2011 December 29

Trends in the Susceptibility of Clinically Important Resistant Bacteria to Tigecycline: Results from the Tigecycline In-vitro Surveillance in Taiwan (TIST), 2006-2010.

Antimicrob Agents Chemother Start a Discussion »

Dec 292011

Trends in the Susceptibility of Clinically Important Resistant Bacteria to Tigecycline: Results from the Tigecycline In-vitro Surveillance in Taiwan (TIST), 2006-2010.

Antimicrob Agents Chemother. 2011 Dec 27;

Authors: Chen YH, Lu PL, Huang CH, Liao CH, Lu CT, Chuang YC, Tsao SM, Chen YS, Liu YC, Chen WY, Jang TN, Lin HC, Chen CM, Shi ZY, Pan SC, Yang CL, Kung HC, Liu CE, Cheng YJ, Liu JW, Sun W, Wang LS, Ko WC, Yu KW, Chiang PC, Lee MH, Lee CM, Hsu GJ, Hsueh PR

Abstract
The Tigecycline In-vitro Surveillance in Taiwan (TIST), a nationwide, prospective surveillance during 2006 to 2010, collected a total of 7,793 clinical isolates, including methicillin-resistant Staphylococcus aureus (MRSA) (n=1,834), penicillin-resistant Streptococcus pneumoniae (PRSP) (n=423), vancomycin-resistant enterococci (VRE) (n=219), extended-spectrum ?-lactamase (ESBL)-producing Escherichia coli (n=1,141), ESBL-producing Klebsiella pneumoniae (n=1,330), Acinetobacter baumannii (n=1,645), and Stenotrophomonas maltophilia (n=903), from different specimens from 20 different hospitals in Taiwan. Minimum inhibitory concentrations (MICs) of tigecycline were determined following the criteria of the US Food and Drug Administration (FDA) and European Committee on Antimicrobial Susceptibility Testing (EUCAST-2011).Among drug-resistant Gram-positive pathogens, all of the PRSP isolates were susceptible to tigecycline (MIC(90), 0.03 ?g/ml) and only one MRSA isolate (MIC(90), 0.5 ?g/ml) and three VRE isolates (MIC(90), 0.125 ?g/ml) were non-susceptible to tigecycline. Among the Gram-negative bacteria, the tigecycline susceptibility rates were 99.65% for ESBL-producing E. coli (MIC(90), 0.5 ?g/ml) and 96.32% for ESBL-producing K. pneumoniae (MIC(90), 2 ?g/ml), when interpreted by FDA criteria, but were 98.7% and 85.8%, respectively, when interpreted by EUCAST-2011 criteria. The susceptibility of A. baumannii (MIC(90), 4 ?g/ml) decreased from 80.9% in 2006 to 55.3% in 2009, but increased to 73.4% in 2010. A bimodal MIC distribution was found among carbapenem-susceptible A. baumannii isolates and an unimodal MIC distribution was found among carbapenem-nonsusceptible A. baumannii isolates. In Taiwan, tigecycline continues to have excellent in vitro activity against several major clinically important drug-resistant bacteria, with the exception of A. baumannii.

PMID: 22203598 [PubMed - as supplied by publisher]

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Impact of facilitating physician access to relevant medical literature on outcomes of hospitalised internal medicine patients: a randomised controlled trial.

evid based med Start a Discussion »

Dec 292011

Impact of facilitating physician access to relevant medical literature on outcomes of hospitalised internal medicine patients: a randomised controlled trial.

Evid Based Med. 2011 Oct;16(5):131-5

Authors: Izcovich A, Malla CG, Diaz MM, Manzotti M, Catalano HN

Abstract
INTRODUCTION: There is limited high-quality evidence regarding the usefulness of bibliographic assistance in improving clinically important outcomes in hospitalised patients. This study was designed to evaluate the impact of providing attending physicians with bibliographic information to assist them in answering medical questions that arise during daily clinical practice.
METHODS: All patients admitted to the Internal Medicine ward of Hospital Aleman in Buenos Aires between March and August 2010 were randomly assigned to one of two groups: intervention or control. Throughout this period, the medical questions that arose during morning rounds were identified. Bibliographic research was conducted to answer only those questions that emerged during the discussion of patients assigned to the intervention group. The compiled information was sent via e-mail to all members of the medical team.
RESULTS: 809 patients were included in the study, 407 were randomly assigned to a search-supported group and 402 to a control group. There was no significant difference in death or transfer to an intensive care unit (ICU) (RR 1.09 (95% CI 0.7 to 1.6)), rehospitalisation (RR 1.0 (95% CI 0.7 to 1.3)) or length of hospitalisation (6.5 vs 6.0 days, p=0.25). The subgroup of search-supported physicians' patients (n=31), whose attending physicians received hand-delivered information, had a significantly lower risk of death or transfer to an ICU compared with the control group (0% vs 13.7%, p=0.03).
CONCLUSIONS: The impact of bibliographic assistance on clinically important outcomes could not be proven by this study. However, results suggest that some interventions, such as delivering information by hand, might be beneficial in a subgroup of inpatients.

PMID: 21949275 [PubMed - indexed for MEDLINE]

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Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination.

Crit Care Med Start a Discussion »

Dec 292011

Transfer of multidrug-resistant bacteria to healthcare workers' gloves and gowns after patient contact increases with environmental contamination.

Crit Care Med. 2011 Dec 24;

Authors: Morgan DJ, Rogawski E, Thom KA, Johnson JK, Perencevich EN, Shardell M, Leekha S, Harris AD

Abstract
OBJECTIVE:: To assess the role of environmental contamination in the transmission of multidrug-resistant bacteria to healthcare workers' clothing. DESIGN:: Prospective cohort. SETTING:: Six intensive care units at a tertiary care hospital. SUBJECTS:: Healthcare workers including registered nurses, patient care technicians, respiratory therapists, occupational/physical therapists, and physicians. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: One hundred twenty of 585 (20.5%) healthcare worker/patient interactions resulted in contamination of healthcare workers' gloves or gowns. Multidrug-resistant Acinetobacter baumannii contamination occurred most frequently, 55 of 167 observations (32.9%; 95% confidence interval [CI] 25.8% to 40.0%), followed by multidrug-resistant Pseudomonas aeruginosa, 15 of 86 (17.4%; 95% CI 9.4% to 25.4%), vancomycin-resistant Enterococcus, 25 of 180 (13.9%, 95% CI 8.9, 18.9%) and methicillin-resistant Staphylococcus aureus, 21 of 152 (13.8%; 95% CI 8.3% to 19.2%). Independent risk factors associated with healthcare worker contamination with multidrug-resistant bacteria were positive environmental cultures (odds ratio [OR] 4.2; 95% CI 2.7-6.5), duration in room for >5 mins (OR 2.0; 95% CI 1.2-3.4), performing physical examinations (OR 1.7; 95% CI 1.1-2.8), and contact with the ventilator (OR 1.8; 95% CI 1.1-2.8). Pulsed field gel electrophoresis determined that 91% of healthcare worker isolates were related to an environmental or patient isolate. CONCLUSIONS:: The contamination of healthcare workers' protective clothing during routine care of patients with multidrug-resistant organisms is most frequent with A. baumannii. Environmental contamination was the major determinant of transmission to healthcare workers' gloves or gowns. Compliance with contact precautions and more aggressive environmental cleaning may decrease transmission.

PMID: 22202707 [PubMed - as supplied by publisher]

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Volume-limited versus pressure-limited hemodynamic management in septic and nonseptic shock.

Crit Care Med Start a Discussion »

Dec 292011

Volume-limited versus pressure-limited hemodynamic management in septic and nonseptic shock.

Crit Care Med. 2011 Dec 24;

Authors: Trof RJ, Beishuizen A, Cornet AD, de Wit RJ, Girbes AR, Groeneveld AB

Abstract
OBJECTIVES:: To evaluate the effect of hemodynamic management guided by upper limits of cardiac filling volumes or pressures on durations of mechanical ventilation and lengths of stay in critically ill patients with shock. DESIGN:: Prospective, randomized, clinical trial. SETTING:: Mixed intensive care unit of a large teaching hospital and mixed intensive care unit of a tertiary care, academic medical center. PATIENTS:: A total 120 septic (n = 72) and nonseptic (n = 48) shock patients, randomized (after stratification) to transpulmonary thermodilution (n = 60) or pulmonary artery catheter (n = 60) between February 2007 and July 2009. INTERVENTIONS:: Hemodynamic management was guided by algorithms including upper limits for fluid resuscitation of extravascular lung water (<10 mL/kg) and global end-diastolic volume index (<850 mL/m) in the transpulmonary thermodilution group and pulmonary artery occlusion pressure (<18-20 mm Hg) in the pulmonary artery catheter group for 72 hrs after enrollment. MEASUREMENTS AND MAIN RESULTS:: Primary outcomes were ventilator-free days and lengths of stay in the intensive care unit and the hospital. Secondary outcomes included organ failures and mortality. Cardiac comorbidity was more frequent in nonseptic than in septic shock. Ventilator-free days, lengths of stay, organ failures, and 28-day mortality (overall 33.3%) were similar between monitoring groups. Transpulmonary thermodilution (vs. pulmonary artery catheter) monitoring was associated with more days on mechanical ventilation and longer intensive care unit and hospital lengths of stay in nonseptic (p = .001) but not in septic shock. In both conditions, fewer patients met the upper limit of volume than of pressure criteria at baseline and transpulmonary thermodilution (vs. pulmonary artery catheter) monitoring was associated with a more positive fluid balance at 24 hrs. CONCLUSIONS:: Hemodynamic management guided by transpulmonary thermodilution vs. pulmonary artery catheter in shock did not affect ventilator-free days, lengths of stay, organ failures, and mortality of critically ill patients. Use of the a transpulmonary thermodilution algorithm resulted in more days on mechanical ventilation and intensive care unit length of stay compared with the pulmonary artery catheter algorithm in nonseptic shock but not in septic shock. This may relate to cardiac comorbidity and a more positive fluid balance with use of transpulmonary thermodilution in nonseptic shock.

PMID: 22202713 [PubMed - as supplied by publisher]

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December 2011
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