Infectious Disease Reports

542 KiB

Open AccessArticle

Changes in Antimicrobial Prescribing Behavior after the Introduction of the Antimicrobial Stewardship Program: A Pre- and Post-Intervention Survey

by Ruchir Chavada, Harry N. Walker, Deborah Tong and Amy Murray

Infect. Dis. Rep. 2017, 9(3), 7268; https://doi.org/10.4081/idr.2017.7268 - 02 Oct 2017

Cited by 6 | Viewed by 962

Abstract

The introduction of an antimicrobial stewardship (AMS) program is associated with a change in antimicrobial prescribing behavior. A proposed mechanism for this change is by impacting the prescribing etiquette described in qualitative studies. This study sought to detect a change in prescribing attitudes 12 months after the introduction of AMS and gauge utility of various AMS interventions. Surveys were distributed to doctors in two regional Australian hospitals on a convenience basis 6 months before, and 12 months after, the introduction of AMS. Agreement with 20 statements describing attitudes (cultural, behavioral and knowledge) towards antimicrobial prescribing was assessed on a 4-point Likert scale. Mean response scores were compared using the Wilcoxon Rank sum test. 155 responses were collected before the introduction of AMS, and 144 afterwards. After the introduction of AMS, an increase was observed in knowledge about available resources such as electronic decision support systems (EDSS) and therapeutic guidelines, with raised awareness about the support available through AMS rounds and the process to be followed when prescribing restricted antimicrobials. Additionally, doctors were less likely to rely on pharmacy to ascertain when an antimicrobial was restricted, depend on infectious diseases consultant advice and use past experience to guide antimicrobial prescribing. Responses to this survey indicate that positive changes to the antimicrobial prescribing etiquette may be achieved with the introduction of an AMS program. Use of EDSS and other resources such as evidence-based guidelines are perceived to be important to drive rational antimicrobial prescribing within AMS programs. Full article

648 KiB

Open AccessArticle

Patterns of Vitamin D, Parathyroid Hormone and c-Terminal Telopeptide of Collagen Type 1 in Caucasian and African Descent HIV-Infected Populations in Central Europe

by Sebastian Noe, Celia Oldenbuettel, Silke Heldwein, Hans Jaeger and Eva Wolf

Infect. Dis. Rep. 2017, 9(3), 7265; https://doi.org/10.4081/idr.2017.7265 - 02 Oct 2017

Cited by 3 | Viewed by 447

Abstract

Risk factors for bone loss in HIV patients might differ or have a different impact in African descent compared to Caucasian populations. The aim of the paper is to analyze the relevance of risk factors on surrogate markers of bone metabolism in HIV-infected African descent and Caucasian patients. This is a cross-sectional study in a single HIV-specialized research and clinical care center in Munich, Germany. We included 889 patients in the study, among them 771 Caucasians (86.7%). Only in Caucasians lower vitamin D levels [OR: 2.5 (95CI: 1.6-3.7)], lower calcium levels [OR: 1.8 (1.2-2.8)], and the use of tenofovir disoproxil fumarate [OR: 2.8 (1.8-4.4)] were significantly associated with elevated PTH in multivariate analysis. Likewise, only in Caucasians elevated PTH was significantly associated with elevated markers of c-terminal telopeptides of collagen type 1 (β-CTX) [OR: 1.7 (1.0-3.0)]. Effects of traditional risk factors for secondary hyperparathyroidism and increased markers of bone turn-over seem to be less distinct in African descent HIV patients. The clinical impact and generalizability of this finding as well as the significance of vitamin D supplementation in African descent patients therefore warrants further investigation. Full article

579 KiB

Open AccessCase Report

Native Joint Propionibacterium Septic Arthritis

by Thomas Taylor, Marcus Coe, Ana Mata-Fink and Richard Zuckerman

Infect. Dis. Rep. 2017, 9(3), 7185; https://doi.org/10.4081/idr.2017.7185 - 02 Oct 2017

Cited by 9 | Viewed by 558

Abstract

Propionibacterium species are associated with normal skin flora and cultures may be dismissed as contaminants. They are increasingly recognized as a cause of septic arthritis following shoulder arthroplasty and arthrotomy. We identified three cases of Propionibacterium septic arthritis in native joints mimicking atypical osteoarthritis and review the literature, clinical course, and treatment of 18 cases. Two cases of Propionibacterium acne in native knee joints and one in a sternoclavicular joint are described. A literature search for Propionibacterium septic arthritis was performed. Clinical course, treatment, and outcome are reviewed for all cases. Our three cases were combined with 15 cases from the literature. Fourteen cases showed few signs of acute infection, slow culture growth, and delayed diagnosis. In 3 cases an early culture was dismissed as a contaminant. Six cases were reported as caused by recent arthrocentesis. Fifteen cases were cured with antibiotics, although 5 of these 15 also required surgical intervention. Two patients were diagnosed while undergoing surgery for osteoarthritis. Four patients required arthroplasty and two of our patients will require arthroplasty for good functional results. Propionibacterium as a cause of septic arthritis in native joints demonstrates few signs of acute infection, presents with prolonged course, and is often misdiagnosed or unsuspected. Anaerobic growth may be delayed or missed altogether, and outcomes are consequently poor. Consider Propionibacterium septic arthritis in atypical osteoarthritis prior to arthroplasty. Full article

560 KiB

Open AccessCase Report

Repeated Spontaneous Clearance of Hepatitis C Virus Infection in the Setting of Long-Term Non-Progression of HIV Infection

by Genevieve Kerkerian, Arshia Alimohammadi, Tyler Raycraft and Brian Conway

Infect. Dis. Rep. 2017, 9(3), 7142; https://doi.org/10.4081/idr.2017.7142 - 02 Oct 2017

Cited by 5 | Viewed by 462

Abstract

Hepatitis C Virus (HCV) and human immunodeficiency virus (HIV) are global pandemics that affect 170 million and 35 million individuals, respectively. Up to 45% of individuals infected with HCV clear their infections spontaneously – correlating to factors like aboriginal descent and some host specific immune factors. HIV, however, establishes true latency in infected cells and cannot be cured. In the setting of longterm non-progressors (LTNPs) of HIV, a state of immune preservation and low circulating viral load is established. Regarding HIV/HCV co-infection, little is known about the relationship between spontaneous clearance of HCV infection and long-term control of HIV infection without medical intervention. We describe a case of a HIVinfected female defined as a LTNP in whom spontaneous clearance of HCV was documented on multiple occasions. Similar cases should be documented and identified in an effort to develop novel hypotheses about the natural control of these infections and inform research on immune-based interventions to control them. Full article

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Infect. Dis. Rep., Volume 9, Issue 3 (October 2017) – 4 articles

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