Intentional hydrocarbon inhalation can be fatal. Death can be secondary to hydrocarbon's cardiopulmonary effects. We present a case of a patient who survived ventricular fibrillation after inhalation of Glade Air Freshener™, which contains short chain aliphatic hydrocarbons (butane and isobutane). Unlike our case, myocardial sensitization and hypoxia are more commonly described with aromatic, halogenated or longer chain hydrocarbons.
Background. With the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) in the United States, visits for skin infections greatly increased. Staphylococci and streptococci are considered predominant causes of wound infections. Clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX) are commonly prescribed, but the efficacy of TMP-SMX has been questioned. Methods. We conducted a randomized, double-blind, superiority trial at 5 US emergency departments. Patients >12 years of age with an uncomplicated wound infection received oral clindamycin 300 mg 4 times daily or TMP-SMX 320 mg/1600 mg twice daily, each for 7 days. We compared the primary outcome, wound infection cure at 7–14 days, and secondary outcomes through 6–8 weeks after treatment, in the per-protocol population. Results. Subjects had a median age of 40 years (range, 14–76 years); 40.1% of wound specimens grew MRSA, 25.7% methicillin-susceptible S. aureus, and 5.0% streptococci. The wound infection was cured at 7–14 days in 187 of 203 (92.1%) clindamycin-treated and 182 of 198 (91.9%) TMP-SMX–treated subjects (difference, 0.2%; 95% confidence interval [CI], −5.8% to 6.2%; P = not significant). The clindamycin group had a significantly lower rate of recurrence at 7–14 days (1.5% vs 6.6%; difference, −5.1%; 95% CI, −9.4% to −.8%) and through 6–8 weeks following treatment (2.0% vs 7.1%; difference, −5.1%; 95% CI, −9.7% to −.6%). Other secondary outcomes were statistically similar between groups but tended to favor clindamycin. Adverse event rates were similar. Conclusions. In settings where MRSA is prevalent, clindamycin and TMP-SMX produce similar cure and adverse event rates among patients with an uncomplicated wound infection. Further study evaluating differential effects of antibiotics on recurrent infection may be warranted. Clinical Trials Registration. NCT00729937.
Abstract Background Acute bacterial skin and skin structure infections (ABSSSI) are a common type of bacterial infection, with the cost of hospitalization being the main contributing factor to overall treatment costs. Two pragmatic clinical trials (Table 1) demonstrated that a new treatment pathway in which patients are treated with the intravenous (IV) long-acting antibiotic, dalbavancin, reduced hospital admission rates and length of stay (LOS) in hospitalized patients. The objective of this study is to evaluate the cost-effectiveness of a single dose of dalbavancin administered in the emergency department (ED) compared with IV antibiotics for appropriate patients who would otherwise be admitted to hospital and receive usual care such as vancomycin or daptomycin. Table 1.References of the Two Pragmatic Clinical Trials Methods A decision-analytic cost-effectiveness model was developed from the perspective of the US healthcare system. The population was ABSSSI patients presenting at the ED, who would be eligible to receive IV antibiotic infusion. Patients can receive IV treatment in the ED, and then discharged or followed by hospital admission for continued management (Fig. 1). A 14-day time horizon was used, representing the typical duration of ABSSSI management. Hospital admission rates and LOS were from the two clinical trials. Cost included ED visits, drug cost, inpatient stay, and physician visits. Input parameter uncertainty was examined via one-way and probabilistic sensitivity analyses. Figure 1.Decision Analytic Model Structure Results Providing dalbavancin in the ED resulted in $4,848 savings per patient (2021 USD). The drug cost of dalbavancin treatment was offset by a mean reduction of 4.24 days LOS per patient, which translated as $1,144 savings per hospitalization day avoided. One-way sensitivity analyses demonstrated that the key drivers were the cost of inpatient hospital stay and the LOS with usual care; however, none of the sensitivity analyses resulted in the new pathway being more costly (Fig. 2). Dalbavancin was cost saving in 100% of simulated scenarios. Figure 2.One-way Sensitivity Analysis Conclusion These results could help guide the management of ABSSSI by shifting care for appropriate patients from the inpatient to the outpatient setting where patients can be managed successfully, thereby freeing up hospital resources and reducing the total costs of ABSSSI treatment. Disclosures FRANK LOVECCHIO, DO, MPH, ABBVIE: Speaker|NIH: Grant/Research Support Alasdair D. Henry, PhD, AbbVie: Grant/Research Support Quan V. Doan, PharmD, AbbVie: Advisor/Consultant|AbbVie: Grant/Research Support|Allergan: Advisor/Consultant|Allergan: Grant/Research Support John L. Lock, PharmD, Abbvie: Employee|Abbvie: Stocks/Bonds Rosie D. Lyles, MD, MHA, MSc, AbbVie: AbbVie Employee|AbbVie: Stocks/Bonds Xiaolan Ye, PhD, AbbVie Inc.: AbbVie Employee|AbbVie Inc.: Stocks/Bonds.
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Blood culture (BC) often fails to detect bloodstream microorganisms in sepsis. However, molecular diagnostics hold great potential. The molecular method PCR/electrospray ionization-mass spectrometry (PCR/ESI-MS) can detect DNA from hundreds of different microorganisms in whole blood. The aim of the present study was to evaluate the performance of this method in a multicenter study including 16 teaching hospitals in the United States ( n = 13) and Europe ( n = 3).
