Infection
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The primary objective of this study was to measure influenza vaccination coverage rates in the general population, including children, and in high-risk groups of five European countries during the season 2007/2008. An additional aim was to analyze coverage trends over seven consecutive seasons and to gain an understanding of the primary drivers and barriers to immunization. ⋯ The change in general influenza vaccination coverage in the 2007/2008 season compared to the previous season was small, but decreases were seen in some target groups. The underlying motivations for and against vaccination did not substantially change. An effort to activate those driving forces that would encourage vaccination as well as dealing with barriers that tend to prevent it may help enhance coverage rates in Europe in the future.
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Randomized Controlled Trial
Biomarkers of thrombosis, fibrinolysis, and inflammation in patients with severe sepsis due to community-acquired pneumonia with and without Streptococcus pneumoniae.
Severe Streptococcus pneumoniae (S. pneum) pneumonia has historically been associated with an acute presentation and increased mortality. Using data from patients with community-acquired pneumonia (CAP) and severe sepsis, we investigated: (1) the baseline patient characteristics and biomarkers of thrombosis, fibrinolysis, and inflammation in patients with CAP due to S. pneum infection (S. pneum CAP) or CAP due to infection with other or unidentified organisms (non-S. pneum CAP); (2) the behavior of these biomarkers over time and during treatment with drotrecogin alfa (activated) (DrotAA, recombinant activated protein C). ⋯ In this population of patients with severe sepsis, patients with S. pneum CAP had a more severe dysregulation of coagulation, fibrinolysis, and inflammation than patients with non-S. pneum CAP; the former also developed significantly elevated levels of markers of thrombosis. Treatment with DrotAA was associated with significant improvements in protein C levels as well as markers of thrombosis. These characteristics may make patients with S. pneum CAP and severe sepsis particularly suited to derive a benefit from therapy with DrotAA.
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Panton-Valentine leukocidin (PVL) is a cytotoxin produced by Staphylococcus aureus that exhibits highly specific lytic activity against polymorphonuclear cells, monocytes, and macrophages. A 34-year-old man admitted for right parietal brain abscess and thickened dura mater in close proximity to a lytic bone lesion is presented. ⋯ A hematogenous infection, route of bone infection with progression to dura mater and brain parenchyma was hypothesized. To our knowledge this is the first reported case of a brain abscess due to PVL-positive S. aureus.
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Since 1988, the Standing Committee on Vaccination (STIKO) at the Robert Koch-Institute, Berlin, has explicitly recommended that health-care workers (HCWs) should be vaccinated against seasonal influenza. However, acceptance of the influenza vaccination by medical personnel is low. ⋯ Our findings confirm the importance of a comprehensive approach to the vaccination, ensuring that HCWs are correctly informed about the vaccine and that it is convenient to receive it.
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Multicenter Study
Promoting Global Research Excellence in Severe Sepsis (PROGRESS): lessons from an international sepsis registry.
The PROGRESS Registry (Promoting Global Research Excellence in Severe Sepsis) was designed to provide comparative data reflecting everyday clinical practice, thereby allowing participating institutions to explore and benchmark medical interventions in severe sepsis. ⋯ The PROGRESS international sepsis registry demonstrates that a large web-based sepsis registry is feasible. Wide variations in outcomes and use of sepsis therapies were observed between countries. These results also suggest that additional opportunities exist across countries to improve severe sepsis outcomes.