Friday, August 15, 2008
Campylobacter Bacteremia: Clinical Features and Factors Associated with Fatal Outcome
Clin Infect Dis. 2008 Aug
Pacanowski J, Lalande V, Lacombe K, Boudraa C, Lesprit P, Legrand P, Trystram D, Kassis N, Arlet G, Mainardi JL, Doucet-Populaire F, Girard PM, Meynard JL; CAMPYL Study Group.
1Service des Maladies Infectieuses et Tropicales and 2Laboratoire de Microbiologie, Hôpital Saint-Antoine, 3Laboratoire de Bactériologie, Hôpital La Pitié-Salpétrière, 4Laboratoire de Bactériologie, Hôpital Tenon, 5Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Hôpital Européen Georges Pompidou, 6Université Paris VI Pierre et Marie Curie, 7Université Paris V René Descartes, 8INSERM UMR-S707, and 9Unité EA 4065, Paris, 10Unité Contrôle Epidémiologie et Prévention de l'Infection and 11Laboratoire de Microbiologie, Hôpital Henri Mondor, Créteil, 12Laboratoire de Microbiologie, Hôpital Paul Brousse, Villejuif, and 13Laboratoire de Microbiologie, Hôpital de Versailles, Le Chesnay, France.
Background. Campylobacter bacteremia is uncommon. The influence of underlying conditions and of the impact of antibiotics on infection outcome are not known.
Methods. From January 2000 through December 2004, 183 episodes of Campylobacter bacteremia were identified in 23 hospitals in the Paris, France, area.
The medical records were reviewed. Characteristics of bacteremia due to Campylobacter fetus and to other Campylobacter species were compared. Logistic regression analysis was performed to identify risk factors for fatal outcome within 30 days.
Results. Most affected patients were elderly or immunocompromised. C. fetus was the most commonly identified species (in 53% of patients). The main underlying conditions were liver disease (39%) and cancer (38%). The main clinical manifestations were diarrhea (33%) and skin infection (16%). Twenty-seven patients (15%) died within 30 days. Compared with patients with bacteremia due to other Campylobacter species, patients with C. fetus bacteremia were older (mean age, 69.5 years vs. 55.6 years; [Formula: see text]) and were more likely to have cellulitis (19% vs. 7%; [Formula: see text]), endovascular infection (13% vs. 1%; [Formula: see text]), or infection associated with a medical device (7% vs. 0%; [Formula: see text]). Independent risk factors for death were cancer (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.2-20.8) and asymptomatic infection (OR, 6.7; 95% CI, 1.5-29.4) for C. fetus bacteremia, the absence of prescription of appropriate antibiotics (OR, 12.2; 95% CI, 0.9-157.5), and prescription of third-generation cephalosporins (OR, 10.2; 95% CI, 1.9-53.7) for bacteremia caused by other species.
Conclusion. Campylobacter bacteremia occurs mainly in immunocompromised patients. Clinical features and risk factors of death differ by infection species.
Monday, August 04, 2008
National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections.
Arch Intern Med. 2008 Jul 28
Hersh AL, Chambers HF, Maselli JH, Gonzales R.
Department of Pediatrics, University of California, San Francisco, 3333 California St, San Francisco, CA 94143-0936, USA. email@example.com
BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a common cause of skin and soft-tissue infections (SSTIs) in the United States. It is unknown whether this development has affected the national rate of visits to primary care practices and emergency departments (EDs) and whether changes in antibiotic prescribing have occurred.
METHODS: We examined visits by patients with SSTIs to physician offices, hospital outpatient departments, and EDs using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1997 to 2005. We estimated annual visit rates for all SSTIs and a subset classified as abscess/cellulitis. For abscess/cellulitis visits, we examined trends in characteristics of patients and clinical settings and in antibiotic prescribing.
RESULTS: Overall rate of visits for SSTIs increased from 32.1 to 48.1 visits per 1000 population (50%; P = .003 for trend), reaching 14.2 million by 2005. More than 95% of this change was attributable to visits for abscess/cellulitis, which increased from 17.3 to 32.5 visits per 1000 population (88% increase; P < .001 for trend). The largest relative increases occurred in EDs (especially in high safety-net-status EDs and in the South), among black patients, and among patients younger than 18 years. Use of antibiotics recommended for CA-MRSA increased from 7% to 28% of visits (P < .001) during the study period. Independent predictors of treatment with these antibiotics included being younger than 45 years, living in the South, and an ED setting.
CONCLUSIONS: The incidence of SSTIs has rapidly increased nationwide in the CA-MRSA era and appears to disproportionately affect certain populations. Although physicians are beginning to modify antibiotic prescribing practices, opportunities for improvement exist, targeting physicians caring for patients who are at high risk.
Archives of Internal Medicine