Jun 012014
 
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Staphylococcus aureus Bacteremia at Five U.S. Academic Medical Centers, 2008-2011: Significant Geographic Variation in Community-Onset Infections.

Clin Infect Dis. 2014 May 30;

Authors: David MZ, Daum RS, Bayer AS, Chambers HF, Fowler VG, Miller LG, Ostrowsky B, Baesa A, Boyle-Vavra S, Eells SJ, Garcia-Houchins S, Gialanella P, Macias-Gil R, Rude TH, Ruffin F, Sieth J, Volinski J, Spellberg B

Abstract
BACKGROUND:  The incidence of community-onset (CO) methicillin-resistant Staphylococcus aureus (MRSA) bacteremia rose from the late 1990s through the 2000s. However, healthcare- onset (HO) MRSA rates have recently declined in the U.S. and Europe.
METHODS:  Data were abstracted from infection prevention databases between January 1, 2008 and December 31, 2011 at five U.S. academic medical centers to determine the number of single-patient blood cultures positive for MRSA and MSSA per calendar year, stratified into CO- and HO infections.
RESULTS:  Across the five centers, 4,171 episodes of bacteremia were identified. Center A (Los Angeles, CA) experienced a significant decline in CO-MRSA bacteremia rates (from a peak in 2009 of 0.42 to 0.18 per 1,000 patient days in 2011 [p=0.005]) while CO-MSSA rates remained stable. Centers B (San Francisco, CA), D (Chicago, IL) and E (Raleigh-Durham, NC) experienced a stable incidence of CO-MRSA and CO-MSSA bacteremia. In contrast, at Center C (New York, NY), the incidence of CO-MRSA increased more than three-fold (0.11 to 0.34 cases per 1,000 patient days [<0.001]). At most of the sites HO-MRSA decreased and HO-MSSA rates were stable. USA300 accounted for 52% (104/202) of genotyped MRSA isolates overall, but this varied by center, ranging from 35% to 80%.
CONCLUSIONS:  CO-MRSA rates and the contribution of USA300 MRSA varied dramatically across diverse geographical areas in the U.S. Enhanced infection control efforts are unlikely to account for such variation in CO infection rates. Bio-ecological and clinical explanations for geographical differences in CO-MRSA bacteremia rates merit further study.

PMID: 24879783 [PubMed - as supplied by publisher]

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May 292014
 

Antimicrobial Resistance and Susceptibility Testing of Anaerobic Bacteria.

Clin Infect Dis. 2014 May 27;

Authors: Schuetz AN

Abstract
Infections due to anaerobic bacteria can be severe and life-threatening. Susceptibility testing of anaerobes is not frequently performed in laboratories, but such testing is important to direct appropriate therapy. Anaerobic resistance is increasing globally, and resistance trends vary by geographic region. An overview of a variety of susceptibility testing methods for anaerobes is covered, and the advantages and disadvantages of each method are reviewed. Specific clinical situations warranting anaerobic susceptibility testing are discussed.

PMID: 24867792 [PubMed - as supplied by publisher]

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May 232014
 
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Foodborne listeriosis acquired in hospitals.

Clin Infect Dis. 2014 May 20;

Authors: Silk BJ, McCoy MH, Iwamoto M, Griffin PM

Abstract
Listeriosis is characterized by bacteremia or meningitis. We searched for listeriosis case series and outbreak investigations published in English by 2013, and assessed the strength of evidence for foodborne acquisition among patients who ate hospital food. We identified 30 reports from 13 countries. Among the case series, the median proportion of cases considered hospital-acquired was 25% (range, 9-67%). The median number of outbreak-related illnesses considered hospital-acquired was 4.0 (range, 2-16). All patients were immunosuppressed in 18 (75%) of 24 reports with available data. Eight outbreak reports with strong evidence for foodborne acquisition in a hospital implicated sandwiches (3 reports), butter, pre-cut celery, Camembert cheese, sausage, and tuna salad (1 report each). Foodborne acquisition of listeriosis among hospitalized patients is well documented internationally. The number of listeriosis cases could be reduced substantially by establishing hospital policies for safe food preparation for immunocompromised patients and by not serving them higher-risk foods.

PMID: 24846635 [PubMed - as supplied by publisher]

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May 162014
 
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Hospital-associated outbreak of Middle East Respiratory Syndrome Coronavirus: A serologic, epidemiologic, and clinical description.

Clin Infect Dis. 2014 May 14;

Authors: Al-Abdallat MM, Payne DC, Alqasrawi S, Rha B, Tohme RA, Abedi GR, Al Nsour M, Iblan I, Jarour N, Farag NH, Haddadin A, Al-Sanouri T, Tamin A, Harcourt JL, Kuhar DT, Swerdlow DL, Erdman DD, Pallansch MA, Haynes LM, Gerber SI, the Jordan MERS-CoV Investigation Team

Abstract
BACKGROUND:  In April 2012, the Jordan Ministry of Health (JMoH) investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; two fatal cases were retrospectively confirmed by rRT-PCR to be the first detected cases of Middle East Respiratory Syndrome (MERS-CoV).
METHODS:  Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical chart reviews and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using three U.S. Centers for Disease Control and Prevention (CDC) serologic tests for detection of anti-MERS-CoV antibodies.
RESULTS:  Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti-MERS-CoV antibodies by at least two of three serologic tests, in addition to two fatal cases identified by rRT-PCR. The case fatality rate among the nine total cases was 22%. Six cases were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at two transfer hospitals having acceptable infection control practices.
CONCLUSION:  Novel serological tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts of a Jordan hospital-associated respiratory illness outbreak in April 2012, resulting in a total of nine test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most cases had no major, underlying medical conditions; none were on hemodialysis. Our observed case fatality was lower than has been reported from outbreaks elsewhere.

PMID: 24829216 [PubMed - as supplied by publisher]

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May 072014
 
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Vancomycin, Metronidazole, or Tolevamer for Clostridium difficile Infection: Results from Two Multinational, Randomized, Controlled Trials.

Clin Infect Dis. 2014 May 5;

Authors: Johnson S, Louie TJ, Gerding DN, Cornely OA, Chasan-Taber S, Fitts D, Gelone SP, Broom C, Davidson DM

Abstract
Background. Clostridium difficile infection (CDI) is a common complication of antibiotic therapy that is also treated with antibiotics, contributing to ongoing disruption of the colonic microbiota and CDI recurrence. Two multinational trials were conducted to compare the efficacy of tolevamer, a non-antibiotic, toxin-binding polymer with vancomycin and metronidazole. Methods. Patients with CDI were randomly assigned to oral tolevamer 9 g (loading dose) followed by 3 g every 8 hours for 14 days, vancomycin 125 mg every 6 hours for 10 days, or metronidazole 375 mg every 6 hours for 10 days in a 2:1:1 ratio. The primary endpoint was clinical success defined as resolution of diarrhea and absence of severe abdominal discomfort for >2 consecutive days including day 10. Results. In a pooled analysis, 563 patients received tolevamer, 289 received metronidazole, and 266 received vancomycin. Clinical success of tolevamer was inferior to both metronidazole and vancomycin (P<0.001), and metronidazole was inferior to vancomycin (P=0.02) (44.2% [n=534], 72.7% [n=278], and 81.1% [n=259], respectively). Clinical success in patients with severe CDI who received metronidazole was 66.3% compared with vancomycin, which was 78.5%. (P=0.059). A post-hoc multivariate analysis that excluded tolevamer found three factors that were strongly associated with clinical success: vancomycin treatment, treatment-naïve status, and mild or moderate CDI severity. Adverse events were similar among the treatment groups. Conclusion. Tolevamer was inferior to antibiotic treatment of CDI, and metronidazole was inferior to vancomycin. Trial Registration. clinicaltrials.gov NCT00106509 and NCT00196794.

PMID: 24799326 [PubMed - as supplied by publisher]

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