Scandinavian journal of infectious diseases
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Scand. J. Infect. Dis. · Sep 2013
ReviewEarly lumbar puncture in adult bacterial meningitis--rationale for revised guidelines.
Current international guidelines recommend cerebral computerized tomography (CT) before lumbar puncture (LP) in many adults with suspected acute bacterial meningitis (ABM), due to concern about LP-induced cerebral herniation. Despite guideline emphasis on early treatment based on symptoms, performing CT prior to LP implies a risk of delayed ABM treatment, which may be associated with a fatal outcome. ⋯ The inappropriate use of the diagnostic treatment sequence of brain CT scan, followed by LP, followed by antibiotics and corticosteroids should be avoided in adults with suspected ABM by omitting needless contraindications for LP, thus eliminating an unnecessary fear of immediate LP. Revised Swedish guidelines regarding early LP are presented, and the background documentation and reasons for omitting impaired consciousness, new onset seizures, and immunocompromised state as contraindications to LP are discussed.
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Scand. J. Infect. Dis. · Aug 2013
Short- and long-term mortality in patients with community-acquired severe sepsis and septic shock.
Severe sepsis and septic shock have a high 30-day mortality (10-50%), but the long-term mortality is not well described. The purpose of this study was to describe long-term mortality among patients with community-acquired severe sepsis or septic shock compared to a population-based reference cohort. ⋯ Patients with severe sepsis and septic shock who survived the first 30 days had a 2.7 times higher mortality hazard in the first year and a 2.3 times higher mortality hazard in the next 3 y, compared to persons of similar age, sex, and comorbidity level.
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Scand. J. Infect. Dis. · Jul 2013
Outcomes and risk factors for mortality in community-onset bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli, with a special emphasis on antimicrobial therapy.
Although extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has emerged as a significant pathogen, there is little information regarding treatment outcomes in community-onset bacteremia due to ESBL E. coli. The purpose of this study was to evaluate treatment outcomes of community-onset bacteremia caused by ESBL-producing E. coli and the factors associated with mortality. ⋯ In patients with community-onset bacteremia caused by ESBL-producing E. coli, severe sepsis and underlying liver disease were significantly associated with mortality, and a delay in appropriate antimicrobial therapy was not associated with a higher mortality if therapy was adjusted appropriately according to the susceptibility results.
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Scand. J. Infect. Dis. · May 2013
Changes in levels of T cell subpopulations to monitor the response to antiretroviral therapy among HIV-1-infected patients during two years of HIV-1 replication suppression.
The aim of this study was to compare the effect of 2 y of antiretroviral therapy (ART) on the percentage of activated CD38⁺CD8⁺ T cells and human leukocyte antigen (HLA)-DR⁺CD8⁺ T cells, and the expression of the co-stimulatory molecule CD28 on CD4⁺ and CD8⁺ T cells in the peripheral blood of HIV-infected adults, and to assess the use of immune activation markers to predict the virological response to ART in a cohort of HIV-1-infected patients in the north-western part of China. ⋯ We show that HAART can be used successfully in Chinese populations with elevated baseline immune activation markers and that the percentage of CD38⁺CD8⁺ T cells may be an additional parameter to the current criteria for estimating the antiretroviral response with HAART.
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Scand. J. Infect. Dis. · Mar 2013
Editorial CommentAntibiotics for sore throat patients--varied opinions.