Hope for patients with asplenia or hyposplenism.
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Bacterial Infections↗
Biomedical subjects
A Tice
Publications and source records attributed to A Tice.
Outpatient parenteral antimicrobial therapy (OPAT): a global perspective. Introduction.
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Anti-Bacterial Agents↗
The use of outpatient parenteral antimicrobial therapy in the management of osteomyelitis: data from the Outpatient Parenteral Antimicrobial Therapy Outcomes Registries.
Because osteomyelitis requires lengthy parenteral antibiotic treatment in patients who are often otherwise healthy, it lends itself well to outpatient parenteral antibiotic therapy (OPAT). Four delivery models for OPAT are (1) self-administration at home, (2) administration by a visiting nurse in the home, (3) infusion center and (4) nursing home. Patient selection is critical to the success of any OPAT program. Clinical and microbiologic data were compiled for more than 500 osteomyelitis patients reported in a registry of OPAT cases in the United States. The most commonly isolated pathogen was Staphylococcus aureus. The antibiotics used most frequently were vancomycin and ceftriaxone. Of 255 patients assessed for bacteriologic outcome, 2 patients developed infection with a new organism and 2 failed to eliminate the causative organism by the end of OPAT therapy. Of 266 patients who were assessed for clinical outcome, 259 improved and 7 failed. Data collected by the OPAT Outcomes Registry confirms that osteomyelitis can be safely and effectively treated with intravenous antibiotics outside the hospital.
Aged↗
A novel multiresistant Streptococcus pneumoniae serogroup 19 clone from Washington State identified by pulsed-field gel electrophoresis and restriction fragment length patterns.
In 1997, a cluster of multiresistant invasive serogroup 19 pneumococcus infections, including two fatalities, was reported in Washington State. Further investigation identified other cases. Fourteen Washington Streptococcus pneumoniae isolates, four from Alaska, and eight isolates from eastern Canada with reduced penicillin susceptibility (MIC of > or =1 microg/ml) were included in the study. Pulsed-field gel electrophoresis (PFGE) with ApaI, SacII, and SmaI restriction enzymes and IS1167 and mef restriction fragment length polymorphism (RFLP) pattern analysis were performed. Twenty of the 26 isolates had identical or related PFGE patterns, with two or all three enzymes, and identical or related IS1167 RFLP patterns, indicating that they were genetically related. These 20 isolates contained the mef gene conferring erythromycin resistance and had identical mef RFLP patterns. The PFGE and RFLP patterns were distinct from those of six multiresistant clones previously described and suggest that a new multiresistant clone has appeared in Washington, Alaska, and eastern Canada. This newly characterized clone should be included in the Pneumococcal Molecular Epidemiology Network.
Anti-Bacterial Agents↗
Outpatient parenteral antimicrobial therapy as an alternative to hospitalization.
Outpatient parenteral antimicrobial therapy (OPAT) has evolved because of advances in antibiotics and the advent of new technology. It provides a cost-effective means of treating seriously infected patients away from hospital. Virtually any infection can be treated on an outpatient basis and several treatment programmes have been designed. Housebound patients can be visited by a nurse who will supervise administration; infusion centres, set up in a clinic or a doctor's office, provide on-hand medical staff and the benefit of a medical facility; self-administration provides autonomy for patient and family and is the least costly. Given the cost-cutting environment in which healthcare now operates worldwide, it is important that OPAT must develop its own procedures and guidelines for quality assurance. For OPAT to work away from the controlled environment of the hospital, it is essential that physicians, nurses and pharmacists adapt to new medical environments and work with the patient to ensure that care is maintained to a high standard.
Ambulatory Care↗
Home intravenous antibiotic therapy.
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Anti-Bacterial Agents↗
Antimalarial therapy for lupus erythematosus: an apparent advantage of quinacrine.
A retrospective study of 26 quinacrine-treated lupus erythematosus patients failed to show evidence of drug-induced ocular changes. Although quinacrine commonly produces minor side effects, such as yellow discoloration of the skin, and may rarely produce very serious side effects, such as aplastic anemia, it appears to produce much less oculotoxicity than does chloroquine.
Aged↗