“
“Objectives: To determine the role of colonizers in the causation of ventilator-associated pneumonia (VAP) and the value of routine pre-VAP endotracheal aspirate (EA) cultures in appropriately treating VAP.
Methods: A prospective observational cohort study was conducted over a period of 15 months. buy I-BET-762 Two hundred patients on mechanical ventilation for > 48 h were studied.
Results: Acinetobacter spp (33.7%) and Pseudomonas spp (29.8%) were the most common colonizers. Of the 200 patients, 36 developed VAP. In 20 VAP patients, the pre-VAP EA culture-based strategy was not useful. However, in the remaining 16 VAP patients, a pre-VAP
EA culture-based strategy would have appropriately treated 13 (81%; CX-4945 ic50 95% confidence interval (CI) 62-100%), in comparison to only nine (56%; 95% CI 32-80%) by the American Thoracic Society (ATS) strategy. The seven patients in whom the ATS guidelines were inappropriate had Acinetobacter spp and Pseudomonas spp resistant to the higher antibiotics recommended by the ATS for multidrug-resistant pathogens. The positive predictive values of Pseudomonas aeruginosa, Acinetobacter baumannii, and methicillin-resistant Staphylococcus aureus (MRSA) isolated from pre-VAP EA cultures were 88%, 83%, and 100%, respectively.
Conclusion: VAP patients should be treated
based on ATS guidelines, but whenever P. aeruginosa, A. baumannii, and MRSA are isolated from pre-VAP EA cultures, the initial antibiotic therapy should be extended to treat these. (C) 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.”
“A 75-year-old woman with dextrocardia, situs inversus, and subpulmonic outflow obstruction presented with recurrent supraventricular tachycardia (SVT). This SVT was easily inducible during electrophysiology study, and pacing maneuvers during SVT were consistent with atypical, slow-slow atrioventricular nodal reentrant tachycardia (AVNRT). The His bundle was identified in the low postero-septal morphologic right atrium, at the typical anatomic site for
slow pathway ablation of AVNRT. Mapping of the retrograde earliest atrial electrogram during AVNRT localized this site to the mid-septal morphologic left atrium, and cryoablation at this site terminated selleck screening library the AVNRT and rendered it noninducible. (PACE 2010; e106-e109).”
“Objective: This study aimed to examine the epidemiological trends in dengue infection and the impact of imported cases and airport fever screening on community transmission in Taiwan, a dengue non-endemic island.
Methods: All of the dengue case data were obtained from the surveillance system of the Taiwan Center for Disease Control and were analyzed by Pearson correlations, linear regression, and geographical information system (GIS)-based mapping. The impact of implementing airport fever screening was evaluated using the Student’s t-test and two-way analysis of variance.