The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Tuberculosis (TB) is a possible complication of solid organ and hematopoietic stem cell transplantation. The identification of candidates for preventive chemotherapy is an effective intervention to protect transplant recipients with latent infection with Mycobacterium tuberculosis from progressing to active disease. The best available proxy for diagnosing latent infection with M. tuberculosis is the identification of an adaptive immune response by the tuberculin skin test or an interferon-γ based ex vivo assay. Risk assessment in transplant recipients for the development of TB depends on, among other factors, the locally expected underlying prevalence of infection with M. tuberculosis in the target population. In areas of high prevalence, preventive chemotherapy for all transplant recipients may be justified without immunodiagnostic testing while in areas of medium and low prevalence, preventive chemotherapy should only be offered to candidates with positive M. tuberculosis-specific immune responses. The diagnosis of TB in transplant recipients can be challenging. Treatment of TB is often difficult due to substantial interactions between anti-TB drugs and immunosuppressive medications. This management guideline summarises current knowledge on the prevention, diagnosis and treatment of TB related to solid organ and hematopoietic stem cell transplantation and provides an expert consensus on questions where scientific evidence is still lacking.     

Multicentre European study for the treatment of advanced emphysema with bronchial valves

This multicentre, blinded, sham-controlled study was performed to assess the safety and effectiveness of bronchial valve therapy using a bilateral upper lobe treatment approach without the goal of lobar atelectasis. Patients with upper lobe predominant severe emphysema were randomised to bronchoscopy with (n = 37) or without (n = 36) IBV Valves for a 3-month blinded phase. A positive responder was defined as having both a ≥ 4-point improvement in St George's Respiratory Questionnaire (SGRQ) and a lobar volume shift as measured by quantitative computed tomography. At 3 months, there were eight (24%) positive responders in the treated group versus none (0%) in the control group (p = 0.002). Also, there was a significant shift in volume in the treated group from the upper lobes (mean ± SD -7.3 ± 9.0%) to the non-treated lobes (6.7 ± 14.5%), with minimal change in the control group (p<0.05). Mean SGRQ total score improved in both groups (treatment: -4.3 ± 16.2; control: -3.6 ± 10.7). The procedure and devices were well tolerated and there were no differences in adverse events reported in the treatment and control groups. Treatment with bronchial valves without complete lobar occlusion in both upper lobes was safe, but not effective in the majority of patients.     

Recommendations for the practice of travel medicine

Travel Medicine has emerged as a distinct entity over the last two decades in response to a very substantial increase in international travel and is now forging its own identity, remit and objectives for care of the traveller. Crucial to the formation of any speciality is the definition of recommendations for its practice. This is particularly important and needed for travel medicine as it overlaps with and forms part of day-to-day work in a number of different medical specialities. This document defines a set of recommendations for the practice of travel medicine from the Faculty of Travel Medicine of the Royal College of Physicians and Surgeons of Glasgow. Their objective is to help raise standards of practice and achieve greater uniformity in provision of services, better to protect those who travel. As travel medicine moves towards applying for speciality status, these standards will also contribute to that process.     

Ceftaroline Potency Among 9 US Census Regions: Report From the 2010 AWARE Program

Ceftaroline is a new antibacterial agent that is active against the major bacterial pathogens found in acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia. The 2010 Assessing Worldwide Antimicrobial Resistance Evaluation (AWARE) Surveillance Program in the United States collected a total of 8434 bacterial isolates from 65 US medical centers across 9 US regions. The isolates were cultured and tested for susceptibility to ceftaroline and comparator agents by reference minimum inhibitory concentration (MIC) methods. An analysis by US Census Bureau region demonstrated that Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), and coagulase-negative staphylococci (CoNS), including methicillin-resistant CoNS, were particularly susceptible to ceftaroline (MIC(90), 1 and 0.5?μg/mL respectively). The MRSA rate was 50.0% overall, which varied from a low of 44.6% in the South Atlantic region to a high of 53.1% in the Mountain region. Susceptibility among MRSA for ceftaroline ranged from 96.7% in the West South Central region to 100% in the West North Central region. All MRSA isolates were inhibited at a ceftaroline MIC of ≤2?μg/mL, and 98.4% were inhibited at a ceftaroline MIC of ≤1?μg/mL. In general, regional differences in activity among staphylococci, streptococci, Haemophilus spp., and Moraxella catarrhalis were minimal due to the high potency of ceftaroline. Greater differences in activity were observed among the Enterobacteriaceae due to the greater diversity of organism types and resistance mechanisms, including those producing extended-spectrum β-lactamase enzymes.