Oral antimicrobial therapy for cellulitis versus outpatient parenteral antimicrobial therapy: a single-centre audit of cellulitis outcomes.

BACKGROUND: Cellulitis is a common acute skin and soft tissue infection that causes substantial morbidity and healthcare costs. AIMS: To audit the impact on cellulitis management, regimen tolerability and outcomes of switching from outpatient parenteral antimicrobial therapy (OPAT) using intravenous (i.v.) cefazolin once daily plus probenecid to oral beta-lactam therapy (OBLT) using oral flucloxacillin plus probenecid. METHODS: We undertook a retrospective audit on cellulitis management, regimen tolerability and outcomes at the Dunedin Public Hospital Emergency Department (ED) before and after a change of the local outpatient cellulitis treatment pathway from OPAT using i.v. cefazolin once daily plus probenecid to OBLT using oral flucloxacillin plus probenecid. RESULTS: OPAT was used in 97/123 (78.9%) patients with cellulitis before compared to 1/70 (1.4%) after the pathway change (odds ratio (OR), 0.04, P < 0.01). OBLT was used in 26/123 (21.1%) patients with cellulitis before and 69/70 (98.6%) after (OR, 218.8, P < 0.01). Antimicrobial change due to intolerance occurred in 4/123 (3.2%) patients with cellulitis before and 4/70 (5.7%) after (OR, 1.8, P, not significant (NS)) the pathway change. Inpatient admission within 28 days occurred in 15/123 (12.2%) cellulitis patients before and 9/70 (12.9%) after (OR, 1.1, P, NS) the pathway change. CONCLUSIONS: Implementation of a change in outpatient cellulitis treatment pathway resulted in a significant change in prescribing practice. Our findings suggest that OBLT was both tolerable and had similar outcomes to OPAT.

Thyroid hormones, brain function and cognition: a brief review.

In addition to their role in cellular metabolic activity, thyroid hormones (THs), also regulate neural development; the central nervous system is particularly dependent on TH for normal maturation and function. Specifically, there appears to be extensive inter-reliance between TH and acetylcholine (Ach), nerve growth factor and hippocampal function. These associations led us to investigate the possible effects of thyroxine (L-T4) on performance of a spatial learning task, where cholinergic activity and hippocampal function are known to be important. Groups of rats (n=20) received saline (controls) or L-T4 at 2.5 or 5mg/kg daily for 4 days as a sub-chronic treatment, or 0, 5 or 10mg/kg doses administered every third day for 28 days prior to testing as a chronic regimen. Rats were assessed in a water maze for their ability to find a submerged or visible platform. Forty minutes prior to water maze testing, half the animals in each group received 1mg/kg scopolamine to elicit a cognitive deficit. Following testing, rats were decapitated, blood samples taken, and the frontal cortex and hippocampus were dissected out for acetylcholinesterase (AChE) assay. The results showed that L-T4 treatment, administered both sub-chronically and chronically, significantly enhanced the ability of rats to learn a spatial memory task, compared with controls. Moreover, both short-term and long-term L-T4 treatment reduced the cognitive-impairing effects of scopolamine. Improvements in performance were shown to occur alongside significantly increased cholinergic activity in frontal cortex and in the hippocampus of treated animals. These findings demonstrate an augmentative effect of L-T4 upon cognitive function, possibly mediated by an enhancement of cholinergic activity. The results support previous findings of a relationship between L-T4 and acetylcholine, and underscore possible mechanisms by which disorders of thyroid function may be associated with cognitive decline.

Mobile phone use facilitates memory in male, but not female, subjects.

In the present study we report on the effects of mobile phone exposure on short- and long-term memory in male and female subjects. Subjects were university undergraduate students, and consisted of right-handed, males (n = 33) and females (n = 29). Individuals were randomly assigned to one of three experimental conditions: no phone exposure; inactive phone exposure; and active phone exposure. They were provided with a series of words to learn, structured in a two-dimensional shape, and given 3 min to memorise the words. After a 12 min distraction task, they were then asked to draw the shape (spatial) and place the correct words (semantic) into the appropriate boxes. One week later the same subjects were brought back to again redraw the shape and words. Error scores were determined and analysed by non-parametric techniques. The results show that males exposed to an active phone made fewer spatial errors than those exposed to an active phone condition, while females were largely unaffected. These results further indicate that mobile phone exposure has functional consequences for human subjects, and these effects appear to be sex-dependent.

Chronic aspirin ingestion improves spatial learning in adult and aged rats.

Epidemiological evidence suggests that nonsteroidal, anti-inflammatory drugs (NSAIDs) may retard the progression of Alzheimer's disease (AD). In the present study, we have chronically treated adult (4-5 months old) and aged (20+ months) rats with water adulterated with aspirin, and examined spatial learning in a swim maze. Adult rats (n=40) and aged rats (n=20) were divided into separate groups assigned to receive either normal drinking water or water with 2 mg/ml of aspirin dissolved in it. For 6 weeks, we monitored daily water and/or drug intake before testing all rats in a standard swim maze over an 8-day period. On average, each rat drank approximately 25 ml of water/day with no apparent control versus aspirin group differences. There was no effect of aspirin in young adult rats except during a visible platform trial where aspirin-treated rats performed better than controls. In contrast, aspirin markedly improved performance in the aged rats during hidden and visible platform trials. Such group differences abated by the eighth test day when all rats performed equally well. The improvements in performance were not correlated with changes in swim speeds indicating that the enhancement was not due to facilitated motor output. These data reveal that a modest, 6-week treatment regimen with aspirin in aged rats is sufficient to induce improvements in both speed of learning and strength of the learned response. We have yet to address the key question as to underlying physiological mechanism(s) that might underpin this augmented cognitive performance. Moreover, it would be useful to ascertain whether or not chronic NSAID treatment might reduce the extent of learning impairments in aged, cognitively impaired animals.

A low complexity rapid molecular method for detection of Clostridium difficile in stool.

Here we describe a method for the detection of Clostridium difficile from stool using a novel low-complexity and rapid extraction process called Heat Elution (HE). The HE method is two-step and takes just 10 minutes, no specialist instruments are required and there is minimal hands-on time. A test method using HE was developed in conjunction with Loop-mediated Isothermal Amplification (LAMP) combined with the real-time bioluminescent reporter system known as BART targeting the toxin B gene (tcdB). The HE-LAMP-BART method was evaluated in a pilot study on clinical fecal samples (tcdB(+), n = 111; tcdB(-), n= 107). The HE-LAMP-BART method showed 95.5% sensitivity and 100% specificity against a gold standard reference method using cytotoxigenic culture and also a silica-based robotic extraction followed by tcdB PCR to control for storage. From sample to result, the HE-LAMP-BART method typically took 50 minutes, whereas the PCR method took >2.5 hours. In a further study (tcdB(+), n = 47; tcdB(-), n= 28) HE-LAMP-BART was compared to an alternative commercially available LAMP-based method, Illumigene (Meridian Bioscience, OH), and yielded 87.2% sensitivity and 100% specificity for the HE-LAMP-BART method compared to 76.6% and 100%, respectively, for Illumigene against the reference method. A subset of 27 samples (tcdB(+), n = 25; tcdB(-), n= 2) were further compared between HE-LAMP-BART, Illumigene, GeneXpert (Cepheid, Sunnyvale, CA) and RIDA®QUICK C. difficile Toxin A/B lateral flow rapid test (R-Biopharm, Darmstadt, Germany) resulting in sensitivities of HE-LAMP-BART 92%, Illumigene 72% GeneXpert 96% and RIDAQuick 76% against the reference method. The HE-LAMP-BART method offers the advantages of molecular based approaches without the cost and complexity usually associated with molecular tests. Further, the rapid time-to-result and simple protocol means the method can be applied away from the centralized laboratory settings.