Archive for September 2, 2012

Hepatic abscess as first manifestation of pneumococcal invasive disease.

Rev Chilena Infectol. 2011 Aug;28(4):381.

Gilardi L, Eugenia Dellepiane M.

Osecac, Programa de Guías de Práctica Clínica, Ciudad Autónoma de Buenos Aires, Argentina. revision_guias@yahoo.com.ar

Abstract

Pneumococcal invasive disease is an important cause of morbidity and mortality in different population groups. Most cases originate from an airway infection. We describe a patient with diabetes mellitus who presented a liver abscess as first manifestation of pneumococcal invasive disease, without respiratory symptoms. The patient was treated with percutaneous drainage and systemic antibiotics with good results. Streptococcus pneumoniae should be considered among the possible etiologies of hepatic abscess, even in absence of respiratory symptoms.

PDF

http://www.scielo.cl/pdf/rci/v28n4/art14.pdf

September 2, 2012 at 9:46 pm

Prevention and treatment of surgical site infection in HIV-infected patients.

BMC Infect Dis. 2012 May 14;12(1):115.

Zhang L, Liu BC, Zhang XY, Li L, Xia XJ, Guo RZ.

ABSTRACT:

BACKGROUND:

Surgical site infection (SSI) are the third most frequently reported nosocomial infection, and the most common on surgical wards. HIV-infected patients may increase the possibility of developing SSI after surgery. There are few reported date on incidence and the preventive measures of SSI in HIV-infected patients. This study was to determine the incidence and the associated risk factors for SSI in HIV-infected patients. And we also explored the preventive measures.

METHODS:

A retrospective study of SSI was conducted in 242 HIV-infected patients including 17 patients who combined with hemophilia from October 2008 to September 2011 in Shanghai Public Health Clinical Center. SSI were classified according to Centers for Disease Control and Prevention (CDC) criteria and identified by bedside surveillance and post-discharge follow-up. Data were analyzed using SPSS 16.0 statistical software (SPSS Inc., Chicago, IL).

RESULTS:

The SSI incidence rate was 47.5% (115 of 242); 38.4% incisional SSIs, 5.4% deep incisional SSIs and 3.7% organ/space SSIs. The SSI incidence rate was 37.9% in HIV-infected patients undergoing abdominal operation. Patients undergoing abdominal surgery with lower preoperative CD4 counts were more likely to develop SSIs. The incidence increased from 2.6% in clean wounds to 100% in dirty wounds. In the HIV-infected patients combined with hemophilia, the mean preoperative albumin and postoperative hemoglobin were found significantly lower than those in no-SSIs group (P<0.05).

CONCLUSIONS:

SSI is frequent in HIV-infected patients. And suitable perioperative management may decrease the SSIs incidence rate of HIV-infected patients.

PDF

http://www.biomedcentral.com/content/pdf/1471-2334-12-115.pdf

September 2, 2012 at 9:44 pm

Antimicrobial susceptibility testing in clinically relevant non-fermenting gram-negative bacilli: recommendations from the Antimicrobial Agents Subcommittee of the Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas, Asociación Argentina de Microbiología.

Rev Argent Microbiol. 2011 Apr-May  V.43 N.2  P.136-53.

Radice M, Marín M, Giovanakis M, Vay C, Almuzara M, Limansky A, Casellas JM, Famiglietti A, Quinteros M, Bantar C, Galas M, Kovensky Pupko J, Nicola F, Pasterán F, Soloaga R, Gutkind G.

Subcomisión de Antimicrobianos, Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas, Asociación Argentina de Microbiología, Ciudad Autónoma de Buenos Aires, Argentina.

Abstract

This document contains the recommendations for antimicrobial susceptibility testing of the clinically relevant non-fermenting gram-negative bacilli (NFGNB), adopted after conforming those from international committees to the experience of the Antimicrobial Agents Subcommittee members and invited experts. This document includes an update on NFGNB classification and description, as well as some specific descriptions regarding natural or frequent antimicrobial resistance and a brief account of associated resistance mechanisms. These recommendations not only suggest the antimicrobial drugs to be evaluated in each case, but also provide an optimization of the disk diffusion layout and a selection of results to be reported. Finally, this document also includes a summary of the different methodological approaches that may be used for detection and confirmation of emerging b-lactamases, such as class A and B carbapenemases.

PDF

http://www.scielo.org.ar/pdf/ram/v43n2/v43n2a12.pdf

September 2, 2012 at 9:41 pm

Plasma HIV-1 RNA detection below 50 copies/ml and risk of virologic rebound in patients receiving highly active antiretroviral therapy.

Clin Infect Dis. 2012 Mar 1  V.54 N.5  P.724-32.

Doyle T, Smith C, Vitiello P, Cambiano V, Johnson M, Owen A, Phillips AN, Geretti AM.

Department of Virology, Royal Free Hampstead NHS Trust, and Department of Virology, UCL Medical School, London, United Kingdom.

Abstract

BACKGROUND:

Plasma human immunodeficiency virus type 1 (HIV-1) RNA suppression <50 copies/mL is regarded as the optimal outcome of highly active antiretroviral therapy (HAART). Current viral load (VL) assays show increased sensitivity, but the significance of RNA detection <50 copies/mL is unclear.

METHODS:

This study investigated the virologic outcomes of 1247 patients with VL <50 copies/mL at an arbitrary time point during HAART (= T0), according to whether the actual, unreported (T0)VL was 40-49 copies/mL, RNA detected <40 copies/mL (RNA(+)), or RNA not detected (RNA(-)), as measured by the Abbott Real Time assay. Predictors of rebound >50 and >400 copies/mL over 12 months following T0 were analyzed with Cox proportional hazards models incorporating the (T0)VL and demographic and clinical data.

RESULTS:

Rebound rates >50 copies/mL were 34.2% for (T0)VL 40-49 copies/mL, 11.3% for RNA(+), and 4.0% for RNA(-); rebound rates >400 copies/mL were 13.0%, 3.8%, and 1.2%, respectively. The adjusted hazard ratios for rebound >50 copies/mL were 4.67 (95% confidence interval, 2.91-7.47; P < .0001) and 1.97 (1.25-3.11; P < .0001) with (T0)VL 40-49 copies/mL and RNA(+), respectively, relative to RNA(-), and 6.91 (2.90-16.47; P < .0001) and 2.88 (1.24-6.69; P < .0001), respectively, for rebound >400 copies/mL. The association was independent of adherence levels.

CONCLUSIONS:

In treated patients monitored by RealTime, a VL of 40-49 copies/mL and, to a lesser extent, RNA detection <40 copies/mL predict rebound >50 and >400 copies/mL independently of other recognized determinants. The goal of HAART may need to be revised to a lower cutoff than 50 copies/mL.

FULL TEXT

http://cid.oxfordjournals.org/content/54/5/724.long

PDF

http://cid.oxfordjournals.org/content/54/5/724.full.pdf+html

 

Comment in

Plasma HIV-1 RNA levels during antiretroviral therapy: how low is low enough? [Clin Infect Dis. 2012]

FULL TEXT

http://cid.oxfordjournals.org/content/54/5/733.long

PDF

http://cid.oxfordjournals.org/content/54/5/733.full.pdf+html

September 2, 2012 at 10:55 am

The persisting burden of invasive pneumococcal disease in HIV patients: an observational cohort study.

BMC Infect Dis. 2011 Nov 11;11:314.

Siemieniuk RA, Gregson DB, Gill MJ.

Southern Alberta HIV Clinic, Calgary, Canada.

Abstract

BACKGROUND:

The increasing use of highly active antiretroviral therapy (HAART) and pneumococcal immunization along with shifting community exposures may have altered the burden of Streptococcus pneumoniae disease in HIV-infected persons. We describe the burden and risk factors for pneumococcal disease in the modern era of HIV care and evaluate the use of a 23-valent pneumococcal polysaccharide vaccine (PPV-23).

METHODS:

The incidence of invasive pneumococcal disease (IPD) between January 1st, 2000 and January 1st, 2010 in a regional HIV population in Southern Alberta, Canada was determined by linking comprehensive laboratory and hospital surveillance data. Clinical and epidemiologic data including risk factors for S. pneumoniae, history of pneumococcal immunization, serotypes of infections, and length of any hospitalizations for pneumococcal disease were evaluated with multivariate analysis. CD4 count and viral load at immunization were evaluated with a nested case-control analysis.

RESULTS:

In 1946 HIV-patients with 11,099 person-years of follow up, there were 68 distinct episodes of pneumococcal disease occurring in 50 patients. Increased risk was seen if female, age >60, Aboriginal ethnicity, lower education, injection drug use, smoking, nadir CD4 <200/μL, chronic obstructive pulmonary disease, and hepatitis C. Overall, the incidence of IPD was 342/100,000 person-years and was reduced to 187/100,000 within three years of PPV-23 immunization (P < 0.01). Although 78% of patients received PPV-23, 74% of IPD episodes were caused by PPV-23 serotypes. In a case-control analysis, HIV viral load at immunization was significantly predictive of PPV-23 failure, while CD4 count was not. 80% of IPD cases required hospitalization: median length of stay was 7 days (range: 1-71); four patients died.

CONCLUSIONS:

Despite universal access to intensive measures to prevent pneumococcal disease including the widespread use of HAART and PPV-23 immunization, the incidence of IPD remains high in HIV patients with its associated morbidity and mortality.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226630/pdf/1471-2334-11-314.pdf

 

September 2, 2012 at 10:53 am


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