20 research outputs found
Age Distribution of Cases of 2009 (H1N1) Pandemic Influenza in Comparison with Seasonal Influenza
INTRODUCTION: Several aspects of the epidemiology of 2009 (H1N1) pandemic influenza have not been accurately determined. We sought to study whether the age distribution of cases differs in comparison with seasonal influenza. METHODS: We searched for official, publicly available data through the internet from different countries worldwide on the age distribution of cases of influenza during the 2009 (H1N1) pandemic influenza period and most recent seasonal influenza periods. Data had to be recorded through the same surveillance system for both compared periods. RESULTS: For 2009 pandemic influenza versus recent influenza seasons, in USA, visits for influenza-like illness to sentinel providers were more likely to involve the age groups of 5-24, 25-64 and 0-4 years compared with the reference group of >64 years [odds ratio (OR) (95% confidence interval (CI)): 2.43 (2.39-2.47), 1.66 (1.64-1.69), and 1.51 (1.48-1.54), respectively]. Pediatric deaths were less likely in the age groups of 2-4 and <2 years than the reference group of 5-17 years [OR (95% CI): 0.46 (0.25-0.85) and 0.49 (0.30-0.81), respectively]. In Australia, notifications for laboratory-confirmed influenza were more likely in the age groups of 10-19, 5-9, 20-44, 45-64 and 0-4 years than the reference group of >65 years [OR (95% CI): 7.19 (6.67-7.75), 5.33 (4.90-5.79), 5.04 (4.70-5.41), 3.12 (2.89-3.36) and 1.89 (1.75-2.05), respectively]. In New Zealand, consultations for influenza-like illness by sentinel providers were more likely in the age groups of <1, 1-4, 35-49, 5-19, 20-34 and 50-64 years than the reference group of >65 years [OR (95% CI): 2.38 (1.74-3.26), 1.99 (1.62-2.45), 1.57 (1.30-1.89), 1.57 (1.30-1.88), 1.40 (1.17-1.69) and 1.39 (1.14-1.70), respectively]. CONCLUSIONS: The greatest increase in influenza cases during 2009 (H1N1) pandemic influenza period, in comparison with most recent seasonal influenza periods, was seen for school-aged children, adolescents, and younger adults
Early switch to oral versus intravenous antimicrobial treatment for hospitalized patients with acute pyelonephritis: a systematic review of randomized controlled trials
Background: Acute pyelonephritis is a common infection with significant
morbidity and mortality, particularly in pediatric populations.
Early-switch strategies (from intravenous to oral treatment) may be an
acceptable or even preferred option in the treatment of patients with
acute pyelonephritis in terms of effectiveness and safety and can also
reduce the economical burden associated with pyelonephritis.
Objective: We sought to evaluate the effectiveness and safety of
early-switch strategies in hospitalized patients with acute
uncomplicated pyelonephritis.
Methods: We searched in PubMed, Cochrane Central Register of Controlled
Trials, and Scopus to identify randomized controlled trials (RCTs) that
compared intravenous antibiotic regimens to regimens including an early
switch to oral (after initial intravenous) treatment.
Results: Eight RCTs (6 in children) were eligible for inclusion. In 5
RCTs the intravenous antibiotic treatment arms were not switched to oral
treatment until the end of the study while in the remaining 3 RCTs the
intravenous arms were switched late to oral treatment (after 5-10 days).
Data regarding the incidence of renal scars, microbiological
eradication, clinical cure, reinfection, persistence of acute
pyelonephritis, and adverse events were provided in 4 (all pediatric
trials), 6 (4 pediatric), 4 (2 pediatric), 5 (3 pediatric), 3 (1
pediatric), and 5 RCTs (3 pediatric), respectively. There were no
differences regarding the above outcomes between the two compared
treatment regimens in either pediatric or adult populations.
Conclusion: Early switch to oral antibiotic strategies seem to be as
effective and safe as intravenous regimens for the treatment of
hospitalized patients with acute pyelonephritis. These findings suggest
that there is probably a potential to decrease the duration of
intravenous treatment by 4-11 days in hospitalized patients with acute
pyelonephritis without compromising their outcomes
Patients included in randomised controlled trials do not represent those seen in clinical practice: focus on antimicrobial agents
Clinicians rely on the findings of randomised controlled trials (RCTs)
to formulate clinical decisions regarding individual patients. We
examined whether patients included in RCTs focusing on antimicrobial
agents are representative of those encountered in real-life clinical
situations. PubMed was searched for RCTs referring to the field of
infectious diseases. Data regarding the exclusion criteria of the
identified RCTs were extracted and critically evaluated. In total, 30
trials (17 referring to respiratory tract, 5 to skin and soft-tissue, 4
to intra-abdominal, 2 to gynaecological and 2 to bloodstream infections)
were included in the study. All retrieved RCTs reported extensive
exclusion criteria. After comparing in a qualitative manner (based on
our clinical experience) the eligible patient population in the
identified RCTs with the respective population that would be encountered
in general practice, it was observed that the above-mentioned patient
populations differ considerably. In conclusion, RCTs in the field of
infectious diseases use extensive and stringent exclusion criteria, a
fact that may lead to considerable difference between the patient
populations of RCTs and those viewed in clinical practice. The
application of the findings of RCTs to the care of individual patients
should be performed cautiously. (C) 2010 Elsevier B.V. and the
International Society of Chemotherapy. All rights reserved
Susceptibility of Urinary Tract Bacteria to Fosfomycin▿
We evaluated the in vitro activity of fosfomycin against urinary isolates in a region in Greece that exhibits considerable antimicrobial resistance by evaluating retrospectively relevant susceptibility data retrieved from the microbiological library of the University Hospital of Heraklion, Crete, Greece. We examined 578 urinary isolates. In total, 516 (89.2%) were susceptible to fosfomycin; 415 isolates were gram negative, and 101 isolates were gram positive. Fosfomycin appears to exhibit good levels of in vitro activity against the examined urinary isolates
Attributable mortality of Stenotrophomonas maltophilia infections: a systematic review of the literature
Aim: Although Stenotrophomonas maltophilia is commonly isolated from
clinical specimens, mainly of immunocompromised patients, mortality
directly attributable to this organism is controversial. We searched
PubMed, Scopus and Cochrane and assessed the available literature
regarding mortality attributable to infection with S, maltophilia.
Method: Crude mortality and mortality of case patients receiving
appropriate or inappropriate initial antibiotic treatment were
evaluated. A total of 15 articles (six matched case-control, seven
case-control and two controlled cohort studies) were identified; 13
studies (the six matched case-control and the seven case-control
studies) were included in the analysis. Results: In seven studies,
mortality of cases differed significantly from that of controls.
Mortality was significantly higher in cases than controls in six of
these studies; it was lower in cases than controls in the one study
where controls had Pseudomonas aeruginosa bacteremia. In six studies,
mortality of cases did not differ significantly compared with the
respective controls. In three of four studies providing relevant data,
mortality of cases treated with inappropriate initial antibiotic
treatment was significantly higher compared with cases treated with
appropriate initial antibiotic treatment. Conclusion: A considerable
mortality rate (up to 37.5%) can be attributed to S. maltophilia
infection. Thus, clinicians should not underestimate the clinical
significance of S. maltophilia infections
Laboratory-confirmed influenza-associated pediatric deaths in different age groups, during the 2009 (H1N1) pandemic influenza period and recent seasonal influenza periods, in the United States of America.*
<p>Abbreviations: y: years.</p><p>Data are from US Centers for Disease Control and Prevention; Influenza-Associated Pediatric Mortality Surveillance System (<a href="http://www.cdc.gov/flu/weekly/fluactivity.htm" target="_blank">http://www.cdc.gov/flu/weekly/fluactivity.htm</a>).</p
Sentinel average weekly consultation rate for influenza-like illness per 100000 patient population (calculated absolute number of annual sentinel consultations<sup>#</sup>) for different age groups, during the 2009 (H1N1) pandemic influenza period and recent seasonal influenza periods, in New Zealand.<sup>*</sup>
<p>Abbreviations: y: years, wks: weeks.</p><p>* Data are from New Zealand Institute of Environmental Science and Research (<a href="http://www.surv.esr.cri.nz/index.php" target="_blank">http://www.surv.esr.cri.nz/index.php</a>).</p><p># Calculated data should be considered as approximate.</p