Increasing hospitalizations for serious skin infections in New Zealand children, 1990-2007.

The incidence of serious skin infections in New Zealand children is significantly higher than in comparative countries. This study aimed to describe the epidemiology of these infections and identify changes in disease distribution over time. Discharge data were analysed for all children admitted to a New Zealand public hospital with a serious skin infection during the period 1990-2007. Patient and admission variables were compared between 1990-1999 and 2000-2007. The incidence of serious skin infections almost doubled from 298·0/100,000 in 1990 to 547·3/100,000 in 2007. The highest rates were observed in boys, preschool-aged children, Maori and Pacific children, those living in deprived neighbourhoods, urban areas and northern regions. Over time there were disproportionate increases in infection rates in Maori and Pacific children and children from highly deprived areas. Serious skin infections are an increasing problem for New Zealand children. Worsening ethnic and socioeconomic health inequalities may be contributing to increasing rates.

Repeated enzyme immunoassays have limited utility in diagnosing Clostridium difficile.

Many clinical laboratories use enzyme immunoassays (EIA) to diagnose Clostridium difficile-associated disease (CDAD). Clinicians frequently order three EIAs to "rule out" CDAD. We performed a retrospective cohort study to determine the clinical utility of repeating EIA testing to diagnose CDAD. We reviewed all EIAs performed by our laboratory during 2005, determined the total number of tests per patient and per testing episode, and calculated the relative negative predictive value (NPV) of one EIA compared to > or =2 EIAs. The laboratory performed 2,938 EIAs, of which 253 (8.6%) tests were positive. Most patients (85%) were diagnosed by the first EIA performed. Of >1,000 testing episodes that included > or =2 EIAs within 7 days, only 15 patients had a positive second or third test after negative initial testing. The relative NPV of the first EIA was 97.4%. These data suggest that using newer generation EIAs, repeated testing is of limited benefit in diagnosing CDAD.

Decrease of cytomegalovirus replication in human immunodeficiency virus infected-patients after treatment with highly active antiretroviral therapy.

Cytomegalovirus (CMV) viremia, as measured by a hybrid capture assay, was used to measure the effectiveness of "immune reconstitution" in human immunodeficiency virus (HIV)-infected subjects treated with highly active antiretroviral therapy (HAART). Of the 28 enrolled patients (mean age, 38 years), 86% were male and 68% were antiretrovirally naive. Of the 23 patients who returned for follow-up, baseline median characteristics were 4.1 log10 CMV DNA copies/106 white blood cells (WBCs), 5.1 log10 HIV RNA copies/mL, and 35 CD4 cells/mm3. After initiation of HAART, median log10 CMV DNA copies/106 WBCs at means of 33, 87, and 385 days were 4.0, 3.3, and 2.5, respectively. Median log10 HIV RNA levels declined from 5.1 to 1.7 at 385 days with a commensurate rise in median CD4 T cells to 166/mm3. Immune reconstitution secondary to HAART results in a significant and progressive decline in CMV viremia in the absence of specific anti-CMV therapy.