Archive for July, 2010

One Health Approach to Influenza: Assessment of Critical Issues and Options

EID August 2010  V.16  N.8

Conference Summary

Thomas F. Powdrill, Terry L. Nipp, and Jennifer L. Rinderknecht

Texas A&M University, College Station, Texas, USA

A task force of experts on influenza, public health, and animal health met at the conference One Health Approach to Influenza: Assessment of Critical Issues and Options in Washington, DC, on December 1–2, 2009. These experts discussed the role of the One Health approach in preparing for and responding to an influenza pandemic or other emerging zoonotic disease by using pandemic (H1N1) 2009 as a case study. The meeting was convened by the US Department of Homeland Security National Center for Foreign Animal and Zoonotic Disease Defense, and the National Institute of Allergy and Infectious Diseases/National Institutes of Health Western Regional Center of Excellence for Biodefense and Emerging Infectious Diseases….

Full Text

http://www.cdc.gov/eid/content/16/8/e1.htm

Advertisements

July 31, 2010 at 6:10 pm Leave a comment

Lethal Necrotizing Pneumonia Caused by an ST398 Staphylococcus aureus Strain

EID August 2010  V.16  N.8 p.1330

Letter

PJean-Philippe Rasigade, Frederic Laurent, Philippe Hubert, François Vandenesch, and Jerome Etienne

Hospices Civils de Lyon, Lyon, France (J.P. Rasigade, F. Laurent, J. Etienne, F. Vandenesch); and Assistance Publique–Hôpitaux de Paris, Paris, France (P. Hubert)

To the Editor: Several recent studies have shown massive colonization of livestock (especially pigs) and livestock workers by methicillin-resistant Staphylococcus aureus (MRSA) in western Europe, Canada, and the United States…

Full Text

http://www.cdc.gov/eid/content/16/8/1330.htm

PDF

http://www.cdc.gov/eid/content/16/8/pdfs/1330.pdf

July 31, 2010 at 6:02 pm Leave a comment

Leptospira Serovar as Prognostic Factor

EID August 2010  V.16  N.8 p.1333

Letter

To the Editor: Herrmann-Storck et al. (1) investigated prognostic factors of leptospirosis and concluded that infection with Leptospira interrogans serovar Icterohemorrhagiae was linked to severe outcomes. We have concerns about this conclusion….

Full Text

http://www.cdc.gov/eid/content/16/8/1333.htm     

PDF

http://www.cdc.gov/eid/content/16/8/pdfs/1333.pdf

July 31, 2010 at 5:57 pm Leave a comment

Early versus Standard Antiretroviral Therapy for HIV-Infected Adults in Haiti

N Engl J of Medicine Jul.15, 2010 V.363  N.3  p.257-265

Patrice Severe, M.D., Marc Antoine Jean Juste, M.D., Alex Ambroise, M.D., Ludger Eliacin, M.D., Claudel Marchand, M.D., Sandra Apollon, B.S., Alison Edwards, M.S., Heejung Bang, Ph.D., Janet Nicotera, R.N., Catherine Godfrey, M.D., Roy M. Gulick, M.D., Warren D. Johnson, Jr., M.D., Jean William Pape, M.D., and Daniel W. Fitzgerald, M.D.

ABSTRACT

Background

For adults with human immunodeficiency virus (HIV) infection who have CD4+ T-cell counts that are greater than 200 and less than 350 per cubic millimeter and who live in areas with limited resources, the optimal time to initiate antiretroviral therapy remains uncertain.

Methods

We conducted a randomized, open-label trial of early initiation of antiretroviral therapy, as compared with the standard timing for initiation of therapy, among HIV-infected adults in Haiti who had a confirmed CD4+ T-cell count that was greater than 200 and less than 350 per cubic millimeter at baseline and no history of an acquired immunodeficiency syndrome (AIDS) illness. The primary study end point was survival. The early-treatment group began taking zidovudine, lamivudine, and efavirenz therapy within 2 weeks after enrollment. The standard-treatment group started the same regimen of antiretroviral therapy when their CD4+ T-cell count fell to 200 per cubic millimeter or less or when clinical AIDS developed. Participants in both groups underwent monthly follow-up assessments and received isoniazid and trimethoprim–sulfamethoxazole prophylaxis with nutritional support.

Results

Between 2005 and 2008, a total of 816 participants — 408 per group — were enrolled and were followed for a median of 21 months. The CD4+ T-cell count at enrollment was approximately 280 per cubic millimeter in both groups. There were 23 deaths in the standard-treatment group, as compared with 6 in the early-treatment group (hazard ratio with standard treatment, 4.0; 95% confidence interval [CI], 1.6 to 9.8; P=0.001). There were 36 incident cases of tuberculosis in the standard-treatment group, as compared with 18 in the early-treatment group (hazard ratio, 2.0; 95% CI, 1.2 to 3.6; P=0.01).

Conclusions

Early initiation of antiretroviral therapy decreased the rates of death and incident tuberculosis. Access to antiretroviral therapy should be expanded to include all HIV-infected adults who have CD4+ T-cell counts of less than 350 per cubic millimeter, including those who live in areas with limited resources. (ClinicalTrials.gov number, NCT00120510 [ClinicalTrials.gov].)

abstract

http://content.nejm.org/cgi/content/full/363/3/257?query=TOC

PDF

http://content.nejm.org/cgi/reprint/363/3/257.pdf

July 27, 2010 at 6:47 pm Leave a comment

Meropenem dosing in critically ill patients with sepsis and without renal dysfunction: intermittent bolus versus continuous administration? Monte Carlo dosing simulations and subcutaneous tissue distribution.

J Antimicrob Chemother July 2009 V.64 N.1 p.142–50.

Jason A. Roberts1,2,3,*, Carl M. J. Kirkpatrick4, Michael S. Roberts5, Thomas A. Robertson5, Andrew J. Dalley1 and Jeffrey Lipman1,3

1 Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia 2 Pharmacy Department, Royal Brisbane and Women’s Hospital, Brisbane, Australia 3 Department of Intensive Care, Royal Brisbane and Women’s Hospital, Brisbane, Australia 4 School of Pharmacy, The University of Queensland, Brisbane, Australia 5 Therapeutics Research Unit, The University of Queensland, Brisbane, Australia

Objectives

To compare the plasma and subcutaneous tissue concentration–time profiles of meropenem administered by intermittent bolus dosing or continuous infusion to critically ill patients with sepsis and without renal dysfunction, and to use population pharmacokinetic modelling and Monte Carlo simulations to assess the cumulative fraction of response (CFR) against Gram-negative pathogens likely to be encountered in critical care units.

Patients and methods

We randomized 10 patients with sepsis to receive meropenem by intermittent bolus administration (n = 5; 1 g 8 hourly) or an equal dose administered by continuous infusion (n = 5). Serial subcutaneous tissue concentrations were determined using microdialysis and compared with plasma data for first-dose and steady-state pharmacokinetics. Population pharmacokinetic modelling of plasma data and Monte Carlo simulations were then undertaken with NONMEM®.

Results

It was found that continuous infusion maintains higher median trough concentrations, in both plasma (intermittent bolus 0 versus infusion 7 mg/L) and subcutaneous tissue (0 versus 4 mg/L). All simulated intermittent bolus, extended and continuous infusion dosing achieved 100% of pharmacodynamic targets against most Gram-negative pathogens. Superior obtainment of pharmacodynamic targets was achieved using administration by extended or continuous infusion against less susceptible Pseudomonas aeruginosa and Acinetobacter species.

Conclusions

This is the first study to compare the relative concentration–time data of bolus and continuous administration of meropenem at the subcutaneous tissue and plasma levels. We found that the administration of meropenem by continuous infusion maintains higher concentrations in subcutaneous tissue and plasma than by intermittent bolus dosing. Administration by extended or continuous infusion will achieve superior CFR against less-susceptible organisms in patients without renal dysfunction.

abstract

http://jac.oxfordjournals.org/cgi/content/abstract/64/1/142

PDF

http://jac.oxfordjournals.org/cgi/reprint/64/1/142

July 27, 2010 at 6:39 pm Leave a comment

Outcomes with daptomycin in the treatment of Staphylococcus aureus infections with a range of vancomycin MICs

J. Antimicrob. Chemother. August 2010  V.65  N.8  p.1784-1791

Jason A. Crompton1, Donald S. North1, MinJung Yoon1, Judith N. Steenbergen1, Kenneth C. Lamp1,* and Graeme N. Forrest2

1 Cubist Pharmaceuticals, 65 Hayden Ave, Lexington, MA 02421, USA 2 Portland VA Medical Center, 3701 SW US Veterans Hospital Rd, P3-ID, Portland, OR 97239, USA

Objectives

Recent recommendations by the Infectious Diseases Society of America for the treatment of Staphylococcus aureus suggest the use of alternative agents when vancomycin MIC values are 2 mg/L. This study examines the outcome of patients treated with daptomycin for S. aureus infections with documented vancomycin MICs.

Patients and methods

All patients with skin, bacteraemia and endocarditis infections due to S. aureus with vancomycin MIC values in CORE 2005–08, a retrospective, multicentre, observational registry, were studied. The outcome (cure, improved, failure or non-evaluable) was the investigator assessment at the end of daptomycin therapy. Success was defined as cure or improved.

Results

Five hundred and forty-seven clinically evaluable patients were identified with discrete vancomycin MIC values [MIC <2 mg/L: 451 (82%); MIC 2 mg/L: 96 (18%)]. The vancomycin MIC groups were well matched for patient characteristics, types of infections, first-line daptomycin use (19%) and prior vancomycin use (58%). Clinical success was reported in 94% of patients. No differences were detected in the daptomycin success rate by the vancomycin MIC group overall or by the infection type. A multivariate logistic regression also failed to identify vancomycin MIC as a predictor of daptomycin failure. Adverse event (AE) rates were not different when analysed by MIC group; both groups had 17% of patients with one AE.

Conclusions

In this diverse population, daptomycin was associated with similar outcomes for patients, regardless of whether the vancomycin MIC was categorized as <2 or 2 mg/L. Further studies are warranted.

abstract

http://jac.oxfordjournals.org/cgi/content/abstract/65/8/1784?etoc

PDF

http://jac.oxfordjournals.org/cgi/reprint/65/8/1784

July 27, 2010 at 12:03 pm Leave a comment

A rifampicin-containing antibiotic treatment improves outcome of staphylococcal deep sternal wound infections

J. Antimicrob. Chemother. August 2010  V.65  N.8  p.1799-1806

Bettina Khanlari1,, Luigia Elzi1,, Laura Estermann1, Maja Weisser1, Wolfgang Brett2, Martin Grapow2, Manuel Battegay1, Andreas F. Widmer1 and Ursula Flückiger1,*

1 Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland 2 Department of Cardiovascular Surgery, University Hospital Basel, Basel, Switzerland

Background

Deep sternal wound infection (DSWI) is a severe complication after cardiac surgery, mostly caused by staphylococci. Little is known about the optimal antibiotic management.

Methods

A 10 year retrospective analysis of 100 patients with staphylococcal DSWI after cardiac surgery in a tertiary hospital. Treatment failure was defined as sternal wound dehiscence or fistula at the end of the prescribed antibiotic therapy, 12 months later, or DSWI-related death.

Results

Most patients were male (83%) and the median age was 72 years [interquartile range (IQR) 63–76]. Coronary artery bypass was the most frequent preceding procedure (93%). The median time to diagnosis of DSWI was 13 days (IQR 10–18) after surgery. Clinical presentation consisted of wound discharge in 77% of patients. Coagulase-negative staphylococci were isolated in 54 and Staphylococcus aureus in 46 patients. All patients received antibiotics and 95% underwent surgical debridement. The median duration of antibiotic treatment was 47 days (IQR 41–78). During follow-up, 21 out of 100 patients experienced treatment failure. Of these, 8/21 patients (38%) died from DSWI after a median of 12 days (IQR 8–30). In the multivariate analysis, a rifampicin-containing antibiotic regimen was the only factor associated with lower risk of treatment failure (hazard ratio 0.26, 95% confidence interval 0.10–0.64, P = 0.004). Prolonged treatment (12 weeks instead of 6 weeks) did not alter outcome (P = 0.716) in patients without prosthetic valve endocarditis.

Conclusions

Treatment of rifampicin-susceptible staphylococcal DSWI with a rifampicin-containing antibiotic regimen may improve the outcome. After surgical debridement an antibiotic treatment of 6 weeks may be adequate for staphylococcal DSWI.

abstract

http://jac.oxfordjournals.org/cgi/content/abstract/65/8/1799?etoc

July 27, 2010 at 12:02 pm Leave a comment

Older Posts


Calendar

July 2010
M T W T F S S
« Jun   Aug »
 1234
567891011
12131415161718
19202122232425
262728293031  

Posts by Month

Posts by Category