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2. Post-splenectomy sepsis: preventative strategies, challenges, and solutions

Author

Luu S, Spelman D, and Woolley IJ

Subjects
Splenectomy, sepsis, OPSI, asplenism, Infectious and parasitic diseases, RC109-216
Abstract

Sarah Luu,1 Denis Spelman,2,3 Ian J Woolley3–5 1Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia; 2Department of Infectious Diseases and Microbiology, Alfred Health, Melbourne, Victoria, Australia; 3Spleen Australia, Alfred Health, Melbourne, Victoria, Australia; 4Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia; 5Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, AustraliaCorrespondence: Ian J WoolleyMonash Infectious Diseases, Monash Medical Centre, Clayton Rd, Victoria 68, AustraliaTel +61 39 594 4533Fax +61 39 594 4564Email Ian.woolley@monash.eduAbstract: Removal of the spleen had already been established as a routine technique to treat splenic trauma and other diseases affecting the spleen before the anatomy, physiology, and function of the spleen were known in the mid-twentieth century. It is now widely accepted that the splenectomized individual is at increased risk for infection, in particular, overwhelming post-splenectomy infection (OPSI). OPSI is a syndrome of fulminant sepsis occurring in splenectomized (asplenic) or hyposplenic individuals that is associated with high mortality and morbidity. Poorly opsonized bacteria such as encapsulated bacteria, in particular, Streptococcus pneumoniae, are often implicated in sepsis. The spleen is a reticuloendothelial organ that facilitates opsonization and phagocytosis of pathogens, in addition to cellular maintenance. Splenectomy is associated with an impairment in immunoglobulin production, antibody-mediated clearance, and phagocytosis, leading to an increased risk of infection and sepsis. Early identification of the at-risk patient, early blood cultures prior to antibiotic administration, urgent blood smears and fast pathogen-detection tests, and sepsis bundles should be utilized in these patients. Prompt management and aggressive treatment can alter the course of disease in the at-risk splenectomized patient. Overwhelming post-splenectomy infection can be prevented through vaccination, chemoprophylaxis, and patient education. This article evaluates post-splenectomy sepsis by summarizing the anatomy and function of the spleen, physiological changes after splenectomy that predispose the splenectomized patient to infection, and current management and prevention strategies.Keywords: splenectomy, sepsis, OPSI, asplenism

Published
2019

10. Candida infective endocarditis

Author

Baddley, J. W., Benjamin, Jr., D. K., Patel, M., Miró, J., Athan, E., Barsic, B., Bouza, E., Clara, L., Elliott, T., Kanafani, Z., Klein, J., Lerakis, S., Levine, D., Spelman, D., Rubinstein, E., Tornos, P., Morris, A. J., Pappas, P., Fowler, Jr., V. G., Chu, V. H., Cabell, C., and The International Collaboration on Endocarditis—Prospective Cohort Study Group (ICE-PCS)

Published
2008
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23. ACKNOWLEDGEMENT OF REVIEWERS

Author

Adams, NG, Adekambi, T, Afeltra, J, Aguado, J, Aires de Sousa, M, Akiyoshi, K, Al Hasan, M, Ala-Kokko, T, Albert, M, Alfandari, S, Allen, D, Allerberger, F, Almyroudis, N, Alp, E, Amin, R, Anderson-Berry, A, Andes, DR, Andremont, A, Andreu, A, Angelakis, M, Antachopoulos, C, Antoniadou, A, Arabatzis, M, Arlet, G, Arnez, M, Arnold, C, Asensio, A, Asseray, N, Ausiello, C, Avni, T, Ayling, R, Baddour, L, Baguelin, M, Bányai, K, Barbour, A, Basco, LK, Bauer, D, Bayston, R, Beall, B, Becker, K, Behr, M, Bejon, P, Belliot, G, Benito-Fernandez, J, Benjamin, D, Benschop, K, Berencsi, G, Bergeron, MG, Bernard, K, Berner, R, Beyersmann, J, Bille, J, Bizzini, A, Bjarnsholt, T, Blanc, D, Blanco, J, Blot, S, Bohnert, J, Boillat, N, Bonomo, R, Bonten, M, Bordon, JM, Borel, N, Boschiroli, ML, Bosilkovski, M, Bosso, JA, Botelho-Nevers, E, Bou, G, Bretagne, S, Brouqui, P, Brun-Buisson, C, Brunetto, M, Bucher, H, Buchheidt, D, Buckling, A, Bulpa, P, Cambau, E, Canducci, F, Cantón, R, Capobianchi, M, Carattoli, A, Carcopino, X, Cardona-Castro, N, Carling, PC, Carrat, F, Castilla, J, Castilletti, C, Cavaco, L, Cavallo, R, Ceccherini-Silberstein, F, Centrón, D, Chappuis, F, Charrel, R, Chen, M, Chevaliez, S, Chezzi, C, Chomel, B, Chowers, M, Chryssanthou, E, Ciammaruconi, A, Ciccozzi, M, Cid, J, Ciofu, O, Cisneros, D, Ciufolini, MG, Clark, C, Clarke, SC, Clayton, R, Clementi, M, Clemons, K, Cloeckaert, Ael, Cloud, J, Coenye, T, Cohen Bacri, S, Cohen, R, Coia, J, Colombo, A, Colson, P, Concerse, P, Cordonnier, C, Cormican, M, Cornaglia, G, Cornely, O, Costa, S, Cots, F, Craxi, A, Creti, R, Crnich, C, Cuenca Estrella, M, Cusi, MG, d'Ettorre, G, da Cruz Lamas, C, Daikos, G, Dannaoui, E, De Barbeyrac, B, De Grazia, S, de Jager, C, de Lamballerie, X, de Marco, F, del Palacio, A, Delpeyroux, F, Denamur, E, Denis, O, Depaquit, J, Deplano, A, Desenclos, J-C, Desjeux, P, Deutch, S, Di Luca, D, Dianzani, F, Diep, B, Diestra, K, Dignani, C, Dimopoulos, G, Divizia, M, Doi, Y, Dornbusch, HJ, Dotis, J, Drancourt, M, Drevinek, P, Dromer, F, Dryden, M, Dubreuil, L, Dubus, J-C, Dumitrescu, O, Dumke, R, DuPont, H, Edelstein, M, Eggimann, P, Eis-Huebinger, A-M, El Atrouni, WI, Entenza, J, Ergonul, O, Espinel-Ingroff, A, Esteban, J, Etienne, J, Fan, X-G, Fenollar, F, Ferrante, P, Ferrieri, P, Ferry, T, Feuchtinger, T, Finegold, S, Fingerle, V, Fitch, M, Fitzgerald, R, Flori, P, Fluit, A, Fontana, R, Fournier, PE, François, M, Francois, P, Freedman, DO, Friedrich, A, Gallego, L, Gallinella, G, Gangneux, J-P, Gannon, V, Garbarg-Chenon, A, Garbino, J, Garnacho-Montero, J, Gatermann, Soeren, Gautret, P, Gentile, G, Gerlich, W, Ghannoum, M, Ghebremedhin, B, Ghigo, E, Giamarellos-Bourboulis, E, Girgis, R, Giske, C, Glupczynski, Y, Gnarpe, J, Gomez-Barrena, E, Gorwitz, RJ, Gosselin, R, Goubau, P, Gould, E, Gradel, K, Gray, J, Gregson, D, Greub, G, Grijalva, CG, Groll, A, Groschup, M, Gutiérrez, J, Hackam, DG, Hall, WA, Hallett, R, Hansen, S, Harbarth, S, Harf-Monteil, C, Hasanjani, Roushan MR, Hasler, P, Hatchette, T, Hauser, P, He, Q, Hedges, A, Helbig, J, Hennequin, C, Herrmann, B, Hezode, C, Higgins, P, Hoesli, I, Hoiby, N, Hope, W, Houvinen, P, Hsu, LY, Huard, R, Humphreys, H, Icardi, M, Imoehl, M, Ivanova, K, Iwamoto, T, Izopet, J, Jackson, Y, Jacobsen, K, Jang, TN, Jasir, A, Jaulhac, B, Jaureguy, F, Jefferies, JM, Jehl, F, Johnstone, J, Joly-Guillou, M-L, Jonas, M, Jones, M, Joukhadar, C, Kahl, B, Kaier, K, Kaiser, L, Kato, H, Katragkou, A, Kearns, A, Kern, W, Kerr, K, Kessin, R, Kibbler, C, Kimberlin, D, Kittang, B, Klaassen, C, Kluytmans, J, Ko, W-C, Koh, W-J, Kostrzewa, M, Kourbeti, I, Krause, R, Krcmery, V, Krizova, P, Kuijper, E, Kullberg, B-J, Kumar, G, Kunin, CM, La Scola, B, Lagging, M, Lagrou, K, Lamagni, T, Landini, P, Landman, D, Larsen, A, Lass-Floerl, C, Laupland, K, Lavigne, JP, Leblebicioglu, H, Lee, B, Lee, CH, Leggat, P, Lehours, P, Leibovici, Lonard, Leon, L, Leonard, N, Leone, M, Lescure, X, Lesprit, P, Levy, PY, Lew, D, Lexau, CA, Li, S-Y, Li, W, Lieberman, D, Lina, B, Lina, G, Lindsay, JA, Livermore, D, Lorente, L, Lortholary, O, Lucet, J-C, Lund, B, Lütticken, R, MacLeod, C, Madhi, S, Maertens, J, Maggi, F, Maiden, M, Maillard, J-Y, Maira-Litran, T, Maltezou, H, Manian, FA, Mantadakis, E, Maragakis, L, Marcelin, A-G, Marchaim, D, Marchetti, O, Marcos, M, Markotic, A, Martina, B, Martínez, J, Martinez, J-L, Marty, F, Maurin, M, McGee, L, Mediannikov, O, Meersseman, W, Megraud, F, Meletiadis, J, Mellmann, A, Meyer, E, Meyer, W, Meylan, P, Michalopoulos, A, Micol, R, Midulla, F, Mikami, Y, Miller, RF, Miragaia, M, Miriagou, V, Mitchell, TJ, Miyakis, S, Mokrousov, I, Monecke, S, Mönkemüller, K, Monno, L, Monod, M, Morales, G, Moriarty, F, Morosini, I, Mortensen, E, Mubarak, K, Mueller, B, Mühlemann, K, Muñoz Bellido, JL, Murray, P, Muscillo, M, Mylotte, J, Naessens, A, Nagy, E, Nahm, MH, Nassif, X, Navarro, D, Navarro, F, Neofytos, D, Nes, I, Ní Eidhin, D, Nicolle, L, Niederman, MS, Nigro, G, Nimmo, G, Nordmann, P, Nougairède, A, Novais, A, Nygard, K, Oliveira, D, Orth, D, Ortiz, JR, Osherov, N, Österblad, M, Ostrosky-Zeichner, L, Pagano, L, Palamara, AT, Pallares, R, Panagopoulou, P, Pandey, P, Panepinto, J, Pappas, G, Parkins, M, Parola, P, Pasqualotto, A, Pasteran, F, Paul, M, Pawlotsky, J-M, Peeters, M, Peixe, L, Pepin, J, Peralta, G, Pereyre, S, Perfect, JR, Petinaki, E, Petric, M, Pettigrew, M, Pfaller, M, Philipp, M, Phillips, G, Pichichero, M, Pierangeli, A, Pierard, D, Pigrau, C, Pilishvili, T, Pinto, F, Pistello, M, Pitout, J, Poirel, L, Poli, G, Poppert, S, Posfay-Barbe, K, Pothier, P, Poxton, I, Poyart, C, Pozzetto, B, Pujol, M, Pulcini, C, Punyadeera, C, Ramirez, M, Ranque, S, Raoult, D, Rasigade, J-P, Re, MC, Reilly, JS, Reinert, R, Renaud, B, Rice, L, Rich, S, Richet, H, Rigouts, L, Riva, E, Rizzo, C, Robotham, J, Rodicio, MR, Rodriguez, J, Rodriguez-Bano, J, Rogier, C, Roilides, E, Rolain, J-M, Rooijakkers, S, Rooney, P, Rossi, F, Rotimi, V, Rottman, M, Roux, V, Ruhe, J, Russo, G, Sadowy, E, Sagel, U, Said, SI, Saijo, M, Sak, B, Sa-Leao, R, Sanders, EAM, Sanguinetti, M, Sarrazin, C, Savelkoul, P, Scheifele, D, Schmidt, W-P, Schønheyder, H, Schönrich, G, Schrenzel, J, Schubert, S, Schwarz, K, Schwarz, S, Sefton, A, Segondy, M, Seifert, H, Seng, P, Senneville, E, Sexton, D, Shafer, RW, Shalit, I, Shankar, N, Shata, TM, Shields, J, Sibley, C, Sicinschi, L, Siljander, T, Simitsopoulou, M, Simoons-Smit, AM, Sissoko, D, Sjögren, J, Skiada, A, Skoczynska, A, Skov, R, Slack, M, Sogaard, M, Sola, C, Soriano, A, Sotto, A, Sougakoff, W, Souli, M, Spelberg, B, Spelman, D, Spiliopoulou, I, Springer, B, Stefani, S, Stein, A, Steinbach, WJ, Steinbakk, M, Strakova, L, Strenger, V, Sturm, P, Sullivan, P, Sutton, D, Symmons, D, Tacconelli, E, Tamalet, C, Tang, JW, Tang, Y-W, Tattevin, P, Thibault, V, Thomsen, RW, Thuny, F, Tong, S, Torres, C, Townsend, R, Tristan, A, Trouillet, J-L, Tsai, H-C, Tsitsopoulos, P, Tuerlinckx, D, Tulkens, P, Tumbarello, M, Tureen, J, Turnidge, JD, Turriziani, O, Tutuian, R, Uçkay, I, Upton, M, Vabret, A, Vamvakas, EC, van den Boom, D, Van Eldere, J, van Leeuwen, W, van Strijp, J, Van Veen, S, Vandamme, P, Vandenesch, F, Vayssier, M, Velin, D, Venditti, M, Venter, M, Venuti, A, Vergnaud, G, Verheij, T, Verhofstede, C, Viscoli, C, Vizza, CD, Vogel, U, Waller, A, Wang, YF, Warn, P, Warris, A, Wauters, G, Weidmann, M, Weill, F-X, Weinberger, M, Welch, D, Wellinghausen, N, Wheat, J, Widmer, A, Wild, F, Willems, R, Willinger, B, Winstanley, C, Witte, W, Wolff, M, Wong, F, Wootton, M, Wyllie, D, Xu, W, Yamamoto, S, Yaron, S, Yildirim, I, Zaoutis, T, Zazzi, M, Zbinden, R, Zehender, Gianguglielmo G, Zemlickova, H, Zerbini, ML, Zhang, L, Zhang, Y, Zhao, Y-D, Zhu, Z, and Zimmerli, W

Published
2011
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27. Mucormycete infection or colonisation: experience of an Australian tertiary referral centre.

Author

Langford, S., Trubiano, J. A., Saxon, S., Spelman, D., and Morrissey, C. O.

Subjects
MUCORMYCOSIS, TERTIARY care, RHIZOPUS, STEM cell transplantation, IMMUNOSUPPRESSIVE agents, PREDNISOLONE, THERAPEUTICS
Abstract

Mucormycosis is associated with significant morbidity and mortality. We reviewed patients with mucormycete isolated at Alfred Health, Australia. A retrospective review of 66 patients with mucormycete(s) identified, between 1 April 2008 and 30 June 2014. Baseline demographic, microbiological, radiological, treatment/outcome data were recorded. Site of isolation was sinopulmonary in 77% and skin/soft tissue in 21%. A total of 32% of cases were proven- IFD, 12% probable- IFD and 56% were defined as no- IFD (or colonisation). Rhizopus spp. was identified in 48%. Comparing probable/proven- IFD with no- IFD/colonisation, more patients were postallogeneic stem cell transplantation (28% vs. 0%, P < 0.01) and were receiving immunosuppressive therapy (59% vs. 24%, P < 0.01) including prednisolone >20 mg daily (24% vs. 5%, P = 0.04). A total of 93% of patients with proven/probable IFD received treatment while 30% of no- IFD/colonisation were treated. A total of 72% of patients with proven/probable IFD and 92% of those with colonisation had no further mucormycete isolated. Thirty day mortality was higher in the proven/probable- IFD cohort (24%) compared with no- IFD/colonisation (3%) ( P = 0.02). Mucormycosis remains uncommon, with 56% of cases not associated with clinical infection. Immunosuppressive therapy remains strongly associated with mucormycosis. Mortality remains high in those with proven/probable IFD. [ABSTRACT FROM AUTHOR]

Published
2016
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28. Travel risk assessment, advice and vaccinations in immunocompromised travellers (HIV, solid organ transplant and haematopoeitic stem cell transplant recipients): A review.

Author

Aung, A. K., Trubiano, J. A., and Spelman, D. W.

Abstract

International travellers with immunocompromising conditions such as human immunodeficiency virus (HIV) infection, solid organ transplantation (SOT) and haematopoietic stem cell transplantation (HSCT) are at a significant risk of travel-related illnesses from both communicable and non-communicable diseases, depending on the intensity of underlying immune dysfunction, travel destinations and activities. In addition, the choice of travel vaccinations, timing and protective antibody responses are also highly dependent on the underlying conditions and thus pose significant challenges to the health-care providers who are involved in pre-travel risk assessment. This review article provides a framework of understanding and approach to aforementioned groups of immunocompromised travellers regarding pre-travel risk assessment and management; in particular travel vaccinations, infectious and non-infectious disease risks and provision of condition-specific advice; to reduce travel-related mortality and morbidity. [ABSTRACT FROM AUTHOR]

Published
2015
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29. DETERMINING THE INTERACTION BETWEEN THE RIO GRANDE AND RIVERSIDE DRAINS USING AN ADCP.

Author

Kinzli, K., Shafike, N., Manana, N., Spelman, D., and Roark, M.

Subjects
GROUNDWATER, ACOUSTIC Doppler current profiler, DRAINAGE, SEEPAGE
Abstract

ABSTRACT The Middle Rio Grande (MRG), located in central New Mexico, is a river that has experienced significant anthropomorphic changes and requires extensive river management to meet all demands for water. To better understand and manage the MRG, the Upper Rio Grande Water Operations Model was developed by several government agencies; however, drain accretion rates, total seepage volumes from the river to the drain network, and salinity were unknown and represented a large data gap. In 2010, a study using an Acoustic Doppler Current Profiler was conducted to determine drain accretion rates throughout the MRG valley. The use of an Acoustic Doppler Current Profiler allowed for a multitude of measurements to be completed in a short-time span. The total yearly baseline drain accretion determined during the study was 269 630 AF, which represents about 59% of the water that is diverted annually in the MRG. The magnitude of the drain accretion was much higher than expected and represents a tangible water volume that needs to be addressed in water accounting and management decisions. The New Mexico Interstate Stream Commission is currently using the collected data to improve Upper Rio Grande Water Operations Model and results from the study will aid the Middle Rio Grande Conservancy District in improving water delivery operations. The findings of this study indicate that a complex groundwater, drain, and river water interaction is taking place near the San Acacia diversion dam with upwelling saline groundwater increasing drain water salinity to levels as high as 1703 μS. Further detailed study of groundwater and river water interactions is suggested in this area. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Published
2014
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31. Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices.

Author

Athan E, Chu VH, Tattevin P, Selton-Suty C, Jones P, Naber C, Miró JM, Ninot S, Fernández-Hidalgo N, Durante-Mangoni E, Spelman D, Hoen B, Lejko-Zupanc T, Cecchi E, Thuny F, Hannan MM, Pappas P, Henry M, Fowler VG Jr, and Crowley AL

Abstract

Context: Infection of implantable cardiac devices is an emerging disease with significant morbidity, mortality, and health care costs.Objectives: To describe the clinical characteristics and outcome of cardiac device infective endocarditis (CDIE) with attention to its health care association and to evaluate the association between device removal during index hospitalization and outcome.Design, Setting, and Patients: Prospective cohort study using data from the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), conducted June 2000 through August 2006 in 61 centers in 28 countries. Patients were hospitalized adults with definite endocarditis as defined by modified Duke endocarditis criteria.Main Outcome Measures: In-hospital and 1-year mortality.Results: CDIE was diagnosed in 177 (6.4% [95% CI, 5.5%-7.4%]) of a total cohort of 2760 patients with definite infective endocarditis. The clinical profile of CDIE included advanced patient age (median, 71.2 years [interquartile range, 59.8-77.6]); causation by staphylococci (62 [35.0% {95% CI, 28.0%-42.5%}] Staphylococcus aureus and 56 [31.6% {95% CI, 24.9%-39.0%}] coagulase-negative staphylococci); and a high prevalence of health care-associated infection (81 [45.8% {95% CI, 38.3%-53.4%}]). There was coexisting valve involvement in 66 (37.3% [95% CI, 30.2%-44.9%]) patients, predominantly tricuspid valve infection (43/177 [24.3%]), with associated higher mortality. In-hospital and 1-year mortality rates were 14.7% (26/177 [95% CI, 9.8%-20.8%]) and 23.2% (41/177 [95% CI, 17.2%-30.1%]), respectively. Proportional hazards regression analysis showed a survival benefit at 1 year for device removal during the initial hospitalization (28/141 patients [19.9%] who underwent device removal during the index hospitalization had died at 1 year, vs 13/34 [38.2%] who did not undergo device removal; hazard ratio, 0.42 [95% CI, 0.22-0.82]).Conclusions: Among patients with CDIE, the rate of concomitant valve infection is high, as is mortality, particularly if there is valve involvement. Early device removal is associated with improved survival at 1 year. [ABSTRACT FROM AUTHOR]

Published
2012
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37. Nocardia Infection in Heart-Lung Transplant Recipients at Alfred Hospital, Melbourne, Australia...

Author

Roberts, S. A., Franklin, J. C., and Spelman, D.

Subjects
COMPLICATIONS from organ transplantation, NOCARDIA
Abstract

Reports on Nocardia infections or nocardiosis in patients undergoing lung-heart transplantations at Alfred Hospital in Melbourne, Victoria. Factors that increase the risk of Nocardia infection in the group; Frequency of occurrence on infection; Susceptibility of all isolates to trimethoprim-sulfamethoxazole, amikacin and imipenem.

Published
2000
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41. Absence of toxicity in patients with malignant otitis externa following long-term treatment with high dosage tobramycin.

Author

Ioannides-Demos, L. L., Li, S. C., Bastone, E. B., Spelman, D. W., Hooper, R. E., Cousins, V. C., and McLean, A. J.

Abstract

An in-vitro model of aminoglycoside dosing was used to demonstrate that the bactericidal activity of tobramycin against Pseudomonas aeruginosa is directly related to the peak concentration of the drug. In addition, six patients who were being treated for malignant otitis externa with long-term, high dosage tobramycin were monitored for oto- and nephro-toxicity; the only adverse effects were transient increases in the serum creatinine concentration in two patients. [ABSTRACT FROM AUTHOR]

Published
1994

42. Dosage adjustment and clinical outcomes of long-term use of high-dose tobramycin in adult cystic fibrosis patients.

Author

Li, Shu C., Bowes, Glenn, Ioannides-Demos, Lisa L., Spicer, W. John, Hooper, Robin E., Spelman, Denis W., Tong, Nicholas, McLean, Allan J., Li, S C, Bowes, G, Ioannides-Demos, L L, Spicer, W J, Hooper, R E, Spelman, D W, Tong, N, and McLean, A J

Abstract

A two-phase study was undertaken designed to investigate the impact of computer-aided drug monitoring on tobramycin concentrations and clinical outcomes in adult patients with cystic fibrosis. In phase one, a baseline (historical control) study of drug use patterns was performed. During the second phase, patients admitted for intravenous treatment with tobramycin for acute exacerbations of pseudomonal pulmonary infections were randomly allocated to one of two schedules. Group A patients had tobramycin dosage regimens decided by clinicians based on pre-existing protocols using serum tobramycin assay data determined three times weekly. Group B patients had dosage regimens determined by a computerized pharmacokinetic predictive program using both population-based pharmacokinetic parameter estimation and fitting of serum concentration-time data using Bayesian regression. The agreed therapeutic target was a peak serum tobramycin concentration of 8–10 mg/L and a trough concentration of 1–2 mg/L. There was a major difference between the two groups comparing the number of paired trough and peak concentrations within the target concentration ranges (group A–14%; group B–34·7%, χ test, < 0001). Average peak tobramycin level was higher in group A patients (A = 8·2±2·2 mg/L; B = 7·5± 1·9 mg/L; < 0·005) while average trough level was higher in group B patients (A = 0·78±0·44 mg/L; B = 1·01±0·42 mg/L; < 0·05). Average dosage was higher in group B patients (A = 8·56±2·36 mg/kg/day; B = 9·56±1·83 mg/kg/day; < 0·05) and average dosing interval was shorter in group B patients (A = 8·05±1·01 h: B = 6·57±0·82 h; < 0·05). No difference in clinical outcome or mortality was observed and mean hospital stay was not different between the two groups. No case of aminoglycoside-induced nephrotoxicity or ototoxicity was observed. We conclude that the use of a computerized predictive programme can improve the control of aminoglycoside concentration-time profiles and allow targeted dosing without toxicity. The system allows for the possibility of tailoring dosage regimens aimed at optimizing efficacy and quality of life with minimal toxicity. [ABSTRACT FROM PUBLISHER]

Published
1991

45. Cryptosporidiosis in patients with AIDS.

Author

Stuart, Rhonda L., Hellard, Margaret E., Jolley, Damien, Spelman, Denis, Hoy, Jennifer, Stevenson, Elaine M., Yates, Maria T., Ryan, Norbert J., Fairley, Christopher K., Stuart, R L, Hellard, M E, Jolley, D, Spelman, D, Hoy, J, Stevenson, E M, Yates, M T, Ryan, N J, and Fairley, C K

Subjects
CRYPTOSPORIDIOSIS, AIDS patients, DIAGNOSIS, DISEASE risk factors, ANIMALS, SEASONS, AIDS-related opportunistic infections, DISEASE complications
Abstract

Cases of cryptosporidiosis in patients with the acquired immunodeficiency syndrome (AIDS) residing in Melbourne over a 6-year period (1990-1995) are described. During this period 85 cases occurred, while 979 new AIDS diagnoses were notified. Over this period temporal clustering in cryptosporidial detection was evident (P=0.007), but the pattern was not statistically associated with the season, rainfall (P=0.88), mean average maximal temperature (P=0.15) or mean average minimal temperature. Further studies should identify these risk factors and provide an opportunity to prevent this devastating disease. [ABSTRACT FROM AUTHOR]

Published
1997
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