Archive for September, 2018

Symptomatic Acute Toxoplasmosis in Returning Travelers

Open Forum Infectious Diseases, April 2018 V.5 N.4

Andrés F Henao-Martínez; Carlos Franco-Paredes; Alan G Palestine; Jose G Montoya

We report a family who acquired acute toxoplasmosis after a trip to Central America. One member developed severe clinical manifestations including bilateral chorioretinitis, hepatitis, and myocarditis requiring therapy. Symptomatic acute toxoplasmosis is unusual and possesses a diagnostic challenge. We discuss the clinical and epidemiological implications, laboratory diagnosis, and treatment plan.

FULL TEXT

https://academic.oup.com/ofid/article/5/4/ofy058/4925380

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September 30, 2018 at 10:51 am

Acute Onset of Pneumococcal Pneumonia Following Instrumentation of the Respiratory Tract

Open Forum Infectious Diseases, April 2018 V.5 N.4

BRIEF REPORTS

Julianna G Gardner; Adriana M Rueda; Daniel M Musher

We describe 22 patients who developed pneumococcal pneumonia within 96 hours of respiratory tract instrumentation. In 59% of cases, the time to onset of symptoms was <24 hours. Instrumentation bypasses normal protective barriers and carries organisms directly to the lower airways, leading to the rapid development of pneumonia.

FULL TEXT

https://academic.oup.com/ofid/article/5/4/ofy047/4958444

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September 30, 2018 at 10:49 am

Antimicrobial Agent Shortages: The New Norm for Infectious Diseases Physicians

Open Forum Infectious Diseases, April 2018 V.5 N.4

Adi V Gundlapalli; Susan E Beekmann; Donald R Graham; Philip M Polgreen; Members of the Emerging Infections Network

Background

In 2012, the US Food and Drug Administration (FDA) required drug manufacturers to give advance notice of impending drug shortages. A survey of infectious diseases (ID) physicians was undertaken to determine the impact of this requirement and to follow-up on prior perceptions of ID physicians on shortages of antimicrobial agents.

Methods

We used a web-based survey of ID physician members of the Emerging Infections Network in 2016.

Results

Of the 701 of 1597 members (44%) who responded, 70% reported the need to modify their antimicrobial choice because of a shortage in the prior 2 years. A majority (73%) reported the shortages affected patient care or outcomes by the use of broader-spectrum (75%), more costly (58%), less effective second-line (45%), or more toxic agents (37%). The most commonly reported antimicrobials in short supply were piperacillin-tazobactam, ampicillin-sulbactam, meropenem, cefotaxime, and cefepime. Respondents learned of shortages from hospital notification, from a colleague, contact from pharmacy after ordering the agent in short supply, or FDA or other website. The antimicrobial stewardship programs (ASPs) of a majority (83%) of respondents’ institutions had developed approaches to deal with shortages. Although 71% indicated that communications were sufficient, most (87%) did not perceive any improvement in communications about shortages since the 2012 FDA requirement.

Conclusions

The persistence of antimicrobial agent shortages reported by ID physicians is disturbing as is the resulting need to use broader-spectrum or more toxic agents. The prominent role of ASPs in helping to deal with shortages, effective communication channels, and the lack of perceived improvement in FDA’s communication strategy merit further consideration.

FULL TEXT

https://academic.oup.com/ofid/article/5/4/ofy068/4985863

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September 30, 2018 at 10:45 am

Epidemiology, Microbiological Diagnosis, and Clinical Outcomes in Pyogenic Vertebral Osteomyelitis: A 10-year Retrospective Cohort Study

Open Forum Infectious Diseases, March 2018 V.5 N.3

EDITOR’S CHOICE

Brian S W Chong; Christopher J Brereton; Alexander Gordon; Joshua S Davis

Background

Pyogenic vertebral osteomyelitis (PVO) is rising in incidence, but optimal methods of investigation and duration of antibiotic therapy remain controversial.

Methods

We conducted a single-center retrospective cohort study of PVO at an Australian teaching hospital. We included all adults with a first episode of PVO between 2006 and 2015. PVO was defined based on the presence of prespecified clinical and radiological criteria. The main exposures of interest were investigation strategy and antibiotic treatment. The main outcome measures were duration of hospital admission, mortality during index admission, symptom resolution during index admission, and attributable readmission within 2 years.

Results

Of 129 included patients, 101 (78%) had a causative organism identified. Patients with an identified pathogen were more likely to be febrile (75% compared with 29%, P < .001) and had a higher mean admission C-reactive protein (207 vs 54, P < .001) compared with patients without an identified pathogen. However, they were less likely to experience an adverse outcome (death or attributable readmission within 2 years; adjusted odds ratio, 0.36; 95% confidence interval, 0.13–0.99; P = .04). Open biopsy of vertebral tissue had a higher diagnostic yield (70%) than fine needle aspirate (41%) or core biopsy (30%). Despite receiving a median of 6 weeks of intravenous antibiotics, only 15% of patients had a full recovery on discharge from index admission.

Conclusions

Clinical outcomes for patients with PVO were poor. Obtaining a microbiological diagnosis is associated with a better outcome. However, prospective and randomized studies are essential to establishing optimal investigation and treatment pathways.

FULL TEXT

https://academic.oup.com/ofid/article/5/3/ofy037/4925997

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September 30, 2018 at 10:44 am

Long-term outcomes of patients with Streptococcus suis infection in Viet Nam: A case-control study

Journal of Infection February 2018 V.76 N.2 P.159–167

Hightlights

  • Severe hearing and vestibular impairment persists in many S. suis survivors.
  • Hearing function tends to only improve in the first 3 months post discharge.
  • Vestibular dysfunction shows little recovery during the follow-up time period.
  • Survivors reported significantly lower health status and quality of life.
  • Appropriate patient management strategies are needed to reduce disease impact.

Objectives

Streptococcus suis is a zoonotic cause of severe meningitis and sepsis in humans. We aimed to assess the long-term outcomes in patients who survived S. suis infection, in particular the progress and impact of vestibulocochlear sequelae.

Methods

This case-control study evaluated outcomes of S. suis infection at discharge and 3 and 9 months post-discharge for 47 prospectively enrolled cases and at 11–34 months for 31 retrospectively enrolled cases. Outcomes in patients were compared to 270 controls matched for age, sex and residency.

Results

The prevalence ratio (PR) of moderate-to-complete hearing loss was 5.0(95%CI 3.6–7.1) in cases at discharge, 3.7(2.5–5.4) at 3 months, 3.2(2.2–4.7) at 9 months, and 3.1(2.1–4.4) in retrospective cases compared to controls. Hearing improvement occurred mostly within the first 3 months with a change in hearing level of 11.1%(95%CI 7.0–15.1%) compared to discharge. The PR of vestibular dysfunction was 2.4(95%CI 1.7–3.3) at discharge, 2.2(1.4–3.1) at 3 months, 1.8(1.1–2.5) at 9 months, and 1.8(1.1–2.6) for retrospective cases compared to controls. Cases also indicated more problems with mobility, self-care and usual activities.

Conclusions

Both hearing and vestibular impairment were common and persist in cases. Appropriate patient management strategies are needed to reduce the incidence and impact of these sequelae.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(17)30311-0/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(17)30311-0/pdf

 

 

September 29, 2018 at 7:43 pm

Tigecycline as a Second-Line Agent for Legionnaires’ Disease in Severely Ill Patients

Open Forum Infectious Diseases Octoboer 1, 2017 V.4 N.4

Treatment of Legionnaires’ disease in severely ill or immunosuppressed patients presents a clinical challenge. Tigecycline (TG) achieves high concentrations intracellularly and has been shown to be effective against L. pneumophila in animal and cell models.

We report our experience using TG as second-line therapy. Clinical response was seen in most patients after switching to TG alone or as a combination therapy.

FULL TEXT

https://academic.oup.com/ofid/article/4/4/ofx184/4372228

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September 29, 2018 at 2:54 pm

Implication of First-Line Antiretroviral Therapy Choice on Second-Line Options

Open Forum Infectious Diseases Octoboer 1, 2017 V.4 N.4

Background

Although there are a number of studies comparing the currently recommended preferred and alternative first-line (1L) antiretroviral therapy (ART) regimens on clinical outcomes, there are limited data examining the impact of 1L regimen choice and duration of virologic failure (VF) on accumulation of drug resistance mutations (DRM). The patterns of DRM from patients failing zidovudine (AZT)-containing versus tenofovir (TDF)-containing ART were assessed to evaluate the predicted susceptibility to second-line (2L) nucleoside reverse-transcriptase inhibitor (NRTI) backbone options in the context of an ongoing programmatic setting that uses viral load (VL) monitoring.

Methods

Paired samples from Nigerian ART patients who experienced VF and switched to 2L ART were retrospectively identified. For each sample, the human immunodeficiency virus (HIV)-1 polymerase gene was sequenced at 2 time points, and DRM was analyzed using Stanford University’s HIVdb program.

Results

Sequences were generated for 191 patients. At time of 2L switch, 28.2% of patients on AZT-containing regimens developed resistance to TDF, whereas only 6.8% of patients on TDF-containing 1L had mutations compromising susceptibility to AZT. In a stratified evaluation, patients with 0–6 months between tested VL samples had no difference in proportion compromised to 2L, whereas those with >6 months between samples had a statistically significant difference in proportion with compromised 2L NRTI. In multivariate analyses, patients on 1L AZT had 9.90 times higher odds of having a compromised 2L NRTI option than patients on 1L TDF.

Conclusions

In the context of constrained resources, where VL monitoring is limited, we present further evidence to support use of TDF as the preferred 1L NRTI because it allows for preservation of the recommended 2L NRTI option.

FULL TEXT

https://academic.oup.com/ofid/article/4/4/ofx233/4587907

PDF (CLIC en PDF)

 

September 29, 2018 at 2:52 pm

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