Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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Exposure network analysis and molecular epidemiologic methods were used to analyze the emergence and regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae over a 1-year period. Although 40 patients and 26 health care facilities were affected, 1 long-term acute care hospital played a critical role in the convergence of patients at high risk, amplification by cross-infection, and dissemination of these multidrug-resistant bacteria. ⋯ We observed extensive transfer of KPC-positive patients throughout the exposure network of 14 acute care hospitals, 2 LTACHs, and 10 nursing homes. Although few cases were identified at most institutions, many facilities were affected. Successful control of KPC-producing Enterobacteriaceae will require a coordinated, regional effort among acute and long-term health care facilities and public health departments.
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Glucocorticoids increase the risk of developing critical disease from viral infections. However, primary care practitioners in China use them as antipyretics, potentially exposing hundreds of millions to this risk. ⋯ Early use of parenteral glucocorticoids therapy for fever reduction and pneumonia prevention increases the risk for critical disease or death from pH1N1 infection. We recommend that guidelines on glucocorticoid use be established and enforced.
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Review Meta Analysis
Procalcitonin to guide duration of antimicrobial therapy in intensive care units: a systematic review.
Can the use of serum procalcitonin levels safely reduce antimicrobial use in intensive care unit (ICU) patients? We performed a systematic literature review that identified 6 published randomized controlled trials comparing PCT-guided antimicrobial therapy to usual care in ICU patients, extracting data on ICU and patient characteristics, PCT guideline content, intensity of antimicrobial exposure, ICU length of stay, infection relapse, and mortality. Procalcitonin guidance was associated with significantly reduced antimicrobial exposure (effect sizes, 19.5%-38%) in all 5 studies assessing its impact on treatment duration but did not significantly impact antimicrobial exposure in the study assessing treatment initiation only. ⋯ Neither infection relapse nor mortality varied significantly in any of the studies. Procalcitonin guidance of antimicrobial duration appears to decrease antimicrobial use in the ICU safely and significantly and may also decrease the length of stay in the ICU.
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Randomized Controlled Trial Clinical Trial
Brain swelling and mannitol therapy in adult cerebral malaria: a randomized trial.
Coma is a frequent presentation of severe malaria in adults and an important cause of death. The role of cerebral swelling in its pathogenesis, and the possible benefit of intravenous mannitol therapy to treat this, is uncertain. ⋯ Brain swelling on CT scan is a common finding in adult patients with cerebral malaria but is not related to coma depth or survival. Mannitol therapy as adjunctive treatment for brain swelling in adult cerebral malaria prolongs coma duration and may be harmful.