Rates of Stenotrophomonas maltophilia colonization and infection in relation to antibiotic cycling protocols.

This study evaluated whether antibiotic cycling programmes using broad-spectrum agents including carbapenems were associated with increased rates of colonization or infection by Stenotrophomonas maltophilia. Retrospective analyses of colonization or infection by S. maltophilia from 1992 to 2002 were conducted using University of Virginia Hospital clinical microbiology records of patients with any culture positive for S. maltophilia and hospital epidemiology records of nosocomial S. maltophilia infections. Incidence rates were calculated and compared for cycling and non-cycling periods. No significant differences were found in incidence rates of S. maltophilia isolates between cycling and non-cycling periods, but there was a significant secular increase in the hospital-wide rate of infections caused by S. maltophilia (P=0.01728). Antibiotic cycling protocols were not associated with a significantly increased rate of colonization of S. maltophilia as determined by the frequency of patients having at least one positive routine clinical culture in this hospital.

Statin use and infections in Veterans with cirrhosis.

BACKGROUND: Evidence about the beneficial effects of statins on reducing infections is accumulating. Identifying ways to reduce infection risk in patients with cirrhosis is important because of increased mortality risk and costs associated with infections. AIM: To estimate the extent to which statin use prolongs time to infection among patients with cirrhosis. METHODS: We identified Veterans with cirrhosis, but without decompensation (n = 19 379) using US Veterans Health Administration data from 2001 to 2009. New users of statins were identified and propensity matched to non-users and users of other cholesterol-lowering medications (1:1 matching). The cohort was followed up for hospitalisations with infections. Cox regression models with time-varying exposures provided estimates of adjusted hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: New statin use was present among 13% of VA patients with cirrhosis without decompensation. Overall, 12.4% of patients developed a serious infection, and 0.1% of patients died. In the propensity-matched sample, statin users experienced hospitalisations with infections at a rate 0.67 less than non-users (95% Confidence Interval: 0.47-0.95). CONCLUSIONS: Infections are a major concern among cirrhotic patients and have the potential to seriously impact both life expectancy and quality of life. Statin use may potentially reduce the risk of infections among patients with cirrhosis.