JAMMI最新文献

This document updates the previous AMMI Canada Foundation Guidance (2013) on the use of antiviral therapy for influenza.

Gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhoeae. The rate of N. gonorrhoeae infections in Canada has increased from 2010 to 2015. Disseminated gonococcal infection typically results from bacteremic spread of N. gonorrhoeae from a preceding mucosal site of disease (e.g., urogenital). Common clinical manifestations of disseminated gonococcal infection include skin lesions, tenosynovitis, and septic arthritis. Bacterial meningitis as a manifestation of disseminated gonococcal infection has been rarely described. A case of bacterial meningitis due to N. gonorrheae, complicated by an ischemic stroke, is reported here. Clinical features that may point to N. gonorrhoeae as the pathogen in a patient with bacterial meningitis include a concomitant active urogenital infection, skin rash, arthritis, and/or tenosynovitis. Parenteral ceftriaxone for 10 to 14 days combined with a single oral dose of azithromycin is currently recommended as the treatment for gonococcal meningitis in recent guidelines. This case is presented to highlight a potential, albeit rare, complication of a preventable disease that has resurged in the last decade in our community.

Background: The preferred ambulatory IV therapy for cellulitis is often once-daily cefazolin combined with once-daily oral probenecid (C+P). However, due to a national probenecid drug shortage in 2011, our centre developed a replacement protocol for the administration of cefazolin continuous infusion (CCI) using elastomeric infusers. Our goal was to compare treatment efficacy, duration of IV therapy, and recurrence associated with CCI and C+P using retrospective data from our centre.

Methods: We conducted a non-inferiority single-centre retrospective cohort study of emergency department medical records. Patients received either C+P (cefazolin 2 g IV once daily plus probenecid 1 g PO once daily) or CCI (cefazolin 2 g IV loading dose, followed by cefazolin 6 g IV via continuous infusion over 24 hours, via an elastomeric infuser). We compared treatment efficacy, duration of IV therapy, and recurrence rates.

Results:  total of 203 patients were analyzed, with 107 included in the CCI arm and 96 in the C+P arm. Overall, CCI users and C+P users were comparable in their sociodemographic and clinical variables measured at admission. We observed increased odds of achieving successful treatment among the CCI group, however it did not reach statistical significance (odds ratio [OR] 2.25; 95% CI 0.84 to 6.07). Recurrence rates were similar between both groups (OR 1.91; 95% CI 0.32 to 11.31). The average duration of IV therapy was similar between groups (p = 0.6).

Conclusions: ith results suggesting that CCI was non-inferior to C+P, and that both approaches required similar treatment durations, CCI could represent an acceptable alternative to C+P for the ambulatory IV treatment of cellulitis.

Background: The new Canadian Residency Accreditation Consortium (CanRAC) standards recommend surveying recently graduated trainees to target improvements in training programs. The goal of this study was to estimate the impact of a rotation in an HIV clinic on trainees' related knowledge, confidence, and practice profile at the Université de Montréal.

Methods: An electronic survey was sent to practising physicians who completed the rotation between 2006 and 2016. Participants were asked to rate their agreement and level of confidence toward HIV- and HCV-related topics using 5-point Likert scales (0 to 4). Descriptive statistics and mean comparisons were calculated.

Results: Among invited participants, 27 of 45 (60%) completed the questionnaire. The majority of respondents were infectious diseases physicians (48%) or family physicians (37%) and had an outpatient caseload of <10 HIV patients/year (80%). For 37% of the respondents, the rotation had a large or very large impact on their career path. They considered that the rotation had increased their knowledge on the overall management of HIV (mean 3.2/4 [95% CI 2.9 to 3.4]), but less on pre-exposure prophylaxis (PrEP) (mean 1.5/4 [95% CI 1.1 to 2.0]) or HCV care (mean 1.9/4 [95% CI 1.4 to 2.3]). Participants felt less confident with genotyping interpretation (mean 2.6/4 [95% CI 2.2 to 2.9]) and PrEP (mean 2.4/4 [95% CI 2.0 to 2.8]).

Conclusions: These results suggest that a rotation in an HIV clinic improves knowledge related to HIV care. Feedback from past graduates helped us identify gaps in knowledge or level of confidence in PrEP and HCV care, which will feed curriculum improvement.