Archive for September, 2010

New Delhi metallo-beta-lactamase (NDM-1): towards a new pandemia?

Clinical Microbiology and Infection Sept. 2010

Jean Marc Rolain1,*, Philippe Parola1,2, Giuseppe Cornaglia3

1. URMITE UMR CNRS-IRD 6236, IFR48, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, Marseille, France

2. EuroTravNet, The ECDC collaborative Network for Tropical and Travel Medicine

3. Department of Pathology and Diagnostics, University of Verona, Italy

Full Text

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2010.03385.x/abstract

PDF

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2010.03385.x/pdf

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September 30, 2010 at 4:03 pm Leave a comment

Current and Potential Usefulness of Pneumococcal Urinary Antigen Detection in Hospitalized Patients With Community-Acquired Pneumonia to Guide Antimicrobial Therapy

Archives of Internal Medicine September 27, 2010

Roger Sordé, MD; Vicenç Falcó, MD; Michael Lowak, MD; Eva Domingo, MD; Adelaida Ferrer, MD; Joaquin Burgos, MD; Mireia Puig, MD; Evelyn Cabral, MD; Oscar Len, MD; Albert Pahissa, MD

Departments of Infectious Diseases (Drs Sordé, Falcó, Burgos, Puig, Cabral, Len, and Pahissa), Microbiology (Drs Lowak and Ferrer), and Emergency Medicine (Dr Domingo), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, and the Spanish Network for Research in Infectious Diseases (REIPI) (Drs Sordé, Cabral, Len, and Pahissa), Spain.

Background 

The role of pneumococcal urinary antigen detection in the treatment of adults with community-acquired pneumonia (CAP) is not well defined. We assessed the usefulness of pneumococcal urinary antigen detection in the diagnosis and antimicrobial guidance in patients hospitalized with CAP.

Methods 

A prospective study of all adults hospitalized with CAP was performed from February 2007 through January 2008. To evaluate the accuracy of the test, we calculated its sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. The gold standard used for diagnosis of pneumococcal pneumonia was isolation in blood or pleural fluid (definite diagnosis) and isolation in sputum (probable diagnosis). Antibiotic modifications, complications, and mortality were analyzed.

Results 

A total of 474 episodes of CAP were included. Streptococcus pneumoniae was the causative pathogen in 171 cases (36.1%). It was detected exclusively by urinary antigen test in 75 cases (43.8%). Sixty-nine patients had CAP caused by a pathogen other than S pneumoniae. Specificity was 96%, positive predictive value ranged from 88.8% to 96.5%, and the positive likelihood ratio ranged from 14.6 to 19.9. The results of the test led the clinicians to reduce the spectrum of antibiotics in 41 patients. Pneumonia was cured in all of them. Potentially, this optimization would be possible in the 75 patients diagnosed exclusively by the test.

Conclusion 

When its findings are positive, the pneumococcal urinary antigen test is a useful tool in the treatment of hospitalized adult patients with CAP because it may allow the clinician to optimize antimicrobial therapy with good clinical outcomes.

abstract

http://archinte.ama-assn.org/cgi/content/abstract/archinternmed.2010.347v1?etoc

September 30, 2010 at 4:00 pm Leave a comment

The Renaissance in HIV Vaccine Development — Future Directions

New England Journal of Medicine, July 29, 2010 V.363

Perspective

From July 18 through July 23, 2010, delegates from around the globe will convene for the biennial International AIDS Conference in Vienna. They will discuss our current risk of losing the war against the human immunodeficiency virus (HIV). Despite an unprecedented outpouring of resources and proliferation of programs, today, for every two patients who begin receiving treatment for HIV, five people are newly infected. Furthermore, new guidelines from the World Health Organization recommending that infected persons begin receiving treatment earlier will significantly increase the number of patients targeted for therapy. If we are to control this pandemic, we must recognize the urgent need to develop and deploy better prevention tools and, most important, a safe and effective HIV vaccine….

Full Text

http://www.nejm.org/doi/full/10.1056/NEJMp1007629?query=TOC   

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMp1007629

September 27, 2010 at 11:52 pm Leave a comment

More Challenges in the Prevention and Management of Community-Associated, Methicillin-Resistant Staphylococcus aureus Skin Disease

Annals Intern Med  17 January 2008

Editorials

Rachel Gorwitz, Scott K. Fridkin, and Kimberly A. Workowski

From the Centers for Disease Control and Prevention and Emory University, Atlanta, GA 30333.

Staphylococcus aureus is and has long been a common cause of community-associated skin infections, transmitted mainly by close (skin-to-skin) contact. Methicillin-resistant S. aureus (MRSA), previously seen almost exclusively in association with health care, emerged in the 1990s as a cause of community-associated skin infection (1). In the United States, a single pulsed-field gel electrophoresis type, USA300, has caused most community-associated MRSA infections…

Full Text

http://www.annals.org/content/148/4/310.full?papetoc=

PDF

http://www.annals.org/content/148/4/310.full.pdf+html

September 27, 2010 at 11:50 pm Leave a comment

Re-treatment of Patients With Chronic Hepatitis C Who Do Not Respond to Peginterferon-{alpha}2b: A Randomized Trial

Ann Intern Med  21 April 2009   V.150  N.8  p.28-54

Articles

Donald M. Jensen, Patrick Marcellin, Bradley Freilich, Pietro Andreone, Adrian Di Bisceglie, Carlos E. Brandao-Mello, K. Rajender Reddy, Antonio Craxi, Antonio Olveira Martin, Gerlinde Teuber, Diethelm Messinger, James A. Thommes, and Andreas Tietz

From the Center for Liver Diseases, University of Chicago Hospitals, Chicago, Illinois; Centre de Recherche Biologique Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France; Liver and Pancreas Institute of Kansas City, Kansas City, Missouri; University of Bologna, Bologna, Italy; Saint Louis University Liver Center, Saint Louis University School of Medicine, Saint Louis, Missouri; University of Rio de Janeiro, Rio de Janeiro, Brazil; University of Pennsylvania, Philadelphia, Pennsylvania; University of Palermo, Palermo, Italy; Hospital La Paz, Madrid, Spain; J.W. Goethe University Hospital, Frankfurt, Germany; IST, Mannheim, Germany; Roche, Nutley, New Jersey; and Roche, Basel, Switzerland.

Abstract

Background

Many patients with chronic hepatitis C have not responded to therapy with pegylated interferon plus ribavirin.

Objective

To evaluate use of peginterferon-α2a plus ribavirin to re-treat nonresponders to peginterferon-α2b plus ribavirin.

Design

Randomized, parallel-group trial conducted between September 2003 and February 2007. Patients and researchers were not blinded to intervention assignment. Random assignment was centralized, computer-generated, and stratified by geographic region, hepatitis C virus (HCV) genotype, and histologic diagnosis.

Setting

106 international centers.

Patients

950 nonresponders to 12 or more weeks of therapy with peginterferon-α2b plus ribavirin.

Intervention

Peginterferon-α2a, 360 µg/wk, for 12 weeks, then 180 µg/wk to complete 72 weeks (group A) or 48 weeks (group B), or peginterferon-α2a, 180 µg/wk for 72 weeks (group C) or 48 weeks (group D). All patients received ribavirin, 1000 or 1200 mg/d.

Measurements

Sustained virologic response (SVR), defined as undetectable (<50 IU/mL) HCV RNA levels 24 weeks after the end of treatment.

Results

The SVR rates in groups A (n = 317), B (n = 156), C (n = 156), and D (n = 313) were 16%, 7%, 14%, and 9%, respectively (relative risk [RR] for group A vs. group D [the primary comparison], 1.80 [95% CI, 1.17 to 2.77]; P = 0.006). Extended treatment duration increased SVR rates (16% for 72 weeks [groups A and C] vs. 8% for 48 weeks [groups B and D]; RR, 2.00 [CI, 1.32 to 3.02]; P < 0.001). Complete viral suppression (HCV RNA level <50 IU/mL)at week 12 was achieved in 21% of patients in groups A and B and 13% of those in groups C and D. Rates of SVR were 49% (77 of 157 patients) and 4% (32 of 719 patients) among those with and without complete viral suppression at week 12, respectively.

Limitation

Nonresponders to peginterferon-α2a plus ribavirin were not evaluated.

Conclusion

Re-treating nonresponders to therapy with peginterferon-α2b plus ribavirin for 72 weeks significantly increases SVR rates compared with re-treating them for 48 weeks. The overall SVR rate was low, but patients who are most likely to respond to re-treatment can be identified at week 12.

abstract

http://www.annals.org/content/150/8/528.abstract?etoc

PDF

http://www.annals.org/content/150/8/528.full.pdf+html

September 27, 2010 at 11:48 pm Leave a comment

Safety and Efficacy of Extended-Duration Antiviral Chemoprophylaxis Against Pandemic and Seasonal Influenza

Ann Intern Med  6 Oct 2009 V.151 N.7 p.464-473

Reviews

Nayer Khazeni, Dena M. Bravata, Jon-Erik C. Holty, Timothy M. Uyeki, Christopher D. Stave, and Michael K. Gould

From Stanford University Medical Center, Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford Sleep Disorders Center, and Lane Medical Library, Stanford, California; Centers for Disease Control and Prevention, Atlanta, Georgia; and Veterans Affairs Palo Alto Health Care System, Palo Alto, California.

Abstract

Background

Neuraminidase inhibitors (NAIs) are stockpiled internationally for extended use in an influenza pandemic.

Purpose

To evaluate the safety and efficacy of extended-duration (>4 weeks) NAI chemoprophylaxis against influenza.

Data Sources

Studies published in any language through 11 June 2009 identified by searching 10 electronic databases and 3 trial registries.

Study Selection

Randomized, placebo-controlled, double-blind human trials of extended-duration NAI chemoprophylaxis that reported outcomes of laboratory-confirmed influenza or adverse events.

Data Extraction

2 reviewers independently assessed study quality and abstracted information from eligible studies.

Data Synthesis

Of 1876 potentially relevant citations, 7 trials involving 7021 unique participants met inclusion criteria. Data were pooled by using random-effects models. Chemoprophylaxis with NAIs decreased the frequency of symptomatic influenza (relative risk [RR], 0.26 [95% CI, 0.18 to 0.37]; risk difference [RD], −3.9 percentage points [CI, −5.8 to −1.9 percentage points]) but not asymptomatic influenza (RR, 1.03 [CI, 0.81 to 1.30]; RD, −0.4 percentage point [CI, −1.6 to 0.9 percentage point]). Adverse effects were not increased overall among NAI recipients (RR, 1.01 [CI, 0.94 to 1.08]; RD, 0.1 percentage point [CI, −0.2 to 0.4 percentage point]), but nausea and vomiting were more common among those who took oseltamivir (RR, 1.48 [CI, 1.86 to 2.33]; RD, 1.7 percentage points [CI, 0.6 to 2.9 percentage points]). Prevention of influenza did not statistically significantly differ between zanamivir and oseltamivir.

Limitations

All trials were industry-sponsored. No study was powered to detect rare adverse events, and none included diverse racial groups, children, immunocompromised patients, or individuals who received live attenuated influenza virus vaccine.

Conclusion

Extended-duration zanamivir and oseltamivir chemoprophylaxis seems to be highly efficacious for preventing symptomatic influenza among immunocompetent white and Japanese adults. Extended-duration oseltamivir is associated with increased nausea and vomiting. Safety and efficacy in several subpopulations that might receive extended-duration influenza chemoprophylaxis are unknown.

abstract

http://www.annals.org/content/151/7/464.abstract?papetoc=

PDF

http://www.annals.org/content/151/7/464.full.pdf+html

September 27, 2010 at 11:46 pm Leave a comment

Cryptosporidiosis: environmental, therapeutic, and preventive challenges

Europ J of Clinical Microb & Infec Dis  August 2010 V.29  N.8  p.927 – 935

 S. Collinet-Adler1, 2, 3  and H. D. Ward1, 2

 (1) Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA

(2) Tufts University, Boston, MA, USA

(3) Tufts Medical Center, Box #41, 800, Washington Street, Boston, MA 02111, USA

 Abstract 

Cryptosporidium spp. are responsible for endemic and epidemic disease worldwide. Clinical manifestations may include acute, persistent, or chronic diarrhea, biliary, and pulmonary disease. Disease severity ranges from asymptomatic or mild to severe, intractable diarrhea with wasting depending on immune status, nutrition, and age. Transmission is fecal–oral with both human and animal reservoirs. Disease is often self limited in healthy individuals, but therapy remains a challenge in the immune-compromised. Prevention currently depends on appropriate hygiene and proper water management and treatment.

 abstract

http://www.springerlink.com/content/v01r030643312067/

September 27, 2010 at 11:44 pm Leave a comment

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