Current Issue : January - March Volume : 2012 Issue Number : 1 Articles : 8 Articles
Background: Recent evidence indicates that Gram-negative bacterial pathogens, the most common of which are\r\nPseudomonas spp., Enterobacteriaceae, and Acinetobacter baumannii, are frequent causes of hospital-acquired\r\ninfections. This study aims to evaluate the in vitro activity of doripenem and comparator carbapenem antibiotics\r\nagainst Gram-negative clinical isolates collected from COMParative Activity of Carbapenem Testing (COMPACT)\r\nstudy centres in Turkey.\r\nMethods: Ten centres in Turkey were invited to submit Pseudomonas aeruginosa, Enterobacteriaceae, and other\r\nGram-negative isolates from intensive care unit (ICU)/non-ICU patients with complicated intra-abdominal infections,\r\nbloodstream infections, or nosocomial pneumonia, including ventilator-associated pneumonia, between May and\r\nOctober 2008. Susceptibility was determined by each centre using E-test. A central laboratory performed species\r\nconfirmation as well as limited susceptibility and quality-control testing.\r\nResults: Five hundred and ninety six isolates were collected. MIC90 values for doripenem, meropenem, and\r\nimipenem, respectively, were 32, = 64, and = 64 mg/L against Pseudomonas spp.; 0.12, 0.12, and 0.5 mg/L against\r\nEnterobacteriaceae; and = 64 mg/L for each against other Gram-negative isolates. In determining the susceptibility\r\nof hospital isolates of selected Gram-negative pathogens to doripenem, imipenem, and meropenem, we found\r\nthat against all pathogens combined, the MIC90 for ICU compared with non-ICU isolates was higher.\r\nConclusions: Doripenem showed similar or slightly better activity than meropenem and better activity than\r\nimipenem against the Gram-negative pathogens collected in Turkey....
Background: To measure Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization prevalence in\r\nhousehold contacts of children with current community associated (CA)-MRSA infections (study group) in\r\ncomparison with a group of household contacts of children without suspected Staphylococcus aureus infection (a\r\ncontrol group).\r\nMethods: This is a cross sectional study. Cultures of the anterior nares were taken. Relatedness of isolated strains\r\nwas tested using pulse field gel electrophoresis (PFGE).\r\nResults: The prevalence of MRSA colonization in the study group was significantly higher than in the control\r\ngroup (18/77 (23%) vs 3/77 (3.9%); p = 0.001). The prevalence of SA colonization was 28/77 (36%) in the study\r\ngroup and 16/77 (21%) in the control group (p = 0.032). The prevalence of SA nasal colonization among patients\r\nwas 6/24 (25%); one with methicillin-susceptible S. aureus (MSSA) and 5 with MRSA. In the study (patient) group,\r\n14/24 (58%) families had at least one household member who was colonized with MRSA compared to 2/29 (6.9%)\r\nin the control group (p = 0.001). Of 69 total isolates tested by PFGE, 40 (58%) were related to USA300. Panton-\r\nValetine leukocidin (PVL) genes were detected in 30/52 (58%) tested isolates. Among the families with =1 contact\r\ncolonized with MRSA, similar PFGE profiles were found between the index patient and a contact in 10/14 families.\r\nConclusions: Prevalence of asymptomatic nasal carriage of MRSA is higher among household contacts of patients\r\nwith CA-MRSA disease than control group. Decolonizing such carriers may help prevent recurrent CA-MRSA\r\ninfections....
Background: Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic\r\nstem cell transplantation (HSCT) patientsThe purpose of this study was to assess the characteristics and outcomes\r\nof HSCT patients with IFIs who are undergoing MV at a single institution in Taiwan.\r\nMethods: We performed an observational retrospective analysis of IFIs in HSCT patients undergoing mechanical\r\nventilation (MV) in an intensive care unit (ICU) from the year 2000 to 2009. The characteristics of these HSCT\r\npatients and risk factors related to IFIs were evaluated. The status of discharge, length of ICU stay, date of death\r\nand cause of death were also recorded.\r\nResults: There were 326 HSCT patients at the Linkou Chang-Gung Memorial Hospital (Taipei, Taiwan) during the\r\nstudy period. Sixty of these patients (18%) were transferred to the ICU and placed on mechanical ventilators. A\r\ntotal of 20 of these 60 patients (33%) had IFIs. Multivariate analysis indicated that independent risk factors for IFI\r\nwere admission to an ICU more than 40 days after HSCT, graft versus host disease (GVHD), and high dose\r\ncorticosteroid (p < 0.01 for all). The overall ICU mortality rate was 88% (53 of 60 patients), and was not significantly\r\ndifferent for patients with IFIs (85%) and those without IFIs (90%, p = 0.676).\r\nConclusion: There was a high incidence of IFIs in HSCT patients requiring MV in the ICU in our study cohort. The\r\nindependent risk factors for IFI are ICU admission more than 40 days after HSCT, GVHD, and use of high-dose\r\ncorticosteroid....
Background: Non-typeable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae are major causes of\r\nbacterial acute otitis media (AOM). Data regarding AOM are limited in Latin America. This is the first active\r\nsurveillance in a private setting in Venezuela to characterize the bacterial etiology of AOM in children < 5 years of\r\nage.\r\nMethods: Between December 2008 and December 2009, 91 AOM episodes (including sporadic, recurrent and\r\ntreatment failures) were studied in 87 children enrolled into a medical center in Caracas, Venezuela. Middle ear\r\nfluid samples were collected either by tympanocentesis or spontaneous otorrhea swab sampling method. Standard\r\nlaboratory and microbiological techniques were used to identify bacteria and test for antimicrobial resistance. The\r\nresults were interpreted according to Clinical Laboratory Standards Institute (CLSI) 2009 for non-meningitis isolates.\r\nAll statistical analyses were performed using SAS 9.1 and Microsoft Excel (for graphical purposes).\r\nResults: Overall, bacteria were cultured from 69.2% (63 of the 91 episodes); at least one pathogen (S. pneumoniae,\r\nH. influenzae, S. pyogenes or M. catarrhalis) was cultured from 65.9% (60/91) of episodes. H. influenzae (55.5%; 35/63\r\nepisodes) and S. pneumoniae (34.9%; 22/63 episodes) were the most frequently reported bacteria. Among H.\r\ninfluenzae isolates, 62.9% (22/35 episodes) were non-capsulated (NTHi) and 31.4% (11/35 episodes) were capsulated\r\nincluding types d, a, c and f, across all age groups. Low antibiotic resistance for H. influenzae was observed to\r\namoxicillin/ampicillin (5.7%; 2/35 samples). NTHi was isolated in four of the six H. influenzae positive samples\r\n(66.7%) from recurrent episodes.\r\nConclusions: We found H. influenzae and S. pneumoniae to be the main pathogens causing AOM in Venezuela.\r\nPneumococcal conjugate vaccines with efficacy against these bacterial pathogens may have the potential to\r\nmaximize protection against AOM....
Background: Tuberculosis (TB) is an enduring health problem worldwide and the emerging threat of multidrug\r\nresistant (MDR) TB and extensively drug resistant (XDR) TB is of particular concern. A better understanding of\r\nbiomarkers associated with TB will aid to guide the development of better targets for TB diagnosis and for the\r\ndevelopment of improved TB vaccines.\r\nMethods: Recombinant proteins (n = 7) and peptide pools (n = 14) from M. tuberculosis (M.tb) antigens associated\r\nwith M.tb pathogenicity, modification of cell lipids or cellular metabolism, were used to compare T cell immune\r\nresponses defined by IFN-g production using a whole blood assay (WBA) from i) patients with TB, ii) individuals\r\nrecovered from TB and iii) individuals exposed to TB without evidence of clinical TB infection from Minsk, Belarus.\r\nResults: We identified differences in M.tb target peptide recognition between the test groups, i.e. a frequent\r\nrecognition of antigens associated with lipid metabolism, e.g. cyclopropane fatty acyl phospholipid synthase. The\r\npattern of peptide recognition was broader in blood from healthy individuals and those recovered from TB as\r\ncompared to individuals suffering from pulmonary TB. Detection of biologically relevant M.tb targets was confirmed\r\nby staining for intracellular cytokines (IL-2, TNF-a and IFN-g) in T cells from non-human primates (NHPs) after BCG\r\nvaccination.\r\nConclusions: PBMCs from healthy individuals and those recovered from TB recognized a broader spectrum of M.tb\r\nantigens as compared to patients with TB. The nature of the pattern recognition of a broad panel of M.tb antigens\r\nwill devise better strategies to identify improved diagnostics gauging previous exposure to M.tb; it may also guide\r\nthe development of improved TB-vaccines....
Background: Increased risk of fractures and osteoporosis have been associated with the use of antiretroviral drugs.\r\nThere is a paucity of prospective evaluations of bone markers after the initiation of drugs currently recommended\r\nto treat HIV infection and results on the evolution of these markers are conflicting. Lastly, the effect of tenofovir on\r\n1,25-(OH)2 vitamin D is uncertain.\r\nMethods: We performed a prospective study on the evolution of bone markers, parathormone and 1,25-(OH)2 vitamin\r\nD before and after standard antiretroviral regimens. This was a sub-study of a trial conducted in antiretroviral-na�¯ve\r\npatients randomized to tenofovir emtricitabine in combination with either atazanavir/ritonavir (ATV/r) or efavirenz\r\n(EFV). Follow-up lasted 48 weeks. The following bone markers were analyzed: C-terminal cross-laps (CTx), osteocalcin\r\n(OC), osteoprotegerin (OPG), and receptor activator of nuclear factor B ligand (RANKL). Mixed-factorial analysis of\r\nvariance with random-coefficient general linear model was used to compare their trends over time and linear\r\nmultivariable regression was performed with a backward selection method to assess predictors of their variations from\r\nbaseline to week 48. Trends of parathormone and 1,25-(OH)2 vitamin D were also evaluated.\r\nResults: Seventy-five patients were studied: 33 received EFV and 42 ATV/r. Significant increases were found for all\r\nmarkers except for RANKL. There was a significant direct association between CTx and OC increases. Multivariable\r\nanalysis showed that higher glomerular filtration rate (estimated through cystatin C clearance) predicted greater\r\nOPG increase, while older age, higher HIV RNA at baseline and use of ATV/r predicted greater CTx increase. A\r\nsignificant increase of parathormone accompanied the evolution of the study markers. 1,25-(OH)2 vitamin D\r\nremained stable, though a seasonality variation was demonstrated.\r\nConclusions: These data demonstrate CTx increase (bone resorption marker) corresponding to OC increase (bone\r\nformation marker) early upon HAART initiation. Moreover, predictors of bone marker increases have been\r\nsuggested, possibly indicating that a stricter monitoring of bone health and pro-active interventions are needed in\r\nolder patients, those with higher HIV RNA, prescribed ATV/r rather than EFV, and with decreased renal function at\r\nbaseline. Further studies are needed to clarify the mechanisms responsible for up-regulation of bone turnover\r\nmarkers, as well as to understand if and what markers are best correlated or predictive of pathological fractures....
Background: Rapid diagnosis of GAS pharyngitis may improve patient care by ensuring that patients with GAS\r\npharyngitis are treated quickly and also avoiding unnecessary use of antibiotics in those without GAS infection.\r\nVery few molecular methods for detection of GAS in clinical throat swab specimens have been described.\r\nMethods: We performed a study of a laboratory-developed internally-controlled rapid Group A streptococcus\r\n(GAS) PCR assay using flocked swab throat specimens. We compared the GAS PCR assay to GAS culture results\r\nusing a collection of archived throat swab samples obtained during a study comparing the performance of\r\nconventional and flocked throat swabs.\r\nResults: The sensitivity of the GAS PCR assay as compared to the reference standard was 96.0% (95% CI 90.1% to\r\n98.4%), specificity 98.6% (95% CI 95.8% to 99.5%), positive predictive value (PPV) 96.9% (95% CI 91.4% to 99.0%) and\r\nnegative predictive value (NPV) of 98.1% (95% CI 95.2% to 99.2%). For conventional swab cultures, sensitivity was\r\n96.0% (95% CI 90.1% to 98.4%), specificity 100% (95% CI 98.2% to 100%), PPV 100%, (95% CI 96.1% to 100%) and\r\nNPV 98.1% (95% CI 95.2% to 99.3%)\r\nConclusions: In this retrospective study, the GAS PCR assay appeared to perform as well as conventional throat\r\nswab culture, the current standard of practice. Since the GAS PCR assay, including DNA extraction, can be\r\nperformed in approximately 1 hour, prospective studies of this assay are warranted to evaluate the clinical impact\r\nof the assay on management of patients with pharyngitis....
Background: Forward planning and preventative measures before travelling can significantly reduce the risk of\r\nmany vaccine preventable travel-related infectious diseases. Higher education students may be at an increased risk\r\nof importing infectious disease as many undertake multiple visits to regions with higher infectious disease\r\nendemicity. Little is known about the health behaviours of domestic or international university students, particularly\r\nstudents from low resource countries who travel to high-resource countries for education. This study aimed to\r\nassess travel-associated health risks and preventative behaviours in a sample of both domestic and international\r\nuniversity students in Australia.\r\nMethods: In 2010, a 28 item self-administered online survey was distributed to students enrolled at the University\r\nof New South Wales, Sydney, Australia. Multiple methods of distributing links to the online survey were utilised.\r\nThe survey examined the international travel history, travel intentions, infection control behaviours and selfreported\r\nvaccination history.\r\nResults: A total of 1663 respondents completed the online survey, 22.1% were international students and 83.9%\r\nwere enrolled at an undergraduate level. Half had travelled internationally in the previous 12 months, with 69% of\r\nthose travelling only once during that time with no difference in travel from Australia between domestic and\r\ninternational students (p = 0.8). Uptake of pre-travel health advice was low overall with 68% of respondents\r\nreporting they had not sought any advice from a health professional prior to their last international trip. Domestic\r\nstudents were more likely to report uptake of a range of preventative travel health measures compared to\r\ninternational students, including diarrhoeal medication, insect repellent, food avoidance and condoms (P < 0.0001).\r\nOverall, students reported low risk perception of travel threats and a low corresponding concern for these threats.\r\nConclusions: Our study highlights the need to educate students about the risk associated with travel and improve\r\npreventative health-seeking and uptake of precautionary health measures in this highly mobile young adult\r\npopulation. Although immunisation is not an entry requirement to study at Universities in Australia, large tertiary\r\ninstitutions provide an opportunity to engage with young adults on the importance of travel health and provision\r\nof vaccines required for travel, including missed childhood vaccines....
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