Archive for June 28, 2018

Opportunities to Improve Fluoroquinolone Prescribing in the United States for Adult Ambulatory Care Visits

Clinical Infectous Diseases July 2918 V.67 N.1 P.134-136


Sarah Kabbani; Adam L Hersh; Daniel J Shapiro; Katherine E Fleming-Dutra; Andrew T Pavia …

La Administración de Alimentos y Medicamentos (FDA) advirtió contra el uso de fluoroquinolonas (FQ) para afecciones con agentes alternativos efectivos.

Se estima que el 5.1% de las prescripciones de FQ ambulatorias en adultos fueron para afecciones que no requirieron antibióticos, y el 19.9% fueron para afecciones donde las FQ no se recomiendan como tratamiento de primera línea.

El uso innecesario de FQ debe reducirse.




June 28, 2018 at 4:09 pm

Elizabethkingia in Children: A Comprehensive Review of Symptomatic Cases Reported From 1944 to 2017

Clinical Infectous Diseases July 2918 V.67 N.1 P.144-149


Eric J Dziuban; Jessica L Franks; Marvin So; Georgina Peacock; David D Blaney

Una revisión exhaustiva de la literatura de casos de infección por Elizabethkingia en niños caracteriza la epidemiología, la demografía, la presentación clínica y los resultados.

Se informaron casos de 1944-2017 (n = 283) que demostraron una alta mortalidad que disminuyó en las últimas décadas y una morbilidad sustancial entre los sobrevivientes, especialmente los neonatos.

Elizabethkingia species often exhibit extensive antibiotic resistance and result in high morbidity and mortality, yet no systematic reviews exist that thoroughly characterize and quantify concerns for infected infants and children.

We performed a review of literature and identified an initial 902 articles; 96 articles reporting 283 pediatric cases met our inclusion criteria and were subsequently reviewed. Case reports spanned 28 countries and ranged from 1944 to 2017.

Neonatal meningitis remains the most common presentation of this organism in children, along with a range of other clinical manifestations. The majority of reported cases occurred as isolated cases, rather than within outbreaks. Mortality was high but has decreased in recent years, although neurologic sequelae among survivors remains concerning.

Child outcomes can be improved through effective prevention measures and early identification and treatment of infected patients.



June 28, 2018 at 4:08 pm

The Clinical Utility of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening to Rule Out MRSA Pneumonia: A Diagnostic Meta-analysis With Antimicrobial Stewardship Implications

Clinical Infectious Diseases July 1, 2018 V.67 N.1 P. 1–7


Diane M Parente; Cheston B Cunha; Eleftherios Mylonakis; Tristan T Timbrook

El cribado de las narinas con Staphylococcus aureus resistente a la meticilina (SARM) tuvo un alto valor predictivo negativo para descartar la neumonía por SARM, pero un bajo valor predictivo positivo para predecirlo. Tal cribado puede ayudar a racionalizar la terapia empírica con antibióticos entre los que no tienen colonización por metástasis de SARM.


Recent literature has highlighted methicillin-resistant Staphylococcus aureus (MRSA) nasal screening as a possible antimicrobial stewardship program tool for avoiding unnecessary empiric MRSA therapy for pneumonia, yet current guidelines recommend MRSA therapy based on risk factors. The objective of this meta-analysis was to evaluate the diagnostic value of MRSA nasal screening in MRSA pneumonia.


PubMed and EMBASE were searched from inception to November 2016 for English studies evaluating MRSA nasal screening and development of MRSA pneumonia. Data analysis was performed using a bivariate random-effects model to estimate pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).


Twenty-two studies, comprising 5163 patients, met our inclusion criteria. The pooled sensitivity and specificity of MRSA nares screen for all MRSA pneumonia types were 70.9% and 90.3%, respectively. With a 10% prevalence of potential MRSA pneumonia, the calculated PPV was 44.8%, and the NPV was 96.5%. The pooled sensitivity and specificity for MRSA community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) were 85% and 92.1%, respectively. For CAP and HCAP both the PPV and NPV increased, to 56.8% and 98.1%, respectively. In comparison, for MRSA ventilated-associated pneumonia, the sensitivity, specificity, PPV, and NPV were 40.3%, 93.7%, 35.7%, and 94.8%, respectively.


Nares screening for MRSA had a high specificity and NPV for ruling out MRSA pneumonia, particularly in cases of CAP/HCAP. Based on the NPV, MRSA nares screening is a valuable tool for AMS to streamline empiric antibiotic therapy, especially among patients with pneumonia who are not colonized with MRSA.



June 28, 2018 at 9:10 am

Cancer Risk in Older Persons Living With Human Immunodeficiency Virus Infection in the United States

Clinical Infectious Diseases July 1, 2018 V.67 N.1 P.50–57

Parag Mahale; Eric A Engels; Anna E Coghill; Amy R Kahn; Meredith S Shiels

El riesgo de cáncer en 183.542 personas mayores que vivían con la infección por el virus de la inmunodeficiencia humana se evaluó utilizando datos del estudio de compatibilidad del cáncer de VIH/SIDA. El riesgo relativo de la mayoría de los cánceres disminuyó con la edad, pero los riesgos absolutos fueron más altos para algunos cánceres.


Cancer risk is increased in persons living with human immunodeficiency virus (HIV) (PLWH). Improved survival has led to an aging of PLWH. We evaluated the cancer risk in older PLWH (age ≥50 years).


We included data from the HIV/AIDS Cancer Match Study (1996–2012) and evaluated risks of Kaposi sarcoma (KS), non-Hodgkin lymphoma (NHL), Hodgkin lymphoma, and cervical, anal, lung, liver, oral cavity/pharyngeal, breast, prostate, and colon cancers in older PLWH with risk in the general population by calculating standardized incidence ratios (SIRs) and excess absolute risks (EARs). Cancer risk by time since HIV diagnosis was estimated using Poisson regression.


We identified 10371 cancers among 183542 older PLWH. Risk was significantly increased for KS (SIR, 103.34), NHL (3.05), Hodgkin lymphoma (7.61), and cervical (2.02), anal (14.00), lung (1.71), liver (2.91), and oral cavity/pharyngeal (1.66) cancers, and reduced for breast (0.61), prostate (0.47), and colon (0.63) cancers. SIRs declined with age for all cancers; however, EARs increased with age for anal, lung, liver, and oral cavity/pharyngeal cancers. Cancer risk was highest for most cancers within 5 years after HIV diagnosis; risk decreased with increasing time since HIV diagnosis for KS, NHL, lung cancer, and Hodgkin lymphoma.


Cancer risk is elevated among older PLWH. Although SIRs decrease with age, EARs are higher for some cancers, reflecting a greater absolute excess in cancer incidence among older PLWH. High risk in the first 5 years after HIV diagnosis for some cancers highlights the need for early HIV diagnosis and rapid treatment initiation.



June 28, 2018 at 9:09 am


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