Oct 302014
 
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Invasive gram-positive bacterial infection in cancer patients.

Clin Infect Dis. 2014 Nov 15;59 Suppl 5:S331-4

Authors: Holland T, Fowler VG, Shelburne SA

Abstract
Systematic studies have shown that gram-positive organisms are the leading cause of invasive bacterial disease in patients with cancer. A broad range of gram-positive bacteria cause serious infections in the cancer patient with the greatest burden of disease being due to staphylococci, streptococci, and enterococci. The evolution of cancer therapy and the changing epidemiology of major gram-positive pathogens mean that ongoing efforts are needed to understand and mitigate the impact of these bacteria in patients with malignancy. The development of novel antibacterials, optimization of treatment approaches, implementation of improved vaccines, and manipulation of the microbiome are all active areas of investigation in the goal of improving the survival of the cancer patient through amelioration of the disease burden of gram-positive bacteria.

PMID: 25352626 [PubMed - in process]

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Oct 302014
 
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Antibiotic-resistant gram-negative bacterial infections in patients with cancer.

Clin Infect Dis. 2014 Nov 15;59 Suppl 5:S335-9

Authors: Perez F, Adachi J, Bonomo RA

Abstract
Patients with cancer are at high risk for infections caused by antibiotic resistant gram-negative bacteria. In this review, we summarize trends among the major pathogens and clinical syndromes associated with antibiotic resistant gram-negative bacterial infection in patients with malignancy, with special attention to carbapenem and expanded-spectrum β-lactam resistance in Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia-all major threats to our cancer patients. Optimal therapy for these antibiotic-resistant pathogens still remains to be determined.

PMID: 25352627 [PubMed - in process]

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Oct 302014
 
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Advances in prevention and management of central line-associated bloodstream infections in patients with cancer.

Clin Infect Dis. 2014 Nov 15;59 Suppl 5:S340-3

Authors: Raad I, Chaftari AM

Abstract
Central lines, which are essential for treating cancer, are associated with at least 400 000 episodes of bloodstream infection in patients with cancer every year in the United States. Effective novel interventions for preventing and managing these infections include antimicrobial-coated catheters and antimicrobial lock solutions.

PMID: 25352628 [PubMed - in process]

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Oct 112014
 

Is Bacteremic Sepsis Associated with Higher Mortality in Transplant Recipients than in Non-Transplant Patients? A Matched Case-Control Propensity-Adjusted Study.

Clin Infect Dis. 2014 Oct 9;

Authors: Kalil AC, Syed A, Rupp ME, Chambers H, Vargas L, Maskin A, Miles CD, Langnas A, Florescu DF

Abstract
BACKGROUND:  Sepsis is a serious solid organ transplant (SOT) complication. Evidence on survival differences between SOT and non-SOT patients with sepsis is lacking.
METHODS:  Matched, case-control propensity-adjusted study. Conditional logistic regression was performed for risk factor analysis; Cox proportional hazards regression for survival analysis.
RESULTS:  A total of 369 patients (123 cases; 246 controls) diagnosed with blood culture proven sepsis were matched 1:2 by age, gender, and hospital location. The distribution of allografts: 36.6% kidney, 34.1% liver, 13% kidney-pancreas, 7.3% small bowel/liver, 5.7% heart/lung, and 3.3% multivisceral. The conditional logistic regression showed that the following factors were significantly more frequently associated with SOT compared to non-SOT: higher number of comorbidities OR=8.2 [95%CI 1.48 to 45.44] (p=0.016); higher SOFA score OR=1.2 [95%CI 1.07 to 1.32] (p=0.001); presence of nosocomial infection OR=36.3 [95%CI 9.71 to 135.96] (p<0.0001); inappropriate initial antibiotics OR=0.04 [95%CI 0.006 to 0.23] (p<0.0001); and lower white blood cell count OR=0.93 [95%CI 0.89 to 0.97] (p<0.0001). Cox proportional hazards regression showed that after all adjustments for clinical presentation, severity of illness and types of infection, SOT recipients with sepsis had a significantly lower risk of death at 28 days: HR=0.22 [95%CI 0.09 to 0.54] (p=0.001), and at 90 days: HR=0.43 [95%CI 0.20 to 0.89] (P=0.025).
CONCLUSIONS:  The 28-day and 90-day mortality were significantly decreased for transplant recipients compared with non-transplant patients. These findings suggest that the immunosuppression associated with transplantation may provide a survival advantage to transplant recipients with sepsis through modulation of the inflammatory response.

PMID: 25301215 [PubMed - as supplied by publisher]

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Oct 092014
 
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Single-dose Oritavancin Compared to 7-10 days of Vancomycin in the Treatment of Gram-Positive Acute Bacterial Skin and Skin Structure Infections; the SOLO II Non-inferiority Study.

Clin Infect Dis. 2014 Oct 6;

Authors: Corey GR, Good S, Jiang H, Moeck G, Wikler M, Green S, Manos P, Keech R, Singh R, Heller B, Bubnova N, O'Riordan W, for the SOLO II Investigators

Abstract
BACKGROUND:  Oritavancin is a lipoglycopeptide antibiotic with rapid bactericidal activity against gram-positive bacteria. Its concentration dependent activity and long half-life allow for single-dose treatment.
METHODS:  In a randomized, double-blind trial, adults with acute bacterial skin and skin structure infections received either a single IV 1200 mg dose of oritavancin or 7 to 10 days of twice-daily vancomycin. Three efficacy endpoints were tested for non-inferiority: 1) primary composite endpoint at 48 to 72 hours (cessation of spreading or reduction in lesion size, absence of fever, and no rescue antibiotic); 2) investigator-assessed clinical cure 7 to 14 days after end of treatment; and 3) ≥20% reduction in lesion area at 48 to 72 hours.
RESULTS:  A total of 503 and 502 patients comprised the modified intent to treat (mITT) population for oritavancin and vancomycin, respectively. All three efficacy endpoints met the 10% non-inferiority margin: the primary composite endpoint, 80.1% vs 82.9%; [95% confidence interval (CI): -7.5, 2.0], investigator-assessed clinical cure, 82.7% vs 80.5%, [CI: -2.6, 7.0] and proportion of patients attaining ≥20% reduction in lesion area, 85.9% vs 85.3%, [CI: -3.7, 5.0] for oritavancin vs vancomycin respectively. Efficacy outcomes by pathogen, including methicillin-resistant Staphylococcus aureus and the frequency of adverse events were similar between treatment groups.
CONCLUSIONS:  A single 1200 mg dose of oritavancin was non-inferior to 7 to 10 days of vancomycin in treating ABSSSI caused by gram-positive pathogens, and was well tolerated. Oritavancin provides a single-dose alternative to multi-dose therapies for the treatment of ABSSSI. Trial registration. ClinicalTrials.gov identifier: NCT01252732.

PMID: 25294250 [PubMed - as supplied by publisher]

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Sep 282014
 

Antimicrobial Stewardship: Philosophy Versus Practice.

Clin Infect Dis. 2014 Oct 15;59(suppl 3):S112-S121

Authors: Dodds Ashley ES, Kaye KS, DePestel DD, Hermsen ED

Abstract
To promote the judicious use of antimicrobials and preserve their usefulness in the setting of growing resistance, a number of policy-making bodies and professional societies have advocated the development of antimicrobial stewardship programs. Although these programs have been implemented at many institutions in the United States, their impact has been difficult to measure. Current recommendations advocate the use of both outcome and process measures as metrics for antimicrobial stewardship. Although patient outcome metrics have the greatest impact on the quality of care, the literature shows that antimicrobial use and costs are the indicators measured most frequently by institutions to justify the effectiveness of antimicrobial stewardship programs. The measurement of more meaningful outcomes has been constrained by difficulties inherent to these measures, lack of funding and resources, and inadequate study designs. Antimicrobial stewardship can be made more credible by refocusing the antimicrobial review process to target specific disease states, reassessing the usefulness of current metrics, and integrating antimicrobial stewardship program initiatives into institutional quality and safety efforts.

PMID: 25261538 [PubMed - as supplied by publisher]

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