Archive for March 15, 2015

Prior statin use and 90-day mortality in Gram-negative and Gram-positive bloodstream infection: a prospective observational study

European J of Clin Microb & Inf Dis MARCH 2015 V.34 N.3 P.609-617

  1. Mehl, S. Harthug, S. Lydersen, J. Paulsen, B. O. Åsvold, E. Solligård, J. K. Damås & T.-H. Edna
  2. Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Post Box 333, 7601, Levanger, Norway
  3. Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
  4. Department of Medicine, Haukeland University Hospital, Bergen, Norway
  5. Institute of Medicine, University of Bergen, Bergen, Norway
  6. Regional Centre for Child and Youth Mental Health and Child Welfare—Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
  7. Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
  8. Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway
  9. Department of Endocrinology, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
  10. Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
  11. Clinic of Anesthesia and Intensive Care, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
  12. Department of Infectious Diseases, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
  13. Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway

e-mail: A. Mehl arne.mehl@hnt.no  

             Harthug stig.harthug@helse-bergen.no  

             Lydersen stian.lydersen@ntnu.no  

In several studies on patients with bloodstream infection (BSI), prior use of statins has been associated with improved survival. Gram-positive and Gram-negative bacteria alert the innate immune system in different ways.

We, therefore, studied whether the relation between prior statin use and 90-day total mortality differed between Gram-positive and Gram-negative BSI.

We conducted a prospective observational cohort study of 1,408 adults with BSI admitted to Levanger Hospital between January 1, 2002, and December 31, 2011. Data on the use of statins and other medications at admission, comorbidities, functional status, treatment, and outcome were obtained from the patients’ hospital records.

The relation of statin use with 90-day mortality differed between Gram-negative and Gram-positive BSI (p-value for interaction 0.01).

Among patients with Gram-negative BSI, statin users had significantly lower 90-day total mortality [odds ratio (OR) 0.42, 95 % confidence interval (CI) 0.23–0.75, p=0.003].

The association remained essentially unchanged after adjusting for the effect of sex, age, functional status before the infection, and underlying diseases that were considered confounders (adjusted OR 0.38, 95 % CI 0.20–0.72, p=0.003).

A similar analysis of patients with Gram-positive BSI showed no association of statin use with mortality (adjusted OR 1.22, 95 % CI 0.69–2.17, p=0.49).

The present study suggests that prior statin use is associated with a lower 90-day total mortality in Gram-negative BSI, but not in Gram-positive BSI.

abstract

http://link.springer.com/article/10.1007/s10096-014-2269-6?wt_mc=alerts.TOCjournals

 

PDF

http://download.springer.com/static/pdf/992/art%253A10.1007%252Fs10096-014-2269-6.pdf?auth66=1426442555_59e8b7b0cd72e4f66f1989ab7d5adf0d&ext=.pdf

 

March 15, 2015 at 3:11 pm

Antimicrobial susceptibility profiles, serotype distribution and virulence determinants among invasive, non-invasive and colonizing Streptococcus agalactiae (group B streptococcus) from Malaysian patients

European J of Clin Microb & Inf Dis MARCH 2015 V.34 N.3 P.579-584

  1. Eskandarian, Z. Ismail, V. Neela, A. van Belkum, M. N. M. Desa & S. Amin Nordin
  2. Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
  3. Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
  4. bioMérieux R&D Microbiology, La Balme Les Grottes, 38390, France
  5. Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia

e-mail: S. Amin Nordin syafinaz@upm.edu.my

A total of 103 group B streptococci (GBS) including 22 invasive, 21 non-invasive, and 60 colonizing isolates were collected in a Malaysian hospital (June 2010–October 2011).

Isolates were characterized by conventional and molecular serotyping and analyzed for scpB, lmb, hylB, cylE, bac, bca and rib gene content.

Antimicrobial susceptibility to penicillins, macrolides, lincosamides, quinolones and tetracyclines was determined using disk diffusion and the MICs for penicillin were determined by E-test.

Molecular serotyping for all eight serotypes (Ia, Ib, II–VII) was in full accordance with conventional serotyping. Overall, taking CS and MS together, serotype VI was the most common capsular type (22.3 %) followed by VII (21.4 %), III (20.4 %), Ia (17.5 %), V (9.7 %), II (7.7 %) and IV (1 %). Susceptibility to beta-lactam antimicrobials was prevalent (100 %).

Resistance rates for erythromycin, clindamycin and tetracycline were 23.3 %, 17.5 % and 71.8 %, respectively. PCR-virulence gene screening showed the presence of cylE, lmb, scpB and hylB in almost all the isolates while rib, bca, and bac genes were found in 29.1 %, 14.6 % and 9.7 % of the isolates.

Certain genes were significantly associated with specific serotypes, namely, rib with serotypes Ia, II, III and VI; bca and bac with serotypes II and III.

Furthermore, serotype Ia was significantly more common among patients with invasive infections (p<0.01) and serotype VI isolates were significantly more common among carriers (p<0.05).

In summary, serotype distribution correlates with virulence gene content will be useful in epidemiological studies and design of vaccines.

PDF

http://download.springer.com/static/pdf/214/art%253A10.1007%252Fs10096-014-2265-x.pdf?auth66=1426442030_35b227c6397c3e6a2cc7a1c05d282de9&ext=.pdf

March 15, 2015 at 3:07 pm

Epidemiology, clinical history and microbiology of peritonsillar abscess

European J of Clin Microb & Inf Dis MARCH 2015 V.34 N.3 P.549-554

  1. Mazur, E. Czerwińska, I. Korona-Głowniak, A. Grochowalska & M. Kozioł-Montewka
  2. Medical Microbiology Department, Medical University of Lublin, ul. Chodźki 1, 20-093, Lublin, Poland
  3. Department of Otolaryngology, Regional Specialist Hospital in Radom, ul. Aleksandrowicza 5, 26-617, Radom, Poland
  4. Department of Pharmaceutical Microbiology, Medical University of Lublin, ul. Chodźki 1, 20-093, Lublin, Poland
  5. Microbiological Laboratory, Regional Specialist Hospital in Radom, ul. Aleksandrowicza 5, 26-617, Radom, Poland

e-mail: E. Mazur elamazur@yahoo.com    

The purpose of this investigation was to explore the epidemiology, clinical history and microbiology of peritonsillar abscess (PTA).

A retrospective review of PTA cases treated at the Department of Otolaryngology, Regional Specialist Hospital in Radom, Poland between 1st October 2003 and 30th September 2013 was undertaken.

A total of 111 PTA patients were admitted. The study population consisted of 57.7 % males and 42.3 % females, with an average age of 31.0 (range 5–78) years. Smokers comprised 22.0 % of the study group.

The seasonal variation of PTA was statistically insignificant (p=0.45).

Recurrent tonsillitis occurred in 35.5 % of patients. In comparison with the rest of the study population, patients with a history of recurrent pharyngotonsillitis had higher incidence of previous PTA episodes [odds ratio (OR) 17.8, 95 % confidence interval (CI) 2.1–148.7, p=0.001].

Also, they were more frequently treated with antibiotics prior to hospitalisation (OR 4.6, 95 % CI 2.0–10.9, p=0.0005) and had significantly longer hospital stay (p=0.03).

Bacterial cultures of abscess aspirates were performed in 40.5 % of patients. Monomicrobial growth was detected in 77.8 % of aerobic cultures. Streptococcus pyogenes, growing most frequently in monoculture, was found in 28.9 % of aerobic cultures.

PTA patients with and without recurrent pharyngotonsillitis differed with regard to clinical history and course of disease.

The percentage of smokers among PTA patients was lower than that described in the literature. Monomicrobial growth predominated in PTA aspirate cultures. S. pyogenes proved to be the most frequent pathogen.

abstract

http://link.springer.com/article/10.1007/s10096-014-2260-2?wt_mc=alerts.TOCjournals

PDF

http://download.springer.com/static/pdf/339/art%253A10.1007%252Fs10096-014-2260-2.pdf?auth66=1426441839_a2451bd5d8c59dcaa7623b6f3f51e3a5&ext=.pdf

 

March 15, 2015 at 3:03 pm

Extended-Duration Dosing and Distribution of Dalbavancin into Bone and Articular Tissue

Antimicrobial Agents and Chemotherapy April 2015 V.59 N.4 P.1849-1855

Michael W. Dunne, Sailaja Puttagunta, Craig R. Sprenger, Chris Rubino, Scott Van Wart, and James Baldassarre

aDurata Therapeutics, Inc., Branford, Connecticut, USA

bInstitute for Clinical Pharmacodynamics, Latham, New York, USA

cPRACS Institute, Ltd., Fargo, North Dakota, USA

Dalbavancin is an intravenous lipoglycopeptide with activity against Gram-positive pathogens and an MIC90 for Staphylococcus aureus of 0.06 μg/ml.

With a terminal half-life of >14 days, dosing regimens with infrequent parenteral administration become available to treat infectious diseases such as osteomyelitis and endocarditis that otherwise require daily dosing for many weeks.

In order to support a rationale for these novel regimens, the pharmacokinetics over an extended dosing interval and the distribution of dalbavancin into bone and articular tissue were studied in two phase I trials and pharmacokinetic modeling was performed.

Intravenous administration of 1,000 mg of dalbavancin on day 1 followed by 500 mg weekly for seven additional weeks was well tolerated and did not demonstrate evidence of drug accumulation.

In a separate study, dalbavancin concentrations in cortical bone 12 h after infusion of a single 1,000-mg intravenous infusion were 6.3 μg/g and 2 weeks later were 4.1 μg/g.

A two-dose, once-weekly regimen that would provide tissue exposure over the dalbavancin MIC for Staphylococcus aureus for 8 weeks, maximizing the initial exposure to treatment while minimizing the frequency of intravenous therapy, is proposed.

PDF

http://aac.asm.org/content/59/4/1849.full.pdf+html

March 15, 2015 at 2:58 pm

Use of In Vitro Vancomycin Testing Results To Predict Susceptibility to Oritavancin, a New Long-Acting Lipoglycopeptide

Antimicrobial Agents and Chemotherapy April 2015 V.59 N.4 P.2405-2409

Ronald N. Jones, John D. Turnidge, Greg Moeck, Francis F. Arhin, and Rodrigo E. Mendes

aJMI Laboratories, North Liberty, Iowa, USA

bUniversity of Adelaide, Adelaide, South Australia, Australia

cThe Medicines Company, Ville Saint Laurent, Quebec, Canada

Oritavancin is a recently approved lipoglycopeptide antimicrobial agent with activity against Gram-positive pathogens. Its extended serum elimination half-life and concentration-dependent killing enable single-dose treatment of acute bacterial skin and skin structure infections.

At the time of regulatory approval, new agents, including oritavancin, are not offered in the most widely used susceptibility testing devices and therefore may require application of surrogate testing using a related antimicrobial to infer susceptibility.

To evaluate vancomycin as a predictive susceptibility marker for oritavancin, 26,993 recent Gram-positive organisms from U.S. and European hospitals were tested using reference MIC methods. Organisms included Staphylococcus aureus, coagulase-negative staphylococci (CoNS), beta-hemolytic streptococci (BHS), viridans group streptococci (VGS), and enterococci (ENT).

These five major pathogen groups were analyzed by comparing results with FDA-approved susceptible breakpoints for both drugs, as well as those suggested by epidemiological cutoff values and supported by pharmacokinetic/pharmacodynamic analyses.

Vancomycin susceptibility was highly accurate (98.1 to 100.0%) as a surrogate for oritavancin susceptibility among the indicated pathogen species.

Furthermore, direct MIC comparisons showed high oritavancin potencies, with vancomycin/oritavancin MIC90 results of 1/0.06, 2/0.06, 0.5/0.12,1/0.06, and >16/0.06 μg/ml for S. aureus, CoNS, BHS, VGS, and ENT, respectively.

In conclusion, vancomycin demonstrated acceptable accuracy as a surrogate marker for predicting oritavancin susceptibility when tested against the indicated pathogens.

In contrast, 93.3% of vancomycin-nonsusceptible enterococci had oritavancin MIC values of ≤0.12 μg/ml, indicating a poor predictive value of vancomycin for oritavancin resistance against these organisms.

Until commercial oritavancin susceptibility testing devices are readily available, isolates that when tested show vancomycin susceptibility can be inferred to be susceptible to oritavancin by using FDA-approved breakpoints.

PDF

http://aac.asm.org/content/59/4/2405.full.pdf+html

March 15, 2015 at 2:54 pm


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