A national survey of infectious disease practitioners on their use of outpatient parenteral antimicrobial therapy (OPAT).

Background: The use of outpatient parenteral antimicrobial therapy (OPAT) is standard medical practice; however, significant heterogeneity in practice exists. We hypothesized that formal OPAT programs are associated with increased physician participation in patient safety activities.

Methods: United States Infectious Disease (ID) physicians were contacted and asked to participate in an electronic survey from April through June 2012.

In routine clinical practice, few physicians use early viral kinetics to guide HCV dual therapy treatment decisions.

Background & Aims: PROPHESYS is a large, multinational, non-interventional prospective cohort study of chronic hepatitis C patients treated with peginterferon alfa/ribavirin. This subanalysis assesses rates of premature treatment discontinuation stratified by on-treatment virological response (VR).

Methods: This PROPHESYS subanalysis is restricted to treatment-naive, hepatitis C virus (HCV) genotype (G)1/2/3 mono-infected patients who received peginterferon alfa-2a (40KD)/ribavirin with intended treatment duration of 48 (G1) or 24 weeks (G2/3).

JUMP-C: a randomized trial of mericitabine plus pegylated interferon alpha-2a/ribavirin for 24 weeks in treatment-naïve HCV genotype 1/4 patients.

Unlabelled: Mericitabine is a selective nucleoside analog inhibitor of the hepatitis C virus (HCV) NS5B RNA-dependent RNA polymerase, with activity across all HCV genotypes. Treatment-naïve patients infected with HCV genotype 1 or 4 were randomized to 24 weeks of double-blind treatment with either mericitabine 1,000 mg (N = 81) or placebo (N = 85) twice-daily (BID) in combination with pegylated interferon alpha-2a (Peg-IFNα-2a)/ribavirin (RBV). Patients randomized to mericitabine with HCV RNA <15 IU/mL from week 4 to 22 (extended rapid virologic response; eRVR) stopped all treatment at week 24; all other patients continued Peg-IFNα-2a/RBV to complete 48 weeks of treatment.

Changes in fasting plasma glucose levels with ribavirin and pegylated interferon treatment in normal and impaired glucose tolerant patients with chronic hepatitis C.

Background: Patients with Hepatitis C Virus (HCV) infection have increased rates of glucose intolerance, and studies have shown the improvement of fasting plasma glucose (FPG) levels after clearance of HCV infection with standard ribavirin plus pegylated interferon treatment. The purpose of this study was to examine glycemic changes with standard HCV treatment in patients with impaired fasting glucose (IFG) and normal fasting glucose (NFG).

Methods: A retrospective study of FPG changes in HCV patients with IFG and NFG treated with standard HCV therapy was conducted.

Oritavancin: a new opportunity for outpatient therapy of serious infections.

Oritavancin is a new antibiotic for the treatment of serious infections with Gram-positive bacteria. It has been shown to be effective against methicillin-susceptible and -resistant Staphylococcus aureus as well as enterococci. With a terminal half-life of 393 hours, oritavancin lends itself to a convenient and potentially cost-effective single-dose regimen.

A probe-based method for confirmation of methicillin-resistant Staphylococcus aureus and detection of Panton-Valentine leukocidin and tst virulence genes.

Probe-based detection of mecA, lukS/F-PV (Panton-Valentine leukocidin), and tst virulence genes in 435 isolates of Staphylococcus aureus had comparable sensitivity and specificity to end-point polymerase chain reaction as a reference standard.

Access to care: the physician's perspective.

Private practice physicians in Hawaii were surveyed to better understand their impressions of different insurance plans and their willingness to care for patients with those plans. Physician experiences and perspectives were investigated in regard to reimbursement, formulary limitations, pre-authorizations, specialty referrals, responsiveness to problems, and patient knowledge of their plans. The willingness of physicians to accept new patients from specific insurance company programs clearly correlated with the difficulties and limitations physicians perceive in working with the companies (p<0.

Risk factors for community-associated methicillin-resistant Staphylococcus aureus cellulitis--and the value of recognition.

Objectives: To identify the risk factors for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) cellulitis.

Methods: A review of risk factors for CA-MRSA skin and soft tissue infection in previously published literature was first performed. A retrospective cohort study was then conducted in a teaching ambulatory-care clinic of a tertiary medical center in Honolulu, Hawaii.

Investigating approaches to improving appropriate antibiotic use among higher risk ethnic groups.

A field study with follow up investigations sought to: 1. determine whether cold packs (over-the-counter symptomtic treatments), coupled with in-office education, improve antibiotic-related knowledge, attitudes and behaviors more than in-office education alone in patient populations with high percentages of Asian Americans and Hawaiian/Pacific Islanders; 2. identify possible reasons for intervention outcomes as described by physicians who participated in the field study; and 3.

Empiric outpatient therapy with trimethoprim-sulfamethoxazole, cephalexin, or clindamycin for cellulitis.

Background: Limited data exist on optimal empiric oral antibiotic treatment for outpatients with cellulitis in areas with a high prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections.

Methods: We conducted a 3-year retrospective cohort study of outpatients with cellulitis empirically treated at a teaching clinic of a tertiary-care medical center in Hawaii. Patients who received more than 1 oral antibiotic, were hospitalized, or had no follow-up information were excluded.

Staphylococcus aureus: methicillin-susceptible S. aureus to methicillin-resistant S. aureus and vancomycin-resistant S. aureus.

The evolution of methicillin-resistant and vancomycin-resistant Staphylococcus aureus has demanded serious review of antimicrobial use and development of new agents and revised approaches to prevent and overcome drug resistance. Depending on local conditions and patient risk factors, empirical therapy of suspected S. aureus infection may require coverage of drug-resistant organisms with newer agents and novel antibiotic combinations.

Viral hepatitis in Hawai'i--differing perspectives.

This publication contains information from a conference titled "Individual Perspectives on the Silent Epidemic of Viral Hepatitis in Hawai'i" held in October of 2007 with updates and additional contributions from annual conferences in 2008 and 2009. These conferences were sponsored by the Hepatitis Support Network of Hawai'i and held in Honolulu, Hawai'i at the Queen's Conference Center. The primary objectives of the conferences have been to heighten awareness of viral hepatitis in Hawai'i and to bring together health care professionals to learn about these infections and to help them respond to the challenges they bring to the people of Hawai'i.

Albinterferon Alfa-2b was not inferior to pegylated interferon-α in a randomized trial of patients with chronic hepatitis C virus genotype 1.

Background & Aims: The current standard of care for patients with chronic hepatitis C virus (HCV) genotype 1 is once-weekly pegylated interferon-α (Peg-IFNα) plus daily ribavirin for 48 weeks. We evaluated the efficacy/safety of albinterferon alfa-2b (albIFN), a novel, long-acting, genetic fusion polypeptide of albumin and IFNα-2b.

Methods: In the phase 3 ACHIEVE-1 trial, 1331 patients were assigned equally to 3 open-label, 48-week treatment groups: Peg-IFNα-2a 180 μg every week, or albIFN 900 or 1200 μg every 2 weeks administered subcutaneously, with weight-based oral ribavirin 1000-1200 mg/day.

Prevention of community-associated methicillin-resistant Staphylococcus aureus infection among Asian/Pacific Islanders: a qualitative assessment.

Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has been increasingly reported over the past decade, including in Asian/Pacific Islanders (A/PIs).

Methods: We conducted ethnographic interviews in O'ahu and Kaua'i, Hawai'i, with 10 Asian/Pacific Islanders identified as having a history of CA-MRSA infections.

Results: Most (7/10) thought skin infections were not a new problem in Hawai'i.

Comparative effectiveness of antibiotics for the treatment of MRSA complicated skin and soft tissue infections.

Objective: With a growing number of studies and comparators in MRSA skin infections, a unified framework for comparing treatments is needed for health technology assessment (HTA). The objective was to systematically assess the success rates of common antimicrobial agents for the treatment of complicated skin and soft tissue infections (cSSTIs) caused by MRSA.

Methods: MEDLINE, EMBASE, and Cochrane databases were searched to identify published clinical trials in which dalbavancin, daptomycin, linezolid, telavancin, teicoplanin, tigecycline, and vancomycin were used to treat cSSTIs.

Quantitation of Staphylococcus aureus in seawater using CHROMagar SA.

A microbiological algorithm has been developed to analyze beach water samples for the determination of viable colony forming units (CFU) of Staphylococcus aureus (S. aureus). Membrane filtration enumeration of S.

Weight loss, leukopenia and thrombocytopenia associated with sustained virologic response to Hepatitis C treatment.

Objective: To identify apparent adverse effects of treatment of chronic hepatitis C and their relationship to sustained virologic response (SVR).

Methods: A retrospective study was conducted of all Hepatitis C virus (HCV)-infected patients treated with pegylated interferon and ribavirin in an academic ambulatory infectious disease practice. Clinical and laboratory characteristics were compared between patients with SVR and without SVR.

Topical antibiotic treatment for uncomplicated skin and skin structure infections: review of the literature.

Uncomplicated skin infections account for almost 200 million physician-office visits in the USA annually. Treating these infections is estimated to cost in excess of US$350 million each year. The primary etiology of these infections is Staphylococcus aureus, over 60% of which is estimated to be methicillin resistant across the USA.

Viral hepatitis in a homeless shelter in Hawai'i.

It is estimated that as many as 21,000 people in the state of Hawai'i may be infected with HCV Most of those infected with viral hepatitis are unaware they are infected. Complications from viral hepatitis include liver cirrhosis and hepatocellular carcinoma. Hawai'i has the highest incidence of hepatocellular carcinoma in the United States.

Hansen's disease with HIV: a case of immune reconstitution disease.

Immune reconstitution inflammatory syndrome (IRIS) is an acute symptomatic expression of a latent infection during the recovery of the immune system usually as a response to antiretroviral therapy (ART). Opportunistic infections can trigger IRIS. Hansen's disease is an infection caused by Mycobacterium leprae (M.