Current inpatient treatment options for COVID-19:an update

In dit overzichtsartikel geven wij een update van de adviezen voor de medicamenteuze behandeling van covid-19 in de tweede lijn.Deze adviezen zijn opgesteld door de Stichting Werkgroep Antibioticabeleid (SWAB) in samenwerking met onder andere de Federatie Medisch Specialisten (FMS).Zowel opties voor behandeling in het ziekenhuis als opties voor behandeling in de ambulante setting worden besproken.De behandeling omvat zowel anti-inflammatoire als antivirale therapie.In this article we provide an overview of the current treatment recommendations for COVID-19. These recommendations are made by the SWAB (StichtingWerkgroepAntibioticabeleid), in cooperation with the FMS (FederatieMedischSpecialisten (online: swab.nl/nl/covid-19.). Treatment options for patients in both ambulatory care and admitted to the hospital are listed. These treatment options include both antiinflammatory and antiviral therapy.</p

Renal failure and leukocytosis are predictors of a complicated course of clostridium difficile infection if measured on day of diagnosis

Nonsevere Clostridium difficile infection (CDI) and severe CDI, which carries a higher risk than nonsevere CDI for treatment failure and CDI recurrence, are difficult to distinguish at the time of diagnosis. To investigate the prognostic value of 3 markers of severe CDI suggested by recent guidelines (fever, leukocytosis, and renal failure), we used the database of 2 randomized controlled trials, which contained information for 1105 patients with CDI. Leukocytosis (risk ratio [RR], 2.29; 95% confidence interval [CI], 1.63–3.21) and renal failure (RR, 2.52; 95% CI, 1.82–3.50) were associated with treatment failure. Fever, although associated with treatment failure (RR, 2.45; 95% CI, 1.07–5.61), was rare. Renal failure was the only significant predictor of recurrence (RR, 1.45; 95% CI, 1.05–2.02). Different timing of measurements of leukocyte count and serum creatinine level around the CDI diagnosis led to a different severity classification in many cases. In conclusion, both leukocytosis and renal failure are useful predictors, although timing of measurement is important

Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics

Clostridium difficile infections (CDIs) are common in developed countries and affect 250000 hospitalized patients annually in the USA. The most important risk factor for the disease is antibiotic therapy. To determine the period at risk for CDI after cessation of antibiotics, we performed a multicentre casecontrol study in the Netherlands between March 2006 and May 2009. Three hundred and thirty-seven hospitalized patients with diarrhoea and a positive toxin test were compared with 337 patients without diarrhoea. Additionally, a control group of patients with diarrhoea due to a cause other than CDI (n227) was included. In the month prior to the date of inclusion, CDI patients more frequently used an antibiotic compared with non-diarrhoeal patients (77 versus 49). During antibiotic therapy and in the first month after cessation of the therapy, patients had a 710-fold increased risk for CDI (OR 6.710.4). This risk declined in the period between 1 and 3 months after the antibiotic was stopped (OR 2.7). Similar results were observed when the second control group was used. All antibiotic classes, except first-generation cephalosporins and macrolides, were associated with CDI. Second- and third-generation cephalosporins (OR 3.3 and 5.3, respectively) and carbapenems (OR 4.7) were the strongest risk factors for CDI. Patients with CDI used more antibiotic classes and more defined daily doses, compared with non-diarrhoeal patients. Antibiotic use increases the risk for CDI during therapy and in the period of 3 months after cessation of antibiotic therapy. The highest risk for CDI was found during and in the first month after antibiotic use. Our study will aid clinicians to identify high-risk patient

Osteonecrose als late complicatie bij hiv-geïnfecteerde patiënten

Osteonecrosis of the femoral head was diagnosed in a 22-year-old woman and a 46-year-old man, both with HIV infection . Both had groin pain and impaired mobility. Conservative treatment did not relieve the pain. Both patients underwent a surgical procedure, i.e. core decompression and total hip replacement. In HIV-infected patients, osteonecrosis, i.e. avascular necrosis is an increasingly common problem in view of current longer life expectancy. The incidence of osteonecrosis is higher in HIV-infected patients than in the general population. Osteonecrosis should be included in differential diagnosis of groin or hip pain in HIV-positive patients. This may enable more rapid diagnosis and reduce the need for surger

Spatial clustering and livestock exposure as risk factor for community-acquired Clostridium difficile infection.

Clostridium difficile infections (CDI) account for 1.5% of diarrhoeic episodes in patients attending a general practitioner in the Netherlands, but its sources are unknown. We searched for community clusters to recognise localised point sources of CDI