Alan Pithie

Ethanol lock therapy to treat tunnelled central venous catheter-associated blood stream infections: Results from a prospective trial

In order to assess the efficacy of 70% ethanol locks in addition to antibiotic therapy to treat tunnelled central venous catheter-associated bloodstream infections, a pilot study of 19 patients was performed prospectively using ethanol locks for 5 d in addition to antibiotic therapy to treat tunnelled central venous catheter-associated bacteraemia. 12 patients had mono-microbial infections and 7 had polymicrobial isolates. 17 of 19 patients completed ethanol lock therapy. 15 of 17 patients completing ethanol lock therapy had no recurrence of the original organism and retained their catheter for a median of 36 and an average of 47 d following initiation of ethanol lock therapy. These results demonstrate the safety and potential efficacy of this technique against a broad range of potentially virulent organisms. The intervention was acceptable to both staff and patients with no significant side-effects. These preliminary results from our prospective pilot study suggest that ethanol lock therapy is safe and easily integrated into clinical practice, and may have utility in treating central venous catheter-associated infections, avoiding removal of catheters in patients requiring long-term venous access.

Outpatient intravenous treatment for infective endocarditis: safety, effectiveness and one-year outcomes.

OBJECTIVES To describe the use and outcomes of outpatient antimicrobial therapy (OPAT) for infective endocarditis (IE) within the Canterbury region of New Zealand over an 8 year period. METHODS All cases of IE admitted to Christchurch Hospital were reviewed. Prospectively collected data from our OPAT services database and retrospective data from case notes were analysed. RESULTS There were 213 episodes of IE meeting modified Duke Criteria over this time. Patients received OPAT in 100 episodes. Viridans streptococci were the infecting organism in 34, Staphylococcus aureus in 27, and enterococci in 10. Adverse events were encountered in 27 episodes. Of these, 24 were related to intravenous lines, infusion devices or adverse drug reactions which resolved with change of treatment. There were 3 serious adverse events which were likely to have occurred in hospital. During 12-month follow-up there were 5 further episodes of IE and 2 deaths unlikely to be directly related to the episode of IE. CONCLUSIONS Despite significant co-morbidities and complications, nearly half of all patients with IE, including those with disease due to S. aureus and enterococci, successfully completed their treatment as outpatients. Continuous infusion devices were successfully used in 32 patients, including 22 with disease due to S. aureus.

Enhanced detection of Legionnaires' disease by PCR testing of induced sputum and throat swabs

To the Editor: Legionnaires’ disease, particularly that caused by non-pneumophila species, is notoriously underdiagnosed [1, 2]. We recently found a four-fold increase in case detection of Legionnaires’ disease through a laboratory-initiated strategy of systematic PCR testing for Legionella species of all lower respiratory specimens from patients with pneumonia or immune compromised status [3]. This strategy relies on the availability of lower respiratory specimens and the recording of relevant clinical information on laboratory requisition forms by clinicians. We recognised that this strategy will miss testing patients who could not expectorate sputum and when inadequate clinical information is written on laboratory requisition forms. To address this diagnostic gap we enhanced case detection by actively identifying patients with community-acquired pneumonia (CAP) and by collecting induced sputum from those unable to expectorate voluntarily. In addition, we evaluated throat swabs as an alternative specimen for PCR testing. From October 2012 to March 2013 patients admitted to Christchurch Hospital and The Princess Margaret Hospital (both in Christchurch, New Zealand) with CAP and aged ≥18 years were recruited. For logistical reasons, recruitment occurred on weekdays only. The study period was chosen to coincide with peak Legionnaires’ disease activity in Christchurch [3]. Patients were excluded if the pneumonia was hospital acquired or associated with bronchial obstruction, bronchiectasis or tuberculosis. Patients were not eligible for sputum induction if they required high-flow oxygen or assisted ventilation at enrolment. Ethical approval was obtained from the New Zealand Northern A Ethics Committee. Informed consent was obtained from the patient or their next of kin with …

Prevalence of concurrent deep vein thrombosis in patients with lower limb cellulitis: a prospective cohort study

BackgroundLower limb cellulitis and deep vein thrombosis share clinical features and investigation of patients with cellulitis for concurrent DVT is common. The prevalence of DVT in this group is uncertain. This study aimed to determine the prevalence of deep vein thrombosis (DVT) in patients with lower limb cellulitis and to investigate the utility of applying the Wells algorithm to this patient group.MethodsPatients admitted with lower limb cellulitis prospectively underwent a likelihood assessment for DVT using the Wells criteria followed by investigation with D-dimer and ultrasonography of ipsilateral femoral veins as appropriate. Diagnoses of contralateral DVT or pulmonary embolism during admission were recorded.Results200 patients assessed for DVT. 20% of subjects were high risk by Wells criteria. D-dimer was elevated in 74% and 79% underwent insonation of the affected leg. Ipsilateral DVT was found in 1 patient (0.5%) and non-ipsilateral VTE in a further 2 (1%).ConclusionsDeep vein thrombosis rarely occurs concurrently with lower limb cellulitis. The Wells score substantially overestimates the likelihood of DVT due to an overlap of clinical signs. Investigation for DVT in patients with cellulitis is likely to yield few diagnoses and is not warranted in the absence of a hypercoaguable state.Trial registrationACTRN: 12610000792022 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=320662)

Corynebacterium accolens-Associated Pelvic Osteomyelitis

ABSTRACT Corynebacterium accolens is a rare human pathogen. We encountered a case of C. accolens isolated from a thigh collection in a man with osteomyelitis of the adjacent pubic symphysis.