Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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Liver fibrosis is accelerated in patients coinfected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The reasons for this faster liver disease progression are unclear, although higher plasma HCV RNA levels and distinct HCV genotype distribution in this population, compared with in HCV-monoinfected subjects, could play a role. ⋯ HCV genotype 3, older age, and elevated alanine aminotransferase levels are independent predictors of advanced liver fibrosis in HCV-HIV-coinfected patients.
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Review Meta Analysis
The impact of penicillin resistance on short-term mortality in hospitalized adults with pneumococcal pneumonia: a systematic review and meta-analysis.
The clinical impact of penicillin resistance on the outcome of pneumococcal pneumonia has remained controversial. We performed a meta-analysis of prospective cohort studies to examine the association between penicillin resistance and short-term all-cause mortality for pneumococcal pneumonia. ⋯ Penicillin resistance is associated with a higher mortality rate than is penicillin susceptibility in hospitalized patients with pneumococcal pneumonia. Additional efforts are needed to understand the mechanisms of this association.
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Comparative Study
Preventing transmission of multidrug-resistant bacteria in health care settings: a tale of 2 guidelines.
Two guidelines for the control of multidrug-resistant organisms in health care facilities have appeared during the past 3 years--one from the Society for Healthcare Epidemiology of America and one, in draft form, from the Healthcare Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention. These guidelines reflect universal concern in the infection-control community about today's unprecedented levels of activity of multidrug-resistant organisms and about inadequate or inconsistent application of potentially effective control measures. ⋯ Recommendations regarding indications for active surveillance cultures and the extent of their use constitute the major divergence. Although implementation of comprehensive control plans for multidrug-resistant organisms advocated by both guidelines will require health care facilities to confront difficult programmatic issues, aggressive and widespread adoption of control measures for multidrug-resistant organisms is urgently needed.