Archive for February 7, 2013

Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection

N Engl J of Medicine Feb.7, 2013 V.368 P.533-542

Michael W. Climo, M.D., Deborah S. Yokoe, M.D., M.P.H., David K. Warren, M.D., Trish M. Perl, M.D., Maureen Bolon, M.D., Loreen A. Herwaldt, M.D., Robert A. Weinstein, M.D., Kent A. Sepkowitz, M.D., John A. Jernigan, M.D., Kakotan Sanogo, M.S., and Edward S. Wong, M.D.

BACKGROUND

Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs).

METHODS

We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine–impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis.

RESULTS

A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.03), the equivalent of a 23% lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.007), a 28% lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period.

CONCLUSIONS

Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired bloodstream infections. (Funded by the Centers for Disease Control and Prevention and Sage Products; ClinicalTrials.gov number, NCT00502476.)

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1113849

February 7, 2013 at 9:39 am

Designing Tomorrow’s Vaccines

N Engl J of Medicine Feb.7, 2013 V.368 P.551-560

REVIEW ARTICLE

GLOBAL HEALTH

Gary J. Nabel, M.D., Ph.D.- From the Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.

Vaccines are among the most effective interventions in modern medicine. Ever since Edward Jenner’s first use of a vaccine against smallpox in 1796 , the use of vaccines has become indispensable to the eradication of disease. In the 20th century alone, smallpox claimed an estimated 375 million lives, but since 1978, after the completion of a successful eradication campaign, not a single person has died from smallpox. Today, more than 70 vaccines have been licensed for use against approximately 30 microbes, sparing countless lives. Diseases including poliomyelitis, measles, mumps, rubella, and others caused an estimated 39 million infections in the 20th century in the United States, but vaccines have since rendered them uncommon. The success of this public health intervention emanates not only from the identification of effective vaccines but also from a robust infrastructure for vaccine manufacturing, regulatory and safety oversight, and organized approaches to delivery. Vaccines represent the least expensive and most facile way to protect against devastating epidemics. Society derives economic benefits by preventing hospitalization, avoiding long-term disability, and reducing absence from work. In brief, vaccines provide the most cost-effective means to save lives, preserve good health, and maintain a high quality of life…

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMra1204186

February 7, 2013 at 9:38 am

Papulonodular Syphilis

N Engl J of Medicine Feb.7, 2013 V.368 P.561

IMAGES IN CLINICAL MEDICINE

Birgit Ziegler, M.D., and Nina Booken, M.D.- University Hospital of Mannheim, Mannheim, Germany

A 52-year-old woman presented with a 3-week history of asymptomatic erythematous papules and nodules. The lesions initially appeared on the face and tongue (Panels A and B) and subsequently spread to the trunk and lower legs. The patient had no other systemic symptoms. Two weeks earlier, she had been treated with oral penicillin G for a sore throat but had stopped taking the antibiotic after a few days because of angioedema. A biopsy of a facial lesion revealed an inflammatory infiltrate with multiple mature plasma cells suggestive of secondary syphilis. The diagnosis was made on the basis of a titer of 1:160,000 (normal range, 0 to 640) on a Treponema pallidum particle agglutination assay, a value of 5770 U per milliliter (normal range, 0 to 24) on an enzyme-linked immunosorbent assay for T. pallidum IgG, and a positive assay for T. pallidum IgM. The differential diagnosis included leukemia cutis and cutaneous sarcoidosis. The patient received the diagnosis of papulonodular secondary syphilis with mucous plaques and most likely a syphilitic pharyngitis. Because of previous penicillin intolerance, the patient was treated with intravenous ceftriaxone (2 g daily) for 3 weeks. The rash cleared within 4 weeks after the initiation of treatment.

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMicm1203977

February 7, 2013 at 9:36 am

Yellow Fever Outbreak in Sudan

N Engl J of Medicine Feb.7, 2013

Perspective

Lewis Markoff, M.D.- From the Laboratory of Vector-borne Virus Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD.

On November 16, 2012, the Weekly Epidemiological Record of the World Health Organization (WHO) reported that an outbreak of yellow fever was under way in Sudan. By the end of November, the disease had been detected in 26 localities in Sudan’s Darfur region, with 459 suspected cases and 116 related deaths. As of January 16, the Centers for Disease Control and Prevention (CDC) confirmed that 849 cases and 171 deaths had been reported….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMp1300772

February 7, 2013 at 9:34 am


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