[Show abstract][Hide abstract] ABSTRACT: Point-of-care access to current medical information is easily available to the practitioner through the use of smartphones, iPads, and other personal digital assistants. There are numerous mobile applications (apps) that provide easy-to-use and often well-referenced medical guidance for the infectious diseases practitioner. We reviewed 6 commonly utilized mobile apps available for handheld devices: the Emergency Medicine Residents' Association's (EMRA's) Antibiotic Guide, Epocrates Deluxe, Johns Hopkins Antibiotic Guide, Sanford Guide, the Medscape mobile app, and the Infectious Diseases Compendium. We evaluated several basic infectious diseases topics (including but not limited to endocarditis, vancomycin, and Acinetobacter infection) and attempted to objectively score them for metrics that would help the provider determine which mobile app would be most useful for his or her practice. The Johns Hopkins Antibiotic Guide and the Sanford Guide had the highest cumulative scores, whereas EMRA scored the lowest. We found that no single app will meet all of the needs of an infectious diseases physician. Each app delivers content in a unique way and would meet divergent needs for all practitioners, from the experienced clinician to the trainee. The ability to rapidly access trusted medical knowledge at the point of care can help all healthcare providers better treat their patients' infections.
[Show abstract][Hide abstract] ABSTRACT: Pyomyositis is an acute bacterial infection of skeletal muscle not arising from contiguous infection. It is often hematogenous in origin and typically associated with abscess formation. Our objective was to determine if there were any differences in the clinical presentation of disease between Staphylococcus aureus (SA) and non-Staphylococcus aureus pyomyositis. We also sought to determine if methicillin-resistant SA (MRSA) occurred more frequently during the final years of the study period.
A retrospective chart review study at three institutions in two cities.
Sixty cases of pyomyositis were identified between 1990 and 2010. Twenty-nine patients were infected with SA while 31 had other bacterial etiologies or were culture negative. Those with a traumatic event prior to the onset of infection were more likely to have a SA infection while SA infected patients were younger. Our first documented case of MRSA occurred in 2005, but the frequency of MRSA infection remained static over the following five years.
Pyomyositis is an emerging infection that is underappreciated by many physicians. While MRSA has emerged as the foremost cause of SA infections in a majority of clinical conditions, in this series most patients still had methicillin-sensitive SA as their cause of pyomyositis. In light of the severity of pyomyositis and the potential for bacteremia (either as a source or complication of the infection), empiric SA therapy should be initiated in all patients until the culture results are available.
The Journal of infection 01/2012; 64(5):507-12. · 4.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This case report describes the differential diagnosis of cutaneous ulcerations and the utility of the interferon-gamma release assays as a tool to aid in the diagnosis. These new assays can be used to identify mycobacterial infections (specifically Mycobacterium marinum) as the etiologic agents.
[Show abstract][Hide abstract] ABSTRACT: Staphylococcus aureus (SA) bacteremia (SAB) is associated with a high rate of complications, most of which are related to hematogenous seeding into deep tissues or prosthetic material. SA bacteriuria (SABU) has been described in association with SAB, but has not been evaluated as a predictor for complicated bacteremia, which was the objective of our study. METHODS (DESIGN, SETTING, AND PATIENTS): We conducted a retrospective study of patients admitted to the hospital with SAB. The 118 patients included in the study were divided in 2 cohorts: a group with SABU and a group without SA in the urine. We followed the 2 cohorts for an average of 8 months and evaluated the differences in complications and mortality.
SABU was found in 28 of 118 patients with SAB. Eighteen patients (64%) in this group had complications from the bacteremia, while in the group without SABU only 33% (30/90 patients) had complications (P = 0.004). The SABU group also had more deaths (32% vs. 14%; P = 0.036).
In this population of hospitalized patients with SAB, the presence of SABU was associated with an increased risk of early complications, including septic shock, and with higher mortality. A routine urine culture in search of SABU may be a helpful tool for detection of those patients with SAB who are at increased risk of complications and death.
Journal of Hospital Medicine 04/2010; 5(4):208-11. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Patients with diabetes mellitus (DM) have higher risk of infections than the general population; however the impact of DM on the clinical outcomes of community-acquired pneumonia (CAP) remains unclear. The objective of this study was to evaluate the impact of DM on the clinical outcomes of hospitalized patients with CAP.
Methods: A secondary analysis was conducted of the Community-Acquired Pneumonia Organization (CAPO) database from June 2001 to April 2009. Clinical characteristics and outcomes of hospitalized patients with CAP were analyzed and divided into three categories (without DM, controlled DM and uncontrolled DM). Patients were considered to have uncontrolled DM if their blood sugar was > 250 mg/dL on hospital admission. Study outcome was mortality at hospital discharge. Baseline characteristics among the 3 groups were compared using the Chi squared and the Mann-Whitney U tests. A multivariate logistic regression model was used to evaluate the association of mortality between patients without DM vs. patients with controlled DM, and between patients without DM vs. patients with uncontrolled DM.
Results: From a total of 3,273 patients, 2,612 patients had DM, 451 patients had controlled DM, and 210 had uncontrolled DM. There was not statistically significant difference in mortality rate for patients with controlled DM vs. patients without DM, 10.2% vs. 7.7%, aOR 1.1 (95% CI 0.78 - 1.66, p =0.50), On the other hand a statistically significant difference was found for patients with uncontrolled DM vs. patients without DM, 14.8% vs. 7.7%, aOR 1.7 (95% CI 1.06 - 2.65, p = 0.03).
Conclusion: This study shows that patients with CAP and controlled diabetes don’t have worse outcomes when compare to patients without diabetes. However, patients with uncontrolled diabetes have a significantly increased mortality when compared to patients without diabetes. This data suggests that it is not the presence of diabetes but how well a patient controls their diabetes that will determine their prognosis with CAP.
Infectious Diseases Society of America 2009 Annual Meeting; 10/2009
[Show abstract][Hide abstract] ABSTRACT: Combination antibiotic therapy is often indicated for health care associated pneumonia due to resistant pathogens and is recommended in the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines on the management of CAP and HCAP (3, 4). ...
Antimicrobial Agents and Chemotherapy 09/2009; 53(10):4568. · 4.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) infection is increasingly common. Treatment with vancomycin-based therapy is often unsuccessful. Daptomycin is a relatively new lipopeptide antibiotic with potent activity against MRSA.
To describe the successful management of MRSA infection involving the spine.
Two case reports of MRSA infection, one involving epidural and lumbar subdural abscesses, the other with osteomyelitis and discitis.
Two cases are described, one with lumbar epidural and subdural abscesses and the other with osteomyelitis and discitis of the spine. Switching from vancomycin to daptomycin plus rifampin-based therapy resulted in patient improvement that allowed discharge from the hospital.
Both patients recovered fully from their infection.
Daptomycin is a safe and effective option for the treatment of MRSA infection involving the spine.
The spine journal: official journal of the North American Spine Society 06/2009; 9(6):e5-8. · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Pyomyositis is a bacterial infection of skeletal muscle caused by transient bacteremia or local extension of a contiguous infection. Pyomyositis was considered rare in temperate climates with 98 reported cases from 1971-1992 in North America. Clinically experience suggests a recent increase in diagnosis of this challenging disease at Miami Valley Hospital (MVH) in Dayton, Ohio. Methods: The MVH IRB approved this study. Medical records (1990-2007) with a primary or secondary discharge diagnosis of infective pyomyositis were reviewed. Charts were reviewed for clinical presentation, laboratory data, radiographic results, intervention (surgical or radiologic) and antimicrobial therapy to ensure the diagnosis. Infections localized to distal extremities were excluded. Results: Thirty-two cases of pyomyositis were identified. Risk factors included diabetes (31.3%), trauma (31.3%), recent procedure (21.9%), and IVDA (12.5%). Clinical manifestations included pain (96.9%), fever (65.6%), swelling (50%), erythema (37.8%), warmth (34.4%), systemic toxicity (15.6%), and fluctuance (3.1%). The mean sed rate and leukocyte count on admission was 77 mm/hr and 13.5 wbc/mcL respectively. Bacteria included: S. aureus (18 total; 7 deep culture, 8 both blood and deep culture, 3 blood culture; 15 MSSA & 3 MRSA), 2 Pseudomonas aeruginosa, 2 beta hemolytic strep and 2 viridans group streptococcus. Five were culture negative. All had either an abnormal MRI or CT that assisted with diagnosis. 97% of patients underwent at least 1 drainage procedure (interventional radiology 28.1%, surgical 50%, combined surgical and radiologic drainage 18%). Mean duration of antibiotic treatment was 23.6 days (6-56 days). Conclusions: Pyomyositis is increasingly common in temperate climates and should be in the differential diagnosis of patients presenting with pain, fever, swelling and erythema of a muscular area. Risk factors are not reliable and proper imaging is paramount. S. aureus is the most common organism. Treatment includes a drainage procedure with adjuvant antimicrobial therapy.
Infectious Diseases Society of America 2008 Annual Meeting; 10/2008
[Show abstract][Hide abstract] ABSTRACT: Background: In 2001, the FDA approved the first interferon-gamma release assay (IGRA) for the diagnosis of latent and active tuberculosis. There are several nucleic acid amplification tests (NAATs) approved for use in the rapid identification of M. tuberculosis in respiratory samples. The purpose of this study was to determine: (1) availability of IGRA; (2) most common indications for ordering IGRA; (3) availability of NAATs for diagnosis of tuberculosis in various clinical scenarios; and (4) timeliness of TB susceptibility results. Methods: The IDSA Emerging Infections Network (EIN) is a sentinel network of infectious disease consultants (IDCs). In January 2008, we distributed a survey via e-mail and facsimile to IDCs. Results: There were 583 respondents (52% of 1122 members). Over half of respondents considered themselves the local tuberculosis expert. More than 85% of respondents from the West North Central and Pacific regions reported availability of QFT, while ≤45% of respondents from the West South Central, South Atlantic and East South Central regions reported availability. Most (31%) respondents used commercial or reference laboratories for IGRA; only 12 states had members who reported that IGRA was performed at a public health lab. NAATs for rapid identification of M. tuberculosis in respiratory samples was available for 66% of respondents in their local areas; only a quarter (22%) reported that local labs would perform these tests directly on smear-negative respiratory samples. Most (266 of 511 providing an answer) indicated that susceptibility testing is performed in a public health laboratory, and 57% of those said results took more than the recommended time (30 days) to return. Conclusions: Significant geographic variability was observed in the availability and use of the interferon-gamma release assay (IGRA) for latent tuberculosis. There is limited availability of rapid NAATs among local laboratories. There are significant delays in receiving the results of susceptibility testing.
Infectious Diseases Society of America 2008 Annual Meeting; 10/2008
[Show abstract][Hide abstract] ABSTRACT: Mobile technology has the potential to revolutionize how physicians practice medicine. From having access to the latest medical research at the point of care to being able to communicate at a moment's notice with physicians and colleagues around the world, we are practicing medicine in a technological age. During recent years, many physicians have been simultaneously using a pager, cellular telephone, and personal digital assistant (PDA) to keep in communication with the hospital and to access medical information or calendar functions. Many physicians have begun replacing multiple devices with a "smartphone," which functions as a cellular telephone, pager, and PDA. The goal of this article is to provide an overview of the currently available platforms that make up the smartphone devices and the available medical software. Each platform has its unique advantages and disadvantages, and available software will vary by device and is in constant flux.
[Show abstract][Hide abstract] ABSTRACT: Electronic tools for infectious diseases and medical microbiology have the ability to change the way the diagnosis and treatment of infectious diseases are approached. Medical information today has the ability to be dynamic, keeping up with the latest research or clinical issues, instead of being static and years behind, as many textbooks are. The ability to rapidly disseminate information around the world opens up the possibility of communicating with people thousands of miles away to quickly and efficiently learn about emerging infections. Electronic tools have expanded beyond the desktop computer and the Internet, and now include personal digital assistants and other portable devices such as cellular phones. These pocket-sized devices have the ability to provide access to clinical information at the point of care. New electronic tools include e-mail listservs, electronic drug databases and search engines that allow focused clinical questions. The goal of the present article is to provide an overview of how electronic tools can impact infectious diseases and microbiology, while providing links and resources to allow users to maximize their efficiency in accessing this information. Links to the mentioned Web sites and programs are provided along with other useful electronic tools.
The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale / AMMI Canada 12/2007; 18(6):347-52. · 0.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 56-year-old man presented with a cutaneous lesion on his right hand (Figure 1). Approximately 6 weeks previously, he had traveled to Costa Rica for missionary work. During his travel he used a diethyltoluamide-containing insect repellant, but spent one night in the jungle without a mosquito net. Four weeks after his return, he noted a 3 x 2.5-cm ulcer with raised edges and surrounding erythema on the dorsum of his right hand. The patient recalled applying insect repellant with his right hand to other exposed areas of his body but was remiss in applying it to the right hand itself. On examination, the patient was noted to have an ulcerated nodule near his right earlobe (Figure 2) and a second 2 x 1-cm ulcer on the volar aspect of his right wrist (Figure 3). There were no mucocutaneous lesions noted. During the next several weeks, numerous nodules developed in a sporotrichoid pattern on the extensor surface of his right arm (Figure 4). Skin biopsy was performed at the time of initial evaluation and revealed cutaneous leishmaniasis due to Leishmania panamensis. After discussing the different treatment options, miltefosine was administered orally for 28 days. The patient experienced an excellent response to therapy.
[Show abstract][Hide abstract] ABSTRACT: Background
Clostridium difficile associated diarrhea (CDAD) is a common hospital problem. Diagnosis relies on either laboratory testing (tissue cultures or immunoassay testing for which results may require >24 hours) or an invasive test such as colonoscopy. There has been an “urban legend” that CDAD has a unique odor that would allow for the olfactory diagnosis, but this theory has never been scientifically challenged.
Physician requests for stool analysis for CDAD were reviewed. Nursing staff was interviewed and a survey (including nursing demographics as well specific stool related data) was completed prior to stool test results being available. Nurses were included if they “perceived” that they had the ability to diagnose CDAD by smell and were directly involved in the processing/examining the patient’s stool. Patients were excluded if they were on empiric therapy for CDAD with either metronidazole or oral vancomycin for > 24 hours. CDAD was diagnosed by standard testing in the hospital laboratory.
138 nursing staff surveys were completed. The CDAD prevalence rate was 14.5%. The sensitivity by odiferous diagnosis was 55% and the specificity 83%. The positive predictive value was 0.35 (0.19-0.52) and the negative predictive value was 0.92 (0.86-0.97).
Nurses were able to exclude the diagnosis of CDAD with a high degree of confidence, but their ability to diagnose CDAD based on odor was not better than random guessing. This suggests that while CDAD may have some unique olfactory characteristics, exclusion based upon odor is significantly more reliable than confirmation. Further studies are needed to expand upon this preliminary data.
Infectious Diseases Society of America 2006 Annual Meeting; 10/2006
[Show abstract][Hide abstract] ABSTRACT: Antimicrobe.org (http://www.antimicrobe.org) is a World Wide Web-based version of the textbook Antimicrobial Therapy and Vaccines, volumes I and II. The Web site currently consists of 3 texts (Microbes, Antimicrobial Agents, and HIV Clinical Manual) and will soon include a fourth, Empiric. The Web site focuses on therapy for infectious diseases, and it covers, in comprehensive detail, a great majority of infections encountered today. The dynamic nature of a Web-based reference allows for information to be frequently updated and enhances a physician's searching capabilities to find answers to very specific clinical questions and the latest available evidence. A Smart Search engine allows users to ask specific questions and to find focused answers, either within the textbook or through PubMed via a guided PubMed references option. The Web site also provides clinical vignettes and minireviews on hot topics in infectious diseases and hyperlinks to other important articles or Web sites. Chapters are written by experts in their field who provide evidence-based information, as well as anecdotal reports about rare infections. Antimicrobe.org would be of great benefit to physicians who treat infections on a routine basis.
[Show abstract][Hide abstract] ABSTRACT: Case 1: A 39-year-old man with chronic lower extremity lymphedema was admitted to the hospital with acute fever, chills, and left lower extremity pain, swelling, and erythema for the third time in as many months. Examination revealed a temperature of 39 degrees C (102.2 degrees F), and erythmatous induration on the left leg (Figure). The patient was treated with IV clindamycin and cefazolin, with clinical improvement. He was discharged with azithromycin, 500 mg daily for 3 days, done twice monthly. Case 2: A 52-year-old morbidly obese man with stasis dermatitis presented with acute lower extremity pain, swelling, and associated fever. He had been taking prophylactic antibiotics for his recurrent cellulitis for more than a decade and had significantly decreased his number of reoccurrences while on this therapy. He was admitted to the hospital, treated with IV cefazolin, and had a rapid improvement over 48 hours. He was subsequently discharged with continued suppressive antibiotic therapy.
[Show abstract][Hide abstract] ABSTRACT: A 28-year-old white man presented to the Emergency Department with a 24-hour history of an eruption on his extremities, trunk, and face. The patient was known to be HIV positive with a CD4 count of 527 and a viral load of 20,300. He denied fever, chills, malaise, and headache. His social history was significant for the fact that he was in a monogamous homosexual relationship. He had no recent travel, pet exposures, or sick contacts. Physical examination revealed stable vital signs and no documented fever. A maculopapular eruption was present on his face, trunk, and extremities (Figures 1 and 2). There was no palmar or plantar involvement. He was treated with diphenhydramine and topical 2.5% hydrocortisone and advised to return if his condition did not improve. Twelve days after the initial evaluation, the patient consulted us again due to progression of his dermatitis. He had no additional complaints other than an eruption on both palms but neither sole. (Figure 3). The eruption now demonstrated erythematous pink-red oval macules and papules 1-2 cm in size distributed on his scalp, face, trunk, and arms. A few papules contained fine collarettes of scale. Further questioning revealed that the patient had experienced a tender rectal ulcer 2 months previously. A punch biopsy and rapid plasma reagin were performed. The histopathologic examination revealed interface dermatitis with lymphocytes, plasma cells, occasional neutrophils, and a prominent lymphoplasmacytic perivascular dermatitis with infiltration of the vessel walls. Warthrin-Starry and Steiner methods demonstrated spirochetes at the dermal-epidermal junction and in vessel walls, consistent with Treponema pallidum (Figure 4). Rapid plasma reagin and fluorescent Treponema antibody were both reactive with a Venereal Disease Research Laboratory (VDRL) of 1:16. The patient was diagnosed as having secondary syphilis and treated with 2.4 million units of IM benzathine penicillin for 3 weeks. His eruption resolved after the initial treatment and he did not experience a Jarisch-Herxheimer reaction.
[Show abstract][Hide abstract] ABSTRACT: Penicillium sp., other than P. marneffei, is an unusual cause of invasive disease. These organisms are often identified in immunosuppressed patients, either due to human immunodeficiency virus or from immunosuppressant medications post-transplantation. They are a rarely identified cause of infection in immunocompetent hosts.
A 51 year old African-American female presented with an acute abdomen and underwent an exploratory laparotomy which revealed an incarcerated peristomal hernia. Her postoperative course was complicated by severe sepsis syndrome with respiratory failure, hypotension, leukocytosis, and DIC. On postoperative day 9 she was found to have an anastamotic breakdown. Pathology from the second surgery showed transmural ischemic necrosis with angioinvasion of a fungal organism. Fungal blood cultures were positive for Penicillium chrysogenum and the patient completed a 6 week course of amphotericin B lipid complex, followed by an extended course oral intraconazole. She was discharged to a nursing home without evidence of recurrent infection.
Penicillium chrysogenum is a rare cause of infection in immunocompetent patients. Diagnosis can be difficult, but Penicillium sp. grows rapidly on routine fungal cultures. Prognosis remains very poor, but aggressive treatment is essential, including surgical debridement and the removal of foci of infection along with the use of amphotericin B. The clinical utility of newer antifungal agents remains to be determined.
Annals of Clinical Microbiology and Antimicrobials 02/2005; 4:21. · 1.51 Impact Factor