Two-year Surveillance Research Articles

Two-year surveillance on fluconazole susceptibility of Candida spp isolates in a general and university hospital in Rome

Fluconazole susceptibility was tested in 385 clinical yeast isolates (285 Candida albicans, 38 C.glabrata, 31 C.tropicalis, 31 other Candida subsp.) using the agar disk diffusion test. Yeasts were collected from specimens obtained from outpatients (69) and inpatients (intensive care unit: 79 isolates, major burn unit: 31 isolates, hematology ward: 45 isolates, gynecology ward: 67 isolates, other wards: 94 isolates). Three hundred and fifty-six (92%) yeast isolates showed to be susceptible, 18 (5%) were susceptible dose-dependent, and 10 (3%) were resistant to fluconazole. Of the resistant group, 3 isolates were C.albicans, while seven were Candida non-albicans (2 C.rugosa, 2 C.humicola, 1 C.tropicalis, 1 C.ciferrii, 1 C.glabrata). The disk-diffusion method was easy to perform and there were no difficulties in the interpretation of inhibition zone diameters. Fluconazole maintained a good activity against Candida spp despite its extensive use for the prophylaxis and treatment of fungal infections.

Clinical features of tiaprofenic acid (surgam) associated cystitis and a study of risk factors for its development

A case-control study was performed to describe the clinical course and identify risk factors predisposing to the development of tiaprofenic acid associated cystitis. Cases were identified from reports to the Australian Adverse Drug Reactions Advisory Committee and a two-year (1995–1996) national surveillance programme. Definition of a case was onset of symptoms of cystitis while taking tiaprofenic acid with pyuria (>10 WBC/μl) and/or hematuria (>10 RBC/μl), and no evidence of urinary tract infection. Definitions of “prescriber-matched” and “unmatched” controls were those who had been prescribed tiaprofenic acid by the same prescriber within 12 months of the case without developing cystitis or were identified from the databases of local pharmacies of the cases respectively. 81 of 109 identified cases and 109 of 184 potential controls completed a standardised interviewer-administered questionnaire. Median time between the commencement of tiaprofenic acid and symptom onset was 6.3 months (range 0.1–47.1 months). Median interval between presentation to doctor and drug cessation was 3.0 months (range 0–24.5 months). In half the patients, symptoms resolved within 14 days of ceasing therapy. Increasing age was a risk factor for the development of tiaprofenic-acid associated cystitis, age >70 years-odds ratio 3.2 (95% confidence interval 1.3–7.9) compared with age <55 years. Patients taking aspirin had a reduced risk (odds ratio 0.3, 95% confidence interval 0.1–0.9). Dose and amount of fluid consumed per day were not related to the risk of cystitis. Earlier recognition of tiaprofenic acid associated cystitis can potentially reduce the morbidity related to this condition. Apart from an increased risk among older patients, it is likely that this condition represents a drug reaction that cannot be predicted from clinical variables.

Spatial Aspects of Foot-Pad Dermatitis in Swedish Broilers

This study aimed at analysing spatial and spatio-temporal aspects of foot-pad dermatitis in Swedish broilers. The information on disease prevalence and severity was based on a two-year foot-health surveillance programme where information on producer, breed, feed manufacturer, region, abattoir, date of slaughter and several other variables was recorded. The level of clustering in space was analysed on 2-digit zipcode level using Moran's I test which measures similarity of location. The level of clustering in space was also analysed using the Ipop test, which takes the population at risk into consideration. The examination of time-space interaction was carried out using the Barton method and the Knox method. We found a significant (p < 0.001) clustering of regions with respect to foot-pad dermatitis score using Moran's I test, and a significant (p < 0.0001) clustering in space also when related to the number of flocks delivered from each region. The flocks with very high prevalence of foot-pad dermatitis were significantly (p < 0.05) clustered in both time and space, i.e. the flocks with high prevalence of lesions came from the same geographic area during the same time periods. This information will permit us to focus the control efforts within the foot-health surveillance programme on specific regions in specific time periods, thus making the programme more effective.

135 Blood pressure and treatment patterns among Hypertension and Detection Follow-up Program (HDFP) participants during a two-year Post-Trial Surveillance study

135 Blood pressure and treatment patterns among Hypertension and Detection Follow-up Program (HDFP) participants during a two-year Post-Trial Surveillance study

Persistence of reduction in blood pressure and mortality of participants in the Hypertension Detection and Follow-up Program. Hypertension Detection and Follow-up Program Cooperative Group

The Hypertension Detection and Follow-up Program (HDFP) previously described a significant reduction in five-year, all-cause mortality in its intensively treated stepped care (SC) group relative to its referred care (RC) control group. At the time this finding was described, a proportion of the SC cohort had been treated for periods as long as 6.7 years, but comparable RC and SC mortality data beyond five years were not available. These data, which are described herein, indicate that the 6.7-year life-table mortality rates were 95.1/1000 participants for SC vs 116.3/1000 participants for RC, a larger mortality difference than was observed at five years. This favorable finding for SC extended to all major subgroups, including white women and those aged 30 to 49 years at trial entry. Six months after the close of the treatment trial, a two-year posttrial surveillance study, which extended mortality follow-up to 8.3 years, was conducted. The posttrial use of antihypertensive medication declined in SC and increased in RC participants so that by the end of the posttrial period, there was little difference in the percentages of SC and RC participants taking medication. Control of blood pressure, indicated by mean diastolic blood pressure and by percent of participants with a pressure of 90 mm Hg or less, was slightly better for SC than for RC participants (SC group, 86.5 mm Hg and 68% controlled; RC group, 87.8 mm Hg and 62% controlled). The absolute mortality advantage found at 6.7 years persisted and increased throughout the posttrial period of follow-up despite discontinuation of the formal SC therapy program. It is postulated that regression of hypertensive end-organ changes brought about by the more effective SC treatment caused this favorable outcome.

Persistence of Reduction in Blood Pressure and Mortality of Participants in the Hypertension Detection and Follow-up Program

The Hypertension Detection and Follow-up Program (HDFP) previously described a significant reduction in five-year, all-cause mortality in its intensively treated stepped care (SC) group relative to its referred care (RC) control group. At the time this finding was described, a proportion of the SC cohort had been treated for periods as long as 6.7 years, but comparable RC and SC mortality data beyond five years were not available. These data, which are described herein, indicate that the 6.7-year life-table mortality rates were 95.1/1000 participants for SC vs 116.3/1000 participants for RC, a larger mortality difference than was observed at five years. This favorable finding for SC extended to all major subgroups, including white women and those aged 30 to 49 years at trial entry. Six months after the close of the treatment trial, a two-year posttrial surveillance study, which extended mortality follow-up to 8.3 years, was conducted. The posttrial use of antihypertensive medication declined in SC and increased in RC participants so that by the end of the posttrial period, there was little difference in the percentages of SC and RC participants taking medication. Control of blood pressure, indicated by mean diastolic blood pressure and by percent of participants with a pressure of 90 mm Hg or less, was slightly better for SC than for RC participants (SC group, 86.5 mm Hg and 68% controlled; RC group, 87.8 mm Hg and 62% controlled). The absolute mortality advantage found at 6.7 years persisted and increased throughout the posttrial period of follow-up despite discontinuation of the formal SC therapy program. It is postulated that regression of hypertensive end-organ changes brought about by the more effective SC treatment caused this favorable outcome. (<i>JAMA</i>1988;259:2113-2122)