Current Issue : October - December Volume : 2015 Issue Number : 4 Articles : 7 Articles
Background: There is universal awareness of the difficulties faced by doctors when prescribing antimicrobials.\nMethods: Over a six-month period patients hospitalized in the ICU and under treatment with antibiotics and/or\nantifungals were eligible to participate in the study. The data were assessed by two infectious diseases specialists.\nOnce completed, all case forms were sent independently to both evaluators (TZSC and ARM) by e-mail. Based on\nthe data received, the evaluator completed a form automatically generated on the e-mail and returned it to the\noriginal mailbox for further analysis. We assessed the level of agreement between infectious disease specialists\nand the physicians directly responsible for the decision to begin antimicrobial therapy, as well as to assess the\nappropriateness of the regimen prescribed.\nResults: Among the antimicrobial regimens prescribed to the 177 patients, 36 % were considered inappropriate by\nspecialist #1 and 38 % were considered inappropriate by specialist #2. We found 78 % agreement by at least one of\nthe infectious disease specialists with the prescribed antimicrobial regimen, and in 49 % of cases both specialists\nagreed with the prescribed regimen. Both disagreed with the prescribed regimen in 22 % of the cases and they\ndisagreed between themselves in 29 % of the cases.\nConclusion: This study highlights the difficulties in prescribing effective empirical antimicrobial therapy - they are\nof such magnitude that even two specialists in infectious diseases, well acquainted with our hospital�s resistance\npatterns and our patients� profiles have considerable disagreement....
Background: The microbiomes of humans are associated with liver and lung inflammation. We identified and\nverified alterations of the oropharyngeal microbiome and assessed their association with cirrhosis and pneumonia.\nMethods: Study components were as follows: (1) determination of the temporal stability of the oropharyngeal\nmicrobiome; (2) identification of oropharyngeal microbial variation in 90 subjects; (3) quantitative identification of\ndisease-associated bacteria. DNAs enriched in bacterial sequences were produced from low-biomass oropharyngeal\nswabs using whole genome amplification and were analyzed using denaturing gradient gel electrophoresis analysis.\nResults: Whole genome amplification combined with denaturing gradient gel electrophoresis analysis monitored\nsuccessfully oropharyngeal microbial variations and showed that the composition of each subject�s oropharyngeal\nmicrobiome remained relatively stable during the follow-up. The microbial composition of cirrhotic patients with\npneumonia differed from those of others and clustered together in subgroup analysis. Further, species richness and\nthe value of Shannon�s diversity and evenness index increased significantly in patients with cirrhosis and pneumonia\nversus others (p < 0.001, versus healthy controls; p < 0.01, versus cirrhotic patients without pneumonia). Moreover,\nwe identified variants of Bacteroides, Eubacterium, Lachnospiraceae, Neisseria, Actinomyces, and Streptococcus through\nphylogenetic analysis. Quantitative polymerase chain reaction assays revealed that the populations of Bacteroides,\nNeisseria, and Actinomycetes increased, while that of Streptococcus decreased in cirrhotic patients with pneumonia\nversus others (p < 0.001, versus Healthy controls; p < 0.01, versus cirrhotic patients without pneumonia).\nConclusions: Alterations of Bacteroides, Neisseria, Actinomyces, and Streptococcus populations in the oropharyngeal\nmicrobiome were associated with liver cirrhosis and pneumonia....
Background: Human T-lymphotropic virus type 1 (HTLV-1), a retrovirus, is the causative agent of HTLV-1-associated\nmyelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukaemia/lymphoma (ATLL). The reported\nassociation with pulmonary disease such as bronchiectasis is less certain.\nMethods: A retrospective case review of a HTLV-1 seropositive cohort attending a national referral centre. The\ncohort was categorised into HTLV-1 symptomatic patients (SPs) (ATLL, HAM/TSP, Strongyloidiasis and HTLV\nassociated inflammatory disease (HAID)) and HTLV-1 asymptomatic carriers (ACs). The cohort was reviewed for\ndiagnosis of bronchiectasis.\nResult: 34/246 ACs and 30/167 SPs had been investigated for respiratory symptoms by computer tomography (CT)\nwith productive cough +/- recurrent chest infections the predominant indications. Bronchiectasis was diagnosed in\none AC (1/246) and 13 SPs (2 HAID, 1 ATLL, 10 HAM/TSP) (13/167, RR 19.2 95 % CI 2.5-14.5, p = 0.004) with high\nresolution CT. In the multivariate analysis ethnicity (p = 0.02) and disease state (p < 0.001) were independent\npredictors for bronchiectasis. The relative risk of bronchiectasis in SPs was 19.2 (95 % CI 2.5-14.5, p = 0.004) and in\nHAM/TSP patients compared with all other categories 8.4 (95 % CI 2.7-26.1, p = 0.0002). Subjects not of\nAfrican/Afro-Caribbean ethnicity had an increased prevalence of bronchiectasis (RR 3.45 95 % 1.2-9.7, p = 0.02).\nConclusions: Bronchiectasis was common in the cohort (3.4 %). Risk factors were a prior diagnosis of HAM/TSP and\nethnicity but not HTLV-1 viral load, age and gender. The spectrum of HTLV-associated disease should now include\nbronchiectasis and HTLV serology should be considered in patients with unexplained bronchiectasis....
Background: Clostridium difficile infection (CDI) remains one of the major hospital acquired infections in the nation,\noften attributable to increased antibiotic use. Little research, however, exists on the prevalence and impact of CDI\non patient and hospital outcomes among populations requiring such treatment. As such, the goal of this study was\nto examine the prevalence, risk factors, and impact of CDI among pneumonia and urinary tract infection (UTI)\nhospitalizations.\nMethods: The Nationwide Inpatient Sample (2009ââ?¬â??2011), reflecting a 20% stratified sample of community hospitals in\nthe United States, was used. A total of 593,038 pneumonia and 255,770 UTI discharges were included. Survey-weighted\nmultivariable regression analyses were conducted to assess the predictors and impact of CDI among pneumonia and\nUTI discharges.\nResults: A significantly higher prevalence of CDI was present among men with UTI (13.3 per 1,000) as compared\nto women (11.3 per 1,000). CDI was associated with higher in-hospital mortality among discharges for pneumonia\n(adjusted odds ratio [aOR] for men = 3.2, women aOR = 2.8) and UTI (aOR for men = 4.1, women aOR = 3.4). Length of\nstay among pneumonia and UTI discharges were also double upon presence of CDI. In addition, CDI increased\nthe total charges by at least 75% and 55% among pneumonia and UTI discharges, respectively. Patient and hospital\ncharacteristics associated with CDI included being 65 years or older, Charlson Deyo index for comorbidity of 2 or more,\nMedicare as the primary payer, and discharge from urban hospitals, among both pneumonia and UTI discharges.\nConclusion: CDI occurs frequently in hospitalizations among those discharged from hospital for pneumonia and UTI,\nand is associated with increased in-hospital mortality and health resource utilization. Interventions to mitigate the\nburden of CDI in these high-risk populations are urgently needed....
Background: Type-specific high-risk HPV (hrHPV) infection is related to cervical carcinogenesis. The prevalence of\nhrHPV infection varies geographically, which might reflect the epidemiological characteristics of cervical cancer\namong different populations. To establish a foundation for HPV-based screening and vaccination programs in China,\nwe investigated the most recent HPV prevalence and genotypic distributions in different female age groups and\ngeographical regions in China.\nMethods: In 2012, a total of 120,772 liquid-based cytological samples from women enrolled for population- or\nemployee-based cervical screening in 37 Chinese cities were obtained by the Laboratory of Molecular Infectious\nDiseases of Guangzhou KingMed. A total of 111,131 samples were tested by Hybrid Capture II and the other\n9,641 were genotyped using the Tellgenplexââ??¢ HPV DNA Assay.\nResults: The total positive rate for hrHPV was 21.07 %, which ranged from 18.42 % (Nanchang) to 31.94 % (Haikou)\nand varied by region. The regions of Nanchang, Changsha, Hangzhou, Chengdu, Fuzhou, Guangdong, and Guiyang\ncould be considered the low prevalence regions. Age-specific prevalence showed a ââ?¬Å?two-peakââ?¬Â pattern, with the\nyoungest age group (15ââ?¬â??19 years) presenting the highest hrHPV infection rate (30.55 %), followed by a second\npeak for the 50ââ?¬â??60-year-old group. Overall, the most prevalent genotypes were HPV16 (4.82 %) and HPV52 (4.52 %),\nfollowed by HPV58 (2.74 %). Two genotypes HPV6 (4.01 %) and HPV11 (2.29 %) were predominant in the low-risk HPV\n(lrHPV) type, while the mixed genotypes HPV16 + 52 and HPV52 + 58 were most common in women with multiple\ninfections.\nConclusions: This study shows that HPV infection in China has increased to the level of an ââ?¬Å?HPV-heavy-burdenââ?¬Â zone in\ncertain regions, with prevalence varying significantly among different ages and regions. Data from this study represent\nthe most current survey of the nationwide prevalence of HPV infection in China, and can serve as valuable reference to\nguide nationwide cervical cancer screening and HPV vaccination progra...
Background: Antiretroviral therapy (ART) markedly reduces HIV transmission, and testing and treatment programs\nhave been advocated as a method for decreasing transmission at the population level. Little is known, however,\nabout the extent to which sexually transmitted infections (STIs), which increase the HIV infectiousness of untreated\nindividuals, may decrease the effectiveness of treatment as prevention.\nMethods: We searched major bibliographic databases to August 12th, 2014 and identified studies reporting differences\nin HIV transmission rate or in viral load between individuals on ART who either were or were not co-infected with\nanother STI. We used hierarchical Bayesian models to estimate viral load differences between individuals with and\nwithout STI co-infections.\nResults: The search strategy retrieved 1630 unique citations of which 14 studies (reporting on 4607 HIV viral load\nmeasurements from 2835 unique individuals) met the inclusion criteria. We did not find any suitable studies that\nestimated transmission rates directly in both groups. Our meta-analysis of HIV viral load measurements among\ntreated individuals did not find a statistically significant effect of STI co-infection; viral loads were, on average,\n0.11 log10 (95 % CI ?0.62 to 0.83) higher among co-infected versus non-co-infected individuals.\nConclusions: Direct evidence about the effects of STI co-infection on transmission from individuals on ART is very\nlimited. Available data suggests that the average effect of STI co-infection on HIV viral load in individuals on ART\nis less than 1 log10 difference, and thus unlikely to decrease the effectiveness of treatment as prevention. However,\nthere is not enough data to rule out the possibility that particular STIs pose a larger threat....
Background: The aim of this study was to investigate the colonisation by lactobacilli and clinical outcome in\nwomen with bacterial vaginosis (BV) and recurrent vulvovaginal candidiasis (R-VVC) receiving antibiotic or\nanti-fungal treatment in combination with the probiotic EcoVag�® capsules.\nMethods: A total of 40 Scandinavian women diagnosed with BV or VVC on the basis of Amselâ��s criteria or clinical\nsymptoms were consecutively recruited in two pilot open label clinical trials. In trial I, women with BV were treated with\nclindamycin and metronidazole followed by vaginal EcoVag�® capsules, containing Lactobacillus rhamnosus DSM 14870\nand Lactobacillus gasseri DSM 14869, for 5 consecutive days after each antibiotic treatment. In trial II, women were\nrecruited in three groups as follows: women with BV receiving clindamycin and metronidazole treatment together\nwith a prolonged administration of EcoVag�® (10 consecutive days after each antibiotic treatment followed by weekly\nadministration of capsules for next four months), women with R-VVC receiving extended fluconazole and EcoVag�®\ntreatment, and women receiving extended fluconazole treatments only. The difference in frequency of isolation of\nEcoVag�® strains or other lactobacilli between groups was compared by Fisherâ��s exact test.\nResults: The 6-month cure rate for BV was 50 % in trial I while both the 6- and 12-month cure rates were 67 % in\ntrial II. The 6- and 12-month cure rates for VVC were 100 % and 89 % in women receiving fluconazole and EcoVag�®,\nand 100 % and 70 % in women receiving fluconazole only. The frequency of isolation of any Lactobacillus species\nduring the course of the study was associated with cure of BV in trial I and II, whereas the frequency of isolation of\nEcoVag�® strains was significantly associated with the cure of BV in trial II only. As previously observed, a change in\nsexual partner was associated with relapse of BV with an Odds ratio of 77 (95 % CI: 2.665 to 2225).\nConclusions: The study suggests that the treatment with antibiotics or anti-fungal medication in combination\nwith EcoVag�® capsules provide long-term cure against BV and R-VVC as compared to previous reports....
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