Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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There have been 4 recent major advances in the treatment of postherpetic neuralgia (PHN) that are based on the results of randomized, controlled trials. These advances are the demonstrations that gabapentin, the lidocaine patch 5%, and opioid analgesics are efficacious in patients with PHN, and the report that nortriptyline and amitriptyline provide equivalent analgesic benefits for patients with PHN but that nortriptyline is better tolerated. ⋯ Despite these treatment advances, many patients remain refractory to current therapy, and the prevention of PHN has therefore become an important focus of current research. Research on administration of the varicella-zoster vaccine to prevent herpes zoster and on treatment of patients who have herpes zoster with combined antiviral and analgesic therapy to prevent PHN is discussed.
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Randomized Controlled Trial Clinical Trial
Use of full sterile barrier precautions during insertion of arterial catheters: a randomized trial.
To investigate whether institution of maximal sterile barrier precautions (SBPs) during arterial catheter (AC) insertion prevents catheter colonization, as is the case for central venous catheters (CVCs), a randomized study was conducted. Three hundred seventy-three patients in whom a radial or dorsalis pedis AC was going to be inserted were randomized to an SBP group or a standard-of-care group. These patients, in addition to all patients who were admitted to the unit with an AC already in place or who were not eligible for the randomized study, were observed for AC-related colonization and infection. ⋯ Five episodes of AC-related bloodstream infection were diagnosed (1.5 cases per 1000 catheter-days). Use of SBPs did not prevent AC colonization or infection. The incidence of AC-related infectious complications was comparable to the incidence of CVC-related infection reported in the literature.
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Data for 479 patients were analyzed to assess the impact of methicillin resistance on the outcomes of patients with Staphylococcus aureus surgical site infections (SSIs). Patients infected with methicillin-resistant S. aureus (MRSA) had a greater 90-day mortality rate than did patients infected with methicillin-susceptible S. aureus (MSSA; adjusted odds ratio, 3.4; 95% confidence interval, 1.5-7.2). ⋯ Patients with MRSA SSI had a 1.19-fold increase in hospital charges (P=.03) and had mean attributable excess charges of 13,901 dollars per SSI compared with patients who had MSSA SSIs. Methicillin resistance is independently associated with increased mortality and hospital charges among patients with S. aureus SSI.
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To assess the association between inclusion of a macrolide in a beta-lactam-based empirical antibiotic regimen and mortality among patients with bacteremic pneumococcal pneumonia, 10 years of data from a database were analyzed. The total available set of putative prognostic factors was subjected to stepwise logistic regression, with in-hospital death as the dependent variable. ⋯ For patients with bacteremic pneumococcal pneumonia, not adding a macrolide to a beta-lactam-based initial antibiotic regimen is an independent predictor of in-hospital mortality. However, only a randomized study can definitively determine whether this association is due to a real effect of macrolides.