RESUMEN
BACKGROUND: Solid organ transplant recipients are at increased risk for reactivation of herpes zoster, or shingles, and have a higher frequency of serious complications including post-herpetic neuralgia. A live, attenuated shingles vaccine is effective and approved for individuals 50 years and older. The vaccine is contraindicated following transplantation, but may be used in patients with renal failure. Utilization of the vaccine has been poor in patients with end-stage renal disease, including those awaiting transplant, owing to concerns for safety, efficacy, and potential sensitization prior to transplant. METHODS: We conducted a phase I, randomized, placebo-controlled study of the safety and immunogenicity of live, attenuated Oka strain shingles vaccine in subjects prior to or awaiting renal transplant at 3 US centers. Subjects received vaccine a minimum of 4 weeks prior to transplant. RESULTS: The vaccine was safe and well-tolerated. There were no cases of herpes zoster or rash illness. There was no change in donor-specific antibody or calculated panel reactive antibody after vaccination during the follow-up period. There were no rejection episodes. There was a significant 2.1-fold rise in geometric mean titer of anti-VZV antibody at 5 weeks post-vaccine. CONCLUSIONS: The data suggest that the shingles vaccine is safe in subjects with ESRD awaiting transplant. Antibody responses were similar to those seen previously in adults >50 years of age and are consistent with a protective response.
Asunto(s)
Vacuna contra el Herpes Zóster/administración & dosificación , Vacuna contra el Herpes Zóster/efectos adversos , Herpes Zóster/prevención & control , Fallo Renal Crónico/inmunología , Trasplante de Riñón/efectos adversos , Vacunas Atenuadas/administración & dosificación , Adulto , Anciano , Anticuerpos Antivirales/sangre , Método Doble Ciego , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Exantema , Femenino , Herpes Zóster/inmunología , Vacuna contra el Herpes Zóster/inmunología , Herpesvirus Humano 3/inmunología , Humanos , Masculino , Persona de Mediana Edad , Neuralgia Posherpética , Vacunación/efectos adversos , Vacunación/métodos , Vacunas Atenuadas/efectos adversos , Vacunas Atenuadas/inmunologíaRESUMEN
We performed a retrospective cohort study of 84 patients to determine the incidence and predictors of acute kidney injury after antibiotic-impregnated cement spacer (ACS) placement for infected total knee arthroplasties. Acute kidney injury was defined as a more than 50% rise in serum creatinine from a preoperative baseline to a level greater than 1.4 mg/dL within 90 days postoperatively. Total incidence was 17% (n = 14; 95% confidence interval [CI], 10%-26%), and acute kidney injury was significantly associated with ACS tobramycin dose as both a dichotomous variable (>4.8 g; odds ratio, 5.87; 95% CI, 1.43-24.19; P = .01) and linear variable (odds ratio, 1.24 for every 1-g increase; 95% CI, 1.00-1.52; P = .049). Routine monitoring of serum creatinine and measurement of serum aminoglycoside levels in response to a threshold creatinine rise may be warranted after the placement of an aminoglycoside-containing ACS.
Asunto(s)
Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/epidemiología , Antibacterianos/efectos adversos , Artroplastia de Reemplazo de Rodilla/instrumentación , Cementos para Huesos/efectos adversos , Prótesis de la Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/prevención & control , Lesión Renal Aguda/sangre , Anciano , Aminoglicósidos/efectos adversos , Aminoglicósidos/sangre , Aminoglicósidos/uso terapéutico , Antibacterianos/uso terapéutico , Artroplastia de Reemplazo de Rodilla/métodos , Estudios de Cohortes , Creatinina/sangre , Femenino , Humanos , Incidencia , Riñón/fisiopatología , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/cirugía , Reoperación , Estudios Retrospectivos , Tobramicina/efectos adversos , Tobramicina/uso terapéuticoRESUMEN
Th17-driven immune responses contribute to the pathogenesis of many chronic inflammatory diseases. In this study, we investigated the role of IL-17 signaling in chronic gastric inflammation induced by Helicobacter pylori, a Gram-negative bacterium that persistently colonizes the human stomach. Wild-type C57BL/6 mice and mice lacking IL-17RA (IL-17RA(-/-)) were orogastrically infected with H. pylori. Differences in bacterial colonization density and gastric inflammation were not apparent at 1 mo postinfection, but by 3 mo postinfection, H. pylori colonization density was higher and mononuclear gastric inflammation more severe in infected IL-17RA(-/-) mice than in infected wild-type mice. A striking feature was a marked increase in gastric B cells, plasma cells, and lymphoid follicles, along with enhanced H. pylori-specific serum Ab responses, in infected IL-17RA(-/-) mice. Fewer gastric neutrophils and lower levels of neutrophil-recruiting chemokines were detected in infected IL-17RA(-/-) mice than in infected wild-type mice. Gastric IL-17a and IL-21 transcript levels were significantly higher in infected IL-17RA(-/-) mice than in infected wild-type mice or uninfected mice, which suggested that a negative feedback loop was impaired in the IL-17RA(-/-) mice. These results underscore an important role of IL-17RA signaling in regulating B cell recruitment. In contrast to many chronic inflammatory diseases in which IL-17RA signaling promotes an inflammatory response, IL-17RA signaling down-regulates the chronic mononuclear inflammation elicited by H. pylori infection.
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Subgrupos de Linfocitos B/inmunología , Inhibición de Migración Celular/inmunología , Movimiento Celular/inmunología , Mucosa Gástrica/inmunología , Infecciones por Helicobacter/inmunología , Helicobacter pylori/inmunología , Receptores de Interleucina-17/fisiología , Transducción de Señal/inmunología , Animales , Subgrupos de Linfocitos B/metabolismo , Subgrupos de Linfocitos B/patología , Inhibición de Migración Celular/genética , Movimiento Celular/genética , Enfermedad Crónica , Modelos Animales de Enfermedad , Femenino , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patología , Infecciones por Helicobacter/patología , Infecciones por Helicobacter/prevención & control , Helicobacter pylori/crecimiento & desarrollo , Mediadores de Inflamación/metabolismo , Mediadores de Inflamación/fisiología , Interleucina-17/biosíntesis , Interleucina-17/metabolismo , Interleucina-17/fisiología , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Técnicas de Cultivo de Órganos , Receptores de Interleucina-17/deficiencia , Receptores de Interleucina-17/genética , Transducción de Señal/genéticaAsunto(s)
Lesión Renal Aguda/inducido químicamente , Antibacterianos/sangre , Infecciones Relacionadas con Prótesis/terapia , Tobramicina/sangre , Lesión Renal Aguda/sangre , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Cementos para Huesos/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Tobramicina/administración & dosificación , Tobramicina/efectos adversosRESUMEN
The role of fibroblast growth factors and their receptors (FGFRs) in the regulation of normal hematopoietic stem cells is unknown. Here we show that, in mouse bone marrow, long-term repopulating stem cells are found exclusively in the FGFR(+) cell fraction. During differentiation toward committed progenitors, stem cells show loss of FGFR expression. Prolonged culture of bone marrow cells in serum-free medium supplemented with only FGF-1 resulted in robust expansion of multilineage, serially transplantable, long-term repopulating hematopoietic stem cells. Thus, we have identified a simple method of generating large numbers of rapidly engrafting stem cells that have not been genetically manipulated. Our results show that the multipotential properties of stem cells are dependent on signaling through FGF receptors and that FGF-1 plays an important role in hematopoietic stem cell homeostasis.
Asunto(s)
Factor 1 de Crecimiento de Fibroblastos/farmacología , Células Madre Hematopoyéticas/citología , Animales , Antígenos CD34/metabolismo , Células de la Médula Ósea/efectos de los fármacos , Células de la Médula Ósea/metabolismo , Diferenciación Celular , Linaje de la Célula , Cartilla de ADN/química , Hematopoyesis/fisiología , Trasplante de Células Madre Hematopoyéticas , Células Madre Hematopoyéticas/metabolismo , Humanos , Fragmentos Fc de Inmunoglobulinas/metabolismo , Técnicas In Vitro , Ratones , Ratones Endogámicos C57BL , Receptores de Factores de Crecimiento de Fibroblastos/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Irradiación Corporal TotalRESUMEN
BACKGROUND: Information is limited on long-term outcomes after preemptive use of ganciclovir to control cytomegalovirus (CMV) infection in lung transplantation. METHODS: We studied 78 lung recipients who received antithymocyte globulin induction from 1994 to 2000. All patients received six months of oral acyclovir (800 mg TID). This was interrupted three wk post transplantation for a two-wk course of IV ganciclovir. Additional courses of ganciclovir were administered based on serial virological monitoring. CMV-mismatched patients (R-D+) also received four doses of CMV immunoglobulin between weeks 2 and 8. RESULTS: The one yr cumulative risk of CMV disease was 2% (1/61) in CMV seropositive (R+) patients, but was 37% (6/17) in R-D+ patients (p < 0.0001). Over 4.3 yr of follow-up, patients with CMV infection developed more chronic graft dysfunction caused by bronchiolitis obliterans or bronchiolitis obliterans syndrome than patients without CMV infection (p = 0.012). This effect was also apparent in the subgroup of R+ recipients (p = 0.043). Acute rejection and overall survival were not associated with CMV infection. CONCLUSIONS: The use of prophylactic acyclovir and short preemptive courses of ganciclovir effectively controlled CMV disease in R+ patients, but was a relative failure in R-D+ patients. CMV infection was significantly associated with chronic graft dysfunction, even in R+ recipients who had good control of CMV symptoms.
Asunto(s)
Antivirales/administración & dosificación , Infecciones por Citomegalovirus/prevención & control , Ganciclovir/administración & dosificación , Trasplante de Corazón-Pulmón , Aciclovir/administración & dosificación , Adolescente , Adulto , Anciano , Quimioprevención , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/transmisión , Funcionamiento Retardado del Injerto/virología , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Donantes de Tejidos , Adulto JovenRESUMEN
Cytomegalovirus encephalitis occurs rarely in transplant recipients. We describe a patient with cytomegalovirus ventriculoencephalitis who had a very high CSF viral load but a low peripheral blood viral load. No resistance mutations were present in cerebrospinal fluid viral DNA, whereas DNA from blood showed a resistance mutation in the UL54 gene but not in the UL97 gene. Viral replication was intense in the brain ependyma and periventricular areas without evidence of peripheral cytomegalovirus disease. The data provide evidence for compartmentalization of cytomegalovirus infection. Levels of ganciclovir and foscarnet in the cerebrospinal fluid may be inadequate for treatment, even for some drug-susceptible strains, and, together with periventricular replication, may explain the disparity between cerebrospinal fluid viral load and peripheral blood viral load.
Asunto(s)
Infecciones por Citomegalovirus/virología , Citomegalovirus/genética , ADN Viral/sangre , ADN Viral/líquido cefalorraquídeo , Encefalitis Viral/virología , Huésped Inmunocomprometido/inmunología , Trasplante de Células Madre de Sangre Periférica , Enfermedad Aguda , Antivirales/uso terapéutico , Encéfalo/virología , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/sangre , Infecciones por Citomegalovirus/líquido cefalorraquídeo , Infecciones por Citomegalovirus/tratamiento farmacológico , ADN Polimerasa Dirigida por ADN/genética , Farmacorresistencia Viral/genética , Encefalitis Viral/sangre , Encefalitis Viral/líquido cefalorraquídeo , Encefalitis Viral/tratamiento farmacológico , Humanos , Inmunosupresores/uso terapéutico , Leucemia Mieloide/inmunología , Leucemia Mieloide/terapia , Masculino , Persona de Mediana Edad , Mutación , Carga Viral , Proteínas Virales/genéticaRESUMEN
BACKGROUND: CD154 mediates key facets of humoral and cellular immunity to alloantigens, and is tolerogenic to influenza antigens in primates. Barriers to CD154-based tolerance induction for primate cardiac allografts have not previously been defined. METHODS: Heterotopic cardiac allograft outcomes in cynomolgus monkeys treated with a CD154 inhibitor, IDEC-131 (n=27), were compared to no treatment (n=4) or cyclosporine A (n=6). RESULTS: CD154 blockade significantly prolonged median allograft survival, from 6.2 (range 6, 7, n=4) days in untreated controls, to 39 (8,112, n=16) days with intensive monotherapy and 93 (>25, 386; n=3) days with added antithymocyte globulin (ATG), but did not yield tolerance. Alloantibody production was delayed but not prevented by IDEC-131 alone or with ATG, and was exacerbated by infusion of donor bone marrow (n=8). Expression of ICOS was prominent in graft infiltrating lymphocytes, and preceded elaboration of antidonor antibody and vasculopathy. CONCLUSION: CD154 monotherapy modulates primate cardiac alloimmunity, but does not readily induce tolerance. Targeting alternative costimulation pathways, including ICOS, may facilitate tolerance induction based on CD154 blockade.
Asunto(s)
Ligando de CD40/inmunología , Trasplante de Corazón/inmunología , Animales , Anticuerpos Monoclonales/farmacocinética , Anticuerpos Monoclonales/farmacología , Anticuerpos Monoclonales Humanizados , Antígenos de Diferenciación de Linfocitos T/genética , Suero Antilinfocítico/administración & dosificación , Trasplante de Médula Ósea , Ciclosporina/farmacología , Femenino , Expresión Génica , Supervivencia de Injerto/efectos de los fármacos , Supervivencia de Injerto/inmunología , Trasplante de Corazón/patología , Inmunosupresores/farmacología , Proteína Coestimuladora de Linfocitos T Inducibles , Isoanticuerpos/biosíntesis , Macaca fascicularis , Masculino , Linfocitos T/inmunología , Donantes de Tejidos , Trasplante HomólogoRESUMEN
BACKGROUND: Members of the Src family of tyrosine kinases (SFKs) are requisite signaling molecules activated by multiple receptors during immune responses. Their expression and catalytic activity has not been characterized in allograft rejection in vivo. METHODS: We measured expression and catalytic activity of SFKs in MHC- mismatched murine cardiac allografts. We also examined the effects of a Src inhibitor (CGP77675) with or without anti-CD154 mAb on graft survival, histology, and expression and catalytic activity of SFKs within the grafts. RESULTS: In acutely rejecting allografts from untreated controls, total activity of Hck and Lyn increased 10-fold, predominantly reflecting increases in the amount of protein. Total activity of Lck increased only fourfold, reflecting small changes in both the amount of protein and specific activity. One dose of anti-CD154 plus CGP77675 markedly diminished cellular infiltration, but survival was only moderately prolonged despite inhibition of all SFKs in the rejected grafts. Two doses of anti-CD154 plus CGP77675 allowed permanent graft acceptance in 60% of recipients even after discontinuation of the inhibitor. Both rejected and long surviving grafts showed increased activity of all SFKs. Recipients that rejected their grafts showed serum alloantibody production, and grafts rejected during treatment demonstrated deposition of complement indicating the contribution of antibody to rejection. CONCLUSIONS: The myeloid and B cell Src family kinases, Hck and Lyn, rather than the T cell Src kinase Lck, show the greatest increase in expression and total activity in rejecting allografts. Both rejected and long-surviving grafts show significant increases in SFK expression and acitivity.
Asunto(s)
Ligando de CD40/efectos de los fármacos , Rechazo de Injerto/enzimología , Rechazo de Injerto/prevención & control , Supervivencia de Injerto , Trasplante de Corazón , Familia-src Quinasas/antagonistas & inhibidores , Animales , Anticuerpos/farmacología , Ligando de CD40/inmunología , Linfocitos T CD8-positivos/inmunología , Rechazo de Injerto/inmunología , Supervivencia de Injerto/efectos de los fármacos , Supervivencia de Injerto/inmunología , Corazón/efectos de los fármacos , Ratones , Ratones Endogámicos C57BL , Inhibidores de Proteínas Quinasas/farmacología , Pirimidinas/farmacología , Pirroles/farmacología , Trasplante HomólogoRESUMEN
Background. Histoplasmosis causes severe disease in patients with defects of cell-mediated immunity. It is not known whether outcomes vary related to the type of immunodeficiency or class of antifungal treatment. Methods. We reviewed cases of active histoplasmosis that occurred at Vanderbilt University Medical Center from July 1999 to June 2012 in patients with human immunodeficiency virus (HIV) infection, a history of transplantation, or tumor necrosis factor (TNF)-α inhibitor use. These groups were compared for differences in clinical presentation and outcomes. In addition, outcomes were related to the initial choice of treatment. Results. Ninety cases were identified (56 HIV, 23 transplant, 11 TNF-α inhibitor). Tumor necrosis factor-α patients had milder disease, shorter courses of therapy, and fewer relapses than HIV patients. Histoplasma antigenuria was highly prevalent in all groups (HIV 88%, transplant 95%, TNF-α 91%). Organ transplant recipients received amphotericin B formulation as initial therapy less often than other groups (22% vs 57% HIV vs 55% TNF-α; P = .006). Treatment failures only occurred in patients with severe disease. The failure rate was similar whether patients received initial amphotericin or triazole therapy. Ninety-day histoplasmosis-related mortality was 9% for all groups and did not vary significantly with choice of initial treatment. Conclusions. Histoplasmosis caused milder disease in patients receiving TNF-α inhibitors than patients with HIV or solid organ transplantation. Treatment failures and mortality only occurred in patients with severe disease and did not vary based on type of immunosuppression or choice of initial therapy.
RESUMEN
BACKGROUND: Successful management of an ABO-mismatched lung allograft recipient has not previously been described. METHODS: Because of a clerical error, a 67-year-old blood type B patient with idiopathic pulmonary fibrosis received a left single-lung allograft from a blood type A donor. Cyclophosphamide was added to immunosuppression with anti-thymocyte globulin induction, cyclosporine, mycophenolate mofetil, and prednisone. When increasing anti-A antibody titers were detected, antigen-specific immunoadsorption, anti-CD20 monoclonal antibody, and recombinant soluble complement receptor type 1 (TP10) were administered. RESULTS: Rising anti-A antibody titers were reduced acutely by immunoadsorption, and remained low during long-term follow-up. Humoral injury to the graft was not detected. Acute cellular rejection and multiple complications were successfully managed. Three years after transplantation the patient is clinically well on stable maintenance immunosuppression and prophylactic photochemotherapy. CONCLUSIONS: Modulation of anti-A antibody, preserved graft function, and a favorable patient outcome can be achieved for an ABO-mismatched lung allograft.
Asunto(s)
Sistema del Grupo Sanguíneo ABO , Incompatibilidad de Grupos Sanguíneos/terapia , Proteínas del Sistema Complemento/inmunología , Terapia de Inmunosupresión/métodos , Trasplante de Pulmón/inmunología , Ácido Micofenólico/análogos & derivados , Anciano , Antiinflamatorios/administración & dosificación , Suero Antilinfocítico/administración & dosificación , Incompatibilidad de Grupos Sanguíneos/inmunología , Ciclofosfamida/administración & dosificación , Ciclosporina/administración & dosificación , Supervivencia de Injerto/inmunología , Humanos , Técnicas de Inmunoadsorción , Inmunosupresores/administración & dosificación , Masculino , Ácido Micofenólico/administración & dosificación , Prednisona/administración & dosificación , Trasplante HomólogoRESUMEN
We report two cases of culture-negative bacterial endocarditis in which the organisms were identified by amplification and sequencing of the bacterial 16S rRNA gene. These results support an important role for polymerase chain reaction followed by direct sequencing to determine the etiology of culture-negative bacterial endocarditis and to guide appropriate antimicrobial therapy.
Asunto(s)
Endocarditis Bacteriana/microbiología , Reacción en Cadena de la Polimerasa/métodos , ARN Ribosómico 16S/análisis , Streptococcus/clasificación , Adulto , Antibacterianos , Quimioterapia Combinada/administración & dosificación , Ecocardiografía Doppler , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/tratamiento farmacológico , Reacciones Falso Negativas , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , ARN Bacteriano/análisis , Medición de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Streptococcus/genéticaRESUMEN
The Helicobacter pylori hpyIM gene encodes a type II DNA methyltransferase that is highly conserved among strains. To investigate the potential role of M.HpyI methyltransferase activity in controlling gene expression in H. pylori, we analyzed gene transcription profiles in wild-type strain J166 and an isogenic hpyIM mutant strain using gene arrays. This analysis showed that the expression of a majority of genes was unaffected by hpyIM mutation, especially in exponential phase cultures. However, in stationary phase cultures and in cells adherent to AGS gastric epithelial cells in vitro, loss of hpyIM function altered the expression of the stress-responsive dnaK operon. Complementation of the hpyIM mutation using a shuttle plasmid encoding a wild-type copy of the gene re-established the wild-type pattern of dnaK operon expression. These data suggested that hpyIM, encoding a DNA methyltransferase, may have a role in H. pylori physiology that supersedes its original function in a type II restriction-modification system.
Asunto(s)
Adhesión Bacteriana , Proteínas de Escherichia coli , Regulación Bacteriana de la Expresión Génica , Proteínas HSP70 de Choque Térmico/genética , Helicobacter pylori/enzimología , Helicobacter pylori/genética , Metiltransferasa de ADN de Sitio Específico (Adenina Especifica)/fisiología , Proteínas Bacterianas , Prueba de Complementación Genética , Proteínas HSP70 de Choque Térmico/biosíntesis , Helicobacter pylori/metabolismo , Helicobacter pylori/patogenicidad , Mutación , Análisis de Secuencia por Matrices de Oligonucleótidos , Operón , Metiltransferasa de ADN de Sitio Específico (Adenina Especifica)/genética , Transcripción GenéticaRESUMEN
Five hundred five blood cultures collected through a peripheral intravenous catheter (PIV) in an emergency department were matched to cultures obtained by dedicated venipuncture from the same patient within 10 minutes. The relative risk of contamination for cultures collected through PIVs compared with dedicated venipuncture was 1.83 (95% confidence interval, 1.08-3.11).
Asunto(s)
Bacterias/aislamiento & purificación , Recolección de Muestras de Sangre/métodos , Cateterismo Periférico/efectos adversos , Servicio de Urgencia en Hospital , Adulto , Recolección de Muestras de Sangre/normas , Estudios de Cohortes , Intervalos de Confianza , Humanos , Medición de Riesgo , Estados UnidosAsunto(s)
Trasplante de Corazón , Inmunosupresores/farmacocinética , Miembro 1 de la Subfamilia B de Casetes de Unión a ATP/metabolismo , Antiinfecciosos/efectos adversos , Antiinfecciosos/farmacocinética , Antidepresivos/efectos adversos , Antidepresivos/farmacocinética , Transporte Biológico , Biotransformación , Fármacos Cardiovasculares/efectos adversos , Fármacos Cardiovasculares/farmacocinética , Sistema Enzimático del Citocromo P-450/metabolismo , Interacciones Farmacológicas , Trasplante de Corazón/inmunología , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/clasificación , Inmunosupresores/uso terapéutico , Tasa de Depuración Metabólica , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/farmacocinéticaAsunto(s)
Trasplante de Corazón , Complicaciones Posoperatorias/tratamiento farmacológico , Antiinfecciosos/farmacología , Antiinfecciosos/uso terapéutico , Antidepresivos/farmacología , Antidepresivos/uso terapéutico , Antihipertensivos/farmacología , Antihipertensivos/uso terapéutico , Depresión/complicaciones , Depresión/tratamiento farmacológico , Diabetes Mellitus/tratamiento farmacológico , Difosfonatos/farmacología , Difosfonatos/uso terapéutico , Interacciones Farmacológicas , Gota/complicaciones , Gota/tratamiento farmacológico , Cardiopatías/complicaciones , Cardiopatías/cirugía , Humanos , Hiperlipidemias/complicaciones , Hiperlipidemias/tratamiento farmacológico , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Hipoglucemiantes/farmacología , Hipoglucemiantes/uso terapéutico , Hipolipemiantes/farmacología , Hipolipemiantes/uso terapéutico , Inmunosupresores/farmacología , Inmunosupresores/uso terapéutico , Control de Infecciones , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/tratamiento farmacológico , Osteoporosis/complicaciones , Osteoporosis/tratamiento farmacológico , Inhibidores de Agregación Plaquetaria/farmacología , Inhibidores de Agregación Plaquetaria/uso terapéuticoRESUMEN
Of all blood cultures positive for coagulase-negative staphylococci collected in 1 year at an academic hospital, 100 were selected randomly for review and designated true positives or contaminated. For the 85 patients whose cultures were determined to be contaminated, chart abstractions revealed substantial unnecessary antibiotic administration, additional laboratory tests and procedures, and hospital readmissions.