Archive for October, 2012

Summary of the British Transplantation Society Guidelines for the Prevention and Management of CMV Disease After Solid Organ Transplantation.

Transplantation. 2011 Dec 15 V.92 N.11  P.1181-7.

Andrews PA, Emery VC, Newstead C.


SW Thames Renal & Transplantation Unit, St. Helier Hospital, Surrey, UK.


The third edition of the British Transplantation Society Guidelines for the Prevention and Management of CMV Disease after Solid Organ Transplantation was published in March 2011. This article summarizes the important changes and advances in management in this rapidly evolving field. The pros and cons of universal, or targeted anti-cytomegalovirus (CMV) prophylaxis, and pre-emptive anti-CMV therapy are discussed, especially with respect to advances in CMV polymerase chain reaction monitoring. The evidence for oral anti-CMV prophylaxis using valganciclovir is presented, together with a summary of the treatment of CMV disease and emerging fields such as CMV vaccination, CMV genotyping, and drug resistance.




October 31, 2012 at 2:05 pm

Case 33-2009: A woman with fever after cesarean section.

N Engl J Med. 2010 Jan 21 V.362 N.3 P.273  author reply 273-4.

Clay R, Camann W.


Comment on

Case records of the Massachusetts General Hospital. Case 33-2009. A 35-year-old woman with fever, abdominal pain, and hypotension after cesarean section. [N Engl J Med. 2009]


October 31, 2012 at 2:02 pm

Adherence to guidelines and its impact on outcomes in patients hospitalized with community-acquired pneumonia at a university hospital.

J Bras Pneumol. 2012 Apr;38(2):148-57.

Silveira CD, Ferreira CS, Corrêa Rde A.


Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.



To evaluate the agreement between the criteria used for hospitalization of patients with community-acquired pneumonia (CAP) and those of the Brazilian Thoracic Association guidelines, and to evaluate the association of that agreement with 30-day mortality. Secondarily, to evaluate the agreement between the treatment given and that recommended in the guidelines with length of hospital stay, microbiological profile, 12-month mortality, complications, ICU admission, mechanical ventilation, and 30-day mortality.


This was a retrospective study involving adult patients hospitalized between 2005 and 2007 at the Federal University of Minas Gerais Hospital das Clínicas, located in Belo Horizonte, Brazil. Medical charts and chest X-rays were reviewed.


Among the 112 patients included in the study, admission and treatment criteria were in accordance with the guidelines in 82 (73.2%) and 66 (58.9%), respectively. The 30-day and 12-month mortality rates were 12.3% and 19.4%, respectively. The 30-day mortality rate was lower for patients in whom the CRB-65 (mental Confusion, Respiratory rate, Blood pressure, and age > 65 years) score was 1-2 and the antibiotic therapy was in accordance with the guidelines (p = 0.01). Cerebrovascular disease and appropriate antibiotic therapy showed independent associations with 30-day mortality. There was a trend toward an association between guideline-concordant antibiotic therapy and shorter hospital stay.


In the population studied, admission and treatment criteria that were in accordance with the guidelines were associated with favorable outcomes in hospitalized patients with CAP. Cerebrovascular disease, as a risk factor, and guideline-concordant antibiotic therapy, as a protective factor, were associated with 30-day mortality.


Comment in

Recommendations and implementation of guidelines for community-acquired pneumonia: more problems than solutions. [J Bras Pneumol. 2012]


October 31, 2012 at 2:01 pm

Quality of care in patients with community acquired pneumonia and sepsis in a Swiss hospital.

Swiss Med Wkly. 2012 Feb 10;142:0.

Widmer CC, Bachli EB.


Clinic of Internal Medicine, Uster Hospital, Switzerland.



Community acquired pneumonia (CAP) and sepsis are leading causes of hospitalisation after admission to a medical emergency department (ED). Identifying these potentially life-threatening diseases is not always easy due to often unspecific or minimal symptoms. However, quick application of antibiotics is known to be crucial and is correlated with better outcome. The international guidelines of the joint commission suggest a 4 hour-rule for optimal quality of care in CAP and sepsis. In this study we assessed the door-to-needle time (DNT) in patients admitted to our ED with the diagnosis of CAP and/or sepsis. Furthermore we investigated the CRB-65 score, its clinical performance and its influence on DNT.


Retrospective observational study of all patients admitted and hospitalised through the ED of a Swiss hospital with the diagnosis of sepsis or pneumonia from June 2009 to June 2010 (n = 139).


In 73% of the cases DNT was lower than the recommended 4 hours. In CAP, a correlation between the CRB-65 and DNT was not found (ρ = 0.13, p = 0.30). Further parameters, e.g. temperature or blood pressure did not improve DNT significantly. Analysis of the CRB-65 score was regularly impeded due to absent documented information on respiratory rate or confusion state.


In most cases it was feasible to fulfill the 4 hours DNT. The CRB-65 score is an easy bedside tool, which was not routinely assessed by our emergency room personnel but its assessment did not affect DNT in our hospital.


PDF (clic en “Article as PDF”)

October 31, 2012 at 2:00 pm

Helicobacter pylori therapy: Present and future.


World J Gastrointest Pharmacol Ther. 2012 Aug 6 V.3 N.4 P.68-73.

De Francesco V, Ierardi E, Hassan C, Zullo A.


Vincenzo De Francesco, Enzo Ierardi, Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Ospedali Riuniti, 71100 Foggia, Italy.


Helicobacter pylori (H. pylori) plays a crucial role in the pathogenesis of chronic active gastritis, peptic ulcer and gastric mucosa-associated lymphoid tissue-lymphoma, and is also involved in carcinogenesis of the stomach. H. pylori treatment still remains a challenge for physicians, since no current first-line therapy is able to cure the infection in all treated patients. Several factors may help in the eradication of therapy failure.

We reviewed both bacterial and host factors involved in therapeutic management of the H. pylori infection. In addition, we evaluated data on the most successful therapy regimens – sequential and concomitant therapies – currently available for H. pylori eradication.


October 30, 2012 at 3:41 pm

Update on triple therapy for eradication of Helicobacter pylori: current status of the art.

Clin Exp Gastroenterol. 2012 V.5  P.151-7.

Urgesi R, Cianci R, Riccioni ME.


Gastroenterology and Endoscopy Unit, Viterbo.


With the rising prevalence of antimicrobial resistance, the treatment success of standard triple therapy has recently declined to unacceptable levels (ie, 80% or less). Following the failure of conventional triple therapy, novel eradication regimens have been developed including sequential therapy, concomitant quadruple therapy, hybrid (dual-concomitant) therapy, bismuth-containing quadruple therapy, and a therapy with administration of N-acetylcysteine before a culture-guided antibiotic regimen.

This article reviews the literature published on Helicobacter pylori eradication in the last year, focusing on the development of alternative strategies for first-, second-, and third-line rescue therapy for the eradication of H. pylori.


October 30, 2012 at 3:39 pm

Policy statement—Recommendations for the prevention of perinatal group B streptococcal (GBS) disease.

Pediatrics. 2011 Sep V.128 N.3 P.611-6.

Committee on Infectious Diseases; Committee on Fetus and Newborn, Baker CJ, Byington CL, Polin RA.

Collaborators (45)


The Centers for Disease Control and Prevention (CDC) guidelines for the prevention of perinatal group B streptococcal (GBS) disease were initially published in 1996. The AmericanAcademy of Pediatrics (AAP) also published a policy statement on this topic in 1997.

In 2002, the CDC published revised guidelines that recommended universal antenatal GBS screening; the AAP endorsed these guidelines and published recommendations based on them in the 2003 Red Book. Since then, the incidence of early-onset GBS disease in neonates has decreased by an estimated 80%. However, in 2010, GBS disease remained the leading cause of early-onset neonatal sepsis.

The CDC issued revised guidelines in 2010 based on evaluation of data generated after 2002. These revised and comprehensive guidelines, which have been endorsed by the AAP, reaffirm the major prevention strategy–universal antenatal GBS screening and intrapartum antibiotic prophylaxis for culture-positive and high-risk women–and include new recommendations for laboratory methods for identification of GBS colonization during pregnancy, algorithms for screening and intrapartum prophylaxis for women with preterm labor and premature rupture of membranes, updated prophylaxis recommendations for women with a penicillin allergy, and a revised algorithm for the care of newborn infants. The purpose of this policy statement is to review and discuss the differences between the 2002 and 2010 CDC guidelines that are most relevant for the practice of pediatrics.


October 30, 2012 at 3:38 pm

Current debate on the use of antibiotic prophylaxis for caesarean section.

BJOG. 2011 Jan V.118 N.2 P.193-201.

Lamont RF, Sobel JD, Kusanovic JP, Vaisbuch E, Mazaki-Tovi S, Kim SK, Uldbjerg N, Romero R.


Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA.


Caesarean delivery is frequently complicated by surgical site infections, endometritis and urinary tract infection. Most surgical site infections occur after discharge from the hospital, and are increasingly being used as performance indicators. Worldwide, the rate of caesarean delivery is increasing. Evidence-based guidelines recommended the use of prophylactic antibiotics before surgical incision. An exception is made for caesarean delivery, where narrow-range antibiotics are administered after umbilical cord clamping because of putative neonatal benefit. However, recent evidence supports the use of pre-incision, broad-spectrum antibiotics, which result in a lower rate of maternal morbidity with no disadvantage to the neonate.


October 29, 2012 at 2:04 pm

Antibiotics prophylaxis in connection with caesarean section–guidelines at Norwegian maternity departments.

Tidsskr Nor Laegeforen. 2011 Nov 29 V.131 N.23 P.2355-8.

Eriksen HM, Sæther AR, Økland I, Langen E, Sandness Y, Bødtker A, Skjeldestad FE.


Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Norway.



The frequency of caesarean sections is increasing. Infection in operation wounds and/or underlying spaces and organs is a common complication. In Veileder I fødselshjelp [Clinical Guidelines in Obstetrics], 2008, antibiotic prophylaxis is recommended in the form of single dose ampicillin or first generation cephalosporins in connection with acute caesarean sections and under special conditions such as prolonged operations. We wanted to find out whether Norwegian maternity departments follow these recommendations.


All head senior consultants at maternity departments that carried out more than one caesarean section in 2008 were invited to take part in a survey of the department’s written guidelines for use of antibiotic prophylaxis in connection with caesarean section. The extent to which the guidelines were followed was evaluated using data from the Norwegian Surveillance System for Hospital-Associated Infections (NOIS).


38 of the 42 maternity wards in the investigation had written guidelines for antibiotic prophylaxis. Four of these maternity wards gave prophylaxis in all Caesarean sections, one only on indication, and 33 in acute Caesarean section. The guidelines varied as regards choice of type of antibiotic and time of administration. In the maternity wards with written guidelines recommending use of antibiotic prophylaxis in all Caesarean sections, were practice in accordance with the guidelines. When the guidelines recommended prophylactic use only in acute operations, there was agreement between practice and guidelines in 71 % to 97 % of the patients in the ward.


Most Norwegian maternity wards have written guidelines on antibiotic prophylaxis in Caesarean section. The contents of the guidelines varied but are mainly in agreement with current Norwegian recommendations.



October 29, 2012 at 2:03 pm

Efficacy of single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post-caesarean infection: study protocol for a randomized controlled trial.

Trials. 2012 Jun 21 V.13 P.89.

Lyimo FM, Massinde AN, Kidenya BR, Konje E, Mshana SE.


Department of Obstetrics and Gynaecology, Catholic University of Health Sciences and Allied Science and Bugando Medical Centre, Box 1464, Mwanza, Tanzania.



BACKGROUND: Caesarean section is a commonly performed operation worldwide. It has been found to increase rates of maternal infectious morbidities more than five times when compared to vaginal delivery. Provision of intravenous prophylactic antibiotics 30 to 60 minutes prior to caesarean section has been found to reduce post-caesarean infection tremendously. Many centers recommend provision of a single dose of antibiotics, as repeated doses offer no benefit over a single dose.At Bugando Medical Centre post caesarean infection is among the top five causes of admission at the post-natal ward. Unfortunately, there is no consistent protocol for the administration of antibiotic prophylaxis to patients who are designated for caesarean section. Common practice and generally the clinician’s preference are to provide repeated dosages of antibiotic prophylaxis after caesarean section to most of the patients. This study aims to determine the comparative efficacy of a single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post caesarean infection.


The study is an interventional, open-label, two-armed, randomized, single-center study conducted at Bugando Medical Centre Mwanza, Tanzania. It is an ongoing trial for the period of seven months; 490 eligible candidates will be enrolled in the study. Study subjects will be randomly allocated into two study arms; “A” and “B”. Candidates in “A” will receive a single dose of gentamicin in combination with metronidazole 30 to 60 minutes prior to the operation and candidates in “B” will receive the same drugs prior to the operation and continue with gentamicin and metronidazole for 24 hours. The two groups will be followed up for a period of one month and assessed for signs and symptoms of surgical site infection.Data will be extracted from a case record form and entered into Epi data3.1 software before being transferred to SPSS version 17.0 for analysis. The absolute difference in proportion of women who develop surgical site infection in the two study arms will be the effectiveness of one regime over the other.


Current Controlled TrialsISRCTN44462542.


October 29, 2012 at 2:02 pm

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