RESUMEN
Vancomycin remains a clinically useful antibiotic despite the advent of several alternative drugs. Optimising vancomycin therapy with therapeutic drug monitoring is widely recommended. The aim of therapeutic drug monitoring is to help the clinician to achieve target pharmacodynamic parameters in the case of vancomycin, an area under the concentration time curve/minimum inhibitory concentration ratio of ≥400. Vancomycin monitoring methods can be categorised into four categories: empiric trough concentrations; linear regression analysis (one-compartment model), population methods and Bayesian estimation procedures. Although the empiric trough concentrations and population methods are easy to use and require minimal resources, there are large differences in the published vancomycin model parameters. This demonstrates that there is great variance in pharmacokinetic parameters between the models and a single vancomycin model cannot be applied to all patient populations. The linear regression and Bayesian methods recommended more accurate dosage regimens; however, they require additional resources such as information technology and healthcare personnel with background training in pharmacokinetics. The Bayesian methods offered additional advantages such as calculation of doses based on a single-serum concentration and optimisation of the patient's previous pharmacokinetic data to determine subsequent dosage regimens. Computerised programs, utilising the Bayesian estimation procedures, are able to achieve target concentrations in a greater percentage of patients earlier in the course of therapy than the empiric trough concentrations and population methods. We recommend the use of these programs providing there is appropriate expertise available to make appropriate recommendations.
Asunto(s)
Monitoreo de Drogas/métodos , Vancomicina/farmacocinética , Vancomicina/uso terapéutico , Animales , Teorema de Bayes , Monitoreo de Drogas/tendencias , Humanos , Modelos Lineales , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/fisiología , Infecciones Estafilocócicas/sangre , Infecciones Estafilocócicas/tratamiento farmacológico , Resistencia a la Vancomicina/efectos de los fármacos , Resistencia a la Vancomicina/fisiologíaRESUMEN
Staphylococcus aureus is the most common cause of skin and soft tissue infections (SSTIs). Such infections have increased in several countries recently and at a time when community-associated methicillin-resistant S. aureus (CA-MRSA) strains have emerged globally. We examined changes in Australian hospitalisations for the treatment of cutaneous abscesses between 1999 and 2008, a period when increased numbers of CA-MRSA infections were being reported. National hospitalisation data for cutaneous abscess treatment (1999-2008) were examined. Hospitalisation numbers were collated and age-specific admission rates calculated and examined for changes over time. Yearly admissions for the treatment of cutaneous abscesses increased by 48%, from 8,849 (1999-2000) to 13,126 (2007-2008). The crude annual hospitalisation rate per 100,000 population rose from 46 to 62 respectively. However, increases in admission rates were limited to the 10 to 54 years age range. Incidence rate ratios (IRRs) for final versus baseline year admission rates for these age groups ranged from 1.36 (95% confidence interval [CI] 1.04-1.78) for those aged 10-14 years to 1.64 (95% CI 1.26-2.12) for those aged 45-49 years; p<0.05. Increases in hospitalisation for cutaneous abscess treatment have occurred in Australia during the last decade. Research into the underlying causes and prevention of these infections is a public health priority.
Asunto(s)
Absceso/epidemiología , Infecciones Cutáneas Estafilocócicas/epidemiología , Adolescente , Adulto , Australia/epidemiología , Niño , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Infecciones Cutáneas Estafilocócicas/tratamiento farmacológico , Infecciones Cutáneas Estafilocócicas/microbiología , Staphylococcus aureus/patogenicidadRESUMEN
BACKGROUND: Secondary bacterial pneumonia due to community onset methicillin-resistant Staphylococcus aureus (MRSA) has become a highly publicised cause of influenza-associated death. There is a risk that case reports of fatal outcomes with post-influenza MRSA pneumonia may unduly influence antibiotic prescribing. AIMS: The aim of this study was to demonstrate the incidence of community-onset MRSA pneumonia in 2009 H1N1 influenza patients. METHODS: The microbiology records of patients positive for influenza A (H1N1) in 2009 were reviewed for positive blood or respiratory tract cultures and urinary pneumococcal antigen results within a Queensland database. Patients with such positive results within 48 h of hospital admission and a positive H1N1 influenza result in the prior 6 weeks were included. RESULTS: In 2009, 4491 laboratory-confirmed pandemic influenza A (H1N1) infections were detected. Fifty patients (1.1% of the H1N1 cohort) who were hospitalised with H1N1 and who had a bacterial respiratory tract pathogen were identified. Streptococcus pneumoniae (16 patients; 32%), Staphylococcus aureus (13 patients; 26%) and Haemophilus influenzae (9 patients; 18%) were the most commonly cultured organisms. Of the cohort of 4491 patients, MRSA was detected in only two patients, both of whom were admitted to intensive care units and survived after prolonged admissions. CONCLUSIONS: Influenza-associated community-onset MRSA pneumonia was infrequently identified in the 2009 H1N1 season in Queensland, despite community-onset MRSA skin and soft tissue infections being very common. Although post-influenza MRSA pneumonia is of great concern, its influence on empiric-prescribing guidelines should take into account its incidence relative to other secondary bacterial pathogens.
Asunto(s)
Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/epidemiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Perfil de Impacto de Enfermedad , Infecciones Estafilocócicas/epidemiología , Adulto , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/epidemiología , Femenino , Humanos , Gripe Humana/diagnóstico , Masculino , Persona de Mediana Edad , Queensland/epidemiología , Infecciones Estafilocócicas/diagnóstico , Adulto JovenRESUMEN
The Sequenom MassARRAY iPLEX single-nucleotide polymorphism (SNP) typing platform uses matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) coupled with single-base extension PCR for high-throughput multiplex SNP detection. In this study, we investigated the use of iPLEX MassARRAY technology for methicillin-resistant Staphylococcus aureus (MRSA) genotyping. A 16-plex MassARRAY iPLEX GOLD assay (MRSA-iPLEX) was developed that targets a set of informative SNPs and binary genes for MRSA characterization. The method was evaluated with 147 MRSA isolates, and the results were compared with those of an established SYBR Green-based real-time PCR system utilizing the same SNP-binary markers. A total of 2352 markers belonging to 44 SNP-binary profiles were analysed by both real-time PCR and MRSA-iPLEX. With real-time PCR as the reference standard, MRSA-iPLEX correctly assigned 2298 of the 2352 (97.7%) markers. Sequence variation in the MRSA-iPLEX primer targets accounted for the majority of MRSA-iPLEX erroneous results, highlighting the importance of primer target selection. MRSA-iPLEX provided optimal throughput for MRSA genotyping, and was, on a reagent basis, more cost-effective than the real-time PCR methods. The 16-plex MRSA-iPLEX is a suitable alternative to SYBR Green-based real-time PCR typing of major sequence types and clonal complexes of MRSA.
Asunto(s)
Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/genética , Tipificación Molecular/métodos , Polimorfismo de Nucleótido Simple , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/métodos , Infecciones Estafilocócicas/microbiología , Costos y Análisis de Costo , Humanos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Reacción en Cadena en Tiempo Real de la Polimerasa/economía , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/economíaRESUMEN
OBJECTIVE: To determine prevalence of, and trends in, overweight and obesity in South Australian children aged 4 years during the period 1995-2002. METHODS: Data from 114 669 children collected as part of Child and Youth Health 'preschool health assessments' of 4-year-olds throughout the state in the years 1995-2002 were analysed. Body mass index was calculated from height and weight data and prevalence of overweight and obesity for males and females determined using a standard world-wide definition. Yearly prevalence rates were compared for changes over time. RESULTS: Rates of overweight and obesity have increased over the period 1995-2002. In 1995, of females 12.8% were overweight or obese (obese 3.5%). Of males 10.2% were overweight or obese (obese 3.2%). The equivalent figures in 2002 were for females 21.4% (obese 5.8%) and males 17.3% (obese 4.1%). Rates of overweight and obesity were greater in females than males in all years (except obesity rate in 1995). CONCLUSION: Data from this large, consecutive yearly dataset of South Australian 4-year-old children show a significant increase in the rates of overweight and obesity. Much of this increase appears to have occurred in the mid-to-late 1990s. It is uncertain if these changes have plateaued at this time. These results reinforce rising obesity prevalence as a significant child health issue. They also indicate that obesity is seen as early as the preschool years; with implications for theories of causation and for prevention and treatment strategies.
Asunto(s)
Obesidad/epidemiología , Índice de Masa Corporal , Preescolar , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Prevalencia , Distribución por Sexo , Australia del Sur/epidemiologíaRESUMEN
Two loci encoding Theta class glutathione transferases (GSTs) have been identified in humans. In situ hybridization studies have localized the GSTT1 gene to 22q11.2. This is the same band to which we previously localized the GSTT2 gene. This finding confirms the trend for human GST genes to be found in class-specific clusters.
Asunto(s)
Cromosomas Humanos Par 22 , Glutatión Transferasa/genética , Familia de Multigenes/genética , Mapeo Cromosómico , Genes , Humanos , Hibridación de Ácido NucleicoRESUMEN
Two forms of glutathione synthetase deficiency have been described. While one form is mild, causing hemolytic anemia, the other more severe form causes 5-oxo-prolinuria with secondary neurological involvement. Despite the existence of two deficiency phenotypes, Southern blots hybridized with a glutathione synthetase cDNA suggest that there is a single glutathione synthetase gene in the human genome. Analysis of somatic cell hybrids showed the human glutathione synthetase gene (GSS) to be located on chromosome 20, and this assignment has been refined to subband 20q11.2 using in situ hybridization.