Archive for April, 2014

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

Implementation of a cost-effective strategy to prevent neonatal early-onset group B haemolytic streptococcus disease in the Netherlands.

BMC Pregnancy Childbirth. 2013 Jul 30;13:155.

Kolkman DG1, Rijnders ME, Wouters MG, van den Akker-van Marle ME, van der Ploeg CK, de Groot CJ, Fleuren MA.

1Department of Child Health, TNO, PO Box 2215, 2301 CE Leiden, The Netherlands.



Early-onset Group B haemolytic streptococcus infection (EOGBS) is an important cause of neonatal morbidity and mortality in the first week of life.

Primary prevention of EOGBS is possible with intra-partum antibiotic prophylaxis (IAP.)

Different prevention strategies are used internationally based on identifying pregnant women at risk, either by screening for GBS colonisation and/or by identifying risk factors for EOGBS in pregnancy or labour.

A theoretical cost-effectiveness study has shown that a strategy with IAP based on five risk factors (risk-based strategy) or based on a positive screening test in combination with one or more risk factors (combination strategy) was the most cost-effective approach in the Netherlands.

IAP for all pregnant women with a positive culture in pregnancy (screening strategy) and treatment in line with the current Dutch guideline (IAP after establishing a positive culture in case of pre-labour rupture of membranes or preterm birth and immediate IAP in case of intra-partum fever, previous sibling with EOGBS or GBS bacteriuria), were not cost-effective.

Cost-effectiveness was based on the assumption of 100% adherence to each strategy. However, adherence in daily practice will be lower and therefore have an effect on cost-effectiveness.


The aims are to: a.) implement the current Dutch guideline, the risk-based strategy and the combination strategy in three pilot regions and b.) study the effects of these strategies in daily practice. Regions where all the care providers in maternity care implement the allocated strategy will be randomised. Before the introduction of the strategy, there will be a pre-test (use of the current guideline) involving 105 pregnant women per region. This will be followed by a post-test (use of the allocated strategy) involving 315 women per region. The outcome measures are: 1.) adherence to the specific prevention strategy and the determinants of adherence among care providers and pregnant women, 2.) outcomes in pregnant women and their babies and 3.) the costs of each strategy in relation to the effects.


This study will provide recommendations for the implementation of the most cost-effective prevention strategy for EOGBS in the Netherlands on the basis of feasibility in daily practice.


April 18, 2014 at 10:54 am

Evaluation of the efficacy and safety of tigecycline for treatment of respiratory tract infections: systematic review of literature.

Rev Chilena Infectol. 2013 Dec;30(6):591-7.

Article in Spanish

Moya Cordero P, Ruiz-Aragón J, Molina Linde JM, Márquez-Peláez S, Motiva Sánchez V.



Tigecycline is indicated for the treatment of complicated skin infections, soft tissue and intraabdominal infections. Its use could be extended to community-acquired pneumonia (CAP) and hospital pneumonia (HN). The objective was to evaluate the efficacy and safety of tigecycline in the treatment of respiratory infections.


systematic review (2012). Databases used were MEDLINE, EMBASE, Cochrane Library, CRD and WOK. We identified clinical trials of adults with respiratory infection, treated with tigecycline. The quality of the studies was assessed using CASPe checklist.


We selected four clinical trials of high-moderate quality. Three studies with patients with CAP and a trial with HN patients. In patients with CAP, efficacy of tigecycline (88.6 to 90.6%) was higher than levofloxacin (85.3 to 87.2%). The non inferiority testing was statistically significant (p < 0.001). In the study of patients with HN tigecycline showed an efficiency of 67.9% versus 78.2% for imipenem/cilastatin. Main adverse effects were gastrointestinal.


The efficacy of tigecycline is non inferior than levofloxacin in patients with CAP, but less than imipenem in patients with HN. Tigecycline demonstrates noninferiority versus others tested antibiotics, and it shows a good safety profile.



April 18, 2014 at 10:52 am

Clinical review: new technologies for prevention of intravascular catheter-related infections.

Crit Care. 2004 Jun;8(3):157-62.

Cicalini S1, Palmieri F, Petrosillo N.

12nd Infectious Diseases Unit, Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, IRCCS, Rome, Italy.


Intravascular catheters have become essential devices for the management of critically and chronically ill patients.

However, their use is often associated with serious infectious complications, mostly catheter-related bloodstream infection (CRBSI), resulting in significant morbidity, increased duration of hospitalization, and additional medical costs.

The majority of CRBSIs are associated with central venous catheters (CVCs), and the relative risk for CRBSI is significantly greater with CVCs than with peripheral venous catheters.

However, most CVC-related infections are preventable, and different measures have been implemented to reduce the risk for CRBSI, including maximal barrier precautions during catheter insertion, catheter site maintenance, and hub handling.

The focus of the present review is on new technologies for preventing infections that are directed at CVCs.

New preventive strategies that have been shown to be effective in reducing risk for CRBSI, including the use of catheters and dressings impregnated with antiseptics or antibiotics, the use of new hub models, and the use of antibiotic lock solutions, are briefly described.


April 17, 2014 at 8:42 am

Severe Staphylococcus aureus infection in three pediatric intensive care units: analysis of cases of necrotizing pneumonia.

Arch Argent Pediatr. 2014 Apr;112(2):163-168.

Article in English, Spanish

Taffarel P1, Bonetto G2, Penazzi M1, Jorro Barón F1, Saenz S2, Uranga M3, Mari E4, Pereda R5, Debaisi G1.

1Servicio de Terapia Intensiva, Hospital General de Niños Pedro de Elizalde.

2Servicio de Terapia Intensiva, Hospital de Niños de la Santísima Trinidad, Córdoba.

3Servicio de Infectología, Hospital del Niño de San Justo, San Justo.

4Servicio de Terapia Intensiva, Hospital del Niño de San Justo, San Justo.

5Servicio de Microbiología, Hospital General de Niños Pedro de Elizalde.


Staphylococcus aureus frequently affects human beings. Among clinical manifestations, necrotizing pneumonia is associated with a high mortality rate.

Our objective is to describe the progress of severe Staphylococcus aureus infections in three intensive care units and analyze cases ofnecrotizing pneumonia in the period ranging from January 2011 to March 2013.

Forty-three patients were studied, 76.7% had a community-acquired infection, and 31 had community-acquired methicillin-resistant Staphylococcus aureus.

The main reason for admission was respiratory failure. Bacteremia was confirmed in 55.8% of cases. Mechanical ventilation was required in 86% of admitted patients, while 27 patients developed septic shock.

The length of stay in the intensive care unit was 13 (5-25) days, and the mortality rate was 14%. Necrotizing pneumonia was observed in 51% of cases.

Conclusion. A high rate of community-acquired infection was identified. Necrotizing pneumonia was associated with a worse clinical course.



April 17, 2014 at 8:38 am

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