Epidemiology of community-onset Staphylococcus aureus infections in pediatric patients: an experience at a Children's Hospital in central Illinois

Background  

The nation-wide concern over methicillin-resistant Staphylococcus aureus (MRSA) has prompted many clinicians to use vancomycin when approaching patients with suspected staphylococcal infections. We sought to characterize the epidemiology of community-onset S. aureus infections in hospitalized children to assist local clinicians in providing appropriate empiric antimicrobial therapy.     

Emergence of vancomycin resistant Staphylococcus aureus (VRSA) from a tertiary care hospital from northern part of India

Background  

Glycopeptides such as vancomycin are frequently the antibiotics of choice for the treatment of infections caused by methicillin resistant Staphylococcus aureus (MRSA). For the last 7 years incidence of vancomycin intermediate S. aureus and vancomycin resistant S. aureus (VISA and VRSA respectively) has been increasing in various parts of the world. The present study was carried out to find out the presence of VISA and VRSA in the northern part of India.     

Appropriate use criteria for transthoracic echocardiography: Are they relevant to European centers?

Background

There is a growing interest in appropriate use criteria (AUC) for cardiovascular imaging referrals in Europe. These criteria, developed by American subspecialty societies, have been in use since 2007 and show a temporal reduction in inappropriate transthoracic echocardiogram (TTE) requests. When applied to European centers, inappropriate referral rates as high as 15% have been observed.

Methods

A retrospective analysis of TTE referrals for appropriateness and major abnormality detection was conducted over a two‐month period at Cork University Hospital (CUH).

Results

Overall, 1277 requests were assessed, of which 97.7% were classifiable. Of the 1235 classifiable studies, 1049 (84.9%) were appropriate, 135 (10.9%) were inappropriate, and 51 (4.1%) were uncertain. Main indications were the evaluation of cardiac structure and function (496, 40.2%), hypertension, heart failure or cardiomyopathy (349, 28.3%), and valvular function (228, 18.5%). Inappropriate referral rates were significantly higher for outpatients compared to inpatients (13.8% vs 7.1%, P < .05) and cardiologist referrals compared to noncardiologists (13.1 vs 8.0%, P < .05), while one in three requests for the evaluation of valvular function (32.5%) were inappropriate. Compared to inappropriate studies, appropriate and uncertain scans had a greater prevalence of ≥1 major abnormalities (33.6% vs 19.3%, P < .001) and greater detection rates of new abnormalities (27.6% vs 13.3%, P < .001).

Conclusion

Application of the 2011 AUC yields similar results to those reported from the US. The application of said criteria to our center could avoid one of every ten scans currently ordered.     

Investigation of Staphylococcus strains with heterogeneous resistance to glycopeptides in a Turkish university hospital

Background  

The hetero-glycopeptide intermediate staphylococci is considered to be the precursor of glycopeptide intermediate staphylococci especially vancomycin intermediate Staphylococcus aureus (VISA). For this purpose, we aimed to investigate the heterogeneous resistance to glycopeptide and their frequencies in 135 Staphylococcus strains.     

Faecal pharmacokinetics of orally administered vancomycin in patients with suspected <Emphasis Type="Italic">Clostridium difficile</Emphasis> infection

Background  

Oral vancomycin (125 mg qid) is recommended as treatment of severe Clostridium difficile infection (CDI). Higher doses (250 or 500 mg qid) are sometimes recommended for patients with very severe CDI, without supporting clinical evidence. We wished to determine to what extent faecal levels of vancomycin vary according to diarrhoea severity and dosage, and whether it is rational to administer high-dose vancomycin to selected patients.     

Emergence of Carbapenem resistant Gram negative and vancomycin resistant Gram positive organisms in bacteremic isolates of febrile neutropenic patients: A descriptive study

Background  

This study was conducted to evaluate drug resistance amongst bacteremic isolates of febrile neutropenic patients with particular emphasis on emergence of carbapenem resistant Gram negative bacteria and vancomycin resistant Enterococcus species.     

Impact of inappropriate empiric antimicrobial therapy on outcome in <Emphasis Type="Italic">Pseudomonas aeruginosa</Emphasis> bacteraemia: a stratified analysis according to sites of infection

Background  

The purpose of this study was to evaluate the impact of inappropriate empiric antimicrobial therapy on the outcome of Pseudomonas aeruginosa bacteraemia according to the primary infection site.     

Does vancomycin prescribing intervention affect vancomycin-resistant enterococcus infection and colonization in hospitals? A systematic review

Background  

Vancomycin resistant enterococcus (VRE) is a major cause of nosocomial infections in the United States and may be associated with greater morbidity, mortality, and healthcare costs than vancomycin-susceptible enterococcus. Current guidelines for the control of VRE include prudent use of vancomycin. While vancomycin exposure appears to be a risk factor for VRE acquisition in individual patients, the effect of vancomycin usage at the population level is not known. We conducted a systematic review to determine the impact of reducing vancomycin use through prescribing interventions on the prevalence and incidence of VRE colonization and infection in hospitals within the United States.     

Evaluation of high-dose daptomycin for therapy of experimental Staphylococcus aureus foreign body infection

Background  

Daptomycin is a novel cyclic lipopeptide whose bactericidal activity is not affected by current antibiotic resistance mechanisms displayed by S. aureus clinical isolates. This study reports the therapeutic activity of high-dose daptomycin compared to standard regimens of oxacillin and vancomycin in a difficult-to-treat, rat tissue cage model of experimental therapy of chronic S. aureus foreign body infection.     

Mecamylamine treatment for alcohol dependence: a randomized controlled trial

Background and aims

The nicotinic acetylcholine receptor antagonist, mecamylamine, is a potential novel pharmacotherapy for alcohol use disorder. The aims were to compare alcohol consumption between mecamylamine and placebo and test if smoking status modified treatment effects.

Design

Out‐patient, randomized, double‐blind clinical trial for 12 weeks of treatment with mecamylamine (10 mg) (n = 65) versus placebo (n = 63).

Setting

Connecticut, USA.

Participants

Individuals had current alcohol dependence (n = 128), had an average age of 48.5 [standard deviation (SD) = 9.4], 110 (85.9%) were men, and included 74 smokers (57.8%) and 54 non‐smokers (42.2%). Participants were randomized to mecamylamine 10 mg per day or placebo. All subjects also received medical management therapy administered by trained research personnel.

Measurements

Primary outcome was percentage of heavy drinking days during the last month of treatment; other outcomes included drinking days, drinks per drinking days, alcohol craving, smoking, symptoms of nicotine withdrawal and side effects.

Findings

There were no significant differences in the percentage of heavy drinking days at 3 months between the mecamylamine (mean = 18.4, SD = 29.0) and placebo treatment groups (mean = 20.4, SD = 29.2) [F_{1, 100} = 1.3, P = 0.25; effect size d = 0.07; mean difference = 2.06, 95% confidence interval (CI) = ?8.96 to 13.08]. There were no significant differences in percentage of drinking days or in drinks per drinking day at month 3 between the mecamylamine and placebo groups; there were no significant interactions.

Conclusions

Mecamylamine 10 mg per day did not reduce alcohol consumption significantly in treatment‐seeking smokers and non‐smokers with alcohol use disorder.     

Treatment of recurrent Clostridium difficile infection: a systematic review

Background

Clostridium difficile infection (CDI) recurs in nearly one-third of patients who develop an initial infection. Recurrent CDI (RCDI) is associated with considerable morbidity, mortality, and cost. Treatment for RCDI has not been not well examined.

Methods

A systematic review.

Results

Sixty-four articles were identified evaluating eight different treatment approaches: metronidazole, vancomycin, fidaxomicin, nitazoxanide, rifampin, immunoglobulins, probiotics, and fecal bacteriotherapy. The meta-analysis found vancomycin to have a similar efficacy to metronidazole, although studies used varying doses and durations of therapy. Fidaxomicin was slightly more efficacious than vancomycin, though the number of studies was small. Good evidence for probiotics was limited. Fecal bacteriotherapy was found to be highly efficacious in a single randomized trial.

Conclusion

Metronidazole and vancomycin have good evidence for use in RCDI but heterogeneity in treatment duration and dose precludes robust conclusions. Fidaxomicin may have a role in treatment, but evidence is limited to subgroup analyses. Fecal bacteriotherapy was the most efficacious. Saccharomyces boulardii may have a role as adjunctive treatment.     

Major life events and risk of alcohol use disorders: a prospective cohort study

Aims

To estimate associations of individual major life events as well as accumulated major life events in childhood, adult private life and adult work life with risk of alcohol use disorders (AUD).

Design

Prospective cohort study with baseline examination in 1991–93 and linkage to national registers to identify AUD at follow‐up.

Setting

Copenhagen, Denmark.

Participants

Individuals (aged 21–93 years) who participated in the Copenhagen City Heart Study in 1991–93 (n = 8758).

Measurements

The primary outcome was first registration with AUD during follow‐up (n = 249). AUD was identified in the Danish National Patient Register, in the Danish Psychiatric Central Register and in an outpatient treatment register. Major life events were assessed by a questionnaire in the Copenhagen City Heart study. Data were analysed by Cox proportional hazards models adjusted for age, sex, educational level, household income, cohabitation status and psychiatric comorbidity.

Findings

Serious family conflicts in childhood [hazard ratio (HR) = 1.35; 95% confidence interval (CI) = 1.00, 1.83] and serious economic problems in adult life (HR = 2.22; 95% CI = 1.64, 3.01) were associated significantly with increased risk of AUD. Prospective analyses did not show consistent effects of accumulation of major life events in childhood or adult life, but an additional analysis based on all AUD registrations suggested an association between accumulated childhood events and risk of AUD.

Conclusions

Serious economic problems in adult life are associated strongly with risk of alcohol use disorders, and there may be an influence of accumulated childhood events on risk of alcohol use disorders.     

Comparing surgeon- and nephrologist-inserted Tenckhoff catheters: experience from a metropolitan centre in Sydney

Background

Peritoneal dialysis (PD) is an effective home-based form of dialysis. Although several factors limit its use, the timely and successful insertion of a PD catheter is essential for increased uptake.

Aims

This retrospective observational study was performed at a tertiary teaching hospital in Sydney with the aim of comparing outcomes of PD catheter insertion using a percutaneous, modified Seldinger technique utilised by a trained nephrologist to the traditional surgical insertion using a mini-laparotomy.

Results

Over an 8-year period, 194 PD catheters were inserted. Aside from lower body mass indexes in the nephrologist-led interventions (P = 0.02), patient demographics were well matched. Time-to-insertion was significantly shorter with the percutaneous technique (P < 0.001). Univariant logistic regression noted no difference in the complication rate between the nephrologist-inserted and surgically inserted groups (likelihood ratio, 1.59; P = 0.08). There were differences in the type of adverse outcomes with each technique. Surgical procedures were more likely to have exit site leaks (P = 0.009) and peritonitis (P = 0.004), whereas procedure abandonment (P = 0.009) was more common in nephrologist-led procedures.

Conclusions

The current study highlights that with careful patient selection, trained nephrologists in metropolitan areas can successfully insert PD catheters. Our experience noted fewer delays to catheter insertion, with similar total complication rates.     

Severe symptomatic hyponatremia during citalopram therapy - a case report

Background  

Hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone is an uncommon complication of treatment with the new class of antidepressant agents, the selective serotonin reuptake inhibitors. The risk of hyponatremia seems to be highest during the first weeks of treatment particularly, in elderly females and in patients with a lower body weight.     

Utilité diagnostique de l’hypo-uricémie dans l’hyponatrémie par sécrétion inadéquate d’hormone antidiurétique

Purpose

Hypo-uricemia is still considered as a hallmark of the syndrome of inappropriate secretion of antidiuretic hormone.

Methods

We analyzed prospectively 98 hospitalized patients with hyponatremia (≤135 mmol/L), excluding those receiving diuretic treatment. Gold standard for the syndrome of inappropriate secretion of antidiuretic hormone combined plasma hypoosmolality, inappropriately concentrated urine, and normal volemia.

Results

A final diagnosis of inappropriate secretion of antidiuretic hormone was obtained in 55 patients. They were significantly hypo-uricemic (188 μmol/L [153–245], median [interquartile range]) versus 241 μmol/L, [179–333]; p < 0,02) but hypo-uricemia (≤240 μmol/L) performed poorly as a diagnostic test: 71 % sensitivity, 53 % specificity. Positive and negative likelihood ratios were 1,67 and 0,49, respectively.

Conclusions

The syndrome of inappropriate secretion of antidiuretic hormone is associated with a lower plasma uric acid concentration, but in routine clinical practice, contrary to what has been previously published, this difference is insufficient for hypouricemia to discriminate reliably between the syndrome of inappropriate secretion of antidiuretic hormone and other causes of hyponatremia.     

Nosocomial methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> (MRSA) bacteremia in Taiwan: Mortality analyses and the impact of vancomycin,MIC = 2 mg/L,by the broth microdilution method

Background  

Previous studies regarding the prognosis of patients infected with MRSA isolates characterized by a high minimum inhibitory concentration (MIC) for vancomycin have generally used a commercial Etest. Little research has been conducted on determining the vancomycin susceptibility of MRSA using a reference microdilution. Additionally, there is discordance between the MIC result from an Etest and the value determined using the reference microdilution method.     

Effect of a thin customized insole on pain and walking ability in rheumatoid arthritis: A randomized study

Objective

The aim of the study was to investigate the immediate effects of a thin, easily customizable insole on pain and walking ability in patients with rheumatoid arthritis (RA) who have forefoot pain, and to determine whether the insoles were in use 1 year afterwards.

Design

An experimental, assessor‐blinded design was applied to compare the immediate effects when walking with or without insoles in random order. After 1 year, a structured telephone interview was conducted.

Participants

Twenty‐one subjects with RA and foot pain in at least one forefoot when walking and in response to the Gänslen test were recruited consecutively from the outpatient clinic and the inpatient ward at a hospital for people with rheumatic disease.

Intervention

Each subject was given a 4‐mm thin individually customized insole of a malleable plastic material (CI‐Core®) with synthetic textile material on the upper side.

Main outcome measures

The 6‐min walk test (6MWT) was used to assess the ability to walk, and a 10‐cm visual analogue scale to measure the intensity of foot pain induced by walking with and without the insole. A standardized questionnaire with five items was used to determine the use of, and degree of satisfaction with, insoles after 1 year.

Results

The median (interquartile range) foot pain intensity was 19 (15) with and 36 (27) without insoles (p < 0.001; effect size = 0.6). No statistically significant differences in 6MWT were found between the presence or absence of insoles (p = 0.07). After 1 year, 90% of the participants were still using the insoles.

Conclusions

The use of thin, easily customizable insoles resulted in immediate clinically relevant relief in walking‐induced forefoot pain. Most of the patients were still using the insoles after 1 year.     

Cost comparison of linezolid versus vancomycin for treatment of complicated skin and skin-structure infection caused by methicillin-resistant Staphylococcus aureus in Quebec

BACKGROUND:

In Canada, complicated skin and skin-structure infection (cSSSI) caused by methicillin-resistant Staphylococcus aureus (MRSA) is usually treated with antibiotics in hospital, with a follow-up course at home for stable patients. The cost implications of using intravenous and oral linezolid instead of intravenous vancomycin in Canadian clinical practice have not been examined.

OBJECTIVES:

To evaluate the potential treatment cost impact for the Quebec health care system of linezolid versus vancomycin for MRSA-related cSSSI therapy, using a net impact analysis approach.

METHODS:

Health care resource use associated with linezolid and vancomycin therapy was estimated for patients in Quebec, based on expert opinion. Costs were assigned to health care resources (antibiotics, medical supplies, laboratory testing and health care professional time) based on unit prices. The base-case analysis assumed 14 days of antibiotic treatment for both agents; five days in hospital followed by nine days at home. Therapy duration, length of inpatient treatment and discharge rates were varied in sensitivity analyses.

RESULTS:

Antibiotic costs were higher for linezolid than for vancomycin, for both inpatient ($874 versus $144, respectively) and outpatient therapy ($1,356 versus $1,242, respectively). Compared with vancomycin, lower costs for antibiotic preparation, administration and monitoring of linezolid offset drug acquisition costs. Total treatment costs were $3,850 for linezolid versus $5,189 for vancomycin. Results were sensitive to the number of treatment days spent at home and the discharge rate.

CONCLUSION:

Using linezolid instead of vancomycin to treat MRSA-related cSSSI, for hospital and home courses combined, may reduce health care resource utilization and costs in Quebec.