Thursday, March 27, 2008
Late onset group B Streptococcus infection: 7 year experience in a tertiary hospital (2000-2006)
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
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
# posted by Pat O'Connor @ 9:13 AM
Sunday, March 23, 2008
The Management of Clostridium difficile Infection: Antibiotics, Probiotics and Other Strategies
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
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
# posted by Pat O'Connor @ 12:31 AM
The evaluation and treatment of complicated skin and skin structure infections
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
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
# posted by Pat O'Connor @ 12:25 AM
Thursday, March 20, 2008
Early neonatal bacterial infections: Could superficial bacteriologic samples at birth be limited?]
Early neonatal bacterial infections: Could superficial bacteriologic samples at birth be limited?
Arch Pediatr. 2008 Mar 10
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
# posted by Pat O'Connor @ 5:07 PM
Friday, March 14, 2008
Management of common bacterial infections of the skin
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
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
# posted by Pat O'Connor @ 4:57 AM
Wednesday, March 05, 2008
Serum markers in community-acquired pneumonia and ventilator-associated pneumonia
Serum markers in community-acquired pneumonia and ventilator-associated pneumonia
Curr Opin Infect Dis. 2008 Apr
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
# posted by Pat O'Connor @ 9:08 PM
What is healthcare-associated pneumonia and how is it managed?
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
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
# posted by Pat O'Connor @ 9:01 PM
Sunday, March 02, 2008
Diphtheria
Diphtheria
Basic Fact Sheet - 2007
Description
Diphtheria is an acute bacterial disease caused by toxigenic strains of Corynebacterium diphtheriae. There are four biotypes: gravis, mitis, intermedius and belfanti (1). Toxin-producing strains of C. ulcerans may also cause a diphtheria-like illness. The disease affects the mucous membranes of the respiratory tract (respiratory diphtheria), the skin (cutaneous diphtheria), and occasionally mucous membranes at other sites (eyes, ears, or vagina).
Cutaneous diphtheria is common in tropical countries (2). Humans are the only known reservoir of C. diphtheriae. Diphtheria is transmitted to close contacts by respiratory droplets or by direct contact with discharge from skin lesions, and rarely from fomites. Raw milk or dairy products have been reported as vehicles for transmission (3).
Occurrence
Diphtheria is sporadically reported in the US and the last case occurred in an elderly traveler immediately after returning to the US from a country with endemic diphtheria (4). However, the disease can cause morbidity and mortality in developing countries where childhood vaccination coverage is low (5). Large outbreaks of diphtheria occurred in the 1990s throughout Russia and the newly independent states of the former Soviet Union (6). In the Americas, diphtheria was more recently reported from Paraguay, the Dominican Republic, and Haiti (5). Countries with endemic diphtheria (5) are shown in the Table 4-1.
Risk for Travelers
Travelers to countries with endemic diphtheria are at a higher risk of disease following exposure to toxigenic C. diphtheriae if they are inadequately immunized or not up-to-date with diphtheria booster immunizations. Although immunization does not prevent colonization or carriage of C. diphtheriae, symptomatic, or clinically evident infection is extremely rare in adequately immunized persons. Most cases occur in unvaccinated or inadequately immunized persons (7–9).
Clinical Presentation
The incubation period is 2-5 days (range 1-10 days), and the onset of symptoms is gradual. Early symptoms of respiratory diphtheria include malaise, sore throat, difficulty in swallowing, loss of appetite, and a mild fever (rarely >101° F). If the larynx is involved, the affected person may become hoarse. Within 2–3 days, an adherent, gray membrane forms over the mucous membrane of the tonsils, pharynx, or both. Attempts to remove the membrane cause bleeding. In severe cases of respiratory diphtheria, cervical lymphadenopathy and soft tissue swelling in the neck give rise to a “bull-neck” appearance (10). Extensive membrane formation may result in life-threatening or fatal airway obstruction. Diphtheria toxin can cause serious systemic complications, including myocarditis and neuropathies, if it is absorbed from the site of infection. Cutaneous and nasal diphtheria are localized infections that are rarely associated with systemic toxicity. The case-fatality rate of respiratory diphtheria is 5%-10%.
Prevention
VACCINE
Routine Immunizations for Infants and Children <7>
Immunization for infants and children up to the seventh birthday consists of five doses of DTaP vaccine. The first three doses are usually given at ages 2, 4 and 6 months, the fourth dose at ages 15-18 months, and the fifth dose at ages 4-6 years. The fifth dose is not necessary if the fourth dose was given after the child’s fourth birthday (11).
Travelers should be advised to complete as many doses as possible of the primary series before traveling. At least three doses of DTaP are necessary for protection against diphtheria. If an accelerated schedule is required to complete the series of DTaP vaccine, the schedule may be started as soon as the infant is 6 weeks of age, with the second and third doses given 4 weeks after each preceding dose (Table 8-4). The fourth dose should not be given before the child is 12 months of age and should be separated from the third dose by at least 6 months. The fifth dose should not be given before the child is age 4 years. Interruption of the recommended schedule or delay in doses does not lead to a reduction in the level of immunity reached on completion of the primary series. There is no need to restart a series regardless of the time that has elapsed between doses. For infants and children older than 7 years with a contraindication to the pertussis component of DTaP, diphtheria-tetanus (DT) can be used (11) (Tables 8-2, 8-3 and 8-4).
Primary Immunizations for Children ≥7 Years of Age, Adolescents, and Adults
There is no pertussis-containing vaccine licensed for children 7 to 9 years of age. In 2005, two tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines were licensed for use by the FDA. BOOSTRIX (GlaxoSmith-Kline Biologicals) has been licensed for use in people 10-18 years old and ADACEL (Sanofi Pasteur) has been licensed for use in people 11-64 years old (12).
Children 7–9 years of age who have not received a primary series against tetanus and diphtheria should receive three doses of Td because no pertussis-containing vaccine is licensed for use in this age group (11). If a child is 10 years old, a single dose of BOOSTRIX may be substituted for one of the Td doses.
Persons older than 11 years of age who have never been vaccinated against tetanus, diphtheria or pertussis (no dose of pediatric DTP/DTaP/DT/ or Td) should receive three doses of a tetanus and diphtheria toxoid-containing vaccine. For persons 11–64 years of age, the preferred schedule is a single Tdap dose, followed by a dose of Td given 4-8 weeks later. A second dose of Td is given at 6–12 months after the earlier Td dose. Two doses of a Td-containing vaccine can provide some protection against diphtheria, but a single dose is of little benefit. In the rare instance when vaccine administration following a 6–12-month interval cannot be ensured, an interval of 4-8 weeks may be used to complete the primary series (12,13).
Anyone whose history of primary tetanus and diphtheria vaccination is uncertain should be considered unvaccinated and should receive the three-dose series. Anyone who has received only one or two prior doses of tetanus and diphtheria toxoids should receive additional dose(s) to complete the three-dose series. A single dose of Tdap can be substituted for any of the Td doses (11,12).
Booster Immunizations for Children ≥7 Years of Age, Adolescents, and Adults
Adolescents 11–18 years of age should receive a single dose of Tdap instead of Td for booster immunization against tetanus, diphtheria, and pertussis if they have completed the recommended childhood DTwP/DTaP vaccination series. Thereafter, routine booster doses of Td vaccine should be given at 10-year intervals (11,12). This is especially important for travelers who will be living or working with local populations in countries where diphtheria is endemic.
Adults 19–64 years of age should receive a single dose of Tdap (ADACEL) to replace a single dose of Td for active booster immunization against tetanus, diphtheria and pertussis, if they received their last dose of Td more than 10 years earlier and have not previously received a dose of Tdap. Replacing one dose of Td with Tdap should reduce the morbidity associated with pertussis in adults and may reduce the risk of transmitting pertussis to persons at increased risk for pertussis and its complications (13). Tdap is not licensed or recommended for adults 65 years of age and older, who should receive Td instead.
Adverse Reactions
Local reactions (erythema and induration with or without tenderness) are common after the administration of vaccines containing diphtheria, tetanus, and pertussis antigens (DTaP, TD, Td, Tdap) (11,12). Mild systemic reactions such as drowsiness, fretfulness, and low-grade fever can occur after vaccination with DTaP. These reactions are self-limited and can be managed with symptomatic treatment of acetaminophen or ibuprofen. Swelling involving the entire thigh or upper arm has occurred after the fourth and fifth doses of DTaP. These reactions are also self limited (11).
Anaphylactic and other serious adverse reactions are rare after receipt of preparations containing diphtheria, tetanus or pertussis components, or a combination of these. Arthus-type hypersensitivity reactions, characterized by severe local reactions, have been reported in adults who received frequent boosters of tetanus or diphtheria toxoids (11).
Precautions and Contraindications
An immediate anaphylactic reaction to a prior dose of vaccine or vaccine component is a contraindication to further vaccination with DTaP, DT, Tdap, or Td. Encephalopathy not due to another identifiable cause within 7 days of vaccination is a contraindication to further vaccination with a pertussis-containing vaccine. DT or Td may be substituted for DTaP or Tdap, respectively.
Moderate or severe acute illness is a precaution to vaccination. Mild illnesses, such as otitis media or upper respiratory infection, are not contraindications. Anyone for whom vaccination is deferred because of moderate or severe acute illness should be vaccinated when the condition improves.
Development of Guillain-Barré syndrome 6 weeks or less after a previous dose of a tetanus toxoid-containing vaccine is considered a precaution. Risks and benefits of immunization should be evaluated by the vaccine provider before administering Td or Tdap. Certain infrequent adverse events following pertussis vaccination are considered precautions (not contraindications) to additional doses of DTaP but not to Tdap: a seizure, with or without fever, occurring within 3 days of immunization; temperature higher than 40.5° C (105° F) not resulting from another identifiable cause within 48 hours of immunization; collapse or a shock-like state (hypotonic-hyporesponsive episode) within 48 hours of immunization, or persistent, inconsolable crying lasting longer than 3 hours and occurring within 48 hours of immunization. These events have not been demonstrated to cause permanent sequelae. In certain circumstances (e.g., during a communitywide outbreak of pertussis), the benefit of additional vaccination with DTaP in children or Tdap in adults may outweigh the risk of another reaction.
Progressive neurologic conditions characterized by changing developmental findings are considered contraindications to receipt of pertussis vaccine. Such disorders include infantile spasms and other epilepsies beginning in infancy (3). Infants and children with stable neurologic conditions such as cerebral palsy or controlled seizures should be vaccinated.
Treatment
The diagnosis is usually presumptive, based on clinical features. A definitive diagnosis is based on a positive culture of C. diphtheriae from a throat swab, membrane. Toxin production is confirmed by performing a modified Elek test.
Patients with respiratory diphtheria require hospitalization, immediate treatment with diphtheria antitoxin (DAT), appro-priate antibiotics and supportive care, and monitoring of their close contacts (14,15).
References
Funke F, von Graevenitz A, Clarridge JE 3rd, Bernard KA. Clinical microbiology of coryneform bacteria. Clin Microbiol Rev. 1997;10:125-59.
Galazka AM. The immunologic basis for immunization: Diphtheria (WHO/EPI/GEN/13.13). Geneva, World Health Organization, 1993. Available at: http://whqlibdoc.who.int/hq/1993/WHO_EPI_GEN_93.13_mod2.pdf.
American Academy of Pediatrics. Diphtheria. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:277–81.
CDC. Summary of notifiable diseases—United States, 2004. MMWR Morbid Mortal Wkly Rep. 2004;53:46.
World Health Organization. WHO vaccine-preventable diseases monitoring system: 2005 global summary. Geneva, Switzerland: World Health Organization, 2006.
Galazka A. The changing epidemiology of diphtheria in the vaccine era. J Infect Dis. 2000;181(suppl 1):S2-9.
Bisgard KM, Hardy IRB, Popovic T, Strebel PM, Wharton M, Chen RT, et al. Respiratory diphtheria in the United States, 1980 through 1995. Am J Public Health. 1998;88:787–91.
CDC. Fatal respiratory diphtheria in a U.S. traveler to Haiti—2003. MMWR Morbid Mortal Wkly Rep. 2003;52:1285–6.
CDC. Diphtheria acquired by U.S. citizens in the Russian Federation and Ukraine—1994. MMWR Morbid Mortal Wkly Rep. 1995; 44:243–4.
Wharton M, Vitek CR. Diphtheria toxoid. In: Plotkin SA, Orenstein WA, eds. Vaccines. 4th ed. Philadelphia: W.B. Saunders; 2004:211–28.
CDC. General recommendations on immunizations: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP). MMWR Recomm Rep. 2002;51(RR-2):1–35.
CDC. Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommm Rep. 2006;55(RR-3):1–50.
CDC. ACIP Votes to Recommend Use of Combined Tetanus, Diphtheria and Pertussis (Tdap) Vaccine for Adults. Available at PDF (Accessed on August 11, 2006.
Farizo KM, Strebel PM, Chen RT, Kimbler A, Cleary TJ, Cochi SL. Fatal respiratory disease due to Corynebacterium diphtheriae: case report and review of guidelines for management, investigation, and control. Clin Infect Dis. 1993;16:59-68.
CDC. Notice to Readers: Availability of diphtheria antitoxin through an Investigational New Drug protocol. MMWR Morbid Mortal Wkly Rep. 2004;53:413.
CDC
Basic Fact Sheet - 2007
Description
Diphtheria is an acute bacterial disease caused by toxigenic strains of Corynebacterium diphtheriae. There are four biotypes: gravis, mitis, intermedius and belfanti (1). Toxin-producing strains of C. ulcerans may also cause a diphtheria-like illness. The disease affects the mucous membranes of the respiratory tract (respiratory diphtheria), the skin (cutaneous diphtheria), and occasionally mucous membranes at other sites (eyes, ears, or vagina).
Cutaneous diphtheria is common in tropical countries (2). Humans are the only known reservoir of C. diphtheriae. Diphtheria is transmitted to close contacts by respiratory droplets or by direct contact with discharge from skin lesions, and rarely from fomites. Raw milk or dairy products have been reported as vehicles for transmission (3).
Occurrence
Diphtheria is sporadically reported in the US and the last case occurred in an elderly traveler immediately after returning to the US from a country with endemic diphtheria (4). However, the disease can cause morbidity and mortality in developing countries where childhood vaccination coverage is low (5). Large outbreaks of diphtheria occurred in the 1990s throughout Russia and the newly independent states of the former Soviet Union (6). In the Americas, diphtheria was more recently reported from Paraguay, the Dominican Republic, and Haiti (5). Countries with endemic diphtheria (5) are shown in the Table 4-1.
Risk for Travelers
Travelers to countries with endemic diphtheria are at a higher risk of disease following exposure to toxigenic C. diphtheriae if they are inadequately immunized or not up-to-date with diphtheria booster immunizations. Although immunization does not prevent colonization or carriage of C. diphtheriae, symptomatic, or clinically evident infection is extremely rare in adequately immunized persons. Most cases occur in unvaccinated or inadequately immunized persons (7–9).
Clinical Presentation
The incubation period is 2-5 days (range 1-10 days), and the onset of symptoms is gradual. Early symptoms of respiratory diphtheria include malaise, sore throat, difficulty in swallowing, loss of appetite, and a mild fever (rarely >101° F). If the larynx is involved, the affected person may become hoarse. Within 2–3 days, an adherent, gray membrane forms over the mucous membrane of the tonsils, pharynx, or both. Attempts to remove the membrane cause bleeding. In severe cases of respiratory diphtheria, cervical lymphadenopathy and soft tissue swelling in the neck give rise to a “bull-neck” appearance (10). Extensive membrane formation may result in life-threatening or fatal airway obstruction. Diphtheria toxin can cause serious systemic complications, including myocarditis and neuropathies, if it is absorbed from the site of infection. Cutaneous and nasal diphtheria are localized infections that are rarely associated with systemic toxicity. The case-fatality rate of respiratory diphtheria is 5%-10%.
Prevention
VACCINE
Routine Immunizations for Infants and Children <7>
Immunization for infants and children up to the seventh birthday consists of five doses of DTaP vaccine. The first three doses are usually given at ages 2, 4 and 6 months, the fourth dose at ages 15-18 months, and the fifth dose at ages 4-6 years. The fifth dose is not necessary if the fourth dose was given after the child’s fourth birthday (11).
Travelers should be advised to complete as many doses as possible of the primary series before traveling. At least three doses of DTaP are necessary for protection against diphtheria. If an accelerated schedule is required to complete the series of DTaP vaccine, the schedule may be started as soon as the infant is 6 weeks of age, with the second and third doses given 4 weeks after each preceding dose (Table 8-4). The fourth dose should not be given before the child is 12 months of age and should be separated from the third dose by at least 6 months. The fifth dose should not be given before the child is age 4 years. Interruption of the recommended schedule or delay in doses does not lead to a reduction in the level of immunity reached on completion of the primary series. There is no need to restart a series regardless of the time that has elapsed between doses. For infants and children older than 7 years with a contraindication to the pertussis component of DTaP, diphtheria-tetanus (DT) can be used (11) (Tables 8-2, 8-3 and 8-4).
Primary Immunizations for Children ≥7 Years of Age, Adolescents, and Adults
There is no pertussis-containing vaccine licensed for children 7 to 9 years of age. In 2005, two tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines were licensed for use by the FDA. BOOSTRIX (GlaxoSmith-Kline Biologicals) has been licensed for use in people 10-18 years old and ADACEL (Sanofi Pasteur) has been licensed for use in people 11-64 years old (12).
Children 7–9 years of age who have not received a primary series against tetanus and diphtheria should receive three doses of Td because no pertussis-containing vaccine is licensed for use in this age group (11). If a child is 10 years old, a single dose of BOOSTRIX may be substituted for one of the Td doses.
Persons older than 11 years of age who have never been vaccinated against tetanus, diphtheria or pertussis (no dose of pediatric DTP/DTaP/DT/ or Td) should receive three doses of a tetanus and diphtheria toxoid-containing vaccine. For persons 11–64 years of age, the preferred schedule is a single Tdap dose, followed by a dose of Td given 4-8 weeks later. A second dose of Td is given at 6–12 months after the earlier Td dose. Two doses of a Td-containing vaccine can provide some protection against diphtheria, but a single dose is of little benefit. In the rare instance when vaccine administration following a 6–12-month interval cannot be ensured, an interval of 4-8 weeks may be used to complete the primary series (12,13).
Anyone whose history of primary tetanus and diphtheria vaccination is uncertain should be considered unvaccinated and should receive the three-dose series. Anyone who has received only one or two prior doses of tetanus and diphtheria toxoids should receive additional dose(s) to complete the three-dose series. A single dose of Tdap can be substituted for any of the Td doses (11,12).
Booster Immunizations for Children ≥7 Years of Age, Adolescents, and Adults
Adolescents 11–18 years of age should receive a single dose of Tdap instead of Td for booster immunization against tetanus, diphtheria, and pertussis if they have completed the recommended childhood DTwP/DTaP vaccination series. Thereafter, routine booster doses of Td vaccine should be given at 10-year intervals (11,12). This is especially important for travelers who will be living or working with local populations in countries where diphtheria is endemic.
Adults 19–64 years of age should receive a single dose of Tdap (ADACEL) to replace a single dose of Td for active booster immunization against tetanus, diphtheria and pertussis, if they received their last dose of Td more than 10 years earlier and have not previously received a dose of Tdap. Replacing one dose of Td with Tdap should reduce the morbidity associated with pertussis in adults and may reduce the risk of transmitting pertussis to persons at increased risk for pertussis and its complications (13). Tdap is not licensed or recommended for adults 65 years of age and older, who should receive Td instead.
Adverse Reactions
Local reactions (erythema and induration with or without tenderness) are common after the administration of vaccines containing diphtheria, tetanus, and pertussis antigens (DTaP, TD, Td, Tdap) (11,12). Mild systemic reactions such as drowsiness, fretfulness, and low-grade fever can occur after vaccination with DTaP. These reactions are self-limited and can be managed with symptomatic treatment of acetaminophen or ibuprofen. Swelling involving the entire thigh or upper arm has occurred after the fourth and fifth doses of DTaP. These reactions are also self limited (11).
Anaphylactic and other serious adverse reactions are rare after receipt of preparations containing diphtheria, tetanus or pertussis components, or a combination of these. Arthus-type hypersensitivity reactions, characterized by severe local reactions, have been reported in adults who received frequent boosters of tetanus or diphtheria toxoids (11).
Precautions and Contraindications
An immediate anaphylactic reaction to a prior dose of vaccine or vaccine component is a contraindication to further vaccination with DTaP, DT, Tdap, or Td. Encephalopathy not due to another identifiable cause within 7 days of vaccination is a contraindication to further vaccination with a pertussis-containing vaccine. DT or Td may be substituted for DTaP or Tdap, respectively.
Moderate or severe acute illness is a precaution to vaccination. Mild illnesses, such as otitis media or upper respiratory infection, are not contraindications. Anyone for whom vaccination is deferred because of moderate or severe acute illness should be vaccinated when the condition improves.
Development of Guillain-Barré syndrome 6 weeks or less after a previous dose of a tetanus toxoid-containing vaccine is considered a precaution. Risks and benefits of immunization should be evaluated by the vaccine provider before administering Td or Tdap. Certain infrequent adverse events following pertussis vaccination are considered precautions (not contraindications) to additional doses of DTaP but not to Tdap: a seizure, with or without fever, occurring within 3 days of immunization; temperature higher than 40.5° C (105° F) not resulting from another identifiable cause within 48 hours of immunization; collapse or a shock-like state (hypotonic-hyporesponsive episode) within 48 hours of immunization, or persistent, inconsolable crying lasting longer than 3 hours and occurring within 48 hours of immunization. These events have not been demonstrated to cause permanent sequelae. In certain circumstances (e.g., during a communitywide outbreak of pertussis), the benefit of additional vaccination with DTaP in children or Tdap in adults may outweigh the risk of another reaction.
Progressive neurologic conditions characterized by changing developmental findings are considered contraindications to receipt of pertussis vaccine. Such disorders include infantile spasms and other epilepsies beginning in infancy (3). Infants and children with stable neurologic conditions such as cerebral palsy or controlled seizures should be vaccinated.
Treatment
The diagnosis is usually presumptive, based on clinical features. A definitive diagnosis is based on a positive culture of C. diphtheriae from a throat swab, membrane. Toxin production is confirmed by performing a modified Elek test.
Patients with respiratory diphtheria require hospitalization, immediate treatment with diphtheria antitoxin (DAT), appro-priate antibiotics and supportive care, and monitoring of their close contacts (14,15).
References
Funke F, von Graevenitz A, Clarridge JE 3rd, Bernard KA. Clinical microbiology of coryneform bacteria. Clin Microbiol Rev. 1997;10:125-59.
Galazka AM. The immunologic basis for immunization: Diphtheria (WHO/EPI/GEN/13.13). Geneva, World Health Organization, 1993. Available at: http://whqlibdoc.who.int/hq/1993/WHO_EPI_GEN_93.13_mod2.pdf.
American Academy of Pediatrics. Diphtheria. In: Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:277–81.
CDC. Summary of notifiable diseases—United States, 2004. MMWR Morbid Mortal Wkly Rep. 2004;53:46.
World Health Organization. WHO vaccine-preventable diseases monitoring system: 2005 global summary. Geneva, Switzerland: World Health Organization, 2006.
Galazka A. The changing epidemiology of diphtheria in the vaccine era. J Infect Dis. 2000;181(suppl 1):S2-9.
Bisgard KM, Hardy IRB, Popovic T, Strebel PM, Wharton M, Chen RT, et al. Respiratory diphtheria in the United States, 1980 through 1995. Am J Public Health. 1998;88:787–91.
CDC. Fatal respiratory diphtheria in a U.S. traveler to Haiti—2003. MMWR Morbid Mortal Wkly Rep. 2003;52:1285–6.
CDC. Diphtheria acquired by U.S. citizens in the Russian Federation and Ukraine—1994. MMWR Morbid Mortal Wkly Rep. 1995; 44:243–4.
Wharton M, Vitek CR. Diphtheria toxoid. In: Plotkin SA, Orenstein WA, eds. Vaccines. 4th ed. Philadelphia: W.B. Saunders; 2004:211–28.
CDC. General recommendations on immunizations: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP). MMWR Recomm Rep. 2002;51(RR-2):1–35.
CDC. Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommm Rep. 2006;55(RR-3):1–50.
CDC. ACIP Votes to Recommend Use of Combined Tetanus, Diphtheria and Pertussis (Tdap) Vaccine for Adults. Available at PDF (Accessed on August 11, 2006.
Farizo KM, Strebel PM, Chen RT, Kimbler A, Cleary TJ, Cochi SL. Fatal respiratory disease due to Corynebacterium diphtheriae: case report and review of guidelines for management, investigation, and control. Clin Infect Dis. 1993;16:59-68.
CDC. Notice to Readers: Availability of diphtheria antitoxin through an Investigational New Drug protocol. MMWR Morbid Mortal Wkly Rep. 2004;53:413.
CDC
Labels: anaphylactic, bacterial disease, belfanti, cutaneous diphtheria, Diphtheria, diphtheria antitoxin (DAT), edema, Elek test, erythema, induration, intermedius, mitis, swelling, vaccine; allergy
# posted by Pat O'Connor @ 7:14 PM
Saturday, March 01, 2008
Effect and Mechanism of Andrographolide on the Recovery of Pseudomonas aeruginosa Susceptibility to Several Antibiotics
Effect and Mechanism of Andrographolide on the Recovery of Pseudomonas aeruginosa Susceptibility to Several Antibiotics
J Int Med Res. 2008 Jan-Feb
Wu CM, Cao JL, Zheng MH, Ou Y, Zhang L, Zhu XQ, Song JX.
Department of Liver Diseases, The Traditional Chinese Medical Hospital of Wenzhou, Wenzhou, China.
Effectiveness and mechanism of action of andrographolide on the recovery of Pseudomonas aeruginosa susceptibility to antibiotics was investigated. In the presence of andrographolide, the Mueller-Hinton broth dilution method measured minimal inhibitory concentrations (MIC) of ceftazidine, cefpirome, chloramphenicol, L-ofloxacin, kanamycin, imipenem and meropenem. Real-time fluorescence quantitative polymerase chain reaction was used to determine mexB mRNA expressions in P. aeruginosa PAO1 strain and MexAB-OprM overexpressing strain. Relative mexB mRNA expression was detected in both strains incubated for 3 and 9 h. When andrographolide-treated groups were compared with controls, the MIC of ceftazidine, cefpirome, L-ofloxacin and meropenem for both strains decreased, and the relative mexB mRNA expression was significantly lower, although between andrographolide groups there were no significant differences. Compared with the inactivated quorum-sensing system, relative amounts of mexB mRNA in the PAO1 strain and MexAB-OprM overexpressing strain in the activated quorum-sensing system increased 10- and 30-fold, respectively. Andrographolide recovered P. aeruginosa susceptibility to antibiotics and reduced the MexAB-OprM efflux pump expression level.
PMID: 18304418 [PubMed - in process]
J Int Med Res. 2008 Jan-Feb
Wu CM, Cao JL, Zheng MH, Ou Y, Zhang L, Zhu XQ, Song JX.
Department of Liver Diseases, The Traditional Chinese Medical Hospital of Wenzhou, Wenzhou, China.
Effectiveness and mechanism of action of andrographolide on the recovery of Pseudomonas aeruginosa susceptibility to antibiotics was investigated. In the presence of andrographolide, the Mueller-Hinton broth dilution method measured minimal inhibitory concentrations (MIC) of ceftazidine, cefpirome, chloramphenicol, L-ofloxacin, kanamycin, imipenem and meropenem. Real-time fluorescence quantitative polymerase chain reaction was used to determine mexB mRNA expressions in P. aeruginosa PAO1 strain and MexAB-OprM overexpressing strain. Relative mexB mRNA expression was detected in both strains incubated for 3 and 9 h. When andrographolide-treated groups were compared with controls, the MIC of ceftazidine, cefpirome, L-ofloxacin and meropenem for both strains decreased, and the relative mexB mRNA expression was significantly lower, although between andrographolide groups there were no significant differences. Compared with the inactivated quorum-sensing system, relative amounts of mexB mRNA in the PAO1 strain and MexAB-OprM overexpressing strain in the activated quorum-sensing system increased 10- and 30-fold, respectively. Andrographolide recovered P. aeruginosa susceptibility to antibiotics and reduced the MexAB-OprM efflux pump expression level.
PMID: 18304418 [PubMed - in process]
Labels: andrographolide; Pseudomonas aeruginosa; MexAB-OprM efflux pump; Mueller-Hinton broth dilution
# posted by Pat O'Connor @ 6:57 PM
Optimal treatment of hepatic abscess
Optimal treatment of hepatic abscess
Am Surg. 2008 Feb
Hope WW, Vrochides DV, Newcomb WL, Mayo-Smith WW, Iannitti DA.
Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
Many treatment strategies have been proposed for pyogenic liver abscesses; however, the indications for liver resection for treatment have not been studied in a systematic manner. The purpose of our study was to evaluate the role of surgical treatment in pyogenic abscesses and to determine an optimal treatment algorithm. We retrospectively reviewed the medical records of all patients who had a pyogenic liver abscess at Rhode Island Hospital between 1995 and 2002. Abscesses and treatment strategies were classified into three groups each. The abscess groups included Abscess Type I (small <3>3 cm, unilocular), and Abscess Type III (large >3 cm, complex multilocular). The treatment strategy groups included Treatment Group A (antibiotics alone), Treatment Group B (percutaneous drainage plus antibiotics), and Treatment Group C (primary surgical therapy). Descriptive statistics were calculated and chi2 used for comparison with a P <>3 cm), multiloculated abscesses had a significantly higher success rate than percutaneous drainage plus antibiotic therapy (33% versus 100%, P < or =" 0.01)." p =" 0.40).">
PMID: 18306874 [PubMed - in process]
Am Surg. 2008 Feb
Hope WW, Vrochides DV, Newcomb WL, Mayo-Smith WW, Iannitti DA.
Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
Many treatment strategies have been proposed for pyogenic liver abscesses; however, the indications for liver resection for treatment have not been studied in a systematic manner. The purpose of our study was to evaluate the role of surgical treatment in pyogenic abscesses and to determine an optimal treatment algorithm. We retrospectively reviewed the medical records of all patients who had a pyogenic liver abscess at Rhode Island Hospital between 1995 and 2002. Abscesses and treatment strategies were classified into three groups each. The abscess groups included Abscess Type I (small <3>3 cm, unilocular), and Abscess Type III (large >3 cm, complex multilocular). The treatment strategy groups included Treatment Group A (antibiotics alone), Treatment Group B (percutaneous drainage plus antibiotics), and Treatment Group C (primary surgical therapy). Descriptive statistics were calculated and chi2 used for comparison with a P <>3 cm), multiloculated abscesses had a significantly higher success rate than percutaneous drainage plus antibiotic therapy (33% versus 100%, P < or =" 0.01)." p =" 0.40).">
PMID: 18306874 [PubMed - in process]
# posted by Pat O'Connor @ 6:50 PM
