Archive for July 30, 2017

Editorial – Vancomycin Prophylaxis for Total Joint Arthroplasty: Incorrectly Dosed and Has a Higher Rate of Periprosthetic Infection Than Cefazolin

Clinical Orthopaedics and Related Research July 2017 V.475 N.7 P.1762-1766

 

Daniel Wongworawat MD

PDF

https://link.springer.com/content/pdf/10.1007%2Fs11999-017-5354-1.pdf

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July 30, 2017 at 3:00 pm

Risk Factors for 30-Day Mortality in Patients with Methicillin-Resistant Staphylococcus aureus Bloodstream Infections

International Journal of Infectious Diseases August 2017 V.60 N.8 P.3-6

Pedro Ayau, Ana C. Bardossy, Guillermo Sanchez, Ricardo Ortiz, Daniela Moreno, Pamela Hartman, Khulood Rizvi, Tyler C. Prentiss, Mary B. Perri, Meredith Mahan, Vanthida Huang, Katherine Reyes, Marcus J. Zervos

Highlights

  • The aim of this study was to identify risk factors associated with 30-day mortality in patients with MRSA BSI.
  • 1,168 patients with confirmed MRSA BSI were identified over a 9-year period in which 30-day all-cause mortality was 16%.
  • There was no significant variability in 30-day mortality over our 9-year study period.
  • Our study showed that age, cancer, heart disease, neurologic disease, nursing home residence and Charlson score >3 are risk factors for 30-day mortality in patients with MRSA BSI.
  • Diabetes, PVD and readmission because of infection have statistically significant protective effects on 30-day mortality

Objectives

Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections (BSI) are a major health care problem accounting for a large percentage of nosocomial infections. The aim of this study was to identify risk factors associated with 30-day mortality in patients with MRSA BSI.

Methods

This was a retrospective study performed in Southeast Michigan. Over a 9- year period, a total of 1,168 patients were identified with MRSA BSI. Patient demographics and clinical data were retrieved and evaluated using electronic medical health records.

Results

30-day mortality during the 9-year study period was 16%. Significant risk factors for 30-day mortality were age, cancer, heart disease, neurologic disease, nursing home residence and Charlson score >3 with Odds Ratio (OR) of 1.03 (CI 1.02–1.04), 2.29 (CI 1.40–3.75), 1.78 (CI 1.20–2.63), 1.65 (CI 1.08–2.25), 1.66 (CI 1.02 − 2.70) and 1.86 (CI 1.18 − 2.95) correspondingly. Diabetes mellitus, peripheral vascular disease (PVD), and readmission were protective factors for 30-day mortality with OR of 0.53 (CI 0.36–0.78), 0.46 (CI 0.26–0.84) and 0.13 (CI0.05 − 0.32) respectively.

Conclusions

Our study identified significant risk factors for 30-day mortality in patients with MRSA BSI. Interestingly, diabetes mellitus, PVD and readmission were protective effects on 30-day mortality. There was no statistically significant variability in 30-day mortality over the 9-year study period.

PDF

http://www.ijidonline.com/article/S1201-9712(17)30146-7/pdf

July 30, 2017 at 12:57 pm

Efficacy of indefinite chronic oral antimicrobial suppression for prosthetic joint infection in the elderly: a comparative study

International Journal of Infectious Diseases July 2017 V.60 N.7 P.57-60

 

  1. Prendki, P. Sergent, A. Barrelet, E. Oziol, E. Beretti, M. Berlioz-Thibal, F. Bouchand, F.A. Dauchy, E. Forestier, G. Gavazzi, C. Ronde-Oustau, J. Stirnemann, A. Dinh

Highlights

  • Antimicrobial suppression appears to be effective for prosthetic joint infection (PJI).
  • Antimicrobial suppression appears safe for PJI.
  • Antimicrobial suppression is an adequate option for elderly patients with PJI.

Background

During prosthetic joint infection (PJI), surgical management is sometimes impossible and indefinite chronic oral antimicrobial suppression (ICOAS) may be the only option. The outcomes of elderly patients who benefited from ICOAS with strictly palliative intent were evaluated.

Methods

A national retrospective cohort study was performed in France, involving patients aged >75 years with a PJI who were managed with planned life-long ICOAS from 2009 to 2014. Patients who experienced an event were compared to those who did not. An event was defined as a composite outcome in patients undergoing ICOAS, including local or systemic progression of the infection, death, or discontinuation of antimicrobial therapy because of an adverse drug reaction.

Results

Twenty-one patients were included, with a median age of 85 years (interquartile range 81–88 years). Eight of the 21 patients experienced an event: one had an adverse drug reaction, three had systemic progression of sepsis, and two had local progression. Two of the 21 patients died. No death was related to ICOAS or infection. There was no significant difference between the population with an event and the population free of an event with regard to demographic, clinical, and microbiological characteristics (p > 0.05).

Conclusions

ICOAS appeared to be an effective and safe option in this cohort.

PDF

http://www.ijidonline.com/article/S1201-9712(17)30144-3/pdf

 

July 30, 2017 at 12:54 pm

Staphylococcus aureus soft tissue infection may increase the risk of subsequent staphylococcal soft tissue infections

International Journal of Infectious Diseases July 2017 V.60 N.7 P.44-48

Cindy Bouvet, Shpresa Gjoni, Besa Zenelaj, Benjamin A. Lipsky, Elif Hakko, Ilker Uçkay

Background

Staphylococcus aureus is the most common cause of soft tissue infections. It is unknown, however, if a patient who has had such an infection is at greater risk for future soft tissue infections with S. aureus.

Methods

We conducted an epidemiological survey of adult patients hospitalized in the only public hospital in Geneva for treatment (usually combined surgical and medical) of a soft tissue infection caused by S. aureus. By reviewing nursing and medical records from the emergency department and hospital wards, we assessed whether or not they developed any other soft tissue infections (excluding a recurrence) after or before the index one.

Results

Among 1023 index episodes of soft tissue infections, 670 (65%) were caused by S. aureus, of which 47 were caused by methicillin-resistant strains (30 healthcare-associated and 17 community-acquired). The patients’ median age was 51 years and 334 (34%) were immune-compromised. The median time span between the patient’s first and last consultation (for any reason) in our hospital was 21.4 years (interquartile range, 10-30 years). In addition to their index infection, 124 patients (12%) developed a new nosocomial or community-acquired soft tissue infection. Among the index cases with an S. aureus infection, 92 (14%) had another soft tissue infection, compared to 32 (9%) who had a non-staphylococcal index infection (Pearson-χ2-test; p = 0.03). Similarly, patients with an index S. aureus infection, compared to those with a non-S. aureus infection, had a higher rate of another soft tissue infection caused by S. aureus (χ2-test; p < 0.01). In multivariate analysis, an index infection due to S. aureus shows a high association to further S. aureus soft tissue infections (logistic regression; odds ratio 2.5, 95% confidence interval 1.4-4.6).

Conclusion

Among adult patients hospitalised for a soft tissue infection, those infected with S. aureus (compared with other pathogens) may be at higher risk of a subsequent soft tissue infection, particularly with S. aureus.

PDF

http://www.ijidonline.com/article/S1201-9712(17)30138-8/pdf

July 30, 2017 at 12:52 pm

Evaluation of the variability and safety of serum trough concentrations of vancomycin in patients admitted to the intensive care unit

International Journal of Infectious Diseases July 2017 V.60 N.7 P.17-22

Xiaodan Qian, Guantao Du, Chunmei Weng, Haijun Zhou, Xianju Zhou

Highlights

  • The vancomycin trough concentration varies significantly in intensive care unit (ICU) patients.
  • Sex, age, and the estimated glomerular filtration rate are independent factors affecting the trough concentration.
  • The fixed-dose regimen of 2 g/day may be inappropriate in ICU patients.
  • The dose should be individualized based on weight, age, and renal function.

Objective

To examine the variability and safety of serum trough concentrations of vancomycin in patients admitted to the intensive care unit (ICU) and to analyze the factors influencing the trough concentration.

Methods

Data were collected retrospectively from ICU patients receiving vancomycin treatment at a fixed dose of 2 g/day due to unobtainable weight data, at Changzhou No. 2 People’s Hospital, between 2012 and 2015. Vancomycin trough concentrations were compared between groups stratified by sex, age, and estimated glomerular filtration rate (eGFR).

Results

The vancomycin trough concentration varied significantly among ICU patients on a fixed dose of 2 g/day. Only 16.9% of ICU patients met the concentration target of 15–20 mg/l, while 25% of patients showed supratherapeutic concentrations. A higher proportion of female patients than male patients showed supratherapeutic concentrations (40.4% vs. 15.5%). The trough concentration was positively correlated with age (y = 0.279 x − 2.085; R2 = 0.186) and negatively correlated with eGFR (y = −0.2 x + 33.776; R2 = 0.366). Vancomycin-related nephrotoxicity occurred at an incidence of 5.9%.

Conclusions

These results suggest that the fixed-dose regimen is not appropriate for ICU patients in view of the low incidence of target trough concentrations and the high incidence of supratherapeutic concentrations. The dose should be individualized based on weight, age, and renal function to improve outcomes and patient safety.

PDF

http://www.ijidonline.com/article/S1201-9712(17)30130-3/pdf

July 30, 2017 at 12:49 pm

Changing patterns in leptospirosis: a three-decade study in Brazil

International Journal of Infectious Diseases July 2017 V.60 N.7 P.4-10

Elizabeth De Francesco Daher, Gabriela Studart Galdino de Carvalho, Douglas de Sousa Soares, Matheus Henrique Mendes, Sérgio Luiz Arruda Parente Filho, Hermano Alexandre Lima Rocha, Geraldo Bezerra da Silva Junior

Background

This study was conducted to investigate changes in the clinical pattern of leptospirosis over time, analyzing its clinical and laboratory presentations in a metropolitan city of Brazil.

Method

This was a retrospective study including all patients with leptospirosis admitted to tertiary care hospitals in Fortaleza in the northeast of Brazil, between 1985 and 2015. Patients were divided into three groups according to the year of hospital admission: group I for the years 1985–1995, group II for 1996–2005, and group III for 2006–2015. Demographic, clinical, and laboratory data were compared between the groups.

Results

A total of 507 patients were included. Their mean age was 37.3 ± 15.9 years and 82.4% were male. The mean time between symptom onset and admission was 7 ± 4 days. There was a linear decrease in the levels of serum urea (190.1 ± 92.7, 135 ± 79.5, and 95.6 ± 73.3 mg/dl, respectively, p < 0.0001) and creatinine (5.8 ± 2.9, 3.8 ± 2.6, and 3.0 ± 2.5 mg/dl, respectively, p < 0.0001) in each decade, while levels of hemoglobin (10.31 ± 1.9, 10.8 ± 2.0, and 11.5 ± 2.1 g/dl, respectively, p < 0.0001) and platelets (57.900 ± 52.650, 80.130 ± 68.836, and 107.101 ± 99.699 × 109/l, respectively, p < 0.0001) increased. There was a tendency towards a linear decrease in mortality (22%, 14%, and 11.6%, respectively, p = 0.060).

Conclusions

Leptospirosis showed significant changes over time in this region. The main changes point to a decrease in disease severity and complications, such as acute kidney injury. Mortality has decreased, being close to 11%.

PDF

http://www.ijidonline.com/article/S1201-9712(17)30135-2/pdf

July 30, 2017 at 12:47 pm

A new paradigm in pneumococcal conjugate vaccination: moving from individual to herd protection

International Journal of Infectious Diseases July 2017 V.60 N.7 P.96-97

Editorial

Gail L. Rodgers, Keith P. Klugman

Immunization programs incorporating pneumococcal conjugate vaccines (PCV) have led to a dramatic decrease in invasive pneumococcal disease (IPD) due to vaccine serotypes, pneumonia, and otitis media in children receiving these vaccines. Consistent with the conjugate Haemophilus influenzae type B vaccine (Hib) experience (Moulton et al., 2000), decreased nasopharyngeal (NP) carriage resulting in decreased transmission and the herd or indirect effect (decrease in disease in the unvaccinated) has also been seen with PCV, but the magnitude of this benefit has far surpassed initial expectations (Lexau et al., 2005, Pilishvili et al., 2010, Moore et al., 2015, Von Gottberg et al., 2014). Two years following the introduction of PCV7 into the routine vaccination program in the USA using a 3 + 1 schedule (three infant doses at 2, 4, and 6 months of age and one toddler dose at 12–15 months of age), a profound effect was found in the unvaccinated: PCV7 prevented more than twice as many invasive cases through indirect effects than through its direct effect of protecting vaccinated children (CDC, 2005). This has been documented in other countries, including those using reduced dosing schedules such as 2 + 1, as well as in countries using the extended serotype vaccines, PCV10 and PCV13 (Shiri et al., 2017). A reduction in NP carriage of vaccine serotypes, a precursor of the herd effect, was documented in the original 3 + 0 study of conjugate vaccination of infants in Africa (Mbelle et al., 1999) and was confirmed in countries using 3 + 0 schedules (Hammitt et al., 2014). The mechanism for protection in the unvaccinated is due to the decrease and/or near elimination of vaccine serotypes from the nasopharynx. This in turns leads to decreased transmission of these serotypes and decreased disease. Thus, the effect on NP carriage, a non-disease state and critical precursor to disease, is key to the control of pneumococcal disease in countries unlikely to have immunization programs able to immunize all of their children.

PDF

http://www.ijidonline.com/article/S1201-9712(17)30126-1/pdf

 

July 30, 2017 at 12:44 pm

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