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Intravenous (IV) zanamivir could be a suitable alternative for the treatment of severe influenza A(H1N1)pdm09 infection in patients who are unable to take oral or inhaled medication, for example, those on mechanical ventilation and extracorporeal membrane oxygenation (ECMO). However, data on the clinical outcomes of such patients is limited.
We report the clinical outcomes of four patients who were admitted at the intensive care unit during the 2017–2018 influenza season with severe sepsis (SOFA score > 11) and acute respiratory distress syndrome requiring ECMO and mechanical ventilation. Two patients were immune-compromised. The A(H1N1)pdm09 genome was confirmed by polymerase chain reaction (PCR) on nasopharyngeal specimen swabs prior to administration of IV zanamivir at a dose of 600 mg twice daily. Weekly qualitative PCR analysis was done to monitor viral clearance, with zanamivir treatment being discontinued upon receipt of negative results. In addition, the patients were managed for concomitant multidrug-resistant bacterial infections, with infection resolution confirmed with blood cultures.
The median time for zanamivir treatment was 10 days (IQR 10–17). The clinical outcome was favourable with all four patients surviving and improving clinically. All four patients achieved viral clearance of A(H1N1)pdm09 genome, and resolution of multidrug-resistant bacterial infections.
IV zanamivir could be a good therapeutic option in patients with severe influenza A(H1N1)pdm09 infection who are unable to take oral or aerosolised antiviral medication. We recommend prospective randomized control trials to support this hypothesis.
John F. McNamara, Patrick NA. Harris, Mark D. Chatfield, Penelope Lorenc, David L. Paterson
To evaluate the sequential organ failure assessment (SOFA), modified SOFA scoring and a novel performance score based on the Karnofsky score for measuring outcome following a bloodstream infection.
The sepsis-induced immunodepression contributes to impaired clinical outcomes of various stress conditions. This syndrome is well documented and characterized by attenuated function of innate and adaptive immune cells. Several pharmacological interventions aimed to restore the immune response are emerging of which interferon-gamma (IFNγ) is one. It is of paramount relevance to obtain clinical information on optimal timing of the IFNγ-treatment, −tolerance, −effectiveness and outcome before performing a RCT. We describe the effects of IFNγ in a cohort of 18 adult and 2 pediatric sepsis patients.
In this open-label prospective multi-center case-series, IFNγ treatment was initiated in patients selected on clinical and immunological criteria early ( 7 days) following the onset of sepsis. The data collected in 18 adults and 2 liver transplanted pediatric patients were: clinical scores, monocyte expression of HLA-DR (flow cytometry), lymphocyte immune-phenotyping (flow cytometry), IL-6 and IL-10 plasma levels (ELISA), bacterial cultures, disease severity, and mortality.
In 15 out of 18 patients IFNγ treatment was associated with an increase of median HLA-DR expression from 2666 [IQ 1547; 4991] to 12,451 [IQ 4166; 19,707], while the absolute number of lymphocyte subpopulations were not affected, except for the decrease number of NK cells 94.5 [23; 136] to 32.5 [13; 90.8] (0.0625)]. Plasma levels of IL-6 464 [201–770] to 108 (89–140) ng/mL (p = 0.04) and IL-10 from IL-10 from 29 [12–59] to 9 [1–15] pg/mL decreased significantly. Three patients who received IFNγ early after ICU admission (
Fei Peng, Wei Chang, Chun Pan, Yi Yang
We appreciated the comments by Dr van Oers and colleagues concerning the effect of PCT-guided cessation of antibiotics in patients with the SOFA score less than 8. Our meta-analysis revealed that PCT-guided cessation of antibiotic therapy decreased the short-term mortality in patients with an average SOFA score < 8, suspected sepsis or lower algorithm adherence (< 70%), but not in those with a score > 8, confirmed sepsis or higher adherence(Peng et al., 2019). Compared to the standard care group, PCT-guided antibiotic therapy failed to decrease the mortality or shorten the ICU length of stay, as previous trials reported(Bouadma et al., 2010; Jensen et al., 2011; Bloos et al., 2016).
Jos A.H. van Oers, Maarten W Nijsten, Evelien de Jong, Albertus Beishuizen, Dylan W de Lange
Retningslinjer til sundhedsprofessionelle vedr. håndtering af infektion med zikavirus (2019)
Antiviral behandling af hiv smittede personer (2019)
Lumbalpunktur af patienter i blodfortyndende behandling (2019)
Lack of weight gain during the first two months of treatment and HIV independently predict unsuccessful treatment outcomes in tuberculosis
14.11.2019The Journal of Infectious Diseases Advance Access
Diverse HIV-1 Drug Resistance Profiles at Screening for ACTG A5288: A Study of People Experiencing Virologic Failure on Second-line ART in Resource Limited Settings
14.11.2019Clinical Infectious Diseases Advance Access
Tuberculosis outbreaks among students in mainland China: a systematic review and meta-analysis
14.11.2019Latest Results for BMC Infectious Diseases
Correction to: Malaria control across borders: quasi-experimental evidence from the Trans-Kunene malaria initiative (TKMI)
14.11.2019Latest Results for Malaria Journal
Analysis on external competency assessment for malaria microscopists in China
14.11.2019Latest Results for Malaria Journal
Hvad synes Professor Troels Lillebæk om"The global prevalence of latent tuberculosis: a systematic review and meta-analysis."?
Hvorfor anbefaler Professor Lars Østergaard artiklen"Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial."?
Hvorfor synes Professor Thomas Benfield, at du bør læse"Oral versus Intravenous Antibiotics for Bone and Joint Infection."?
Hvorfor anbefaler Professor Niels Obel artiklen"Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis."?
Hvad synes Professor Thomas Benfield om"Duration of Antibiotic Treatment in Community-Acquired Pneumonia: A Multicenter Randomized Clinical Trial."?
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