Liver cirrhosis as a risk factor for mortality in a national cohort of patients with bacteremia.
J Infect. 2011 Aug 2;
Authors: Kang CI, Song JH, Chung DR, Peck KR, Yeom JS, Ki HK, Son JS, Lee JS, Kim YS, Jung SI, Kim SW, Chan…

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Hyponatremia in patients with infectious diseases.
J Infect. 2011 Aug 2;
Authors: Liamis G, Milionis HJ, Elisaf M
Hyponatremia is a common electrolyte disturbance associated with considerable morbidity and mortality. H…

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Clinical predictors of Pseudomonas aeruginosa bacteremia among Gram-negative bacterial infections in non-neutropenic patients with solid tumor.
J Infect. 2011 Jul 12;
Authors: Joo EJ, Kang CI, Ha YE, Kim J, Kang SJ, Park SY, L…

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Immunomodulatory agents in the treatment of community-acquired pneumonia: A systematic review.
J Infect. 2011 Jul 5;
Authors: Corrales-Medina VF, Musher DM
Despite the availability of excellent antibiotics, the mortali…

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A simple model to predict bacteremia in women with acute pyelonephritis.
J Infect. 2011 Jun 22;
Authors: Kim KS, Kim K, Jo YH, Kim TY, Lee JH, Lee SJ, Rhee JE, Suh GJ
OBJECTIVES: To construct a simple model to predict …

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Early diagnosis model for meningitis supports public health decision making.
J Infect. 2011 May 20;
Authors: Close RM, Ejidokun OO, Verlander NQ, Fraser G, Meltzer M, Rehman Y, Muir P, Ninis N, Stuart JM
OBJECTIVE: To …

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Mandatory reporting and improvements in diagnosing Clostridium difficile Infection: An incompatible dichotomy?
J Infect. 2011 Mar 23;
Authors: Goldenberg SD, Price NM, Tucker D, Wade P, French GL
Toxin enzyme immunoass…

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Serological responses following influenza a h1n1 2009 infection in adults.
J Infect. 2011 Mar 17;
Authors: Tan S, Gordon DL, Honda-Okubo Y, Petrovsky N, Phillips P, Huddleston S, Sadlon TA
OBJECTIVE: : The aim of this …

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Staphylococcus aureus bacteraemia – nationwide assessment of treatment adequacy and outcome.
J Infect. 2011 Mar 11;
Authors: Asgeirsson H, Kristjansson M, Kristinsson KG, Gudlaugsson O
OBJECTIVES: To assess the treatme…

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The epidemiology of clostridium difficile in scotland.

J Infect. 2011 Feb 4;

Authors: Wiuff C, Brown DJ, Mather H, Banks AL, Eastaway A, Coia JE

OBJECTIVES: The objective of this study was to characterise the epidemiology of C.difficile in Scotland by determining the distribution of PCR ribotypes and antimicrobial susceptibility in 1613 isolates collected from all healthboard areas of Scotland in the period November 2007- December 2009. METHODS: We performed PCR ribotyping and antimicrobial susceptibility testing by Etest on 1613 isolates from severe cases and outbreaks of CDI in all parts of Scotland between 2007-2009, and compared resistance profiles in the 10 most common ribotypes with those of the less common ribotypes. We further determined the local distribution of ribotypes in Scottish healthboard areas and correlated those to the local incidence rates of Clostridium difficile infection. RESULTS: Ribotypes 106 (29.4%), 001 (22.0%) and 027 (12.6%) were predominant types – other ribotypes included 002, 005, 014, 015, 020, 023 and 078. The ribotypes varied between healthboards. Antimicrobial susceptibility testing of C. difficile isolates showed high frequencies of resistance to moxifloxacin, levofloxacin, erythromycin and cefotaxime in the epidemic C. difficile ribotypes 001, 027 and 106 compared to other less common ribotypes. Furthermore, reduced susceptibility to metronidazole was found only in the epidemic strains. CONCLUSIONS: These findings are compatible with the hypothesis that fluoroquinolones, macrolides and cephalosporins may play a role in the spread of C. difficile in Scotland, while the role of metronidazole needs further investigations, and highlights the role of antimicrobial stewardship in preventing and controlling Clostridium difficile infection (CDI).

PMID: 21300104 [PubMed - as supplied by publisher]

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Moxifloxacin monotherapy versus ß-lactam mono- or combination therapy in hospitalized patients with community-acquired pneumonia.

J Infect. 2011 Jan 26;

Authors: Ewig S, Hecker H, Suttorp N, Marre R, Welte T

OBJECTIVE: In this observational study, we compared the outcomes of moxifloxacin monotherapy as compared to ß-lactam monotherapy as well as ß-lactam combination therapy in patients with community-acquired pneumonia (CAP). METHODS: Patients recruited within the German Competence Network for CAP (CAPNETZ) were evaluated for treatment regimen. Primary outcome variables were six months overall mortality,pneumonia-related mortality according to clinical judgment and treatment failures (necessity for treatment change and death). RESULTS: Overall, 4091 patients (mean age 64.4 ± 17.8 (range 18-101) years, 2433 male (59.5%)) were included. 2068 patients received moxifloxacin (n=365) or ß-lactam monotherapy (n=1703). 330 patients died within six months. After controlling for confounders in multivariate analysis, moxifloxacin monotherapy had higher survival as compared to ß-lactam monotherapy (hazard ratio for moxifloxacin 0.57, 95% CI 0.35 – 0.92). Multivariate analysis including interaction terms showed that the protective effect of moxifloxacin was not present for CRB-65 class 0 but increased with higher CRB-65 scores (HR 0.69, 95% CI 0.50 – 0.96). Regarding pneumonia-related death, moxifloxacin monotherapy was also protective in multivariate analysis (HR 0.36, 95% CI 0.13 – 0.99). Moxifloxacin was also significantly associated with less treatment failures (p < 0.001). In addition, it was not inferior to combination ß-lactam treatment (p = 0.062). CONCLUSIONS: In CRB-65 class 0 moxifloxacin was equivalent to ß-lactams. Our observations are in support of a use of moxifloxacin monotherapy in hospitalized patients with moderate CAP (CRB65 class 1 and 2).

PMID: 21276814 [PubMed - as supplied by publisher]

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Concomitant Staphylococcus aureus bacteriuria is associated with complicated S. aureus bacteremia.

J Infect. 2009 Oct;59(4):240-6

Authors: Pulcini C, Matta M, Mondain V, Gaudart A, Girard-Pipau F, Mainardi JL, Dellamonica P

OBJECTIVES: To identify factors associated with complicated Staphylococcus aureus bacteremia (SAB) in adults. METHODS: Prospective observational multicenter study during 2 years in Nice University Hospital and during 6 months in the Hôpital Européen Georges Pompidou, Paris, including all adult inpatients with SAB assessed by an Infectious Diseases (ID) specialist. RESULTS: We included 104 SAB (79 in Nice and 25 in Paris), of which 45 were complicated, including 18 endocarditis and 23 bone and joint infections. A concomitant urine sample was performed in 65% of the cases, showing S. aureus bacteriuria 23/68 (34%) times. Blood cultures were drawn 48-96h after an appropriate antibiotic therapy had been started in 70 of the 104 cases (67%) and were positive in 28 cases (40%). CONCLUSIONS: The 3 following factors were found to be associated with complicated SAB in univariate analysis: community acquisition (56% vs 26%, P=0.002), concomitant bacteriuria (47% vs 19%, P=0.016) and persistent bacteremia (55% vs 26%, P=0.016). This last factor was associated with endocarditis, but not with other complications such as bone and joint infections.

PMID: 19666050 [PubMed - indexed for MEDLINE]

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Clinical effectiveness of oseltamivir for influenza A(H1N1) virus with H274Y neuraminidase mutation.

J Infect. 2009 Sep;59(3):207-12

Authors: Kawai N, Ikematsu H, Iwaki N, Kondou K, Hirotsu N, Kawashima T, Maeda T, Tanaka O, Doniwa K, Kashiwagi S

OBJECTIVE: To evaluate the clinical effectiveness of oseltamivir therapy started within 48h of the onset for influenza A(H1N1) virus with H274Y neuraminidase (NA) mutation. METHODS: Virus was isolated before and four to six days after starting oseltamivir treatment from 73 outpatients with influenza A(H1N1) virus in the 2007-2008 and 2008-2009 seasons. NA inhibition assays (IC(50)) and sequence analyses were done using influenza viruses isolated from these patients. Body temperature was evaluated before and on the second, third, and fourth days after starting treatment. RESULTS: H274Y mutation was not shown in the 2007-2008 season (44 patients) and shown in all 29 patients in the 2008-2009 season by NA sequence analyses. The mean IC(50) before oseltamivir treatment was significantly higher in 2008-2009 (319.3+/-185.4 nM) than in 2007-2008 (1.5+/-0.8 nM; p<.001). Patients < or =15 years with oseltamivir-resistant virus infection had a higher ratio of patients persisted virus after oseltamivir treatment than patients >15 years (50% and 11.8%, respectively, p=0.038), and a significant higher body temperature during oseltamivir treatment, compared to patients < or =15 years treated for oseltamivir-sensitive virus infection. CONCLUSION: The clinical effectiveness of oseltamivir for the A(H1N1) virus was reduced in the 2008-2009 season compared with the previous season, especially in children, probably due to the H274Y mutation. Oseltamivir seems to be not recommended for children and patients with high-risk underlying diseases infected with H274Y mutated A(H1N1) virus.

PMID: 19619898 [PubMed - indexed for MEDLINE]

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Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes.

J Infect. 2009 Jun;58(6):403-10

Authors: Johnson S

Episodes of recurrent Clostridium difficile infection (CDI) are difficult to treat for several reasons. Foremost, data are lacking to support any particular treatment strategy. In addition, treatment of recurrent episodes is not always successful, and repeated, prolonged treatment is often necessary. Identification of subgroups at risk for recurrent CDI may aid in diagnosing and treating these patients. Two likely mechanistic factors increasing the risk of recurrent CDI are an inadequate immune response to C. difficile toxins and persistent disruption of the normal colonic flora. Important epidemiologic risk factors include advanced age, continuation of other antibiotics, and prolonged hospital stays. Current guidelines recommend that the first recurrent episode be treated with the same agent (i.e., metronidazole or vancomycin) used for the index episode. However, if the first recurrence is characterized as severe, vancomycin should be used. A reasonable strategy for managing a subsequent episode involves tapering followed by pulsed doses of vancomycin. Other potentially effective strategies for recurrent CDI include vancomycin with adjunctive treatments, such as Saccharomyces boulardii, rifaximin “chaser” therapy after vancomycin, nitazoxanide, fecal transplantation, and intravenous immunoglobulin. New treatment agents that are active against C. difficile, but spare critical components of the normal flora, may decrease the incidence of recurrent CDI.

PMID: 19394704 [PubMed - indexed for MEDLINE]

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Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease.

J Infect. 2009 Jun;58(6):417-24

Authors: Molinos L, Clemente MG, Miranda B, Alvarez C, del Busto B, Cocina BR, Alvarez F, Gorostidi J, Orejas C,

PURPOSE: The purpose of this study was to analyse the possible differences, especially those regarding mortality, between patients hospitalized for community-acquired pneumonia (CAP) with and without chronic obstructive pulmonary disease (COPD), and the risk factors related to mortality in the COPD group. METHODS: 710 patients with CAP were included in a prospective multicenter observational study. 244 of the patients had COPD confirmed by spirometry. RESULTS: COPD was associated with mortality in patients with CAP (OR=2.62 CI: 1.08-6.39). Patients with COPD and CAP had a significantly higher 30-day mortality rate as compared to patients without COPD. Multivariate analysis showed that PaO(2)< or =60 mmHg (OR=7.95; 95% CI: 3.40-27.5), PaCO(2)> or =45 mmHg (OR=4.6; CI: 2.3-15.1); respiratory rate > or =30/min (OR=12.25; CI: 3.45-35.57), pleural effusion (OR=8.6; 95% CI: 2.01-24.7), septic shock (OR=12.6; 95% CI: 3.4-45.66) and renal failure (OR=13.4; 95% CI: 3.2-37.8) were significantly related to mortality. Purulent sputum and fever were considered as protective factors. CONCLUSIONS: COPD was an independent risk factor for mortality in patients with CAP. Hypoxemia and hypercapnia are associated with mortality in patients with CAP with and without COPD. Chronic obstructive pulmonary disease and PaCO(2) value could be useful prognostic factors and should be incorporated in risk stratification in patients with CAP.

PMID: 19329187 [PubMed - indexed for MEDLINE]

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