Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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Clinicians continue to question the usefulness of microscopic examination of Gram-stained sputum specimens ("Gram staining") and sputum culture for diagnosis of pneumonia. We analyzed the sensitivity of these techniques in 105 patients with pneumococcal pneumonia proven by blood culture. Gram staining revealed gram-positive cocci in pairs and chains, and culture yielded pneumococci in only 31% and 44% of all cases, respectively. ⋯ If patients receiving antibiotics for >24 h had been excluded, Gram staining would have suggested pneumococci in 63%, and culture results would have been positive in 86%. Sensitivity increased in inverse proportion to the duration of antibiotic therapy (P<.05). Microscopic examination of sputum samples before antibiotics were administered and performance of culture within 24 h of receipt of such treatment yielded the correct diagnosis in >80% of cases of pneumococcal pneumonia.
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Practice Guideline Guideline
Evidence-based recommendations for antimicrobial use in febrile neutropenia in Japan: executive summary.
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Randomized trials of adjunctive treatment of bacterial sepsis with polyclonal immunoglobulin show conflicting results. We performed a systematic review and a meta-analysis of the results of randomized trials that compared reductions in mortality rates in patient groups treated with polyclonal immunoglobulin versus either placebo or no treatment in addition to conventional treatment. High-quality trials had adequate concealment of allocation, were double-blinded and placebo-controlled, and made data available for intention-to-treat analyses. ⋯ Meta-analysis of all trials showed a relative risk of death with immunoglobulin treatment of 0.77 (95% confidence interval [CI], 0.68-0.88). High-quality trials (involving a total of 763 patients, 255 of whom died) showed a relative risk of 1.02 (95% CI, 0.84-1.24), whereas other trials (involving a total of 948 patients, 292 of whom died) showed a relative risk of 0.61 (95% CI, 0.50-0.73). Because high-quality trials failed to demonstrate a reduction in mortality, polyclonal immunoglobulin should not be used for treatment of sepsis except in randomized clinical trials.
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We sought to characterize the molecular epidemiology of gram-negative bacilli (GNB) causing infections in infants and associated with carriage on nurses' hands after hand hygiene was performed. From March 2001 to January 2003, GNB caused 192 (34%) of 562 hospital-acquired infections in the 2 participating neonatal intensive care units (NICUs) and were isolated from the hands of 45 (38%) of 119 nurses. ⋯ In contrast, only 9% of strains that caused infections were cultured from nurses' hands. These data suggest that practices in addition to hand hygiene are needed to prevent horizontal transmission of GNB in the NICU.