Assessing Universal Screening for MRSA
The Particulars: In 2004, a hospital survey indicated that MRSA prevalence was about 8.5%, a finding that was approximately three times higher than other estimates reported estimates. Testing patients in the ICU only—as is mandated in several states—does not produce enough benefit because too few patients are tested.
Data Breakdown: In 2005, a study team at NorthShore University Health System began a MRSA screening program with rapid polymerase chain reaction (PCR) testing. Every patient was admitted to one of three hospitals in the system for MRSA. After being screened for the infection, those with MRSA were treated with mupirocin and chlorhexidine baths. After 1 year, 37,179 patients were screened. A 70% reduction in MRSA was observed. A cost savings of $1.8 million was also observed. The hospital system spent nearly $24,000 more on patients with MRSA than on those without the infection. Researchers indicated that half of these costs is absorbed by insurance and Medicare, but noted that the financial burden of MRSA infections makes universal screening worthwhile.
Take Home Pearl: Universal screening using rapid PCR for MRSA in hospitals appears to be a cost-effective means to reduce the incidence of MRSA and decrease costs.
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Treating CAP in Hospitalized Patients
The Particulars: Community-acquired pneumonia (CAP) is a serious illness and common cause of mortality and morbidity. In the United States, 5.6 million cases of CAP occur annually, resulting in 4.5 million visits to physicians’ offices and 1.1 million hospitalizations. Detailed analyses from previously reported data of the two pivotal trials demonstrated that ceftaroline administered intravenously met the primary endpoint of non-inferiority in patients with moderate to severe CAP requiring hospitalization. Ceftaroline therapy was also generally well tolerated, with an adverse event profile similar to ceftriaxone.
Data Breakdown: Two randomized, double-blind, multicenter phase III studies—FOCUS 1 and FOCUS 2—were conducted, comparing clinical outcomes following treatment with ceftaroline versus ceftriaxone in hospitalized adult patients with moderate to severe CAP. Combined results of FOCUS 1 and FOCUS 2 demonstrated a clinical cure rate of 84.3% for ceftaroline and 77.7% for ceftriaxone in an integrated clinically evaluable patient population. The overall microbiological response rate in the microbiologically evaluable population was 87% for ceftaroline and 81% for ceftriaxone. In a microbiological modified intent-to-treat population, clinical cure rates were 84.8% for the ceftaroline group and 80.4% for the ceftriaxone cohort.
Take Home Pearl: Ceftaroline appears to be a promising new cephalosporin for the treatment of serious CAP in hospitalized patients.
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A New Therapy for CDI Recurrence?
The Particulars: Clostridium difficile infection (CDI) recurrence has become a serious problem in mortality, and there is a significant need for new therapies that keep patients from returning to the hospital. Mortality more than doubles when CDI is not cured after 1 year, and hospital stays are nearly 75% longer for CDI patients when compared with average stays.
Data Breakdown: In phase 3 analyses of previously reported recurrence data, patients treated with fidaxomicin—an investigational therapy for CDI—had a substantially lower recurrence rate (13.3%) than those treated with vancomycin (24.0%). The recurrence rate difference between fidaxomicin and vancomycin was even greater (10.9% vs 24.3%, respectively) in patients who did not receive CDI therapy (either vancomycin or metronidazole) in a 24-hour pre-trial enrollment period.
Take Home Pearl: Fidaxomicin may be more effective than vancomycin at reducing the recurrence of CDI.
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Increasing Survival in Adults Hospitalized With Influenza
The Particulars: The CDC recently issued updated interim recommendations for the use of antiviral medications to treat and prevent influenza for the 2009-2010 season. The guidance covers seasonal influenza as well as the pandemic influenza A (H1N1) virus.
Data Breakdown: A retrospective, observational study was conducted in two general hospitals in Hong Kong over 2 years, studying patients older than 18 who were hospitalized with confirmed influenza. Most patients were older (average age 70), 60% had underlying chronic illness, and 78% were hospitalized with influenza complications. Investigators analyzed 760 total patients, 395 of whom received oseltamivir phosphate. The rate of mortality was reduced by 37% in patients treated with oseltamivir phosphate when compared with patients who were not treated (3.8% in patients treated with oseltamivir phosphate vs 6.0% in patients receiving no treatment).
Take Home Pearl: Patients with influenza who are treated with oseltamivir phosphate appear to have significantly higher survival rates than untreated patients, further supporting the potential benefits of antiviral treatment in severe cases.
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Investigational Drug Promising in Flu Prevention & Treatment
The Particulars: DAS181 is an investigational broad spectrum drug candidate being evaluated in the treatment and prevention of influenza-like illness caused by all strains of influenza and parainfluenza. The agent works by inactivating the human receptor for these viruses. It may be less likely than currently-available antiviral drugs to encounter acquired resistance. Previous preclinical studies have shown that DAS181 has significant therapeutic and prophylactic activity in in vivo animal models and in human ex vivo lung tissue for a highly virulent H5N1 strain of influenza.
Data Breakdown: Two studies of DAS181 activity against H1N1 influenza and neuraminidase inhibitor-resistant influenza were performed in collaboration with researchers at the CDC, University of Hong Kong, and Saint Louis University. One study examined in vitro, ex vivo, and in vivo models to evaluate the activity of DAS181 against multiple human novel 2009 influenza A (H1N1) viruses. Data suggested that DAS181 exhibited potent inhibitory activity against these viruses in the different models. A second study examined in vivo and in vitro activity of DAS181 against patient isolates of community-acquired seasonal influenza from the 2008-2009 influenza season. All isolates had the H274Y mutation associated with resistance to oseltamivir phosphate. DAS181 in vitro was aneffective inhibitor of oseltamivir phosphate-resistant influenza virus.
Take Home Pearl: DAS181 may play an important role for public health preparedness during influenza pandemics.
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