Archive for July 26, 2013

Two case reports of gastroendoscopy-associated Acinetobacter baumannii bacteremia.

World J Gastroenterol. 2013 May 14;19(18):2835-40.

Chen CH, Wu SS, Huang CC.


Section of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan.


Two cases of gastroendoscopy-associated Acinetobacter baumannii (A. baumannii) bacteremia were discovered at the study hospital. The first case was a 66-year-old woman who underwent endoscopic retrograde cholangiopancreatography and endoscopic retrograde papillotomy, and then A. baumannii bacteremia occurred. The second case was a 70-year-old female who underwent endoscopic retrograde biliary drainage due to obstruction of intra-hepatic ducts, and bacteremia occurred due to polymicrobes (Escherichia coli, viridans streptococcus, and A. baumannii). After a literature review, we suggest that correct gastroendoscopy technique and skill in drainage procedures, as well as antibiotic prophylaxis, are of paramount importance in minimizing the risk of gastroendoscopy-associated bacteremia.




KEYWORDS: Acinetobacter baumannii, Antibiotic prophylaxis, Bacteremia, Endoscopy



July 26, 2013 at 2:45 pm

Timing of administration of prophylactic antibiotics for caesarean section: a systematic review and meta-analysis.

BJOG. 2013 May;120(6):661-9.

Baaqeel H, Baaqeel R.


College of Medicine-Jeddah, King Saud bin Abdulaziz University for Health Sciences and Department of OB/GYN, King Abdulaziz Medical City-WR, Jeddah, Saudi Arabia.



Prophylactic antibiotics reduce infectious morbidity from caesarean section. The timing of their administration, however, is a matter of controversy.


To examine maternal and neonatal infectious morbidity in women receiving preoperative prophylaxis compared with those receiving intraoperative administration.


Medline, Embase, Current Controlled Trials and Cochrane Central were searched from their inception dates to December 2011.


Randomised controlled trials of a single dose of any antibiotic comparing preoperative with intraoperative administration were selected.


Trial characteristics, outcomes and quality measures, based on the Cochrane tool for risk of bias, were independently extracted. The random effect model of DerSimonian and Laird to estimate relative risks (RRs) for maternal and neonatal outcomes was used.


Six trials met the inclusion criteria, reporting on 2313 women and 2345 newborns. Preoperative administration was associated with a significant 41% reduction in the rate of endometritis compared with intraoperative administration (RR 0.59; 95% confidence interval [95% CI] 0.37-0.94; I2 0%). In the preoperative group, there were nonsignificant reductions in the rates of wound infection (RR 0.71; 95% CI 0.44-1.14; I2 0%), maternal febrile morbidity (RR 0.94; 95% CI 0.46-1.95; I2 0%), neonatal sepsis (RR 0.81; 95% CI 0.47-1.41; I2 0%), neonatal septic work-up (RR 0.93; 95% CI 0.71-1.21; I2 0%) and neonatal intensive-care unit admission (RR 0.92; 95% CI 0.65-1.28; I2 0%). There were nonsignificant increases in the rates of maternal pyelonephritis (RR 1.09; 95% CI 0.49-2.43; I2 0%) and neonatal pneumonia (RR 3.36; 95% CI 0.55-20.47; I2 0%).


Compared with intraoperative administration, preoperative antibiotics significantly reduce the rate of endometritis. The lack of neonatal adverse effects should be cautiously interpreted given the limited power of the trials to detect such effects.



key words: Prophylactic antibiotics, caesarean section, maternal and neonatal infectious,

July 26, 2013 at 2:43 pm

Impact of USA300 Methicillin-Resistant Staphylococcus aureus on Clinical Outcomes of Patients With Pneumonia or Central Line–Associated Bloodstream Infections

Clinical Infectious Diseases July 15, 2012 V.55 N.2 P.232-241

Fernanda C. Lessa1, Yi Mu1, Susan M. Ray2, Ghinwa Dumyati3, Sandra Bulens1,4, Rachel J. Gorwitz1, Gregory Fosheim1, Aaron S. DeVries5, William Schaffner6, Joelle Nadle7, Kenneth Gershman8, Scott K. Fridkin1, and for the Active Bacterial Core surveillance (ABCs) MRSA Investigators of the Emerging Infections Program

1Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention

2Emory University School of Medicine, Atlanta, Georgia

3Infectious Diseases Division, Department of Medicine, University of Rochester, New York

4Atlanta Research and Education Foundation, Decatur, Georgia

5Minnesota Department of Health, St Paul

6Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee

7California Emerging Infections Program, Oakland

8Colorado Department of Public Health and Environment, Denver

Correspondence: Fernanda C. Lessa, MD, MPH, 1600 Clifton Rd NE, MS A-24, Atlanta, GA 30333 (


The USA300 methicillin-resistant Staphylococcus aureus (MRSA) strain, which initially emerged as a cause of community-associated infections, has recently become an important pathogen in healthcare-associated infections (HAIs). However, its impact on patient outcomes has not been well studied. We evaluated patients with invasive MRSA infections to assess differences in outcomes between infections caused by USA100 and those caused by USA300.


Population-based data for invasive MRSA infections were used to identify 2 cohorts: (1) nondialysis patients with central line–associated bloodstream infections (CLABSIs) and (2) patients with community-onset pneumonia (PNEUMO) during 2005–2007 from 6 US metropolitan areas. Medical records of patients with confirmed MRSA USA100 or USA300 infection were reviewed. Logistic regression and, when appropriate, survival analysis was performed to evaluate mortality, early and late complications, and length of stay.


A total of 236 and 100 patients were included in the CLABSI and PNEUMO cohorts, respectively. USA300 was the only independent predictor of early complications for PNEUMO patients (odds ratio [OR], 2.6; P = .02). Independent predictors of CLABSI late complications included intensive care unit (ICU) admission before MRSA culture (adjusted OR [AOR], 2.1; P = .01) and Charlson comorbidity index (AOR, 2.6; P = .003), but not strain type. PNEUMO patients were significantly more likely to die if they were older (P = .02), black (P < .001), or infected with USA100 strain (P = .02), whereas those with CLABSI were more likely to die if they were older (P < .001), had comorbidities (P < .001), or had an ICU admission before MRSA culture (P = .001).


USA300 was associated with early complications in PNEUMO patients. However, it was not associated with mortality for either PNEUMO or CLABSI patients. Concerns regarding higher mortality from HAIs caused by USA300 may not be warranted.



key words: MRSA, USA300 methicillin-resistant Staphylococcus aureus, healthcare-associated infections (HAIs), invasive MRSA infections, central line–associated bloodstream infections (CLABSIs),


July 26, 2013 at 2:38 pm

Concerning the timing of antibiotic administration in women undergoing caesarean section: a systematic review and meta-analysis.

BMJ Open. 2013 Apr 18;3(4). pii: e002028.

Heesen M, Klöhr S, Rossaint R, Allegeaert K, Deprest J, Van de Velde M, Straube S.


Department of Anaesthesiology, Klinikum Bamberg, Bamberg, Germany.



To assess the effects on maternal infectious morbidity and neonatal outcomes of the timing of antibiotic prophylaxis in women undergoing caesarean section. A recent National Institute for Health and Clinical Excellence (NICE) guideline reported that antibiotic administration before skin incision reduces the risk of maternal infection; this recommendation was based on a meta-analysis, however one including trials that were not double blind and not including a trial published recently.


Systematic review and meta-analysis.


Searches of PubMed and EMBASE and reference lists of the retrieved articles.


Randomised double-blind controlled trials comparing the administration of antibiotics before skin incision with administration after cord clamping.


Data on maternal total infectious morbidity, endometritis and wound infection, as well as neonatal intensive care unit admission, neonatal infection and neonatal sepsis were extracted and combined using random effects meta-analysis.


Five studies reporting on 1777 parturients were included in our systematic review. The relative risk (RR) for maternal total infectious morbidity for antibiotic administration before incision compared with antibiotic administration after cord clamping was 0.64 (95% CI 0.36 to 1.15). Likewise, there was no difference in the risk of wound infection (RR 0.72, 95% CI 0.41 to 1.27). Parturients receiving the antibiotic preoperatively had a significantly reduced risk of endometritis (RR 0.48, 95% CI 0.27 to 0.87; number needed to treat 41, 95% CI 23 to 165). Analyses of the neonatal outcome parameters revealed no differences between the regimens of antibiotic administration, but were based on few studies.


In contrast to a recent NICE guideline, we did not find a reduction in total infectious morbidity with antibiotic administration before skin incision; we confirmed a reduction in the risk of endometritis and a lack of effect on the risk for wound infection.


July 26, 2013 at 8:49 am

Impact of Appropriate Antimicrobial Therapy on Mortality Associated With Acinetobacter baumannii Bacteremia: Relation to Severity of Infection

Clinical Infectious Diseases July 15, 2012 V.55 N.2 P.209-215

Yi-Tzu Lee1,3,5, Shu-Chen Kuo1,6, Su-Pen Yang2,3, Yi-Tsung Lin1,3, Fan-Chen Tseng6, Te-Li Chen1,3,4, and Chang-Phone Fung1,3

1Institute of Clinical Medicine

2School of Medicine, National Yang-Ming University

3Division of Infectious Diseases

4Immunology Research Center, Taipei Veterans General Hospital, Taipei

5Department of Medicine, Chutung Veterans Hospital, Hsinchu County

6National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan

Correspondence: Te-Li Chen, Division of Infectious Diseases, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan (


The efficacy of antimicrobial therapy for Acinetobacter baumannii bacteremia has been difficult to establish because of confounding by underlying diseases, severity of infection, and differences in the pathogenicity of Acinetobacter species. This retrospective study was conducted to evaluate the effect of appropriate antimicrobial therapy on 14-day mortality after adjustment for multiple risk factors.


The population consisted of 252 patients with monomicrobial A. baumannii bacteremia admitted to a large teaching hospital in Taiwan. The isolates were identified to species level using reference molecular methods. Predictors of 14-day mortality were determined by logistic regression analysis. The influence of severity of infection, determined by Acute Physiology and Chronic Health Evaluation (APACHE) II score, on the impact of appropriate use of antimicrobials on 14-day mortality was assessed by including an interaction term.


The overall 14-day mortality rate was 29.8% (75 of 252 patients). The unadjusted mortality rate for appropriate antimicrobial therapy was 13.2% (12 of 91 patients). Appropriate therapy was independently associated with reduced mortality (odds ratio [OR], 0.22; 95% confidence interval [CI], .01–.50; P < .001), and the effect was influenced by APACHE II score (OR for interaction term, 0.90; 95% CI, .82–.98; P = .02). A subgroup analysis revealed that the benefit of appropriate therapy was limited to patients with high APACHE II scores (OR for patients with scores >25 and ≤35, 0.16 [95% CI, .07–.37]; OR for those with scores >35, 0.06; 95% CI, .01–.25).


Appropriate antimicrobial therapy significantly reduced 14-day mortality for A. baumannii bacteremia in severely ill patients.



July 26, 2013 at 8:47 am

Viruses Associated With Pneumonia in Adults

Clinical Infectious Diseases July 1, 2012 V.55 N.1 P.107-113

Ellie J. C. Goldstein, Section Editor

Thomas C. Cesario

Department of Medicine, University of California, Irvine, California

Correspondence: Thomas C. Cesario, MD, City Tower, Ste 110, 333 City Drive West, Orange, CA 92868 (


Viral pneumonia, which is typically associated with disease in childhood, is increasingly recognized as causing problems in adults. Certain viruses, such as influenza virus, can attack fully immunocompetent adults, but many viruses take advantage of more-vulnerable patients. The latter include patients receiving immunosuppressive therapy and elderly subjects, particularly those residing in long-term care facilities. The range of viruses producing pneumonia in adults includes common agents, such as varicella-zoster virus and influenza virus, as well as respiratory syncytial virus, human metapneumovirus, adenoviruses, picornaviruses, and coronaviruses. The roles played by other agents, such as rhinoviruses and human bocaviruses, in pneumonia are still under study. While therapy for most of theses agents, at least in adults, has not yet been fully clarified, it is reasonable to assume antivirals may work in certain situations if they are introduced early enough in the course of infection.


July 26, 2013 at 8:45 am

Emergency Department Visit Rates for Abscess Versus Other Skin Infections During the Emergence of Community-Associated Methicillin-Resistant Staphylococcus aureus, 1997–2007

Clinical Infectious Diseases July 1, 2012 V.55 N.1 P.103-105

Munirih L. Qualls1, Megan M. Mooney1, Carlos A. Camargo Jr3, Tanya Zucconi2, David C. Hooper4, and Daniel J. Pallin1,5

1Department of Emergency Medicine

2Center for Clinical Excellence, Brigham and Women’s Hospital

3Department of Emergency Medicine

4Division of Infectious Diseases, Massachusetts General Hospital

5Division of Emergency Medicine, Children’s Hospital Boston, Massachusetts

Correspondence: Daniel J. Pallin, MD, MPH, 75 Francis St, Boston, MA 02115 (


Due to a flaw in the International Classification of Diseases, Ninth Revision, Clinical Modification coding system, epidemiology of skin and soft-tissue infections (SSTIs) has conflated abscess with other SSTIs. We analyzed emergency department visits during 1997–2007, finding that the odds of abscess relative to any other diagnosis increased 11% per year, or 3.1-fold, whereas other SSTIs increased minimally.


July 26, 2013 at 8:43 am


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