June 30, 2008

In the IDSA Journals

MRSA: Prevalence Rising; CA- vs. HA- Lines Blurring; Genetic Factors Identified

Three studies and an editorial in the May 1 issue of The Journal of Infectious Diseases examine the prevalence, genetic factors, and identifying characteristics of methicillin-resistant Staphylococcus aureus (MRSA) in the United States. A large, nationally representative survey of the U.S. population found the prevalence of MRSA colonization increased from 0.8 percent in 2001-2002 to 1.5 percent in 2003-2004, even as the overall prevalence of S. aureus colonization decreased. (Gorwitz et al., J Infect Dis. 2008;197:1226-1234.) A second study in the same issue of JID finds the distinctions between hospital-associated and community-associated MRSA are blurring. Markers for CA-MRSA such as clindamycin susceptibility, Panton-Valentine leukocidin genes, and staphylococcal cassette chromosome mec (SCCmec) type IV were found in significant proportions of hospital isolates.  (David et al., J Infect Dis. 2008;197:1235-1243.) Another study found genetic factors in both S. aureus and the human host influence infection and long-term colonization. (Emonts et al., J Infect Dis. 2008;197:1244-1253.) An editorial commentary accompanies the three articles. (Flynn and Cohen, J Infect Dis. 2008;197:1217-1219.)

Monthly Treatment Reduces Bacterial Vaginosis in Women at Risk for HIV Infection

Monthly treatment with metronidazole plus fluconazole cut nearly in half the risk of bacterial vaginosis in this study of more than 300 female sex workers in Mombasa, Kenya. Reducing vaginal infections may offer a women-controlled method to reduce the risk of HIV infection. The treatment also increased the odds of colonization with potentially beneficial Lactobacillis bacteria by about 50 percent. (McClelland et al., J Infect Dis. 2008;197:1361-1368; editorial commentary by Shin and Kaul, J Infect Dis. 2008;197:1355-1357.)

Pneumococcal Necrotizing Pneumonia 

There has been an increase in the incidence of necrotizing pneumonia due to Streptococcus pneumoniae in Utah children from 2001 through 2006. Pneumococcal necrotizing pneumonia was associated with nonvaccine pneumococcal serotypes, especially type 3. (Bender et al., Clin Infect Dis. 2008;46:1346-52.)

Coordinated Laboratory System for Human Avian Influenza A (H5N1)

The Thai National Institutes of Health established the National Coordinating Laboratory System to standardize and improve case detection and reporting. Comparing results from before and after establishment of the system, the median time from the procurement of specimens to the reporting of results decreased from 17 days to two days, and the time required for specimen shipment decreased from 46.5 hours to 21.1 hours. The laboratory surveillance program in Thailand serves as a model for H5N1 preparedness that can be adopted or modified for use in other countries. (Kitphati et al., Clin Infect Dis. 2008;46:1394-1400.)

Mortality and Bloodstream Infection 

To assess the impact of bloodstream infection on mortality following coronary artery bypass surgery, the authors analyzed data from more than 4,500 patients treated over a nine-year period. Approximately 3 percent of patients developed bloodstream infections, and these were associated with a four-fold increase in the risk of death in the three-month period after coronary artery bypass surgery. The risk of death was higher for patients with infections due to gram-negative pathogens or Staphylococcus aureus. Paradoxically, among patients with bacteremia, the risk of death was highest for those patients who had the lowest baseline risk of infection and was lowest for patients who had the highest risk of infection. (Olsen et al., Clin Infect Dis. 2008;46:1537-46.)

More from the literature: the IDSA Journal Club

Don’t miss this new feature to help you stay up to date on the infectious diseases literature. Each month, the IDSA Journal Club will feature brief summaries of key infectious diseases studies in the previous month’s major journals chosen by the new IDSA Literature Review Panel.

In addition, the “In This Issue” section of each issue of Clinical Infectious Diseases highlights several important studies from that journal. (Click for June 1 or June 15.)

For a review of other recent research in the infectious diseases literature, see “In the Literature,” by Stanley Deresinski, MD, in each issue of Clinical Infectious Diseases.

June 1:

  • Adult Immunizations: 2007-2008
  • Telbivudine versus Adefovir for Chronic Hepatitis B Virus (HBV) Infection
  • Telbivudine versus Lamivudine for Chronic HBV Infection
  • The Circle Continues Unbroken: Now Corticosteroids Are Not Effective for Septic Shock (See also this month’s IDSA Journal Club)
  • Intensive Attempts to Maintain Euglycemia Are Harmful to Patients with Severe Sepsis

June 15:

  • Worldwide Control of Typhoid
  • Doripenem Treatment of Ventilator-Associated Pneumonia
  • A New Mechanism of Resistance to Linezolid-And It's Transferable
  • Effective Treatment Reduces the Incidence of Hepatic Failure in Patients with Advanced Chronic Hepatitis C Virus (HCV) Infection

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IDSA Journal Club, June 2008
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Members on the Move
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