Bianca Nogrady

Medication errors or adverse drug events after surgery occur in as many as one in twenty perioperative medication administrations, according to data published online in the journal Anesthesiology.

A prospective observational study of 277 surgical operations and 3,671 medication administrations found 193 cases (5.3%) involved a medication error or adverse drug event, nearly four-fifths (79.3%) of which were preventable and 68.9% of which were serious (Anesthesiology. 2015 Oct. doi:10.1097/ALN.0000000000000904).

Among the 51 medication errors that led to adverse reactions, nearly half were the result of inappropriate medication doses and 31.4% were due to omitted medications or failure to act, but the most common overall error type was a labeling error.

The medications most commonly associated with errors were propofol, phenylephrine, and fentanyl, and operations greater than 6 hours in duration or with 13 or more medication administrations were associated with a significantly greater risk of errors.

“Examples of technology-based interventions [to minimize perioperative MEs and/or ADEs] include bar code–assisted syringe labeling systems, point-of-care bar code–assisted anesthesia documentation systems, specific drug decision support, and alerts,” wrote the study’s lead author Dr. Karen C. Nanji of Massachusetts General Hospital in Boston, and her coauthors.

The study was supported by the Doctors Company Foundation and the National Institute of General Medical Sciences of the National Institutes of Health. One coauthor – Dr. David Bates – declared financial interests in medical decision support software, as well as funding and positions with a variety of medical technology companies.

Medication errors or adverse drug events after surgery occur in as many as one in twenty perioperative medication administrations, according to data published online in the journal Anesthesiology.

A prospective observational study of 277 surgical operations and 3,671 medication administrations found 193 cases (5.3%) involved a medication error or adverse drug event, nearly four-fifths (79.3%) of which were preventable and 68.9% of which were serious (Anesthesiology. 2015 Oct. doi:10.1097/ALN.0000000000000904).

Among the 51 medication errors that led to adverse reactions, nearly half were the result of inappropriate medication doses and 31.4% were due to omitted medications or failure to act, but the most common overall error type was a labeling error.

The medications most commonly associated with errors were propofol, phenylephrine, and fentanyl, and operations greater than 6 hours in duration or with 13 or more medication administrations were associated with a significantly greater risk of errors.

“Examples of technology-based interventions [to minimize perioperative MEs and/or ADEs] include bar code–assisted syringe labeling systems, point-of-care bar code–assisted anesthesia documentation systems, specific drug decision support, and alerts,” wrote the study’s lead author Dr. Karen C. Nanji of Massachusetts General Hospital in Boston, and her coauthors.

The study was supported by the Doctors Company Foundation and the National Institute of General Medical Sciences of the National Institutes of Health. One coauthor – Dr. David Bates – declared financial interests in medical decision support software, as well as funding and positions with a variety of medical technology companies.

Medication errors or adverse drug events after surgery occur in as many as one in twenty perioperative medication administrations, according to data published online in the journal Anesthesiology.

A prospective observational study of 277 surgical operations and 3,671 medication administrations found 193 cases (5.3%) involved a medication error or adverse drug event, nearly four-fifths (79.3%) of which were preventable and 68.9% of which were serious (Anesthesiology. 2015 Oct. doi:10.1097/ALN.0000000000000904).

Among the 51 medication errors that led to adverse reactions, nearly half were the result of inappropriate medication doses and 31.4% were due to omitted medications or failure to act, but the most common overall error type was a labeling error.

The medications most commonly associated with errors were propofol, phenylephrine, and fentanyl, and operations greater than 6 hours in duration or with 13 or more medication administrations were associated with a significantly greater risk of errors.

“Examples of technology-based interventions [to minimize perioperative MEs and/or ADEs] include bar code–assisted syringe labeling systems, point-of-care bar code–assisted anesthesia documentation systems, specific drug decision support, and alerts,” wrote the study’s lead author Dr. Karen C. Nanji of Massachusetts General Hospital in Boston, and her coauthors.

The study was supported by the Doctors Company Foundation and the National Institute of General Medical Sciences of the National Institutes of Health. One coauthor – Dr. David Bates – declared financial interests in medical decision support software, as well as funding and positions with a variety of medical technology companies.

Patients taking opioids for rheumatoid arthritis are at significantly higher risk of serious infection, particularly those taking long-acting formulations or opioids known to have immunosuppressive properties, new data suggest.

While it has been known for some time that opioids have wide-ranging adverse effects, this is the first convincing evidence of an increased risk of infection associated with opioid use in patients with rheumatoid arthritis, Dr. Samuel Whittle, consultant rheumatologist at the Queen Elizabeth Hospital in Adelaide, Australia, said when asked to comment on the study.

©thegoodphoto/thinkstockphotos.com

Dr. Whittle, who was not involved in the study, said that these data add to the growing body of evidence that the adverse effects of opioids outweigh the benefits.

“It fits with our general sense these days that opioids really are a poor choice of analgesics in people with rheumatoid arthritis, but people continue to prescribe them because our analgesic armory is not that good,” he said.

Andrew D. Wiese of Vanderbilt University, Nashville, Tenn., and his colleagues analyzed a retrospective cohort of 1,790 patients with rheumatoid arthritis who were enrolled in Tennessee Medicaid during 1995-2009 and experienced at least one hospitalization for serious infection. The patients served as their own controls during periods of opioid nonuse. The rate of infection in these patients was 39% higher when they were taking opioids, compared with periods of nonuse, after adjusting for age, season, nursing home residency, and medication use.

The rate of infection was twice as high when they were using long-acting opioids, compared with nonuse, and 72% higher for the use of immunosuppressive opioids. New opioid use also more than doubled the risk of serious infection in the study (Arthritis Rheumatol. 2015 Oct 16. doi: 10.1002/art.39462)

Researchers also found evidence of a dose-response effect, as patients taking 60 mg or more of morphine equivalent per day had a 73% greater rate of infection than in periods of nonuse, compared with a 24% higher rate in those taking less than 15 mg morphine equivalent per day.

Patients who experienced infections were most likely to get a nonpneumonia infection, while the rates of pneumonia infection were not significantly different between periods of opioid use and nonuse.

To assess whether pain could have been a confounding factor, the researchers looked at nonsteroidal anti-inflammatory medication use as the exposure of interest and found no significant increase in the rate of hospitalizations for serious infections when compared with nonuse.

“The potential association between the risk of infection and opioid use is supported by the literature regarding the immunosuppressive effects of certain opioids from in vitro experiments and animal models, including morphine, methadone, and fentanyl (fentanyl [was] not included in our study, which is restricted to oral formulations),” the investigators wrote.

“Although our study lends support to the idea that opioids might cause further immunosuppression in patients with RA, these patients are already at higher risk of infection and possibly more likely to receive opioid therapy compared to other patient populations. Further studies are needed to determine whether this association exists in other patient populations.”

Another big research challenge, Dr. Whittle said, is “to learn better the mechanisms for persistent pain in people with rheumatoid arthritis, and hopefully through that we might be able to target therapies a little bit better.”

The study was supported by the National Institute on Aging and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. There were no conflicts of interest declared.

Patients taking opioids for rheumatoid arthritis are at significantly higher risk of serious infection, particularly those taking long-acting formulations or opioids known to have immunosuppressive properties, new data suggest.

While it has been known for some time that opioids have wide-ranging adverse effects, this is the first convincing evidence of an increased risk of infection associated with opioid use in patients with rheumatoid arthritis, Dr. Samuel Whittle, consultant rheumatologist at the Queen Elizabeth Hospital in Adelaide, Australia, said when asked to comment on the study.

©thegoodphoto/thinkstockphotos.com

Dr. Whittle, who was not involved in the study, said that these data add to the growing body of evidence that the adverse effects of opioids outweigh the benefits.

“It fits with our general sense these days that opioids really are a poor choice of analgesics in people with rheumatoid arthritis, but people continue to prescribe them because our analgesic armory is not that good,” he said.

Andrew D. Wiese of Vanderbilt University, Nashville, Tenn., and his colleagues analyzed a retrospective cohort of 1,790 patients with rheumatoid arthritis who were enrolled in Tennessee Medicaid during 1995-2009 and experienced at least one hospitalization for serious infection. The patients served as their own controls during periods of opioid nonuse. The rate of infection in these patients was 39% higher when they were taking opioids, compared with periods of nonuse, after adjusting for age, season, nursing home residency, and medication use.

The rate of infection was twice as high when they were using long-acting opioids, compared with nonuse, and 72% higher for the use of immunosuppressive opioids. New opioid use also more than doubled the risk of serious infection in the study (Arthritis Rheumatol. 2015 Oct 16. doi: 10.1002/art.39462)

Researchers also found evidence of a dose-response effect, as patients taking 60 mg or more of morphine equivalent per day had a 73% greater rate of infection than in periods of nonuse, compared with a 24% higher rate in those taking less than 15 mg morphine equivalent per day.

Patients who experienced infections were most likely to get a nonpneumonia infection, while the rates of pneumonia infection were not significantly different between periods of opioid use and nonuse.

To assess whether pain could have been a confounding factor, the researchers looked at nonsteroidal anti-inflammatory medication use as the exposure of interest and found no significant increase in the rate of hospitalizations for serious infections when compared with nonuse.

“The potential association between the risk of infection and opioid use is supported by the literature regarding the immunosuppressive effects of certain opioids from in vitro experiments and animal models, including morphine, methadone, and fentanyl (fentanyl [was] not included in our study, which is restricted to oral formulations),” the investigators wrote.

“Although our study lends support to the idea that opioids might cause further immunosuppression in patients with RA, these patients are already at higher risk of infection and possibly more likely to receive opioid therapy compared to other patient populations. Further studies are needed to determine whether this association exists in other patient populations.”

Another big research challenge, Dr. Whittle said, is “to learn better the mechanisms for persistent pain in people with rheumatoid arthritis, and hopefully through that we might be able to target therapies a little bit better.”

The study was supported by the National Institute on Aging and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. There were no conflicts of interest declared.

Patients taking opioids for rheumatoid arthritis are at significantly higher risk of serious infection, particularly those taking long-acting formulations or opioids known to have immunosuppressive properties, new data suggest.

While it has been known for some time that opioids have wide-ranging adverse effects, this is the first convincing evidence of an increased risk of infection associated with opioid use in patients with rheumatoid arthritis, Dr. Samuel Whittle, consultant rheumatologist at the Queen Elizabeth Hospital in Adelaide, Australia, said when asked to comment on the study.

©thegoodphoto/thinkstockphotos.com

Dr. Whittle, who was not involved in the study, said that these data add to the growing body of evidence that the adverse effects of opioids outweigh the benefits.

“It fits with our general sense these days that opioids really are a poor choice of analgesics in people with rheumatoid arthritis, but people continue to prescribe them because our analgesic armory is not that good,” he said.

Andrew D. Wiese of Vanderbilt University, Nashville, Tenn., and his colleagues analyzed a retrospective cohort of 1,790 patients with rheumatoid arthritis who were enrolled in Tennessee Medicaid during 1995-2009 and experienced at least one hospitalization for serious infection. The patients served as their own controls during periods of opioid nonuse. The rate of infection in these patients was 39% higher when they were taking opioids, compared with periods of nonuse, after adjusting for age, season, nursing home residency, and medication use.

The rate of infection was twice as high when they were using long-acting opioids, compared with nonuse, and 72% higher for the use of immunosuppressive opioids. New opioid use also more than doubled the risk of serious infection in the study (Arthritis Rheumatol. 2015 Oct 16. doi: 10.1002/art.39462)

Researchers also found evidence of a dose-response effect, as patients taking 60 mg or more of morphine equivalent per day had a 73% greater rate of infection than in periods of nonuse, compared with a 24% higher rate in those taking less than 15 mg morphine equivalent per day.

Patients who experienced infections were most likely to get a nonpneumonia infection, while the rates of pneumonia infection were not significantly different between periods of opioid use and nonuse.

To assess whether pain could have been a confounding factor, the researchers looked at nonsteroidal anti-inflammatory medication use as the exposure of interest and found no significant increase in the rate of hospitalizations for serious infections when compared with nonuse.

“The potential association between the risk of infection and opioid use is supported by the literature regarding the immunosuppressive effects of certain opioids from in vitro experiments and animal models, including morphine, methadone, and fentanyl (fentanyl [was] not included in our study, which is restricted to oral formulations),” the investigators wrote.

“Although our study lends support to the idea that opioids might cause further immunosuppression in patients with RA, these patients are already at higher risk of infection and possibly more likely to receive opioid therapy compared to other patient populations. Further studies are needed to determine whether this association exists in other patient populations.”

Another big research challenge, Dr. Whittle said, is “to learn better the mechanisms for persistent pain in people with rheumatoid arthritis, and hopefully through that we might be able to target therapies a little bit better.”

The study was supported by the National Institute on Aging and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. There were no conflicts of interest declared.

Injections of botulinum toxin into epicardial fat pads during cardiac surgery may provide long-term suppression of atrial fibrillation, according to results from a randomized, placebo-controlled trial published Oct. 20.

Sixty patients with a history of atrial fibrillation, who were undergoing coronary artery bypass graft surgery, were randomized to an injection of botulinum toxin or saline into each epicardial fat pad during surgery.

©luiscar/Thinkstockphotos.com

Data from 12 months of monitoring via an implantable loop recorder showed patients who received the botulinum toxin injections had a significantly reduced incidence of atrial fibrillation, compared with the placebo group in the 30 days after surgery (7% vs. 30%, P = .024) and at 12 months (0% vs. 27%, P = .002).

Both groups showed significant decreases in heart rate variability after surgery, but at 3 months, these had largely recovered in the placebo group and remained depressed in the botulinum toxin group until 6 months (Circ Arrhythm Electrophysiol. 2015 Oct 20. doi: 10.1161/CIRCEP.115.003199).

No patients in the botulinum group developed persistent atrial fibrillation or required antiarrhythmic therapy or interventions, and there were no significant differences between the two groups in other outcomes such as hospital length of stay or postoperative complications.

“The blocking effects are temporary and recover in 1 to 6 months, depending on the injection site [but] for patients with a high short-term risk of postoperative AF after cardiac surgery, temporary suppression of AF without any destruction of the anatomic structures is clinically desirable,” wrote Dr. Evgeny Pokushalov of State Research Institute of Circulation Pathology, Novosibirsk, Russia, and coauthors.

No conflicts of interest were declared.

Injections of botulinum toxin into epicardial fat pads during cardiac surgery may provide long-term suppression of atrial fibrillation, according to results from a randomized, placebo-controlled trial published Oct. 20.

Sixty patients with a history of atrial fibrillation, who were undergoing coronary artery bypass graft surgery, were randomized to an injection of botulinum toxin or saline into each epicardial fat pad during surgery.

©luiscar/Thinkstockphotos.com

Data from 12 months of monitoring via an implantable loop recorder showed patients who received the botulinum toxin injections had a significantly reduced incidence of atrial fibrillation, compared with the placebo group in the 30 days after surgery (7% vs. 30%, P = .024) and at 12 months (0% vs. 27%, P = .002).

Both groups showed significant decreases in heart rate variability after surgery, but at 3 months, these had largely recovered in the placebo group and remained depressed in the botulinum toxin group until 6 months (Circ Arrhythm Electrophysiol. 2015 Oct 20. doi: 10.1161/CIRCEP.115.003199).

No patients in the botulinum group developed persistent atrial fibrillation or required antiarrhythmic therapy or interventions, and there were no significant differences between the two groups in other outcomes such as hospital length of stay or postoperative complications.

“The blocking effects are temporary and recover in 1 to 6 months, depending on the injection site [but] for patients with a high short-term risk of postoperative AF after cardiac surgery, temporary suppression of AF without any destruction of the anatomic structures is clinically desirable,” wrote Dr. Evgeny Pokushalov of State Research Institute of Circulation Pathology, Novosibirsk, Russia, and coauthors.

No conflicts of interest were declared.

Injections of botulinum toxin into epicardial fat pads during cardiac surgery may provide long-term suppression of atrial fibrillation, according to results from a randomized, placebo-controlled trial published Oct. 20.

Sixty patients with a history of atrial fibrillation, who were undergoing coronary artery bypass graft surgery, were randomized to an injection of botulinum toxin or saline into each epicardial fat pad during surgery.

©luiscar/Thinkstockphotos.com

Data from 12 months of monitoring via an implantable loop recorder showed patients who received the botulinum toxin injections had a significantly reduced incidence of atrial fibrillation, compared with the placebo group in the 30 days after surgery (7% vs. 30%, P = .024) and at 12 months (0% vs. 27%, P = .002).

Both groups showed significant decreases in heart rate variability after surgery, but at 3 months, these had largely recovered in the placebo group and remained depressed in the botulinum toxin group until 6 months (Circ Arrhythm Electrophysiol. 2015 Oct 20. doi: 10.1161/CIRCEP.115.003199).

No patients in the botulinum group developed persistent atrial fibrillation or required antiarrhythmic therapy or interventions, and there were no significant differences between the two groups in other outcomes such as hospital length of stay or postoperative complications.

“The blocking effects are temporary and recover in 1 to 6 months, depending on the injection site [but] for patients with a high short-term risk of postoperative AF after cardiac surgery, temporary suppression of AF without any destruction of the anatomic structures is clinically desirable,” wrote Dr. Evgeny Pokushalov of State Research Institute of Circulation Pathology, Novosibirsk, Russia, and coauthors.

No conflicts of interest were declared.

High-resolution glutamate-based neuroimaging could help identify epileptic foci in individuals with epilepsy who have been assessed as nonlesional via conventional brain MRI, a study has found.

Researchers used glutamate chemical exchange saturation transfer imaging (GluCEST) in four patients with drug-resistant epilepsy who did not show lesions on MRI, and in 11 healthy controls, according to a paper published in Science Translational Medicine.

The glutamate-based imaging showed higher concentrations of glutamate in the ipsilateral hippocampus than in the contralateral hippocampus, and two independent, blinded epilepsy specialists both accurately lateralized the seizure onset in all four patients (Sci Transl Med. 2015 Oct 14. doi: 10.1126/scitranslmed.aaa7095).

Davis et al., Science Translational Medicine (2015)

Patients with drug-resistant epilepsy currently undergo a range of presurgical imaging, including 3-T MRI and single-photon emission computed tomography (SPECT), but in many patients this still fails to identify a seizure focus, despite the fact that 87% of patients in this group have previously been found to have abnormal histopathology.

“Because it is also well established that patients with lesional epilepsy have better surgical outcomes than those with nonlesional epilepsy, new neuroimaging techniques capable of detecting subtle lesions could potentially improve patient care and increase the chance of seizure freedom after surgery,” wrote Dr. Kathryn Adamiak Davis of Penn Epilepsy Center at the Hospital of the University of Pennsylvania, Philadelphia, and her coauthors.

The National Institutes of Health and the University of Pennsylvania supported the study. There were no conflicts of interest declared.

High-resolution glutamate-based neuroimaging could help identify epileptic foci in individuals with epilepsy who have been assessed as nonlesional via conventional brain MRI, a study has found.

Researchers used glutamate chemical exchange saturation transfer imaging (GluCEST) in four patients with drug-resistant epilepsy who did not show lesions on MRI, and in 11 healthy controls, according to a paper published in Science Translational Medicine.

The glutamate-based imaging showed higher concentrations of glutamate in the ipsilateral hippocampus than in the contralateral hippocampus, and two independent, blinded epilepsy specialists both accurately lateralized the seizure onset in all four patients (Sci Transl Med. 2015 Oct 14. doi: 10.1126/scitranslmed.aaa7095).

Davis et al., Science Translational Medicine (2015)

Patients with drug-resistant epilepsy currently undergo a range of presurgical imaging, including 3-T MRI and single-photon emission computed tomography (SPECT), but in many patients this still fails to identify a seizure focus, despite the fact that 87% of patients in this group have previously been found to have abnormal histopathology.

“Because it is also well established that patients with lesional epilepsy have better surgical outcomes than those with nonlesional epilepsy, new neuroimaging techniques capable of detecting subtle lesions could potentially improve patient care and increase the chance of seizure freedom after surgery,” wrote Dr. Kathryn Adamiak Davis of Penn Epilepsy Center at the Hospital of the University of Pennsylvania, Philadelphia, and her coauthors.

The National Institutes of Health and the University of Pennsylvania supported the study. There were no conflicts of interest declared.

High-resolution glutamate-based neuroimaging could help identify epileptic foci in individuals with epilepsy who have been assessed as nonlesional via conventional brain MRI, a study has found.

Researchers used glutamate chemical exchange saturation transfer imaging (GluCEST) in four patients with drug-resistant epilepsy who did not show lesions on MRI, and in 11 healthy controls, according to a paper published in Science Translational Medicine.

The glutamate-based imaging showed higher concentrations of glutamate in the ipsilateral hippocampus than in the contralateral hippocampus, and two independent, blinded epilepsy specialists both accurately lateralized the seizure onset in all four patients (Sci Transl Med. 2015 Oct 14. doi: 10.1126/scitranslmed.aaa7095).

Davis et al., Science Translational Medicine (2015)

Patients with drug-resistant epilepsy currently undergo a range of presurgical imaging, including 3-T MRI and single-photon emission computed tomography (SPECT), but in many patients this still fails to identify a seizure focus, despite the fact that 87% of patients in this group have previously been found to have abnormal histopathology.

“Because it is also well established that patients with lesional epilepsy have better surgical outcomes than those with nonlesional epilepsy, new neuroimaging techniques capable of detecting subtle lesions could potentially improve patient care and increase the chance of seizure freedom after surgery,” wrote Dr. Kathryn Adamiak Davis of Penn Epilepsy Center at the Hospital of the University of Pennsylvania, Philadelphia, and her coauthors.

The National Institutes of Health and the University of Pennsylvania supported the study. There were no conflicts of interest declared.

The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in children is low but has increased significantly since 1999, particularly among isolates from intensive care units and from blood and lower respiratory tract cultures, new data suggest.

Analysis of 316,253 Enterobacteriaceae isolates reported to 300 U.S. laboratories participating in the Surveillance Network-USA database between 1999 and 2012 showed 0.08% of isolates were carbapenem resistant, with the most common resistant isolates being Enterobacter species isolated from urinary sources and from the inpatient non-ICU setting.

©CDC/James Archer

“Unlike for adults, where increases were greater than for children, we did not find that the increase in CRE in children appeared to be related to residence in long-term care facilities, because only 0.1% of CRE isolates came from this setting,” wrote Dr. Latania K. Logan, director of pediatric infectious diseases at Rush University Medical Center, Chicago, and her coauthors.

The study, published Oct. 14 in Emerging Infectious Diseases, showed a significant overall increase from 0% to 0.47% in carbapenem-resistant Enterobacteriaceae over the 12-year study period; among ICU isolates, the prevalence increased from 0% to 4.5% over the same period.

Many of the carbapenem-resistant isolates also were resistant to other antimicrobial drugs, such as trimethoprim/sulfamethoxazole and ciprofloxacin, and nearly half (48.3%) were resistant to more than three antimicrobial drug classes (Emerg Infect Dis. 2015 Oct 14. doi: 10.3201/eid2111.150548).

The study was supported by the National Institutes of Health, the Children’s Foundation, the Global Antibiotic Resistance Partnership, the Bill and Melinda Gates Foundation, and the Health Grand Challenges Program at Princeton University. No conflicts of interest were declared.

The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in children is low but has increased significantly since 1999, particularly among isolates from intensive care units and from blood and lower respiratory tract cultures, new data suggest.

Analysis of 316,253 Enterobacteriaceae isolates reported to 300 U.S. laboratories participating in the Surveillance Network-USA database between 1999 and 2012 showed 0.08% of isolates were carbapenem resistant, with the most common resistant isolates being Enterobacter species isolated from urinary sources and from the inpatient non-ICU setting.

©CDC/James Archer

“Unlike for adults, where increases were greater than for children, we did not find that the increase in CRE in children appeared to be related to residence in long-term care facilities, because only 0.1% of CRE isolates came from this setting,” wrote Dr. Latania K. Logan, director of pediatric infectious diseases at Rush University Medical Center, Chicago, and her coauthors.

The study, published Oct. 14 in Emerging Infectious Diseases, showed a significant overall increase from 0% to 0.47% in carbapenem-resistant Enterobacteriaceae over the 12-year study period; among ICU isolates, the prevalence increased from 0% to 4.5% over the same period.

Many of the carbapenem-resistant isolates also were resistant to other antimicrobial drugs, such as trimethoprim/sulfamethoxazole and ciprofloxacin, and nearly half (48.3%) were resistant to more than three antimicrobial drug classes (Emerg Infect Dis. 2015 Oct 14. doi: 10.3201/eid2111.150548).

The study was supported by the National Institutes of Health, the Children’s Foundation, the Global Antibiotic Resistance Partnership, the Bill and Melinda Gates Foundation, and the Health Grand Challenges Program at Princeton University. No conflicts of interest were declared.

The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in children is low but has increased significantly since 1999, particularly among isolates from intensive care units and from blood and lower respiratory tract cultures, new data suggest.

Analysis of 316,253 Enterobacteriaceae isolates reported to 300 U.S. laboratories participating in the Surveillance Network-USA database between 1999 and 2012 showed 0.08% of isolates were carbapenem resistant, with the most common resistant isolates being Enterobacter species isolated from urinary sources and from the inpatient non-ICU setting.

©CDC/James Archer

“Unlike for adults, where increases were greater than for children, we did not find that the increase in CRE in children appeared to be related to residence in long-term care facilities, because only 0.1% of CRE isolates came from this setting,” wrote Dr. Latania K. Logan, director of pediatric infectious diseases at Rush University Medical Center, Chicago, and her coauthors.

The study, published Oct. 14 in Emerging Infectious Diseases, showed a significant overall increase from 0% to 0.47% in carbapenem-resistant Enterobacteriaceae over the 12-year study period; among ICU isolates, the prevalence increased from 0% to 4.5% over the same period.

Many of the carbapenem-resistant isolates also were resistant to other antimicrobial drugs, such as trimethoprim/sulfamethoxazole and ciprofloxacin, and nearly half (48.3%) were resistant to more than three antimicrobial drug classes (Emerg Infect Dis. 2015 Oct 14. doi: 10.3201/eid2111.150548).

The study was supported by the National Institutes of Health, the Children’s Foundation, the Global Antibiotic Resistance Partnership, the Bill and Melinda Gates Foundation, and the Health Grand Challenges Program at Princeton University. No conflicts of interest were declared.

Individuals infected with the hepatitis C virus who have a higher ratio of alanine aminotransferase to aspartate aminotransferase may be at greater risk of developing nonalcoholic fatty liver disease and hepatosteatosis, new data suggest.

A community-based observational study in 1,354 Taiwanese individuals seropositive for hepatitis C virus – including 433 with nonalcoholic fatty liver disease – found a high alanine aminotransferase to aspartate aminotransferase ratio was significantly and independently associated with nonalcoholic fatty liver disease (OR, 1.90; 95% CI, 1.37 to 2.65; P less than .001) and high-degree nonalcoholic fatty liver disease (OR, 2.44; 95% CI, 1.58 to 3.77; P less than .001).

Courtesy NIH

This effect was observed even after researchers accounted for potential confounders: age, body mass index, metabolic syndrome, cholesterol level, hepatitis B virus infection, and smoking.

The study found the ALT/AST ratio was significantly higher among patients with nonalcoholic fatty liver disease (1.2 ± 0.4 vs. 1.1 ± 0.4; P less than .001) – defined as hepatic steatosis by echogenic imaging – according to a paper published online Sept. 14 in BMJ Open.

Nonalcoholic fatty liver disease is a particular issue because not only can it progress to severe liver disease but it is also associated with a lower likelihood of achieving a sustained virologic response to antiviral therapy. In addition, the majority of cases of nonalcoholic fatty liver disease are silent and are discovered incidentally, the authors wrote.

“This is the first study to reveal a strong relationship between the ALT/AST ratio and NAFLD in patients with HCV, and the ALT/AST ratio was also an independent risk factor apart from the conventional risk factors for hepatosteatosis including the MetS [metabolic syndrome], LDL, TC, waist/hip ratio, and body mass index,” wrote Dr. Ming-Shyan Lin of Chang Gung Memorial Hospital, Taiwan, and coauthors.

While the AST/ALT ratio is a marker of liver cirrhosis and advanced liver disease, the ALT/AST ratio is also a marker for insulin resistance and metabolic syndrome.

Researchers also noted that individuals with hepatitis C infection and nonalcoholic fatty liver disease had a significantly higher incidence of metabolic syndrome, significantly higher fasting glucose, uric acid, and triglycerides, and a lower HDL than did those with low-degree nonalcoholic fatty liver disease.

“The prevalence of hepatosteatosis in chronic hepatitis C infection has been reported in up to 31%-72%, which is significantly higher than that in participants with other chronic liver disease such as hepatitis B or autoimmune hepatitis, suggesting a direct effect of HCV replication in the development of excess fat accumulation in the liver,” the authors wrote.

In this cohort, the prevalence of nonalcoholic fatty liver disease was 31.9%, and 19.6% of participants had moderate to severe hepatosteatosis (BMJ Open 2015, Sep 14. doi:10.1136/bmjopen-2015-008797).

Given the silent nature of nonalcoholic fatty liver disease, the authors suggested that the findings could help clinicians identify individuals with hepatosteatosis and implement interventions such as weight loss to reduce their risk of further progression.

No conflicts of interest were declared.

Individuals infected with the hepatitis C virus who have a higher ratio of alanine aminotransferase to aspartate aminotransferase may be at greater risk of developing nonalcoholic fatty liver disease and hepatosteatosis, new data suggest.

A community-based observational study in 1,354 Taiwanese individuals seropositive for hepatitis C virus – including 433 with nonalcoholic fatty liver disease – found a high alanine aminotransferase to aspartate aminotransferase ratio was significantly and independently associated with nonalcoholic fatty liver disease (OR, 1.90; 95% CI, 1.37 to 2.65; P less than .001) and high-degree nonalcoholic fatty liver disease (OR, 2.44; 95% CI, 1.58 to 3.77; P less than .001).

Courtesy NIH

This effect was observed even after researchers accounted for potential confounders: age, body mass index, metabolic syndrome, cholesterol level, hepatitis B virus infection, and smoking.

The study found the ALT/AST ratio was significantly higher among patients with nonalcoholic fatty liver disease (1.2 ± 0.4 vs. 1.1 ± 0.4; P less than .001) – defined as hepatic steatosis by echogenic imaging – according to a paper published online Sept. 14 in BMJ Open.

Nonalcoholic fatty liver disease is a particular issue because not only can it progress to severe liver disease but it is also associated with a lower likelihood of achieving a sustained virologic response to antiviral therapy. In addition, the majority of cases of nonalcoholic fatty liver disease are silent and are discovered incidentally, the authors wrote.

“This is the first study to reveal a strong relationship between the ALT/AST ratio and NAFLD in patients with HCV, and the ALT/AST ratio was also an independent risk factor apart from the conventional risk factors for hepatosteatosis including the MetS [metabolic syndrome], LDL, TC, waist/hip ratio, and body mass index,” wrote Dr. Ming-Shyan Lin of Chang Gung Memorial Hospital, Taiwan, and coauthors.

While the AST/ALT ratio is a marker of liver cirrhosis and advanced liver disease, the ALT/AST ratio is also a marker for insulin resistance and metabolic syndrome.

Researchers also noted that individuals with hepatitis C infection and nonalcoholic fatty liver disease had a significantly higher incidence of metabolic syndrome, significantly higher fasting glucose, uric acid, and triglycerides, and a lower HDL than did those with low-degree nonalcoholic fatty liver disease.

“The prevalence of hepatosteatosis in chronic hepatitis C infection has been reported in up to 31%-72%, which is significantly higher than that in participants with other chronic liver disease such as hepatitis B or autoimmune hepatitis, suggesting a direct effect of HCV replication in the development of excess fat accumulation in the liver,” the authors wrote.

In this cohort, the prevalence of nonalcoholic fatty liver disease was 31.9%, and 19.6% of participants had moderate to severe hepatosteatosis (BMJ Open 2015, Sep 14. doi:10.1136/bmjopen-2015-008797).

Given the silent nature of nonalcoholic fatty liver disease, the authors suggested that the findings could help clinicians identify individuals with hepatosteatosis and implement interventions such as weight loss to reduce their risk of further progression.

No conflicts of interest were declared.

Individuals infected with the hepatitis C virus who have a higher ratio of alanine aminotransferase to aspartate aminotransferase may be at greater risk of developing nonalcoholic fatty liver disease and hepatosteatosis, new data suggest.

A community-based observational study in 1,354 Taiwanese individuals seropositive for hepatitis C virus – including 433 with nonalcoholic fatty liver disease – found a high alanine aminotransferase to aspartate aminotransferase ratio was significantly and independently associated with nonalcoholic fatty liver disease (OR, 1.90; 95% CI, 1.37 to 2.65; P less than .001) and high-degree nonalcoholic fatty liver disease (OR, 2.44; 95% CI, 1.58 to 3.77; P less than .001).

Courtesy NIH

This effect was observed even after researchers accounted for potential confounders: age, body mass index, metabolic syndrome, cholesterol level, hepatitis B virus infection, and smoking.

The study found the ALT/AST ratio was significantly higher among patients with nonalcoholic fatty liver disease (1.2 ± 0.4 vs. 1.1 ± 0.4; P less than .001) – defined as hepatic steatosis by echogenic imaging – according to a paper published online Sept. 14 in BMJ Open.

Nonalcoholic fatty liver disease is a particular issue because not only can it progress to severe liver disease but it is also associated with a lower likelihood of achieving a sustained virologic response to antiviral therapy. In addition, the majority of cases of nonalcoholic fatty liver disease are silent and are discovered incidentally, the authors wrote.

“This is the first study to reveal a strong relationship between the ALT/AST ratio and NAFLD in patients with HCV, and the ALT/AST ratio was also an independent risk factor apart from the conventional risk factors for hepatosteatosis including the MetS [metabolic syndrome], LDL, TC, waist/hip ratio, and body mass index,” wrote Dr. Ming-Shyan Lin of Chang Gung Memorial Hospital, Taiwan, and coauthors.

While the AST/ALT ratio is a marker of liver cirrhosis and advanced liver disease, the ALT/AST ratio is also a marker for insulin resistance and metabolic syndrome.

Researchers also noted that individuals with hepatitis C infection and nonalcoholic fatty liver disease had a significantly higher incidence of metabolic syndrome, significantly higher fasting glucose, uric acid, and triglycerides, and a lower HDL than did those with low-degree nonalcoholic fatty liver disease.

“The prevalence of hepatosteatosis in chronic hepatitis C infection has been reported in up to 31%-72%, which is significantly higher than that in participants with other chronic liver disease such as hepatitis B or autoimmune hepatitis, suggesting a direct effect of HCV replication in the development of excess fat accumulation in the liver,” the authors wrote.

In this cohort, the prevalence of nonalcoholic fatty liver disease was 31.9%, and 19.6% of participants had moderate to severe hepatosteatosis (BMJ Open 2015, Sep 14. doi:10.1136/bmjopen-2015-008797).

Given the silent nature of nonalcoholic fatty liver disease, the authors suggested that the findings could help clinicians identify individuals with hepatosteatosis and implement interventions such as weight loss to reduce their risk of further progression.

No conflicts of interest were declared.