Posts filed under ‘Sepsis’

Predictors of pneumonia in lower respiratory tract infections – 3C prospective cough complication cohort study.

European Respiratory Journal ERJ  November 2017 V.50 N.5

Michael Moore1, Beth Stuart 1, Paul Little1, Sue Smith2, Matthew J. Thompson3, Kyle Knox2, Anne van den Bruel2, Mark Lown1 and David Mant2

Affiliations:

1 University of Southampton, Primary Care Medical Group, Aldermoor Health Centre, Southampton, UK.

2 Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.

3 Dept of Family Medicine, University of Washington, Seattle, WA, USA.

Correspondence: Michael Moore, University of Southamptom K. E-mail: mvm198@soton.ac.uk

ABSTRACT

The aim was to aid diagnosis of pneumonia in those presenting with lower respiratory tract symptoms in routine primary care. A cohort of 28 883 adult patients with acute cough attributed to lower respiratory tract infections (LRTIs) was recruited from 5222 UK practices in 2009–13. Symptoms, signs and treatment were recorded at presentation and subsequent events followed-up for 30 days by chart review. The predictive value of patient characteristics, presenting symptoms and clinical findings for the diagnosis of pneumonia in the first 7 days was established.

Of the 720 out of 28 883 (2.5.%) radiographed within 1 week of the index consultation, 115 (16.0%; 0.40% of 28 883) were assigned a definite or probable pneumonia diagnosis. The significant independent predictors of radiograph-confirmed pneumonia were temperature >37.8°C (RR 2.6; 95% CI 1.5–4.8), crackles on auscultation (RR 1.8; 1.1–3.0), oxygen saturation <95% (RR 1.7; 1.0–3.1) and pulse >100·min–1 (RR 1.9; 1.1–3.2). Most patients with pneumonia (99/115, 86.1%) exhibited at least one of these four clinical signs; the positive predictive value of having at least one of these signs was 20.2% (95% CI 17.3–23.1).

In routine practice, radiograph-confirmed pneumonia as a short-term complication of LRTI is very uncommon (one in 270). Pulse oximetry may aid the diagnosis of pneumonia in this setting.

FULL TEXT

http://erj.ersjournals.com/content/50/5/1700434?etoc

PDF

http://erj.ersjournals.com/content/erj/50/5/1700434.full.pdf

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December 7, 2017 at 8:34 am

Ceftriaxone-Resistant Neisseria gonorrhoeae, Canada, 2017.

Emerging Infectious Diseases February 15, 2018 Feb 15 V.24 N.2

Lefebvre B, Martin I, Demczuk W, Deshaies L, Michaud S, Labbé AC, Beaudoin MC, Longtin J.

Author affiliations: Institut National de Santé Publique du Québec, Québec, Québec, Canada (B. Lefebvre, J. Longtin); Public Health Agency of Canada, Winnipeg, Manitoba, Canada (I. Martin, W. Demczuk); Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec (L. Deshaies); Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec (S. Michaud); Université de Montréal, Québec (A.-C. Labbé); Centre de Recherche en Infectiologie, Université Laval, Québec (M.-C. Beaudoin, J. Longtin)

Abstract

We identified a ceftriaxone-resistant Neisseria gonorrhoeae isolate in a patient in Canada. This isolate carried the penA-60 allele, which differs substantially from its closest relative, mosaic penA XXVII (80% nucleotide identity). Epidemiologic and genomic data suggest spread from Asia. Antimicrobial susceptibility surveillance helps prevent spread of highly resistant N. gonorrhoeae strains.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/24/2/17-1756_article

December 5, 2017 at 7:10 am

Avian Influenza A(H7N2) Virus in Human Exposed to Sick Cats, New York, USA, 2016

Emerging Infectious Diseases December 2017 V.23 N.12

Atanaska Marinova-Petkova, Jen Laplante, Yunho Jang, Brian Lynch, Natosha Zanders, Marisela Rodriguez, Joyce Jones, Sharmi Thor, Erin Hodges, Juan A. De La Cruz, Jessica Belser, Hua Yang, Paul Carney, Bo Shu, LaShondra Berman, Thomas Stark, John Barnes, Fiona Havers, Patrick Yang, Susan C. Trock, Alicia Fry, Larisa Gubareva, Joseph S. Bresee, James Stevens, Demetre Daskalakis, Dakai Liu, Christopher Lee, Mia Kim Torchetti, Sandra Newbury, Francine Cigel, Kathy Toohey-Kurth, Kirsten St. George, David E. Wentworth, Stephen Lindstrom, and C. Todd Davis

Author affiliations:

Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A. Marinova-Petkova, Y. Jang, B. Lynch, N. Zanders, M. Rodriguez, J. Jones, S. Thor, E. Hodges, J.A. De La Cruz, J. Belser, H. Yang, P. Carney, B. Shu, L. Berman, T. Stark, J. Barnes, F. Havers, P. Yang, S.C. Trock, A. Fry, L. Gubareva, J.S. Bresee, J. Stevens, D.E. Wentworth, S. Lindstrom, C.T. Davis); New York State Department of Health, Albany, New York, USA (J. Laplante, K. St. George); New York City Department of Health and Mental Hygiene, Long Island City, New York, USA (D. Daskalakis, D. Liu, C.T. Lee); US Department of Agriculture, Ames, Iowa, USA (M.K. Torchetti); University of Wisconsin, Madison, Wisconsin, USA (S. Newbury, F. Cigel, K. Toohey-Kurth)

An outbreak of influenza A(H7N2) virus in cats in a shelter in New York, NY, USA, resulted in zoonotic transmission. Virus isolated from the infected human was closely related to virus isolated from a cat; both were related to low pathogenicity avian influenza A(H7N2) viruses detected in the United States during the early 2000s.

PDF

https://wwwnc.cdc.gov/eid/article/23/12/pdfs/17-0798.pdf

 

December 4, 2017 at 8:14 am

Predictors of pneumonia in lower respiratory tract infections: 3C prospective cough complication cohort study

European Respiratory Journal  November 22, 2017        

Michael Moore, Beth Stuart, Paul Little, Sue Smith, Matthew J. Thompson, Kyle Knox, Anne van den Bruel, Mark Lown, David Mant

Abstract

The aim was to aid diagnosis of pneumonia in those presenting with lower respiratory tract symptoms in routine primary care.

A cohort of 28 883 adult patients with acute cough attributed to lower respiratory tract infections (LRTIs) was recruited from 5222 UK practices in 2009–13.

Symptoms, signs and treatment were recorded at presentation and subsequent events followed-up for 30 days by chart review.

The predictive value of patient characteristics, presenting symptoms and clinical findings for the diagnosis of pneumonia in the first 7 days was established.

Of the 720 out of 28 883 (2.5.%) radiographed within 1 week of the index consultation, 115 (16.0%; 0.40% of 28 883) were assigned a definite or probable pneumonia diagnosis.

The significant independent predictors of radiograph-confirmed pneumonia were temperature >37.8°C (RR 2.6; 95% CI 1.5–4.8), crackles on auscultation (RR 1.8; 1.1–3.0), oxygen saturation <95% (RR 1.7; 1.0–3.1) and pulse >100·min–1 (RR 1.9; 1.1–3.2).

Most patients with pneumonia (99/115, 86.1%) exhibited at least one of these four clinical signs; the positive predictive value of having at least one of these signs was 20.2% (95% CI 17.3–23.1).

In routine practice, radiograph-confirmed pneumonia as a short-term complication of LRTI is very uncommon (one in 270).

Pulse oximetry may aid the diagnosis of pneumonia in this setting.

FULL TEXT

http://erj.ersjournals.com/content/50/5/1700434

PDF

http://erj.ersjournals.com/content/erj/50/5/1700434.full.pdf

 

December 2, 2017 at 8:37 am

Use of Linezolid, an Oxazolidinone, in the Treatment of Multidrug-Resistant Gram-Positive Bacterial Infections

Clinical Infectious Diseases January 2000 V.30 N.1 P.146-151

Jason W. Chien, Michelle L. Kucia, and Robert A. Salata

Division of Infectious Diseases, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, Ohio

We report our experience with linezolid in an investigation of its use against resistant gram-positive bacterial infections.

Fifteen patients who had renal failure (n = 6), recent liver transplantation (n = 5) or surgery (n = 6), cancer (n = 3), endocarditis (n = 2), or human im-munodeficiency virus infection (n = 1), along with infections due to vancomycin-resistant entero-coccus (VRE), and 2 patients with infections due to methicillin-resistant Staphylococcus species who had adverse reactions to vancomycin were treated with linezolid (600 mg every 12 h for 5–42 days (mean ± SD, 20.5 ± 3.5 days).

Abscess drainage or prosthetic device removal was undertaken. Microbiological cure occurred in all 10 patients who completed therapy, and all 7 patients alive at follow-up were free of infection.

No deaths were attributable to the index infection. Adverse events associated with linezolid use were mild leukopenia in 1 patient and nausea in another.

It appears that administration of linezolid, in conjunction with surgical intervention or device removal, is an effective treatment option for serious resistant gram-positive bacterial infections.

PDF

http://cid.oxfordjournals.org/content/30/1/146.full.pdf

December 2, 2017 at 8:00 am

Outbreak of a Multiresistant Klebsiella pneumoniae Strain in an Intensive Care Unit: Antibiotic Use as Risk Factor for Colonization and Infection

Clinical Infectious Diseases January 2000 V.30 N.1 P. 55-60

Angel Asensio, Antonio Oliver, Paulino González-Diego, Fernando Baquero, Jose Claudio Pérez-Díaz, Purificación Ros, Javier Cobo, Margarita Palacios, Dolores Lasheras, and Rafael Cantón

1Servicio de Medicina Preventiva, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain

2Servicio de Microbiología, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain

3Unidad de Enfermedades Infecciosas, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain

4Unidad Pediátrica de Cuidados Intensivos, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain

An observational study was undertaken to describe a nosocomial outbreak caused by multiresistant Klebsiella pneumoniae (MRKP).

Ten patients in the pediatric intensive care unit (ICU) at a hospital in Madrid were colonized by or infected with MRKP from October 1997 to April 1998.

Thirty-two patients with MRKP-negative surveillance cultures who were admitted to the ICU during the outbreak period were selected as control patients. Random amplified polymorphic DNA analysis of MRKP isolates revealed patterns that were indistinguishable from each other.

After identification of colonized patients by surveillance cultures and implementation of standard and contact precautions, the outbreak was controlled.

An age <12 weeks (odds ratio [OR], 13.1) and previous treatment with third-generation cephalosporins and aminoglycosides (OR, 31.2) were independently associated with MRKP colonization and/or infection.

Individual exposure to antibiotics, irrespective of other clinical determinants, is a risk factor for MRKP acquisition.

Screening high-risk patients during outbreaks and reducing the use of third-generation cephalosporins and amino-glycosides contribute to the control of these epidemics.

PDF

http://cid.oxfordjournals.org/content/30/1/55.full.pdf

December 2, 2017 at 7:58 am

Candiduria: A Randomized, Double-Blind Study of Treatment with Fluconazole and Placebo

Clinical Infectious Diseases January 2000 V.30 N.1 P.19-24

D. Sobel, C. A. Kauffman, D. McKinsey, M. Zervos, J. A. Vazquez, A. W. Karchmer, J. Lee, C. Thomas, H. Panzer, W. E. Dismukes, and the National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group

1Wayne State University, Detroit, Michigan

2University of Michigan and Veterans Affairs Medical Center, Ann Arbor, Michigan

3Infectious Disease Associates of Kansas City, Kansas City, Missouri

4Harvard Medical School, Boston, Massachusetts

5University of Alabama at Birmingham, Birmingham, Alabama

6Pfizer, Inc., Groton, Connecticut

Management of candiduria is limited by the lack of information about its natural history and lack of data from controlled studies on the efficacy of treating it with antimycotic agents.

We compared fungal eradication rates among 316 consecutive candiduric (asymptomatic or minimally symptomatic) hospitalized patients treated with fluconazole (200 mg) or placebo daily for 14 days.

In an intent-to-treat analysis, candiduria cleared by day 14 in 79 (50%) of 159 receiving fluconazole and 46 (29%) of 157 receiving placebo (P < .001), with higher eradication rates among patients completing 14 days of therapy (P < .0001), including 33 (52%) of 64 catheterized and 42 (78%) of 54 noncatheterized patients.

Pretreatment serum creatinine levels were inversely related to candiduria eradication.

Fluconazole initially produced high eradication rates, but cultures at 2 weeks revealed similar candiduria rates among treated and untreated patients.

Oral fluconazole was safe and effective for short-term eradication of candiduria, especially following catheter removal. Long-term eradication rates were disappointing and not associated with clinical benefit.

PDF

http://cid.oxfordjournals.org/content/30/1/19.full.pdf

December 2, 2017 at 7:56 am

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