March 1, 2008

In the IDSA Journals

Vaccine-derived Poliovirus Is As Virulent as Wild Virus

An unusual twin outbreak of wild-type poliovirus (WPV) and circulating vaccine-derived poliovirus (cVDPV) in Indonesia in 2005 demonstrated that cVDPV is as potent as WPV. Previous cVDPV outbreaks had caused relatively few paralytic cases, leading some to propose that cVDPV might have a lower virulence and attack rate than WPV. The 2005 outbreak on the Indonesian island of Madura was the largest on record, with at least 45 cases. It demonstrated the risks posed by low immunization rates among subpopulations, and the need for vigilant surveillance. (Estívariz et al., J Infect Dis. 2008;197:347-354; commentary by Wright and Modlin, J Infect Dis. 2008;197:335-336.)

Trichomonas Infection Is Associated with Increased HIV Risk

Trichomonas vaginalis is the most common nonviral sexually transmitted disease worldwide. The odds ratio of HIV acquisition among women infected with T. vaginalis was 2.74 in this nested case-control study of a general-population cohort, after controlling for hormonal contraception, other STIs, and behavioral and demographic factors. (Van Der Pol et al., J Infect Dis. 2008;197:548-554; commentary by McClelland, J Infect Dis. 2008;197:487-489.)

VitD2Vitamin D and Tuberculosis 

Studies have shown a relationship between vitamin D deficiency and rates of Mycobacterium tuberculosis infection in immigrants from areas of endemicity. The authors examined the association between moderate-to-severe 25(OH) vitamin D deficiency and M. tuberculosis infection, particularly latent tuberculosis infection, among 375 African immigrants to Australia. They found an inverse relationship between vitamin D levels and both the likelihood of any M. tuberculosis infection and the likelihood of having or having had active tuberculosis. This study adds to the evidence that vitamin D has a role in cell-mediated immunity. (Gibney et al., Clin Infect Dis. 2008;46:443-446.)

Clostridium difficile-attributable Cost

The care of patients who develop infection due to C. difficile can be costly. In this study, performed at a Missouri hospital, the authors calculated the cost of the initial hospitalization with C. difficile–associated disease (CDAD) and the costs of subsequent hospitalizations for CDAD within six months after the initial hospitalization. They used two methods: linear regression and propensity score matched-pair analysis. By linear regression, the cost-of-care per episode was $2,454, and the inpatient cost over a six-month period was $5,042. By propensity score, the per-episode cost was $3,240, and the six-month inpatient cost was $7,179. (Dubberke et al., Clin Infect Dis. 2008;46:497-504.)

Tigecycline and Drug-resistant Gram-negative Bacilli

Tigecycline is active against many multidrug-resistant gram-negative bacilli, but drug resistance is not uncommon and may emerge during treatment. A retrospective review in one center showed that five of nine Acinetobacter baumannii isolates demonstrated intermediate resistance to tigecycline before treatment and that another isolate developed full resistance during treatment. Given this evolution of drug resistance and the availability of other therapies, the authors question the routine use of tigecycline for infections due to multidrug-resistant organisms. (Anthony et al., Clin Infect Dis. 2008;46:567-570.)

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