Archive for July 8, 2016

A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care.

N Engl J Med. 2016 Jun 2;374(22):2111-9.

Saint S1, Greene MT1, Krein SL1, Rogers MA1, Ratz D1, Fowler KE1, Edson BS1, Watson SR1, Meyer-Lucas B1, Masuga M1, Faulkner K1, Gould CV1, Battles J1, Fakih MG1.

Author information

1From the Hospital Outcomes Program of Excellence, Veterans Affairs (VA) Ann Arbor Healthcare System (S.S., M.T.G., S.L.K., D.R., K.E.F.), the Department of Internal Medicine, University of Michigan (UM) Medical School (S.S., M.T.G., S.L.K., M.A.M.R.), and the VA/UM Patient Safety Enhancement Program (S.S., M.T.G., S.L.K., M.A.M.R., D.R., K.E.F.), Ann Arbor, the Michigan Health and Hospital Association, Okemos (S.R.W., B.M.-L., M.M.), and St. John Hospital and Medical Center, Detroit (M.G.F.) – all in Michigan; the Health Research and Educational Trust, Chicago (B.S.E., K.F.); the Centers for Disease Control and Prevention, Atlanta (C.V.G.); and the Agency for Healthcare Research and Quality, Rockville, MD ( J.B.).

Abstract

BACKGROUND:

Catheter-associated urinary tract infection (UTI) is a common device-associated infection in hospitals. Both technical factors–appropriate catheter use, aseptic insertion, and proper maintenance–and socioadaptive factors, such as cultural and behavioral changes in hospital units, are important in preventing catheter-associated UTI.

METHODS:

The national Comprehensive Unit-based Safety Program, funded by the Agency for Healthcare Research and Quality, aimed to reduce catheter-associated UTI in intensive care units (ICUs) and non-ICUs. The main program features were dissemination of information to sponsor organizations and hospitals, data collection, and guidance on key technical and socioadaptive factors in the prevention of catheter-associated UTI. Data on catheter use and catheter-associated UTI rates were collected during three phases: baseline (3 months), implementation (2 months), and sustainability (12 months). Multilevel negative binomial models were used to assess changes in catheter use and catheter-associated UTI rates.

RESULTS:

Data were obtained from 926 units (59.7% were non-ICUs, and 40.3% were ICUs) in 603 hospitals in 32 states, the District of Columbia, and Puerto Rico. The unadjusted catheter-associated UTI rate decreased overall from 2.82 to 2.19 infections per 1000 catheter-days. In an adjusted analysis, catheter-associated UTI rates decreased from 2.40 to 2.05 infections per 1000 catheter-days (incidence rate ratio, 0.86; 95% confidence interval [CI], 0.76 to 0.96; P=0.009). Among non-ICUs, catheter use decreased from 20.1% to 18.8% (incidence rate ratio, 0.93; 95% CI, 0.90 to 0.96; P<0.001) and catheter-associated UTI rates decreased from 2.28 to 1.54 infections per 1000 catheter-days (incidence rate ratio, 0.68; 95% CI, 0.56 to 0.82; P<0.001). Catheter use and catheter-associated UTI rates were largely unchanged in ICUs. Tests for heterogeneity (ICU vs. non-ICU) were significant for catheter use (P=0.004) and catheter-associated UTI rates (P=0.001).

CONCLUSIONS:

A national prevention program appears to reduce catheter use and catheter-associated UTI rates in non-ICUs. (Funded by the Agency for Healthcare Research and Quality.).

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1504906

 

N Engl J Med. 2016 Jun 2;374(22):2168-9.

Catheter-Associated Urinary Tract Infections–Turning the Tide.

Huang SS1.

Author information

1From the Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine.

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMe1604647

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July 8, 2016 at 10:19 am

Thrombocytopenic Purpura Associated with Brucellosis: Report of 2 Cases and Literature Review

Clin Infect Dis. (2000) 31 (4): 904-909

Edward J. Young, Ann Tarry, Robert M. Genta, Neslihan Ayden, and Eduardo Gotuzzo

1 Medical, Veterans Affairs Medical Center, Houston, Texas, USA

2 Laboratory Services, Veterans Affairs Medical Center, Houston, Texas, USA

3 Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

4 Department of Pathology, Baylor College of Medicine, Houston, Texas, USA

5 Department of Medicine, University of Texas Medical School at Houston, Houston, Texas, USA

6 Dahiliye Klinigi, Haydarpasa Numune Hastanesi, Istanbul, Turkey

7 Departamento de Medicina, Hospital Nacional Cayetano Heredia, Lima, Peru

Mild hematologic abnormalities are common in the course of human brucellosis; however, they generally resolve promptly with treatment of the disease. Occasionally, thrombocytopenia is severe and can be associated with bleeding into the skin (purpura) and from mucosal sites. We describe 2 patients infected with Brucella melitensis who presented with thrombocytopenic purpura, and we review 41 additional cases from the literature. Patients ranged in age from 2 to 77 years, and both sexes were affected equally. In the majority of cases, examination of the bone marrow revealed abundant megakaryocytes. Possible mechanisms involved in thrombocytopenia include hypersplenism, reactive hemophagocytosis, and immune destruction of platelets. Recognition of this complication is essential, since hemorrhage into the central nervous system is associated with a high mortality rate

PDF

http://cid.oxfordjournals.org/content/31/4/904.full.pdf+html

July 8, 2016 at 10:04 am

Effects of Subinhibitory Concentrations of Ceftaroline on Methicillin-Resistant Staphylococcus aureus (MRSA) Biofilms.

PLoS One. 2016 Jan 22;11(1):e0147569.

Lázaro-Díez M1, Remuzgo-Martínez S1, Rodríguez-Mirones C1,2, Acosta F3, Icardo JM4, Martínez-Martínez L1,2,5, Ramos-Vivas J1,2.

Author information

1Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Cantabria, Spain.

2Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.

3Grupo de Investigación en Acuicultura, Universidad de Las Palmas de Gran Canaria, Arucas, Gran Canaria, Spain.

4Departamento de Anatomía y Biología Celular, Universidad de Cantabria, Santander, Cantabria, Spain.

5Departamento de Biología Molecular, Universidad de Cantabria, Santander, Cantabria, Spain.

Abstract

Ceftaroline (CPT) is a novel cephalosporin with in vitro activity against Staphylococcus aureus. Ceftaroline exhibits a level of binding affinity for PBPs in S. aureus including PBP2a of methicillin-resistant S. aureus (MRSA). The aims of this study were to investigate the morphological, physiological and molecular responses of MRSA clinical strains and MRSA biofilms to sub-MICs (1/4 and 1/16 MIC) of ceftaroline by using transmission, scanning and confocal microscopy. We have also used quantitative Real-Time PCR to study the effect of sub-MICs of ceftaroline on the expression of the staphylococcal icaA, agrA, sarA and sasF genes in MRSA biofilms. In one set of experiments, ceftaroline was able to inhibit biofilm formation in all strains tested at MIC, however, a strain dependent behavior in presence of sub-MICs of ceftaroline was shown. In a second set of experiments, destruction of preformed biofilms by addition of ceftaroline was evaluated. Ceftaroline was able to inhibit biofilm formation at MIC in all strains tested but not at the sub-MICs. Destruction of preformed biofilms was strain dependent because the biofilm formed by a matrix-producing strain was resistant to a challenge with ceftaroline at MIC, whereas in other strains the biofilm was sensitive. At sub-MICs, the impact of ceftaroline on expression of virulence genes was strain-dependent at 1/4 MIC and no correlation between ceftaroline-enhanced biofilm formation and gene regulation was established at 1/16 MIC. Our findings suggest that sub-MICs of ceftaroline enhance bacterial attachment and biofilm formation by some, but not all, MRSA strains and, therefore, stress the importance of maintaining effective bactericidal concentrations of ceftaroline to fight biofilm-MRSA related infections.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4723258/pdf/pone.0147569.pdf

July 8, 2016 at 10:02 am

Susceptibility patterns of Staphylococcus aureus biofilms in diabetic foot infections.

BMC Microbiol. 2016 Jun 23;16(1):119.

Mottola C1, Matias CS2, Mendes JJ3, Melo-Cristino J4, Tavares L2, Cavaco-Silva P5,6, Oliveira M2.

Author information

1Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Faculdade de Medicina Veterinária, Universidade de Lisboa, Avenida da Universidade Técnica, 1300-477, Lisbon, Portugal. carlamottola@fmv.ulisboa.pt

2Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Faculdade de Medicina Veterinária, Universidade de Lisboa, Avenida da Universidade Técnica, 1300-477, Lisbon, Portugal.

3Departamento de Medicina Interna, Hospital de Santa Marta/Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal.

4Faculdade de Medicina, Universidade de Lisboa, Instituto de Microbiologia, Lisbon, Portugal.

5TechnoPhage, S.A., Lisbon, Portugal.

6Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal.

Abstract

BACKGROUND:

Foot infections are a major cause of morbidity in people with diabetes and the most common cause of diabetes-related hospitalization and lower extremity amputation. Staphylococcus aureus is by far the most frequent species isolated from these infections. In particular, methicillin-resistant S. aureus (MRSA) has emerged as a major clinical and epidemiological problem in hospitals. MRSA strains have the ability to be resistant to most β-lactam antibiotics, but also to a wide range of other antimicrobials, making infections difficult to manage and very costly to treat. To date, there are two fifth-generation cephalosporins generally efficacious against MRSA, ceftaroline and ceftobripole, sharing a similar spectrum. Biofilm formation is one of the most important virulence traits of S. aureus. Biofilm growth plays an important role during infection by providing defence against several antagonistic mechanisms. In this study, we analysed the antimicrobial susceptibility patterns of biofilm-producing S. aureus strains isolated from diabetic foot infections. The antibiotic minimum inhibitory concentration (MIC) was determined for ten antimicrobial compounds, along with the minimum biofilm inhibitory concentration (MBIC) and minimum biofilm eradication concentration (MBEC), followed by PCR identification of genetic determinants of biofilm production and antimicrobial resistance.

RESULTS:

Results demonstrate that very high concentrations of the most used antibiotics in treating diabetic foot infections (DFI) are required to inhibit S. aureus biofilms in vitro, which may explain why monotherapy with these agents frequently fails to eradicate biofilm infections. In fact, biofilms were resistant to antibiotics at concentrations 10-1000 times greater than the ones required to kill free-living or planktonic cells. The only antibiotics able to inhibit biofilm eradication on 50 % of isolates were ceftaroline and gentamicin.

CONCLUSIONS:

The results suggest that the antibiotic susceptibility patterns cannot be applied to biofilm established infections. Selection of antimicrobial therapy is a critical step in DFI and should aim at overcoming biofilm disease in order to optimize the outcomes of this complex pathology.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918071/pdf/12866_2016_Article_737.pdf

July 8, 2016 at 10:00 am

Sexually Transmitted Brucellosis in Humans

Clin Infect Dis. (2010) 51 (2): e12-e15

Eyal Meltzer, Yechezkel Sidi, Gill Smolen, Menachem Banai, Svetlana Bardenstein, and Eli Schwartz

1Center for Geographic Medicine and Department of Medicine C, Tel Hashomer

2Microbiology Laboratory, The Chaim Sheba Medical Center, Tel Hashomer

3Sackler School of Medicine, Tel Aviv University, Tel Aviv

4Department of Bacteriology, Kimron Veterinary Institute Bet Dagan, Israel

Sexual transmission of brucellosis has rarely been reported in humans. We describe 2 cases of probable sexual transmission of Brucella from husband to wife. In 1 case, orchidoepididimitis existed, whereas in the other case, the presence of Brucella in the semen in the absence of genital symptoms was demonstrated by polymerase chain reaction.

PDF

http://cid.oxfordjournals.org/content/51/2/e12.full.pdf+html

July 8, 2016 at 9:57 am

Brucellosis and the Respiratory System

Clin Infect Dis. (2003) 37 (7): e95-e99

Georgios Pappas, Mile Bosilkovski, Nikolaos Akritidis, Maria Mastora, Liliana Krteva, and Epaminondas Tsianos

1Department of Internal Medicine, University Hospital of Ioannina, Greece

2Department of Internal Medicine, Peripheral General Hospital “G. Hatzikosta,” Ioannina, Greece

3Clinic for Infectious Diseases and Febrile Conditions, Medical Faculty, Skopje, Former Yugoslav Republic of Macedonia

Brucellosis is a zoonotic disease that remains endemic worldwide. Its clinical manifestations and focal complications are often troublesome in making a diagnosis. Involvement of the respiratory system in brucellosis is an acknowledged but rare event that is only occasionally described in literature. We describe 37 cases of respiratory involvement during the course of brucellosis that presented as pneumonia, bronchopneumonia, pleural effusion with a predominance of monocytic or lymphocytic infiltrates, and paroxysmal dry cough. We also discuss aspects of the respiratory pathology, radiological characteristics, coexisting complications, and aspects of treatment of respiratory brucellosis.

PDF

http://cid.oxfordjournals.org/content/37/7/e95.full.pdf+html

July 8, 2016 at 9:56 am

Pharmacokinetics of ceftaroline in normal body weight and obese (classes I, II, and III) healthy adult subjects.

Antimicrob Agents Chemother. 2015 Jul;59(7):3956-65.

Justo JA1, Mayer SM2, Pai MP3, Soriano MM1, Danziger LH4, Novak RM1, Rodvold KA5.

Author information

1College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA.

2College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.

3Albany College of Pharmacy and Health Sciences, Albany, New York, USA.

4College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.

5College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA kar@uic.edu .

Abstract

The pharmacokinetic profile of ceftaroline has not been well characterized in obese adults. The purpose of this study was to evaluate the pharmacokinetics of ceftaroline in 32 healthy adult volunteers aged 18 to 50 years in the normal, overweight, and obese body size ranges. Subjects were evenly assigned to 1 of 4 groups based on their body mass index (BMI) and total body weight (TBW) (ranges, 22.1 to 63.5 kg/m(2) and 50.1 to 179.5 kg, respectively). Subjects in the lower-TBW groups were matched by age, sex, race/ethnicity, and serum creatinine to the upper-BMI groups. Serial plasma and urine samples were collected over 12 h after the start of the infusion, and the concentrations of ceftaroline fosamil (prodrug), ceftaroline, and ceftaroline M-1 (inactive metabolite) were assayed. Noncompartmental and population pharmacokinetic analyses were used to evaluate the data. The mean plasma ceftaroline maximum concentration and area under the curve were ca. 30% lower in subjects with a BMI of ≥40 kg/m(2) compared to those <30 kg/m(2). A five-compartment pharmacokinetic model with zero-order infusion and first-order elimination optimally described the plasma concentration-time profiles of the prodrug and ceftaroline. Estimated creatinine clearance (eCLCR) and TBW best explained ceftaroline clearance and volume of distribution, respectively. Although lower ceftaroline plasma concentrations were observed in obese subjects, Monte Carlo simulations suggest the probability of target attainment is ≥90% when the MIC is ≤1 μg/ml irrespective of TBW or eCLCR. No dosage adjustment for ceftaroline appears to be necessary based on TBW alone in adults with comparable eCLCR. Confirmation of these findings in infected obese patients is necessary to validate these findings in healthy volunteers. (This study has been registered at ClinicalTrials.gov under registration no. NCT01648127.).

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468711/pdf/zac3956.pdf

July 8, 2016 at 9:54 am

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