Tuesday, January 22, 2013
A systematic review of validation studies of the use of administrative data to identify serious infections.
A systematic review of validation studies of the use of administrative data to identify serious infections.
Jan 2013
Source
Formerly a the Division of Rheumatology, Department of Medicine, University Health Network, and the Division of Health Care and Outcome Research, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Calgary. cehbarbe@ucalgaryca.
Abstract
OBJECTIVES:
To conduct a systematic review of the literature on the validation of algorithms identifying infections in administrative data for future use in populations with rheumatic diseases.
METHODS:
Medline and Embase were searched using the themes "administrative data" and "infection", between 1950 to October 2012. Inclusion criteria: validation studies of administrative data identifying infections in adult populations. Article quality was assessed using a validated tool.
RESULTS:
5941 articles were identified, 90 articles underwent detailed review and 24 studies were included. The majority (17/24) examined bacterial infections and nine examined opportunistic infections. Eighteen studies were from the United States and all but four studies used ICD-9 codes. Rheumatoid arthritis patients were studied in 6/24. The studies on bacterial infections in general reported highly variable sensitivity and PPV for the diagnosis of infections using administrative data (sensitivity range 4.4-100%, PPV range 21.7-100%). Algorithms to identify opportunistic infections similarly had a highly variable sensitivity (range 20-100%) and PPV (1.3-99%). Thirteen studies compared the diagnostic accuracy of different algorithms which revealed that strategies including comprehensive algorithm using a greater number of diagnostic codes or codes in any position had the highest sensitivity for the diagnosis of infection. Algorithms which incorporated microbiologic or pharmacy data in combination with diagnostic codes had improved PPV for identification of tuberculosis.
CONCLUSION:
Algorithms for identifying infections using administrative data should be selected based on the purpose of the study with careful consideration as to whether a high sensitivity or PPV is required.
Labels: Infections, validation studies
# posted by Pat O'Connor @ 6:16 AM
Sunday, November 04, 2012
FDA warns of harmful tattoo infections
FDA warns of harmful tattoo infections
Officials seeing increase in contaminated tattoos
Updated: Friday, 02 Nov 2012, 10:44 PM EDT
Published : Friday, 02 Nov 2012, 8:19 PM EDT
Published : Friday, 02 Nov 2012, 8:19 PM EDT
(WPRI) -- Today, everywhere you look, people from all walks of life have tattoos. That might lead you to believe tattoos are completely safe. But there can be serious health risks that can result in the need for medical care.
The Food and Drug Administration is warning about an increase in bacterial infections associated with tattoos. There has also been a recent outbreak of illnesses linked to contaminated tattoos. Hopefully if you decide to get one, you'll walk out of a tattoo parlor with a beautiful piece of body art that will last a lifetime. But as we've discovered, complications can occur.
If you want a tattoo, you can find many tattoo artists advertising online. But beware; anyone can claim to be a tattoo artist, but not everyone is licensed to practice. And that, according to health experts, could be a hazard to your health.
Rob Young is a licensed tattoo artist in Greenville. He says his shop is inspected by the Department of Health each time his license is up for renewal. His sterilizing equipment is checked. His certificates are checked. "We have a saying in this business," says Young. "Cheap tattoos aren't good, and good tattoos aren't cheap."
But everywhere you look online, you can find advertisements for cheap tattoos. And the artists themselves, according to the Department of Health, may not be properly licensed. And if they don't have a license, the Department of Health says that tattoo artist is not getting inspected. That means they could be putting profits before your health.
The FDA is also warning you about contaminated inks that have caused serious infections. Pictures on their website reveal one infection they are particularly concerned about. It's a bacterium that has been found in a recent outbreak of illness linked to contaminated tattoo inks. It can lead to lung disease, joint infection, and even infection of your organs.
Before getting a tattoo you're encouraged to check to make sure the tattoo artist is licensed. And check to see whether there have been any actions taken against them by the Rhode Island Department of Health. The Department of Health tells us if they get a complaint about an unlicensed tattoo artist, they will investigate it.
"They're supposed to protect the general public from any sort of health issue," says properly licensed tattoo artist Rob Young. "And these are health issues. And all it takes is one breakout and spread, and I fear that it will leave a black eye for the people that are doing it correctly."
If you are getting a tattoo and want to see the latest inspection report for a particular tattoo parlor, you can. The reports are free and public information. You just need to contact the Department of Health to get it.
Helpful Links:
- FDA Warning
- RI Dept. of Health Rules for Tattoo Parlors
- Licensing Information for Tattoo Artists in RI
- Check the License Status of a Tattoo Artist
Labels: bacteria, FDA, health rules, Infections, license information, tattoo
# posted by Pat O'Connor @ 7:08 AM
Study to Look into Source of Antibiotic-resistant Bacteria Infection
Study to Look into Source of Antibiotic-resistant Bacteria Infection
Antibiotic-resistant bacterial infections are on rise and in order to know more about the same, three Dutch medical schools have started a new research. They have been asking a number of travelers to tropical countries to provide them with stool samples as they return from their trips.
The study has been carried out by the Academic (AMC), Maastricht medical and Erasmus centers. The study researchers have enrolled 2,000 travelers. Study researchers affirmed that they have been focusing on those travelers, who would be travelling to Asia and Africa.
Researcher Jarne van Hattem said, "These travelers will be asked, upon vaccination by a number of travel clinics, if they would like to participate and send stools to us for a year".
The Netherlands has been witnessing a number of incidents of antibiotic-resistant bacterial infections and that too among non-travelling groups. The research will help study researchers know that whether the infection is being passed on by travelers, who go to exotic locations.
The study will help them to come up with measures, which can be adopted to control these infections. Van Hattem said as per his knowledge, this study is one of the largest studies being carried out in Sweden and Australia.
Labels: Africa, antibiotic, Asia, australia, Infections, resistant bacteria, Sweden, vaccination
# posted by Pat O'Connor @ 6:58 AM
Monday, October 29, 2012
Infections following the application of leeches: two case reports and review of the literature.
Infections following the application of leeches: two case reports and review of the literature.
Oct 2012
Abstract
ABSTRACT:
INTRODUCTION: Since the 1980s, leeches have been ingeniously used in the management of venous flap congestion. The presence of anticoagulative substances in their saliva improves the blood drainage. Their digestive tract contains several bacterial species, the main ones being Aeromonas hydrophila and Aeromonas veronii biovar sobria, which contribute to the digestion of ingested blood. These bacteria can be the cause of infections.
CASE PRESENTATION:
We report two cases of septicemia related to Aeromonas veronii biovar sobria that presented after leeches had been applied to congested transverse rectus abdominis myocutaneous flaps for delayed mammary reconstructions. Patient number 1 was a 55-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. On the sixth postoperative day she showed a clinical presentation of septicemia. Aeromonas veronii biovar sobria was identified in the patient's skin and blood bacteriological samples. Her fever ceased after 4 days of antibiotic treatment. Patient number 2 was a 56-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. On the seventh postoperative day we noticed that she showed a clinical presentation of septicemia. Aeromonas veronii biovar sobria was identified in the patient's blood cultures and local bacteriological samples. An antibiogram showed resistance to amoxicillin/clavulanic acid. Her fever ceased on the eleventh postoperative day after 4 days of antibiotic treatment.
CONCLUSION:
The rate of infection after application of leeches is not negligible. The concentration of Aeromonas inside the digestive tracts of leeches largely decreases when the patient is under antibiotic therapy. These germs are sensitive to third-generation cephalosporins and fluoroquinolones and resistant to amoxicillin/clavulanic acid. We recommend preventive treatment based on classical measures of asepsis and on oral antibioprophylaxy with a fluoroquinolone during the whole period of treatment by leeches.
Labels: amoxicillin, Antibiogram, antibiotic therapy, asepsis, blood, clavulanic acid, Infections, leeches, oral, skin, venous anticoagulative substances
# posted by Pat O'Connor @ 11:22 AM
Thursday, October 25, 2012
Postoperative infections in obstetrics and gynecology.
Postoperative infections in obstetrics and gynecology.
Dec 2012
Source
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina.
Abstract
Postoperative infection is the most commonly seen complication of surgery in obstetrics and gynecology. The use of antibiotic prophylaxis has greatly decreased though not completely eliminated this adverse outcome. Postoperative infections include wound cellulitis, wound abscess, endomyometritis, pelvic cellulitis, and pelvic abscess. Infections usually manifest as fever and greater than normal postoperative pain. Refractory fevers maybe because of septic pelvic vein thrombophlebitis or maybe noninfectious in origin. Broad-spectrum antibiotics should be initiated as soon as possible when diagnosis of postoperative infection is made; most patients will respond to treatment within 24 to 48 hours when appropriate antibiotics are selected.
Labels: antibiotics, endomyometritis, gynecology, Infections, obstetrics, pelvic abscess, pelvic cellulitis, postoerative, wound abscess, wound cellulitis
# posted by Pat O'Connor @ 7:52 AM
Saturday, September 01, 2012
Study: Tattoo infections traced to tainted ink
Study: Tattoo infections traced to tainted ink
August 2012
ATLANTA — An outbreak of infected tattoos has led to an unlikely source: the ink.
With the growing popularity of tattoos, health officials say they are seeing more cases of a nasty skin infection caused by a common bacteria traced to the ink. In the largest outbreak, 19 people in Rochester, N.Y., ended up with bubbly rashes on their new tattoos, researchers reported Wednesday.
Infections from tattooing are nothing new. Hepatitis, staph infections and even the superbug known as MRSA have been tied to tattoos. Dirty needles and unsanitary conditions are often to blame.
But all the New York cases were linked to an unidentified artist who wore disposable gloves and sterilized his instruments. The problem, investigators concluded, was in the ink.
"Even if you get a tattoo from a facility that does everything right, it's not risk free," said Dr. Byron Kennedy, deputy director of the health department in New York's Monroe County. He is lead author of a report on last fall's Rochester cases was released by the New England Journal of Medicine on Wednesday.
In the past year, there have been 22 confirmed cases and more than 30 suspected cases of the skin infection in Colorado, Iowa, New York and Washington state, health officials said. The infections were tied to ink or water used to dilute the ink. Tattoo artists and ink makers should use only sterile water to dilute ink, health officials advise.
Scattered reports of the illness in tattoo customers have been reported over the past 10 years. But they may be growing more common as more people get tattoos, experts said. An estimated 1 in 5 U.S. adults have at least one tattoo, an increase from years past, according to polls.
The illnesses were caused by a bacterial cousin of tuberculosis named Mycobacterium chelonae (pronounced chell-OH-nay). The bacteria can cause itchy and painful pus-filled blisters that can take months to clear up, and involve treatment with harsh antibiotics with unpleasant side effects.
The bacteria are common in tap water, and have been seen in the past when tattoo artists used contaminated water to lighten dark ink. The ink used in New York was "gray wash," used for shaded areas of tattoos. The ink was recalled and has not returned to the market.
Companies that make gray wash sometimes use distilled water to lighten the ink, thinking it's clean of infection-causing contaminants. But the bacteria can live in that too, said Tara MacCannell, who led a related investigation by the Centers for Disease Control and Prevention. Her study appears in CDC's Morbidity and Mortality Weekly Report released Wednesday.
Some ink manufacturers add witch hazel or an alcohol preservative to lower risk of certain viruses, but those additives don't kill off the hardy chelonae bacteria, she added.
Investigators found the bacteria in opened and unopened bottles of ink at the New York tattoo parlor. They did not find it in water at the shop, MacCannell said.
Health officials say tattoo customers should ask what kind of ink is being used and what measures are in place to prevent infections.
Labels: antibiotics, contaminants, Hepatitis, Infections, MRSA, Mycobacterium chelonae, skin infection, staph infections, tainted ink, tattoo
# posted by Pat O'Connor @ 9:41 AM
Monday, March 05, 2012
Stomach Acid Drugs Increase Risk of Bacterial Infections
Stomach Acid Drugs Increase Risk of Bacterial Infections, FDA Warns
February 2012
The Food and Drug Administration is warning consumers today that certain stomach acid drugs may increase the risk of a serious intestinal bacteria infection.
The drugs, including Nexium, Prilosec, Prevacid, Zegerid and others, fall into a category called proton pump inhibitors (PPIs). They are prescribed to treat acid reflux, stomach ulcers and other conditions, and work by reducing the amount of acid in the stomach.
The bacterial illness is called Clostridium difficile–associated diarrhea (CDAD), and its main symptom is diarrhea that does not improve, according to an FDA statement. The bacteria are commonly referred to as "C. diff."
"Stomach acid is a very important defense mechanism against pathogens. It kills them." said Dr. Edith R. Lederman, who authored a study published in October linking c.diff infections to stomach acid drugs, in an interview with MyHealthNewsDaily at the time.
Patients taking PPIs who develop diarrhea that does not improve may have CDAD, according to the FDA. The agency is working with manufacturers to include information in the drug labels about the increased risk with use of PPIs. PPIs are the third highest-selling class of drugs in the U.S., according to 2010 findings from Consumer Reports.
Lederman's study, published in the journal Clinical Infectious Diseases, showed nearly half of 485 patients hospitalized at a medical center over a four-year period who had C. difficile infections had previously been prescribed an acid suppressing drug, most of which were either proton-pump inhibitors (PPIs), such as Prilosec and Prevacid, or histamine-2 antagonists, such as Tagamet and Zantac.
The FDA is also reviewing the risk of CDAD in users of histamine H2 receptor blockers.
The elderly, and people with certain medical problems, generally have the greatest chance of developing C. diff infections, according to the Centers for Disease Control and Prevention. The infection can spread in hospitals because C. diff spores can live outside the human body for a very long time, and may be found on items such as bed linens, bed rails, bathroom fixtures and medical equipment.
There are antibiotics that can be used to treat C. diff, according to the CDC, but in some severe cases, surgery to remove the infected part of the intestines may be needed.
In Lederman's study, 23 patients died from their C. diff infections; 19 of them had taken prescription acid suppressants during the 90 days before their hospital stay.
Hand washing, alcohol-based sanitizers, and taking only antibiotics that are prescribed by a doctor can lower a person's risk of getting or spreading C. diff, according to the CDC.
Pass it on: People taking drugs that suppress stomach acid production may be at an increased risk for intestinal bacteria infections.
Labels: Bacterial, CDAD, Clostridium difficile–associated diarrhea, Infections, intestinal bacteria, stomach acid
# posted by Pat O'Connor @ 6:08 AM
Sunday, October 11, 2009
Emerging Infections in Burns
Emerging Infections in Burns
Surg Infect (Larchmt). 2009 Oct 7
Ludwik K. Branski,*
*These authors contributed equally to this work.
Ahmed Al-Mousawi,*
Haidy Rivero,*
Marc G. Jeschke,
Arthur P. Sanford, and
David N. Herndon
Department of Surgery, The University of Texas Medical Branch and Shriners Hospitals
for Children, Galveston, Texas.
Abstract Background:
Patients who suffer severe burns are at higher risk for local
and systemic infections. In recent years, emerging resistant
pathogens have forced burn care providers world wide to search
for alternative forms of treatment. Multidrug-resistant
Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter
spp., and various fungal strains have been the major contributors
to the increase in morbidity and mortality rates. Multi-drug-resistant
S. aureus remains the major cause of gram-positive burn wound
infections world wide. Treatment strategies include rigorous
isolation protocols and new types of antibiotics where necessary.
Methods:
We reviewed 398 severely burned patients (burns >40% total
body surface area [TBSA]) admitted to our hospital between
2000 and 2006. Patients who did not contract multi-drug-resistant
gram-negative organisms during their hospital course and received
our standard antibiotic regimen-vancomycin and
piperacillin/tazobactam-served as controls (piperacillin/tazobactam;
n = 280). The treatment group consisted of patients who, during
their acute hospital stay, developed infections with multi-drug-resistant
gram-negative pathogens and were treated with vancomycin and
colistin for at least three days (colistin; n = 118).
Results:
Gram-negative organisms continue to cause the most severe
infections in burn patients. Colistin has re-emerged as a highly
effective antibiotic against multiresistant Pseudomonas and
Acinetobacter infections of burns.
Patients who required colistin therapy had a significantly
larger average total and full-thickness burn than patients
treated with piperacillin/tazobactam and vancomycin, and the
mortality rate was significantly higher in the colistin group
(p less then 0.05). However, there was no significant difference
between the colistin and piperacillin/tazobactam groups in the
incidence of neurotoxicity, hepatic toxicity, or nephrotoxicity.
The main fungal pathogens in burn patients are Candida spp.,
Aspergillus spp., and Fusarium spp. A definitive diagnosis is
more difficult to obtain than in bacterial infections. Amphotericin B
and voriconazole remain the two most important anti-fungal
substances in our practice.
Conclusions:
Innovations in fluid management, ventilatory support, surgical
care, and antimicrobial therapy have contributed to a significant
reduction in morbidity and mortality rates in burn patients.
Vancomycin and clindamycin are the two most important
reserve antibiotics for methicillin-resistant Staphylococcus
aureus infection.
Oxazolidinones and streptogramins have showed high effectiveness
against gram-positive infections. Colistin has re-emerged as a
highly effective antibiotic against multiresistant Pseudomonas
and Acinetobacter infections.
Current challenges include Candida, Aspergillus, and molds. The
development of new agents, prudent and appropriate use of
antibiotics, and better infection control protocols are paramount
in the ongoing battle against multi-resistant organisms.
Labels: aspergillis, burns, candida, clindamycin, colistin, Gram-positive, Infections, mold, Oxazolidinone, piperacillin, Pseudomona, streptogramins, tazobactam, vancomycin
# posted by Pat O'Connor @ 7:59 AM
