Informatique Médicale, INSERM U717, Université Paris 7, Hôpital Saint-Louis, GHU Nord, Assistance Publique—Hôpitaux de Paris, Paris, France

Abstract  Cervical necrotizing fasciitis (CNF) is a life-threatening complication of pharyngeal or dental infections. The aim of this paper was to investigate whether dental or pharyngeal source result from different pathogen(s) in CNF and whether antibiotics, given before admission, influence the antimicrobial resistance of pathogens. In 152 CNF patients, Streptococcus milleri group and Prevotella species were the predominant isolates, frequently copathogens, mostly in dental CNF samples. Penicillin and clindamycin resistance were observed in 39% and 37% of cases, respectively, independently of any previous antibiotic therapy. Thus, a combined aerobe–anaerobe infection may have a synergistic effect, which allows the infection to spread in cervical tissues.

abstract
http://www.springerlink.com/content/m82604421n152723/

August 3, 2008 at 5:58 pm Leave a comment

Prognostic factors and impact of antibiotherapy in 117 cases of anaerobic bacteraemia

European Journal of Clinical Microbiology & Infectious Diseases  Aug 2008  V.27  N.8  p.671 – 678

R. Robert1, 5 , A. DeRaignac2, G. Le Moal2, S. Ragot3 and G. Grollier4

(1)  Medical Intensive Care Unit, CHU, University of Poitiers, Poitiers, France
(2)  Infectious Disease Unit, CHU, University of Poitiers, Poitiers, France
(3)  Clinical Research Center, CHU, University of Poitiers, Poitiers, France
(4)  Laboratory of Microbiology A, CHU, University of Poitiers, Poitiers, France
(5)  Service de Réanimation Médicale, Hôpital Jean Bernard, CHU, 86021 Poitiers, France

Abstract  Bacteraemia due to anaerobic bacteria occurs infrequently, making the systematic use of an anaerobic blood sample bottle in patients with sepsis controversial. We retrospectively reviewed the clinical and microbiological data from all cases of anaerobic bacteraemia in a teaching hospital over 2 years and determined the prognostic factors and antibiotic management. With the goal of evaluating the morbidity and mortality of bacteraemia due to anaerobic bacteria, a case-control study was also performed. One hundred eighty-four blood cultures from 125 patients grew at least one anaerobic bacterium, representing 0.5% of all and 7.0% of the positive blood cultures. One hundred seventeen patients were studied. In 24 cases, anaerobic blood cultures were associated with concomitant aerobic bacteria isolation. The most frequently isolated anaerobic species were Bacteroides sp. (n = 62), Clostridium sp. (n = 25), and Fusobacterium sp. (n = 12). The most frequent site of origin was the digestive tract (n = 61). In 51 cases, patients did not receive adequate empirical antianaerobic therapy. The mortality rate was 27%. Age [odds ratio (OR) 1.059; 95% confidence interval (CI) 1.021–1.100], cancer history (OR 3.21, 95% CI 1.126–9.156), and ineffective definitive antibiotherapy (OR 19.292, 95% CI 5.330–69.832) were independently associated with increased hospital mortality. The 72 patients that could be matched with patients without anaerobic bacteria according to their primary diagnosis had a longer hospitalisation and a trend toward increased mortality (P = 0.08). Anaerobic bacteraemia contributed significantly to the morbidity of the patients, and adequate empirical antibiotherapy may play an important role in the clinical outcomes.

Part of this work was presented at the ICAAC meeting in Washington, DC, on December 18th, 2005.
abstract
http://www.springerlink.com/content/9g060063l66522p6/

August 3, 2008 at 5:55 pm Leave a comment

Efficacy and safety of caspofungin therapy in elderly patients with proven or suspected invasive fungal infections

European Journal of Clinical Microbiology & Infectious Diseases  Aug 2008  V.27  N.8  p.663 – 670

M. J. DiNubile1, 3 , K. M. Strohmaier1, R. J. Lupinacci1, A. R. Meibohm1, C. A. Sable1, 2 and N. A. Kartsonis1

(1)  Merck Research Laboratories, West Point, PA, USA
(2)  Present address: Novexel SA, Romaineville, France
(3)  Merck & Co., Inc., UG3C-06, P.O. Box 1000, North Wales, PA 19454-1099, USA

Abstract  Invasive fungal infections (IFIs) are serious complications in elderly adults. Caspofungin may provide a useful therapeutic option for elderly patients with or at high risk for IFIs. We retrospectively compared efficacy and safety outcomes in elderly (≥65 years of age) and non-elderly patients in three clinical trials of caspofungin: a double-blind, randomized trial versus amphotericin B for documented invasive candidiasis (IC); an open-label, non-comparative study of definite or probable invasive aspergillosis (IA); and a double-blind, randomized trial versus liposomal amphotericin B as empirical therapy (ET) in febrile neutropenic patients. A total of 159 elderly patients with a median age of 71 years (range, 65–84) received caspofungin in these studies. The median duration of caspofungin therapy was 12 days for IC and ET, and 28 days for IA. Point estimates for the favorable response rates to caspofungin were numerically higher in elderly versus non-elderly patients with IC (83% vs. 68%) or IA (64% vs. 44%) and were similar in patients receiving ET (36% vs. 34%). Adverse events related to caspofungin occurred in generally similar proportions of elderly versus non-elderly patients with IC (clinical, 33% vs. 27%; laboratory, 17% vs. 29%), with IA (clinical, 7% vs. 13%; laboratory, 13% vs. 14%), or receiving ET (clinical, 47% vs. 47%; laboratory, 24% vs. 22%). Nephrotoxicity and infusion-related toxicity developed in comparable proportions of elderly and non-elderly caspofungin recipients in all three studies. In this post-hoc analysis, caspofungin appeared to be as efficacious and well tolerated in elderly patients as in non-elderly patients.

This study was sponsored and funded by Merck & Co., Inc. Portions of this report were presented at the 13th European Congress of Clinical Microbology and Infectious Diseases, Glasgow, UK, 10–13 May 2003.
abstract
http://www.springerlink.com/content/f04630g844662j53/

August 3, 2008 at 5:53 pm Leave a comment

Clinical outcomes and risk factors of community-acquired pneumonia caused by gram-negative bacilli

European Journal of Clinical Microbiology & Infectious Diseases  Aug 2008  V.27  N.8  p.657 – 661

C.-I. Kang1, J.-H. Song1, 3 , W. S. Oh1, K. S. Ko2, 3, D. R. Chung1, K. R. Peck1 and Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study Group

(1)  Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
(2)  Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
(3)  Asian-Pacific Research Foundation for Infectious Diseases (ARFID), Seoul, Republic of Korea

Abstract  To identify specific risk factors and clinical outcomes of community-acquired pneumonia (CAP) caused by gram-negative bacilli (GNB), we compared the clinical features and outcomes of patients with CAP due to GNB with those of patients with non-GNB pneumonia. We performed a prospective observational study of 912 cases of adult CAP in Asian countries from January 2002 to December 2004. Systemic laboratory evaluation for determining the etiology and clinical evaluation were performed. Of 912 cases with CAP, 93 (10.1%) cases were caused by GNB: 59 with K. pneumoniae, 25 P. aeruginosa, 7 Enterobacter species, 1 Acinetobacter baumannii, and 1 Serratia marcescens. CAP caused by GNB was more frequently associated with septic shock, malignancy, cardiovascular diseases, smoking, hyponatremia, and dyspnea, according to multivariate analysis (P < 0.05). Overall 30-day mortality rate was 7.3% (65/885). Mortality was significantly higher in the GNB group than in the non-GNB group [18.3% (17/93) vs. 6.1% (48/792); P < 0.001]. GNB as a causative microorganism was found to be one of the independent risk factors for mortality (adjusted OR = 2.63, 95% CI 1.02–6.78, P = 0.046) with nursing home residence, mechanical ventilation, cardiovascular disease, respiratory rate > 30/min, and hyponatremia (all P < 0.05). GNB was not only a frequent etiology of severe CAP but also an independent risk factor for mortality. Data suggest that an initial empirical antimicrobial coverage of GNB including P. aeruginosa should be seriously considered in cases of severe pneumonia, especially in patients with underlying malignancy, underlying cardiovascular diseases, smoking, septic shock, and hyponatremia.

abstract
http://www.springerlink.com/content/n2221r927mt534l2/

August 3, 2008 at 5:51 pm Leave a comment

Obesity pandemics and the modification of digestive bacterial flora

European Journal of Clinical Microbiology & Infectious Diseases  Aug 2008  V.27  N.8  p.631-634 

D. Raoult

Faculté de Médecine, Unité des Rickettsies, CNRS UMR IRD 6236, IFR48, 27, Boulevard Jean Moulin, 13385 Marseille, France

Abstract  Environmental factors, such as social networks, have an influence on obesity pandemics. The gut microbial flora (microbiota) plays a role in converting nutrients into calories. Variations in microbiota composition are found in obese humans and mice. The microbiota from an obese mouse confers an obese phenotype when transferred to an axenic mouse. There is a large body of experimental evidence and empirical data in the food industry showing that both antibiotics and probiotics, which modify the gut microbiota, can act as growth promoters, increasing the size and weight of animals. The current obesity pandemic may be caused, in part, by antibiotic treatments or colonization by probiotic bacteria. Using metagenomics and microarray analysis, studies of microbiota modifications after antibiotic and probiotic intake may identify the modifications associated with increased size and weight. Epidemiological studies recording these factors in an obese population may be able to link obesity with the absorption of microbiota modifiers.

abstract
http://www.springerlink.com/content/17p22x858ph26q4x/

August 3, 2008 at 5:48 pm Leave a comment

Trypanosoma cruzi Parasitemia in US Blood Donors with Serologic Evidence of Infection

The Journal of Infectious Diseases  15 Aug  2008  V.198  N.4  p.609-613

BRIEF REPORT

David A. Leiby,1 Ross M. Herron, Jr.,2 George Garratty,2 and Barbara L. Herwaldt3

1Transmissible Diseases Department, American Red Cross Holland Laboratory, American Red Cross, Rockville, Maryland; 2Southern California Blood Services Region, American Red Cross, Pomona, California; 3Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/590159

August 3, 2008 at 5:46 pm Leave a comment


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