Archive for August 22, 2008

The Effect of Highly Active Antiretroviral Therapy on Mortality among HIV-Infected Former Plasma Donors in China

Clinical Infectious Diseases 15 September 2008  V.47  N.6  p.825–833 

Fujie Zhang,1,2 Zhihui Dou,1 Lan Yu,1 Jiahong Xu,4 Jin Hua Jiao,4 Ning Wang,1 Ye Ma,1 Yan Zhao,1 Hongxin Zhao,2 and Ray Y. Chen3

1National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 2Ditan Hospital, and 3National Institute of Allergy and Infectious Diseases, US National Institutes of Health, based at the US Embassy in Beijing, Beijing, China; and 4Westat, Rockville, Maryland

Background.  In China, many former plasma donors were infected with the human immunodeficiency virus (HIV) in the early–mid-1990s. Highly active antiretroviral therapy (HAART) was provided for former plasma donors beginning in 2002. The effect of HAART on mortality in this cohort has not been described.

Methods.  This study is a retrospective analysis of the national HIV epidemiology and treatment databases for the period 1993–2006. All HIV-infected subjects from 10 counties with a high prevalence of HIV infection in 6 provinces were eligible. Inclusion criteria were: (1) history of plasma donation, (2) positive Western blot result, (3) clinical diagnosis of AIDS or CD4+ cell count <200 cells/µL at any time, and (4) age 18 years at AIDS diagnosis.

Results.  Of 9059 eligible subjects, 4093 met the inclusion criteria. Mean age was 41 years, 51% were male, 99% were farmers, and 87% were from Henan Province. Overall mortality decreased from 27.3 deaths per 100 person-years in 2001 to 4.6 deaths per 100 person-years in 2006. Conversely, the percentage of patient-years receiving HAART increased from 0% in 2001 to 70.5% in 2006. In a multivariate Cox proportional hazards analysis, not receiving HAART was the greatest risk factor for mortality (hazard ratio, 2.8; 95% confidence interval, 2.4–3.3). Among treated patients, those who had lower CD4+ cell counts and higher numbers of opportunistic infections at the initiation of therapy were at greater risk of death.

Conclusions.  The national treatment program has significantly reduced the mortality rate among HIV-infected former plasma donors through the use of generic drugs in a rural treatment setting with limited laboratory monitoring. Treatment success can be improved through increased coverage and earlier initiation of therapy.

abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/590945

PDF
http://www.journals.uchicago.edu/doi/pdf/10.1086/590945

Editorial Commentary
http://www.journals.uchicago.edu/doi/pdf/10.1086/590940

August 22, 2008 at 6:14 pm Leave a comment

Update on the Appropriate Use of Meropenem for the Treatment of Serious Bacterial Infections

Clinical Infectious Diseases 15 September 2008  V.47  N.s1 

Indice

Introduction: Update on the Appropriate Use of Meropenem for the Treatment of Serious Bacterial

Infections – Marin H. Kollef

Broad-Spectrum Antimicrobials and the Treatment of Serious Bacterial Infections: Getting It Right Up

Front – Marin H. Kollef

Impact of Antibiotic Resistance in Gram-Negative Bacilli on Empirical and Definitive Antibiotic

Therapy – David L. Paterson

The Importance and Future of Antimicrobial Surveillance Studies – Robert Masterton

Pharmacokinetic and Pharmacodynamic Properties of Meropenem – David P. Nicolau

Update on the Efficacy and Tolerability of Meropenem in the Treatment of Serious Bacterial Infections
John F. Mohr III

abstract
http://www.journals.uchicago.edu/toc/cid/47/s1

August 22, 2008 at 6:11 pm Leave a comment

Sexually Transmitted Q Fever

Clinical Infectious Diseases  1 Aug 2001  V.33  N.3  p.399–402

BRIEF REPORT

Adriana Milazzo,1 Robert Hall,1 Paul A. Storm,2 Ray J. Harris,3 William Winslow,4 and Barrie P. Marmion2, 4

1Communicable Disease Control Branch, Department of Human Services, 2Department of Pathology, University of Adelaide, 3School of Pharmacy and Medical Sciences, University of South Australia, 4Infectious Diseases Laboratories, Institute of Medical and Veterinary Science, Adelaide, South Australia, Australia

We report the sexual transmission of Coxiella burnetii from a man with occupationally acquired Q fever to his wife. Fifteen days after coitus, his wife also developed serologically proven acute Q fever. C. burnetii DNA sequences were detected by polymerase chain reaction (PCR) performed on semen samples obtained from the husband at 4 and 15 months after the onset of acute Q fever, but PCR results were variable at 23 months, indicating the presence of few organisms.

abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/321878

PDF
http://www.journals.uchicago.edu/doi/pdf/10.1086/321878

August 22, 2008 at 6:09 pm Leave a comment

Silver-Coated Endotracheal Tubes and Incidence of Ventilator-Associated Pneumonia

JAMA  20 August 2008  V.300  N.7  p.805-813

The NASCENT Randomized Trial

Marin H. Kollef, MD; Bekele Afessa, MD; Antonio Anzueto, MD; Christopher Veremakis, MD; Kim M. Kerr, MD; Benjamin D. Margolis, MD; Donald E. Craven, MD; Pamela R. Roberts, MD; Alejandro C. Arroliga, MD; Rolf D. Hubmayr, MD; Marcos I. Restrepo, MD; William R. Auger, MD; Regina Schinner, Dipl-Stat; for the NASCENT Investigation Group

Washington University School of Medicine, St Louis, Missouri (Dr Kollef); Mayo Clinic College of Medicine, Rochester, Minnesota (Drs Afessa and Hubmayr); South Texas Veterans Health Care System Audie L. Murphy Division, San Antonio, Texas (Drs Anzueto and Restrepo); University Hospital and University of Texas Health Science Center at San Antonio (Dr Anzueto); St John’s Mercy Medical Center, St Louis, Missouri (Dr Veremakis); University of California at San Diego, La Jolla (Drs Kerr and Auger); West Suburban Hospital, Oak Park, Illinois (Dr Margolis); Lahey Clinic Medical Center, Burlington, Massachusetts, and Tufts University School of Medicine, Boston, Massachusetts (Dr Craven); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Roberts); Cleveland Clinic, Cleveland, Ohio (Dr Arroliga); VERDICT, San Antonio, Texas (Dr Restrepo); and FGK Clinical Research GmbH, Munich, Germany (Ms Schinner). Dr Roberts is now with the University of Oklahoma Health Sciences Center, Oklahoma City. Dr Arroliga is now with Scott & White Health Care System and Texas A & M Health Science Center College of Medicine, Temple, Texas.

Context  Ventilator-associated pneumonia (VAP) causes substantial morbidity. A silver-coated endotracheal tube has been designed to reduce VAP incidence by preventing bacterial colonization and biofilm formation.

Objective  To determine whether a silver-coated endotracheal tube would reduce the incidence of microbiologically confirmed VAP.

Design, Setting, and Participants  Prospective, randomized, single-blind, controlled study conducted in 54 centers in North America. A total of 9417 adult patients (18 years) were screened between 2002 and 2006. A total of 2003 patients expected to require mechanical ventilation for 24 hours or longer were randomized.

Intervention  Patients were assigned to undergo intubation with 1 of 2 high-volume, low-pressure endotracheal tubes, similar except for a silver coating on the experimental tube.

Main Outcome Measures  Primary outcome was VAP incidence based on quantitative bronchoalveolar lavage fluid culture with 104 colony-forming units/mL or greater in patients intubated for 24 hours or longer. Other outcomes were VAP incidence in all intubated patients, time to VAP onset, length of intubation and duration of intensive care unit and hospital stay, mortality, and adverse events.

Results  Among patients intubated for 24 hours or longer, rates of microbiologically confirmed VAP were 4.8% (37/766 patients; 95% confidence interval [CI], 3.4%-6.6%) in the group receiving the silver-coated tube and 7.5% (56/743; 95% CI, 5.7%-9.7%) (P = .03) in the group receiving the uncoated tube (all intubated patients, 3.8% [37/968; 95% CI, 2.7%-5.2%] and 5.8% [56/964; 95% CI, 4.4%-7.5%] [P = .04]), with a relative risk reduction of 35.9% (95% CI, 3.6%-69.0%; all intubated patients, 34.2% [95% CI, 1.2%-67.9%]). The silver-coated endotracheal tube was associated with delayed occurrence of VAP (P = .005). No statistically significant between-group differences were observed in durations of intubation, intensive care unit stay, and hospital stay; mortality; and frequency and severity of adverse events.

Conclusion  Patients receiving a silver-coated endotracheal tube had a statistically significant reduction in the incidence of VAP and delayed time to VAP occurrence compared with those receiving a similar, uncoated tube.

abstract
http://jama.ama-assn.org/cgi/content/abstract/300/7/805

August 22, 2008 at 2:04 am Leave a comment

Acute Q Fever in Adult Patients: Report on 63 Sporadic Cases in an Urban Area

Clinical Infectious Diseases  Oct 1999  V.29  N.4  p.874-879

Pere Domingo Carmen Mufloz Tomas Franquet Merce Gurgui Francesc Sancho Guillermo Vazquez

From the Departments of Internal Medicine (Infectious Diseases Unit), Microbiology, Radiology, and Pathology, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain

We report here 63 sporadic urban cases of acute Q fever diagnosed in 1985–1997. Fifty-eight men and five women were included; the mean age (±SD) was 35.6 (± 10.2) years. Twenty-six patients had pneumonia, 30 had hepatitis, and 7 had a self-limited febrile illness. The most frequent radiological abnormalities were lobar or segmental alveolar opacities involving right lower lobes. Chronic bronchitis was significantly more frequent among patients with pneumonic Q fever (P = .01). Thirty-two patients’ illnesses were diagnosed through seroconversion, 12 by a fourfold increase in serum antibody titer, and 19 by initial high titers. Patients who initially received doxycycline had a significantly shorter duration of fever than those treated with erythromycin or other antibiotics (P = .0001 and P = .0004, respectively). No patient died. Acute Q fever affects mainly urban men, most frequently causing hepatitis, except in those with chronic bronchitis, who more frequently develop pneumonia. Hepatic Q fever presented with more pronounced increases in liver function test values than did pneumonic Q fever. Treatment with doxycycline caused a significant reduction in the duration of fever.

abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/520452

PDF
http://www.journals.uchicago.edu/doi/pdf/10.1086/520452

August 22, 2008 at 2:02 am Leave a comment


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