Archive for October, 2014

Outcomes and Metrics for Antimicrobial Stewardship: Survey of Physicians and Pharmacists

Clinical Infectious Diseases OCT 15, 2014 V.59 Suppl.3 S108-S111

Brock Bumpass1,2, Patrick M. McDaneld1,2,3,a, Daryl D. DePestel1, Kenneth C. Lamp1, Thomas J. Chung1, Peggy S. McKinnon1, Monica G. Crompton1, and Elizabeth D. Hermsen1,4

1Global Medical Affairs Department, Cubist Pharmaceuticals, Lexington, Massachusetts

2Massachusetts College of Pharmacy and Health Sciences, Worcester

3Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Worcester/Manchester

4Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha

Correspondence: Elizabeth D. Hermsen, PharmD, MBA, BCPS-ID, Cubist Pharmaceuticals, 65 Hayden Ave, Lexington, MA 02421 (elizabeth.hermsen@cubist.com).

We conducted a survey to compare antimicrobial stewardship outcomes considered to be most important with those used in practice as metrics.

Respondent opinion of important outcomes compared with those collected as metrics were antimicrobial use (15% vs 73%), antimicrobial cost (10% vs 73%), appropriateness of antimicrobial use (56% vs 51%), infection-related mortality rate (34% vs 7%), and antibiotic-associated length of stay (22% vs 12%).

Patient outcomes are important to many practitioners but are rarely used as metrics.

PDF

http://cid.oxfordjournals.org/content/59/suppl_3/S108.full.pdf+html

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October 30, 2014 at 3:21 pm

Community-Acquired Pneumonia

N England J of Med Oct. 20, 2014

REVIEW ARTICLE

D.M. Musher and A.R. Thorner

From the Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center, and the Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine — both in Houston (D.M.M.); and the Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical School, Boston (A.R.T.).

Long recognized as a major cause of death, pneumonia has been studied intensively since the late 1800s, the results of which led to many formative insights in modern microbiology.

Despite this research and the development of antimicrobial agents, pneumonia remains a major cause of complications and death.

Community-acquired pneumonia (CAP) is a syndrome in which acute infection of the lungs develops in persons who have not been hospitalized recently and have not had regular exposure to the health care system….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMra1312885

October 30, 2014 at 3:18 pm

Innovation of Novel Antibiotics: An Economic Perspective

Clinical Infectious Diseases OCT 15, 2014 V.59 Suppl.3 S104-S107

Michael R. McKellar1 and A. Mark Fendrick1,2

1School of Public Health

2Medical School, University of Michigan, Ann Arbor

Correspondence: Michael R. McKellar, MHSA, Center for Value-Based Insurance Design, North Campus Research Complex, 2800 Plymouth Road, Bldg 16, 4th Floor, Ann Arbor, MI 48109-2800 (rmckell@umich.edu).

Despite the public attention to antibiotic overuse and the specter of antimicrobial-resistant pathogens, current infections necessitate the use of antibiotics.

Yet, patients and providers may not fully consider the societal cost associated with inappropriate antimicrobial use and subsequent resistance. Policies intended to limit use to minimize resistance must be balanced with the competing concern of underutilization.

It is difficult to determine whether research and development incentives or reducing the costs of bringing new antibiotics through expedited review will be sufficient.

Likely, the most effective method would be allowing higher prices for use deemed to be clinically appropriate.

The ultimate policy goal is to ensure that antibiotics are used appropriately, with the right patients receiving the right medication at the right time, and that the world has a steady stream of future antibiotics to effectively treat the resistant organisms that will inevitably emerge….

PDF

http://cid.oxfordjournals.org/content/59/suppl_3/S104.full.pdf+html

 

October 25, 2014 at 10:05 am

The early clinical features of dengue in adults: challenges for early clinical diagnosis.

PLoS Negl Trop Dis. 2011;5(5):e1191.

Low JG1, Ong A, Tan LK, Chaterji S, Chow A, Lim WY, Lee KW, Chua R, Chua CR, Tan SW, Cheung YB, Hibberd ML, Vasudevan SG, Ng LC, Leo YS, Ooi EE.

Author information

1Communicable Diseases Centre, Tan Tock Seng Hospital, Singapore, Singapore.

Abstract

BACKGROUND:

The emergence of dengue throughout the tropical world is affecting an increasing proportion of adult cases. The clinical features of dengue in different age groups have not been well examined, especially in the context of early clinical diagnosis.

METHODOLOGY/PRINCIPAL FINDINGS:

We structured a prospective study of adults (≥ 18 years of age) presenting with acute febrile illness within 72 hours from illness onset upon informed consent. Patients were followed up over a 3-4 week period to determine the clinical outcome. A total of 2,129 adults were enrolled in the study, of which 250 (11.7%) had dengue. Differences in the rates of dengue-associated symptoms resulted in high sensitivities when the WHO 1997 or 2009 classification schemes for probable dengue fever were applied to the cohort. However, when the cases were stratified into age groups, fewer older adults reported symptoms such as myalgia, arthralgia, retro-orbital pain and mucosal bleeding, resulting in reduced sensitivity of the WHO classification schemes. On the other hand, the risks of severe dengue and hospitalization were not diminished in older adults, indicating that this group of patients can benefit from early diagnosis, especially when an antiviral drug becomes available. Our data also suggests that older adults who present with fever and leukopenia should be tested for dengue, even in the absence of other symptoms.

CONCLUSION:

Early clinical diagnosis based on previously defined symptoms that are associated with dengue, even when used in the schematics of both the WHO 1997 and 2009 classifications, is difficult in older adults.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104968/pdf/pntd.0001191.pdf

October 25, 2014 at 10:01 am

Infections by Listeria monocytogenes.

Rev Chilena Infectol. 2013 Aug;30(4):417-25.

[Article in Spanish]

Sedano R1, Fica A, Guiñez D, Braun S, Porte L, Dabanch J, Weitzel T, Soto A.

Author information

1Departamento de Medicina, Hospital Militar de Santiago, Santiago, Chile.

Abstract

BACKGROUND:

Listeria monocytogenes infections have been poorly characterized in Chile.

AIM:

To evaluate clinical manifestations and risk factors associated to a fatal outcome in a series of patients.

METHODS:

Retrospective analysis of cases from 1991 to 2012.

RESULTS:

Twenty three cases were identified, including 2 diagnosed after prolonged hospitalization (8.7%) with an average age of 68.4 years (range 44-90).

Known predisposing factors were age > 65 years (60.9%), diabetes mellitus (40.9%), and immunosuppression (27.3%).

Most cases presented after 2003 (70%). No cases associated with neonates, pregnancy or HIV infections were recorded.

Patients presented with central nervous system (CNS) infection (39%), including 8 cases of meningitis and one of rhomboencephalitis; bacteremia (43.5%), including one case with endocarditis; abscesses (8.7%); and other infections (spontaneous bacterial peritonitis and pneumonia; 8.7%).

Risky food consumption was found in 80% of those asked about it. Predominant clinical manifestations were fever (90.9%), and confusion (63.6%). CNS infections were associated to headache (OR 21, p < 0.05), nausea and vomiting (OR 50, p < 0.01).

Only 45.5% received initial appropriate empirical therapy and 36.4% a synergistic combination. Eight patients died (34.8%), this outcome was associated to bacteremia (OR 8.25; IC95 1.2-59 p < 0.05).

CONCLUSIONS:

L. monocytogenes infections appear to be increasing in Chile, causing infections in different sites, attacking vulnerable patients, and have a high case-fatality ratio, especially among those with bacteremia.

PDF

http://www.scielo.cl/pdf/rci/v30n4/art11.pdf

 

October 25, 2014 at 9:59 am

The Role of Public Health in Antimicrobial Stewardship in Healthcare

Clinical Infectious Diseases OCT 15, 2014 V.59 Suppl.3 S101-S103

Kavita K. Trivedi1 and Loria A. Pollack2

1Trivedi Consults, LLC, Albany, California

2Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

Correspondence: Kavita K. Trivedi, MD, Trivedi Consults, LLC, 1020 Curtis St, Albany, CA 94706 (kavita@trivediconsults.com).

Education, surveillance, and promotion of antimicrobial stewardship align with the goals of public health to prevent disease, promote health, and prolong life. Many US federal and state public health organizations are already engaged in antimicrobial stewardship activities.

Healthcare providers are encouraged to work with public health officials on appropriate local antimicrobial stewardship strategies to attain the common goal of reducing antimicrobial resistance and preserving antimicrobials for future generations….

PDF

http://cid.oxfordjournals.org/content/59/suppl_3/S101.full.pdf+html

October 23, 2014 at 2:46 pm

A Case of Severe Ebola Virus Infection Complicated by Gram-Negative Septicemia

N England J of Med Oct. 20, 2014

BRIEF REPORT

Benno Kreuels, M.D., Dominic Wichmann, M.D., Petra Emmerich, Ph.D., Jonas Schmidt-Chanasit, M.D., Geraldine de Heer, M.D., Stefan Kluge, M.D., Abdourahmane Sow, M.D., Thomas Renné, M.D., Ph.D., Stephan Günther, M.D., Ansgar W. Lohse, M.D., Marylyn M. Addo, M.D., Ph.D., and Stefan Schmiedel, M.D.

Ebola virus disease (EVD) developed in a patient who contracted the disease in Sierra Leone and was airlifted to an isolation facility in Hamburg, Germany, for treatment.

During the course of the illness, he had numerous complications, including septicemia, respiratory failure, and encephalopathy.

Intensive supportive treatment consisting of high-volume fluid resuscitation (approximately 10 liters per day in the first 72 hours), broad-spectrum antibiotic therapy, and ventilatory support resulted in full recovery without the use of experimental therapies.

Discharge was delayed owing to the detection of viral RNA in urine (day 31) and sweat (at the last assessment on day 40) by means of polymerase-chain-reaction (PCR) assay, but the last positive culture was identified in plasma on day 14 and in urine on day 26.

This case shows the challenges in the management of EVD and suggests that even severe EVD can be treated effectively with routine intensive care….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1411677

October 23, 2014 at 2:44 pm

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