Infections Prolong Hospitalization
Elderly patients who developed surgical site infections after undergoing orthopedic surgery had significantly longer hospital stays, Dr. Jeanne Lee wrote in a poster at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
Surgical site infection was a significant independent predictor of prolonged hospital stay according to both bivariate and multivariate analyses in the outcomes study conducted by Dr. Lee and her colleagues at Duke University, Durham, N.C.
The study was conducted in eight hospitals between June 1991 and July 2002. The most common procedures were hip arthroplasty in 74 patients (22%), fracture repair in 55 patients (16%), and knee arthroplasty in 40 patients (12%). Staphylococcus aureus was the dominant pathogen, associated with 95 infections (56%); 55% of those pathogens were methicillin resistant.
The mean length of stay was 13 days among 169 infected patients, compared with 4 days among 171 uninfected controls. Mean age was 75 years; 66% were women, and 83% were white.
Other predictors of longer stay were inability to bathe independently, undergoing procedures of longer duration, postoperative glucose levels above 200 mg/dL, and having procedures the same day as hospitalization. The meeting was sponsored by the American Society for Microbiology.
Liver Toxicity Reported With Ketek
The Food and Drug Administration is recommending that physicians monitor patients taking telithromycin (Ketek) for signs and symptoms of liver problems, in response to reports of liver toxicity in three patients taking the drug.
Telithromycin is the first of the ketolide class of antibiotics to be approved and is indicated for treating serious bacterial infections (for example, community-acquired pneumonia, acute bacterial sinusitis, and acute exacerbation of chronic bronchitis) in adults. Ketek is marketed by Aventis Pharmaceuticals Inc.
All three patients developed jaundice and abnormal liver function. One recovered, one required a transplant, and one died. All had been healthy and were not using other prescription drugs.
Examination of two patients' livers revealed massive tissue death. The cases were reported online as an early-release article in the Annals of Internal Medicine (
www.acponline.org/journals/annals/hepatotoxicity.htm
The FDA recommends telithromycin be stopped in patients who develop signs or symptoms of liver problems. Patients taking the antibiotic who are not experiencing side effects such as jaundice should continue taking the medicine as prescribed. Patients who notice any yellowing of their eyes or skin, or other problems such as blurry vision, should immediately contact their physician or other health care provider.
Telithromycin should be used only for infections caused by a susceptible microorganism. These infections include Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Chlamydophila pneumoniae, and Mycoplasma pneumoniae.
Climate Change: Shorter RSV Season?
Global warming could be curtailing the respiratory syncytial virus season in England and Wales, according to results of a study by Dr. Gavin C. Donaldson of University College London.
The seasons associated with both respiratory syncytial virus (RSV) isolation rates in laboratories and with RSV-related emergency department admission rates in England and Wales were significantly shorter—3.1 weeks and 2.5 weeks, respectively—during 1981–2004 for laboratory RSV and 1990–2004 for patients admitted to the emergency department with bronchiolitis than in previous years (Clin. Infect. Dis. 2006;42:677–9).
Dr. Donaldson reviewed the annual mean daily temperatures recorded at four locations to calculate the average temperatures for central England in the study periods. Average temperature increased from 9.2° C in 1981 to 10.5° C in 2004.
The start of the RSV season was defined as the first week in the year in which the number of viral isolations and hospital admissions topped an established threshold; the end of the season was the first week of the year in which the numbers fell below the threshold.
The threshold was set at 60% of each year's average weekly number of isolations and hospital admissions. The findings were similar if the threshold was set at 50% or 70%, though the relationship between hospital admission and temperature was not statistically significant with the threshold set at 50%.
Despite these findings, data on the association between RSV and temperature remain contradictory. Previous studies have confirmed that RSV epidemics persist in tropical regions, and the data have shown higher temperatures in these regions during epidemics, Dr. Donaldson wrote.
From staff reports