Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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Multicenter Study
Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study.
Nosocomial bloodstream infections (BSIs) are important causes of morbidity and mortality in the United States. ⋯ In this study, one of the largest multicenter studies performed to date, we found that the proportion of nosocomial BSIs due to antibiotic-resistant organisms is increasing in US hospitals.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Adequacy of early empiric antibiotic treatment and survival in severe sepsis: experience from the MONARCS trial.
As part of the Monoclonal Anti-TNF: A Randomized Controlled Sepsis (MONARCS) trial, which enrolled patients with suspected sepsis, we sought to determine whether adequate antibiotic therapy was associated with a decreased mortality rate. The study enrolled 2634 patients, 91% of whom received adequate antibiotic therapy. The mortality rate among patients given adequate antibiotic treatment was 33%, versus 43% among patients given inadequate treatment (P<.001). We conclude that adequate antibiotic therapy results in a significant decrease in the crude mortality rate among patients suspected of sepsis.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Intravenous immunoglobulin G therapy in streptococcal toxic shock syndrome: a European randomized, double-blind, placebo-controlled trial.
The efficacy and safety of high-dose intravenous polyspecific immunoglobulin G (IVIG) as adjunctive therapy in streptococcal toxic shock syndrome (STSS) were evaluated in a multicenter, randomized, double-blind, placebo-controlled trial. The trial was prematurely terminated because of slow patient recruitment, and results were obtained from 21 enrolled patients (10 IVIG recipients and 11 placebo recipients). ⋯ Furthermore, a significant increase in plasma neutralizing activity against superantigens expressed by autologous isolates was noted in the IVIG group after treatment (P=.03). Although statistical significance was not reached in the primary end point, the trial provides further support for IVIG as an efficacious adjunctive therapy in STSS.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Systemic host responses in severe sepsis analyzed by causative microorganism and treatment effects of drotrecogin alfa (activated).
Clinical trials with novel therapeutic agents for severe sepsis have suggested that patients might respond differently depending on causative microorganism. Data from a large, placebo-controlled trial of recombinant human drotrecogin alfa (activated) (DrotAA) were analyzed by type of causative microorganism for treatment-associated differences in mortality, coagulopathy, and inflammatory response. ⋯ Levels of coagulation and inflammation biomarkers varied with different pathogens at study entry. Results demonstrate that DrotAA, administered as an adjunct to standard anti-infective therapy, can improve the rate of survival for patients who develop severe sepsis regardless of causative microorganism.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
General microbiology and in vitro susceptibility of anaerobes isolated from complicated skin and skin-structure infections in patients enrolled in a comparative trial of ertapenem versus piperacillin-tazobactam.
In a recently completed study of once-a-day ertapenem versus piperacillin-tazobactam every 6 h in the treatment of complicated skin and skin-structure infections, 540 patients were randomized in a 1rcolon;1 ratio and assigned to 1 of 2 strata: those with a complicating underlying disease or all others. The most common infections in the study were deep soft-tissue abscess (18.9%), followed by diabetic lower extremity infection (18.1%); 7.0% of these were perineal cellulitis/abscess. ⋯ Of the 141 anaerobes tested for susceptibility, 97.2% were susceptible to ertapenem and 97.9% to piperacillin-tazobactam. Ertapenem had excellent in vitro activity against the most common aerobic pathogens and almost all anaerobes recovered from patients with infections of the skin and skin structures.