Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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Randomized Controlled Trial Comparative Study
Standard versus newer antibacterial agents in the treatment of severe acute exacerbation of chronic obstructive pulmonary disease: a randomized trial of trimethoprim-sulfamethoxazole versus ciprofloxacin.
BACKGROUND. Although the use of antibiotics in the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD) is largely accepted, controversy remains regarding whether the choice of antibiotic has any impact on outcome. Our aim was to compare the effects of the combination of trimethoprim and sulfamethoxazole and ciprofloxacin in patients treated for severe COPD exacerbation requiring mechanical ventilation. ⋯ In patients with acute exacerbation of COPD requiring mechanical ventilation, efficacy of trimethoprim-sulfamethoxazole was not inferior to ciprofloxacin. Trial registration. ClinicalTrials.gov identifier: NCT00791505.
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There is debate surrounding the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV). We determined whether PPV was associated with reduced mortality or additional hospitalization for vaccine-preventable infections in patients previously hospitalized for community-acquired pneumonia (CAP). ⋯ One-half of patients discharged from the hospital after pneumonia die or are subsequently hospitalized with a vaccine-preventable infection within 5 years. PPV was not associated with a reduced risk of death or hospitalization. Better pneumococcal vaccination strategies are urgently needed.
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Atrial-esophageal fistula is a rare but often fatal complication of catheter radiofrequency ablation. Patients occasionally have bacteremia and have been misdiagnosed with endocarditis. Infectious diseases specialists are often consulted and need to be aware of this complication. We report a case of atrial-esophageal fistula after radiofrequency ablation that illustrates the salient features of this illness.
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Recent practice guidelines for the diagnosis of catheter-related bloodstream infection (CRBSI) describe as an "unresolved issue" the number of lumens from which blood culture specimens should be drawn to make a conservative diagnosis of CRBSI. Our objective was to determine how many CRBSI episodes would be missed if not all catheter lumens were sampled. ⋯ Samples for blood culture should be obtained through all catheter lumens to establish a diagnosis of CRBSI.