Archive for April, 2016

Listeriosis during Pregnancy: A Public Health Concern.

ISRN Obstet Gynecol. 2013 Sep 26;2013:851712. doi: 10.1155/2013/851712.

Mateus T1, Silva J, Maia RL, Teixeira P.

Author information

1Centro de Biotecnologia e Química Fina (CBQF) Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa/Porto, Rua Dr. António Bernardino Almeida, 4200-072 Porto, Portugal ; Departamento de Medicina Veterinária (EUVG), Escola Universitária Vasco da Gama, Coimbra, Portugal.

Abstract

Listeria was first described in 1926 by Murray, Webb, and Swann, who discovered it while investigating an epidemic infection among laboratory rabbits and guinea pigs. The role of Listeria monocytogenes as a foodborne pathogen was definitively recognized during the 1980s. This recognition was the consequence of a number of epidemic human outbreaks due to the consumption of contaminated foods, in Canada, in the USA and in Europe. Listeriosis is especially severe in immunocompromised individuals such as pregnant women. The disease has a low incidence of infection, although this is undeniably increasing, with a high fatality rate amongst those infected. In pregnant women listeriosis may cause abortion, fetal death, or neonatal morbidity in the form of septicemia and meningitis. Improved education concerning the disease, its transmission, and prevention measures for immunocompromised individuals and pregnant women has been identified as a pressing need.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3804396/pdf/ISRN.OBGYN2013-851712.pdf

April 24, 2016 at 2:17 pm

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:

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

April 24, 2016 at 2:15 pm

Pregnancy and infection.

N Engl J Med. 2014 Jun 5;370(23):2211-8.

Kourtis AP1, Read JS, Jamieson DJ.

Author information

1From the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta (A.P.K., D.J.J.); and the Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco (J.S.R.).

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4459512/pdf/nihms655977.pdf

April 24, 2016 at 2:12 pm

Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial

Lancet April 23, 2016 V.387 N.10029 P.1743–1752

Articles

Michael Hallsworth, Tim Chadborn, PhD, Anna Sallis, Michael Sanders, PhD, Daniel Berry, Felix Greaves, PhD, Lara Clements, Prof Sally C Davies, MD

Background

Unnecessary antibiotic prescribing contributes to antimicrobial resistance. In this trial, we aimed to reduce unnecessary prescriptions of antibiotics by general practitioners (GPs) in England.

Methods

In this randomised, 2 × 2 factorial trial, publicly available databases were used to identify GP practices whose prescribing rate for antibiotics was in the top 20% for their National Health Service (NHS) Local Area Team. Eligible practices were randomly assigned (1:1) into two groups by computer-generated allocation sequence, stratified by NHS Local Area Team. Participants, but not investigators, were blinded to group assignment. On Sept 29, 2014, every GP in the feedback intervention group was sent a letter from England’s Chief Medical Officer and a leaflet on antibiotics for use with patients. The letter stated that the practice was prescribing antibiotics at a higher rate than 80% of practices in its NHS Local Area Team. GPs in the control group received no communication. The sample was re-randomised into two groups, and in December, 2014, GP practices were either sent patient-focused information that promoted reduced use of antibiotics or received no communication. The primary outcome measure was the rate of antibiotic items dispensed per 1000 weighted population, controlling for past prescribing. Analysis was by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN32349954, and has been completed.

Findings

Between Sept 8 and Sept 26, 2014, we recruited and assigned 1581 GP practices to feedback intervention (n=791) or control (n=790) groups. Letters were sent to 3227 GPs in the intervention group. Between October, 2014, and March, 2015, the rate of antibiotic items dispensed per 1000 population was 126·98 (95% CI 125·68–128·27) in the feedback intervention group and 131·25 (130·33–132·16) in the control group, a difference of 4·27 (3·3%; incidence rate ratio [IRR] 0·967 [95% CI 0·957–0·977]; p<0·0001), representing an estimated 73 406 fewer antibiotic items dispensed. In December, 2014, GP practices were re-assigned to patient-focused intervention (n=777) or control (n=804) groups. The patient-focused intervention did not significantly affect the primary outcome measure between December, 2014, and March, 2015 (antibiotic items dispensed per 1000 population: 135·00 [95% CI 133·77–136·22] in the patient-focused intervention group and 133·98 [133·06–134·90] in the control group; IRR for difference between groups 1·01, 95% CI 1·00–1·02; p=0·105).

Interpretation

Social norm feedback from a high-profile messenger can substantially reduce antibiotic prescribing at low cost and at national scale; this outcome makes it a worthwhile addition to antimicrobial stewardship programmes.

Funding

Public Health England.

 

PDF

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00215-4.pdf

April 22, 2016 at 8:01 am

Strong stewardship to fight antimicrobial resistance

Lancet April 23, 2016 V.387 N.10029

Editorial

Antibiotics have undoubtedly revolutionised medicine. However, widespread use of antimicrobial drugs in medicine and agriculture has spurred the evolution of pan-resistant bacterial strains. With few new antibiotics in the development pipeline, the threat to public health of antimicrobial resistance is all too real. Strong stewardship policies are urgently needed to stem inappropriate prescribing and use of antibiotics.

 

On April 13, the Infectious Diseases Society of America and the Society for Health Care Epidemiology of America released a new guideline: Implementing an Antibiotic Stewardship Program, with 27 recommendations that cover a broad range of antibiotic stewardship interventions. Among the recommendations are use of preauthorisation for antibiotic prescribing, restriction of use of antibiotics with high risk of Clostridium difficile infection, and strategies for specific health-care settings (such as nursing homes) to reduce unnecessary or inappropriate antibiotic use. Of note, although these recommendations can be used across a range of clinical settings, the authors highlight the lack evidence for effective antibiotic stewardship interventions, and call for increased research to determine how to best achieve large-scale implementation of these measures.

PDF

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30302-6.pdf

April 22, 2016 at 8:00 am

Antibiotic stewardship: prescribing social norms

Lancet April 23, 2016 V.387 N.10029

Comment

Ian M Gould, Timothy Lawes

With a burgeoning world population, expansions in medical intervention, and intensified agriculture, the need for antibiotic stewardship is increasingly clear. Declining efficacy of antimicrobial prophylaxis for surgery or chemotherapy, and emergence of pan-resistant pathogens, warn of a post-antibiotic era. In the evolutionary arms race of antimicrobial resistance, rejuvenating the neglected pipeline for new agents provides only a partial solution. The key challenge worldwide is translating awareness of resistance into effective stewardship.

In the past decade, the UK has made notable progress. A high media profile has provided political leverage to advance antimicrobial resistance up national health agendas, and surveillance systems for antibiotic consumption and resistance have been established. National targets to reduce broad-spectrum antibiotic use have been associated with declines in Clostridium difficile and meticillin-resistant Staphylococcus aureus. However, declining sensitivities to substitute antibiotics4 suggest that without reducing total antibiotic consumption, we might be replacing rather than eliminating resistances. Sustaining progress will require a major shift in prescribing and consumption norms …

PDF

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)00007-6.pdf

April 22, 2016 at 7:59 am

Zika Virus

N Engl J Med April 21, 2016 V.374 P.1552-1563

REVIEW ARTICLE

L.R. Petersen, D.J. Jamieson, A.M. Powers, and M.A. Honein

From the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO (L.R.P., A.M.P.); and the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (D.J.J), and the Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities (M.A.H), Centers for Disease Control and Prevention, Atlanta.

In 1947, a study of yellow fever yielded the first isolation of a new virus, from the blood of a sentinel rhesus macaque that had been placed in the Zika Forest of Uganda.1 Zika virus remained in relative obscurity for nearly 70 years; then, within the span of just 1 year, Zika virus was introduced into Brazil from the Pacific Islands and spread rapidly throughout the Americas.2 It became the first major infectious disease linked to human birth defects to be discovered in more than half a century and created such global alarm that the World Health Organization (WHO) would declare a Public Health Emergency of International Concern.3 This review describes the current understanding of the epidemiology, transmission, clinical characteristics, and diagnosis of Zika virus infection, as well as the future outlook with regard to this disease…

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMra1602113

April 21, 2016 at 3:24 pm

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