Archive for December 26, 2009

Listeriosis: a resurgent foodborne infection

Clinical Microbiology and Infection  Jan. 2010  V.16  N.1  p.16-23

REVIEW

F. Allerberger 1 and M. Wagner 2

1) Austrian Agency for Health and Food Safety (AGES), Binational Austrian–German Listeria Reference Centre, Vienna and   2) Institute for Milk Hygiene, Milk Technology and Food Science, Department for Farm Animals and Public Veterinary Health, Vienna, Austria

Listeria monocytogenes is the causative agent of human listeriosis, a potentially fatal foodborne infection. Clinical manifestations range from febrile gastroenteritis to more severe invasive forms, including sepsis, meningitis, rhombencephalitis, perinatal infections, and abortions. In recent years, an increasing rate of listeriosis has been reported in several European countries. These increases primarily reflect a higher rate of bacteraemic listeriosis in those ≥65 years of age, and are not otherwise correlated with geography, gender, ethnicity, socioeconomic factors or infectious serotypes. In the late 1980s, an upsurge in listeriosis rates was due to the contamination of a small number of food products. However, a restricted range of strains was responsible for most of the additional cases at that time, and no evidence exists for such a pattern since 2001. From a clinical perspective, the importance of isolating the pathogen as a prerequisite for an accurate epidemiological investigation and ultimately stopping transmission cannot be overemphasized.

abstract

http://www3.interscience.wiley.com/journal/123209920/abstract?CRETRY=1&SRETRY=0

December 26, 2009 at 1:13 am Leave a comment

Continuous Clindamycin Infusion, an Innovative Approach to Treating Bone and Joint Infections

Antimicrobial Agents and Chemotherapy  1 Jan 2010  V.54  N.1  p.88-92

Valérie Zeller,1,2,3* Arnaud Dzeing-Ella,2 Marie-Dominique Kitzis,5 Jean-Marc Ziza,2,3 Patrick Mamoudy,1,3 and Nicole Desplaces1,3,4

Service de Chirurgie Osseuse et Traumatologique,1 Service de Médecine Interne et Rhumatologie,2 Centre de Référence des Infections Ostéo-Articulaires,3 Laboratoire de Biologie Médicale, Groupe Hospitalier Diaconesses—Croix Saint-Simon, 125, rue d’Avron, Paris 75020, France,4 Laboratoire de Microbiologie, Groupe Hospitalier Paris Saint-Joseph, 68, rue des Plantes, Paris 75014, France5

The feasibility, safety, and efficacy of prolonged, continuous, intravenous clindamycin therapy were retrospectively evaluated for 70 patients treated for bone and joint infections, 40% of whom were treated as outpatients. The median treatment duration was 40 days, the median daily clindamycin dose was 2,400 mg, and three moderate-grade adverse events occurred. The median serum clindamycin concentrations on days 3 to 14 and days 8 to 28 were 5 and 6.2 mg/liter, respectively; the median concentration was significantly lower (P < 0.02) in patients treated with rifampin (5.3 mg/liter) than in those not treated with rifampin (8.9 mg/liter). Among 53 patients with a median follow-up of 30 months (range, 24 to 53 months), 49 (92%) were considered cured (1 patient had a relapse, and 3 patients had reinfections).

abstract

http://aac.asm.org/cgi/content/abstract/54/1/88

December 26, 2009 at 1:10 am Leave a comment

International Study of the Prevalence and Outcomes of Infection in Intensive Care Units

JAMA Dec. 2, 2009  V.302  N.21  p.2323-2329

Jean-Louis Vincent, MD, PhD; Jordi Rello, MD; John Marshall, MD; Eliezer Silva, MD, PhD; Antonio Anzueto, MD; Claude D. Martin, MD; Rui Moreno, MD, PhD; Jeffrey Lipman, MD; Charles Gomersall, MD; Yasser Sakr, MD, PhD; Konrad Reinhart, MD; for the EPIC II Group of Investigators

Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium (Dr Vincent); Critical Care Department, Joan XXIII University Hospital, CIBERes, URV-IISPV Tarragona, Spain (Dr Rello); Department of Surgery, Interdepartmental Division of Critical Care Medicine, University of Toronto, St Michael’s Hospital, Toronto, Ontario, Canada (Dr Marshall); Department of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, Brazil (Dr Silva); Department of Pulmonary/Critical Care, University of Texas Health Science Center, San Antonio (Dr Anzueto); Department of Anesthesiology and Intensive Care, Hôpital Nord, Marseille, France (Dr Martin); Department of Intensive Care, Hospital de St António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal (Dr Moreno); Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia (Dr Lipman); Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, and Prince of Wales Hospital, Shatin, Hong Kong, China (Dr Gomersall); and Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena, Germany (Drs Sakr and Reinhart).

Context Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. However, relatively little information is available about the global epidemiology of such infections.

Objective To provide an up-to-date, international picture of the extent and patterns of infection in ICUs.

Design, Setting, and Patients The Extended Prevalence of Infection in Intensive Care (EPIC II) study, a 1-day, prospective, point prevalence study with follow-up conducted on May 8, 2007. Demographic, physiological, bacteriological, therapeutic, and outcome data were collected for 14 414 patients in 1265 participating ICUs from 75 countries on the study day. Analyses focused on the data from the 13 796 adult (>18 years) patients.

Results On the day of the study, 7087 of 13 796 patients (51%) were considered infected; 9084 (71%) were receiving antibiotics. The infection was of respiratory origin in 4503 (64%), and microbiological culture results were positive in 4947 (70%) of the infected patients; 62% of the positive isolates were gram-negative organisms, 47% were gram-positive, and 19% were fungi. Patients who had longer ICU stays prior to the study day had higher rates of infection, especially infections due to resistant staphylococci, Acinetobacter, Pseudomonas species, and Candida species. The ICU mortality rate of infected patients was more than twice that of noninfected patients (25% [1688/6659] vs 11% [ 682/6352], respectively; P < .001), as was the hospital mortality rate (33% [2201/6659] vs 15% [ 942/6352], respectively; P < .001) (adjusted odds ratio for risk of hospital mortality, 1.51; 95% confidence interval, 1.36-1.68; P < .001).

Conclusions Infections are common in patients in contemporary ICUs, and risk of infection increases with duration of ICU stay. In this large cohort, infection was independently associated with an increased risk of hospital death.

abstract

http://jama.ama-assn.org:80/cgi/content/abstract/302/21/2323?etoc

December 26, 2009 at 1:08 am Leave a comment

Intent to Receive Influenza A (H1N1) 2009 Monovalent and Seasonal Influenza Vaccines — Two Counties, North Carolina, August 2009

MMWR Weekly  December 25, 2009  V.58  N.50  p.1401-1405

On September 15, 2009, the Food and Drug Administration approved the manufacture of four influenza A (H1N1) 2009 monovalent vaccines.* Before release of the first batches of the vaccine on September 30, intent to receive the vaccine was estimated at 50% among selected U.S. adult populations (1,2) and as high as 70% for children (2). However, studies in previous years of seasonal influenza vaccination in children, who might require 2 doses based on age and prior vaccination status, have indicated poor compliance with recommendations (3). To measure intent to receive H1N1 and seasonal influenza vaccines among children and adults, during August 28–29, 2009, the North Carolina Center for Public Health Preparedness, with state and local public health officials, conducted a community assessment in two counties. This report summarizes the results of…

Full Text

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5850a1.htm?s_cid=mm5850a1_e

PDF

http://www.cdc.gov/mmwr/PDF/wk/mm5850.pdf

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


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