Weighing the adverse cardiac effects of fluoroquinolones: A risk perspective.

A rare side effect of fluoroquinolone (FQ) antibiotics is QT prolongation, which may result in serious arrhythmias. Most published comparative trials describe the relative risks among the drug class but do not focus on the incidence of serious arrhythmias. It is important for the prescriber to have a sense not only of relative risk but also of incidence to balance the risks against the other attributes of the individual members of the drug class.

Are physician pagers an outmoded technology?

Background: Pagers are the most commonly used method of communications in American hospitals. However, its financial cost and efficiency is unknown.

Objective: To evaluate the efficiency of conventional hospital pagers and to estimate the financial cost of time wasted by the use of these pagers.

Polymicrobial endocarditis in intravenous heroin and fentanyl abuse.

Infective endocarditis is a life threatening condition with a high mortality rate. Intravenous Drug Abusers (IVDA) are more likely to acquire endocarditis. Most of the cases of infective endocarditis are caused by a single pathogen; cases of polymicrobial endocarditis are rare and they are associated with a reported mortality rate of more than 30%.

Statistical considerations in meta-analysis.

Systematic reviews and meta-analyses have recently emerged as key sources of evidence to inform clinical care, from bedside individualized decisions to policy making. This article discusses the principles behind statistical methods for quantitative evidence synthesis, including meta-analysis and meta-regression. The authors present pertinent concepts in an intuitive and nonmathematical fashion by use of examples from the infectious diseases literature.

Efficacy and tolerability of ClO2-generating gloves.

The transmission of pathogenic microorganisms by the hands of workers continues to be a problem in the medical field and the food industry. Compliance with hand hygiene is often poor, and gloves may be contaminated after being donned and may transmit microorganisms. A novel, patented technology allows materials to be impregnated with microspheres that, when activated by light or moisture, generate ClO2 at sustained rates to produce a disinfecting microatmosphere.

Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years.

Objective: To evaluate the impact of an interventional multidisciplinary antibiotic management program on expenditures for antibiotics and on the incidence of nosocomial infections caused by Clostridium difficile and antibiotic-resistant pathogens during 7 years.

Design: Prospective study with comparison with preintervention trends.

Setting: University-affiliated teaching hospital.

Morbidity of infections caused by antimicrobial-resistant bacteria.

Antimicrobial resistance can have 2 effects on the outcome of infection: there can be an accompanying change in the virulence of the organism, and there can be a poorer response to treatment because of the empiric choice of an antimicrobial to which the organism is resistant. We have reviewed published studies relating antimicrobial resistance to the outcomes of infection caused by enteric pathogens. The data for Salmonella and Campylobacter infections suggest that antimicrobial-resistant strains are somewhat more virulent than susceptible strains-that is, they cause more prolonged or more severe illness than do antimicrobial-susceptible strains.

Excess infections due to antimicrobial resistance: the "Attributable Fraction".

Antimicrobial use causes a transient decrease in an individual's resistance to colonization by noncommensal bacteria ("competitive effect") and increases the likelihood of infection upon exposure to a foodborne pathogen. The additional "selective effect" of antimicrobial resistance results in a >3-fold increase in vulnerability to infection by an antimicrobial-resistant pathogen among individuals receiving antimicrobial therapy for unrelated reasons. Combining the increase in vulnerability to infection with the prevalence of taking an antimicrobial agent, it is possible to estimate the attributable fraction, or the number of excess infections that occurred as a result of the unrelated use of an antimicrobial agent to which the pathogen was resistant.

Potential mechanisms of increased disease in humans from antimicrobial resistance in food animals.

There are at least 5 potential mechanisms by which antimicrobial resistance can have adverse effects on human health. The first, called the "attributable fraction," relates to individuals who become infected only because they are taking an antimicrobial agent (for unrelated reasons) to which the pathogen is resistant: the antimicrobial agent, by suppressing their normal microbiota, renders them more vulnerable to infection. A second mechanism involves the linkage of virulence traits to resistance traits so that resistant organisms may be more virulent than susceptible organisms.