Archive for August 11, 2008

Increasing Incidence of Legionellosis in the United States, 1990–2005: Changing Epidemiologic Trends

Clinical Infectious Diseases  1 September 2008  V.47  N.5  p.591–599

Karen Neil and Ruth Berkelman

Department of Epidemiology, Emory University, Atlanta, Georgia

Background.  An abrupt increase in the incidence of legionellosis in the United States has been noted since 2003. Whether the recent increase is associated with shifting epidemiologic trends has not been well characterized.

Methods.  We analyzed all cases of legionellosis reported to the Centers for Disease Control and Prevention through the National Notifiable Disease Surveillance System from 1990 through 2005.

Results.  A total of 23,076 cases of legionellosis were reported to the Centers for Disease Control and Prevention from 1990 through 2005. The number of reported cases increased by 70% from 1310 cases in 2002 to 2223 cases in 2003, with a sustained increase to >2000 cases per year from 2003 through 2005. The eastern United States showed most of the increases in age-adjusted incidence rates after 2002, with the mean rate in the Middle Atlantic states during 2003–2005 exceeding that during 1990–2002 by 96%. During 2000–2005, legionellosis cases were most commonly reported in persons aged 45–64 years. Persons aged <65 years comprised 63% of total cases in 2000–2005. Age-adjusted incidence rates in males exceeded those in females for all age groups and years. Legionellosis incidence showed marked seasonality in eastern states, with most cases reported in the summer or fall.

Conclusions.  Reported legionellosis cases have increased substantially in recent years, particularly in the eastern United States and among middle-aged adults. Legionella infection should be considered in the differential diagnosis of any patient with pneumonia. Public health professionals should focus increased attention on detection and prevention of this important and increasing public health problem.

abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/590557

PDF
http://www.journals.uchicago.edu/doi/pdf/10.1086/590557

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August 11, 2008 at 11:44 pm Leave a comment

Our Evolving Understanding of Legionellosis Epidemiology: Learning to Count

Clinical Infectious Diseases  1 September 2008  V.47  N.5  p.600–602

EDITORIAL COMMENTARY

Victoria Ng,1,3 Patrick Tang,2 and David N. Fisman1,2

1Research Institute of the Hospital for Sick Children and 2Ontario Public Health Laboratories Branch, Toronto, Canada; and 3The Australian National University, Canberra, Australia
abstract
http://www.journals.uchicago.edu/doi/full/10.1086/590558

PDF
http://www.journals.uchicago.edu/doi/pdf/10.1086/590558

August 11, 2008 at 11:41 pm Leave a comment

Predictors of 30-Day Mortality and Hospital Costs in Patients With Ventilator-Associated Pneumonia Attributed to Potentially Antibiotic-Resistant Gram-Negative Bacteria*

Chest  August 2008  V.134  N.2  p.281–287

Katherine E. Kollef; Garrett E. Schramm, PharmD; Angela R. Wills, PharmD; Richard M. Reichley, RPh; Scott T. Micek, PharmD and Marin H. Kollef, MD, FCCP

* From the Division of Pulmonary and Critical Care Medicine (Ms. Kollef and Dr. Kollef), Washington University School of Medicine; Center for Quality and Effectiveness (Mr. Reichley), BJC Healthcare; and Department of Pharmacy (Drs. Schramm, Wills, and Micek), Barnes-Jewish Hospital, St. Louis, MO.

Abstract

Objective: To identify predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia (VAP) attributed to potentially antibiotic-resistant Gram-negative bacteria (PARGNB) [Pseudomonas aeruginosa, Acinetobacter species, and Stenotrophomonas maltophilia].

Design: A retrospective, single-center, observational cohort study.

Setting: Barnes-Jewish Hospital, a 1,200-bed urban teaching hospital.

Patients: Adult patients requiring hospitalization with microbiologically confirmed VAP attributed to PARGNB.

Interventions: Retrospective data collection from automated hospital, microbiology, and pharmacy databases.

Measurements and main results: Seventy-six patients with VAP attributed to PARGNB were identified over a 5-year period. Nineteen patients (25.0%) died during hospitalization. Patients receiving their first dose of appropriate antibiotic therapy within 24 h of BAL sampling had a statistically lower 30-day mortality rate compared to patients receiving the first dose of appropriate therapy >24 h after BAL (17.2% vs 50.0%; p = 0.005). VAP due to Acinetobacter species was most often initially treated with an inappropriate antibiotic regimen, followed by S maltophilia and P aeruginosa (66.7% vs 33.3% vs 17.2%; p = 0.017). Overall, total hospitalization costs were statistically similar in patients initially treated with an inappropriate antibiotic regimen compared to an appropriate regimen ($68,597 ± $55,466 vs $86,644 ± $64,433; p = 0.390).

Conclusions: These data suggest that inappropriate initial antibiotic therapy of microbiologically confirmed VAP attributed to PARGNB is associated with greater 30-day mortality. High rates of VAP attributed to antibiotic-resistant bacteria (eg, Acinetobacter species) may require changes in the local empiric antibiotic treatment of VAP in order to optimize the prescription of appropriate initial therapy.

abstract
http://www.chestjournal.org/cgi/content/abstract/134/2/281

August 11, 2008 at 10:44 am Leave a comment

Tigecycline, a therapeutic option from a new antimicrobial class (the glycylcyclines) in an era of increasing resistance

Journal of Antimicrobial Chemotherapy 1 Sept 2008  V.62  Suppl.1

– The growing burden of antimicrobial resistance

– Tigecycline pharmacokinetic/pharmacodynamic update

– Efficacy and safety of tigecycline compared with vancomycin or linezolid for treatment of serious infections with methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci: a Phase 3, multicentre, double-blind, randomized study

Solo abstracts (hacer CLIC en “abstract” de cada articulo)
http://jac.oxfordjournals.org/content/vol62/suppl_1/index.dtl?etoc

August 11, 2008 at 10:42 am Leave a comment


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