[Show abstract][Hide abstract] ABSTRACT: Carbapenems are frequently used to treat infections due to extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. Thus, the emergence of infections due to carbapenem-resistant K. pneumoniae (CRKp) is a major public health concern.
To identify risk factors associated with the development of CRKp infections.
We conducted a matched case-control study in two hospitals (Henry Dunant Hospital, Athens, Greece and University Hospital of Heraklion, Crete, Greece). The controls were selected among patients with carbapenem-susceptible K. pneumoniae (CSKp) and were matched with CRKp cases for site of infection.
One hundred and six patients were included in our study (53 cases and 53 controls). Mortality was 30.1% and 33.9% for patients with CRKp and CSKp infections, respectively (P = 0.83). Bivariable analysis showed that exposure to anti-pseudomonas penicillins (P = 0.004), carbapenems (P = 0.01), quinolones (P < 0.001) and glycopeptides (P < 0.001), as well as admission to the intensive care unit (P = 0.002), tracheostomy (P = 0.02), chronic obstructive pulmonary disease (P = 0.04), surgery with use of foreign body (P = 0.04) and mechanical ventilation (P = 0.02) were associated with CRKp infection. The multivariable analysis showed that exposure to fluoroquinolones [odds ratio (OR) 4.54, 95% confidence intervals (CIs) 1.78-11.54, P = 0.001] and exposure to antipseudomonal penicillins (OR 2.57, 95% CI 1.00-6.71, P = 0.04) were independent risk factors for CRKp infections.
Our data suggest that prior exposure to fluoroquinolones and antipseudomonal penicillins are independent risk factors for the development of CRKp infections.
Full-text · Article · Dec 2007 · Journal of Antimicrobial Chemotherapy
[Show abstract][Hide abstract] ABSTRACT: The Olympic Games constitute a first-class opportunity to promote athleticism and health messages. Little is known, however on the impact of Olympic Games on the development of health-promotion programs for the general population. Our objective was to identify and describe the population-based health-promotion programs implemented in relation to the Athens 2004 Olympic and Para Olympic Games.
A cross-sectional survey of all stakeholders of the Games, including the Athens 2004 Organizing Committee, all ministries of the Greek government, the National School of Public Health, all municipalities hosting Olympic events and all official private sponsors of the Games, was conducted after the conclusion of the Games.
A total of 44 agencies were surveyed, 40 responded (91%), and ten (10) health-promotion programs were identified. Two programs were implemented by the Athens 2004 Organizing Committee, 2 from the Greek ministries, 2 from the National School of Public Health, 1 from municipalities, and 3 from official private sponsors of the Games. The total cost of the programs was estimated at 943,000 Euros; a relatively small fraction (0.08%) of the overall cost of the Games.
Greece has made a small, however, significant step forward, on health promotion, in the context of the Olympic Games. The International Olympic Committee and the future hosting countries, including China, are encouraged to elaborate on this idea and offer the world a promising future for public health.
Full-text · Article · Feb 2006 · BMC Public Health
[Show abstract][Hide abstract] ABSTRACT: Background: There is a renewed interest in using alternative ways of administration of antimicrobial agents. The continuous intravenous infusion represents one of them. However, the literature lacks a systematic comparison of data of continuous vs intermittent intravenous administration of antibiotics. Methods: Data for this systematic review were identified by searches of Medline (01/1950 to 01/2004), Current Contents, and references from relevant articles; in addition articles were identified through searches of the extensive files of the authors. Search terms included “continuous”, “intravenous”, “antibiotics”, “intermittent”, “bolus”, “dosing”, “infusion”, and “administration”. English language papers were reviewed. We focused on the comparison of the primary outcome, i.e. cure of infection. Results: Our search revealed 54 clinical and/or pharmacokinetic studies, regarding the continuous intravenous infusion of antibiotics. Thirty-four out of 54 were comparative studies and 20 non-comparative. Fifteen comparative studies examined the efficacy of continuous vs intermittent intravenous administration of antibiotics, mainly in patients with neutropenia, cystic fibrosis, or with critical illness. Two trials compared the rate of prevention of surgical site infections. One trial focused only on cost analysis. The remaining 16 comparative trials targeted on pharmacokinetic and pharmacodynamic data. Out of 15 trials comparing the efficacy of the continuous vs the intermittent intravenous mode, 5 randomized clinical trials, which studied a total of 317 patients were analyzed further. A small but not statistically significant difference was found in favor of the continuous mode (83,1% vs 80,4% cure of infection, 95% C.I. of the difference: -11,3% to 5,8%). Conclusion: Continuous intravenous infusion of antibiotics is at least as effective as the intermittent mode of administration. In an era of gradually increasing resistance rates, the potential advantages of the continuous intravenous administration of antibiotics on several clinical and microbiological outcomes should be further investigated.