Approximately 3.9 million Americans live with chronic Hepatitis C virus (CHCV). Major advances have been made in the treatment of CHCV, with the availability of oral directly acting antiviral (DAA) regimens. However, significant barriers to treatment remain for patients accessing safety net providers for care. In 2011, 61,294 Community Health Center (CHC) patients had Hepatitis C as their primary diagnosis. This study provides insight into unique CHC patient characteristics and outcomes of care at two federally qualified health centers (FQHC). We queried electronic health records (EHR) from Q4 2014 to Q1 2018 for Hep C patients attending two FQHCs in South Carolina (n = 223). Data from both practices were aggregated to capture sustained virologic (SVR) rates at 12 weeks post treatment. Patient demographic factors, including age; gender; race/ethnicity, insurance status and people who inject drugs (PWID) were extracted. Clinical measures such as baseline and post treatment viral loads, Fibrosure, AST to Platelet Ratio Index (APRI) measures, pre treatment and post treatment liver ultrasound screening, HCV genotype, and HIV co-infection are reported. Patient outcomes were monitored using SVR viral load values (detectable or nondetectable) at 12 weeks and 1 year from treatment onset. Mean age was 57.03 SD ± 0.65 with 71.7% of the population treated aged 55 or older. Most patients were males (63.2%), African American (68.2%) and uninsured (31.4%). Median baseline HCV viral load was 1,950,000 IU/mL. About 95.9% of the patients were naïve to Hepatitis C treatment. Majority of Fibrosure stages (F0–F2 48.9%; and F3–F4 37.2%) and APRI scores both showed about half of patients presented with little likelihood of liver cirrhosis. Post-liver ultrasound occurred in 37.7% of the population. Top three genotypes were 1a (67.3%), 1b (17.5%) and 2b (5.8%). The proportion of PWID among those responding was 23.4%.HIV coinfection in the population sample was 29.1%, while the SVR VL was nondetectable for 97.6%. Overall, FQHCs served the CDC target baby boomer population age group. Findings show Hepatitis C treatment can be successfully undertaken at FQHCs including difficult to treat populations such as PWID. The SVR viral load shows efficacy of treatment at both FQHCs. All authors: No reported disclosures.
A patient with Mycobacterium chelonei infection was treated with erythromycin stearate and streptomycin. The choice of antibiotics was based on a rapid radiometric susceptibility test developed in our laboratory.
This article describes a prolonged outbreak (January 1977 to February 1980) of amikacin-resistant Serratia marcescens (ARSM) urinary infections and the methods used for its control. Significant factors predisposing to ARSM urinary tract infection included an extended hospital stay, being in the urology ward, and undergoing urologic surgery. There had been on prior administration of amikacin or of other aminoglycosides in 20 of 27 patients with ARSM urinary tract infections. Chronically infected patients who required multiple hospitalizations represented a major reservoir for the perpetuation of the outbreak, overshadowing the importance of aminoglycoside use. Traditional control measures and even a major change in the inanimate environment were only partially effective in controlling the outbreak, but treatment of bacteriuric patients in the urology unit with "second and third generation" cephalosporins interrupted patient-to-patient transmission. No new cases of ARSM bacteriuria appeared in the urology unit in the ensuing 12 months.
Suboptimal doses of amphotericin B in combination with either rifampin or 5-fluorocytosine were better than single-drug therapy in the treatment of disseminated Aspergillus fumigatus infection in mice. Despite the increased effectiveness of combination therapy, none of the therapeutic regimens we used completely eradicated infections in the mice when evaluated by mycological culture, even in long-term survivors.
Two elderly patients diagnosed with Pseudomonas aeruginosa urinary tract infections were treated with oral norfloxacin in the recommended dose of 400 mg q12h. Initially, antimicrobial susceptibility data indicated the organisms were sensitive to norfloxacin. Six to eight days into therapy urine cultures became positive for P. aeruginosa once again; this time, however, susceptibility reports indicated the organisms were now resistant to norfloxacin. Since cross-resistance among norfloxacin, other quinolones, and cephalosporins can occur, we recommend repeated urine cultures during and after norfloxacin therapy in elderly patients with complicated P. aeruginosa urinary tract infections.
