Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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Mortality attributable to bloodstream infection (BSI) is still controversial. We studied the impact of BSI on mortality after coronary artery bypass surgery, including the specific impact of different etiologic organisms. ⋯ BSIs due to gram-negative bacteria and BSIs due to S. aureus contributed significantly to mortality. Mortality attributable to BSI was highest among patients predicted to be least likely to develop infection and was lowest among severely ill patients who were most likely to develop infection. BSI appears to be an important contributor to death after coronary artery bypass surgery, particularly among the healthiest patients.
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Ventilator-associated pneumonia (VAP) rates are advocated as a measure of hospitals' quality of care for critically ill patients. The standard definition used to measure VAP rates, however, is constructed of nonspecific clinical signs common to many common complications of critical care. We created a model in which we estimated the probability of patients with 6 different complications of critical care fulfilling diagnostic criteria for VAP. ⋯ Despite keeping the true, underlying prevalence of VAP fixed at 10%, the apparent rate of VAP varied between 6.0% and 31.6%, depending on the prevalence of other conditions. The addition of microbiological criteria to standard clinical criteria decreased the range of apparent VAP to 3.5%-15.5%. These wide margins of variability suggest that VAP rates are an unreliable measure of quality of care.
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The largest reported mumps outbreak at a US college in 19 years occurred in 2006 at a Kansas university with a 2-dose measles-mumps-rubella (MMR) vaccination policy. We assessed vaccine performance and mumps risk factors, including the possibility of waning vaccine protection. ⋯ High 2-dose MMR coverage protected many students from developing mumps but was not sufficient to prevent the mumps outbreak. Vaccine-induced protection may wane. Similar US settings where large numbers of young adults from wild-type naive cohorts live closely together may be at particular risk for mumps outbreaks.
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Randomized Controlled Trial Multicenter Study
Effect of clarithromycin in patients with sepsis and ventilator-associated pneumonia.
Because clarithromycin provided beneficiary nonantibiotic effects in experimental studies, its efficacy was tested in patients with sepsis and ventilator-associated pneumonia (VAP). ⋯ Clarithromycin accelerated the resolution of VAP and weaning from mechanical ventilation in surviving patients and delayed death in those who died of sepsis. The mortality rate at day 28 was not altered. Results are encouraging and render new perspectives on the management of sepsis and VAP.