Archive for April, 2014

Recommendations for Prevention and Control of Influenza in Children, 2013–2014

Pediatrics  OCT 2013 V.132 N.4 P.1089-1104

From the American Academy of Pediatrics – Policy Statement


The purpose of this statement is to update recommendations for routine use of seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children.

Highlights for the upcoming 2013–2014 season include

(1) this year’s trivalent influenza vaccine contains an A/California/7/2009 (H1N1) pdm09-like virus (same as 2012–2013); an A/Texas/50/2012 (H3N2) virus (antigenically like the 2012–2013 strain); and a B/Massachusetts/2/2012-like virus (a B/Yamagata lineage like 2012–2013 but a different virus);

(2) new quadrivalent influenza vaccines with an additional B virus (B/Brisbane/60/2008-like virus [B/Victoria lineage]) have been licensed by the US Food and Drug Administration;

(3) annual universal influenza immunization is indicated with either a trivalent or quadrivalent vaccine (no preference); and

(4) the dosing algorithm for administration of influenza vaccine to children 6 months through 8 years of age is unchanged from 2012–2013. As always, pediatricians, nurses, and all health care personnel should promote influenza vaccine use and infection control measures.

In addition, pediatricians should promptly identify influenza infections to enable rapid antiviral treatment, when indicated, to reduce morbidity and mortality.


April 28, 2014 at 2:44 pm

Nontuberculous mycobacterial pulmonary infections.

J Thorac Dis. 2014 Mar;6(3):210-220.

Johnson MM, Odell JA.

1 Division of Pulmonary Medicine, 2 Department of Cardiothoracic Surgery, Mayo Clinic, Florida, USA.


Pulmonary infections due to nontuberculous mycobacteria (NTM) are increasingly recognized worldwide.

Although over 150 different species of NTM have been described, pulmonary infections are most commonly due to Mycobacterium avium complex (MAC), Mycobacterium kansasii, and Mycobacterium abscessus.

The identification of these organisms in pulmonary specimens does not always equate with active infection; supportive radiographic and clinical findings are needed to establish the diagnosis.

It is difficult to eradicate NTM infections. A prolonged course of therapy with a combination of drugs is required.

Unfortunately, recurrent infection with new strains of mycobacteria or a relapse of infection caused by the original organism is not uncommon.

Surgical resection is appropriate in selected cases of localized disease or in cases in which the infecting organism is resistant to medical therapy. Additionally, surgery may be required for infections complicated by hemoptysis or abscess formation.

This review will summarize the practical aspects of the diagnosis and management of NTM thoracic infections, with emphasis on the indications for surgery and the results of surgical intervention.

The management of NTM disease in patients with human immunodeficiency virus (HIV) infections is beyond the scope of this article and, unless otherwise noted, comments apply to hosts without HIV infection.


April 28, 2014 at 2:40 pm

Long-term booster schedules with AS03A-adjuvanted heterologous H5N1 vaccines induces rapid and broad immune responses in Asian adults.

BMC Infect Dis. 2014 Mar 15;14:142.

Gillard P1, Chu DW, Hwang SJ, Yang PC, Thongcharoen P, Lim FS, Dramé M, Walravens K, Roman F.

1GlaxoSmithKline Vaccines, Wavre, Belgium.



The pandemic potential of avian influenza A/H5N1 should not be overlooked, and the continued development of vaccines against these highly pathogenic viruses is a public health priority.


This open-label extension booster study followed a Phase III study of 1206 adults who had received two 3.75 μg doses of primary AS03A-adjuvanted or non-adjuvanted H5N1 split-virus vaccine (A/Vietnam/1194/2004; clade 1) (NCT00449670). The aim of the extension study was to evaluate different timings for heterologous AS03A-adjuvanted booster vaccination (A/Indonesia/5/2005; clade 2.1) given at Month 6, 12, or 36 post-primary vaccination. Immunogenicity was assessed 21 days after each booster vaccination and the persistence of immune responses against the primary vaccine strain (A/Vietnam) and the booster strain (A/Indonesia) was evaluated up to Month 48 post-primary vaccination. Reactogenicity and safety were also assessed.


After booster vaccination given at Month 6, HI antibody responses to primary vaccine, and booster vaccine strains were markedly higher with one dose of AS03A-H5N1 booster vaccine in the AS03A-adjuvanted primary vaccine group compared with two doses of booster vaccine in the non-adjuvanted primary vaccine group. HI antibody responses were robust against the primary and booster vaccine strains 21 days after boosting at Month 12 or 36. At Month 48, in subjects boosted at Month 6, 12, or 36, HI antibody titers of ≥1:40 against the booster strain persisted in 39.2%, 61.2%, and 95.6% of subjects, respectively. Neutralizing antibody responses and cell-mediated immune responses also showed that AS03A-H5N1 heterologous booster vaccination elicited robust immune responses within 21 days of boosting at Month 6, 12, or 36 post-primary vaccination. The booster vaccine was well tolerated, and no safety concerns were raised.


In Asian adults primed with two doses of AS03A-adjuvanted H5N1 pandemic influenza vaccine, strong cross-clade anamnestic antibody responses were observed after one dose of AS03A-H5N1 heterologous booster vaccine given at Month 6, 12, or 36 after priming, suggesting that AS03A-adjuvanted H5N1 vaccines may provide highly flexible prime-boost schedules. Although immunogenicity decreased with time, vaccinated populations could potentially be protected for up to three years after vaccination, which is likely to far exceed the peak of the a pandemic.



April 26, 2014 at 2:55 pm

Vaccination issues in patients with inflammatory bowel disease receiving immunosuppression.

Gastroenterol Hepatol (N Y). 2012 Aug;8(8):504-12.

Dezfoli S1, Melmed GY.

1Dr. Dezfoli is a PGY-3 Resident in Internal Medicine at Cedars-Sinai Medical Center in Los Angeles, California. Dr. Melmed is the Director of Clinical Trials at the Inflammatory Bowel Disease Center at Cedars-Sinai Medical Center and an Assistant Clinical Professor of Medicine at the David Geffen School of Medicine at the University of California, Los Angeles, both in Los Angeles, California.


Treatment regimens for Crohn’s disease and ulcerative colitis increase susceptibility to infections, many of which can be prevented by vaccinations.

Increased awareness concerning vaccine-preventable diseases has led to several studies investigating the immunologic responses to vaccines in immunosuppressed patients with inflammatory bowel disease.

This review provides an overview of the evidence-based rationale for currently accepted recommendations regarding the use of both inactivated and live vaccines in this unique population.


April 25, 2014 at 8:29 am

Emergence of high-level resistance to gentamicin and streptomycin in Streptococcus agalactiae in Buenos Aires, Argentina.

Rev Esp Quimioter. 2013 Jun;26(2):112-5.

Article in Spanish

Villar HE1, Jugo MB.

1Departamento de Bacteriología Clínica, Laboratorio Hidalgo, Ladislao Martínez 43 B1640EYA Martínez, Buenos Aires, Argentina.



Streptococcus agalactiae has become recognized as a cause of serious illness in newborns, pregnant women, and adults with chronic medical conditions.

Optimal antimicrobial therapy for serious infections requires the use of synergistic combinations of a cell wall-active agent, such as a penicillin, with an aminoglycoside, which results in bactericidal activity against this organism.

The synergistic effect is eliminated by the acquisition of high-level resistance (HLR) to aminoglycosides. The aim of our study was to determine the prevalence of HLR to gentamicin (GEN) and streptomycin (EST).

The ability to detect HLR using a standard agar screen plate and high-content discs was investigated.


This study was conducted with 141 strains of S. agalactiae isolated from vaginal and rectal swabs of pregnant women at term. Minimum inhibitory concentrations (MICs) to GEN and STR were determined by the E-test method. Disks of GEN (120 μg) and STR (300 μg) were used to detect HLR. Agar screening plates were performed with GEN 100 mg/L, GEN 500 mg/L and STR 2000 mg/L.


The HLR to GEN and STR was detected in 13.5% and 16.3% of the isolates respectively. Among 141 strains, 7.8% were simultaneously resistant to GEN and STR. With 120-μg GEN and 300-μg STR disks, strains for which MICs were ≥ 512 mg/L and ≥ 1024 mg/L had no zones of inhibition. Isolates with inhibitory zones for GEN and STR of ≥13 mm showed a MICs ≤ 64 mg/L and ≤ 512 mg/L. All the screening plates were negative for these isolates. HLR to aminoglycosides was associated (83.9%) with resistance to erythromycin and/or clindamycin.


This study highlights the emergence of strains with HLR to aminoglycosides. The disk-agar diffusion test performed with high-content aminoglycoside disks and screening plates can provide laboratories with a convenient and reliable method for detecting S. agalactiae isolates that are resistant to aminoglycoside-betalactam synergy.



April 25, 2014 at 8:27 am

Comparison of four skin preparation strategies to prevent catheter-related infection in intensive care unit (CLEAN trial): a study protocol for a randomized controlled trial.

Trials. 2013 Apr 27;14:114.

Goudet V1, Timsit JF, Lucet JC, Lepape A, Balayn D, Seguin S, Mimoz O.

1Medical Intensive Care Unit, CHU de Poitiers, Poitiers, France.



Catheter-related infection is the third cause of infections in intensive care units (ICU), increasing the length of stay in ICU and hospital, mortality, and costs. Skin antisepsis is one of the most prevalent preventive measures. In this respect, it would appear preferable to recommend the use of alcoholic povidone iodine or chlorhexidine rather than aqueous povidone iodine. However, the data comparing chlorhexidine to povidone-iodine, both of them in alcoholic solutions, remain limited. Moreover, the benefits of enhanced cleaning prior to disinfection of skin that is not visibly soiled have yet to be confirmed in a randomized study.


A prospective multicenter, 2 × 2 factorial, randomized-controlled, assessor-blind trial will be conducted in 11 intensive care units in six French hospitals. All adult patients aged over 18 years requiring the insertion of at least one peripheral arterial catheter and/or a non-tunneled central venous catheter and/or a hemodialysis catheter and/or an arterial pulmonary catheter will be randomly assigned to have all their catheters cared with one of four skin preparation strategies (2% chlorhexidine/70% isopropyl alcohol or 5% povidone iodine/69% ethanol with or without prior skin scrubbing). At catheter removal, catheter tips will be quantitatively cultured. Sets of aerobic and anaerobic blood cultures will be routinely obtained when a patient has fever, hypothermia, or other indications. In case of suspected catheter-related infection the patient’s form will be reviewed by an independent adjudication committee. We plan to enroll 2,400 patients (4,800 catheters). The main objective is to demonstrate that use of 2% alcoholic chlorhexidine compared to 5% alcoholic povidone iodine in skin preparation lowers the rate of catheter-related infection. The second endpoint is to demonstrate that enhanced skin cleaning prior to disinfection of skin that is not visibly soiled does not reduce catheter colonization. Other outcomes include comparison of skin colonization at catheter insertion site, comparison of catheter colonization and catheter-related bacteremia taking place during implementation of the four strategies of skin preparation, and cutaneous tolerance, length of hospitalization, mortality, and costs.


This study will help to update recommendations on the choice of an antiseptic agent to use in skin preparation prior to insertion of a vascular catheter and, by extension, of an epidural catheter and it will likewise help to update recommendations on the usefulness of skin scrubbing prior to disinfection when the skin is not visibly soiled.


April 22, 2014 at 3:03 pm

Risk factors for hospital-acquired bacteremia.

Intern Med. 2005 Nov;44(11):1157-62.

Yoshida T1, Tsushima K, Tsuchiya A, Nishikawa N, Shirahata K, Kaneko K, Ito K, Kawakami H, Nakagawa S, Suzuki T, Kubo K, Ikeda S.

1Department of Medicine, Azumi General Hospital, Nagano.



Bacteremia is one of the most serious health problems associated with high morbidity and mortality. The aim of this study was to identify risk factors for bacteremia in daily medical care to facilitate rapid and accurate clinical decisions about treatment.


We studied 306 inpatients retrospectively. Age, peripheral neutrophil count, C-reactive protein (CRP), platelets, serum total cholesterol, total protein, albumin and cholinesterase were compared in patients with positive- and negative-blood cultures. The associations between blood culture positivity and glucose tolerance, bedridden state, presence of a central venous catheter (CVC) or urinary catheter were examined. On October 14, 2002, strategies for prevention of catheter-related infection were altered in our hospital. We studied the impact of these changes on the risk of bacteremia.


Sixty-seven patients had positive and 239 had negative blood cultures. Age, neutrophil, platelets, total protein, albumin, and cholinesterase were significantly different between the culture-positive patients and the culture-negative patients. Multivariate analysis showed albumin and platelets as independent predictors. The bedridden state and catheter-inserted states (central venous or urinary) conferred significantly higher positive blood culture rates. Multivariate analysis showed using urinary catheters and indwelling femoral CVCs as independent risk factors. There was no significant difference in the blood culture-positive rate before and after the change in prevention strategies; before the change, 6 of 9 catheter-inserted blood culture-positive cases yielded MRSA, while 4 of 12 cultures yielded Staphylococcus epidermidis after the change.


Our study highlights the risk factors of bacteremia in vulnerable patients.


April 22, 2014 at 3:00 pm

New vaccines against influenza virus.

Clin Exp Vaccine Res. 2014 Jan;3(1):12-28.

Lee YT1, Kim KH1, Ko EJ1, Lee YN1, Kim MC2, Kwon YM1, Tang Y1, Cho MK1, Lee YJ2, Kang SM1.

1Center for Inflammation, Immunity & Infection, and Department of Biology, Georgia State University, Atlanta, GA, USA.

2Animal and Plant Quarantine Agency, Anyang, Korea.


Vaccination is one of the most effective and cost-benefit interventions that prevent the mortality and reduce morbidity from infectious pathogens.

However, the licensed influenza vaccine induces strain-specific immunity and must be updated annually based on predicted strains that will circulate in the upcoming season.

Influenza virus still causes significant health problems worldwide due to the low vaccine efficacy from unexpected outbreaks of next epidemic strains or the emergence of pandemic viruses.

Current influenza vaccines are based on immunity to the hemagglutinin antigen that is highly variable among different influenza viruses circulating in humans and animals. Several scientific advances have been endeavored to develop universal vaccines that will induce broad protection.

Universal vaccines have been focused on regions of viral proteins that are highly conserved across different virus subtypes. The strategies of universal vaccines include the matrix 2 protein, the hemagglutinin HA2 stalk domain, and T cell-based multivalent antigens.

Supplemented and/or adjuvanted vaccination in combination with universal target antigenic vaccines would have much promise.

This review summarizes encouraging scientific advances in the field with a focus on novel vaccine designs.


April 20, 2014 at 3:53 pm

Infective endocarditis due to Granulicatella adiacens – A case report and review.

J Infect Dev Ctries. 2014 Apr 15;8(4):548-550.

Padmaja K1, Lakshmi V, Subramanian S, Neeraja M, Krishna SR, Satish OS.

1Nizam’s Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India.


Infective endocarditis (IE) caused by nutritionally variant Streptococci (NVS) is associated with high bacteriologic and treatment failure and mortality rates compared to endocarditis caused by other Streptococci.

With automated blood culture systems, the rates of NVS-associated IE accounts for 5%-6% cases. We report a case of IE caused by NVS in an elderly female patient with no risk factors.

The patient was successfully treated with combination antimicrobial therapy.



April 20, 2014 at 3:51 pm

Lower Pill Burden and Once-Daily Antiretroviral Treatment Regimens for HIV Infection: A Meta-Analysis of Randomized Controlled Trials

Clinical Infectious Diseases May 1, 2014  V.58 N.9 P.1297-1307

Jean B. Nachega1,2,3,4,a, Jean-Jacques Parienti5,6,a, Olalekan A. Uthman7,8,9, Robert Gross10, David W. Dowdy2, Paul E. Sax11, Joel E. Gallant12, Michael J. Mugavero13, Edward J. Mills14, and Thomas P. Giordano15

+ Author Affiliations

1Department of Epidemiology, Pittsburgh University Graduate School of Public Health, Pennsylvania

2Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

3Department of Medicine,

4Centre for Infectious Diseases, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa

5Department of Biostatistics and Clinical Research, Côte de Nacre University, Côte de Nacre Teaching Hospital

6Faculté de Médecine, Université de Caen Basse-Normandie, EA 4655 Risque Microbien, Caen, France

7Division of Health Sciences, Warwick-Centre for Applied Health Research and Delivery (WCARHD), Warwick Medical School, The University of Warwick, Coventry

8Liverpool School of Tropical Medicine, International Health Group, United Kingdom

9Centre for Evidence-based Health Care, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa

10Perelman School of Medicine, and Philadelphia Veterans Affairs Medical Center, University of Pennsylvania

11Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

12Southwest CARE Center, Santa Fe, New Mexico

13University of Alabama at Birmingham

14Faculty of Health Sciences, University of Ottawa, Ontario, Canada

15Department of Medicine, Baylor College of Medicine, and The Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas

Correspondence: Jean B. Nachega, MD, PhD, MPH, Associate Professor of Medicine, Infectious Diseases, Microbiology and Epidemiology, Pittsburgh University Graduate School of Public Health, Department of Epidemiology, Infectious Diseases Epidemiology Program, 130 DeSoto Street, 503 Parran Hall, Pittsburgh, PA 15261 (


Contemporary antiretroviral treatment regimens are simpler than in the past, with lower pill burden and once-daily dosing frequency common. We performed a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of pill burden and once-daily vs twice-daily dosing on ART adherence and virological outcomes.

A literature search of 4 electronic databases through 31 March 2013 was used. RCTs comparing once-daily vs twice-daily ART regimens that also reported on adherence and virological suppression were included. Study design, study population characteristics, intervention, outcome measures, and study quality were extracted. Study quality was rated using the Cochrane risk-of-bias tool.

Nineteen studies met our inclusion criteria (N = 6312 adult patients). Higher pill burden was associated with both lower adherence rates (P = .004) and worse virological suppression (P < .0001) in both once-daily and twice-daily subgroups, although the association with adherence in the once-daily subgroup was not statistically significant. The average adherence was modestly higher in once-daily regimens than twice-daily regimens (weighted mean difference = 2.55%; 95% confidence interval [CI], 1.23 to 3.87; P = .0002). Patients on once-daily regimens did not achieve virological suppression more frequently than patients on twice-daily regimens (relative risk [RR] = 1.01; 95% CI, 0.99 to 1.03; P = .50). Both adherence and viral load suppression decreased over time, but adherence decreased less with once-daily dosing than with twice-daily dosing.

Lower pill burden was associated with both better adherence and virological suppression. Adherence, but not virological suppression, was slightly better with once- vs twice-daily regimens.


April 18, 2014 at 10:56 am

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