First case of vaccine-strain varicella infection as manifestation of HIV in healthcare worker: a case report and review of the literature.

Live-attenuated varicella vaccination is safe in non-immunocompromised populations and is associated with rare non-serious adverse events. A healthcare worker (HCW) developed varicella infection, and exposure investigation led to immunization against varicella in an exposed non-immune HCW. Subsequently, vaccine-strain-induced disseminated varicella and progressive outer retinal necrosis in the exposed HCW resulted in identification of undiagnosed human immunodeficiency virus infection. This article reviews serious adverse events from varicella vaccination, and extreme caution is advised prior to live vaccination of HCWs.

Risk factors for and impact of carbapenem-resistant Acinetobacter baumannii colonization and infection: matched case-control study.

The objective of this investigation was to identify risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) and its association with mortality. A population-based matched case-control study using the computerized database of Clalit Health Services (CHS) in the period between 2007 and 2012 was conducted. Hospitalized patients with CRAB colonization or infection were compared to hospitalized patients without evidence of A. baumannii, matched by age, ward of hospitalization, season, Charlson score, and length of hospitalization. Risk factors for CRAB isolation were searched for using multivariate analysis. Association of CRAB and other risk factors with mortality were assessed in the cohort. A total of 1190 patients with CRAB were matched to 1190 patients without CRAB. Low socioeconomic status was independently associated with CRAB isolation and CRAB bacteremia [odds ratio 2.18, 95% confidence interval (CI) 1.02-5]. Other risk factors were invasive procedures and bacteremia with other pathogens prior to CRAB isolation, and various comorbidities. Among all patients, CRAB isolation was independently associated with increased mortality (hazard ratio 2.33, 95% CI 2.08-2.6). Socioeconomic status is associated with health outcomes. Our population-based study revealed an almost doubled risk for CRAB in patients at lower socioeconomic status and an association with healthcare exposure. CRAB was associated with mortality and might become a risk indicator for complex morbidity and mortality.

Guidelines for the treatment of pneumonia and urinary tract infections: evaluation of methodological quality using the Appraisal of Guidelines, Research and Evaluation II instrument.

Reliance on evidence-based medicine requires high methodological standards from guideline developers. We sought to determine the methodological quality of guidelines on pneumonia and urinary tract infections (UTIs). We included guidelines published by national or international committees in the last 10 years providing recommendations for antibiotic type or duration. We applied the Appraisal of Guidelines for Research and Evaluation II checklist, adding under each item the specific focus relevant to bacterial infections, addressing antibiotic resistance and local epidemiology. Three assessors scored each guideline independently. Mean aggregated scores, converted to percentage per domain, are presented. We included 13 guidelines on the treatment of pneumonia and seven guidelines for the treatment of UTI. 'Scope and purpose' scored 69.4% for pneumonia and 71.4% for UTI. Guidelines were downgraded for lack of an epidemiological overview relevant to intended users. 'Stakeholder involvement' scored 39.5% for pneumonia and 44.5% UTI, with the major fault being lack of patient consultation. 'Rigour of development' scored 42.8% for pneumonia and 56.9% for UTI. Commonly, the search process lacked precision, no risk of bias assessment was performed, outcomes in primary studies were not critically assessed or used to direct recommendations, and there was no formal methodology for formulating recommendations. 'Clarity of presentation' scored highest: 67.7% for pneumonia and 68.5% for UTI. 'Applicability' of the guidelines in antibiotic stewardship programmes was usually not addressed: 16.9% and 25.4%, respectively. 'Editorial independence' scored 30.6% for pneumonia and 55.6% for UTI. Formal examination of guidelines in infectious diseases showed worrying findings related to core methodology and potential bias caused by competing interests.