Archive for May 31, 2013

Clinical presentation of patients with aseptic meningitis, factors influencing treatment and hospitalization, and consequences of enterovirus cerebrospinal fluid polymerase chain reaction testing.

Can J Infect Dis Med Microbiol. 2012 Spring;23(1):e1-5.

Patriquin G, Hatchette J, Forward K.


Departments of Pathology and Laboratory Medicine, Queen Elizabeth II Health Science Centre; Abstractin English, English, French


Clinical and laboratory features of enteroviral meningitis may overlap with those of bacterial meningitis. In the present retrospective review, we compared features of enteroviral (EV)-positive and -negative patients to determine those that were most influential in admission, discharge and in anti-infective administration.


Data were analyzed from the records of 117 pediatric and adult patients who underwent cerebrospinal fluid (CSF) EV testing over a three-year period.


The oldest EV-positive patient was 34 years of age and the occurrence of the disease was highly seasonal. EV-positive patients were more likely to report fever, rash, photophobia, short onset and exposure to an ill contact. A positive polymerase chain reaction (PCR) result was associated with relatively short hospitalization. Seizure and neurological symptoms were more strongly associated with a negative PCR test result. CSF characteristics did not discriminate well between patients with positive and negative PCR tests. Patients with imperfect Glasgow Coma Scores or with neurological symptoms were more likely to be admitted to hospital than those without. Fever and recent onset predicted determinants of anti-infective use.


The present retrospective study confirms previous reports regarding seasonality and the young age of positive patients. Factors that indicate nonenteroviral etiology were appropriately also those that influenced hospitalization. Patients with EV meningitis were likely to be treated with empirical anti-infectives, and a substantial proportion continued to take antibiotics for more than 24 h after receiving the positive EV PCR test result.


May 31, 2013 at 2:36 pm

Value of digital telethermography for the diagnosis of septic knee prosthesis: a prospective cohort study.

BMC Musculoskelet Disord. 2013 Jan 4;14:7.

Romanò CL, D’Anchise R, Calamita M, Manzi G, Romanò D, Sansone V.


Dipartimento di Chirurgia Ricostruttiva e delle Infezioni Osteo-articolari, Istituto Ortopedico IRCCS Galeazzi – Via Riccardo Galeazzi 4, Milano, 20166 Italy.



Diagnosis of peri-prosthetic infection remains challenging, often requiring a combination of different tests.


In this prospective, case-control study, the diagnostic accuracy of telethermography was evaluated in a group of seventy patients who had had a total knee replacement and were undergoing a reoperation because of infection or another implant-related problem, after a minimum of one year from implant.


An average differential temperature of the affected versus not affected knee of 1.9 °C was observed in infected prosthesis, compared to 0.3 °C in aseptic failures. Considering a normal reference value equal or less than 1.0 °C, telethermography showed an accuracy, sensitivity, specificity, positive and negative predictive value of, respectively: 0.90, 0.89, 0.91, 0.91, 0.88.


Digital telethermography is a reliable option for diagnosing peri-prosthetic knee infection.


May 31, 2013 at 2:33 pm

Therapeutical options in sigmoid diverticulitis. When should we operate?

Chirurgia (Bucur). 2012 Nov-Dec;107(6):715-21.

Pătraşcu T, Doran H, Catrina E, Mihalache O.


“I. Juvara” Department of Surgery, Clinical Hospital “Dr. I. Cantacuzino”, Bucharest, Romania.


Colonic diverticulosis is a benign disease whose incidence has been steadily increasing throughout the world, especially in the economically developed countries in Western Europe. This increase is connected to the population ageing process, the diverticulosis being characteristic in the elderly, and with nowadays’ eating habits. Frequently, colonic diverticuli may cause complications, such as hemorrhage or diverticulitis, with pericolic abscesses or peritonitis. Consequently, efforts are being made to set up a therapeutic algorithm appropriate for the diverticular disease, the predominance of the conservative or surgical attitude being continuously adjusted. We have analyzed the therapeutic options, their advantages and their limitations, based on both the experience of the “Prof. I. Juvara” Surgical Department of the “Dr. I. Cantacuzino” ClinicalHospital and the latest data in medical literature.


May 31, 2013 at 2:31 pm

Ceftriaxone compared with sodium penicillin G for treatment of severe leptospirosis.

Clin Infect Dis. 2003 Jun 15;36(12):1507-13.

Panaphut T, Domrongkitchaiporn S, Vibhagool A, Thinkamrop B, Susaengrat W.


Department of Medicine, Khon Kaen Hospital, Khon Kaen, Thailand.


A prospective, open-label, randomized trial at KhonKaenHospital (Thailand) was conducted from July 2000 through December 2001 to compare the clinical efficacies of ceftriaxone and sodium penicillin G for the treatment of severe leptospirosis. A total of 173 patients with severe leptospirosis were randomly assigned to be treated with either intravenous ceftriaxone (1 g daily for 7 days; n=87) or intravenous sodium penicillin G (1.5 million U every 6 h for 7 days; n=86). The primary outcome was time to fever resolution. Survival analysis demonstrated that the median duration of fever was 3 days for both groups. Ten patients (5 in each group) died of leptospirosis infection. There were no statistically significant differences in the duration of organ dysfunction. Ceftriaxone and sodium penicillin G were equally effective for the treatment of severe leptospirosis. Once-daily administration and the extended spectrum of ceftriaxone against bacteria provide additional benefits over intravenous penicillin.



Comment in

A mountain out of a molehill – do we treat acute leptospirosis, and if so, with what? [Clin Infect Dis. 2003]



Comment: Important open label clinical trial comparing the use of ceftriaxone vs. penicillin for the treatment of severe leptospirosis; the two were equivalent, but late initiation of Rx does not always forestall death in severe cases.

May 31, 2013 at 2:30 pm

Targeted versus Universal Decolonization to Prevent ICU Infection

N Engl J of Medic May 29, 2013 V.368

Susan S. Huang, M.D., M.P.H., Edward Septimus, M.D., Ken Kleinman, Sc.D., Julia Moody, M.S., Jason Hickok, M.B.A., R.N., Taliser R. Avery, M.S., Julie Lankiewicz, M.P.H., Adrijana Gombosev, B.S., Leah Terpstra, B.A., Fallon Hartford, M.S., Mary K. Hayden, M.D., John A. Jernigan, M.D., Robert A. Weinstein, M.D., Victoria J. Fraser, M.D., Katherine Haffenreffer, B.S., Eric Cui, B.S., Rebecca E. Kaganov, B.A., Karen Lolans, B.S., Jonathan B. Perlin, M.D., Ph.D., and Richard Platt, M.D. for the CDC Prevention Epicenters Programthe AHRQ DECIDE Network and Healthcare-Associated Infections Program


Both targeted decolonization and universal decolonization of patients in intensive care units (ICUs) are candidate strategies to prevent health care–associated infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA).


We conducted a pragmatic, cluster-randomized trial. Hospitals were randomly assigned to one of three strategies, with all adult ICUs in a given hospital assigned to the same strategy. Group 1 implemented MRSA screening and isolation; group 2, targeted decolonization (i.e., screening, isolation, and decolonization of MRSA carriers); and group 3, universal decolonization (i.e., no screening, and decolonization of all patients). Proportional-hazards models were used to assess differences in infection reductions across the study groups, with clustering according to hospital.


A total of 43 hospitals (including 74 ICUs and 74,256 patients during the intervention period) underwent randomization. In the intervention period versus the baseline period, modeled hazard ratios for MRSA clinical isolates were 0.92 for screening and isolation (crude rate, 3.2 vs. 3.4 isolates per 1000 days), 0.75 for targeted decolonization (3.2 vs. 4.3 isolates per 1000 days), and 0.63 for universal decolonization (2.1 vs. 3.4 isolates per 1000 days) (P=0.01 for test of all groups being equal). In the intervention versus baseline periods, hazard ratios for bloodstream infection with any pathogen in the three groups were 0.99 (crude rate, 4.1 vs. 4.2 infections per 1000 days), 0.78 (3.7 vs. 4.8 infections per 1000 days), and 0.56 (3.6 vs. 6.1 infections per 1000 days), respectively (P<0.001 for test of all groups being equal). Universal decolonization resulted in a significantly greater reduction in the rate of all bloodstream infections than either targeted decolonization or screening and isolation. One bloodstream infection was prevented per 54 patients who underwent decolonization. The reductions in rates of MRSA bloodstream infection were similar to those of all bloodstream infections, but the difference was not significant. Adverse events, which occurred in 7 patients, were mild and related to chlorhexidine.


In routine ICU practice, universal decolonization was more effective than targeted decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream infection from any pathogen. (Funded by the Agency for Healthcare Research and the Centers for Disease Control and Prevention; REDUCE MRSA number, NCT00980980.)


May 31, 2013 at 2:28 pm

Sunlight as Disinfectant — New Rules on Disclosure of Industry Payments to Physicians

N Engl J of Medic May 30, 2013 V.368  P.2052-2054


Meredith B. Rosenthal, Ph.D., and Michelle M. Mello, J.D., Ph.D.

From the Department of Health Policy and Management, Harvard School of Public Health, Boston.

After extensive public comment, the Centers for Medicare and Medicaid Services (CMS) issued final regulations in February implementing the Physician Payments Sunshine Act, enacted as part of the Affordable Care Act.1 The 287-page document details requirements for producers of drugs, biologics, devices, and medical supplies to disclose virtually all transfers of value to physicians and teaching hospitals. The provisions were intended to help patients make more informed decisions and to deter financial relationships that might inflate health care costs.1 The rules go well beyond preexisting law but stop short of directly regulating financial relationships. Given that CMS projects compliance costs to industry of nearly $1 billion over 5 years, it is reasonable to ask what benefits disclosure is likely to bring…..


May 31, 2013 at 2:26 pm


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