Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review.

Clin Infect Dis. Apr 1, 2009 V.48 N.7 P.922-30.

Ammerlaan HS1, Kluytmans JA, Wertheim HF, Nouwen JL, Bonten MJ.

Author information

1 Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands. H.Ammerlaan@umcutrecht.nl

Abstract

A systematic review was performed to determine the effectiveness of different approaches for eradicating methicillin-resistant Staphylococcus aureus carriage. Twenty-three clinical trials were selected that evaluated oral antibiotics (7 trials), topically applied antibiotics (12 trials), or both (4 trials). Because of clinical heterogeneity, quantitative analysis of all studies was deemed to be inappropriate, and exploratory subgroup analyses were performed for studies with similar study populations, methods, and targeted bacteria. The estimated pooled relative risk of treatment failure 1 week after short-term nasal mupirocin treatment, compared with placebo, was 0.10 (range, 0.07-0.14). There was low heterogeneity between study outcomes, and effects were similar for patients and healthy subjects, as well as in studies that included only methicillin-susceptible S. aureus carriers or both methicillin-susceptible S. aureus and methicillin-resistant S. aureus carriers. The development of drug resistance during treatment was reported in 1% and 9% of patients receiving mupirocin and oral antibiotics, respectively. Short-term nasal application of mupirocin is the most effective treatment for eradicating methicillin-resistant S. aureus carriage, with an estimated success of rate of 90% 1 week after treatment and approximately 60% after a longer follow-up period.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/48/7/10.1086/597291/2/48-7-922.pdf?Expires=1494547126&Signature=C-3w0qidaoRa7nD1JLkVurTsGPMZt6nFPH~~ukmz~Wrdd2rLVyc4nFgZ5uT0RDQSwfwFtWB2QPZw8l7HjcKFHWaiSy8qEDU3uZM28k~O4MHJYjd~B86s2~s8-xP9j04r6TKdnJ2lsY3VZLXEb22vNGmERggjk4B2h7DUCAJGXBBba-7AixeOYEbLumFS8-5SmkCgBSKsKsa8UWzqmXJWZrQDlgMLMzqAUURfPITtO9AoiLUzDH~bVNd5zCozVmfpbxf3nAVk4cZVekXwNiAH3SYHOKfVd3YomfEzd5~tBxRwwqnxDp8kvCJtB1oFv9HNMf3Jy1GdMCnjNuyVrA1cQg__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

May 10, 2017 at 7:11 pm

“Utilización de penicilina benzatínica como tratamiento para la prevención de sífilis congénita en el primer nivel de atención de la salud.” 36 pags

Organización Panamericana de la Salud

Ministerio de Salud de la Provincia de Buenos Aires – Argentina

Dirección Provincial de Programas Sanitarios

Dirección HIV/SIDA/ITS

Este documento fue escrito por Mariana Ceriotto (Médica especialista en Infectología y Salud Pública. Diplomada en Gestión Pública. Experta en prevención, diagnóstico y tratamiento de las infecciones perinatales).

La revisión técnica fue realizada por: Marcelo Vila (Asesor Subregional para el Cono Sur- Unidad de VIH, hepatitis, TBC e ITS- OPS/OMS); Adriana Duran (Directora de Programas Sanitarios- Ministerio de Salud de la Provincia de Buenos Aires) y Mónica Moyano (Directora de VIH-ITS y Hepatitis virales- Ministerio de Salud de la Provincia de Buenos Aires).

Avalan este documento:

  • Asociación Argentina de Alergia e Inmunología Clínica (AAAeIC)
  • Sociedad Argentina de Infectología (SADI)
  • Sociedad de Ginecología Y Obstetricia de la Provincia de Buenos Aires (SOGBA)
  • Dirección de SIDA y ETS- Ministerio de Salud de la Nación

Esta publicación contó con apoyo financiero de la OPS/OMS.

Contenido

  1. La persistencia del problema de la sífilis congénita como problema de salud pública en Argentina y la región de las Américas
  2. El tratamiento de la embarazada con diagnóstico de sífilis
  3. Alergia a beta-lactámicos
  4. Uso de penicilina benzatínica en el primer nivel de atención
  5. Recomendaciones
  6. Cuestionario para la evaluación de los factores de riesgo
  7. Evaluación de los factores de riesgo de alergia a penicilina
  8. Protocolo de diagnóstico y tratamiento inicial de reacciones anafilácticas
  9. Referencias bibliográficas

 

PDF

http://www.paho.org/arg/images/gallery/PenicilinaFinal.pdf

May 10, 2017 at 7:59 am

Guidelines – Recommendations on hepatitis C screening for adults

Canadian Medical Journal Association April 24, 2017 V.189 N.16

Canadian Task Force on Preventive Health Care

An estimated 0.64%–0.71% of Canadians (220 000–245 000 people) have chronic hepatitis C virus (HCV) infection,1 and approximately 44%2 of those may be undiagnosed. HCV can be transmitted directly through percutaneous exposure (e.g., through inadequately sterilized medical equipment) or through receipt of contaminated blood products.3 People who inject drugs are at highest risk, but recipients of unscreened blood products, tissues or organs and patients undergoing long-term hemodialysis are also at increased risk.3 Less common modes of transmission include vertical transmission, high-risk sexual contact, unsterilized tattoo or piercing equipment, and occupational exposure.3 Not all people with chronic HCV infection will develop cirrhosis or signs or symptoms indicative of liver disease.4 It is estimated that approximately 84% of people infected with HCV do not develop cirrhosis 20 years after acute infection, and 59% after 30 years.5,6 Progression of liver fibrosis is variable and influenced by factors such as alcohol consumption, age at time of infection, male sex and HIV coinfection.7

PDF

http://www.cmaj.ca/content/189/16/E594.full.pdf+html

May 9, 2017 at 3:35 pm

Use of azithromycin and risk of ventricular arrhythmia

Canadian Medical Journal Association April 18, 2017 V.189 N.15

Gianluca Trifirò, Maria de Ridder, Janet Sultana, Alessandro Oteri, Peter Rijnbeek, Serena Pecchioli, Giampiero Mazzaglia, Irene Bezemer, Edeltraut Garbe, Tania Schink, Elisabetta Poluzzi, Trine Frøslev, Mariam Molokhia, Igor Diemberger, and Miriam C.J.M. Sturkenboom

BACKGROUND

There are conflicting findings from observational studies of the arrhythrogenic potential of azithromycin. Our aim was to quantify the association between azithromycin use and the risk of ventricular arrhythmia.

METHODS

We conducted a nested case–control study within a cohort of new antibiotic users identified from a network of 7 population-based health care databases in Denmark, Germany, Italy, the Netherlands and the United Kingdom for the period 1997–2010. Up to 100 controls per case were selected and matched by age, sex and database. Recency of antibiotic use and type of drug (azithromycin was the exposure of interest) at the index date (occurrence of ventricular arrhythmia) were identified. We estimated the odds of ventricular arrhythmia associated with current azithromycin use relative to current amoxicillin use or nonuse of antibiotics (≥ 365 d without antibiotic exposure) using conditional logistic regression, adjusting for confounders.

RESULTS

We identified 14 040 688 new antibiotic users who met the inclusion criteria. Ventricular arrhythmia developed in 12 874, of whom 30 were current azithromycin users. The mean age of the cases and controls was 63 years, and two-thirds were male. In the pooled data analyses across databases, azithromycin use was associated with an increased risk of ventricular arrhythmia relative to nonuse of antibiotics (adjusted odds ratio [OR] 1.97, 95% confidence interval [CI] 1.35–2.86). This increased risk disappeared when current amoxicillin use was the comparator (adjusted OR 0.90, 95% CI 0.48–1.71). Database-specific estimates and meta-analysis confirmed results from the pooled data analysis.

INTERPRETATION

Current azithromycin use was associated with an increased risk of ventricular arrhythmia when compared with nonuse of antibiotics, but not when compared with current amoxicillin use. The decreased risk with an active comparator suggests significant confounding by indication.

PDF

http://www.cmaj.ca/content/189/15/E560.full.pdf+html

May 9, 2017 at 3:34 pm

Synovial Fluid Cell Count for Diagnosis of Chronic Periprosthetic Hip Infection.

Journal of Bone & Joint Surgery – American May 3, 2017 V.99 N.9 P.753-759

Higuera, Carlos A.; Zmistowski, Benjamin; Malcom, Tennison…

Background

There is a paucity of data regarding the threshold of synovial fluid white blood-cell (WBC) count and polymorphonuclear cell (neutrophil) percentage of the WBC count (PMN%) for the diagnosis of chronic periprosthetic joint infection (PJI) after total hip arthroplasty. Despite this, many organizations have provided guidelines for the diagnosis of PJI that include synovial fluid WBC count and PMN%. We attempted to define a threshold for synovial fluid WBC count and PMN% for the diagnosis of chronic PJI of the hip using a uniform definition of PJI and to investigate any variations in the calculated thresholds among institutions.

Methods

From 4 academic institutions, we formed a cohort of 453 patients with hip synovial fluid cell count analysis as part of the work-up for revision total hip arthroplasty. Using the definition of PJI from the Musculoskeletal Infection Society (MSIS), 374 joints were diagnosed as aseptic and 79, as septic. Intraoperative aspirations were performed as routine practice, regardless of the suspicion for infection, in 327 (72%) of the patients. Using receiver operating characteristic curves, the optimal threshold values for synovial WBC count and PMN% were identified.

Results

For the diagnosis of chronic PJI of the hip, the threshold for the overall cohort was 3,966 cells/μL for WBC count and 80% for PMN%. Despite the high predictive accuracy for the cohort, there was notable institutional variation in fluid WBC count and PMN%. Furthermore, the rate of PJI was 14% (4 of 28) for patients with a WBC count of 3,000 to 5,000 cells/μL compared with 91% (20 of 22) for patients with a WBC count of >50,000 cells/μL. Similarly, the rate of PJI was 29% (14 of 49) for patients with a PMN% of 75% to 85% compared with 69% (33 of 48) for patients with a PMN% of >95%.

Conclusions

Using the MSIS criteria, the optimal synovial fluid WBC count and PMN% to diagnose chronic PJI in the hip is closer to thresholds for the knee than those previously reported for the hip. This study validates the diagnostic utility of synovial fluid analysis for the diagnosis of periprosthetic hip infection; however, we also identified a clinically important “gray area” around the threshold for which the presence of PJI may be unclear.

Level of Evidence

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

FULL TEXT

http://journals.lww.com/jbjsjournal/Fulltext/2017/05030/Synovial_Fluid_Cell_Count_for_Diagnosis_of_Chronic.6.aspx

May 9, 2017 at 3:34 pm

Sexually acquired Zika virus: a systematic review

Clinical Microbiology and Infection May 2017 V.23 N.5

Moreira, T.M. Peixoto, A.M. Siqueira, C.C. Lamas

1) Instituto Nacional de Infectologia Evandro Chagas, Fundaçao Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil ~

2) Universidade do Grande Rio (Unigranrio), Rio de Janeiro, Brazil

3) Unidade de pesquisa cardiovascular, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil

Background:

Zika virus (ZIKV) is transmitted to humans primarily by Aedes mosquito bites. However, circumstantial evidence points to a sexual transmission route.

Objectives:

To assess the sexually acquired ZIKV cases and to investigate the shedding of ZIKV in genital fluids.

Data sources:

PubMed, Scopus, Pro-MED-mail and WHO ZIKV notification databases from inception to December 2016.

Selection criteria:

Reports describing ZIKV acquisition through sex and studies reporting the detection or isolation of ZIKV in the genital fluids were included.

Risk-of-bias assessment:

The risk of bias was assessed using the National Institute of Health Tool.

Results:

Eighteen studies reporting on sex-acquired ZIKV and 21 describing the presence of ZIKV in genital fluids were included. The overall risk of bias was moderate. Sexual transmission was male efemale (92.5%), femaleemale (3.7%) and maleemale (3.7%). Modes of sexual transmission were unprotected vaginal (96.2%), oral (18.5%) and anal (7.4%) intercourse. The median time between onset of symptoms in the index partner and presumed sexual transmission was 13 days (range 4e44 days). ZIKV RNA was detected in semen as late as 188 days (range 3e188 days) following symptom onset, and infectious virus was isolated in semen up to 69 days after symptom onset. No study reported ZIKV isolation from female genital samples, but detection did occur up to 13 days after symptom onset.

Conclusions:

ZIKV is potentially sexually transmitted and persists in male genital secretions for a prolonged period after symptom onset

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)30659-0/pdf

May 9, 2017 at 8:26 am

Corticosteroids in treating CAP – has the time really come.

Clinical Microbiology and Infection May 2017 V.23 N.5

Blot, A. Salmon-Rousseau, P. Chavanet, L. Piroth*

Departement d’Infectiologie, Centre Hospitalier Universitaire, Dijon, France

Whether corticosteroids should be used in the treatment of severe community-acquired pneumonia (CAP) is still a matter of debate.

This question is all the more relevant as pneumonia remains a leading cause of death worldwide.

Severe CAP is associated with an increase in pulmonary and circulatory cytokines, which may be associated with treatment failure, especially in bacteraemic pneumococcal pneumonia.

Thus corticosteroids, which suppress inflammatory reactions and prevent the migration of inflammatory cells to tissues, may be of particular interest in the treatment of such severe pneumonias …

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)30388-3/pdf

May 9, 2017 at 8:25 am

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