Wednesday, May 14, 2008
Infectious complications in patients with Hodgkin's lymphoma of unfavourable prognosis
Infectious complications in patients with Hodgkin's lymphoma of unfavourable prognosis
Antibiot Khimioter. 2007
Analysis of the infectious complications in 48 primary patients with Hodgkin's lymphoma of infavourable prognosis recorded within 1998-2006 is presented. Respiratory tract infections, mucositis and Herpes infection were stated in 43, 24 and 22% of the patients respectively. Bacterial infections predominated (61% of the patients), then followed viral and fungal infections (26 and 43% of the patients respectively). Associations of bacterial and fungal infections were most frequent (50% of the patients). Associations of bacterial and viral infections were less frequent (30%) and fungal and viral infection associations were revealed in 20% of the patients. The structure of the bacterial, viral and fungal infections and the dynamics of the pathogen spectra are presented. The results of the analysis showed that the infections were frequent complications in such patients and could be due not only to obligate but also to opportunistic pathogens, that requires design of the diagnostic algorithm for prediction of the complication process and outcome, thus improving the remote results of the treatment.PMID: 18461807 [PubMed - in process]
Labels: Hodgkin's lymphoma; infectious complications; bacterial infections
Tuesday, April 22, 2008
Necrotizing skin and soft-tissue infections associated with septicemia: 7 cases report and review.
J Med Assoc Thai. 2008 Jan
Thaichinda S, Kositpantawong N.
Division of Dermatology, Department of Medicine, Hat Yai Hospital, Songkhla, Thailand. bombergirl_16@hotmail.com
The authors report seven cases of necrotizing skin and soft-tissue infections, with clinical presenting as hemorrhagic bullae, gangrenous cellulitis or necrotizing fasciitis, in association with septicemia, between January 2003 and January 2007 in Hat Yai Hospital. Six were male and the majority of the lesions, six cases, occurred in the lower extremities. The average age of the patients was 50.0 +/- 11.019 years old. All patients presented with watery diarrhea, severe abdominal pain, high fever and sepsis. The skin lesions were begun with erythema, tender and swelling with formation of hemorrhagic bullae, gangrene and necrosis within 24-48 hours. Three of them were caused by Streptococcus spp., another three by Halophilic Vibrios, and only one by Aeromonas hydrophila. Furthermore, the literatures related with clinical manifestations of necrotizing skin and soft-tissue infections, etiologic pathogens, histological finding, management in setting of sepsis, comorbid conditions, complications and patients' outcome were reviewed.
Labels: Aeromonas hydrophila, gangrenous cellulitis, Halophilic Vibrios, hemorrhagic bullae, necrotizing fasciitis, septicemia, soft tissue infections
Thursday, March 27, 2008
Late onset group B Streptococcus infection: 7 year experience in a tertiary hospital (2000-2006)
An Pediatr (Barc). 2008 Mar
Prieto Tato LM, Gimeno Díaz de Atauri A, Aracil Santos J, Omeñaca Teres F, Del Castillo Martín F, de José Gómez MI.
Servicio de Enfermedades Infecciosas Infantil. Hospital Universitario La Paz. Madrid. España.
INTRODUCTION: Group B Streptococcus (GBS) is a major cause of neonatal infection. Two forms of the disease have been described according to the age of presentation: early, beginning in the first 6 days of life, and late, occurring from day 7 up to 3 months of age.
OBJECTIVES: To analyze the epidemiology of the late onset form of GBS disease in a tertiary hospital after implementing preventive strategies aimed to reduce the rate of vertical transmission. METHODS: We retrospectively reviewed the medical records of children diagnosed with late GBS infection between January 2000 and December 2006. Diagnostic criteria included a positive blood culture and/or a positive cerebrospinal fluid (CSF) culture for GBS in any patient aged between 7 and 89 days.
RESULTS: 24 patients were identified, most of them presenting after January 2005. Median age was 36.2 days (range 9 to 81). GBS isolates in blood were found in 20 patients, 1 in CSF and 3 in both. Most frequently children presented with fever (70.8 %) and irritability (54.1 %). Five patients (20.8 %) had a cellulitis-adenitis syndrome. Cefotaxime and ampicillin were the most often used antibiotic combination. No ampicillin resistances were found.
CONCLUSIONS: The number of children with late GBS disease has increased in our center. Accordingly, the recent recommendations for the prevention of perinatal GBS vertical transmission were not effective for reducing late GBS infection. This may be due to horizontal infections from maternal sources, community or cross infections. It is important to maintain clinical suspicion of late GBS infection and start early antibiotic treatment.
Keywords: Group B Streptococcus. Late onset disease. Horizontal transmission.
Annals of Pediatric
Labels: ampicillin, cefotaxime, GBS, Group B Streptococcus, Horizontal transmission.cellulitis-adenitis syndrome, Late onset disease
Sunday, March 23, 2008
The Management of Clostridium difficile Infection: Antibiotics, Probiotics and Other Strategies
J Chemother. 2008 Feb
Senok AC, Rotimi VO.
Clostridium difficile-associated disease remains an important nosocomial infection associated with significant morbidity and mortality. In recent years, there has been an upward trend in the incidence of this condition with continuing high rates of recurrent disease with available treatment regimens. In this article, we review the current literature on the management of C. difficile-associated disease (CDAD). The potential role for alternative therapeutic options for the treatment of CDAD, including the use of bacteriotherapy in the form of probiotics, immunotherapy and ion-exchange resins as well as new drugs under investigation is explored.
The evidence indicates a need for innovative approaches to the management of this condition. The combined use of antibiotic therapy and replacement of gut microbiota using probiotics remains promising and we suggest a multi-pronged approach in the management of this challenging infection.
Journal of Chemotherapy
Labels: antibiotics, bacteriotherapy, Clostridium difficile Infection, gut microbiota, immunotherapy, morbidity, mortality, propbiotics
The evaluation and treatment of complicated skin and skin structure infections
April 2008
Exper Opinion on Parhmacotherapy
Paul B Cornia1,2 MD, Heather L Davidson1 MD & Benjamin A Lipsky1 MD
1University of Washington School of Medicine, Primary and Specialty Medicine Service, Veterans Affairs Puget Sound Health Care System and Department of Medicine, Seattle, WA 98108-1597, USA
2Assistant Professor of Medicine University of Washington, VA Puget Sound Health Care System (S-111), 1660 South Columbian Way, Seattle, WA 98108-1597, USA +1 206 764 2551; +1 206 764 2936; paul.cornia@med.va.gov
Background:
Skin and skin structure infections are frequently encountered in clinical practice. Fortunately, these infections usually produce only mild to moderate symptoms and signs. Some, however, are severe and may even be life-threatening.
Objective:
To review the approach to the evaluation and treatment of patients with complicated skin and skin structure infections and to discuss when to consider using either established antibiotics or recently licensed agents for treating these infections.
Methods:
In addition to a non-systematic literature review of complicated skin and skin structure infections and necrotizing fasciitis, we identified recent articles examining the microbiology and describing recently licensed antibiotics for treating these infections.
Results/conclusions:
Clinicians must learn to recognize the early symptoms and signs of severe skin and skin structure infections to ensure they select appropriate empiric antibiotic therapy and, when needed, obtain prompt surgical consultation. While the recent approvals of new agents for treating these infections are welcome, particularly in light of the continued emergence of antibiotic-resistant bacteria, traditional antibiotic regimens remain appropriate for most cases.
Expert Opinion
Labels: antibiotic therapy, bacterial myonecrosis. skin structurw infections, necrotizing fasciitis, skin infections
Thursday, March 20, 2008
Early neonatal bacterial infections: Could superficial bacteriologic samples at birth be limited?]
Arch Pediatr. 2008 Mar 10
Noguer Stroebel A, Thibaudon C, Dubos JP, Djavadzadeh-Amini M, Husson MO, Truffert P.
Service de pédiatrie en maternité, pôle d’obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 2, rue Oscar-Lambert, 59037 Lille cedex, France.
INTRODUCTION: Without promptly started antibiotic therapy, early neonatal bacterial infections incur a significant mortality. Superficial bacteriologic samples at birth have in France a real place for the diagnosis and the decision to treat a neonate. OBJECTIVES: In order to limit their indication and their choice, the aim of this article was to describe the proportion of neonates with samples and to determine the diagnostic value of the gastric aspirate, the ear swab and the placental sample.
METHODS: Neonates born in the CHRU of Lille in 2005 and staying in the maternity ward were prospectively included. Criteria for samples, type of samples and diagnosis taken were noted. Sensibility, specificity, positive and negative predictive values and likelihood ratios for a positive test and a negative test were calculated.
RESULTS AND CONCLUSION: This study included 3918 neonates; 1.7% (65 children) were infected according to our criteria; 42.3% received bacteriologic samples. In accordance with the Anaes guidelines (2002), if mothers were Group B Streptoccocci positive and received intrapartum antibiotics (up to 2 injections) or did not have any screening test whithout any other indication of samples, the neonate did not have to receive bacteriologic samples. The gastric aspirate was the best exam thanks to the excellent negative predictive value of its direct examination: 99.4% (IC 95%: 98.8-99.7), its high likelihood ratio for a positive test: 10.04 (IC 95%: 8.29-12.15) and its low likelihood ratio for a negative test: 0.16 (IC 95%: 0.09-0.29); this sample could restrict the antibiotics' ratio given to the neonate. Placental sample could be taken only in certain indications.
ElsevierLabels: Anaes guidelines, bacterial infections, ear swab, gastric aspirate, Group B Streptoccocci positive, intrapartum antibiotics, neonatal, Placental sample
Friday, March 14, 2008
Management of common bacterial infections of the skin
Curr Opin Infect Dis. 2008 Apr
Bernard P.
Department of Dermatology, Robert Debré Hospital, Reims, France.
PURPOSE OF REVIEW: Bacterial skin infections commonly encountered in the community include impetigo, folliculitis/furunculosis, simple abscesses, erysipelas and other nonnecrotizing cellulitis. The review focuses on recent epidemiological, bacteriological and therapeutic advances.
RECENT FINDINGS: Impetigo and erysipelas occur in about 20 and 1 person/1000/year, respectively. Main risk factors for erysipelas are toe-web intertrigo and lymphedema. The true incidence of furunculosis is unknown, whereas outbreaks in small communities are reported worldwide. Staphylococcus aureus is the predominant pathogen for impetigo and furunculosis, and methicillin-resistant strains play a growing role in both diseases.
Erysipelas are mainly caused by streptococci, whereas local complications (i.e. abscesses or blisters) may be due to staphylococci, including methicillin-resistant strains in involved geographic areas. Recent trends for treating impetigo and furunculosis predate community-acquired methicillin-resistant S. aureus.
For outbreaks of furunculosis, stringent decolonization measures are showing promise, whereas there is no validated therapeutic regimen for chronic furunculosis.
Current trends for erysipelas involve ambulatory treatments and reduced duration of antibiotics.
SUMMARY: Despite better epidemiological or bacteriological knowledge of common bacterial skin infections, the exact role of methicillin-resistant staphylococci needs regular surveys in involved geographic areas. Antibiotic treatment must be active on staphylococci and, to a lesser degree, on streptococci.
Lippincott, Williams & Wilkins
Labels: common bacterial infections. skin infections, erysipelas impetigo, furuncles, furunculosis, lymphedema, staphylococci, streptococci, toe-web intertrigo
Wednesday, March 05, 2008
Serum markers in community-acquired pneumonia and ventilator-associated pneumonia
Curr Opin Infect Dis. 2008 Apr
Póvoa P.
Faculty of Medical Sciences, New University of Lisbon, Medical Intensive Care Unit, Department of Medicine, São Francisco Xavier Hospital, Lisbon, Portugal.
PURPOSE OF REVIEW: This article reviews recent data on the usefulness of serum markers in community-acquired pneumonia and ventilator-associated pneumonia. The focus is on clinical studies, with an emphasis on adult critically ill patients.
RECENT FINDINGS: Serum markers have demonstrated potential value in early prediction and diagnosis of pneumonia, in monitoring the clinical course and in guiding antibiotic therapy. C-reactive protein appears to perform better in diagnosing infection, because several studies have shown that procalcitonin may remain undetectable in some patients, specifically those with pneumonia. Procalcitonin exhibited a better correlation with clinical severity, however. Furthermore, one report demonstrated the efficacy and safety of procalcitonin-guided antibiotic therapy in community-acquired pneumonia.
SUMMARY: Serum markers should only be used as a complementary tool to support the current clinical approach. Use of serum markers, in particular procalcitonin and C-reactive protein, represents a promising strategy in the clinical decision-making process in patients in whom pneumonia is suspected. Specifically, these markers can be used to guide culture sampling and empirical antibiotic prescription, and to monitor the clinical course, adjust the duration of antibiotic therapy and identify nonresponders, in whom an aggressive diagnostic and therapeutic approach may prevent further clinical deterioration.
Lippincott, Williams & WilkinsLabels: c-reactive protein, culture sampling, Pneumococcal; antimicrobial resistance; community-acquired pneumonia; beta-lactam; serum marker, procalcitorin, ventilator-associated pneumonia
What is healthcare-associated pneumonia and how is it managed?
Curr Opin Infect Dis. 2008 Apr
Carratalà J, Garcia-Vidal C.
Infectious Disease Service, Hospital Universitari de Bellvitge, Institut dʼInvestigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, LʼHospitalet de Llobregat, Barcelona, Spain.
PURPOSE OF REVIEW: Pneumonia developing before hospital admission in patients in close contact with the health system was recently termed 'healthcare-associated pneumonia' and proposed as a new category of respiratory infection. We focus on the recent literature concerning the epidemiology, causative organisms, antibiotic susceptibilities, and outcomes of and empirical antibiotic therapy for this condition.
RECENT FINDINGS: The reported incidence of healthcare-associated pneumonia among patients requiring hospitalization for pneumonia ranges from 17% to 67%. Hospitalization within 90 days before pneumonia, attending a dialysis clinic and residing in a nursing home were the most common criteria for healthcare-associated pneumonia. Compared with patients with community-acquired pneumonia, those with healthcare-associated pneumonia are older, have greater co-morbidity, and are more likely to have aspiration pneumonia and pneumonia caused by antibiotic-resistant pathogens. Patients with healthcare-associated pneumonia also more frequently initially receive an inappropriate antibiotic therapy, have higher case fatality rates and have longer hospital stay.
SUMMARY: Many patients hospitalized with pneumonia via the emergency department have healthcare-associated pneumonia. There are significant differences in the spectrum of causative organisms and antibiotic susceptibilities between healthcare-associated and community-acquired pneumonia. Physicians should differentiate patients with healthcare-associated pneumonia from those with community-acquired pneumonia to promote a targeted approach when selecting initial antibiotic therapy.
Lippincott, Williams & Wilkins
Labels: antibiotic-resistant pathogens, aspiration pneumonia, epidemiology, healthcare-associated pneumonia, respiratory tract infection
