A Streptococcus pneumoniae                     (pneumococcus) -infekciók ezer arca

Incidence and mortality rates of infections caused by Streptococcus pneumoniae (pneumococcus) are high worldwide and in Hungary among paediatric as well as adult populations. Pneumococci account for 35–40% of community acquired adult pneumonias requiring hospitalization, while 25–30% of Streptococcus pneumoniae pneumonias are accompanied by bacteraemia. 5–7% of all infections are fatal but this rate is exponentially higher in high risk patients and elderly people. Mortality could reach 20% among patients with severe invasive pneumococcal infections. Complications may develop despite administration of adequate antibiotics. The authors summarize the epidemiology of pneumococcal infections, pathogenesis of non-invasive and invasive disease and present basic clinical aspects through demonstration of four cases. Early risk stratification, sampling of hemocultures, administration of antibiotics and wider application of active immunization could reduce the mortality of invasive disease. Anti-pneumococcal vaccination is advisable for adults of ≥50 years and high risk patients of ≥18 years who are susceptible to pneumococcal disease. Orv. Hetil., 2015, 156(44), 1769–1777.

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Is Antifungal Prophylaxis Useful In Stem Cell Transplantation (SCT) During Hospitalization?.

Blood ◽

10.1182/blood.v116.21.4541.4541 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4541-4541

Author(s):

Giuseppe Irrera ◽

Messina Giuseppe ◽

Giuseppe Console ◽

Massimo Martino ◽

Cuzzola Maria ◽

...

Keyword(s):

High Risk ◽

Conflicts Of Interest ◽

Fungal Infections ◽

Mucosal Damage ◽

Invasive Disease ◽

Secondary Prophylaxis ◽

Antifungal Prophylaxis ◽

Antifungal Drugs ◽

High Risk Patients ◽

Risk Patients

Abstract Abstract 4541 Introduction: Limited data demonstrate to what extent preventing fungal exposures is effective in preventing infection and disease. Further studies are needed to determine the optimal duration of fluconazole prophylaxis in allogeneic recipients to prevent invasive disease with fluconazole-susceptible Candida species during neutropenia. Oral, nonabsorbable antifungal drugs might reduce superficial colonization and control local mucosal candidiasis, but have not been demonstrated to reduce invasive candidiasis. Anti-fungal prophylaxis is recommended in a subpopulation of autologous recipients with underlying hematologic malignancies with prolonged neutropenia and mucosal damage. Methods: This is a retrospective study of 1007 SCT performed in our center between 1992 and 2009 in 809 consecutive patients, irrespective of diagnosis. HEPA filter and environmental monitoring (air, water, surfaces) are attributes of our transplant center. Results: The main characteristics of the patients are reported in Table 1. Systemic prophylaxis was used according to the guidelines (Table 2): fluconazole in the nineties, then itraconazole and from 2004 was either abolished or substituted with non-adsorbable prophylaxis in transplants with standard risk. Secondary prophylaxis was prescribed for high risk patients (with infectious fungal history, suggestive iconography, positive fungal biomarker). In 17 years our Center has never been colonized by mould. Only 3 probable aspergillosis infections and 4 proven fungal infections (fusarium, mucor and 2 aspergillosis) were diagnosed, all in allogeneic patients (2 haplotipical, 1 singenic, 1 sibiling, 1 MUD and 2 mismatched), resulting in death in all cases. No infection was documented in autologous setting, while the infection rate in allogenic setting was 3.6% with an incidence rate of 1.1 infection per 10000 transplants/year. These results are significantly lower than published reports. Conclusion: Systemic antifungal prophylaxis should not be performed in autologous SCT patients. The abuse of systemic prophylaxis targeting yeasts has influenced the change of epidemiology in the transplant setting with prevalence of mould infections. The identification of high risk patients is useful to select patients for systemic antifungal or secondary prophylaxis to reducing overtreatment, incidence of resistant strains and costs. Disclosures: No relevant conflicts of interest to declare.

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A Virtual Clinic Improves Pneumococcal Vaccination for Asplenic Veterans at High Risk for Pneumococcal Disease

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv165 ◽

2015 ◽

Vol 2 (4) ◽

Cited By ~ 3

Author(s):

Robin L. Jump ◽

Richard Banks ◽

Brigid Wilson ◽

Michelle M. Montpetite ◽

Rebecca Carter ◽

...

Keyword(s):

High Risk ◽

Medical Record ◽

Electronic Medical Record ◽

Pneumococcal Disease ◽

Pneumococcal Vaccination ◽

Vaccination Status ◽

High Risk Patients ◽

Risk Patients ◽

Virtual Clinic

Abstract We developed a “virtual clinic” to improve pneumococcal vaccination among asplenic adults. Using an electronic medical record, we identified patients, assessed their vaccination status, entered orders, and notified patients and providers. Within 180 days, 38 of 76 patients (50%) received a pneumococcal vaccination. A virtual clinic may optimize vaccinations among high-risk patients.

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Vaccination Rates in Patients With Medical Indications for the Pneumococcal Polysaccharide Vaccine in a Family Medicine Clinic

Journal of Pharmacy Practice ◽

10.1177/0897190017745411 ◽

2017 ◽

Vol 32 (2) ◽

pp. 154-157 ◽

Cited By ~ 2

Author(s):

Anthony Trovato ◽

Karen Gunning ◽

Karly Pippitt

Keyword(s):

High Risk ◽

Family Medicine ◽

Pneumococcal Vaccination ◽

Low Risk ◽

Vaccination Rates ◽

Medical Indication ◽

High Risk Patients ◽

Patients With Diabetes ◽

Risk Patients ◽

Patient Refusal

Background: Pneumococcal vaccination rates among high-risk patients (eg, diabetes, asthma, smoking) seen in 2 family medicine clinics are unknown. Objectives: To assess differences in pneumococcal polysaccharide vaccination rates and reasons for nonvaccination among patients with diabetes and asthma and patients who smoke. Methods: A chart review at 2 family medicine residency training clinics showed 425 patients with a medical indication for PPSV23 were seen between April 1, 2015, and April 30, 2015. One reviewer searched the electronic health records to assess reasons for nonvaccination. Results: Rates of nonvaccination were 29.8% in patients with diabetes, 58.7% in patients with asthma, and 62.5% in patients who smoke cigarettes. Patients were classified into 3 groups based on the reasons for nonvaccination: documented patient refusal, not being addressed by a provider, and being documented as low risk despite the presence of a medical indication. Conclusion: The 3 reasons for nonvaccination were vaccination not being addressed, misclassification of high-risk patients as low-risk patients for infection, and documented patient refusal. Providers overlooked vaccination more often in patients with asthma and cigarette use than in patients with diabetes. Patients seeing pharmacists were most likely to be vaccinated, whereas patients seeing physician assistants were least likely to be vaccinated. Pharmacists see patients to provide medication management and preventive care, whereas other providers treat more urgent conditions. Because indications are often overlooked and not addressed, pharmacists can play a larger role in identifying and vaccinating high-risk patients.

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Cytomegalovirus infection in renal transplantation: clinical aspects, management and the perspectives

Einstein (São Paulo) ◽

10.1590/s1679-45082015rw3175 ◽

2015 ◽

Vol 13 (1) ◽

pp. 142-148 ◽

Cited By ~ 11

Author(s):

Lúcio Roberto Requião-Moura ◽

Ana Cristina Carvalho de Matos ◽

Alvaro Pacheco-Silva

Keyword(s):

Renal Transplantation ◽

High Risk ◽

Cytomegalovirus Infection ◽

Invasive Disease ◽

Infectious Complications ◽

Clinical Aspects ◽

Cell Clones ◽

Risk Patients ◽

Risk Of Disease ◽

Ganciclovir Resistance

Cytomegalovirus infection is one of most frequent infectious complications after renal transplantation, and can be classified as primo-infection, when the transmission occurs through the graft, or reactivation, when the recipient is cytomegalovirus seropositive. After transplantation, cytomegalovirus can appear as an infection, when the patient presents with evidence of viral replication without symptoms or disease, which has two clinical spectra: typical viral syndrome or invasive disease, which is a less common form. Their effects can be classified as direct, while the disease is developed, or indirect, with an increase of acute rejection and chronic allograft dysfunction risks. Diagnosis must be made based on viremia by one of the standardized methods: antigenemia or PCR, which is more sensitive. The risk factors related to infection after transplantation are the serologic matching (positive donor and negative recipient) and anti-lymphocyte antibody drugs. One of the strategies to reduce risk of disease should be chosen for patients at high risk: preemptive treatment or universal prophylaxis. Recent clinical research has described ganciclovir resistance as an emergent problem in management of cytomegalovirus infection. Two types of mutation that cause resistance were described: UL97 (most frequent) and UL54. Today, sophisticated methods of immunologic monitoring to detect specific T-cell clones against cytomegalovirus are used in clinical practice to improve the management of high-risk patients after renal transplantation.

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Prevalence of Influenza Vaccination and Pneumococcal Vaccination in Elderly and High-Risk Patients Seen in a University General Medicine Clinic

American Journal of Therapeutics ◽

10.1097/mjt.0b013e3181400114 ◽

2008 ◽

Vol 15 (6) ◽

pp. 528-530 ◽

Cited By ~ 4

Author(s):

Hoang Lai ◽

Wilbert S Aronow ◽

Andrew H Gutwein

Keyword(s):

High Risk ◽

Influenza Vaccination ◽

Pneumococcal Vaccination ◽

General Medicine ◽

High Risk Patients ◽

Medicine Clinic ◽

Risk Patients ◽

General Medicine Clinic

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83: Incidence and mortality of invasive fungal infections in high-risk patients receiving posaconazole versus fluconazole or itraconazole prophylaxis

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2006.12.086 ◽

2007 ◽

Vol 13 (2) ◽

pp. 33

Author(s):

A. Langston ◽

J.H. Lipton ◽

O.A. Cornely ◽

A.J. Ullmann ◽

H. Patino ◽

...

Keyword(s):

High Risk ◽

Fungal Infections ◽

Invasive Fungal Infections ◽

High Risk Patients ◽

Incidence And Mortality ◽

Risk Patients

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Use of NSAIDs for the Chemoprevention of Colorectal Cancer

Annals of Pharmacotherapy ◽

10.1345/aph.1c489 ◽

2003 ◽

Vol 37 (11) ◽

pp. 1664-1674 ◽

Cited By ~ 49

Author(s):

Jill M Herendeen ◽

Celeste Lindley

Keyword(s):

Colorectal Cancer ◽

High Risk ◽

General Population ◽

Clinical Studies ◽

Adenomatous Polyps ◽

Medline Search ◽

High Risk Patients ◽

Incidence And Mortality ◽

Risk Patients ◽

Cox 2

OBJECTIVE: To discuss the role of nonsteroidal antiinflammatory drugs (NSAIDs) in the chemoprevention of colorectal cancer. DATA SOURCES: A MEDLINE search (1966–May 2003) was performed to identify key literature. Search items included, but were not limited to, NSAIDs, colorectal cancer, chemoprevention, cyclooxygenase-2 (COX-2)–specific inhibitors, and familial adenomatous polyposis (FAP). STUDY SELECTION AND DATA EXTRACTION: The search included experimental (in vitro and animal models) and clinical studies evaluating the use of NSAIDs for the chemoprevention of colorectal cancer. The MEDLINE search was supplemented by references from selected articles. DATA SYNTHESIS: Numerous experimental, epidemiologic, and clinical studies suggest that NSAIDs have promise as anticancer agents. The mechanism by which NSAIDs lead to decreased colon carcinogenesis is not fully understood, but may involve restoration of apoptosis and inhibition of prostaglandin-mediated angiogenesis. Compelling evidence from many observational studies has consistently documented a 40–50% reduction in the risk of adenomatous polyps, colorectal cancer incidence, and mortality in patients using NSAIDs. Recent randomized, controlled trials have demonstrated a benefit with aspirin in reducing the rate of development of new or recurrent adenomas in high-risk patients. In addition, randomized studies using sulindac and celecoxib in patients with FAP have documented significant regression of existing adenomatous polyps. CONCLUSIONS: Inhibition of COX-2 is an example of a targeted approach to the chemoprevention of colorectal cancer. However, controversy exists about the safety, efficacy, and optimal treatment regimen of NSAIDs as long-term chemopreventive agents in the general population. Ongoing studies in high-risk patients with both selective and nonselective COX inhibitors will provide important information in the area of colorectal chemoprevention, but clinical trials' use of adenomas as surrogate markers for chemoprevention trials makes their application to the general population limited.

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