2012 February 04

Antiviral treatment of cytomegalovirus infection: an update.

Expert Opin Pharmacother Start a Discussion »

Feb 042012

Antiviral treatment of cytomegalovirus infection: an update.

Expert Opin Pharmacother. 2012 Feb 2;

Authors: Härter G, Michel D

Abstract
This editorial summarizes recent developments in the management of ganciclovir-resistant human cytomegalovirus (HCMV) infections. All current drugs available for systemic treatment, including ganciclovir (GCV), valganciclovir, foscarnet and cidofovir, target the viral polymerase. However, all such compounds are hampered by dose-related toxicities and the emergence of resistance. Different approaches (e.g., PCR-based direct sequencing, pyrosequencing, mass spectrometry-based comparative sequencing) allow the fast detection of resistant HCMV and are well suited to therapy monitoring. However, more studies are required on the dynamic of mixed HCMV populations under drug pressure. Alternate antiviral compounds with new mechanisms of action, such as artesunate, leflunomid, letermovir and maribavir, are now being investigated in clinical studies. An advantage of some of the new substances is lesser toxicity issues, which might lead to new prophylactic and treatment strategies.

PMID: 22299626 [PubMed - as supplied by publisher]

Link to Article at PubMed

Risk factors for catheter-related bloodstream infection: a prospective multicenter study in Brazilian intensive care units.

Braz J Infect Dis Start a Discussion »

Feb 042012

Risk factors for catheter-related bloodstream infection: a prospective multicenter study in Brazilian intensive care units.

Braz J Infect Dis. 2011 Jul-Aug;15(4):328-31

Authors: Bicudo D, Batista R, Furtado GH, Sola A, Medeiros EA

Abstract
INTRODUCTION: Central venous catheters (CVC) are devices of great importance in health care. The advantages gained from the use of catheters outweigh the complications that might result from their use, among which bloodstream infections (BSI). In spite of its importance, few national studies have addressed this issue.
OBJECTIVE: The aim this study was to determine the incidence of BSI in patients with CVC, hospitalized in ICU, as well as the variables associated with this complication.
METHODS: Multicentric cohort study carried out at ICUs of three hospitals at Universidade Federal de São Paulo complex.
RESULTS: A total of 118 cases of BSI in 11.546 catheters day were observed: 10.22 BSI per 1,000 catheters day. On average, BSI was associated to seven additional days of hospital stay in our study (p < 0.001), with a significant difference between types of catheters. Concerning the place of insertion, there was no statistical difference in BSI rates.
CONCLUSION: We concluded that a patient who uses a catheter for longer than 13 days presents a progressive risk for infection of approximately three times higher in relation to a patient who uses the catheter for less than 13 days (p < 0.001). The median duration of catheter use was 14 days among patients with BSI and 9 days in patients without infection (p < 0.001). There was higher prevalence of gram-negative infections. The risk factors for BSI were utilization of multiple-lumen catheters, duration of catheterization and ICU length of stay.

PMID: 21861002 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Enhancing Care for Hospitalized Older Adults with Cognitive Impairment: A Randomized Controlled Trial.

J Gen Intern Med Start a Discussion »

Feb 042012

Enhancing Care for Hospitalized Older Adults with Cognitive Impairment: A Randomized Controlled Trial.

J Gen Intern Med. 2012 Feb 3;

Authors: Boustani MA, Campbell NL, Khan BA, Abernathy G, Zawahiri M, Campbell T, Tricker J, Hui SL, Buckley JD, Perkins AJ, Farber MO, Callahan CM

Abstract
BACKGROUND: Approximately 40% of hospitalized older adults have cognitive impairment (CI) and are more prone to hospital-acquired complications. The Institute of Medicine suggests using health information technology to improve the overall safety and quality of the health care system. OBJECTIVE: Evaluate the efficacy of a clinical decision support system (CDSS) to improve the quality of care for hospitalized older adults with CI. DESIGN: A randomized controlled clinical trial. SETTING: A public hospital in Indianapolis. POPULATION: A total of 998 hospitalized older adults were screened for CI, and 424 patients (225 intervention, 199 control) with CI were enrolled in the trial with a mean age of 74.8, 59% African Americans, and 68% female. INTERVENTION: A CDSS alerts the physicians of the presence of CI, recommends early referral into a geriatric consult, and suggests discontinuation of the use of Foley catheterization, physical restraints, and anticholinergic drugs. MEASUREMENTS: Orders of a geriatric consult and discontinuation orders of Foley catheterization, physical restraints, or anticholinergic drugs. RESULTS: Using intent-to-treat analyses, there were no differences between the intervention and the control groups in geriatric consult orders (56% vs 49%, P = 0.21); discontinuation orders for Foley catheterization (61.7% vs 64.6%, P?=?0.86); physical restraints (4.8% vs 0%, P?=?0.86), or anticholinergic drugs (48.9% vs 31.2%, P?=?0.11). CONCLUSION: A simple screening program for CI followed by a CDSS did not change physician prescribing behaviors or improve the process of care for hospitalized older adults with CI.

PMID: 22302355 [PubMed - as supplied by publisher]

Link to Article at PubMed

Comparison of rates of reported adverse events associated with i.v. iron products in the United States.

Am J Health Syst Pharm Start a Discussion »

Feb 042012

Comparison of rates of reported adverse events associated with i.v. iron products in the United States.

Am J Health Syst Pharm. 2012 Feb 15;69(4):310-20

Authors: Bailie GR

Abstract
Purpose An analysis of reported adverse events (AEs) among patients using i.v. iron products, including the newer agent ferumoxytol, is presented. Methods All AE reports to the Food and Drug Administration (FDA) citing iron sucrose, ferric gluconate, high- and low-molecular-weight iron dextran products, or ferumoxytol from October 2009 through June 2010 were evaluated. The rates of various classifications of reported AEs were calculated on a per-unit-sold basis and, for comparison of products supplied in different unit sizes, also in terms of 100-mg dose equivalents (DEq) of iron. Results A total of 197 reported AEs were identified (a cumulative rate of 14.1 AEs per million units sold). The rates of all AE classifications combined ranged from 5.25 to 746 per million units sold for iron sucrose and ferumoxytol, respectively; using the other method of calculation, the rates ranged from 5.24 per million DEq (iron sucrose) to 147 per million DEq (ferumoxytol). Relative to iron sucrose and sodium ferric gluconate, ferumoxytol was associated with significantly elevated risks of death (odds ratio [OR], 475 and 156, respectively; p < 0.0001), serious nonfatal AEs (OR, 263 and 121, respectively; p < 0.0001), and all evaluated AE classifications combined (OR, 142 and 109, respectively; p < 0.05). Conclusion Analysis of reports submitted to FDA revealed large differences among i.v. iron products in reported deaths, serious AEs, other major AEs, and other AEs. Iron sucrose and sodium ferric gluconate were associated with much lower rates of AEs per million units sold than iron dextran or ferumoxytol, which were associated with the highest rates of all reported AE classifications.

PMID: 22302256 [PubMed - in process]

Link to Article at PubMed

Methicillin-resistant Staphylococcus aureus infection and hospitalization in high-risk patients in the year following detection.

PLoS ONE Start a Discussion »

Feb 042012

Methicillin-resistant Staphylococcus aureus infection and hospitalization in high-risk patients in the year following detection.

PLoS One. 2011;6(9):e24340

Authors: Huang SS, Hinrichsen VL, Datta R, Spurchise L, Miroshnik I, Nelson K, Platt R

Abstract
BACKGROUND: Many studies have evaluated methicillin-resistant Staphylococcus aureus (MRSA) infections during single hospitalizations and subsequent readmissions to the same institution. None have assessed the comprehensive burden of MRSA infection in the period after hospital discharge while accounting for healthcare utilization across institutions.
METHODOLOGY/PRINCIPAL FINDINGS: We conducted a retrospective cohort study of adult patients insured by Harvard Pilgrim Health Care who were newly-detected to harbor MRSA between January 1991 and December 2003 at a tertiary care medical center. We evaluated all MRSA-attributable infections associated with hospitalization in the year following new detection, regardless of hospital location. Data were collected on comorbidities, healthcare utilization, mortality and MRSA outcomes. Of 591 newly-detected MRSA carriers, 23% were colonized and 77% were infected upon detection. In the year following detection, 196 (33%) patients developed 317 discrete and unrelated MRSA infections. The most common infections were pneumonia (34%), soft tissue (27%), and primary bloodstream (18%) infections. Infections occurred a median of 56 days post-detection. Of all infections, 26% involved bacteremia, and 17% caused MRSA-attributable death. During the admission where MRSA was newly-detected, 14% (82/576) developed subsequent infection. Of those surviving to discharge, 24% (114/482) developed post-discharge infections in the year following detection. Half (99/185, 54%) of post-discharge infections caused readmission, and most (104/185, 55%) occurred over 90 days post-discharge.
CONCLUSIONS/SIGNIFICANCE: In high-risk tertiary care patients, newly-detected MRSA carriage confers large risks of infection and substantial attributable mortality in the year following acquisition. Most infections occur post-discharge, and 18% of infections associated with readmission occurred in hospitals other than the one where MRSA was newly-detected. Despite gains in reducing MRSA infections during hospitalization, the risk of MRSA infection among critically and chronically ill carriers persists after discharge and warrants targeted prevention strategies.

PMID: 21949707 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Finding the cause of acute kidney injury: Which index of fractional excretion is better?

Cleve Clin J Med Start a Discussion »

Feb 042012

Finding the cause of acute kidney injury: Which index of fractional excretion is better?

Cleve Clin J Med. 2012 Feb;79(2):121-6

Authors: Gotfried J, Wiesen J, Raina R, Nally JV

Abstract
The fractional excretion of urea (FEU) is a useful index for differentiating the main categories of causes of acute kidney injury, ie, prerenal causes and intrinsic causes. It may be used in preference to the more widely used fractional excretion of sodium (FENa) in situations in which the validity of the latter is limited, such as in patients taking a diuretic.

PMID: 22301562 [PubMed - in process]

Link to Article at PubMed

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