Dalbavancin: a novel once-weekly lipoglycopeptide antibiotic.

The increasing prevalence of drug-resistant gram-positive cocci, such as methicillin-resistant Staphylococcus aureus, has underscored the need for new agents for the treatment of this type of infection. Dalbavancin, a new lipoglycopeptide, has the desirable characteristics of increased in vitro activity, compared with vancomycin, for most gram-positive pathogenic bacteria, as well as an extremely long half-life, permitting once-weekly intravenous dosing. Clinical studies comparing linezolid with 2 doses of dalbavancin have shown comparable efficacy for the treatment of skin and soft-tissue infection. Dalbavancin has also proven to be effective for therapy of catheter-related bloodstream infections. It has an excellent safety profile in studies to date. Dalbavancin will likely have a significant role in outpatient intravenous therapy for patients with potentially serious drug-resistant gram-positive coccal infections.

Implications of detecting the mold Syncephalastrum in clinical specimens of New Orleans residents after Hurricanes Katrina and Rita.

After the extensive flooding in New Orleans following Hurricanes Katrina and Rita, thousands of homes in the flooded areas had significant growth of mold. The potential health effects from exposures to these extraordinary environments are unknown. In February 2006, we investigated a cluster of patients with clinical specimens yielding Syncephalastrum, a zygomycete that rarely causes infection. We identified the cases of eight patients from September 12, 2005, to January 12, 2006, with specimens from sputum, bronchoalveolar lavage, endotracheal aspirate, ear swab, and nasal swab. All patients appeared to be transiently colonized without evidence of infection, even among immunosuppressed patients. Only one patient reported significant exposure to mold (working on mold remediation without wearing a respirator) on the day of his incident culture.

When less is more: can we abandon prophylactic platelet transfusion in Dengue fever?

Dengue fever (DF) has several hematological manifestations including thrombocytopenia and increased bleeding risk. Prophylactic platelet transfusion-in the absence of major bleeding-is utilized in DF with thrombocytopenia with the intention of preventing hemorrhagic complications. However, prophylactic platelet transfusion in DF is neither standardized nor supported by clinical evidence. We conclude that risks, costs and poor resource utilization associated with prophylactic platelet transfusion in DF far outweigh any potential hematological benefit, and as such, should not constitute routine clinical practice.

Dengue knowledge, attitudes, and practices among primary care physicians in Singapore.

INTRODUCTION: Dengue fever remains a significant public health concern in Singapore. Appropriate, timely diagnosis and risk stratification for severe disease are crucial in the optimal management of this illness. In the outpatient setting, the primary care physician plays a key role in dengue diagnosis, management, and triage. We present a descriptive analysis of the variations in dengue knowledge, attitudes, and practices among primary care physicians (PCPs) in Singapore. MATERIALS AND METHODS: A survey of 25 multiple-choice questions was mailed to 2000 PCPs in Singapore. Responses were analysed by physician age group (21-40, 41-60, and >61) and practice setting (government subsidised polyclinic or private practice). RESULTS: Of the 3 questions assessing dengue knowledge, 89.9% chose 2 or 3 of the preferred responses. Half of the respondents utilised dengue diagnostic tests at least 50% of the time, and 75% used serology when doing so. Older respondents and those from private practices used diagnostic tests more often than their counterparts, and both groups favoured non-serology tests. About 85% of surveyed PCPs monitored confirmed or suspected cases daily, and one-third referred patients to a hospital always or often. CONCLUSIONS: While no major gaps in knowledge about dengue were identified in PCPs in Singapore, there were significant variations in clinical practice by physician age group and practice setting. The results of this survey provide a useful opportunity to identify strengths and areas in need of improved awareness in primary care management of dengue.