Sensitivity and clinical utility of the anti-cytosolic 5'-nucleotidase 1A (cN1A) antibody test in sporadic inclusion body myositis: Report of 40 patients from a single neuromuscular center.

Sporadic inclusion body myositis (IBM) is the most common acquired myopathy affecting patients over age 50. The discovery of an autoantibody directed against a 43-44 kD protein (anti-cytosolic-5'-nucleotidase 1A or anti-cN1A) has provided support for the hypothesis of an immune-mediated pathogenesis. Previous studies have reported variable test sensitivity and specificity, and inconsistent results on the predictive value. In our cohort of 40 patients with clinico-pathologically or clinically defined IBM, we found the sensitivity of the anti-cN1A antibody test to be 50%. Comparing characteristics for test positive and test negative groups, we found that patients in our cohort testing positive for the anti-cN1A antibody were significantly more likely to be older than age 60 years at symptom onset. We found no positive association between anti-cN1A reactivity and other clinical, laboratory, and muscle histopathologic findings. Based on all clinical studies published to date including the present, the anti-cN1A antibody test shows high diagnostic specificity, moderate sensitivity, and a low predictive value in regards to age of onset, disease severity and other associated clinicopathological findings.

The Role of Patient History and Body Site Surveillance Cultures as Predictors of Colonization in a Long-Term Acute Care Hospital Setting.

BACKGROUND: Long-term acute care hospitals (LTACHs) have high rates of antibiotic and device use, hospital-acquired infections, and antibiotic resistance. Admission surveillance cultures are controversial. OBJECTIVE: Evaluate the significance of patienthistory and multiple body site admission surveillance cultures for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). DESIGN: Retrospective review of preadmission history and surveillance cultures from multiple body sites of 594 new admissions and cultures obtained for subsequent clinical status changes. RESULTS: Thirteen percent of patients were positive for MRSA and 16% for VRE on admission screening. Neither MRSA nor VRE history was predictive of colonization: 44% of patients with MRSA history screened MRSA positive; 48% with VRE history screened VRE positive. No single body site was predictive for MRSA or VRE colonization. CONCLUSION: Neither patient history nor a single body site was highly predictive of colonization; multisite surveillance may be optimal to evaluate MRSA and VRE burden.

Low rate of bacteremia with a subcutaneously implanted central venous access device.

PURPOSE: Patients at long-term acute care hospitals (LTACs) are medically complex with multiple comorbidities and high rates of antibiotic and device use. The objective of the study was to analyze the incidence and rate of central line-associated bloodstream infections (CLABSI) and the critical factors for patient care, management, placement and maintenance of the implanted central venous access device at this LTAC. METHODS: A 13-year retrospective chart review was performed comprising 191 medically complex patients with multiple comorbidities who had an implanted central line port. Information analyzed included (1) number of catheters; (2) number of patients; (3) number of catheter line days; (4) patient demographics; (5) port location; (6) admission diagnoses; (7) type, incidence and rate of catheter-related complications. RESULTS: The total number of catheter days was over 183,183 with a mean of 959 catheter days per patient. The mean rate of CLABSI was 0.087 per 1,000 days; incidence was less than 8% of patients with catheters. CONCLUSIONS: The study found a markedly lower rate of CLABSI than reported for other LTACs as well as intensive care units, over 14- to 100-fold lower than other LTACs. The authors propose that standardized catheter placement with implementation of rigorous, prospective catheter care plans and a team approach to management were responsible for extremely low complication rates. These results can be extrapolated to different settings across the healthcare continuum.