Safety and effectiveness of home intravenous antibiotic therapy for multidrug-resistant bacterial infections.

Home intravenous antibiotic therapy is an alternative to hospital admission for moderately severe infections. However, few studies have analyzed its safety and effectiveness in the treatment of infections caused by multidrug-resistant bacteria. The purpose of this study is to analyze the safety and effectiveness of home intravenous antibiotic therapy in multidrug-resistant bacterial infections. We analyzed prospectively all patients admitted to our service who underwent home intravenous antibiotic therapy during the period 2008-2012. All the treatments were administered by caretakers or self-administered by patients, through elastomeric infusion devices. Effectiveness was evaluated by analyzing the readmission rate for poor infection control. Safety was evaluated by analyzing adverse events, catheter-related complications, and readmissions not related to poor infection control. There were 433 admissions (in 355 patients) for home intravenous antibiotic therapy during the study period. There were 226 (52.2 %) admissions due to multidrug-resistant bacterial infections and 207 (47.8 %) due to non-multidrug-resistant infections. Hospital readmissions in patients with multidrug-resistant infections were uncommon. Multidrug-resistant enterococcal infections, healthcare-associated infections, and carbapenem therapy were independent variables associated with increased readmissions due to poor infection control. Readmissions not related to poor infection control, adverse events, and catheter-related complications were similar in multidrug-resistant compared to non-multidrug-resistant bacterial infections. Home intravenous therapy, administered by patients or their caretakers using elastomeric infusion pumps, was safe and effective for the treatment of most multidrug-resistant bacterial infections.

Influence of parity at time of detection of serologic antibodies to Mycobacterium avium subspecies paratuberculosis on reduction in daily and lifetime milk production in Holstein cows.

Mycobacterium avium ssp. paratuberculosis (MAP) is the causative agent of bovine paratuberculosis, also known as Johne's disease. Two production variables (daily and lifetime milk) were compared in this longitudinal study of cows classified based upon serum ELISA results for MAP. The sample included adult Holstein cows that had completed their productive life (n = 2,808 animals) since testing began and that had been raised by and were located on 2 commercial dairies in Texas. These animals were tested at the conclusion of each of their lactations using a commercial ELISA. The serological response was interpreted based on the calculated sample-to-positive value, a quantifiable measure of antibodies, and categorized on both a dichotomous scale [positive (≥0.25) vs. negative] and into 5 classes (negative: 0 to 0.09, suspect: 0.10 to 0.24, low positive: 0.25 to 0.39, positive: 0.40 to 0.99, or strong positive: ≥1.00). All models developed were adjusted for herd, birth (year) cohort, and parity at first MAP test. Based on adjusted comparisons using the dichotomous scale: 1) cows detected as positive during their first parity produced less (P < 0.0001) milk per day of life since first parturition (-1.64 kg/d) and during their lifetime in the herd (-8,704 kg); 2) cows testing positive for the first time during second parity did not produce less per day of life (P > 0.05); however, cows did produce less (P = 0.024) milk overall during their lifetime in the herd, but only when tested for the first time during their second lactation (-4,058 kg); 3) cows testing positive for the first time during third parity did not differ (P > 0.05); and 4) cows testing positive for the first time during their fourth or later parity produced more milk during their lifetime, but only when tested for the first time at third or greater lactation (e.g., 10,602 kg for fourth parity; P = 0.005) compared with their always-negative herd mates tested for the first time in their first lactation. In the adjusted model developed to evaluate milk production losses throughout the lifetime of the animal, when categorizing animals into 5 MAP classes at their first test, suspect animals numerically have reduced production (-1,419 kg; P = 0.162), whereas significant losses occurred in the low positive class (-4,397 kg; P = 0.034) and highly significant losses in the positive (-7,724 kg; P < 0.0001) and strong positive classes (-10,972 kg; P < 0.0001) compared with herd mates testing negative.

Talc preparations used for pleurodesis vary markedly from one preparation to another.

BACKGROUND: At the present time, talc is the one of the agents most commonly used for the production of a pleurodesis. However, there have been several recent reports of acute pneumonitis developing after the intrapleural administration of talc. The incidence of pneumonitis has varied markedly from center to center. OBJECTIVE: To compare the physical characteristics of talc used for the production of pleurodesis in various localities. DESIGN: Eight talc preparations (four from the United States, and one each from Brazil, France, Spain, and Taiwan) were analyzed for the distribution of the particle size and the type and amount of impurities. MEASUREMENTS: The physical characteristics of the talc specimens were determined using radiograph diffraction and scanning electron microscopy. RESULTS: The mean and median particle size varied by more than a factor of three among the eight different talc preparations. In addition, the impurities of the different talc preparations were quite varied. CONCLUSIONS: We conclude that there is marked variation in the physical characteristics of the talc preparations used intrapleurally for the production of a pleurodesis. We speculate that different incidences of acute pneumonitis at various centers after intrapleural administration of talc may be due to differences in the physical characteristics of the talc preparations used for pleurodesis.

Histochemical localization of esterases in the integument of the female Boophilus microplus (Acari: Ixodidae) tick.

The cattle tick Boophilus microplus (Canestrini) is one of the most important ectoparasites affecting tropical cattle with worldwide distribution. Application of organophosphate compounds (OP) is extensively used as a tick control method. However, the appearance of ticks resistant to the OP decreases the therapeutic efficacy of such compounds. Esterases have been implicated as potential biochemical mechanisms for detoxification in B. microplus larvae. We found increased esterase activity in the inner layers of the integument of OP resistant adult female B. microplus ticks as compared with the OP susceptible ticks. We discuss the potential role of these enzymes during acaricide metabolism and propose future research.

Antibiotic levels in empyemic pleural fluid.

OBJECTIVE: To determine the degree to which bioactive penicillin, metronidazole, ceftriaxone, clindamycin, vancomycin, and gentamicin penetrate into empyemic pleural fluid using our new rabbit model of empyema. METHODS: An empyema was created via the intrapleural injection of 10(8)()Pasteurella multocida bacteria into the pleural space of New Zealand white rabbits. After an empyema was verified by thoracentesis and pleural fluid analysis, penicillin, 24,000 U/kg; metronidazole, 37 mg/kg; ceftriaxone, 30 mg/kg; clindamycin, 9 mg/kg; vancomycin, 15 mg/kg; or gentamicin, 1 mg/kg, were administered IV. Antibiotic levels in samples of pleural fluid and serum, collected serially for up to 480 min, were then determined using a bioassay. RESULTS: The degree to which the different antibiotics penetrated into the infected pleural space was highly variable. Penicillin penetrated most easily, followed by metronidazole, ceftriaxone, clindamycin, vancomycin, and gentamicin. Of the antibiotics tested, penicillin and metronidazole equilibrated the most rapidly with the infected pleural fluid. Penicillin levels remained elevated in pleural fluid even after serum levels had decreased. CONCLUSIONS: Using this rabbit model of empyema, there was marked variation in the penetration of antibiotics into the empyemic fluid. Although there are species differences between rabbit and human pleura, the variance in degree of penetration of antibiotics into the pleural space should be considered when antibiotics are selected for the treatment of patients with empyema.

Diagnostic utility of CYFRA 21-1, carcinoembryonic antigen, CA 125, neuron specific enolase, and squamous cell antigen level determinations in the serum and pleural fluid of patients with pleural effusions.

BACKGROUND: To the authors' knowledge the role of tumor marker determination in the differential diagnosis of pleural effusions has not been established definitively. The current article reports the results of a study of CYFRA 21-1, carcinoembryonic antigen (CEA), cancer antigen 125 (CA 125), squamous cell antigen (SCC), and neuron specific enolase (NSE) in the serum and pleural fluid of patients with pleural effusions of diverse etiologies. METHODS: One hundred forty-six patients with pleural effusions (43 malignant, 47 tuberculous, 32 miscellaneous benign, and 24 paramalignant) were studied prospectively. Levels of CYFRA 21-1, CA 125, CEA, NSE, and SCC were measured by radioimmunoassay in the pleural fluid in all patients and in the serum in 118 patients. RESULTS: There were no significant differences between the serum and pleural fluid levels of tumor markers with the exception of CA 125, which was higher in the pleural fluid. With maximum specificity, the highest sensitivity in the diagnosis of pleural malignancy was obtained with a combination of CYFRA 21-1 (with a cutoff value of 150 U/L), CEA (with a cutoff value of 40 ng/mL), and CA 125 (with a cutoff value of 1000 ng/mL) in pleural fluid. NSE and SCC added no diagnostic value. The simultaneous use of tumor markers and cytology in pleural fluid increased the sensitivity from 55.8% to 81%. CONCLUSIONS: These findings suggest that a combination of CYFRA 21-1, CEA, and CA 125 in the pleural fluid can be a useful addition to pleural cytology in the diagnosis of malignant pleural effusion.

Antibiotic treatment of patients with pneumonia and pleural effusion.

Despite all medical advances of this century, pneumonia is still a common condition and the sixth leading cause of mortality in the United States. A pleural effusion develops in up to 40% of cases of pneumonia and empyema in 5% to 10% of those patients. The morbidity and mortality rates in patients with pleural effusions as a consequence of pneumonia are higher than in patients with pneumonia alone. In this review we discuss the classification, bacteriology, and the appropriate antibiotic treatment of patients with parapneumonic pleural effusions.

[Benign asbestos pleural effusion. Report of a first series in Spain]. / Derrame pleural benigno por asbesto. Descripción de la primera serie en España.

Up to now, only 2 cases of benign asbestos pleural effusion have been described in Spain. We report our experience of 15 patients diagnosed of benign asbestos pleural effusion (BAPE). Between 1980 and January 1995, 15 patients were diagnosed of BAPE according to the following criteria: a) evidence of pleural effusion; b) previous asbestos exposure, and c) exclusion of other etiologies of last during 3 years of follow-up. Retrospective review of diagnostic and evolutive data from the patients' clinical records. Asbestos exposure was intense in 8 patients and slight in 7. There were 11 effusions on the left side and 4 on the right side. All effusions were exudative, with a pleural adenosine deaminase level lower than 43 U/l. Eleven patients had a lymphocytic pleural fluid. All patients had nonspecific pleural histology, and asbestos bodies were detected in one case. Eleven patients achieved a radiographic resolution in less than 3 months, and 3 patients presented relapses. Fourteen patients had a good outcome, and one patient presented a lung adenocarcinoma after 5 years of follow-up. Benign asbestos pleural effusions are predominant on the left side, have a tendency to relapse and the exposition can be occasional. The outcome is good in most of the cases.