Archive for October 14, 2010

Clinical presentation and prognosis of the 2009 H1N1 influenza A infection in HIV-1-infected patients: a Spanish multicenter study.

AIDS. 23 Oct 2010  V.24  N.16  p.2461-7.

Riera M, Payeras A, Marcos MA, Viasus D, Farinas MC, Segura F, Torre-Cisneros J, Martín-Quirós A, Rodríguez-Baño J, Vila J, Cordero E, Carratalà J.

Hospital Son Dureta, Spain.

Abstract

OBJECTIVE

The aim of the study was to describe the clinical presentation and prognosis in HIV-1-infected patients with hospital admission and pandemic influenza A 2009 (H1N1) confirmed, and compare this data with those of a general population.

DESIGN

This is a prospective study in nature.

METHODS

All adult patients admitted to 13 hospitals in Spain with confirmed influenza A 2009(H1N1) virus infection by real-time reverse transcriptase PCR assay or culture from June 12 to November 10, 2009 were recruited and followed up until 1 month after discharge. In the HIV group risk factors for HIV infection, AIDS criteria, last CD4 cell count and viral load, and antiretroviral therapy and pneumococcal vaccines were collected.

RESULTS

Five hundred and eighty-five patients were recruited, 26 with HIV-1 infection and 559 non-HIV. The HIV patients had a long-term well controlled infection with a median CD4 cell count 503 cells/μl and 84% with undetectable viral load, although more frequently they had chronic liver and chronic obstructive pulmonary disease. No significant differences were observed about reported symptoms and physical findings on hospital admission. About 50% of patients in both groups present radiological infiltrates and 30% present respiratory failures. Practically all the patients in both groups received influenza antiviral therapy and in each group 80% received antibacterial therapy. No differences were observed in clinical outcomes.

CONCLUSION

In HIV patients, well controlled on HAART, the pandemic influenza virus AH1N1 had a similar clinical outcome and prognosis to that of non-HIV patients.

October 14, 2010 at 6:37 pm Leave a comment

Early combination antibiotic therapy yields improved survival compared with monotherapy in septic shock: a propensity-matched analysis.

Crit Care Med. Sept 2010 V.38  N.9  p.1773-85.

Kumar A, Zarychanski R, Light B, Parrillo J, Maki D, Simon D, Laporta D, Lapinsky S, Ellis P, Mirzanejad Y, Martinka G, Keenan S, Wood G, Arabi Y, Feinstein D, Kumar A, Dodek P, Kravetsky L, Doucette S; Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group.

Collaborators (57)Wood KE, Laupland K, Kramer A, Penner C, Light B, Sharma S, Lapinsky S, Marshall J, Dial S, Bagshaw S, Skrobik I, Patel G, Gurka D, Zanotti S, Dellinger P, Feinstein D, Guzman J, Al Shirawi N, Al Memish Z, Ronald J, Suleman M, Gulati H, Halmarson E, Suppes R, Peters C, Sullivan K, Bohmeier R, Muggaberg S, Kravetsky L, Ahsan MW, Singh A, Carter L, Wiebe K, Kolesar L, Richards J, Jaswal D, Chou H, Kosick T, Fu W, Chan C, Ren JJ, Bahrainian M, Haque Z, Torshizi OA, Paulin H, Khan F, Kumar R, Harvey J, Kim C, Li J, Campbell L, Taiberg L, Schorr C, Tchokonte R, Gonzales C, Serrano N, Delgra S.

Section of Critical Care Medicine, Health Sciences Centre/St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. akumar61@yahoo.com

Comment in:

Crit Care Med. 2010 Sep;38(9):1906-8.

http://www.ncbi.nlm.nih.gov/pubmed/20724888

Crit Care Med. 2010 Sep;38(9):1905-6.

http://www.ncbi.nlm.nih.gov/pubmed/20585123?dopt=Abstract

Abstract

BACKGROUND

Septic shock represents the major cause of infection-associated mortality in the intensive care unit. The possibility that combination antibiotic therapy of bacterial septic shock improves outcome is controversial. Current guidelines do not recommend combination therapy except for the express purpose of broadening coverage when resistant pathogens are a concern.

OBJECTIVE

To evaluate the therapeutic benefit of early combination therapy comprising at least two antibiotics of different mechanisms with in vitro activity for the isolated pathogen in patients with bacterial septic shock.

DESIGN

Retrospective, propensity matched, multicenter, cohort study.

SETTING

Intensive care units of 28 academic and community hospitals in three countries between 1996 and 2007.

SUBJECTS

A total of 4662 eligible cases of culture-positive, bacterial septic shock treated with combination or monotherapy from which 1223 propensity-matched pairs were generated.

MEASUREMENTS AND MAIN RESULTS

The primary outcome of study was 28-day mortality. Using a Cox proportional hazards model, combination therapy was associated with decreased 28-day mortality (444 of 1223 [36.3%] vs. 355 of 1223 [29.0%]; hazard ratio, 0.77; 95% confidence interval, 0.67-0.88; p = .0002). The beneficial impact of combination therapy applied to both Gram-positive and Gram-negative infections but was restricted to patients treated with beta-lactams in combination with aminoglycosides, fluoroquinolones, or macrolides/clindamycin. Combination therapy was also associated with significant reductions in intensive care unit (437 of 1223 [35.7%] vs. 352 of 1223 [28.8%]; odds ratio, 0.75; 95% confidence interval, 0.63-0.92; p = .0006) and hospital mortality (584 of 1223 [47.8%] vs. 457 of 1223 [37.4%]; odds ratio, 0.69; 95% confidence interval, 0.59-0.81; p < .0001). The use of combination therapy was associated with increased ventilator (median and [interquartile range], 10 [0-25] vs. 17 [0-26]; p = .008) and pressor/inotrope-free days (median and [interquartile range], 23 [0-28] vs. 25 [0-28]; p = .007) up to 30 days.

CONCLUSION

Early combination antibiotic therapy is associated with decreased mortality in septic shock. Prospective randomized trials are needed.

abstract

http://www.ncbi.nlm.nih.gov/pubmed/20639750?dopt=Abstract

October 14, 2010 at 6:16 pm Leave a comment

Influence of empiric therapy with a beta-lactam alone or combined with an aminoglycoside on prognosis of bacteremia due to gram-negative microorganisms.

Antimicrob Agents Chemother. Sept 2010  V.54  N.9  p.3590-6

Martínez JA, Cobos-Trigueros N, Soriano A, Almela M, Ortega M, Marco F, Pitart C, Sterzik H, Lopez J, Mensa J.

Department of Infectious Diseases, Hospital Clinic-IDIBAPS, Villarroel 170, 08036 Barcelona, Spain. jamarti@clinic.ub.es

Abstract

Evidence supporting the combination of aminoglycosides with beta-lactams for gram-negative bacteremia is inconclusive. We have explored the influence on survival of empirical therapy with a beta-lactam alone versus that with a beta-lactam-aminoglycoside combination by retrospectively analyzing a series of bacteremic episodes due to aerobic or facultative gram-negative microorganisms treated with single or combination therapy. The outcome variable was a 30-day mortality. Prognostic factors were selected by regression logistic analysis. A total of 4,863 episodes were assessed, of which 678 (14%) received combination therapy and 467 (10%) were fatal. Factors independently associated with mortality included age greater than 65 (odds ratio [OR], 2; 95% confidence interval [CI], 1.6 to 2.6), hospital acquisition (OR, 1.5; 95% CI, 1.2 to 1.9), a rapidly or ultimately fatal underlying disease (OR, 2.5; 95% CI, 2 to 3.2), cirrhosis (OR, 1.9; 95% CI, 1.4 to 2.6), prior corticosteroids (OR, 1.5; 95% CI, 1.1 to 2), shock on presentation (OR, 8.8; 95% CI, 7 to 11), pneumonia (OR, 2.8; 95% CI, 1.9 to 4), and inappropriate empirical therapy (OR, 1.8; 95% CI, 1.3 to 2.5). Subgroup analysis revealed that combination therapy was an independent protective factor in episodes presenting shock (OR, 0.6; 95% CI, 0.4 to 0.9) or neutropenia (OR, 0.5; 95% CI, 0.3 to 0.9). Combination therapy improved the appropriateness of empirical therapy in episodes due to extended-spectrum beta-lactamase (ESBL)- or AmpC-producing Enterobacteriaceae and Pseudomonas aeruginosa. In patients with gram-negative bacteremia, we could not find an overall association between empirical beta-lactam-aminoglycoside combination therapy and prognosis. However, a survival advantage cannot be discarded for episodes presenting shock or neutropenia, hence in these situations the use of combination therapy may still be justified. Combination therapy also should be considered for patients at risk of being infected with resistant organisms, if only to increase the appropriateness of empirical therapy.

abstract

http://www.ncbi.nlm.nih.gov/pubmed/20585123?dopt=Abstract

October 14, 2010 at 6:14 pm Leave a comment


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