Drug Shortage-Associated Increase in Catheter-Related Blood Stream Infection in Children.
Drug Shortage-Associated Increase in Catheter-Related Blood Stream Infection in Children.
Filed under: Drug and Alcohol Rehabilitation
Pediatrics. 2012 Oct 8;
Ralls MW, Blackwood RA, Arnold MA, Partipilo ML, Dimond J, Teitelbaum DH
BACKGROUND:Ethanol lock therapy (ELT) has been shown to reduce the incidence of catheter-related blood stream infections (CRBSI) in intestinal failure (IF) patients. Dosing and frequency remains undefined. Scrutiny of pharmaceutical facilities by the Food and Drug Administration led to the voluntary shutdown of the sole supplier of ethanol, resulting in a nationwide shortage. To conserve supply, we reduced ELT frequency from a daily regimen. We examined the impact that reduction in ELT frequency had on CRBSI in pediatric IF patients.METHODS:We retrospectively reviewed our parenteral nutrition-dependent IF children. Primary outcome measure was CRBSI per 1000 catheter days after ELT frequency reduction. Data were compared (paired t test) to the same group over 1 year before ethanol shortage and to historical controls.RESULTS:During the shortage 13 outpatients received ELT. Eight met study criteria. Mean ± SD age was 9.1 ± 7.8 years. Mean CRBSI rate per 1000 catheter days was 0.7 ± 1.3 before ELT shortage. This increased to 6.2 ± 2.5 after frequency reduction (P < .001). This CRBSI rate was similar to historical IF children not on ELT (8.0 ± 5.4). Seven children developed CRBSI after frequency reduction, 6 requiring hospitalization, 2 to the ICU. Mean length of stay (15.5 days) averaged $ 104,783(± 111,034) in hospital charges. Organisms included Gram-negatives (6), methicillin-resistant Staphylococcus aureus (1), and Candida spp (1).CONCLUSIONS:ELT frequency reduction resulted in complete failure in CRBSI prophylaxis. The nationwide shortage of this drug has been costly both financially and in patient morbidity. HubMed – drug
Prevention of Invasive Cronobacter Infections in Young Infants Fed Powdered Infant Formulas.
Filed under: Drug and Alcohol Rehabilitation
Pediatrics. 2012 Oct 8;
Jason J
BACKGROUND:Invasive Cronobacter infection is rare, devastating, and epidemiologically/microbiologically linked to powdered infant formulas (PIFs). In 2002-2004, the US Food and Drug Administration advised health care professionals to minimize PIF and powdered human milk fortifier (HMF)’s preparation, feeding, and storage times and avoid feeding them to hospitalized premature or immunocompromised neonates. Labels for PIF used at home imply PIF is safe for healthy, term infants if label instructions are followed.METHODS:1) Medical, public health, Centers for Disease Control and Prevention, US Food and Drug Administration, and World Health Organization records, publications, and personal communications were used to compare 68 (1958-2003) and 30 (2004-2010) cases of invasive Cronobacter disease in children without underlying disorders. 2) The costs of PIFs and ready-to-feed formulas (RTFs) were compared.RESULTS:Ninety-nine percent (95/96) of all infected infants were <2 months old. In 2004-2010, 59% (17/29) were term, versus 24% (15/63) in 1958-2003; 52% (15/29) became symptomatic at home, versus 21% (13/61). Of all infected infants, 26% (22/83) had received breast milk (BM), 23% (19/82) RTF, and 90% (76/84) PIF or HMF. Eight percent received BM and not PIF/HMF; 5%, RTF without PIF/HMF. For at least 10 PIF-fed infants, label instructions were reportedly followed. Twenty-four ounces of milk-based RTF cost $ 0.84 more than milk-based PIF; 24 ounces of soy-based RTF cost $ 0.24 less than soy-based PIF.CONCLUSIONS:Cronobacter can infect healthy, term (not just hospitalized preterm) young infants. Invasive Cronobacter infection is extremely unusual in infants not fed PIF/HMF. RTFs are commercially sterile, require minimal preparation, and are competitively priced. The exclusive use of BM and/or RTF for infants <2 months old should be encouraged. HubMed – drug
Draft Genome Sequence of an Extremely Drug-Resistant KPC-Producing Klebsiella pneumoniae ST258 Epidemic Strain.
Filed under: Drug and Alcohol Rehabilitation
J Bacteriol. 2012 Nov; 194(21): 6014
Chmelnitsky I, Doniger T, Shklyar M, Naparstek L, Banin E, Edgar R, Carmeli Y
Extremely drug-resistant (XDR) Klebsiella pneumoniae carbapenemase-producing clone ST258 has rapidly disseminated worldwide. We report here the draft genome sequence of the K. pneumoniae ST258 XDR clinical strain from Israel.
HubMed – drug
Antivirulence Genes: Insights into pathogen evolution through gene loss.
Filed under: Drug and Alcohol Rehabilitation
Infect Immun. 2012 Oct 8;
Bliven KA, Maurelli AT
The emergence of new pathogens and the exploitation of novel pathogenic niches by bacteria typically require the horizontal transfer of virulence factors and subsequent adaptation – a ‘fine-tuning’ process -for the successful incorporation of these factors into the microbe’s genome. Function of newly-acquired virulence factors may be hindered by expression of genes already present in the bacterium. Occasionally, certain genes must be inactivated or deleted for full expression of the pathogen phenotype to occur. These genes are known as antivirulence genes (AVG). Originally identified in Shigella, AVG have improved our understanding of pathogen evolution and provided a novel approach for drug and vaccine development. In this review, we revisit the AVG definition and update the list of known AVG, which now includes genes from pathogens such as Salmonella, Yersinia pestis, and the virulent Francisella tularensis subspecies. AVG encompass a wide variety of different roles within the microbe, including genes involved in metabolism, biofilm synthesis, lipopolysaccharide modification, and host vasoconstriction. More recently, the use of one of these AVG (lpxL) as a potential vaccine candidate highlights the practical application of studying AVG inactivation in microbial pathogens.
HubMed – drug
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