Archive for September 22, 2017

Readmission due to infection following total hip and total knee procedures: A retrospective study

Medicine: September 2017 – Volume 96 – Issue 38 – p e7961

Zawadzki, Nadine BSPHa; Wang, Yao MPHa; Shao, Hui PhDa; Liu, Emelline MSHSb; Song, Chao MPHc; Schoonmaker, Michele PhDc; Shi, Lizheng PhDa,*

Abstract

Policymakers have expanded readmissions penalty programs to include elective arthroplasties, but little is known about the risk factors for readmissions following these procedures. We hypothesized that infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA) lead to excess readmissions and increased costs. This study aims to evaluate the proportion of readmissions due to infections following THA and TKA.

Healthcare Cost and Utilization Project–State Inpatient Databases were used for the study. Procedure codes “8151” and “8154” were used to identify inpatient discharges with THA and TKA in Florida (FL) 2009 to 2013, Massachusetts (MA) 2010 to 2012, and California (CA) 2009 to 2011. Readmission was measured by a Centers for Medicare and Medicaid Services (CMS) validated algorithm. Infections were identified by ICD-9-CM codes: 99859, 99666, 6826, 0389, 486, 4821, 00845, 5990, 48242, 04111, 04112, 04119, 0417, 99591, and 99592. Descriptive analysis was performed.

In CA, 4.29% of patients were readmitted with 33.02% of the total readmissions for infection. In FL, 4.7% of patients were readmitted with 33.39% of the readmissions for infection. In MA, 3.92% of patients were readmitted with 35.2% of readmissions for infection. Of the total number of readmissions due to infection, methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) together accounted for 14.88% in CA, 13.38% in FL, and 13.11% in MA.

The rate of infection is similar across all 3 states and is a leading cause for readmission following THA and TKA. Programs to reduce the likelihood of MRSA or MSSA infection would reduce readmissions due to infection.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/09220/Readmission_due_to_infection_following_total_hip.18.aspx

PDF (CLIC en “ARTICLE as PDF”)

 

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September 22, 2017 at 4:20 pm

Infective endocarditis in patients with cancer: a consequence of invasive procedures or a harbinger of neoplasm? –  A prospective, multicenter cohort

Medicine: September 2017 – Volume 96 – Issue 38 – p e7913

Fernández-Cruz, Ana MD, PhDa,b,*; Muñoz, Patricia MD, PhDa,b,c,d; Sandoval, Carmen MDb,e; Fariñas, Carmen MD, PhDf; Gutiérrez-Cuadra, Manuel MD, PhDf; Pericás Pulido, Juan M. MD, PhDg; Miró, José M. MD, PhDg; Goenaga-Sánchez, Miguel Á. MDh; de Alarcón, Arístides MDi; Bonache-Bernal, Francisco MDj; Rodríguez, MªÁngeles MD, PhDk; Noureddine, Mariam MD, PhDl; Bouza Santiago, Emilio MD, PhDa,b,c,d; on behalf of the Spanish Collaboration on Endocarditis (GAMES)

Abstract

The aim of the study was to draw a comparison between the characteristics of infective endocarditis (IE) in patients with cancer and those of IE in noncancer patients.

Patients with IE, according to the modified Duke criteria, were prospectively included in the GAMES registry between January 2008 and February 2014 in 30 hospitals. Patients with active cancer were compared with noncancer patients.

During the study period, 161 episodes of IE fulfilled the inclusion criteria. We studied 2 populations: patients whose cancer was diagnosed before IE (73.9%) and those whose cancer and IE were diagnosed simultaneously (26.1%). The latter more frequently had community-acquired IE (67.5% vs 26.4%, P < .01), severe sepsis (28.6% vs 11.1%, P = .013), and IE caused by gastrointestinal streptococci (42.9% vs 16.8%, P < .01). However, catheter source (7.1% vs 29.4%, P = .003), invasive procedures (26.2% vs 44.5%, P = .044), and immunosuppressants (9.5% vs 35.6%, P = .002) were less frequent.

When compared with noncancer patients, patients with cancer were more often male (75.2% vs 67.7%, P = .049), with a higher comorbidity index (7 vs 4). In addition, IE was more often nosocomial (48.7% vs 29%) and originated in catheters (23.6% vs 6.2%) (all P < .01). Prosthetic endocarditis (21.7% vs 30.3%, P = .022) and surgery when indicated (24.2% vs 46.5%, P < .01) were less common. In-hospital mortality (34.8% vs 25.8%, P = .012) and 1-year mortality (47.8% vs 30.9%, P < .01) were higher in cancer patients, although 30-day mortality was not (24.8% vs 19.3%, P = .087).

A significant proportion of cases of IE (5.6%) were recorded in cancer patients, mainly as a consequence of medical interventions. IE may be a harbinger of occult cancer, particularly that of gastrointestinal or urinary origin.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/09220/Infective_endocarditis_in_patients_with_cancer___a.11.aspx

PDF (CLIC en “ARTICLE as PDF”)

September 22, 2017 at 4:19 pm

2017-09 Antibacterial agents in clinical development – An analysis of the antibacterial clinical development pipeline, including tuberculosis. OMS 45 pags

Contents:

Acknowledgements

Abbreviations and acronyms

Executive summary

  1. Introduction
  2. Methods and search results

2.1 Scope and inclusion criteria

2.2 Assessment of activity against priority pathogens and innovativeness

  1. Agents in clinical development

3.1 Antibiotics potentially active against pathogens on the WHO priority  pathogens list

3.2 Combinations without new chemical entities

3.3 Agents in development for treating tuberculosis

3.4 Agents in development for treating Clostridium difficile infections

3.5 Biological agents

3.6 Agents that are not under active development or for which there is no  recent information

  1. Analysis of the clinical pipeline
  2. Outlook and discussion

5.1 The current clinical pipeline is insufficient against pathogens on the  WHO priority pathogens list and TB.

5.2 More innovative approaches are required, but there are scientific  challenges.

5.3 Outlook: More work is required to fill the pipeline.

5.4 Methodological considerations

  1. References

Annex 1. Search strategy and results

Annex 2. Declarations of interests of advisory group members

PDF

http://apps.who.int/iris/bitstream/10665/258965/1/WHO-EMP-IAU-2017.11-eng.pdf

 

September 22, 2017 at 8:03 am

Elimination of Perinatal Hepatitis B: Providing the First Vaccine Dose Within 24 Hours of Birth

Pediatrics September 2017 V. 140 N.3

COMMITTEE ON INFECTIOUS DISEASES, COMMITTEE ON FETUS AND NEWBORN

Kristi Watterberg, MD, FAAP, Chairperson, William Benitz, MD, FAAP, Ivan Hand, MD, FAAP, Eric Eichenwald, MD, FAAP, Brenda Poindexter, MD, FAAP, Dan L. Stewart, MD, FAAP, Susan W. Aucott, MD, FAAP, Karen M. Puopolo, MD, PhD, FAAP, Jay P. Goldsmith, MD, FAAP

Abstract

After the introduction of the hepatitis B vaccine in the United States in 1982, a greater than 90% reduction in new infections was achieved. However, approximately 1000 new cases of perinatal hepatitis B infection are still identified annually in the United States. Prevention of perinatal hepatitis B relies on the proper and timely identification of infants born to mothers who are hepatitis B surface antigen positive and to mothers with unknown status to ensure administration of appropriate postexposure immunoprophylaxis with hepatitis B vaccine and immune globulin. To reduce the incidence of perinatal hepatitis B transmission further, the American Academy of Pediatrics endorses the recommendation of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention that all newborn infants with a birth weight of greater than or equal to 2000 g receive hepatitis B vaccine by 24 hours of age.

FULL TEXT

http://pediatrics.aappublications.org/content/140/3/e20171870

PDF

http://pediatrics.aappublications.org/content/pediatrics/140/3/e20171870.full.pdf

September 22, 2017 at 8:02 am


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