Archive for June 21, 2017

Practice Patterns and Outcomes Associated With Procalcitonin Use in Critically Ill Patients With Sepsis.

Clin Infect Dis. Jun. 1, 2017 V.64 N.11 P.1509-1515.

Chu DC1, Mehta AB1, Walkey AJ1,2.

Author information

1 The Pulmonary Center, Boston University School of Medicine and Division of Pulmonary, Allergy, and Critical Care Medicine Internal Medicine, and.

2 Center for Implementation and Improvement Sciences, Boston Medical Center, Massachusetts.

Abstract

BACKGROUND.:

Randomized trials support use of procalcitonin (PCT)-based algorithms to decrease duration of antibiotics for critically ill patients with sepsis. However, current use of PCT and associated outcomes in real-world clinical settings is unclear. We sought to determine PCT use in critically ill patients with sepsis in the United States and to examine associations between PCT use and clinical outcomes.

METHODS.:

This was a retrospective cohort study of approximately 20% of patients with sepsis hospitalized in US intensive care units. Hierarchical regression models were used to determine associations of PCT use with outcomes (antibiotic-days, incidence of Clostridium difficile infection, and in-hospital mortality). Sensitivity analyses were conducted to assess robustness of findings to different methods used to address unmeasured confounding (eg, instrumental variable, difference-in-differences analyses).

RESULTS.:

Among 20750 critically ill patients with sepsis in 107 hospitals with PCT available, 3769 (18%) patients had PCT levels checked; 1119 (29.7%) had serial PCT measurements. PCT use was associated with increased antibiotic-days (adjusted relative risk, 1.1; 95% confidence interval [CI], 1.15-1.18) and incidence of C. difficile (adjusted odds ratio, 1.42; 95% CI, 1.09-1.85) without a change in mortality (adjusted hazard ratio, 1.05; 95% CI, 0.93-1.19). Analysis of PCT use by instrumental variable and difference-in-difference analyses showed similar lack of antibiotic or outcome improvements associated with PCT use.

CONCLUSIONS.:

PCT use was not associated with improved antibiotic use or other clinical outcomes in real-world settings. Programs to improve implementation of PCT-based strategies are warranted prior to widespread adoption.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/64/11/10.1093_cid_cix179/2/cix179.pdf?Expires=1498186943&Signature=fgSlOHUhyUR2khAL-7wgs~fXb0Q-q2CWV6OJkKR0wEbrPxFz6Rma192kSnet2oxU8FgimCYwKGvrLlWwKSw6Aro5Op4z1APhms4uVKi~Pw7il3UEKFdS4nyDX~iQoRDzifIRtGAGCvpUu0DVUx9a5uXXDzfbadFmNZaOxHo2772r9hlNv2msp4UZrFB8v7SVBiKZ3Xd1EoykYO6U1mu7GkOXmeJNx7dDXGLBfzp6xx040-AfbI0wYH-zRfnbM1gF~bmiFlHtr3uS8Riv~mkkqeozqtGkGFLGlto8UZgmfZPoZ-NT3L4YnKo4SOrEdzO~7lgKgmWLi5z7glZPYztCwg__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

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June 21, 2017 at 10:07 pm

Brucella melitensis prosthetic joint infection.

J Bone Jt Infect. 2017 Apr 5;2(3):136-142.         doi: 10.7150/jbji.18408. eCollection 2017.

Flury D1, Behrend H2, Sendi P3, von Kietzell M1, Strahm C1.

Author information

1 Department of Infectious Diseases, Cantonal Hospital of St. Gallen, St. Gallen.

2 Department of Orthopaedics and Traumatology, Cantonal Hospital of St. Gallen, St. Gallen.

3 Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.

Abstract

Periprosthetic joint infection (PJI) due to Brucella spp. is rare.

We report a case in a 75-year-old man and review 29 additional cases identified in a literature search. The diagnosis of Brucella PJI is challenging, in particular in non-endemic countries.

Serological tests prior to joint aspiration or surgical intervention are reasonable. Involvement of infection control and timely information to laboratory personnel is mandatory upon diagnosis.

There is no uniform treatment concept, neither with respect to surgical intervention nor for the duration of antimicrobials.

Most cases have a successful outcome, irrespective of surgical modality, and with an antimicrobial combination regimen for 12 or more weeks.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441145/pdf/jbjiv02p0136.pdf

June 21, 2017 at 7:59 am


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