<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_407"
                     title="ICU Catheter Infections Can Be Virtually Eliminated (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/CriticalCare/InfectionControl/tb/18308?impressionId=1265810067281"
                     
      Catheter-related infections aren&apos;t inevitable in the ICU, according to a quality initiative that maintained rates at nearly zero for three years in Michigan hospitals.&lt;br&gt;
&lt;br&gt;The maintenance phase, after initial implementation of low-tech measures such as handwashing and removal of unneeded catheters, saw no rebound in catheter-related infections, Peter J. Pronovost, MD, PhD, of Johns Hopkins, and colleagues reported online in &lt;em&gt;BMJ&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The first 18 months of their &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/4771&quot; mce_href=&quot;http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/4771&quot; target=&quot;_blank&quot;&gt;Keystone ICU initiative&lt;/a&gt; dropped catheter-related interventions from a mean of 7.7 and median of 2.2 per 1,000 catheter days down to 1.3 and 0, respectively.&lt;br&gt;
&lt;br&gt;At the 36 month mark, infection rates remained almost nil, at a mean of 1.1 and median of 0 per 1,000 catheter days.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;&quot;For the most part, hospitals view these infections as inevitable, as the cost of doing business, that patients are too sick, that these can&apos;t be prevented,&quot; Pronovost told &lt;em&gt;MedPage Today&lt;/em&gt;. &quot;That&apos;s just not true.&quot;&lt;/p&gt;
&lt;p&gt;Catheter-related infections are the number one cause of preventable death in hospitals and ICUs, ahead of even ventilator-related pneumonia, he noted.&lt;/p&gt;
&lt;p&gt;The changes seen at the 90 Michigan ICUs that stayed with the catheter-related infection initiative were impressive, representing one of the largest and longest improvements the field has seen.&lt;/p&gt;
&lt;p&gt;Often, quality initiatives fail on durability after the study funding and resources disappear, and hospitals are left on their own, Pronovost noted.&lt;/p&gt;
&lt;p&gt;&quot;If you push you might get some effect, but then you stop pushing  --  in other words the external control goes away  --  and the performance goes right back down,&quot; he said in an interview. &quot;It can&apos;t just be the stick that drives it.&quot;&lt;/p&gt;
&lt;p&gt;The intervention started with 103 ICUs that implemented strategies to reduce rates of catheter-related bloodstream infections rates over 18 months, with measurement and feedback of infection rates.&lt;/p&gt;
&lt;p&gt;The strategies aimed at improving execution of five evidence-based recommendations, as follows: &lt;ul&gt; &lt;li&gt;Hand washing before insertion of the catheter&lt;/li&gt; &lt;li&gt;Using gowns and full barrier precautions at catheter insertion&lt;/li&gt; &lt;li&gt;Cleaning the skin with chlorhexidine before catheter insertion&lt;/li&gt; &lt;li&gt;Avoiding the femoral site when possible&lt;/li&gt; &lt;li&gt;Removing unnecessary catheters&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Then, over the subsequent 18-month maintenance period, ICU teams were instructed to integrate this intervention into staff orientation, to collect monthly data from hospital infection control staff, and to report infection rates to physicians and others.&lt;/p&gt;
&lt;p&gt;Along with the sustained reduction in overall catheter-related infections, the researchers found a prolonged reduction in bloodstream infections that was significant during all study periods, compared to baseline.&lt;/p&gt;
&lt;p&gt;Rates decreased from a mean of 7.7 and median 2.7 of per 1,000 catheter days at baseline to 1.3 and 0, respectively, at 16 to 18 months after implementation. They remained at 1.1 and 0 at months 34 to 36 (-1% versus 18 months, 95% CI -9% to +7%).&lt;/p&gt;
&lt;p&gt;ICU teams interviewed attributed the continuously low rates to five factors: &lt;ul&gt; &lt;li&gt;Continued feedback on infection data&lt;/li&gt; &lt;li&gt;Improvements in safety culture as part of the project&lt;/li&gt; &lt;li&gt;An &quot;unremitting belief in the preventability of bloodstream infections&quot;&lt;/li&gt; &lt;li&gt;Involvement of senior leaders&lt;/li&gt; &lt;li&gt;A noncompetitive, shared goal to reduce infection rates throughout the state&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Of these, Pronovost called culture change in the ICUs the key factor to sustainability, although the researchers cautioned that which aspects contributed were not formally evaluated.&lt;/p&gt;
&lt;p&gt;They said they could not determine the impact incentive payments from Blue Cross Blue Shield of Michigan to hospitals that continued their participation  --  payments that were based on performance thresholds in subsequent years.&lt;/p&gt;
&lt;p&gt;Pronovost&apos;s team is now working to implement the quality initiative state-by-state nationwide, supported by the Agency for Healthcare Research and Technology.&lt;/p&gt;
&lt;p&gt;&quot;It seems absurd that this wouldn&apos;t be in every hospital in the country,&quot; he said in an interview. &quot;It&apos;s worked on a large scale, it&apos;s exceedingly cheap, there&apos;s no fancy technology.&quot;&lt;/p&gt;
&lt;p&gt;Success isn&apos;t only for community hospitals, Pronovost emphasized.&lt;/p&gt;
&lt;p&gt;Large, often academic, medical centers frequently express the conviction that their sicker, more complex ICU population wouldn&apos;t produce the same results, that their infections truly are inevitable, he said.&lt;/p&gt;
&lt;p&gt;&quot;To them I say, Not so,&quot; he told &lt;em&gt;MedPage Today&lt;/em&gt;. &quot;We have shown at Johns Hopkins, at the University of Michigan, at Pittsburgh, using a similar but different approach, at Tufts  --  many large academic medical centers have had dramatic reductions of these infections.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The project was supported, for the period from October 2003 to September 2005, by the Agency for Healthcare Research and Quality and the Michigan Health &amp;amp; Hospital Association.&lt;/p&gt;&lt;p&gt;Pronovost and a co-author reported receiving received lecture fees from various healthcare organizations and grant support from the Agency for Healthcare Research and Quality, the Robert Wood Johnson Foundation, the National Patient Safety Agency, and the World Health Organization to study and improve quality of care, including catheter-related bloodstream infections.&lt;/p&gt;&lt;p&gt;Co-authors reported conflicts of interest with government agencies, Cubist, Astellas, Merck, Forrest, Cadence, the Robert Wood Johnson Foundation, Lilly, Edward Life Sciences, and Sage.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_301"
                     title="Tight Glucose Control Fails in Septic Shock (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/CriticalCare/Sepsis/tb/18160?impressionId=1265810067281"
                     
      Septic shock patients treated with a corticosteroid get no survival advantage from tight glucose control or addition of a second corticosteroid to provide more mineralocorticoid activity, according to results of a randomized trial.&lt;br&gt;
&lt;br&gt;Aiming for normoglycemia at 80 to 110 mg/dL rather than the standard 150 mg/dL had no impact on inhospital mortality rates (45.9% versus 42.9%, &lt;em&gt;P&lt;/em&gt;=0.50), Djillali Annane, MD, of H&amp;#244;pital Raymond Poincar&amp;#233; in Garches, France, and colleagues found.&lt;br&gt;
&lt;br&gt;Inhospital mortality was likewise similar whether patients got hydrocortisone (Solu-Cortef) alone or with the addition of fludrocortisone ([Florinef] 42.9% versus 45.8%, &lt;em&gt;P&lt;/em&gt;=0.50), they reported in the Jan. 27 issue of the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;This aggressive treatment strategy should not be routine, the researchers recommended.&lt;/p&gt;
&lt;p&gt;These findings largely match the general lack of benefit seen with tight glycemic control in recent studies with ICU patients overall.&lt;/p&gt;
&lt;p&gt;The prematurely terminated &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/SCCM/5096&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/SCCM/5096&quot; target=&quot;_blank&quot;&gt;European Glucontrol Trial&lt;/a&gt; found no mortality benefit but a seven-fold higher risk of hypoglycemia with an 80 to 110 mg/dL target in the ICU.&lt;/p&gt;
&lt;p&gt;In the &lt;a href=&quot;http://www.medpagetoday.com/CriticalCare/Intensivists/13397&quot; mce_href=&quot;http://www.medpagetoday.com/CriticalCare/Intensivists/13397&quot; target=&quot;_blank&quot;&gt;NICE-SUGAR&lt;/a&gt; study, 90-day mortality was actually higher in the tight glucose control group (27.9% versus 24.9%, &lt;em&gt;P&lt;/em&gt;=0.02), although there was a trend for benefit in patients who got corticosteroids (&lt;em&gt;P&lt;/em&gt;=0.06).&lt;/p&gt;
&lt;p&gt;Glucose targets are being re-evaluated across medicine as the &quot;lower is better&quot; paradigm has had a safety asterisk added everywhere from diabetes care to the ICU, noted Richard Bergenstal, MD, American Diabetes Association president for medicine and science.&lt;/p&gt;
&lt;p&gt;&quot;All of a sudden it&apos;s becoming more than a single number,&quot; he told &lt;em&gt;MedPage Today&lt;/em&gt;. &quot;Now be it inpatient or outpatient, we&apos;re realizing that ... you have to do it while you&apos;re minimizing hypoglycemia.&quot;&lt;/p&gt;
&lt;p&gt;A more nuanced and &lt;a href=&quot;http://www.medpagetoday.com/Cardiology/Diabetes/13818&quot; mce_href=&quot;http://www.medpagetoday.com/Cardiology/Diabetes/13818&quot; target=&quot;_blank&quot;&gt;individualized&lt;/a&gt; strategy is prudent, Bergenstal agreed.&lt;/p&gt;
&lt;p&gt;The current clinical uncertainty underscores the need for large-scale international cooperation to get adequately powered trials, according to an accompanying editorial.&lt;/p&gt;
&lt;p&gt;In it, Greet Van den Berghe, MD, PhD, of the Catholic University of Leuven, Belgium, cautioned that Annane&apos;s Corticosteroids and Intensive Insulin Therapy for Septic Shock (COIITSS) study was grossly underpowered.&lt;/p&gt;
&lt;p&gt;The initial studies that led to rapid adoption of intensive insulin therapy in ICUs around the world had suggested an absolute reduction in mortality of only 3%, whereas the COIITSS study projected a 12.5% absolute benefit.&lt;/p&gt;
&lt;p&gt;More importantly, the study achieved mean glucose levels of only between 120 and 130 mg/dL in the intervention group for whom the aim was 80 to 110 mg/dL, which resulted in considerable overlap with the standard care group for whom mean levels were about 145 mg/dL.&lt;/p&gt;
&lt;p&gt;This could account for the lack of difference in outcome, Van den Berghe said.&lt;/p&gt;
&lt;p&gt;But the intensive insulin group did have &quot;markedly&quot; lower blood glucose levels for the duration of their ICU stay and spent more time in the 80 to 110 mg/dL range compared with the standard care group (both &lt;em&gt;P&lt;/em&gt;&amp;lt;0.00001), the researchers noted.&lt;/p&gt;
&lt;p&gt;Because corticosteroids further aggravate the &quot;diabetes of injury&quot; seen with septic shock, Annane&apos;s group undertook a multicenter trial of 509 adults treated for septic shock with multiple organ dysfunction over a three year period at 11 ICUs in France.&lt;/p&gt;
&lt;p&gt;Patients were randomly assigned to tight glucose control using continuous intravenous insulin infusion to target a glucose level of 80 to 110 mg/dL or conventional insulin therapy targeted to guidelines-recommended 150 mg/dL or under. They were additionally randomized to receive hydrocortisone alone (50-mg bolus every six hours) or in combination with fludrocortisone (50-&amp;#956;g tablets once daily) for seven days.&lt;/p&gt;
&lt;p&gt;Aside from the lack of inhospital mortality advantage, tight glucose control also failed to produce a benefit for the following secondary endpoints: &lt;ul&gt; &lt;li&gt;Overall survival (hazard ratio 1.04, &lt;em&gt;P&lt;/em&gt;=0.78) &lt;/li&gt; &lt;li&gt; ICU length of stay for survivors (median 10 versus nine days, &lt;em&gt;P&lt;/em&gt;=0.68)&lt;/li&gt; &lt;li&gt;Duration of hospital stay overall (24 versus 22 days, &lt;em&gt;P&lt;/em&gt;=0.87)&lt;/li&gt; &lt;li&gt;Median vasopressor-free days (four for both, P=0.58)&lt;/li&gt; &lt;li&gt;Median mechanical ventilation-free days (10 versus 13, &lt;em&gt;P&lt;/em&gt;=0.51)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Nor was there evidence for interaction with fludrocortisone in the primary endpoint (relative risk 0.89 versus 0.91 hydrocortisone alone, &lt;em&gt;P&lt;/em&gt;=0.31) or benefit in any other endpoint.&lt;/p&gt;
&lt;p&gt;The one effect of intensive insulin appeared to be an increase in episodes of severe hypoglycemia, defined by glucose falling below 40 mg/dL (mean 0.29 versus 0.14 episodes per patient, &lt;em&gt;P&lt;/em&gt;=0.003).&lt;/p&gt;
&lt;p&gt;However, having hypoglycemia did not increase the risk of death in intervention group patients compared with controls (45.2% versus 50%).&lt;/p&gt;
&lt;p&gt;The researchers cautioned that the study did not rule out a benefit from some degree of glucose control compared with none.&lt;/p&gt;
&lt;p&gt;They also noted that healthcare providers were not blinded to administration of fludrocortisone, for which no placebo was available.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the Assistance Publique&amp;#8211;H&amp;#244;pitaux de Paris. The researchers reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;Van den Berghe, through the Catholic University of Leuven, reported receiving structural research financing from the Methusalem program, funded by the Flemish government.&lt;/p&gt;&lt;p&gt;Bergenstal reported receiving research funding and serving on advisory boards for various pharmaceutical companies related to novel diabetes drugs but without any personal financial compensation.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_255"
                     title="Biomarker Guideline Reduced Antibiotic Use (CME/CE)"
                     score="0.001"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/InfectionControl/tb/18114?impressionId=1265810067281"
                     
      &lt;p&gt;A biomarker-guided strategy for antibiotics in intensive care units reduced drug use without increasing mortality, French researchers said.&lt;/p&gt;
&lt;p&gt;In a randomized, open-label study, the biomarker procalcitonin allowed physicians to reduce the quantity of antibiotics they prescribed, according to Michel Wolff, MD, of H&amp;#244;pital Bichat-Claude-Bernard in Paris, and colleagues.&lt;/p&gt;
&lt;p&gt;In principle, the approach could slow the emergence of antibiotic resistance, Wolff and colleagues concluded online in &lt;em&gt;The Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Procalcitonin is thought to be a &quot;fairly specific marker for severe bacterial infection in patients with suspected sepsis,&quot; the researchers noted in the journal.&lt;/p&gt;
&lt;p&gt;As well, serum procalcitonin concentrations have been shown to be a useful guide to reducing antibiotic use in patients with lower-respiratory-tract infections, they said.&lt;/p&gt;
&lt;p&gt;But the value of the biomarker in reducing inappropriate antibiotic use has not been shown in all intensive care patients, they said. To fill the gap, they conducted a prospective study of 630 patients in eight French ICUs.&lt;/p&gt;
&lt;p&gt;Patients were randomly assigned to be treated according to usual antibiotic protocols or to have their therapy guided by procalcitonin levels.&lt;/p&gt;
&lt;p&gt;For patients in the procalcitonin group, doctors were encouraged to start antibiotics at inclusion if the levels were 0.5 micrograms per liter or greater. Otherwise, they were discouraged from doing so.&lt;/p&gt;
&lt;p&gt;They were also encouraged to stop antibiotics, once started, if the procalcitonin concentration fell by 80% or more from its peak, or if the concentration was below 0.5 micrograms per liter.&lt;/p&gt;
&lt;p&gt;The primary endpoints were death from any cause at 28 and 60 days and differences in antibiotic use.&lt;/p&gt;
&lt;p&gt;The researchers reported: &lt;ul&gt; &lt;li&gt;At 30 days, mortality in the procalcitonin group was 21.2%, compared with 20.4% in the control group, for an absolute difference of 0.8%. That was well below the pre-set 10% difference for non-inferiority.&lt;/li&gt; &lt;li&gt;At 60 days, the comparable figures were 30% and 26.1%, for an absolute difference of 3.8%, which also established non-inferiority.&lt;/li&gt; &lt;li&gt;Patients in the procalcitonin group had 14.3 days without antibiotics, on average, compared with 11.6 days in the control group. The absolute difference of 2.7 days was significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The researchers cited a number of limitations, including the open design, which might have permitted bias, and a low number of surgical patients, which may limit how widely the findings can be applied.&lt;/p&gt;
&lt;p&gt;As well, they noted, 53% of patients in the procalcitonin group did not get therapy guided by the study protocol. Despite that, Wolff and colleagues said, the results remained statistically significant if those patients were excluded.&lt;/p&gt;
&lt;p&gt;Various studies have shown that it&apos;s possible to curtail unnecessary antibiotic use in hospitals, according to Marin Kollef, MD, of Washington University School of Medicine in St Louis.&lt;/p&gt;
&lt;p&gt;But because of the limitations of the French study, it remains unclear whether using procalcitonin is the best approach, he wrote in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;&quot;Whether the ideal strategy involves the use of a serum marker such as procalcitonin or a locally applied practice protocol remains to be established,&quot; Kollef concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Assistance Publique-H&amp;#244;pitaux de Paris, France, and Brahms, Germany. Wolff reported financial links with Merck Sharp &amp;amp; Dohme-Chibret, Janssen-Cilag, Gilead, and AstraZeneca.&lt;/p&gt;&lt;p&gt;Kollef reported no conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1443"
                     title="Hand Hygiene Up, Fear Down in H1N1 Outbreak"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/14123?impressionId=1265810067281"
                     
      TORONTO, May 8 -- Americans are washing their hands more and worrying less about H1N1 (swine) flu than they were last week, a new poll shows.
              &lt;br&gt; 
              &lt;br&gt;Conducted by the Harvard School of Public Health, the poll shows that 67% of Americans are now washing their hands or using sanitizers more often, compared with 59% who said the same thing a week ago, according to Robert Blendon, Sc.D., of the Harvard Opinion Research Program.
              &lt;br&gt; 
              &lt;br&gt;At the same time, Dr. Blendon told reporters in a CDC news conference that 61% of respondents said they were not concerned that they or a family member would get the H1N1 flu within the next year.
              &lt;br&gt; 
              &lt;br&gt;That&apos;s up from 53% who weren&apos;t worried a week ago, Dr. Blendon said.
              &lt;p&gt; 
              &lt;p&gt;Some 77% continue to follow news of the outbreak closely -- no change from last week -- indicating some &quot;uncertainty&quot; about how the outbreak is evolving, he said. 
              &lt;p&gt; 
              &lt;p&gt;The hand hygiene finding is &quot;very encouraging,&quot; said acting CDC director Richard Besser, M.D., and it may have spinoffs in controlling other pathogens that spread in the same way as flu.
              &lt;p&gt; 
              &lt;p&gt;Also encouraging, he said, is the finding that 55% of Americans say they have made preparations to remain at home if they or members of their family become ill. 
              &lt;p&gt; 
              &lt;p&gt;Pollsters did not ask that question a week ago, so there was no trend to report, but it is one of the messages the CDC and other public health agencies have been pushing.
              &lt;p&gt; 
              &lt;p&gt;The poll is the second in a series on H1N1 flu conducted by Harvard. This survey, conducted by telephone,  involved a representative national sample of 1,067 adults 18 and over.
              &lt;p&gt; 
              &lt;p&gt;The margin of error for the total sample is plus or minus 3.6 percentage points, the researchers said in a statement.
              &lt;p&gt; 
              &lt;p&gt;Among other findings:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;83% of Americans say they are satisfied with the management of the outbreak by public health authorities
                &lt;li&gt;88% are satisfied with the information they are getting
                &lt;li&gt;43% know that H1N1 flu and swine flu are the same thing, up from 20% a week ago
                &lt;li&gt;48% of parents of school children under 18 are concerned that they or a family member will get H1NI flu in the next year, significantly higher than the 36% among people who do not have children in school. 
                &lt;li&gt;50% of parents with children in school say their schools have not given them any information about what they are doing to reduce the possible spread of H1N1 in the school
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;Meanwhile, in Geneva, a World Health organization official described the groups of people subject to severe disease in Mexico.
              &lt;p&gt; 
              &lt;p&gt;The H1N1 flu caused severe symptoms in some previously healthy young adults, as well as those with underlying conditions such as diabetes and cardiovascular disease, said Sylvie Briand, M.D., Ph.D., of the agency&apos;s global influenza program.
              &lt;p&gt; 
              &lt;p&gt;The cause of death in most cases was viral pneumonia that progressed to acute respiratory distress, respiratory failure, and major organ failure, she told reporters.
              &lt;p&gt; 
              &lt;p&gt;&quot;It&apos;s very rare that young adults become severely sick with flu, so this is a new feature with this virus,&quot; Dr. Briand said.
              &lt;p&gt; 
              &lt;p&gt;On the other hand, those with underlying medical conditions are a known high-risk group during seasonal flu season, so the same finding with H1N1 is no surprise, she said.
              &lt;p&gt; 
              &lt;p&gt;Dr. Briand cautioned that the number of cases -- reviewed yesterday by WHO in a conference call with Mexican clinicians -- is still small and the investigation is continuing.
              &lt;p&gt; 
              &lt;p&gt;Most of the severe disease was among people with underlying conditions, Dr. Briand said, but she did not specify which disorders or diseases were seen most often. 
              &lt;p&gt; 
              &lt;p&gt;In the reviewed cases, she said, there was &quot;no major impact&quot; from bacterial infections, additional factors that can lead to severe symptoms and death during seasonal flu outbreaks.
              &lt;p&gt; 
              &lt;p&gt;Dr. Briand said the experience of past pandemics shows that both viral pneumonia and super-infection with bacteria -- leading to pneumonia -- have been causes of death.
              &lt;p&gt; 
              &lt;p&gt;&quot;This disease is mild in most cases,&quot; she said. &quot;However, we will see some serious disease, mostly in people with underlying conditions, which is close to the pattern that we see in seasonal flu.&quot;
              &lt;p&gt; 
              &lt;p&gt;&quot;We can expect also some cases in people -- previously healthy -- who will suffer from the disease directly,&quot; she added.
              &lt;p&gt; 
              &lt;p&gt;The agency said the virus has been confirmed now in 25 countries, with roughly 2,500 laboratory-confirmed cases. The U.S. and Mexico still have the lion&apos;s share. 
              &lt;p&gt; 
              &lt;p&gt;Dr. Besser said the U.S. now has 1,639 confirmed cases, with a median age of 14. 
              &lt;p&gt; 
              &lt;p&gt;All told, 57 people have been treated in hospitals, and data are available on 26. For those patients, he said, 58% are reported to have had an underlying condition.
            
    </recommendedItem>
    <recommendedItem id="20090101_19_2507"
                     title="Hospital-Acquired MRSA Poses Risk in Home"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/InfectionControl/tb/15459?impressionId=1265810067281"
                     
      &lt;p&gt;Patients infected with methicillin-resistant &lt;em&gt;Staphlycoccus aureus&lt;/em&gt; (MRSA) during a hospital stay risk transferring it to household contacts once they&apos;re discharged, French researchers said.&lt;/p&gt;
&lt;p&gt;In a year-long study, about one in five household contacts of colonized patients were found to have the organism, according to Jean-Christophe Lucet, MD, PhD, of the Bichat-Claude Bernard Hospital in Paris and colleagues.&lt;/p&gt;
&lt;p&gt;On the other hand, the risk of disease appeared to be small  --  none of the colonized contacts developed an overt MRSA infection, Lucet and colleagues reported in the Aug. 10/24 issue of &lt;em&gt;Archives of Internal Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The factors that predicted colonization, the researchers found, were older age and active involvement in the care of the index patient.&lt;/p&gt;
&lt;p&gt;Sharing the same bed or bedroom wasn&apos;t associated with acquiring the organism.&lt;/p&gt;
&lt;p&gt;The researchers followed a cohort of patients discharged from one of 47 Paris-area hospitals to a home healthcare program from February 2003 to March 2004.&lt;/p&gt;
&lt;p&gt;Of the 1,501 patients screened for MRSA before discharge, 191 were found to be carrying the organism and 148 agreed to take part in the study. The participants had 213 household contacts and 188 agreed to take part.&lt;/p&gt;
&lt;p&gt;The participating patients were regularly monitored for MRSA carriage by home healthcare nurses using nasal swabs and swabs of any chronic skin breaks. Household contacts were tested at the same times, using nasal swabs.&lt;/p&gt;
&lt;p&gt;The researchers found: &lt;ul&gt; &lt;li&gt;75 of the affected patients cleared the organism within a year, with an estimated median time to clearance of 282 days.&lt;/li&gt; &lt;li&gt;Patients who were self-sufficient in daily activities were more likely to clear the organism. The hazard ratio was 0.63, with a 95% confidence interval from 0.40 to 1.00, which was significant at &lt;em&gt;P&lt;/em&gt;=0.049.&lt;/li&gt; &lt;li&gt;Of the 188 household contacts, 36 (19.1%) acquired MRSA.&lt;/li&gt; &lt;li&gt;Being older significantly increased the risk that a household contact would acquire the organism. The adjusted odds ratio was 1.71 per decade of life, with a 95% confidence interval from 1.32 to 2.21, which was significant at &lt;em&gt;P&lt;/em&gt;=0.001.&lt;/li&gt; &lt;li&gt;Helping to care for the index patient also sharply increased the risk. The adjusted odds ratio was 3.58, with a 95% confidence interval from 1.33 to 9.62, which was significant at &lt;em&gt;P&lt;/em&gt;=0.01.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Lucet and colleagues noted that the study included older individuals with many comorbidities, especially chronic skin lesions, which may limit its applicability to a younger, more self-sufficient population.&lt;/p&gt;
&lt;p&gt;They also noted that they didn&apos;t use molecular analysis to confirm that the MRSA strains acquired by contacts were identical to the strains in the corresponding patients, although antibiotic susceptibility patterns were the same.&lt;/p&gt;
&lt;p&gt;The simplest message of the study may be that people caring for such patients should wash their hands, according to Lisa Winston, MD, and Henry Chambers, MD, both of the University of California San Francisco.&lt;/p&gt;
&lt;p&gt;&quot;Good hand hygiene practices have been appropriately emphasized in healthcare settings and may deserve more emphasis in the home,&quot; they said in an accompanying invited commentary.&lt;/p&gt;
&lt;p&gt;On the other hand, the study may have overestimated MRSA transmission, they said.&lt;/p&gt;
&lt;p&gt;&quot;The authors defined MRSA &apos;transmission&apos; as any positive finding on a swab from a household contact,&quot; they said, &quot;without data to show that the index patient was colonized before the household contact.&quot;&lt;/p&gt;
&lt;p&gt;The study also failed to report whether clearing of MRSA by patients was accompanied by similar clearance in contacts, or vice versa, Winston and Chamber noted.&lt;/p&gt;
&lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was supported by the Direction de la Recherche Clinique of AP-HP, a publicly funded nonprofit organization in Paris.&lt;/p&gt;
The researchers made no disclosures.&lt;/p&gt;
&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt; &lt;p&gt;
    </recommendedItem>
</recommendedContent>