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PubMed2000

Current issues in the treatment of resistant bloodstream infections.

Bloodstream infections cause significant morbidity and mortality for patients with hematologic malignancy. Antimicrobial drugs are the most reliable currently available treatment for infection, but several issues must be considered before choosing the appropriate regimen. Practitioners must be aware of changes in patterns of microbial prevalence and in drug resistance. Current worldwide data indicate a shift to gram-positive pathogens, with coagulase-negative staphylococci being the most common, and enterococcal and viridans group streptococcal species becoming problematic. Antimicrobial resistance continues to rise among these species, and while current drugs and combinations of them are effective in most cases, successful therapy will require the development of new drugs for which resistance has not emerged. Examples of such drugs include the oxazolidinones and glycylcyclines. While antibiotics will continue to be essential treatment for most patients with fever and neutropenia, a judicious reduction of exposure to antimicrobial drugs and enhanced infection control measures are warranted in the face of increasing antimicrobial resistance (e.g., vancomycin-resistant enterococci). The standard of care for patients who develop fever while neutropenic is empiric, broad-spectrum antibiotics that are modified as needed until fever and infection subside. Several factors, including antibiotic resistance, must be considered in choosing the empiric regimen.

Anti-Bacterial Agents↗
PubMed1991

[Emergency obstetric hysterectomy: report of fifteen cases].

From June 1978 to June 1990, there were 41,989 deliveries, 13,396 cesarean sections and 15 emergency obstetric hysterectomies at Taipei Chang Gung Memorial Hospital. The incidence of emergency obstetric hysterectomy is 36/100,000 deliveries. The mean age of patients is 31.7 years old. The indications for hysterectomy were placental disorder (60.0%), uterine atony (26.7%), and uterine rupture (13.3%). The present series showed that 14 cases had total abdominal hysterectomy, while only one case had a subtotal hysterectomy. Total hysterectomy should generally be performed unless maternal instability mandates a more expeditious subtotal hysterectomy. The most common postoperative complication included unknown fever and urinary tract infection. For those four cases of post-cesarean hysterectomy, conservative treatment was tried but failed. All cases presented with hypotension (less than 80/60 mmHg), tachycardia (greater than 100 times/min) and with a mean hemoglobin of 9 mg% during the observation period. In these patients, blood loss, operating time and length of hospitalization was increased when compared with a group of 7 patients undergoing cesarean hysterectomy. In patients with placenta accreta, who are candidates for cesarean hysterectomy, initial hypotension, tachycardia and shock developed during cesarean section. It must be emphasized that conservative aggressive measures to control obstetric hemorrhage remain the mainstay of therapy, but emergency hysterectomy played the life-saving role with which every practitioner of obstetrics must be familiar and keep in mind.

Adult↗
PubMed1989

An information campaign--an important measure in controlling the use of antibiotics.

Denmark is one of the countries using the smallest quantity of antibiotics in proportion to its population. Nevertheless, the use of ampicillin and co-trimoxazole has been found to be undesirably high. An information campaign was carried out to reduce the ampicillin and co-trimoxazole usage and to increase the penicillin usage as a consequence. To evaluate the efficacy of the campaign 602 general practitioners participated in the study, and the antibiotic treatment of 7607 patients, treated in week 13 in 1987, was recorded. These prescriptions were compared with the prescriptions recorded in two previous but identical investigations in 1979 and in 1983. The prescribing habits had changed significantly after the information campaign, resulting in national savings of two million Danish kroner/million inhabitants/year. Information could be an important measure in controlling the worldwide use of antibiotics.

Ampicillin↗
PubMed1989

Antimicrobial use in hospital-acquired infections.

The appropriate use of antibiotics in nosocomial infections has been a goal of infectious disease practitioners and hospital epidemiologists since the emergence of resistant staphylococci more than 30 years ago. This challenge has assumed new proportions in the 1980s for many reasons. First, resistant gram-positive and gram-negative bacteria are increasingly common. Thus many traditional drugs or combinations of drugs lack efficacy. Second, there are so many new antibiotics available that it is difficult for any but the most knowledgeable to use each of them appropriately. Third, economic reality has forced hospitals and physicians to alter their activities and focus more on cost considerations than was ever necessary before. Last, infectious disease as a subspecialty in internal medicine is profoundly different in the 1980s; many infections must be controlled for life rather than cured because of underlying infection with human immunodeficiency virus, which suppresses immunity. The use of antibiotics is now rapidly changing and the state of the art in 1989 is likely to be outdated very soon as new pathogens emerge and new drugs are developed. The appropriate use of the quinolones is a great challenge that we now face. Can we preserve this valuable class of drugs, or will resistance develop quickly because of widespread, indiscriminate, and inappropriate use? To what extent can we phase out aminoglycoside use without compromising efficacy and without promoting the development of resistance? Do the monobactams have a real role to play in combination therapy? How should formularies approach the diverse cephalosporins that now inundate the market? These are only a few of the fundamental questions that must be addressed as this decade ends.

Anti-Bacterial Agents↗
PubMedDate not supplied

[The complex diagnosis and treatment of sexually transmitted infections and their complications].

The article is dedicated to problems of diagnosis and treatment of those infections transmitted by sexual intercourse (STI) and their complications. A well-advised and feasible scheme of examining patients having applied for medical advice is suggested. Principal groups of drugs are described together with particular representatives of the above groups, the use of which will, we believe, help in delivering medical care to STI patients in a most efficient way. Levels of quality of delivering medical services are worked out depending on optimality of employment of different groups of drugs and their combinations in the treatment of STI and complications thereof. The data obtained during the studies made are to be used in the following circumstances: prescription by medical practitioners of particular schemes of STI treatment; control of quality of the health services delivery in medical settings dealing with those patients presenting with STI and complications thereof; planning of drug purchases by medical institutions providing profile medical care.

Female↗
PubMed2000

Activity of decoquinate against Cryptosporidium parvum in cell cultures and neonatal mice.

Cryptosporidium parvum is an apicomplexan parasite that is an important cause of diarrhea in neonatal calves and humans. No treatment is currently available for neonatal calves. We have recently learned from colleagues in the pharmaceutical industry that dairy practitioners are sometimes using decoquinate for the treatment of neonatal bovine cryptosporidiosis. Therefore, the present study was undertaken to determine whether the clinical observations in calves can be substantiated by laboratory investigation. Oocysts of the KSU-1 isolate of C. parvum were used to infect human ileocecal epithelial cells in vitro to measure the efficacy of treatment using an ELISA based assay. No activity was observed at 10 or 50microM decoquinate, but at 100microM an 8% inhibition of development was seen. Oocysts of the AUCp-1 isolate of C. parvum were then used to infect suckling mice. The numbers of oocysts observed in suckling mice treated with 2.5 or 5.0mg/kg decoquinate were not significantly different from untreated control suckling mice (p0.05). The results of our study suggest that decoquinate should have little efficacy for treatment of neonatal bovine cryptosporidiosis if administered once per day and that any clinical improvement observed in treated calves may be due to factors unrelated to decoquinate's effect on C. parvum.

Animals↗
PubMed1999

Post-partum sexual abstinence in West Africa: implications for AIDS-control and family planning programmes.

OBJECTIVE: To assess whether the custom of prolonged post-partum sexual abstinence in Benin is associated with an increased incidence of extra-marital sexual contacts by husbands. DESIGN: Cross-sectional survey of adult men and women. METHODS: Data obtained from men on their extra-marital sexual behaviour in the past 12 months were linked to data on post-partum abstinence over the same time interval reported by wives. Multivariate analysis was applied to assess the association between conjugal abstinence and husband's extra-marital sex, net of the effects of possible confounders. RESULTS: Approximately half of married men experienced post-partum abstinence in the past 12 months. In this group, 32% reported one or more extra-marital sexual contacts compared with 20% among those who experienced no abstinence (OR = 1.8, P < 0.001). This association is essentially unchanged after controlling for marriage type, age, education, urban-rural residence, income and household wealth. Age, income and wealth are also significant predictors of the probability of extra-marital sex. The effects of income and wealth largely disappear when attention is restricted to extra-marital sex without using a condom on the most recent occasion. CONCLUSIONS: The potentially protective effect of prolonged abstinence after childbirth in Benin (and probably in much of West Africa) is offset by an increased probability that husbands will seek extra-marital partners without using condoms. Although not quantifiable, the enhanced longer-term risks of sexually transmitted diseases/HIV infection for wives probably outweigh the short-term benefits. Family planning practitioners in this region should not hesitate to recommended the early resumption of sex and suitable methods of post-partum contraception for women who express concern or uncertainty about their husband's behaviour.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Giardiasis in Canterbury: the first nine months reported cases.

AIM: To obtain epidemiological information about giardiasis in Canterbury. METHOD: From October 1990 general practitioners were requested to report laboratory confirmed cases. The first 100 cases were sent a questionnaire and also asked to provide the details of two persons to be controls. RESULTS: In the first nine months 109 cases were reported. Eighty four cases completed questionnaires and 51 were matched with controls. The overall reported attack rate was 4.0 per 10,000 population per year. The rate was highest for preschool children and young adults and in rural areas. There was a significant risk associated with having contact with sewage or travelling overseas and a marginal risk for drinking water outside Christchurch. CONCLUSION: The results indicated that giardiasis was relatively common in Canterbury and confirmed that the major mechanisms of infection were probably the same as those previously identified overseas, namely person to person spread via faecal-oral transmission and the drinking of inadequately filtered water.

Adolescent↗
PubMed1993

Roxithromycin versus cefaclor in lower respiratory tract infection: a general practice pharmacoeconomic study.

An economic evaluation comparing roxithromycin 150mg twice daily and cefaclor 250mg thrice daily in the treatment of lower respiratory tract infections (LRTI) was undertaken as part of a randomised clinical trial in New Zealand general practice. The observed statistically significant difference in adverse events, withdrawal rates and extra treatment courses in favour of roxithromycin in the clinical study was translated into medical cost savings. Treatment failures, withdrawals or adverse events resulted in additional costs for 11 of 120 (9%) patients receiving roxithromycin and 19 of 118 (16%) patients receiving cefaclor. In these cases (treatment failures, withdrawals, adverse effects) additional antibiotics and general practitioner visits were required 3 times more often and the cost of additional medication for treating failure or adverse effects was 3 times higher for patients treated with cefaclor than for patients receiving roxithromycin. The total direct medical cost per patient treated with roxithromycin was $NZ9.37 lower (on an incremental basis) than for patients treated with cefaclor, despite a higher drug acquisition cost. An estimate of $NZ656 000 per year in total savings in direct medical costs could be made in New Zealand if roxithromycin were to replace all cefaclor prescriptions in the treatment of LRTI.

Cefaclor↗
PubMed2005

Prevention interventions with persons living with HIV/AIDS: state of the science and future directions.

The National Institutes of Health (NIH/NIMH), the Centers for Disease Control and Prevention (CDC), and the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA) support the CDC's Serostatus Approach to Fighting the HIV Epidemic (SAFE; Janssen et al., 2001). One aim of the strategy is to help individuals living with HIV (and their partners) adopt and sustain HIV and STD risk reduction, treatment adherence, and effective strategies for coping with HIV/AIDS. Efficacious interventions are needed by community organizations and clinics that provide evidence-based services. To expedite translation from research to practice, we convened scientist-practitioners, HIV treatment and prevention providers, and community/consumer members. In this article, we include an overview of prevention trials with HIV-positive persons presented at the meeting, discuss strengths and limitations, recommendations for future research, and discuss sponsoring agencies' plans for advancing prevention tailored for persons living with HIV.

Centers for Disease Control and Prevention, U.S.↗
PubMed2005

[The role of public health service in prevention and control of infectious diseases in the Federal Republic of Germany. Tasks, structures and responsibilities--an overview].

The goal is to describe the structure of administration for the control of infectious diseases in the German states. Internationally there is an increasing risk of potentially global transmission of infectious diseases and therefore increasing need for improved control mechanisms which are viable locally, regionally and internationally. The international public health community must ensure that responses to infectious disease with a potential impact on more than one county entail concerted action, clear communication and decision making by diverse administration agencies. Given Germany's federal structure, the 16 states have differing protocols delineating responsibilities for infection control systems. This paper provides an overview, going into detail only with regard to the administration structure in Hesse. In 2001, the German law governing infectious disease control was amended and significantly expanded. With regard to protection of humans from infectious disease, each state must define its schedule of responsibilities on the resulting scope of duties. Each state in Germany has entrusted the local public health service at the county level with the responsibility for infection prevention and control. As a rule, at the state level both an expert agency and one or more district administration agencies have been installed; these work directly with the Ministry of Health at the state level. In addition to this, Hesse has established a "centre of competence for highly contagious diseases." In the event of an infectious emergency, this network provides special treatment of highly infectious patients and expertise for public health services and the Ministry of Health on a 24-h shift basis. In times of ongoing structural transformation, it is important to emphasize that expertise at the state level is not an alternative to maintaining enough specialised personnel in the public health services themselves. Specialized practitioners are needed to ensure professional and fast-acting responses, both for the prevention and control of infectious diseases.

Communicable Disease Control↗
PubMed1981

[Incidence of infectious diseases in general practice. Results of a survey conducted in 1979 (author's transl)].

In 1979, a sample survey was conducted among 53 general practitioners to determine the incidence of infectious diseases in general medical practice. The survey showed that 45% of the patients seen by these doctors were suffering from an infection, that 53% of these (i.e. 24% of all patients) were treated with antibiotics and that G.P.'s play an important role in preventive medicine. These results might exert a useful influence on the teaching of infectious diseases to medical students and physicians.

Family Practice↗
PubMed1994

A case-control study of drugs and other determinants as potential causes of Guillain-Barré syndrome.

The Guillain-Barré syndrome is an inflammatory demyelinating polyneuropathy with an acute or subacute onset. The current case-control study was performed to investigate the possible role of drugs and other determinants in the causation of the Guillain-Barré syndrome. Patients were included as cases if they fulfilled the criteria for acute Guillain-Barré syndrome and were unable to walk 10 m independently and had been admitted to the hospital within 2 weeks of onset of the neuropathy. For every case, two controls without the disease were obtained from the general practitioner (GP) of the patient with Guillain-Barré syndrome. Controls had the same type of health care insurance, were of the same gender and age (within 5 years), and resident in the same area. By telephone, the GPs of the patients with Guillain-Barré syndrome were interviewed. There were 71 female and 75 male cases and 142 female and 149 male controls. Significantly more cases than controls had been prescribed drugs in the 3 months prior to the index date and also diagnoses or symptoms in cases were more common. Case patients used significantly more frequently antipropulsives (loperamide), penicillins (amoxicillin with or without clavulanic acid) and vaccines. Female controls used significantly more often oral contraceptives. More cases than controls suffered from infections of the respiratory, gastrointestinal or urinary tract prior to the onset of neurological symptoms. In a logistic regression analysis, symptoms concerning the gastrointestinal and respiratory system were strongly associated with the Guillain-Barré syndrome. The use of oral contraceptives was significantly lower in female cases which could be compatible with the hypothesis that these drugs are protective.

Adult↗
PubMed1999

Development of a Web-based clinical information system for surveillance of multiresistant organisms and nosocomial infections.

To optimize the surveillance and control of infections at our hospital, we have developed a clinical information system (CIS) linked to a server providing three kinds of patient-oriented data reports: 1/an automated alert for multiresistant bacteria from a data-driven mechanism; 2/the relevant data for surveillance of hospital-acquired infections; 3/some clinical and educational data for antibiotic prescribing. The new CIS is a Web-based one and now integrated to the Hospital Information System (HIS). In a close collaboration with the experts, we have, first, specified the relevant information for each report. Then, we have linked the system to those HIS DBs containing this information. Finally we have developed a well-secured intranet Web site, on which the concerned practitioners can instantaneously review the latest alerts and/or the summarized/detailed reports. The preliminary results shows that the system is reliable in medical practice and the response time is satisfying.

Algorithms↗
PubMed1992

Patient's rights and doctor's rights: HIV-infected physicians and dentists on the cut edge.

Media, professional associations, public health agencies, legislators, and courts have focused attention to the problem of HIV-infected healthcare professionals. Practitioners should become aware of recently revised ethical guidelines, the doctrine of informed consent, court decisions, and legislation because of the effects these events have on practice and because patients will pose questions on these issues.

Dentistry↗
PubMed2005

Culturing dermatophytes rapidly from each toe web by fingertip.

The diagnosis of tinea pedis is usually confirmed by microscopy and culture of skin scrapings. Isolating dermatophytes by fungal culture gives more reliable proof of infection and has the advantage of identifying the causative organisms. Nevertheless, culture examination is complementary to microscopy and is not routinely performed because it is time- and cost-consuming. Herein, we propose a new culturing method, the 'finger-sampling method', for collecting dermatophytes from patients' toe webs using the examiner's fingertip as a sample collection tool. Using this method, four toe webs of a foot can be examined at one time on one culture dish. Every toe web of 50 patients with untreated tinea pedis were examined, and dermatophytes were grown from 83 out of 107 (78%) KOH positive toe webs. The isolation ratio by the finger-sampling method was comparable to that by traditional slant culture of skin scrapings performed by skilled practitioners. Culture results were also positive in 19 out of 53 (36%) diseased but KOH negative toe webs and in 38 (16%) normal toe webs, suggesting the existence of unidentified infection. Additionally, we confirmed the efficacy of this method for detecting dermatophyte attachment on the healthy toe web skin of volunteers who had just been exposed to contaminated areas, i.e. Japanese public baths or a bath mat stepped on by a patient disseminating dermatophyte propagules.

Adolescent↗
PubMed2002

The scope of guidelines to prevent healthcare-associated infections.

As care is increasingly delivered in the community rather than acute settings, there has been concern that this might be accompanied by a rise in healthcare-associated infection. Consequently, the National Institute for Clinical Excellence (NICE) has commissioned a set of infection prevention guidelines for healthcare workers in community and primary care. The guideline developers were anxious to concentrate this guidance on the areas of most concern to practitioners, particularly in relation to devices. This article describes how a survey and focus groups were employed to identify the areas for guideline development, namely standard principles, long-term indwelling urinary catheters, enteral feeds and central intravascular devices.

Community Health Services↗
PubMed2003

Effectiveness of meningococcal C conjugate vaccine in teenagers in England.

Meningococcal C conjugate vaccine was introduced into clinical practice in the UK before phase 3 trials had been undertaken. We therefore did a case-control study in teenagers to assess vaccine effectiveness. All cases (n=31) enrolled had laboratory confirmed meningococcal C disease. We also enrolled between one and three controls (n=65) per case, matched by age, sex, and general practitioner. Three patients and 23 controls had been vaccinated. The protective effectiveness of the vaccine, estimated by conditional logistic regression, was 93% (95% CI 39-99), which is similar to screening method estimates. The estimated protective effectiveness varied little when potential confounding risk factors were taken into account. Our findings indicate that the vaccine is highly protective against invasive meningococcal C disease.

Adolescent↗