Metabolomics of cerebrospinal fluid from humans treated for rabies.

Rabies is a rapidly progressive lyssavirus encephalitis that is statistically 100% fatal. There are no clinically effective antiviral drugs for rabies. An immunologically naïve teenager survived rabies in 2004 through improvised supportive care; since then, 5 additional survivors have been associated with use of the so-called Milwaukee Protocol (MP). The MP applies critical care focused on the altered metabolic and physiologic states associated with rabies. The aim of this study was to examine the metabolic profile of cerebrospinal fluid (CSF) from rabies patients during clinical progression of rabies encephalitis in survivors and nonsurvivors and to compare these samples with control CSF samples. Unsupervised clustering algorithms distinguished three stages of rabies disease and identified several metabolites that differentiated rabies survivors from those who subsequently died, in particular, metabolites related to energy metabolism and cell volume control. Moreover, for those patients who survived, the trajectory of their metabolic profile tracked toward the control profile and away from the rabies profile. NMR metabolomics of human rabies CSF provide new insights into the mechanisms of rabies pathogenesis, which may guide future therapy of this disease.

Good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults in the UK: a consensus statement.

These good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) are an update to a previous consensus statement on OPAT in the UK published in 1998. They are based on previous national and international guidelines, but have been further developed through an extensive consultation process, and are underpinned by evidence from published literature on OPAT. They provide pragmatic guidance on the development and delivery of OPAT services, looking at all aspects of service design, care delivery, outcome monitoring and quality assurance, with the aim of ensuring that OPAT services provide high-quality, low-risk care, whatever the healthcare setting. They will provide a useful resource for teams developing new services, as well as a practical set of quality indicators for existing services.

Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK.

UK good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) were published in 2012 and 2015 for adult and paediatric patients, respectively. Here we update the initial good practice recommendations in a combined document based on a further review of the OPAT literature and an extensive consultation process. As with the previous good practice recommendations, these updated recommendations are intended to provide pragmatic guidance for new and established OPAT services across a range of settings and to act as a set of quality indicators for service evaluation and quality improvement.

The epidemiology of peritonsillar abscess disease in Northern Ireland.

OBJECTIVES: 1. To describe the epidemiology of peritonsillar abscess disease in Northern Ireland. 2. To describe the impact of the nature of microbiological sampling on culture results. METHOD: Retrospective review of cases of peritonsillar abscess identified by diagnostic coding in three centres in Northern Ireland between August 2001 and July 2002. RESULTS: One hundred and twenty eight cases of confirmed peritonsillar abscess were treated as inpatients accounting for 1 in 10,000/year of the population in the hospitals' catchment area. The mean age was 26.4 (range 9-78) years. Sixty-nine patients were male; the mean length of hospital stay was 3 days. Culture yield was greatest from needle aspirates; throat swabs and blood cultures were typically unhelpful. Beta haemolytic streptococci were the most common isolates. Resistance among Group A haemolytic streptococci to macrolide antibiotics was present in 26% of isolates. Heterophile antibody testing was routine and revealed that Epstein-Barr virus infectious mononucleosis had a prevalence of 1.8% in this group of patients. CONCLUSION: In this population, although there were many similarities with the clinical features reported by other investigators, there were also several differences. Notably, we found a comparatively low proportion of anaerobic infections. Although cultures results did not influence individual patient treatment, reviewing data derived from populations is valuable for guiding empirical antibiotic therapy. SUMMARY: The epidemiology of peritonsillar abscess disease is not well described. Other investigators describing the bacteriology give differing results, presumably reflecting different countries and techniques. The need for routine microbiological testing has been questioned in several reports, but the benefit of routine culture and sensitivity data for planning empirical antibiotic treatment has not been explored. We present a retrospective review of 128 cases of confirmed peritonsillar abscess in Northern Ireland from August 2001 to July 2002. The annual population incidence in this region is 1 in 10,000/year. In this group concurrent Epstein-Barr virus infection was found to have a prevalence of 1.8%. The yield of positive cultures from routine microbiological sampling was low in comparison to that reported in detailed prospective studies, from various countries. Needle aspiration was the best technique for obtaining pus for culture; throat swabs and blood cultures were unhelpful. Culture results did not affect individual patient treatment, but may have a potentially useful role for selecting empirical therapy.

Diagnosis and treatment of endogenous fungal endophthalmitis.

Endogenous infectious endophthalmitis is rare, and a primary source is usually identified. A case of primary fungal endophthalmitis successfully treated with vitrectomy and systemic antifungal therapy is presented. The aetiology and treatment of the condition are discussed.

Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS.

BACKGROUND: Hepatitis C virus (HCV) remains a problem within hemodialysis units. This study measures HCV prevalence and seroconversion rates across seven countries and investigates associations with facility-level practice patterns. METHODS: The study sample was from the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective, observational study of adult hemodialysis patients randomly selected from 308 representative dialysis facilities in France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States. Logistic regression was used to model odds of HCV prevalence, and Cox regression was used to model time from study entry to HCV seroconversion. RESULTS: Mean HCV facility prevalence was 13.5% and varied among countries from 2.6% to 22.9%. Increased HCV prevalence was associated with longer time on dialysis, male gender, black race, diabetes, hepatitis B (HBV) infection, prior renal transplant, and alcohol or substance abuse in the previous 12 months. Approximately half of the facilities (55.6%) had no seroconversions during the study period. HCV seroconversion was associated with longer time on dialysis, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), HBV infection, and recurrent cellulitis or gangrene. An increase in highly trained staff was associated with lower HCV prevalence (OR = 0.93 per 10% increase, P= 0.003) and risk of seroconversion (RR = 0.92, P= 0.07). Seroconversion was associated with an increase in facility HCV prevalence (RR = 1.36, P < 0.0001), but not with isolation of HCV-infected patients (RR = 1.01, P= 0.99). CONCLUSION: There are differences in HCV prevalence and rate of seroconversion at the country and the hemodialysis facility level. The observed variation suggests opportunities for improved HCV outcomes.

Patterns of hepatitis B prevalence and seroconversion in hemodialysis units from three continents: the DOPPS.

BACKGROUND: Hepatitis B (HBV) historically has been a public health issue within hemodialysis units. This study estimates HBV prevalence and seroconversion rates across seven countries and investigates associations with facility level practice patterns. METHODS: The study sample was from the Dialysis Outcomes and Practice Patterns Study (DOPPS), a cross-sectional, prospective, observational study of adult hemodialysis patients randomly selected from 308 dialysis facilities in France, Germany, Italy, Spain, the United Kingdom, Japan, and the United States. Logistic regression was used to model the odds ratio (OR) of HBV prevalence, and Cox regression was used to model time from entry into the study to HBV seroconversion. RESULTS: In this sample, mean HBV facility prevalence was 3.0% with a median of 1.9%. The percentage of facilities with an HBV prevalence 0% to 5% was 78.5%. Adjusted HBV prevalence was higher in France, Germany, and Italy and lower in Japan and the United Kingdom. The majority of facilities (78.1%) had a seroconversion rate of 0 conversions per 100 patient-years. Presence of a protocol for HBV-infected patients was significantly associated with HBV seroconversion in the separate practice pattern model [risk ratio (RR) = 0.52, P = 0.03] and in the combined practice pattern model (RR = 0.44, P = 0.01). CONCLUSION: There are differences in HBV prevalence and rate of seroconversion both at the country and the hemodialysis facility level. Presence of a protocol for HBV-infected patients was strongly and significantly associated with decreased risk for seroconversion. The observed variation suggests opportunities for improved HBV outcomes with further definition of optimal practice patterns at the facility level.