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Eligible patients, who were treated with trimethoprim-sulfamethoxazole or macrolides, were retrospectively identified from our outpatient clinic in 2009. The two main outcome measures were sinonasal complaints and nasal endoscopic findings. A 5-point grading scale was used to score the results compared with the pre-treatment situation. This was measured at several time-points during, and after the antibiotic course, and at the end of the follow-up term.
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The purpose of this study was to compare the incidence of reinfection in patients who received oral antibiotic prophylaxis with those who did not following two-stage revision knee arthroplasty. Additional purposes included: (1) comparison of these findings to the infection rate in patients who underwent revision for aseptic reasons, and (2) characterisation of the organisms responsible for reinfection following revision procedures. Twenty-eight two-stage revision knee arthroplasty procedures were followed up by a mean of 33 days of oral antibiotics (range, 28-43 days), while the remaining 38 procedures received only 24-72 hours of in-patient antibiotics. The incidence of reinfection in each group within 12 months was compared. The reinfection rates were additionally compared to those of 237 patients who underwent revision for aseptic loosening over the same time period. Patients who were treated with postoperative antibiotic prophylaxis had a considerably lower reinfection rate, with one reinfection in the prophylaxis group (4%), compared to six reinfections in the no-prophylaxis group (16%). The reinfection rates remained higher compared to those found in patients who underwent revision knee arthroplasty for aseptic loosening (1 of 237 patients; 0.4%). Both high and low virulence organisms were identified in the patients who were subsequently reinfected. A minimum of 28 days of postoperative oral antibiotics appeared to decrease reinfection rates following two-stage revision knee arthroplasty. These results suggest that the use of oral antibiotic prophylaxis following re-implantation may be appropriate in all patients undergoing two-stage revision, even in the absence of any signs of active infection.
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Two long-term care facilities in St. Paul, MN.
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Cyclophosphamide has been used extensively for other dermatologic reactions. Relief of pain and regression of the lesions in our patient occurred more quickly than anticipated.
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The frequency of isolation of viridans streptococci from the blood of neutropenic patients with cancer has significantly increased over the course of the last 10-15 years. Risk factors in this patient population include severe neutropenia, oral mucositis, administration of high-dose cytosine arabinoside, and antimicrobial prophylaxis with either trimethoprim-sulfamethoxazole or a fluoroquinolone. In some patients with cancer and neutropenia who develop viridans streptococcal bacteremia, a toxic shock-like syndrome has been described; Streptococcus mitis has been the causative species in most cases. Because resistance of viridans streptococci to a variety of antimicrobial agents is increasingly recognized, penicillin susceptibility cannot be assumed, and empirical vancomycin therapy should be used to treat neutropenic patients with cancer who have shock or are developing acute respiratory distress syndrome. Given the seriousness of septicemia caused by viridans streptococci and the potential for selection of other resistant microorganisms, the routine practice of antimicrobial prophylaxis for neutropenic patients with cancer should be reconsidered.
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This study evaluates physician preferences for treatment and adherence to guidelines.
To investigate risk factors for pneumococcal carriage and non-susceptibility among HIV-infected mineworkers in South Africa.
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A thorough literature review, with the appropriate MeSH terms, was conducted using PubMed, Medline, and The Cochrane Database. A number of cases describing PJP in patients with various systemic diseases and immunosuppressive medications, along with a Cochrane review, were highlighted.