Archive for October, 2013

Results at seven years after the use of intracamerular cefazolin as an endophthalmitis prophylaxis in cataract surgery.

BMC Ophthalmol. 2012 Jan 24;12:2.

Romero-Aroca P, Méndez-Marin I, Salvat-Serra M, Fernández-Ballart J, Almena-Garcia M, Reyes-Torres J.

Source

Ophthalmology Service, Hospital Universitari Sant Joan, IISPV, Universidad Rovira i Virgili, Reus, Spain. romeropere@gmail.com

Abstract

BACKGROUND:

To evaluate results after seven years using prophylactic intracameral cefazolin for the prevention of endophthalmitis in cataract surgery.

METHODS:

A prospective, observational study of all patients submitted to cataract surgery over the period January 1996 to December 2009. All cases of postoperative endophthalmitis over that period were reviewed. The patients were classified in two groups: Group 1 (11,696 patients) operated on between January 1996 and December 2002, Group 2 (13,305 patients) between January 2003 and December 2009 (in whom a 1 mg/0.1 bolus of intracameral cefazolin was instilled).

RESULTS:

During the study period, 76 cases of endophthalmitis were observed in Group 1, and seven in Group 2. The rate of postoperative endophthalmitis reduced from 0.63% to 0.05% with a cefazolin injection. The relative risk (RR) for endophthalmitis in Group 1 against group 2 was 11.45 [95% CI 5.72-22.84, p < 0.001].

CONCLUSIONS:

An intracameral bolus injection of cefazolin (1 mg in 0.1 ml solution) at the conclusion of the cataract surgery significantly reduced the rate of postoperative endophthalmitis.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3297516/pdf/1471-2415-12-2.pdf

October 31, 2013 at 3:34 pm

Laboratory testing for cytomegalovirus among pregnant women in the United States: a retrospective study using administrative claims data.

BMC Infect Dis. 2012 Dec 3;12:334.

Leung J, Cannon MJ, Grosse SD, Bialek SR.

Source

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA. JLeung@cdc.gov

Abstract

BACKGROUND:

Routine cytomegalovirus (CMV) screening during pregnancy is not recommended in the United States and the extent to which it is performed is unknown. Using a medical claims database, we computed rates of CMV-specific testing among pregnant women.

METHODS:

We used medical claims from the 2009 Truven Health MarketScan® Commercial databases. We computed CMV-specific testing rates using CPT codes.

RESULTS:

We identified 77,773 pregnant women, of whom 1,668 (2%) had a claim for CMV-specific testing. CMV-specific testing was significantly associated with older age, Northeast or urban residence, and a diagnostic code for mononucleosis. We identified 44 women with a diagnostic code for mononucleosis, of whom 14% had CMV-specific testing.

CONCLUSIONS:

Few pregnant women had CMV-specific testing, suggesting that screening for CMV infection during pregnancy is not commonly performed. In the absence of national surveillance for CMV infections during pregnancy, healthcare claims are a potential source for monitoring practices of CMV-specific testing

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582420/pdf/1471-2334-12-334.pdf

October 31, 2013 at 3:33 pm

Malaria Surveillance — United States, 2011

MMWR  November 1, 2013  Surveillance Summaries  V.62  N.SS-5 P.1-17

Karen A. Cullen, PhD

Paul M. Arguin, MD

Division of Parasitic Diseases and Malaria, Center for Global Health, CDC

Corresponding author: Karen Cullen, PhD, Division of Parasitic Diseases, Center for Global Health, CDC. Telephone: 404-718-4702; E-mail: kcullen@cdc.gov.

Malaria in humans is caused by the bite of an infected female Anopheles mosquito. Most infections in the U.S. occur among persons who have traveled to regions with ongoing malaria transmission. However, malaria is also occasionally acquired by persons who have not traveled out of the country through exposure to infected blood products, congenital transmission, laboratory exposure, or local mosquitoborne transmission. This report summarizes malaria cases in the United States in 2011.

PDF

http://www.cdc.gov/mmwr/pdf/ss/ss6205.pdf

October 31, 2013 at 3:30 pm

Safety of besifloxacin ophthalmic suspension 0.6% as a prophylactic antibiotic following routine cataract surgery: results of a prospective, parallel-group, investigator-masked study.

Clin Ophthalmol. 2012;6:855-63.

Malhotra R, Gira J, Berdy GJ, Brusatti R.

Source

Ophthalmology Associates, St Louis, MO, USA.

Abstract

BACKGROUND:

The purpose of this study was to evaluate the safety and tolerability of besifloxacin ophthalmic suspension 0.6% compared with moxifloxacin ophthalmic solution 0.5%, when used for infection prophylaxis following uncomplicated phacoemulsification clear cornea surgery using sutureless corneal incision.

METHODS:

This prospective, two-site, parallel-group, investigator-masked clinical study included patients aged ≥18 years scheduled to undergo phacoemulsification with intraocular lens implantation. Patients received one drop of either besifloxacin ophthalmic suspension or moxifloxacin ophthalmic solution four times daily, beginning 3 days prior to surgery, which was continued for 7 days postoperatively. The primary endpoint was the rate of adverse events. Secondary endpoints included endothelial cell count, central corneal thickness, and overall and central corneal staining measured on days 7 (±1 day) and 28 (±2 days) following surgery, and intraocular pressure and best-corrected visual acuity measured on days 1, 7 (±1 day), and 28 (±2 days) following surgery.

RESULTS:

Of the 60 patients enrolled, 58 (29 per treatment group) completed the study. No adverse events were reported in either treatment group. Changes in the central corneal thickness, endothelial cell count, and corneal staining were small and similar between treatments at follow-up visits (P ≥ 0.1549). Intraocular pressure was similar between treatment groups at each visit, as was the distribution of best-corrected visual acuity. The final best-corrected visual acuity was 20/30 or better in 85% of the patients.

CONCLUSION:

In this study, besifloxacin ophthalmic suspension 0.6% was well tolerated when used prophylactically to prevent postoperative endophthalmitis following sutureless cataract surgery.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373231/pdf/opth-6-855.pdf

October 30, 2013 at 12:34 pm

Cytomegalovirus in pregnancy: to screen or not to screen.

BMC Pregnancy Childbirth. 2013 Apr 18;13:96.

Walker SP, Palma-Dias R, Wood EM, Shekleton P, Giles ML.

Source

Department of Perinatal Medicine, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC 3084, Australia. spwalker@unimelb.edu.au

Abstract

BACKGROUND:

Cytomegalovirus (CMV) infection is now the commonest congenital form of infective neurological handicap, recognized by the Institute of Medicine as the leading priority for the developed world in congenital infection. In the absence of an effective vaccine, universal screening for CMV in pregnancy has been proposed, in order that primary infection could be diagnosed and- potentially- the burden of disability due to congenital CMV prevented.

DISCUSSION:

Universal screening for CMV to identify seronegative women at the beginning of pregnancy could potentially reduce the burden of congenital CMV in one of three ways. The risk of acquiring the infection during pregnancy has been shown to be reduced by institution of simple hygiene measures (primary prevention). Among women who seroconvert during pregnancy, CMV hyperimmune globulin (CMV HIG) shows promise in reducing the risk of perinatal transmission (secondary prevention), and CMV HIG and/ or antivirals may be effective in reducing the risk of clinical sequelae among those known to be infected (tertiary prevention). The reports from these studies have re-ignited interest in universal screening for CMV, but against the potential benefit of these exciting therapies needs to be weighed the challenges associated with the implementation of any universal screening in pregnancy. These include; the optimal test, and timing of screening, to maximize detection; an approach to the management of equivocal results, and the cost effectiveness of the proposed screening program. In this article, we provide an overview of current knowledge and ongoing trials in the prevention, diagnosis and management of congenital CMV. Recognising that CMV screening is already being offered to many patients on an ad hoc basis, we also provide a management algorithm to guide clinicians and assist in counseling patients.

SUMMARY:

We suggest that- on the basis of current data- the criteria necessary to recommend universal screening for CMV are not yet met, but this position is likely to change if trials currently underway confirm that CMV HIG and/ or antivirals are effective in reducing the burden of congenital CMV disease.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661373/pdf/1471-2393-13-96.pdf

October 30, 2013 at 12:33 pm

Observational study to assess pregnant women’s knowledge and behaviour to prevent toxoplasmosis, listeriosis and cytomegalovirus.

BMC Pregnancy Childbirth. 2013 Apr 30;13:98.

Pereboom MT, Manniën J, Spelten ER, Schellevis FG, Hutton EK.

Source

Department of Midwifery Science, AVAG and the EMGO+ Institute for Health and Care Research, VU University Medical Center, PO Box 7057, Room D4,40, 1007 MB Amsterdam, The Netherlands. m.pereboom@vumc.nl

Abstract

BACKGROUND:

Toxoplasmosis, listeriosis and cytomegalovirus (CMV) can negatively affect pregnancy outcomes, but can be prevented by simple precautions of pregnant women. Literature suggests that pregnant women are not always adequately informed by their care provider about preventable infectious diseases and most pregnant women have a low level of knowledge regarding these topics. There is not much information about the actual risk behaviour of pregnant women. The purpose of this study was to assess knowledge and risk behaviour related to toxoplasmosis, listeriosis and CMV infection prevention in pregnant women.

METHODS:

A cross-sectional survey among pregnant women from twenty midwifery practices across the Netherlands that participated in the DELIVER study, between October 2010 and December 2010. The questionnaire items covered respondents’ knowledge of preventive practices in general, risk behaviour, and sources of received information.

RESULTS:

Of the 1,097 respondents (response 66.0%), 75.3% had heard, read or seen information about toxoplasmosis, 61.7% about listeriosis and 12.5% about CMV. The majority reported having heard about these infections from their care providers or read about these in printed media or on the Internet. Respondents showed limited knowledge about preventive practices for toxoplasmosis, listeriosis or CMV infection. Regarding toxoplasmosis, risk behaviour was more prevalent among respondents who had a high level of education, had the Dutch nationality, did not take folic acid during their first trimester, and had ever worked in a children day-care setting. Regarding listeriosis, risk behaviour was more prevalent among respondents who where in their third trimester. Regarding CMV infections, risk behaviour was less prevalent among respondents who were in their third trimester of pregnancy.

CONCLUSION:

Of the respondents, a substantial part did not have knowledge about preventive practices to avoid listeriosis, toxoplasmosis and CMV infections during pregnancy. Many pregnant women are appropriately avoiding risk behaviour, without knowing what they are avoiding. Advising pregnant women about behaviours and life-style habits to prevent infectious diseases remains important and information about preventive practices need to be complete and adequate. However, it may be less important to give pregnant women specific infectious diseases information. More attention towards CMV is necessary.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644250/pdf/1471-2393-13-98.pdf

October 30, 2013 at 12:31 pm

Good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults in the UK: a consensus statement.

J Antimicrob Chemother. 2012 May;67(5):1053-62.

Chapman AL, Seaton RA, Cooper MA, Hedderwick S, Goodall V, Reed C, Sanderson F, Nathwani D; BSAC/BIA OPAT Project Good Practice Recommendations Working Group.

Collaborators (18)

Source

Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK. ann.chapman@sth.nhs.uk

Abstract

These good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) are an update to a previous consensus statement on OPAT in the UK published in 1998. They are based on previous national and international guidelines, but have been further developed through an extensive consultation process, and are underpinned by evidence from published literature on OPAT. They provide pragmatic guidance on the development and delivery of OPAT services, looking at all aspects of service design, care delivery, outcome monitoring and quality assurance, with the aim of ensuring that OPAT services provide high-quality, low-risk care, whatever the healthcare setting. They will provide a useful resource for teams developing new services, as well as a practical set of quality indicators for existing services

PDF

http://jac.oxfordjournals.org/content/67/5/1053.full.pdf+html

October 30, 2013 at 12:24 pm

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