The Advocate - June 8, 1961

Original title (1951-1987)--The Advocate: official publication of the Archdiocese of Newark (N.J.)

Vancomycin versus Linezolid in the Treatment of Methicillin-Resistant Staphylococcus aureus Meningitis

Abstract Background: Vancomycin is the mainstay of treatment for methicillin-resistant Staphylococcus aureus (MRSA) meningitis. However, successful outcomes with linezolid have not been reported in a large series of patients. We conducted a single-center retrospective cohort study to compare vancomycin with linezolid in the treatment of MRSA meningitis. Methods: We extracted data and outcomes for all adult patients (age > 18 years) with culture-proved MRSA meningitis who received vancomycin or linezolid between January 2006 and June 2011. A definite diagnosis of meningitis was based on the isolation of MRSA in at least one cerebrospinal fluid (CSF) culture and findings in CSF that are typical of the infection. Linezolid was given intravenously (IV) at a dosage of 600 mg q12h and vancomycin IV at 500 mg q6h. Results: A total of 8 patients with MRSA meningitis (5 male, 3 female; age [mean -SD] 61.6 -13.2 years) received vancomycin and 9 patients (7 male, 2 female; age 59.1 -15.6 years) received linezolid. All isolated strains of MRSA were susceptible to both vancomycin and linezolid. The rates of microbiologic success with linezolid or vancomycin, in terms of clearance of MRSA from CSF on day 5, were 7/9 and 2/8 (p = 0.044, Fisher exact test). No severe adverse events occurred in either treatment arm of the study. One-month survival of the patients in whom treatment was successful microbiologically was 2/2 in the vancomycin-treated group and 4/7 in the linezolidtreated group. Minimum inhibitory concentration (MIC) data for vancomycin were available for 5/6 treatment failures with vancomycin, and vancomycin MIC values of these five strains were 2 mg/L. Conclusion: Analysis of the findings in the limited cohorts in our study suggests that linezolid is superior to vancomycin for treating MRSA meningitis, especially in cases in which there is a high MIC (2 mg/L) for vancomycin. A clinical study involving larger cohorts may increase the evidence available in relation to this question

Post COVID-19 irritable bowel syndrome

Objectives: The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut-brain interaction after hospitalisation for SARS-CoV-2 infection. Design: GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires. Results: The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p<0.001). At the 12-month follow-up, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls. Conclusion: Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls. Trial registration number: NCT04691895

Cost Analysis of Nosocomial Infections in a Tertiary Care Referral Hospital's Neurology Intensive Care Unit: A Case-Control Study

WOS: 000365428100009Aim: The purpose of this study is to overview nosocomial infections (NI), to determine risk factors and to evaluate the clinical and financial impact of NI on direct hospital cost among neurology intensive care unit (NICU) patients in a tertiary-care referral hospital. Material and Methods: A retrospective case control study was performed. The sample size was calculated to be at least 51 per group. A list of the last 55 patients who acquired an infection in NICU was obtained from infection control committee. These patients were matched with uninfected patients according to age, sex, diagnosis. The data were collected from patient files, accounting records. Results: A total of 79 NI occurred in 55 cases. The most common NI were pneumonia (48%), catheter related urinary tract infection (39%). Acinetobacter baumannii (25%) is most commonly responsible for NI. NI were detected less in patients who were conscious, non-intubated, without blood transfusion, tracheostomy, urinary catheter or mechanical ventilation. The mortality ratio was 53.1% in cases and 30.8% in controls. The excess costs of NI were $7121.15 and extra length of stay was 26.9 days. Although reimbursement took longer than six months, the Social Security Institution paid back the total billing amount. Conclusion: Given the impact on monetary and health costs of NI, measures to prevent NI in the hospital are strongly recommended for patient safety and for hospital reputation. NICUs in tertiary care referral facilities do not cause financial burden; on the contrary, they provide an opportunity to balance the budget

Cytomegalovirus Disease Causing Outbreak in Family Members

WOS: 000488951800014Primary cytomegalovirus (CMV) infection generally occurs during childhood/early adolescence and is usually an asymptomatic or mild and self-limiting disease in immunocompetent patients. Mononucleosis-like syndrome due to primary CMV may occur in middle-aged or advanced-aged adults, though rare. Three middle-aged patients from the same family admitted to our clinic with acute CMV infection. Two of the three cases were hospitalized, CMV antibodies were examined and at the same time the third case had an acute CMV infection. CMV transmission among middle-aged family members Is very rare. This study reports three cases of acute CMV infection and it's transmission from person to person in the same family

A Case of Chickenpox Developing 11 Years after Renal Transplantation

WOS: 000514116300017In solid organ transplant recipients, it is recommended that the necessary vaccinations be completed at least 4 weeks before transplant. Chickenpox infection in adulthood can lead to serious clinical conditions such as pneumonia, hepatitis, and central nervous system infections. Herein, the case of chickenpox in a 36-year-old female patient with renal transplantation for end-stage renal disease due to vesicoureteral reflux 11 years previously and without a history of chickenpox or its vaccination before and after transplantation is reported. in this case, because of the development of thrombocytopenia associated with intravenous acyclovir, treatment was successfully concluded with oral valacyclovir