Archive for May 9, 2015

Sonication as a diagnostic approach used to investigate the infectious etiology of prosthetic hip joint loosening.

Pol J Microbiol. 2014;63(3):299-306.

Bogut A, Niedźwiadek J, Kozioł-Montewka M, Strzelec-Nowak D, Blacha J, Mazurkiewicz T, Macias J, Marczyński W.

Abstract

The purpose of the study was to evaluate the usefulness of sonication for the diagnosis of prosthetic joint infections (PJIs) by its comparison with periprosthetic tissues (PTs) and synovial fluid (SV-F) cultures.

The study groups included 54 patients undergoing exchange of total hip prostheses for so called “aseptic” loosening occurring without clinical manifestations of an accompanying PJI and 22 patients who developed a sinus tract communicating with the prosthesis which was indicative of an ongoing infectious process.

Significant positive culture results were obtained among 10 (18.5%) patients with “aseptic” implant failure and in 18 (81.8%) patients who developed a sinus tract.

Sonicate-fluid (S-F) yielded bacterial growth in all culture-positive patients with “aseptic” loosening vs. 15 patients with presumed PJIs. There was a concordance in terms of bacterial species isolated from S-F and conventional cultures from individual patients. Coagulase-negative staphylococci were isolated most frequently.

Sensitivity of sonication (75%) exceeded that estimated for PTs (69%) and SV-F (45%) cultures. We conclude that identification of causative agents of PJIs which is critical to further therapeutic decisions is aided by the combination of sonication and conventional culture.

PDF

http://www.pjm.microbiology.pl/archive/vol6332014299.pdf

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May 9, 2015 at 8:52 pm

Urinary tract infections in older women: a clinical review.

JAMA. 2014 Feb 26;311(8):844-54.

Mody L1, Juthani-Mehta M2.

Abstract

IMPORTANCE:

Asymptomatic bacteriuria and symptomatic urinary tract infections (UTIs) in older women are commonly encountered in outpatient practice.

OBJECTIVE:

To review management of asymptomatic bacteriuria and symptomatic UTI and review prevention of recurrent UTIs in older community-dwelling women.

EVIDENCE REVIEW:

A search of Ovid (Medline, PsycINFO, Embase) for English-language human studies conducted among adults aged 65 years and older and published in peer-reviewed journals from 1946 to November 20, 2013.

RESULTS:

The clinical spectrum of UTIs ranges from asymptomatic bacteriuria, to symptomatic and recurrent UTIs, to sepsis associated with UTI requiring hospitalization. Recent evidence helps differentiate asymptomatic bacteriuria from symptomatic UTI. Asymptomatic bacteriuria is transient in older women, often resolves without any treatment, and is not associated with morbidity or mortality. The diagnosis of symptomatic UTI is made when a patient has both clinical features and laboratory evidence of a urinary infection. Absent other causes, patients presenting with any 2 of the following meet the clinical diagnostic criteria for symptomatic UTI: fever, worsened urinary urgency or frequency, acute dysuria, suprapubic tenderness, or costovertebral angle pain or tenderness. A positive urine culture (≥105 CFU/mL) with no more than 2 uropathogens and pyuria confirms the diagnosis of UTI. Risk factors for recurrent symptomatic UTI include diabetes, functional disability, recent sexual intercourse, prior history of urogynecologic surgery, urinary retention, and urinary incontinence. Testing for UTI is easily performed in the clinic using dipstick tests. When there is a low pretest probability of UTI, a negative dipstick result for leukocyte esterase and nitrites excludes infection. Antibiotics are selected by identifying the uropathogen, knowing local resistance rates, and considering adverse effect profiles. Chronic suppressive antibiotics for 6 to 12 months and vaginal estrogen therapy effectively reduce symptomatic UTI episodes and should be considered in patients with recurrent UTIs.

CONCLUSIONS AND RELEVANCE:

Establishing a diagnosis of symptomatic UTI in older women requires careful clinical evaluation with possible laboratory assessment using urinalysis and urine culture. Asymptomatic bacteriuria should be differentiated from symptomatic UTI. Asymptomatic bacteriuria in older women should not be treated.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194886/pdf/nihms579889.pdf

May 9, 2015 at 8:48 pm

Penicillin allergy – A practical guide for clinicians

Cleveland Clinic Journal of Medicine May 2015 V.82 N.5 P.295-300.

ALEXEI GONZALEZ-ESTRADA, MD

Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic

CRISTINE RADOJICIC, MD

Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic

ADDRESS: Alexei Gonzalez-Estrada, MD, Department of Allergy and Clinical Immunology, Respiratory Institute, A90, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; e-mail: gonzala5@ccf.org

ABSTRACT

Penicillin allergy is the most commonly reported drug allergy in the United States. However, after undergoing a complete evaluation by a board-certified allergist, including skin testing, 90% of patients labeled as “penicillin-allergic” are able to tolerate penicillin.

Clinical presentation is key in classifying reactions as either mediated by or not mediated by immunoglobulin E (IgE), and in determining which patients may benefit from penicillin skin testing, graded-dose challenge, or desensitization.

Cross-reactivity between penicillin and other beta-lactams is less common than previously thought.

FULL TEXT

http://www.ccjm.org/current-issue/issue-single-view/penicillin-allergy-a-practical-guide-for-clinicians/a2a3023e2bee9ab01b1588d59cd57fe5.html

PDF

http://www.ccjm.org/uploads/media/Gonzalez-Estrada_PenicillinAllergy.pdf

May 9, 2015 at 8:43 pm


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