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July 2008
Volume 18, Number 7
In the IDSA Journals

Racial Disparities in Kidney Disease Progression

The results of this study suggest that disparities in end-stage renal disease (ESRD) between HIV-positive whites and African Americans is more likely a result of faster disease progression from chronic kidney disease (CKD) than a higher incidence of CKD in African Americans.  In this study of more than 3,000 African Americans and more than 1,000 whites in Baltimore, MD, African Americans were somewhat more likely than their white counterparts to develop CKD.  But progression to ESRD was much more rapid in the African Americans who developed CKD. (Lucas et al., J Infect Dis. 2008;197:1548-1557; commentary by Wyatt, J Infect Dis. 2008;197:1490-1492.)

CMV Vaccine Shows Promise

In this phase I clinical trial, an adjuvanted DNA vaccine encoding two cytomegalovirus (CMV) antigens, phosphoprotein 65 (pp65) and glycoprotein B (gB), was well tolerated and generated antibody or cellular immune responses in 45 percent of CMV-seronegative subjects and 25 percent of seropositive subjects.  Cellular immune responses were stronger than antibody responses. Sixty-eight percent of seronegative subjects showed memory T cell responses at 32 weeks. (Wloch et al., J Infect Dis. 2008;197:1634-1642; commentary by Go and Pollard, J Infect Dis. 2008;197:1631-1633.)

PCV7 and pneumococcal meningitis

Following the introduction of routine vaccination of young children with 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, the annual mean rate of pneumococcal meningitis hospitalization decreased by 66 percent among children aged less than 2 years and by 51.5 percent among children 2-4 years of age. Among adults over 65 years of age, rates decreased by 33 percent. (Tsai et al., Clin Infect Dis. 2008;46:1664-1672; commentary by Dagan, Clin Infect Dis. 2008;46:1673-1676.)  

 

Use of active surveillance cultures for MRSA: a review

Active surveillance cultures (ASCs) are universal or targeted screening cultures of samples from patients admitted to a hospital and have been proposed to reduce the number of infections caused by multidrug-resistant organisms. This review of the literature sought evidence of the efficacy and cost-effectiveness of ASCs in the control of methicillin-resistant Staphylococcus aureus (MRSA) infection. Important gaps in the literature were identified, including a need for a clear definition of ASCs, a clear implementation protocol, and rigorous economic evaluations. Existing evidence may favor the use of ASCs, but the evidence is of poor quality, and definitive recommendations cannot be made. (McGinigle et al., Clin Infect Dis. 2008;46:1717-1725; commentary by Milstone and Perl, Clin Infect Dis. 2008;46:1726-1728.)

C. difficile infection after perioperative prophylaxis

Perioperative antibacterial prophylaxis is used to prevent surgical site infections but occasionally may lead to Clostridium difficile infection. In this study, the authors found that the risk of C. difficile infection following perioperative antibacterial prophylaxis was 0.7 cases per 1000 surgical procedures for the period 1999-2002. The rate increased to 15 cases per 1000 surgical procedures for the period 2003-2005 after the emergence of a hypervirulent strain of C. difficile. (Carignan et al., Clin Infect Dis. 2008;46:1838-1843.)

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 July 1 or July 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.

July 1:

  • Get the Blood Culture before the Fever?
  • Rifampicin Prophylaxis for Leprosy
  • Nan(non)bacteria
  • Voriconazole for Scedosporium Infection

July 15:

  • Eliminating Yaws
  • An Oncogenic Polyomavirus?
  • Bon Appétit, Mon Bactérie!
  • Tuberculosis and Infliximab

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