Eileen Hilton

A Randomized and Blinded Multicenter Trial of High-Dose Fluconazole plus Placebo versus Fluconazole plus Amphotericin B as Therapy for Candidemia and Its Consequences in Nonneutropenic Subjects

A randomized, blinded, multicenter trial was conducted to compare fluconazole (800 mg per day) plus placebo with fluconazole plus amphotericin B (AmB) deoxycholate (0.7 mg/kg per day, with the placebo/AmB component given only for the first 5-6 days) as therapy for candidemia due to species other than Candida krusei in adults without neutropenia. A total of 219 patients met criteria for a modified intent-to-treat analysis. The groups were similar except that those who were treated with fluconazole plus placebo had a higher mean (+/- standard error) Acute Physiology and Chronic Health Evaluation II score (16.8+/-0.6 vs. 15.0+/-0.7; P=.039). Success rates on study day 30 by Kaplan-Meier time-to-failure analysis were 57% for fluconazole plus placebo and 69% for fluconazole plus AmB (P=.08). Overall success rates were 56% (60 of 107 patients) and 69% (77 of 112 patients; P=.043), respectively; the bloodstream infection failed to clear in 17% and 6% of subjects, respectively (P=.02). In nonneutropenic subjects, the combination of fluconazole plus AmB was not antagonistic compared with fluconazole alone, and the combination trended toward improved success and more-rapid clearance from the bloodstream.

Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis.

OBJECTIVE To assess whether daily ingestion of yogurt containing Lactobacillus acidophilus prevents vulvovaginal candidal infections. DESIGN Crossover trial for at least 1 year during which patients were examined for candidal infections and colonizations while receiving either a yogurt-free or a yogurt-containing diet. Patients served as their own controls. SETTING Ambulatory infectious disease center in a teaching hospital providing tertiary care. PATIENTS Thirty-three women with recurrent candidal vaginitis were eligible after recruitment from community practices and clinics and through advertising. Twelve patients were eliminated for protocol violations. Of the remaining 21 patients, 8 who were assigned to the yogurt arm initially refused to enter the control phase 6 months later. Thus, 13 patients completed the protocol. INTERVENTIONS Women ate yogurt for 6 months of the study period. MEASUREMENTS Colonization of lactobacilli and candida in the vagina and rectum; candidal infections of the vagina. MAIN RESULTS Thirty-three eligible patients were studied. A threefold decrease in infections was seen when patients consumed yogurt containing Lactobacillus acidophilus. The mean (+/- SD) number of infections per 6 months was 2.54 +/- 1.66 in the control arm and 0.38 +/- 0.51 per 6 months in the yogurt arm (P = 0.001). Candidal colonization decreased from a mean of 3.23 +/- 2.17 per 6 months in the control arm to 0.84 +/- 0.90 per 6 months in the yogurt arm (P = 0.001). CONCLUSION Daily ingestion of 8 ounces of yogurt containing Lactobacillus acidophilus decreased both candidal colonization and infection.

Duration of Tick Attachment as a Predictor of the Risk of Lyme Disease in an Area in which Lyme Disease Is Endemic

Animal studies have shown an exponential increase in the risk of Borrelia burgdorferi infection after 48-72 h of deer tick attachment. Persons with tick bites were prospectively studied to determine if those with prolonged tick attachment constitute a high-risk group for infection. Ticks were identified, measured for engorgement, and assayed by polymerase chain reaction (PCR) for B. burgdorferi DNA. Duration of attachment was determined from the scutal index of engorgement. Of 316 submissions, 229 were deer ticks; 14% were positive by PCR. Paired sera and an intact tick for determination of duration of attachment were available for 105 subjects (109 bites). There were 4 human cases (3.7% of bites) of B. burgdorferi infection. The incidence was significantly higher for duration of attachment > or =72 h than for <72 h: 3 (20%) of 15 vs. 1 (1.1%) of 94 (P = .008; odds ratio, 23.3; 95% confidence interval, 2.2-242). PCR was an unreliable predictor of infection. Tick identification and measurement of engorgement can be used to identify a small, high-risk subset of persons who may benefit from antibiotic prophylaxis.

Is the use of boxed gloves in an intensive care unit safe

Abstract purpose: To identify the type, rate, burden, and pattern of contamination of boxed, clean but nonsterile gloves in our intensive care unit (ICU). materials and methods: The fingertips of the first, middle, and last two pairs of gloves in 29 boxes in routine service in our ICU were cultured. The first of each of these three sets were removed aseptically, the second in a routine fashion. results: We found 16 of 29 (55%) first pairs removed aseptically to be contaminated with a mean bioburden of 1.8 colony-forming units (CPU). The percentage contamination and bioburden did not change significantly with position in the box. Use of routine compared with strict aseptic technique increased the rate of contamination by only 11% (95% confidence interval [CI] -0.05 to +0.27 percentage points) and bioburden by only a mean of 3.4 colonies per pair (CI − 0.51 to +4.90 CPU). The length of the time the boxes were open and in use was unrelated to whether the final aseptically removed pair was sterile or contaminated. The predominant organisms were coagulase-negative staphylococcL conclusions: One half the pairs of latex examination gloves in our ICU were sterile despite repeated barehanded access to the boxes. Those contaminated exhibited a small bioburden of low pathogenic potential. No pattern of contamination or unsafe duration of box use were observed. The use of boxed, clean, nonsterile gloves appears safe for routine use in an ICU.

Status of Immunity to Tetanus, Measles, Mumps, Rubella, and Polio among U.S. Travelers

Visitors to developing countries should be counseled and vaccinated on the basis of data about the prevalence of diseases in the areas to be visited, the travelers level of immunity, the type of t...

Intravenous ampicillin/sulbactam versus cefuroxime axetil in the treatment of patients hospitalized with community-acquired lower respiratory tract infections

The efficacy and tolerability of ampicillin/sulbactam versus cefuroxime axetil administered intravenously in the treatment of community-acquired lower respiratory tract infections in patients requiring hospitalization were assessed in a randomized study. A total of 103 adult patients were enrolled, with 49 receiving ampicillin/sulbactam and 54 receiving cefuroxime. Twenty-five of the 49 patients in the ampicillin/sulbactam group and 22 of the 54 patients in the cefuroxime axetil group were included in the statistical analyses. No statistically significant differences were observed between the two groups with regard to demographics or clinical, radiologic, and bacteriologic response rates. There was no apparent difference in the incidence of adverse effects.