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Background: Although antibiotic prophylaxis against infective endocarditis is recommended, the true risk factors for infective endocarditis are unclear.Objective: To quantitate the risk for endocarditis from dental treatment and cardiac abnormalities.Design: Population-based, case-control study.Setting: 54 hospitals in the Philadelphia area.Patients: Persons with community-acquired infective endocarditis not associated with intravenous drug use were compared with community residents, matched by age, sex, and neighborhood of residence.Measurements: Information on demographic characteristics, host risk factors, and dental treatment was obtained from structured telephone interviews, dental records, and medical records.Results: During the preceding 3 months, dental treatment was no more frequent among case-patients than controls (adjusted odds ratio, 0.8 [95% CI, 0.4 to 1.5]). Of 273 case-patients, 104 (38%) knew of previous cardiac lesions compared with 17 controls (6%) (adjusted odds ratio, 16.7 [CI, 7.4 to 37.4]). Case-patients more often had a history of mitral valve prolapse (adjusted odds ratio, 19.4 [CI, 6.4 to 58.4]), congenital heart disease (adjusted odds ratio, 6.7 [CI, 2.3 to 19.4]), cardiac valvular surgery (adjusted odds ratio, 74.6 [CI, 12.5 to 447]), rheumatic fever (adjusted odds ratio, 13.4 [CI, 4.5 to 39.5]), and heart murmur without other known cardiac abnormalities (adjusted odds ratio, 4.2 [CI, 2.0 to 8.9]). Among case-patients with known cardiac lesions--the target of prophylaxis--dental therapy was significantly (P = 0.03) less common than among controls (adjusted odds ratio, 0.2 [CI, 0.04 to 0.7] over 3 months). Few participants received prophylactic antibiotics.Conclusions: Dental treatment does not seem to be a risk factor for infective endocarditis, even in patients with valvular abnormalities, but cardiac valvular abnormalities are strong risk factors. Few cases of infective endocarditis would be preventable with antibiotic prophylaxis, even with 100% effectiveness assumed. Current policies for prophylaxis should be reconsidered. [ABSTRACT FROM AUTHOR]

The purpose of this investigation was to study the influence of diabetes mellitus (DM) on outcomes of infective endocarditis (IE). Outcomes were compared between 150 diabetic and 905 non-diabetic patients with IE from the International Collaboration on Endocarditis Merged Database. Compared to non-diabetic patients, diabetic patients were older (median age 63 vs 57 y, p<0.001), were more often female (42.0% vs 31.9%, p=0.01), more often had comorbidities (41.5% vs 26.7%, p<0.001), and were more likely to be dialysis dependent (12.7% vs 4.0%, p<0.001). S. aureus was isolated more often (30.7% vs 21.7%, p=0.02), and microorganisms from the viridans Streptococcus group less often (16.7% vs 28.2%, p = 0.001) in the diabetic group. There was no difference with respect to the presence of congestive heart failure, embolism, intra-cardiac abscess, new valvular regurgitation, or valvular vegetation. Diabetic patients underwent surgical intervention less frequently (32.0% vs 44.9%, p = 0.003), and had higher overall in-hospital mortality (30.3% vs 18.6%, p = 0.001). On multivariable analysis, DM was an independent predictor of mortality (odds ratio (OR) = 1.71, 95% confidence interval (CI) 1.08-2.70), especially in male patients, as diabetic males had higher mortality than non-diabetic males (OR 2.18, CI 1.08-4.35). DM is an independent predictor of in-hospital mortality among patients hospitalized with IE. [ABSTRACT FROM AUTHOR]

Objective: --To assess the efficacy of intrathecal therapy with tetanus antibody (antitetanus equine serum or human tetanus immune globulin) in neonatal and adult tetanus using meta-analytical techniques.Data Sources: --Clinical trials identified by searching MEDLINE and by reviewing bibliographies of published articles.Study Selection: --Studies in English with concurrent controls treated without intrathecal therapy.Data Extraction: --Data were extracted by one author and verified by the second; conflicts were resolved by discussion.Data Synthesis: --No major treatment effect was found in neonatal tetanus when all studies were considered. A benefit was suggested for antitetanus equine serum in adult disease, but this finding should be accepted with caution. Subgroup analyses were limited in power. Methodological difficulties in neonatal and adult trials were common and safety has not been established.Conclusions: --Intrathecal therapy for tetanus with either antitetanus equine serum or human tetanus immune globulin is not of proven benefit and should only be given in the context of well-designed, controlled trials. [ABSTRACT FROM AUTHOR]

Objective: To determine whether asymptomatic bacteriuria in elderly ambulatory women is a marker of increased mortality and, if so, whether it is because of an association with other determinants of mortality or because asymptomatic bacteriuria is itself an independent cause, the removal of which might improve longevity.Design: A cohort study and a controlled clinical trial of the effect of antimicrobial treatment.Setting: A geriatric center and 21 continuing care retirement communities.Participants: Women without urinary tract catheters.Measurements: Urine cultures every 6 months (the same organism at 10(5) colony-forming units or more per mL on two midstream urine specimens defined asymptomatic bacteriuria), comorbidity, and mortality.Results: In the observational study, infected residents (n = 318) were older, and sicker, and had higher mortality (18.7 per 100,000 resident-days) than uninfected residents (n = 1173; 10.1 per 100,000 resident-days). However, in a multivariate Cox analysis, infection was not related to mortality (relative risk, 1.1; P > 0.2), whereas age at entry and self-rated health (score 1 [excellent] to 4 [bad or poor]) were strong predictors. In the clinical trial, mortality in 166 treated residents (13.8 per 100,000 resident-days) was comparable to that of 192 untreated residents (15.1 per 100,000 resident-days); the relative rate was 0.92 (95% CI, 0.57 to 1.47). The cure rates among treated and untreated residents were 82.9% and 15.6%, respectively.Conclusion: Urinary tract infection was not an independent risk factor for mortality, and its treatment did not lower the mortality rate. Screening and treatment of asymptomatic bacteriuria in ambulatory elderly women to decrease mortality do not appear warranted. [ABSTRACT FROM AUTHOR]

Previously, others suggested that the failure of cephalothin plus an aminoglycoside to cure enterococcal endocarditis could be overcome, if the peak serum cephalothin level exceeded the MIC of the enterococcus by several fold. Therefore, rabbits with enterococcal endocarditis were treated with gentamicin and either penicillin or cephalothin at doses providing peak serum levels about 5 and 10 times the MIC of the enterococcus. Of these regimens, only cephalothin at doses providing peak levels 10 times the MIC of the enterococcus resulted in high valve sterilization (100%) and survival rates (90%). Cephalothin and gentamicin should not be used to treat human enterococcal endocarditis, because the dose of cephalothin required for cure would appear to be prohibitively high. [ABSTRACT FROM PUBLISHER]

Patients receiving gentamicin (25) or tobramycin (29) were evaluated in a randomized, prospective, double-blind study. Sequential serum samples for creatinine determination and urine samples for urinalysis, β-2-microglobulin, and -acetyl-glucosaminidase assays were obtained to assess the frequency of nephrotoxicity and to evaluate measures possibly predicting impaired renal function. Each aminoglycoside induced measurable decrements in renal function. Although the mean total dose per kg and mean serum trough levels were slightly higher in the tobramycin group, there was a trend towards greater toxicity in those receiving gentamicin, whether measured as a mean increase in serum creatinine during therapy, as an elevation of 0·3 mg/dl or more in serum creatinine, or as at least a doubling of the serum creatinine. Adjusted for the dose or the serum trough level of aminoglycoside, increments in serum creatinine concentration were observed more often with gentamicin. The differences were minor and their clinical significance remains unestablished. The development of casts correlated with nephrotoxicity, but the remaining parameters were not helpful as predictors of renal functional impairment. Each aminoglycoside must be used cautiously, following previous guidelines, to lessen the incidence of toxicity. Dosage should be decreased when urinary casts appear. [ABSTRACT FROM PUBLISHER]

Describes a case of infection from the use of leeches in medicine. Information on the therapeutic use of leeches for ailments; Description of the common medical leech; Discussion on the association of leech to infections.

Discusses an epidemiologic study of bacteriuria in an elderly population. Complications of bacteriuria; Association between bacteriuria and decreased survival in elderly persons; Efficacy of antimicrobial therapy for asymptomatic bacteriuria.

Presents a study which examined the occurrence of pyuria and asymptomatic bacteriuria in elderly ambulatory women. Overview of previous studies on pyuria and bacteriuria in the elderly; Definition of low-titer bacteriuria; Correlation of pyuria with various levels of bacteriuria.

Presented in part at the 58th Annual Meeting of the American Academy of Dermatology, 2000, and at the Annual Scientific Meeting of the Society of Cosmetic Chemists, December 2000 Assays of moisturizer efficacy have traditionally focused on a moisturizer's ability to alleviate dry skin. More recently, a moisturizer's ability to prevent primary irritation has been recognized. To assess and compare the ability of moisturizers to alleviate skin dryness and primary irritation, as well as prevent their return, four controlled-application clinical ( in vivo) studies were carried out: hand-wash test, regression test, reduction in pre-existing irritation study, and prevention-of-irritation studies. Overall conclusions were confirmed in a home-use clinical (validation) study of people suffering from mild eczema. The controlled in vivo studies demonstrate that: (a) a moisturizer can alleviate skin dryness and irritation, and prevent their return; and (b) the efficacy of different moisturizers can be differentiated, based on their composition. The home-use study results demonstrated that the most effective moisturizer identified by the controlled-application studies was highly effective against the signs of eczema. In vivo modelling of moisturizer efficacy enables assessment and optimization of different benefits separately, while predicting the quantitative and perceived (observed) relevance of the benefits the moisturizer delivers to consumers. [ABSTRACT FROM AUTHOR]

BACKGROUND: Device-related infection rates are useful measures and have been calculated using number of discharges (admissions) as denominator. Today, the preferred measure calculates rates with a denominator based on device days. This measure is thought to provide a more accurate portrayal of the burden of infection but the data require considerable effort to collect. The objective is to determine whether patient “hospital days” can serve as a surrogate for “device days.” We undertook a study to compare urinary catheter–related infection rates using each of these measures. METHODS: This large, nationwide healthcare system introduced systematic, computer-based data collection several years ago. Data over a 2.5-year period were reviewed to determine infection rates as a percentage of the population, and infection rates per 1000 urinary catheter days. Rates for hospitals of similar size and location were compared. RESULTS: The study included observations on 99,834 patients during 2002–2004. The infection rates per 1000 days over the entire period were 4.72 per 1000 patient days and 6.48 per 1000 device days. The correlation of infection rates per month using device days compared to patient days was 0.978 (p < 0.001) using Pearson''s and 0.987 (p < 0.001) using Spearman''s. This shows that the values are not independent. CONCLUSIONS: Rates calculated on the basis of patient discharges correlated highly with rates calculated using device days. The high correlation between these rates suggests that for some purposes rates based on discharges can serve as a surrogate for rates based on device days. Such a change would reduce the data-gathering burden on infection control practitioners. [Copyright &y& Elsevier]

Purpose: To describe clinical features and outcomes of enterococcal left-sided native valve endocarditis and to compare it to endocarditis caused by other pathogens. Subjects and Methods: Patients in the International Collaboration on Endocarditis-Merged Database were included if they had left-sided native valve endocarditis. Demographic characteristics, clinical features, and outcomes were analyzed. Multivariable analysis evaluated enterococcus as a predictor of mortality. Results: Of 1285 patients with left-sided native valve endocarditis, 107 had enterococcal endocarditis. Enterococcal endocarditis was most frequently seen in elderly men, frequently involved the aortic valve, tended to produce heart failure rather than embolic events, and had relatively low short-term mortality. Compared to patients with non-enterococcal endocarditis, patients with enterococcal endocarditis had similar rates of nosocomial acquisition, heart failure, embolization, surgery, and mortality. Compared to patients with streptococcal endocarditis, patients with enterococcal endocarditis were more likely to be nosocomially acquired (9 of 59 [15%] vs 2 of 400 [1%]; P <.0001) and have heart failure (49 of 107 [46%] vs 234 of 666 [35%]; P = 0.03). Compared to patients with S. aureus endocarditis, patients with enterococcal endocarditis were less likely to embolize (28 of 107 [26%] vs 155 of 314 [49%]; P <.0001) and less likely to die (12 of 107 [11%] vs 83 of 313 [27%]; P = 0.001). Multivariable analysis of all patients with left-sided native valve endocarditis showed that enterococcal endocarditis was associated with lower mortality (odds ratio [OR] 0.49; 95% confidence interval [CI] 0.24 to 0.97). Conclusions: Enterococcal native valve endocarditis has a distinctive clinical picture with a good prognosis. [ABSTRACT FROM AUTHOR]