ABSTRACT
This study determined whether motivational interviewing-based cognitive behavioral therapy (MI-CBT) adherence counseling combined with modified directly observed therapy (MI-CBT/mDOT) is more effective than MI-CBT counseling alone or standard care (SC) in increasing adherence over time. A three-armed randomized controlled 48-week trial with continuous electronic drug monitored adherence was conducted by randomly assigning 204 HIV-positive participants to either 10 sessions of MI-CBT counseling with mDOT for 24 weeks, 10 sessions of MI-CBT counseling alone, or SC. Poisson mixed effects regression models revealed significant interaction effects of intervention over time on non-adherence defined as percent of doses not-taken (IRR = 1.011, CI = 1.000-1.018) and percent of doses not-taken on time (IRR = 1.006, CI = 1.001-1.011) in the 30 days preceding each assessment. There were no significant differences between groups, but trends were observed for the MI-CBT/mDOT group to have greater 12 week on-time and worse 48 week adherence than the SC group. Findings of modest to null impact on adherence despite intensive interventions highlights the need for more effective interventions to maintain high adherence over time.
Subject(s)
Anti-HIV Agents/therapeutic use , Directly Observed Therapy , HIV Infections/drug therapy , Medication Adherence , Motivational Interviewing , Adolescent , Adult , Aged , Cognitive Behavioral Therapy , Directly Observed Therapy/methods , Directly Observed Therapy/psychology , Female , HIV Infections/psychology , Humans , Male , Medication Adherence/psychology , Middle Aged , Motivational Interviewing/methods , Young AdultSubject(s)
Acetamides/pharmacokinetics , Anti-Infective Agents/pharmacokinetics , Enterococcus faecium , Gram-Positive Bacterial Infections/metabolism , Oxazolidinones/pharmacokinetics , Peritonitis/metabolism , Peritonitis/microbiology , Vancomycin Resistance , Acetamides/therapeutic use , Aged , Anti-Infective Agents/therapeutic use , Humans , Linezolid , Male , Oxazolidinones/therapeutic use , Peritonitis/drug therapyABSTRACT
Candidemia is the fourth most frequent nosocomial bloodstream infection in the US. The clinical characteristics and outcome of candidemia in adult patients with diabetes mellitus (DM) have not been reported in the literature. The objective of the study was to determine the epidemiology and determinants of mortality in diabetic patients with candidemia. A retrospective cohort study among diabetic patients with candidemia was carried out at 2 medical centers. The primary outcome was death from any cause after the onset of candidemia until discharge from the hospital. A stepwise logistic regression analysis was performed to determine the predictors of mortality. From June 1995 to June 2003, 87 patients with both DM and candidemia were studied. Candida albicans was the most common (48/87, 55%) and Candida glabrata the second most common isolate of candidemia (18/87, 21%). Overall hospital mortality was 39% (34/87). Logistic regression analysis identified 3 independent determinants of death; Apache II score > or =23 (OR 8.3, 95% CI{2.7, 25.4}, p =0.0002), nosocomial candidemia (OR 10.2, 95% CI{1.1, 97.9}, p = 0.04), and mechanical ventilation (OR 3.6, 95% CI{1.1, 11.2}, p = 0.03). The study demonstrates the emergence of non-albicans species of Candida as major causes of candidemia among diabetic patients. The severity of illness reflected by Apache II was the most significant predictor of mortality among diabetic patients with candidemia.
Subject(s)
Candidiasis/complications , Cross Infection/epidemiology , Diabetes Complications/mortality , Diabetes Mellitus/mortality , APACHE , Aged , Antifungal Agents/therapeutic use , Candidiasis/drug therapy , Candidiasis/mortality , Cross Infection/drug therapy , Cross Infection/mortality , Diabetes Complications/drug therapy , Diabetes Complications/epidemiology , Diabetes Mellitus/epidemiology , Female , Humans , Length of Stay , Logistic Models , Male , Middle Aged , Multicenter Studies as Topic , Predictive Value of Tests , Retrospective Studies , Risk Factors , United States/epidemiologyABSTRACT
Diabetic foot osteomyelitis is among the most common and serious complications in patients with diabetes mellitus. It is often a polymicrobial infection. We report the first case of foot osteomyelitis in a diabetic patient caused by Fusarium solani.
