Archive for May, 2009

Development and assessment of a new early scoring system using non-specific clinical signs and biological results to identify children and adult patients with a high probability of infective endocarditis on admission

Journal of Antimicrobial Chemotherapy  December 2008  V.62 N.6  p.1434-1440

Hervé Richet1, Jean-Paul Casalta1, Franck Thuny2, Julien Mérrien1, Jean-Robert Harlé3, Pierre-Jean Weiller4, Gilbert Habib2 and Didier Raoult1,*

1 Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France 2 Department of Cardiology, Hôpital de la Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France 3 Service of Internal Medicine, Hôpital de la Conception, 147 Boulevard Baille, 13385 Marseille Cedex 05, France 4 Service of Internal Medicine, Hôpital de la Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France

Objectives: The aim of this study was to assess whether non-specific clinical signs or biological results can identify patients with a high probability of infective endocarditis (IE) to improve outcome.

Patients and methods: All patients tested for IE were included in a cohort and classified according to the modified Duke criteria. Patients with rejected endocarditis served as controls. Univariate and multivariate analyses were performed, and a score was calculated by adding 1 when a variable independently associated with IE (excluding major Duke criteria) was present and 0 when the variable was absent. A second score for patients with prior valvular damage (PVD) was also used. Scores were evaluated using the ROC curve method.

Results: IE was diagnosed in 402 of 2039 participants (19.7%). By multivariate analysis, PVD, fever, emboli, stroke, splenomegaly, finger clubbing, leucocytosis and erythrocyte sediment rate >50 were independently associated with IE. The rate of IE increased significantly from 4% (10/254) for a score of 0 to 83% (10/12) for a score of 6 in all patients, and from 9.5% (23/241) to 100% (10/10) in patients with PVD. The area under the ROC curve was 0.75 for the first score and 0.7 for the second. In a prospective study of 117 patients with suspicion of IE, the proportion of confirmed IE was 19% and the area under the ROC curve was 0.72.

Conclusions: This simple score can be used to identify patients with a high probability of IE, in the emergency room or on admission, to speed up diagnosis, or to initiate empirical antimicrobial therapy without replacing the modified Duke criteria.



May 30, 2009 at 6:00 pm Leave a comment

Acute HIV-1 infection

NEJM  Apr.9, 2009  V.360  N.15  p.1540-8

Case: A 47-Year-Old Man with Fever, Headache, Rash, and Vomiting


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May 30, 2009 at 5:58 pm Leave a comment

Development of antiviral agents for enteroviruses

Journal of Antimicrobial Chemotherapy  December 2008  V.62 N.6  p.1169-1173

Tzu-Chun Chen1,2,3, Kuo-Feng Weng1,2, Shih-Cheng Chang1,2, Jing-Yi Lin1,2, Peng-Nien Huang1,2 and Shin-Ru Shih1,2,4,5,*

1 Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan 2 Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan 3 Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan 4 Clinical Virology Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan 5 Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Chunan, Taiwan

Enteroviruses (EVs) are common human pathogens that are associated with numerous disease symptoms in many organ systems of the body. Although EV infections commonly cause mild or non-symptomatic illness, some of them are associated with severe diseases such as CNS complications. The current absence of effective vaccines for most viral infection and no available antiviral drugs for the treatment of EVs highlight the urgency and significance of developing antiviral agents. Several key steps in the viral life cycle are potential targets for blocking viral replication. This article reviews recent studies of antiviral developments for EVs based on various molecular targets that interrupt viral attachment, viral translation, polyprotein processing and RNA replication.

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May 27, 2009 at 6:45 pm Leave a comment

Community Strains of Methicillin-Resistant Staphylococcus aureus as Potential Cause of Healthcare-associated Infections, Uruguay, 2002–2004

Emerging Infectious Diseases Journal August 2008  V.14  N.8

Stephen R. Benoit,*  Concepción Estivariz,* Cristina Mogdasy,† Walter Pedreira,‡ Antonio Galiana,‡ Alvaro Galiana,§ Homero Bagnulo,‡ Rachel Gorwitz,* Gregory E. Fosheim,* Linda K. McDougal,* and Daniel Jernigan*

*Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Asociación Española, Montevideo, Uruguay; ‡Hospital Maciel, Montevideo; and §Hospital Pereira Rossell, Montevideo


Community-associated MRSA (CA-MRSA) strains have emerged in Uruguay. We reviewed Staphylococcus aureus isolates from a large healthcare facility in Montevideo (center A) and obtained information from 3 additional hospitals on patients infected with CA-MRSA. An infection was defined as healthcare-onset if the culture was obtained >48 hours after hospital admission. At center A, the proportion of S. aureus infections caused by CA-MRSA increased from 4% to 23% over 2 years; the proportion caused by healthcare-associated MRSA (HA-MRSA) decreased from 25% to 5%. Of 182 patients infected with CA-MRSA, 38 (21%) had healthcare-onset infections. Pulsed-field gel electrophoresis determined that 22 (92%) of 24 isolates were USA1100, a community strain. CA-MRSA has emerged in Uruguay and appears to have replaced HA-MRSA strains at 1 healthcare facility. In addition, CA-MRSA appears to cause healthcare-onset infections, a finding that emphasizes the need for infection control measures to prevent transmission within healthcare settings.

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May 27, 2009 at 6:42 pm Leave a comment

Influenza in patients with human immunodeficiency virus infection.

Chest  July 1, 1990  V.98  N.1  p.33-37

S Safrin, J D Rush, and J Mills

Department of Medicine, University of California, San Francisco

Although patients infected with human immunodeficiency virus (HIV) might be expected to have more severe illness due to influenza virus infection than normal persons, the course of influenza in such patients has not been well delineated. We describe six consecutive HIV-infected patients at San Francisco General Hospital in whom influenza virus was isolated from induced sputum or bronchoalveolar lavage specimens between December 1988 and March 1989. Although neither clinical presentation of influenza nor rate of secondary complications appeared to be altered from that in healthy individuals, our power of comparison was limited by small sample size. However, a high prevalence of hypoxemia and a trend toward prolonged duration of illness were identified. Larger, controlled studies are needed to define the course of influenza virus infection in HIV-infected patients as compared with nonimmunosuppressed patients.




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May 26, 2009 at 6:33 pm Leave a comment

Daptomycin versus vancomycin plus gentamicin for treatment of bacteraemia and endocarditis due to Staphylococcus aureus: subset analysis of patients infected with methicillin-resistant isolates

Journal of Antimicrobial Chemotherapy  December 2008  V.62 N.6  p.1413-1421

Susan J. Rehm1,*, Helen Boucher2, Donald Levine3, Marilyn Campion4, Barry I. Eisenstein5,6, Gloria A. Vigliani4, G.Ralph Corey7 and Elias Abrutyn8,

1 Cleveland Clinic, Cleveland, OH, USA 2 Tufts Medical Center, Boston, MA, USA 3 Wayne State University School of Medicine, Detroit, MI, USA 4 Consultants, Newton, MA, USA 5 Cubist Pharmaceuticals, Lexington, MA, USA 6 Harvard Medical School, Boston, MA, USA 7 Duke University Medical Center, Durham, NC, USA 8 Drexel University College of Medicine, Philadelphia, PA, USA

Objectives:  In a prospective, randomized trial, daptomycin was non-inferior to standard therapy for Staphylococcus aureus bacteraemia and right-sided endocarditis. Since rates of infection due to methicillin-resistant S. aureus (MRSA) infection are increasing and treatment outcomes for bacteraemia caused by MRSA are generally worse than those observed with methicillin-susceptible S. aureus bacteraemia, clinical characteristics and treatment results in the trial’s pre-specified subset of patients with MRSA were analysed.

Methods: Clinical characteristics and outcomes of patients receiving daptomycin were compared with those receiving vancomycin plus low-dose gentamicin. Success was defined as clinical improvement with clearance of bacteraemia among patients who completed adequate therapy, received no potentially effective non-study antibiotics and had negative blood cultures 6 weeks after end of therapy.

Results:  Twenty of the 45 (44.4%) daptomycin patients and 14 of the 43 (32.6%) vancomycin/gentamicin patients were successfully treated (difference 11.9%; confidence interval –8.3 to 32.1). Success rates for daptomycin versus vancomycin/gentamicin were 45% versus 27% in complicated bacteraemia, 60% versus 45% in uncomplicated bacteraemia and 50% versus 50% in right-sided MRSA endocarditis. Cure rates in patients with septic emboli and in patients who received pre-enrolment vancomycin were similar between treatment groups. However, in both treatment groups, success rates were lower in the elderly (75 years). Persisting or relapsing bacteraemia occurred in 27% of daptomycin and 21% of vancomycin/gentamicin patients; among these patients, MICs of 2 mg/L occurred in five daptomycin and four vancomycin/gentamicin patients. The clinical course of several patients may have been influenced by lack of surgical intervention.

Conclusions:  Daptomycin was an effective alternative to vancomycin/gentamicin for MRSA bacteraemia or right-sided endocarditis.




May 26, 2009 at 1:05 am Leave a comment

Methicillin-resistant Staphylococcus aureus and animals: zoonosis or humanosis?

Journal of Antimicrobial Chemotherapy  December 2008  V.62 N.6  p.1181-1187


Marina Morgan*

Department of Medical Microbiology, Royal Devon & Exeter Foundation NHS Trust, Church Lane, Exeter, Devon EX2 5AD, UK

Methicillin-resistant Staphylococcus aureus (MRSA) is increasing worldwide. Occasionally, animals are colonized or infected incidentally with human strains. Recently, however, new strains of MRSA emerging from within the animal kingdom, particularly in pigs, are causing human infection. MRSA has been reported in species as diverse as companion animals, horses and pigs, through to chinchillas, bats and parrots. In contrast, whereas strains of community-associated MRSA, the majority of which carry genes encoding Panton–Valentine leucocidin, are spreading rapidly in human populations, only sporadic cases have been reported in animals to date. Although MRSA has been found in some meat products, the implications for human infection through consumption are unclear. This review examines the epidemiology of MRSA in animals and human attendants/owners, the diagnosis and management of MRSA colonization, infection and infection control strategies in animals.


May 26, 2009 at 1:03 am Leave a comment

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