Archive for September, 2009

Bacterial Coinfections in Lung Tissue Specimens from Fatal Cases of 2009 Pandemic Influenza A (H1N1) United States, May–August 2009

MMWR  Early Release Sept 29, 2009  V.58  p.1-4

To help determine the role of bacterial coinfection during the current influenza pandemic, postmortem lung specimens from patients with fatal 2009 pandemic influenza A (H1N1) were examined. A total of 22 (29%) of 77 U.S. patients with fatal pandemic influenza A (H1N1) had concurrent bacterial lung infections. These findings underscore the importance of pneumococcal vaccination for persons at increased risk for pneumococcal pneumonia and the need for early recognition of bacterial pneumonia in persons with influenza.

Full Text

http://www.cdc.gov:80/mmwr/preview/mmwrhtml/mm58e0929a1.htm?s_cid=rr58e0929a1_e

PDF

http://www.cdc.gov/mmwr/pdf/wk/mm58e0929.pdf

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September 30, 2009 at 10:39 am Leave a comment

Impact of Hepatitis B Virus Infection on Human Immunodeficiency Virus Response to Antiretroviral Therapy in Nigeria

Clinical Infectious Diseases  15 October 2009  V.49  N.8  p.1268–1273

John Idoko,1 Seema Meloni,2 Mohammed Muazu1, Ladep Nimzing,1 Bitrus Badung,1 Claudia Hawkins,3Jean-Louis Sankalé,2 Ernest Ekong,2 Robert Murphy,3 Phyllis Kanki,2 and Chloe L. Thio4

1Jos University Teaching Hospital, Jos, Plateau State, Nigeria; 2Harvard School of Public Health, Boston, Massachusetts; 3Northwestern University, Chicago, Illinois; and 4Johns Hopkins University, Baltimore, Maryland

Background. As highly active antiretroviral therapy (ART) is introduced into areas of the world in which hepatitis B virus (HBV) infection is highly endemic, it is important to determine the influence of HBV on persons with human immunodeficiency virus (HIV) and HBV coinfection who are receiving ART.

Methods. We studied 1564 HIV‐infected patients in Jos, Nigeria, who initiated ART. Participants with HIV-HBV coinfection had hepatitis B e antigen (HBeAg) and HBV DNA status determined. CD4+ T cell count and HIV load at ART initiation were compared between individuals with HIV monoinfection and those with HIV-HBV coinfection with use of univariate methods. Regression analyses were used to determine if HBeAg status or HBV DNA at ART initiation were associated with baseline HIV parameters or ART response.

Results. The median CD4+ T cell count of the 262 participants with HIV-HBV coinfection (16.7%) was 107 cells/mL, compared with 130 cells/mL for participants with HIV monoinfection at ART initiation (P<.001). Participants with HIV-HBV coinfection also had higher HIV loads than did patients with HIV monoinfection (4.96 vs 4.75 log10 copies/mL; P=.02). Higher HBV DNA and detectable HBeAg levels were independently associated with lower CD4+ T cell counts at ART initiation but not with higher HIV loads. In a multivariable model, HBeAg-positive patients were less likely than HBeAg-negative patients to suppress HIV replication to 400 copies/mL (odds ratio, 0.54; P=.03) at 24 weeks, but they had similar CD4+ T cell increases. At 48 weeks, there was no significant effect of HBeAg status on ART response.

Conclusions. Among HIV-infected Nigerian individuals, HBV coinfection, especially among those with high levels of HBV replication, was associated with lower CD4+ T cell counts at ART initiation, independent of HIV RNA level. Patients with HBeAg-positive status had a slower virological response to ART, compared with HBeAg-negative patients. Further work is needed to understand the effects of HBV on CD4+ T cells.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/605675

PDF

http://www.journals.uchicago.edu/doi/pdf/10.1086/605675

September 29, 2009 at 5:47 pm Leave a comment

Cutaneous Malignancies Among HIV-Infected Persons

Archiv of Internal Med. June 22, 2009  V.169 N.12  p.1130-1138

Nancy Crum-Cianflone, MD, MPH; Katherine Huppler Hullsiek, PhD; Elizabeth Satter, MD; Vincent Marconi, MD; Amy Weintrob, MD; Anuradha Ganesan, MD; R. Vincent Barthel, MD; Susan Fraser, MD; Brian K. Agan, MD

Tri-Service AIDS Clinical Consortium, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Drs Crum-Cianflone, Hullsiek, Marconi, Weintrob, Ganesan, Barthel, Fraser, and Agan); Infectious Disease Clinic (Dr Crum-Cianflone) and Department of Dermatology (Dr Satter), Naval Medical Center San Diego, San Diego, California; Division of Biostatistics, University of Minnesota, Minneapolis (Dr Hullsiek); and Infectious Disease Clinics, San Antonio Military Medical Center, San Antonio Texas (Dr Marconi), Walter Reed Army Medical Center, Washington, DC (Dr Weintrob), National Naval Medical Center, Bethesda (Dr Ganesan), Naval Medical Center Portsmouth, Portsmouth, Virginia (Dr Barthel), and Tripler Medical Center, Honolulu, Hawaii (Dr Fraser).

Background As the life expectancy of persons infected with human immunodeficiency virus (HIV) increases, cancers have become an important cause of morbidity and mortality. Although cutaneous cancers are the most common malignant neoplasms in the general population, little data exist among HIV-positive persons, especially regarding the impact of HIV-specific factors.

Methods We evaluated the incidence rates and factors associated with the development of cutaneous malignancies among HIV-infected persons by examining data that were prospectively collected from a large HIV study that included 4490 participants (1986-2006). Poisson regression and Cox proportional hazards models were performed.

Results Six percent of HIV-infected persons (n = 254) developed a cutaneous malignancy during 33 760 person-years of follow-up (mean, 7.5 years). Since the advent of highly active antiretroviral therapy (HAART), the incidence rates of cutaneous non–AIDS-defining cancers (NADCs), in particular basal cell carcinoma, have exceeded the rates of cutaneous AIDS-defining cancers such as Kaposi sarcoma. Factors associated with the development of cutaneous NADCs in the multivariate models included increasing age (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.7-2.6) and race. Compared with the white/non-Hispanic race, African Americans (HR, 0.03; 95% CI, 0.01-0.14) and other races (HR, 0.14; 95% CI, 0.03-0.57) had a lower risk of cutaneous NADCs. There were no significant associations between cutaneous NADCs and time-updated CD4 lymphocyte counts, HIV RNA levels, or receipt of HAART.

Conclusions At present, the most common cutaneous malignancies among HIV-infected persons are NADCs. Cutaneous NADCs do not appear to be significantly associated with immune function or HAART but rather are related to traditional factors such as aging and skin color.

abstract

http://archinte.ama-assn.org:80/cgi/content/abstract/169/12/1130?etoc

September 29, 2009 at 5:44 pm Leave a comment

Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals

Infection Control and Hospital Epidemiology  October 2008  V.29  N.s1  S31–S40

Susan E. Coffin, MD, MPH; Michael Klompas, MD; David Classen, MD, MS; Kathleen M. Arias, MS, CIC; Kelly Podgorny, RN, MS, CPHQ; Deverick J. Anderson, MD, MPH; Helen Burstin, MD; David P. Calfee, MD, MS; Erik R. Dubberke, MD; Victoria Fraser, MD; Dale N. Gerding, MD; Frances A. Griffin, RRT, MPA; Peter Gross, MD; Keith S. Kaye, MD; Evelyn Lo, MD; Jonas Marschall, MD; Leonard A. Mermel, DO, ScM; Lindsay Nicolle, MD; David A. Pegues, MD; Trish M. Perl, MD; Sanjay Saint, MD; Cassandra D. Salgado, MD, MS; Robert A. Weinstein, MD; Robert Wise, MD; Deborah S. Yokoe, MD, MPH

From the Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (S.E.C.); the Brigham and Women’s Hospital and Harvard Medical School, Boston (M.K., D.S.Y.), and the Institute for Healthcare Improvement, Cambridge (F.A.G.), Massachusetts; the University of Utah, Salt Lake City (D.C.); the Association for Professionals in Infection Control and Epidemiology (K.M.A.) and the National Quality Forum (H.B.), Washington, D.C.; the Loyola University Chicago Stritch School of Medicine (D.N.G.), the Stroger (Cook County) Hospital and the Rush University Medical Center (R.A.W.), Chicago, the Joint Commission, Oakbrook Terrace (K.P., R.W.), and the Hines Veterans Affairs Medical Center, Hines (D.N.G.), Illinois; the Duke University Medical Center, Durham, North Carolina (D.J.A., K.S.K.); the Mount Sinai School of Medicine, New York, New York (D.P.C.); the Washington University School of Medicine, St. Louis, Missouri (E.R.D., V.F., J.M.); the Hackensack University Medical Center, Hackensack (P.G.) and the University of Medicine and Dentistry–New Jersey Medical School, Newark (P.G.), New Jersey; the Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island (L.A.M.); the David Geffen School of Medicine at the University of California, Los Angeles (D.A.P.); the Johns Hopkins Medical Institutions and University, Baltimore, Maryland (T.M.P.); the Ann Arbor Veterans Affairs Medical Center and the University of Michigan Medical School, Ann Arbor, Michigan (S.S.); the Medical University of South Carolina, Charleston (C.D.S.); and the University of Manitoba, Winnipeg, Canada (E.L., L.N.).

Abstract

http://www.journals.uchicago.edu/doi/full/10.1086/591062

PDF

http://www.journals.uchicago.edu/doi/pdf/10.1086/591062

September 29, 2009 at 5:42 pm Leave a comment

Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals

Infection Control and Hospital Epidemiology  October 2008  V.29  N.s1  S22–S30

Jonas Marschall, MD; Leonard A. Mermel, DO, ScM; David Classen, MD, MS; Kathleen M. Arias, MS, CIC; Kelly Podgorny, RN, MS, CPHQ; Deverick J. Anderson, MD, MPH; Helen Burstin, MD; David P. Calfee, MD, MS; Susan E. Coffin, MD, MPH; Erik R. Dubberke, MD; Victoria Fraser, MD; Dale N. Gerding, MD; Frances A. Griffin, RRT, MPA; Peter Gross, MD; Keith S. Kaye, MD; Michael Klompas,

MD; Evelyn Lo, MD; Lindsay Nicolle, MD; David A. Pegues, MD; Trish M. Perl, MD; Sanjay Saint, MD;  Cassandra D. Salgado, MD, MS; Robert A. Weinstein, MD; Robert Wise, MD; Deborah S. Yokoe, MD, MPH

From the Washington University School of Medicine, St. Louis, Missouri (J.M., E.R.D., V.F.); the Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island (L.A.M.); the University of Utah, Salt Lake City (D.C.); the Association for Professionals in Infection Control and Epidemiology (K.M.A.) and the National Quality Forum (H.B.), Washington, D.C.; the Joint Commission, Oakbrook Terrace (K.P., R.W.), the Loyola University Chicago Stritch School of Medicine (D.N.G.) and the Stroger (Cook County) Hospital and Rush University Medical Center (R.A.W.), Chicago, and the Hines Veterans Affairs Medical Center, Hines (D.N.G.), Illinois; the Duke University Medical Center, Durham, North Carolina (D.J.A., K.S.K.); the Mount Sinai School of Medicine, New York, New York (D.P.C.); the Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (S.E.C.); the Institute for Healthcare Improvement, Cambridge (F.A.G.), and Brigham and Women’s Hospital and Harvard Medical School, Boston (D.S.Y., M.K.), Massachusetts; the Hackensack University Medical Center, Hackensack (P.G.), and the University of Medicine and Dentistry–New Jersey Medical School, Newark (P.G.), New Jersey; the David Geffen School of Medicine at the University of California, Los Angeles (D.A.P.); the Johns Hopkins Medical Institutions and University, Baltimore, Maryland (T.M.P.); the Ann Arbor Veterans Affairs Medical Center and the University of Michigan Medical School, Ann Arbor, Michigan (S.S.); the Medical University of South Carolina, Charleston (C.D.S.); and the University of Manitoba, Winnipeg, Canada (E.L., L.N.).

Abstract

http://www.journals.uchicago.edu/doi/full/10.1086/591059

PDF

http://www.journals.uchicago.edu/doi/pdf/10.1086/591059

September 29, 2009 at 5:41 pm Leave a comment

A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals

Infection Control and Hospital Epidemiology  October 2008  V.29  N.s1  S12–S21

Supplement Article: Executive Summary

Deborah S. Yokoe, MD, MPH; Leonard A. Mermel, DO, ScM; Deverick J. Anderson, MD, MPH; Kathleen M. Arias, MS, CIC; Helen Burstin, MD; David P. Calfee, MD, MS; Susan E. Coffin, MD, MPH; Erik R. Dubberke, MD; Victoria Fraser, MD; Dale N. Gerding, MD; Frances A. Griffin, RRT, MPA; Peter Gross, MD; Keith S. Kaye, MD; Michael Klompas, MD; Evelyn Lo, MD; Jonas Marschall, MD; Lindsay Nicolle, MD; David A. Pegues, MD; Trish M. Perl, MD; Kelly Podgorny, RN, MS, CPHQ; Sanjay Saint, MD; Cassandra D. Salgado, MD, MS; Robert A. Weinstein, MD; Robert Wise, MD; David Classen, MD, MS

From the Brigham and Women’s Hospital and Harvard Medical School, Boston (D.S.Y., M.K.), and the Institute for Healthcare Improvement, Cambridge (F.A.G.), Massachusetts; the Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island (L.A.M.); the Duke University Medical Center, Durham, North Carolina (D.J.A., K.S.K.); the Association for Professionals in Infection Control and Epidemiology (K.M.A.) and the National Quality Forum (H.B.), Washington, D.C.; the Mount Sinai School of Medicine, New York, New York (D.P.C.); the Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (S.E.C.); the Washington University School of Medicine, St. Louis, Missouri (E.R.D., V.F., J.M.); the Loyola University Chicago Stritch School of Medicine (D.N.G.), the Stroger (Cook County) Hospital and the Rush University Medical Center (R.A.W.), Chicago, the Joint Commission, Oakbrook Terrace (K.P., R.W.), and the Hines Veterans Affairs Medical Center, Hines (D.N.G.), Illinois; the Hackensack University Medical Center, Hackensack (P.G.), and the University of Medicine and Dentistry–New Jersey Medical School, Newark (P.G.), New Jersey; the David Geffen School of Medicine at the University of California, Los Angeles (D.A.P.); the Johns Hopkins Medical Institutions and University, Baltimore, Maryland (T.M.P.); the Ann Arbor Veterans Affairs Medical Center and the University of Michigan Medical School, Ann Arbor, Michigan (S.S.); the Medical University of South Carolina, Charleston (C.D.S.); the University of Utah, Salt Lake City (D.C.); and the University of Manitoba, Winnipeg, Canada (E.L., L.N.).

Preventable healthcare‐associated infections (HAIs) occur in US hospitals. Preventing these infections is a national priority, with initiatives led by healthcare organizations, professional associations, government and accrediting agencies, legislators, regulators, payers, and consumer advocacy groups. To assist acute care hospitals in focusing and prioritizing efforts to implement evidence‐based practices for prevention of HAIs, the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America Standards and Practice Guidelines Committee appointed a task force to create a concise compendium of recommendations for the prevention of common HAIs. This compendium is implementation focused and differs from most previously published guidelines in that it highlights a set of basic HAI prevention strategies plus special approaches for use in locations and/or populations within the hospital when infections are not controlled by use of basic practices, recommends that accountability for implementing infection prevention practices be assigned to specific groups and individuals, and includes proposed performance measures for internal quality improvement efforts.

Abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/591060

PDF

http://www.journals.uchicago.edu/doi/pdf/10.1086/591060

September 29, 2009 at 5:39 pm Leave a comment

Pseudomonas aeruginosa Bacteremia: Risk Factors for Mortality and Influence of Delayed Receipt of Effective Antimicrobial Therapy on Clinical Outcome

Clinical Infectious Diseases  Sept.15, 2003  V.37  N.6  p745-751

Cheol-In Kang,1 Sung-Han Kim,1 Hong-Bin Kim,1 Sang-Won Park,1 Young-Ju Choe,1 Myoung-don Oh,1 Eui-Chong Kim,2 and Kang-Won Choe1

Departments of 1Internal Medicine and 2Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

Among the nosocomial pathogens, Pseudomonas aeruginosa is recognized as a major cause of morbidity and mortality. Data on 136 patients with P. aeruginosa bacteremia were retrospectively analyzed to evaluate risk factors for mortality. The median age of the patients was 55 years (range, 15–85 years), 78.7% of the cases were hospital-acquired, and the 30-day mortality rate was 39% (53 of 136 patients). Multivariate analysis demonstrated that risk factors for mortality included severe sepsis, pneumonia, delay in starting effective antimicrobial therapy, and an increasing APACHE II score (all P values <.05). In 123 of the 136 patients (excluding 13 patients treated with inadequate definitive antibiotics), 30-day mortality was 27.7% (13 of 47 patients) in the group of patients who received initially effective empirical antimicrobial therapy, and 43.4% (33 of 76) in the group of patients who received delayed effective antimicrobial therapy (P=.079). There was a trend toward higher mortality as the length of delay increased. Delay in starting effective antimicrobial therapy for P. aeruginosa bacteremia tended to be associated with higher mortality.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/377200

PDF

http://www.journals.uchicago.edu/doi/pdf/10.1086/377200

September 27, 2009 at 11:02 pm Leave a comment

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