Doug Brunk

SAN DIEGO – Magnetic resonance imaging identified additional breast cancer in 11% of women with newly diagnosed disease who were otherwise eligible for partial breast irradiation, preliminary results from an ongoing study demonstrated.

Treatment of these patients with limited radiation fields would result in undertreatment of the tumor and could potentially compromise disease control, Dr. Paige L. Dorn said at the meeting.

Treatment for early-stage breast cancer with partial breast irradiation is currently under investigation in a multi-institutional, randomized controlled trial, NSABP B-39. Retrospective data from the University of Chicago Hospitals and Clinics and other institutions “have shown that MRI is able to find additional disease in 5%–10% of otherwise partial breast irradiation–eligible candidates, based on mammogram and ultrasound alone,” said Dr. Dorn of the university's department of radiation oncology. “The purpose of this study is to evaluate the utility of MRI in detecting clinically occult foci of disease in a prospectively identified cohort of partial breast irradiation candidates uniformly undergoing MRI in addition to mammogram and ultrasound.”

Since June of 2009, all imaging and surgical pathology have been reviewed in a multidisciplinary setting by radiologists, surgeons, pathologists, and radiation oncologists at the university to determine candidacy for partial breast irradiation. In patients eligible for partial breast irradiation, Dr. Dorn and her associates prospectively documented whether MRI identified additional lesions in the same quadrant (multifocal), a different quadrant (multicentric), or the contralateral breast. They biopsied suspicious MRI findings to confirm pathology and then prospectively recorded whether MRI findings prompted a change in the eligibility for partial breast irradiation according to the entry criteria outlined in NSABP B-39. Prospectively collected data was verified by retrospective evaluation of all patient records.

Of 486 patients screened by the researchers between June 2009 and October 2010, Dr. Dorn reported that 91 (18.7%) were deemed eligible for partial breast irradiation based on mammogram, ultrasound, and pathology alone. Their median age was 56 years.

Of the 91 patients, 66 had invasive ductal or lobular carcinoma, 18 patients had ductal carcinoma in situ, and 7 had invasive lobular disease. MRI identified additional disease in 10 patients. Multifocal disease was seen in 9 of these patients, while contralateral disease was confirmed in 1.

The researchers also found that MRI was more likely to identify occult disease in patients younger than age 50, in those who were premenopausal, and in those who had tumor sizes of 2 cm or greater.

Dr. Dorn said the study had certain limitations, including the fact that the potential impact of MRI on disease outcomes after partial breast irradiation remains unknown. “Whether these multifocal lesions would have been surgically excised is unknown,” she added.

Based on the results of this and other studies, she concluded that MRI “should be increasingly considered as part of the work-up for partial breast irradiation candidates. MRI may help refine criteria for patient selection, especially in those with higher-risk features. We plan to continue this prospective study to further define the role of MRI in this population.”

Dr. Dorn said she had no relevant financial conflicts.

MRI 'should be increasingly considered as part of the work-up for partial breast irradiation candidates.'

Source DR. DORN

SAN DIEGO – Magnetic resonance imaging identified additional breast cancer in 11% of women with newly diagnosed disease who were otherwise eligible for partial breast irradiation, preliminary results from an ongoing study demonstrated.

Treatment of these patients with limited radiation fields would result in undertreatment of the tumor and could potentially compromise disease control, Dr. Paige L. Dorn said at the meeting.

Treatment for early-stage breast cancer with partial breast irradiation is currently under investigation in a multi-institutional, randomized controlled trial, NSABP B-39. Retrospective data from the University of Chicago Hospitals and Clinics and other institutions “have shown that MRI is able to find additional disease in 5%–10% of otherwise partial breast irradiation–eligible candidates, based on mammogram and ultrasound alone,” said Dr. Dorn of the university's department of radiation oncology. “The purpose of this study is to evaluate the utility of MRI in detecting clinically occult foci of disease in a prospectively identified cohort of partial breast irradiation candidates uniformly undergoing MRI in addition to mammogram and ultrasound.”

Since June of 2009, all imaging and surgical pathology have been reviewed in a multidisciplinary setting by radiologists, surgeons, pathologists, and radiation oncologists at the university to determine candidacy for partial breast irradiation. In patients eligible for partial breast irradiation, Dr. Dorn and her associates prospectively documented whether MRI identified additional lesions in the same quadrant (multifocal), a different quadrant (multicentric), or the contralateral breast. They biopsied suspicious MRI findings to confirm pathology and then prospectively recorded whether MRI findings prompted a change in the eligibility for partial breast irradiation according to the entry criteria outlined in NSABP B-39. Prospectively collected data was verified by retrospective evaluation of all patient records.

Of 486 patients screened by the researchers between June 2009 and October 2010, Dr. Dorn reported that 91 (18.7%) were deemed eligible for partial breast irradiation based on mammogram, ultrasound, and pathology alone. Their median age was 56 years.

Of the 91 patients, 66 had invasive ductal or lobular carcinoma, 18 patients had ductal carcinoma in situ, and 7 had invasive lobular disease. MRI identified additional disease in 10 patients. Multifocal disease was seen in 9 of these patients, while contralateral disease was confirmed in 1.

The researchers also found that MRI was more likely to identify occult disease in patients younger than age 50, in those who were premenopausal, and in those who had tumor sizes of 2 cm or greater.

Dr. Dorn said the study had certain limitations, including the fact that the potential impact of MRI on disease outcomes after partial breast irradiation remains unknown. “Whether these multifocal lesions would have been surgically excised is unknown,” she added.

Based on the results of this and other studies, she concluded that MRI “should be increasingly considered as part of the work-up for partial breast irradiation candidates. MRI may help refine criteria for patient selection, especially in those with higher-risk features. We plan to continue this prospective study to further define the role of MRI in this population.”

Dr. Dorn said she had no relevant financial conflicts.

MRI 'should be increasingly considered as part of the work-up for partial breast irradiation candidates.'

Source DR. DORN

SAN DIEGO – Magnetic resonance imaging identified additional breast cancer in 11% of women with newly diagnosed disease who were otherwise eligible for partial breast irradiation, preliminary results from an ongoing study demonstrated.

Treatment of these patients with limited radiation fields would result in undertreatment of the tumor and could potentially compromise disease control, Dr. Paige L. Dorn said at the meeting.

Treatment for early-stage breast cancer with partial breast irradiation is currently under investigation in a multi-institutional, randomized controlled trial, NSABP B-39. Retrospective data from the University of Chicago Hospitals and Clinics and other institutions “have shown that MRI is able to find additional disease in 5%–10% of otherwise partial breast irradiation–eligible candidates, based on mammogram and ultrasound alone,” said Dr. Dorn of the university's department of radiation oncology. “The purpose of this study is to evaluate the utility of MRI in detecting clinically occult foci of disease in a prospectively identified cohort of partial breast irradiation candidates uniformly undergoing MRI in addition to mammogram and ultrasound.”

Since June of 2009, all imaging and surgical pathology have been reviewed in a multidisciplinary setting by radiologists, surgeons, pathologists, and radiation oncologists at the university to determine candidacy for partial breast irradiation. In patients eligible for partial breast irradiation, Dr. Dorn and her associates prospectively documented whether MRI identified additional lesions in the same quadrant (multifocal), a different quadrant (multicentric), or the contralateral breast. They biopsied suspicious MRI findings to confirm pathology and then prospectively recorded whether MRI findings prompted a change in the eligibility for partial breast irradiation according to the entry criteria outlined in NSABP B-39. Prospectively collected data was verified by retrospective evaluation of all patient records.

Of 486 patients screened by the researchers between June 2009 and October 2010, Dr. Dorn reported that 91 (18.7%) were deemed eligible for partial breast irradiation based on mammogram, ultrasound, and pathology alone. Their median age was 56 years.

Of the 91 patients, 66 had invasive ductal or lobular carcinoma, 18 patients had ductal carcinoma in situ, and 7 had invasive lobular disease. MRI identified additional disease in 10 patients. Multifocal disease was seen in 9 of these patients, while contralateral disease was confirmed in 1.

The researchers also found that MRI was more likely to identify occult disease in patients younger than age 50, in those who were premenopausal, and in those who had tumor sizes of 2 cm or greater.

Dr. Dorn said the study had certain limitations, including the fact that the potential impact of MRI on disease outcomes after partial breast irradiation remains unknown. “Whether these multifocal lesions would have been surgically excised is unknown,” she added.

Based on the results of this and other studies, she concluded that MRI “should be increasingly considered as part of the work-up for partial breast irradiation candidates. MRI may help refine criteria for patient selection, especially in those with higher-risk features. We plan to continue this prospective study to further define the role of MRI in this population.”

Dr. Dorn said she had no relevant financial conflicts.

MRI 'should be increasingly considered as part of the work-up for partial breast irradiation candidates.'

Source DR. DORN

DENVER – Obese dialysis patients younger than age 65 years were 1.6 times more likely to die within 7 years, compared with their younger, normal-weight dialysis counterparts.

In addition, young and elderly dialysis patients alike who were underweight faced about a twofold increased risk of dying within the same time frame.

The findings come from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a prospective analysis of 1,749 dialysis patients at 38 centers who were at least 18 years old at their first dialysis treatment and were followed until death, transplantation, or a maximum of 7 years.

“Mortality patterns of body mass index differ between young and elderly dialysis patients,” Dr. Ellen K. Hoogeveen said during a press briefing at the annual meeting of the American Society of Nephrology, where the findings  were presented.

“Obesity may be harmful in patients younger than 65 years. For patients younger than 65 years starting with dialysis, it is important to strive for normal weight.”

At baseline, Dr. Hoogeveen and her colleagues classified patients into one of two age groups: young (younger than age 65) and elderly (age 65 and older). They also classified them into one of four weight groups based on body mass index: underweight (less than 20 kg/m²), normal weight (20-25 kg/m²), overweight (26-30 kg/m²), and obese (higher than 30 kg/m²).

Cox regression analysis was used to calculate hazard ratios associated with BMI categories, awith normal weight used as the reference category, according to the investigators.

Dr. Hoogeveen, of the department of nephrology at Jeroen Bosch Hospital, Den Bosch, the Netherlands, reported that the mean age of the younger patients in the study was 51 years, while the mean age of the elderly patients was 73 years. The mean BMI of both the younger and the older groups was 24 kg/m², and more than half were men (62% in each group).

The 7-year mortality rate for all patients was 67%. When the researchers adjusted for age, gender, smoking, cardiovascular disease, and modality of dialysis, they found that younger patients who were obese at baseline were 1.6 times more likely to die within 7 years than were younger, normal-weight patients. Elderly obese patients were 1.1 times more likely to die within 7 years than were younger, normal-weight patients, a statistically significant difference.

In addition, young and elderly dialysis patients alike who were underweight at baseline were at significantly increased risk of dying within 7 years, compared with younger patients who had a normal BMI (hazard ratios of 2.2 and 1.6, respectively).

One of the study authors, Dr. Elisabeth Boeschoten, is a consultant for Amgen and Baxter and receives grants/research support from Abbott, Amgen, Baxter, Genzyme, Roche, and Shire. All of the other authors reported no relevant financial disclosures.

DENVER – Obese dialysis patients younger than age 65 years were 1.6 times more likely to die within 7 years, compared with their younger, normal-weight dialysis counterparts.

In addition, young and elderly dialysis patients alike who were underweight faced about a twofold increased risk of dying within the same time frame.

The findings come from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a prospective analysis of 1,749 dialysis patients at 38 centers who were at least 18 years old at their first dialysis treatment and were followed until death, transplantation, or a maximum of 7 years.

“Mortality patterns of body mass index differ between young and elderly dialysis patients,” Dr. Ellen K. Hoogeveen said during a press briefing at the annual meeting of the American Society of Nephrology, where the findings  were presented.

“Obesity may be harmful in patients younger than 65 years. For patients younger than 65 years starting with dialysis, it is important to strive for normal weight.”

At baseline, Dr. Hoogeveen and her colleagues classified patients into one of two age groups: young (younger than age 65) and elderly (age 65 and older). They also classified them into one of four weight groups based on body mass index: underweight (less than 20 kg/m²), normal weight (20-25 kg/m²), overweight (26-30 kg/m²), and obese (higher than 30 kg/m²).

Cox regression analysis was used to calculate hazard ratios associated with BMI categories, awith normal weight used as the reference category, according to the investigators.

Dr. Hoogeveen, of the department of nephrology at Jeroen Bosch Hospital, Den Bosch, the Netherlands, reported that the mean age of the younger patients in the study was 51 years, while the mean age of the elderly patients was 73 years. The mean BMI of both the younger and the older groups was 24 kg/m², and more than half were men (62% in each group).

The 7-year mortality rate for all patients was 67%. When the researchers adjusted for age, gender, smoking, cardiovascular disease, and modality of dialysis, they found that younger patients who were obese at baseline were 1.6 times more likely to die within 7 years than were younger, normal-weight patients. Elderly obese patients were 1.1 times more likely to die within 7 years than were younger, normal-weight patients, a statistically significant difference.

In addition, young and elderly dialysis patients alike who were underweight at baseline were at significantly increased risk of dying within 7 years, compared with younger patients who had a normal BMI (hazard ratios of 2.2 and 1.6, respectively).

One of the study authors, Dr. Elisabeth Boeschoten, is a consultant for Amgen and Baxter and receives grants/research support from Abbott, Amgen, Baxter, Genzyme, Roche, and Shire. All of the other authors reported no relevant financial disclosures.

DENVER – Obese dialysis patients younger than age 65 years were 1.6 times more likely to die within 7 years, compared with their younger, normal-weight dialysis counterparts.

In addition, young and elderly dialysis patients alike who were underweight faced about a twofold increased risk of dying within the same time frame.

The findings come from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a prospective analysis of 1,749 dialysis patients at 38 centers who were at least 18 years old at their first dialysis treatment and were followed until death, transplantation, or a maximum of 7 years.

“Mortality patterns of body mass index differ between young and elderly dialysis patients,” Dr. Ellen K. Hoogeveen said during a press briefing at the annual meeting of the American Society of Nephrology, where the findings  were presented.

“Obesity may be harmful in patients younger than 65 years. For patients younger than 65 years starting with dialysis, it is important to strive for normal weight.”

At baseline, Dr. Hoogeveen and her colleagues classified patients into one of two age groups: young (younger than age 65) and elderly (age 65 and older). They also classified them into one of four weight groups based on body mass index: underweight (less than 20 kg/m²), normal weight (20-25 kg/m²), overweight (26-30 kg/m²), and obese (higher than 30 kg/m²).

Cox regression analysis was used to calculate hazard ratios associated with BMI categories, awith normal weight used as the reference category, according to the investigators.

Dr. Hoogeveen, of the department of nephrology at Jeroen Bosch Hospital, Den Bosch, the Netherlands, reported that the mean age of the younger patients in the study was 51 years, while the mean age of the elderly patients was 73 years. The mean BMI of both the younger and the older groups was 24 kg/m², and more than half were men (62% in each group).

The 7-year mortality rate for all patients was 67%. When the researchers adjusted for age, gender, smoking, cardiovascular disease, and modality of dialysis, they found that younger patients who were obese at baseline were 1.6 times more likely to die within 7 years than were younger, normal-weight patients. Elderly obese patients were 1.1 times more likely to die within 7 years than were younger, normal-weight patients, a statistically significant difference.

In addition, young and elderly dialysis patients alike who were underweight at baseline were at significantly increased risk of dying within 7 years, compared with younger patients who had a normal BMI (hazard ratios of 2.2 and 1.6, respectively).

One of the study authors, Dr. Elisabeth Boeschoten, is a consultant for Amgen and Baxter and receives grants/research support from Abbott, Amgen, Baxter, Genzyme, Roche, and Shire. All of the other authors reported no relevant financial disclosures.

DENVER – Over the course of 3 months, 28% of patients admitted to a major cancer hospital had clinical signs of acute kidney injury, results from a single-center analysis showed.

While the incidence of acute kidney injury is higher in hospitalized high-risk patients and has been shown to be directly associated with morbidity, mortality, and higher cost, “there is very little literature available about what happens to cancer patients admitted to the hospital,” lead study author Dr. Abdulla K. Salahudeen said in an interview during a poster session at the annual meeting of the American Society of Nephrology. “Our study suggests that we need to take measures to mitigate acute kidney injury in cancer patients.”

In what is believed to be the first study of its kind, Dr. Salahudeen and his associates reviewed the electronic medical records of 5,491 cancer patients who were hospitalized at MD Anderson Cancer Center, Houston, between May 1 and July 31, 2006. They obtained demographic information as well as laboratory and pharmacy data, and defined the incidence of acute kidney injury as having a rise in absolute serum creatinine of 0.3 mg/dL or greater.

Complete information was available on 5,013 of the 5,491 patients, explained Dr. Salahudeen, chief of the section of nephrology and director of the dialysis unit at University of Texas MD Anderson Cancer Center, Houston.

The mean age of these patients was 55 years, 53% were male, and 72% were white. The researchers determined that 14% had preexisting acute kidney injury while another 14% developed the condition during their hospital stay.

On univariate analysis, the clinical risk factors significantly associated with acute kidney injury were use of antibiotics (odds ratio 2.06), use of IV contrast (OR 1.99), use of multiple antidiabetic agents (1.69), and use of chemotherapeutic agents (OR 1.38).

On multivariate analysis, clinical risk factors significantly associated with acute kidney injury were transfer to the ICU (OR 1.40), use of chemotherapeutic agents (OR 1.29), use of antibiotics (OR 1.30), and having diabetes (OR 1.06).

Multivariate analysis also revealed that patients who had acute kidney injury had higher rates of transfer to the ICU, (OR 1.44), mortality (OR 5.20), and length of hospitalization (OR 2.1), compared with their counterparts who did not have acute kidney injury.

“It is possible that what we are seeing is an association between severity of cancer and level of kidney injury,” said Dr. Salahudeen, who emphasized the preliminary nature of the study.

Dr. Salahudeen said that he had no relevant financial disclosures.

DENVER – Over the course of 3 months, 28% of patients admitted to a major cancer hospital had clinical signs of acute kidney injury, results from a single-center analysis showed.

While the incidence of acute kidney injury is higher in hospitalized high-risk patients and has been shown to be directly associated with morbidity, mortality, and higher cost, “there is very little literature available about what happens to cancer patients admitted to the hospital,” lead study author Dr. Abdulla K. Salahudeen said in an interview during a poster session at the annual meeting of the American Society of Nephrology. “Our study suggests that we need to take measures to mitigate acute kidney injury in cancer patients.”

In what is believed to be the first study of its kind, Dr. Salahudeen and his associates reviewed the electronic medical records of 5,491 cancer patients who were hospitalized at MD Anderson Cancer Center, Houston, between May 1 and July 31, 2006. They obtained demographic information as well as laboratory and pharmacy data, and defined the incidence of acute kidney injury as having a rise in absolute serum creatinine of 0.3 mg/dL or greater.

Complete information was available on 5,013 of the 5,491 patients, explained Dr. Salahudeen, chief of the section of nephrology and director of the dialysis unit at University of Texas MD Anderson Cancer Center, Houston.

The mean age of these patients was 55 years, 53% were male, and 72% were white. The researchers determined that 14% had preexisting acute kidney injury while another 14% developed the condition during their hospital stay.

On univariate analysis, the clinical risk factors significantly associated with acute kidney injury were use of antibiotics (odds ratio 2.06), use of IV contrast (OR 1.99), use of multiple antidiabetic agents (1.69), and use of chemotherapeutic agents (OR 1.38).

On multivariate analysis, clinical risk factors significantly associated with acute kidney injury were transfer to the ICU (OR 1.40), use of chemotherapeutic agents (OR 1.29), use of antibiotics (OR 1.30), and having diabetes (OR 1.06).

Multivariate analysis also revealed that patients who had acute kidney injury had higher rates of transfer to the ICU, (OR 1.44), mortality (OR 5.20), and length of hospitalization (OR 2.1), compared with their counterparts who did not have acute kidney injury.

“It is possible that what we are seeing is an association between severity of cancer and level of kidney injury,” said Dr. Salahudeen, who emphasized the preliminary nature of the study.

Dr. Salahudeen said that he had no relevant financial disclosures.

DENVER – Over the course of 3 months, 28% of patients admitted to a major cancer hospital had clinical signs of acute kidney injury, results from a single-center analysis showed.

While the incidence of acute kidney injury is higher in hospitalized high-risk patients and has been shown to be directly associated with morbidity, mortality, and higher cost, “there is very little literature available about what happens to cancer patients admitted to the hospital,” lead study author Dr. Abdulla K. Salahudeen said in an interview during a poster session at the annual meeting of the American Society of Nephrology. “Our study suggests that we need to take measures to mitigate acute kidney injury in cancer patients.”

In what is believed to be the first study of its kind, Dr. Salahudeen and his associates reviewed the electronic medical records of 5,491 cancer patients who were hospitalized at MD Anderson Cancer Center, Houston, between May 1 and July 31, 2006. They obtained demographic information as well as laboratory and pharmacy data, and defined the incidence of acute kidney injury as having a rise in absolute serum creatinine of 0.3 mg/dL or greater.

Complete information was available on 5,013 of the 5,491 patients, explained Dr. Salahudeen, chief of the section of nephrology and director of the dialysis unit at University of Texas MD Anderson Cancer Center, Houston.

The mean age of these patients was 55 years, 53% were male, and 72% were white. The researchers determined that 14% had preexisting acute kidney injury while another 14% developed the condition during their hospital stay.

On univariate analysis, the clinical risk factors significantly associated with acute kidney injury were use of antibiotics (odds ratio 2.06), use of IV contrast (OR 1.99), use of multiple antidiabetic agents (1.69), and use of chemotherapeutic agents (OR 1.38).

On multivariate analysis, clinical risk factors significantly associated with acute kidney injury were transfer to the ICU (OR 1.40), use of chemotherapeutic agents (OR 1.29), use of antibiotics (OR 1.30), and having diabetes (OR 1.06).

Multivariate analysis also revealed that patients who had acute kidney injury had higher rates of transfer to the ICU, (OR 1.44), mortality (OR 5.20), and length of hospitalization (OR 2.1), compared with their counterparts who did not have acute kidney injury.

“It is possible that what we are seeing is an association between severity of cancer and level of kidney injury,” said Dr. Salahudeen, who emphasized the preliminary nature of the study.

Dr. Salahudeen said that he had no relevant financial disclosures.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the literature, “but not in patients with end-stage renal disease who are on dialysis,” Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. “This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings.”

Using the Nationwide Inpatient Sample, Dr. Sakhuja, an internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, at least 18 years old, who were admitted in 2007. The primary outcomes were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

“As this is a retrospective study we cannot describe a causal relationship,” Dr. Sakhuja commented. “However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don't tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher.”

Dr. Sakhuja said that the findings underscore “the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services.” He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in people with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the literature, “but not in patients with end-stage renal disease who are on dialysis,” Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. “This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings.”

Using the Nationwide Inpatient Sample, Dr. Sakhuja, an internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, at least 18 years old, who were admitted in 2007. The primary outcomes were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

“As this is a retrospective study we cannot describe a causal relationship,” Dr. Sakhuja commented. “However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don't tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher.”

Dr. Sakhuja said that the findings underscore “the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services.” He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in people with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Patients with end-stage renal disease who were admitted to the hospital on a weekend were 17% more likely to die in the hospital than were those who were admitted on a weekday, results from a large retrospective analysis showed.

Poor outcomes related to weekend hospital admission for many acute medical conditions have been described in the literature, “but not in patients with end-stage renal disease who are on dialysis,” Dr. Ankit Sakhuja said in an interview during a poster session at the annual meeting of the American Society of Nephrology. “This population of dialysis patients is very fragile, because they get admitted much more frequently than the general population who are not on dialysis and they have much poorer outcomes than the general population. It becomes important to see how they do in different settings.”

Using the Nationwide Inpatient Sample, Dr. Sakhuja, an internal medicine resident at the Medical College of Wisconsin, Milwaukee, and his associates analyzed data from 836,550 patients with ESRD, at least 18 years old, who were admitted in 2007. The primary outcomes were all-cause in-hospital mortality and time to hemodialysis.

Of the total, 164,800 (20%) were admitted on a weekend. Dr. Sakhuja reported that roughly 8% of patients admitted on a weekend died in the hospital, compared with 7% of those who were admitted on a weekday, a difference that was statistically significant.

After adjusting for age, gender, race, other medical conditions, and hospital characteristics, the researchers found that patients admitted on a weekend were 17% more likely to die in the hospital compared with their counterparts who were admitted on a weekday. The also found that patients admitted on a weekend experienced delays in the start of dialysis treatment by 0.29 days compared with those who were admitted on weekdays.

“As this is a retrospective study we cannot describe a causal relationship,” Dr. Sakhuja commented. “However, unavailability of dialysis facilities over weekends, especially on Sundays, and different staffing patterns over weekends in hospitals could be playing a role. The patients don't tend to get less sick on the weekends. In fact, the seriousness of disease in patients admitted on weekends is higher.”

Dr. Sakhuja said that the findings underscore “the deficiencies in our current model of work in the hospitals where there is limited availability of both number of physicians and other accessory hospital staff and services.” He and his colleagues propose shift work and better incentives for hospital staff on the weekends to prevent this phenomenon.

He said that a prospective study is needed to confirm the findings and to determine other factors that affect this weekend effect in people with ESRD.

Dr. Sakhuja reported having no relevant financial disclosures.

DENVER – Of people with at least six clinical markers of chronic kidney disease, 12% were aware of their diagnosis, results from a large analysis showed.

Of the common markers of chronic kidney disease (CKD), only elevated albuminuria was associated with greater individual awareness of chronic kidney disease.

The findings underscore the importance of good communication when common markers of chronic kidney disease arise, Dr. Delphine S. Tuot said in an interview during a poster session at the meeting.

“Even individuals with six manifestations of CKD – that means they're hypertensive, they have acidosis, anemia, hyperkalemia, hyperphosphatemia, and albuminuria – are unaware that their kidneys are implicated in these conditions and that they have kidney disease,” said Dr. Tuot of the division of nephrology at the University of California, San Francisco. “I found that astounding.”

She and her associates from the Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team evaluated data from 1,725 nonpregnant adults with chronic kidney disease who participated in the National Health and Nutrition Examination Survey, 1999-2008, and who had seen a health care provider within the previous year. Awareness of chronic disease was defined as answering “yes” to the following question: “Have you ever been told by a doctor or other health care provider that you have weak or failing kidneys?”

The researchers created a clinical markers index score (CMIS), which ranged from 0 to 7 and consisted of equally weighted binary indicators of abnormal values for clinical markers. Those included albuminuria (a urine albumin to creatinine ratio of greater than 17 mg/g in women and greater than 25 mg/g in men); hyperkalemia (a serum potassium level of greater than 5.0 mEq/L); hyperphosphatemia (a serum phosphate level of greater than 4.5 mEq/L); anemia (a hemoglobin level of less than 12.5 g/dL in women and less than 13.5 g/dL in men); acidosis (a serum bicarbonate level of less than 22 mEq/L); hypertension (greater than 140/90 mm Hg without albuminuria or greater than 130/80 mm Hg with albuminuria); and an elevated blood urea nitrogen level (15 mmol/L or greater).

Next, Dr. Tuot and her associates used multivariable logistic regression to estimate the odds and percentages of awareness of CKD based on respondents' CMIS, adjusted for demographic characteristics and diabetes, weighted to the U.S. population.

Of respondents with at least six clinical markers of CKD, 12% were aware of their disease, Dr. Tuot reported, compared with 11% who had four to five markers, 10% who had two to three markers, and 6% who had up to one marker.

Of the markers in the CMIS, only albuminuria was significantly associated with greater individual awareness of CKD (odds ratio, 3.4).

“Chronic kidney disease is important,” Dr. Tuot said. “Its presence and consequences need to be relayed to patients. Have that early conversation and assure patients that just because they have kidney disease does not mean they will need dialysis.”

Dr. Tuot acknowledged certain limitations of the study, including its cross-sectional design and the fact that NHANES lacks specific information about physicians or other health care providers who provided care to the respondents.

The project was supported under a cooperative agreement from the Centers for Disease Control and Prevention through the Association of American Medical Colleges. Dr. Tuot said she was supported by the American Kidney Fund Clinical Scientist in Nephrology grant.

DENVER – Of people with at least six clinical markers of chronic kidney disease, 12% were aware of their diagnosis, results from a large analysis showed.

Of the common markers of chronic kidney disease (CKD), only elevated albuminuria was associated with greater individual awareness of chronic kidney disease.

The findings underscore the importance of good communication when common markers of chronic kidney disease arise, Dr. Delphine S. Tuot said in an interview during a poster session at the meeting.

“Even individuals with six manifestations of CKD – that means they're hypertensive, they have acidosis, anemia, hyperkalemia, hyperphosphatemia, and albuminuria – are unaware that their kidneys are implicated in these conditions and that they have kidney disease,” said Dr. Tuot of the division of nephrology at the University of California, San Francisco. “I found that astounding.”

She and her associates from the Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team evaluated data from 1,725 nonpregnant adults with chronic kidney disease who participated in the National Health and Nutrition Examination Survey, 1999-2008, and who had seen a health care provider within the previous year. Awareness of chronic disease was defined as answering “yes” to the following question: “Have you ever been told by a doctor or other health care provider that you have weak or failing kidneys?”

The researchers created a clinical markers index score (CMIS), which ranged from 0 to 7 and consisted of equally weighted binary indicators of abnormal values for clinical markers. Those included albuminuria (a urine albumin to creatinine ratio of greater than 17 mg/g in women and greater than 25 mg/g in men); hyperkalemia (a serum potassium level of greater than 5.0 mEq/L); hyperphosphatemia (a serum phosphate level of greater than 4.5 mEq/L); anemia (a hemoglobin level of less than 12.5 g/dL in women and less than 13.5 g/dL in men); acidosis (a serum bicarbonate level of less than 22 mEq/L); hypertension (greater than 140/90 mm Hg without albuminuria or greater than 130/80 mm Hg with albuminuria); and an elevated blood urea nitrogen level (15 mmol/L or greater).

Next, Dr. Tuot and her associates used multivariable logistic regression to estimate the odds and percentages of awareness of CKD based on respondents' CMIS, adjusted for demographic characteristics and diabetes, weighted to the U.S. population.

Of respondents with at least six clinical markers of CKD, 12% were aware of their disease, Dr. Tuot reported, compared with 11% who had four to five markers, 10% who had two to three markers, and 6% who had up to one marker.

Of the markers in the CMIS, only albuminuria was significantly associated with greater individual awareness of CKD (odds ratio, 3.4).

“Chronic kidney disease is important,” Dr. Tuot said. “Its presence and consequences need to be relayed to patients. Have that early conversation and assure patients that just because they have kidney disease does not mean they will need dialysis.”

Dr. Tuot acknowledged certain limitations of the study, including its cross-sectional design and the fact that NHANES lacks specific information about physicians or other health care providers who provided care to the respondents.

The project was supported under a cooperative agreement from the Centers for Disease Control and Prevention through the Association of American Medical Colleges. Dr. Tuot said she was supported by the American Kidney Fund Clinical Scientist in Nephrology grant.

DENVER – Of people with at least six clinical markers of chronic kidney disease, 12% were aware of their diagnosis, results from a large analysis showed.

Of the common markers of chronic kidney disease (CKD), only elevated albuminuria was associated with greater individual awareness of chronic kidney disease.

The findings underscore the importance of good communication when common markers of chronic kidney disease arise, Dr. Delphine S. Tuot said in an interview during a poster session at the meeting.

“Even individuals with six manifestations of CKD – that means they're hypertensive, they have acidosis, anemia, hyperkalemia, hyperphosphatemia, and albuminuria – are unaware that their kidneys are implicated in these conditions and that they have kidney disease,” said Dr. Tuot of the division of nephrology at the University of California, San Francisco. “I found that astounding.”

She and her associates from the Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team evaluated data from 1,725 nonpregnant adults with chronic kidney disease who participated in the National Health and Nutrition Examination Survey, 1999-2008, and who had seen a health care provider within the previous year. Awareness of chronic disease was defined as answering “yes” to the following question: “Have you ever been told by a doctor or other health care provider that you have weak or failing kidneys?”

The researchers created a clinical markers index score (CMIS), which ranged from 0 to 7 and consisted of equally weighted binary indicators of abnormal values for clinical markers. Those included albuminuria (a urine albumin to creatinine ratio of greater than 17 mg/g in women and greater than 25 mg/g in men); hyperkalemia (a serum potassium level of greater than 5.0 mEq/L); hyperphosphatemia (a serum phosphate level of greater than 4.5 mEq/L); anemia (a hemoglobin level of less than 12.5 g/dL in women and less than 13.5 g/dL in men); acidosis (a serum bicarbonate level of less than 22 mEq/L); hypertension (greater than 140/90 mm Hg without albuminuria or greater than 130/80 mm Hg with albuminuria); and an elevated blood urea nitrogen level (15 mmol/L or greater).

Next, Dr. Tuot and her associates used multivariable logistic regression to estimate the odds and percentages of awareness of CKD based on respondents' CMIS, adjusted for demographic characteristics and diabetes, weighted to the U.S. population.

Of respondents with at least six clinical markers of CKD, 12% were aware of their disease, Dr. Tuot reported, compared with 11% who had four to five markers, 10% who had two to three markers, and 6% who had up to one marker.

Of the markers in the CMIS, only albuminuria was significantly associated with greater individual awareness of CKD (odds ratio, 3.4).

“Chronic kidney disease is important,” Dr. Tuot said. “Its presence and consequences need to be relayed to patients. Have that early conversation and assure patients that just because they have kidney disease does not mean they will need dialysis.”

Dr. Tuot acknowledged certain limitations of the study, including its cross-sectional design and the fact that NHANES lacks specific information about physicians or other health care providers who provided care to the respondents.

The project was supported under a cooperative agreement from the Centers for Disease Control and Prevention through the Association of American Medical Colleges. Dr. Tuot said she was supported by the American Kidney Fund Clinical Scientist in Nephrology grant.

Expanded STD prevention recommendations and revised gonorrhea treatment regimens are key features in the updated Sexually Transmitted Diseases Treatment Guidelines released in December 2010 by the Centers for Disease Control and Prevention.

Dr. Kimberly A. Workowski, of the division of STD prevention at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, chaired the effort and wrote the guidelines with her colleague, Dr. Stuart Berman, after consulting with numerous experts. The guidelines, last updated in 2006, are available online or by contacting CDC-INFO at 800-232-4636.

Expanded STD prevention recommendations include support for the pre-exposure human papillomavirus (HPV) vaccine, which the report calls "one of the most effective methods for preventing transmission of some STDs." Two vaccines are currently available: the quadrivalent HPV vaccine (Gardasil; Merck), which also prevents genital warts, and the bivalent HPV vaccine (Cervarix; GlaxoSmithKline). Routine vaccination of females aged 11 or 12 years is recommended with either vaccine, as is catch-up vaccination for females aged 13-26 years. More information regarding HPV vaccination can be found at the CDC website.

The guidelines also include revised gonorrhea treatment regimens in the wake of Neisseria gonorrhoeae’s decreased susceptibility to cephalosporins and other antimicrobials. In 2007 the CDC recommended that fluoroquinolones not be used for gonorrhea treatment because of resistance to that class of antimicrobials (MMWR 2007;56:332-6).

"What we’ve been seeing over the past number of decades is change in the N. gonorrhoeae organism in different parts of the world," Dr. Workowski said in an interview. "There have been increasing reports of isolates resistant to cephalosporins from Southeast Asia and from Norway."

Because of these developments, patients who present with an uncomplicated urogenital gonorrheal infection should be treated with a single 250-mg intramuscular injection of ceftriaxone. If this is not an option, consider a single 400-mg tablet of cefixime, or a single-dose cephalosporin regimen. To prevent co-infection with Chlamydia trachomatis, treatment with azithromycin 1 mg orally in a single dose or doxycycline 100 mg twice a day* for 7 days is recommended.

Other changes that differ from the 2006 guidelines include:

• New treatment regimens for genital warts and bacterial vaginosis. The list of patient-applied options for treating external genital warts now includes sinecatechins 15% ointment, a green-tea extract. "We don’t know exactly how it works from a scientific standpoint," said Dr. Workowski, who is also an associate professor of medicine at Emory University, Atlanta. "But in published studies it has done well for genital warts, so it’s another alternative."

The guidelines recommend applying a 0.5-cm strand of ointment to each wart three times per day until complete clearance of warts. "This product should not be continued for longer than 16 weeks," the recommendations state. "The medication should not be washed off after use. Sexual (i.e., genital, anal, or oral) contact should be avoided while the ointment is on the skin. The most common side effects of sinecatechins 15% are erythema, pruritus/burning, pain, ulceration, edema, induration, and vesicular rash."

The list of alternative regimens for treating bacterial vaginosis now includes tinidazole 2 g orally once daily for 2** days or tinidazole 1 g orally once daily for 5 days.

• Increasing awareness of lymphogranuloma venereum proctocolitis. Lymphogranuloma venereum is a disease that causes enlarged lymph nodes in the inguinal-femoral area, and it can also cause an infection in the rectum, Dr. Workowski said. Lymphogranuloma venereum proctocolitis can present as rectal bleeding or rectal pain "and is being increasingly recognized in men who have sex with men, particularly in HIV-infected men who have sex with men," she said. "It can also occur in women who engage in receptive rectal intercourse," and should be part of the differential diagnosis in anyone who engages in receptive anal intercourse and presents with a bloody discharge or pain around the rectal area.

• The emergence of azithromycin-resistant Treponema pallidum. Penicillin remains the treatment of choice for syphilis. In those with allergy to penicillin, a 14-day course of doxycycline 100 mg orally twice daily or a 14-day course of tetracycline 500 mg four times daily is recommended. "Azithromycin as a single 2-g oral dose is effective for treating early syphilis," according to the guidelines. "However, T. pallidum chromosomal mutations associated with azithromycin resistance and treatment failures have been documented in several areas in the United States. As such, azithromycin should be used with caution only when treatment with penicillin or doxycycline is not feasible."

• Discussion of the role of Mycoplasma genitalium and trichomoniasis in the evaluation of urethritis and cervicitis and treatment-related implications. While N. gonorrhoeae and C. trachomatis are well established as clinically important infectious causes of urethritis, M. genitalium has also been associated with urethritis. "If clinic-based diagnostic tools (e.g., Gram-stain microscopy, first void urine with microscopy, and leukocyte esterase) are not available, patients should be treated with drug regimens effective against both gonorrhea and chlamydia," the guidelines state. "Further testing to determine the specific etiology is recommended because both chlamydia and gonorrhea are reportable to health departments and a specific diagnosis might improve partner notification and treatment."

The guidelines note that culture, nucleic acid hybridization tests, and nucleic acid amplification testing (NAAT) are available for the detection of both N. gonorrhoeae and C. trachomatis. "Culture and hybridization tests require urethral swab specimens, whereas NAATs can be performed on urine specimens. Because of their higher sensitivity, NAATs are preferred for the detection of C. trachomatis."

• Revised guidance on the evaluation of neurosyphilis. Laboratory diagnosis of neurosyphilis usually depends on various combinations of reactive serologic test results, cerebrospinal fluid cell (CSF) count or protein, and a reactive CSF-Venereal Disease Research Lab [VDRL] test with or without clinical manifestations. "Among persons with HIV infection, the CSF leukocyte count usually is elevated (greater than 5 white blood cell count/mm3); using a higher cutoff (greater than 20 white blood cell count/mm3) might improve the specificity of neurosyphilis diagnosis," the guidelines state. "The CSF-VDRL might be nonreactive even when neurosyphilis is present; therefore, additional evaluation using FTA-ABS [fluorescent treponemal antibody absorbed] testing on CSF can be considered. The CSF FTA-ABS test is less specific for neurosyphilis than the CSF-VDRL but is highly sensitive; neurosyphilis is highly unlikely with a negative CSF FTA-ABS test."

Dr. Workowski and Dr. Berman emphasized that the guidelines "should be regarded as a source of clinical guidance and not prescriptive standards; health care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. They are applicable to various patient-care settings, including family-planning clinics, private physicians’ offices, managed care organizations, and other primary care facilities."

Expanded STD prevention recommendations and revised gonorrhea treatment regimens are key features in the updated Sexually Transmitted Diseases Treatment Guidelines released in December 2010 by the Centers for Disease Control and Prevention.

Dr. Kimberly A. Workowski, of the division of STD prevention at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, chaired the effort and wrote the guidelines with her colleague, Dr. Stuart Berman, after consulting with numerous experts. The guidelines, last updated in 2006, are available online or by contacting CDC-INFO at 800-232-4636.

Expanded STD prevention recommendations include support for the pre-exposure human papillomavirus (HPV) vaccine, which the report calls "one of the most effective methods for preventing transmission of some STDs." Two vaccines are currently available: the quadrivalent HPV vaccine (Gardasil; Merck), which also prevents genital warts, and the bivalent HPV vaccine (Cervarix; GlaxoSmithKline). Routine vaccination of females aged 11 or 12 years is recommended with either vaccine, as is catch-up vaccination for females aged 13-26 years. More information regarding HPV vaccination can be found at the CDC website.

The guidelines also include revised gonorrhea treatment regimens in the wake of Neisseria gonorrhoeae’s decreased susceptibility to cephalosporins and other antimicrobials. In 2007 the CDC recommended that fluoroquinolones not be used for gonorrhea treatment because of resistance to that class of antimicrobials (MMWR 2007;56:332-6).

"What we’ve been seeing over the past number of decades is change in the N. gonorrhoeae organism in different parts of the world," Dr. Workowski said in an interview. "There have been increasing reports of isolates resistant to cephalosporins from Southeast Asia and from Norway."

Because of these developments, patients who present with an uncomplicated urogenital gonorrheal infection should be treated with a single 250-mg intramuscular injection of ceftriaxone. If this is not an option, consider a single 400-mg tablet of cefixime, or a single-dose cephalosporin regimen. To prevent co-infection with Chlamydia trachomatis, treatment with azithromycin 1 mg orally in a single dose or doxycycline 100 mg twice a day* for 7 days is recommended.

Other changes that differ from the 2006 guidelines include:

• New treatment regimens for genital warts and bacterial vaginosis. The list of patient-applied options for treating external genital warts now includes sinecatechins 15% ointment, a green-tea extract. "We don’t know exactly how it works from a scientific standpoint," said Dr. Workowski, who is also an associate professor of medicine at Emory University, Atlanta. "But in published studies it has done well for genital warts, so it’s another alternative."

The guidelines recommend applying a 0.5-cm strand of ointment to each wart three times per day until complete clearance of warts. "This product should not be continued for longer than 16 weeks," the recommendations state. "The medication should not be washed off after use. Sexual (i.e., genital, anal, or oral) contact should be avoided while the ointment is on the skin. The most common side effects of sinecatechins 15% are erythema, pruritus/burning, pain, ulceration, edema, induration, and vesicular rash."

The list of alternative regimens for treating bacterial vaginosis now includes tinidazole 2 g orally once daily for 2** days or tinidazole 1 g orally once daily for 5 days.

• Increasing awareness of lymphogranuloma venereum proctocolitis. Lymphogranuloma venereum is a disease that causes enlarged lymph nodes in the inguinal-femoral area, and it can also cause an infection in the rectum, Dr. Workowski said. Lymphogranuloma venereum proctocolitis can present as rectal bleeding or rectal pain "and is being increasingly recognized in men who have sex with men, particularly in HIV-infected men who have sex with men," she said. "It can also occur in women who engage in receptive rectal intercourse," and should be part of the differential diagnosis in anyone who engages in receptive anal intercourse and presents with a bloody discharge or pain around the rectal area.

• The emergence of azithromycin-resistant Treponema pallidum. Penicillin remains the treatment of choice for syphilis. In those with allergy to penicillin, a 14-day course of doxycycline 100 mg orally twice daily or a 14-day course of tetracycline 500 mg four times daily is recommended. "Azithromycin as a single 2-g oral dose is effective for treating early syphilis," according to the guidelines. "However, T. pallidum chromosomal mutations associated with azithromycin resistance and treatment failures have been documented in several areas in the United States. As such, azithromycin should be used with caution only when treatment with penicillin or doxycycline is not feasible."

• Discussion of the role of Mycoplasma genitalium and trichomoniasis in the evaluation of urethritis and cervicitis and treatment-related implications. While N. gonorrhoeae and C. trachomatis are well established as clinically important infectious causes of urethritis, M. genitalium has also been associated with urethritis. "If clinic-based diagnostic tools (e.g., Gram-stain microscopy, first void urine with microscopy, and leukocyte esterase) are not available, patients should be treated with drug regimens effective against both gonorrhea and chlamydia," the guidelines state. "Further testing to determine the specific etiology is recommended because both chlamydia and gonorrhea are reportable to health departments and a specific diagnosis might improve partner notification and treatment."

The guidelines note that culture, nucleic acid hybridization tests, and nucleic acid amplification testing (NAAT) are available for the detection of both N. gonorrhoeae and C. trachomatis. "Culture and hybridization tests require urethral swab specimens, whereas NAATs can be performed on urine specimens. Because of their higher sensitivity, NAATs are preferred for the detection of C. trachomatis."

• Revised guidance on the evaluation of neurosyphilis. Laboratory diagnosis of neurosyphilis usually depends on various combinations of reactive serologic test results, cerebrospinal fluid cell (CSF) count or protein, and a reactive CSF-Venereal Disease Research Lab [VDRL] test with or without clinical manifestations. "Among persons with HIV infection, the CSF leukocyte count usually is elevated (greater than 5 white blood cell count/mm3); using a higher cutoff (greater than 20 white blood cell count/mm3) might improve the specificity of neurosyphilis diagnosis," the guidelines state. "The CSF-VDRL might be nonreactive even when neurosyphilis is present; therefore, additional evaluation using FTA-ABS [fluorescent treponemal antibody absorbed] testing on CSF can be considered. The CSF FTA-ABS test is less specific for neurosyphilis than the CSF-VDRL but is highly sensitive; neurosyphilis is highly unlikely with a negative CSF FTA-ABS test."

Dr. Workowski and Dr. Berman emphasized that the guidelines "should be regarded as a source of clinical guidance and not prescriptive standards; health care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. They are applicable to various patient-care settings, including family-planning clinics, private physicians’ offices, managed care organizations, and other primary care facilities."

Expanded STD prevention recommendations and revised gonorrhea treatment regimens are key features in the updated Sexually Transmitted Diseases Treatment Guidelines released in December 2010 by the Centers for Disease Control and Prevention.

Dr. Kimberly A. Workowski, of the division of STD prevention at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, chaired the effort and wrote the guidelines with her colleague, Dr. Stuart Berman, after consulting with numerous experts. The guidelines, last updated in 2006, are available online or by contacting CDC-INFO at 800-232-4636.

Expanded STD prevention recommendations include support for the pre-exposure human papillomavirus (HPV) vaccine, which the report calls "one of the most effective methods for preventing transmission of some STDs." Two vaccines are currently available: the quadrivalent HPV vaccine (Gardasil; Merck), which also prevents genital warts, and the bivalent HPV vaccine (Cervarix; GlaxoSmithKline). Routine vaccination of females aged 11 or 12 years is recommended with either vaccine, as is catch-up vaccination for females aged 13-26 years. More information regarding HPV vaccination can be found at the CDC website.

The guidelines also include revised gonorrhea treatment regimens in the wake of Neisseria gonorrhoeae’s decreased susceptibility to cephalosporins and other antimicrobials. In 2007 the CDC recommended that fluoroquinolones not be used for gonorrhea treatment because of resistance to that class of antimicrobials (MMWR 2007;56:332-6).

"What we’ve been seeing over the past number of decades is change in the N. gonorrhoeae organism in different parts of the world," Dr. Workowski said in an interview. "There have been increasing reports of isolates resistant to cephalosporins from Southeast Asia and from Norway."

Because of these developments, patients who present with an uncomplicated urogenital gonorrheal infection should be treated with a single 250-mg intramuscular injection of ceftriaxone. If this is not an option, consider a single 400-mg tablet of cefixime, or a single-dose cephalosporin regimen. To prevent co-infection with Chlamydia trachomatis, treatment with azithromycin 1 mg orally in a single dose or doxycycline 100 mg twice a day* for 7 days is recommended.

Other changes that differ from the 2006 guidelines include:

• New treatment regimens for genital warts and bacterial vaginosis. The list of patient-applied options for treating external genital warts now includes sinecatechins 15% ointment, a green-tea extract. "We don’t know exactly how it works from a scientific standpoint," said Dr. Workowski, who is also an associate professor of medicine at Emory University, Atlanta. "But in published studies it has done well for genital warts, so it’s another alternative."

The guidelines recommend applying a 0.5-cm strand of ointment to each wart three times per day until complete clearance of warts. "This product should not be continued for longer than 16 weeks," the recommendations state. "The medication should not be washed off after use. Sexual (i.e., genital, anal, or oral) contact should be avoided while the ointment is on the skin. The most common side effects of sinecatechins 15% are erythema, pruritus/burning, pain, ulceration, edema, induration, and vesicular rash."

The list of alternative regimens for treating bacterial vaginosis now includes tinidazole 2 g orally once daily for 2** days or tinidazole 1 g orally once daily for 5 days.

• Increasing awareness of lymphogranuloma venereum proctocolitis. Lymphogranuloma venereum is a disease that causes enlarged lymph nodes in the inguinal-femoral area, and it can also cause an infection in the rectum, Dr. Workowski said. Lymphogranuloma venereum proctocolitis can present as rectal bleeding or rectal pain "and is being increasingly recognized in men who have sex with men, particularly in HIV-infected men who have sex with men," she said. "It can also occur in women who engage in receptive rectal intercourse," and should be part of the differential diagnosis in anyone who engages in receptive anal intercourse and presents with a bloody discharge or pain around the rectal area.

• The emergence of azithromycin-resistant Treponema pallidum. Penicillin remains the treatment of choice for syphilis. In those with allergy to penicillin, a 14-day course of doxycycline 100 mg orally twice daily or a 14-day course of tetracycline 500 mg four times daily is recommended. "Azithromycin as a single 2-g oral dose is effective for treating early syphilis," according to the guidelines. "However, T. pallidum chromosomal mutations associated with azithromycin resistance and treatment failures have been documented in several areas in the United States. As such, azithromycin should be used with caution only when treatment with penicillin or doxycycline is not feasible."

• Discussion of the role of Mycoplasma genitalium and trichomoniasis in the evaluation of urethritis and cervicitis and treatment-related implications. While N. gonorrhoeae and C. trachomatis are well established as clinically important infectious causes of urethritis, M. genitalium has also been associated with urethritis. "If clinic-based diagnostic tools (e.g., Gram-stain microscopy, first void urine with microscopy, and leukocyte esterase) are not available, patients should be treated with drug regimens effective against both gonorrhea and chlamydia," the guidelines state. "Further testing to determine the specific etiology is recommended because both chlamydia and gonorrhea are reportable to health departments and a specific diagnosis might improve partner notification and treatment."

The guidelines note that culture, nucleic acid hybridization tests, and nucleic acid amplification testing (NAAT) are available for the detection of both N. gonorrhoeae and C. trachomatis. "Culture and hybridization tests require urethral swab specimens, whereas NAATs can be performed on urine specimens. Because of their higher sensitivity, NAATs are preferred for the detection of C. trachomatis."

• Revised guidance on the evaluation of neurosyphilis. Laboratory diagnosis of neurosyphilis usually depends on various combinations of reactive serologic test results, cerebrospinal fluid cell (CSF) count or protein, and a reactive CSF-Venereal Disease Research Lab [VDRL] test with or without clinical manifestations. "Among persons with HIV infection, the CSF leukocyte count usually is elevated (greater than 5 white blood cell count/mm3); using a higher cutoff (greater than 20 white blood cell count/mm3) might improve the specificity of neurosyphilis diagnosis," the guidelines state. "The CSF-VDRL might be nonreactive even when neurosyphilis is present; therefore, additional evaluation using FTA-ABS [fluorescent treponemal antibody absorbed] testing on CSF can be considered. The CSF FTA-ABS test is less specific for neurosyphilis than the CSF-VDRL but is highly sensitive; neurosyphilis is highly unlikely with a negative CSF FTA-ABS test."

Dr. Workowski and Dr. Berman emphasized that the guidelines "should be regarded as a source of clinical guidance and not prescriptive standards; health care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. They are applicable to various patient-care settings, including family-planning clinics, private physicians’ offices, managed care organizations, and other primary care facilities."

Expanded STD prevention recommendations and revised gonorrhea treatment regimens are key features in the updated Sexually Transmitted Diseases Treatment Guidelines released in December 2010 by the Centers for Disease Control and Prevention.

Dr. Kimberly A. Workowski, of the division of STD prevention at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, chaired the effort and wrote the guidelines with her colleague, Dr. Stuart Berman, after consulting with numerous experts. The guidelines, last updated in 2006, are available online or by contacting CDC-INFO at 800-232-4636.

Expanded STD prevention recommendations include support for the pre-exposure human papillomavirus (HPV) vaccine, which the report calls "one of the most effective methods for preventing transmission of some STDs." Two vaccines are currently available: the quadrivalent HPV vaccine (Gardasil; Merck), which also prevents genital warts, and the bivalent HPV vaccine (Cervarix; GlaxoSmithKline). Routine vaccination of females aged 11 or 12 years is recommended with either vaccine, as is catch-up vaccination for females aged 13-26 years. More information regarding HPV vaccination can be found at the CDC website.

The guidelines also include revised gonorrhea treatment regimens in the wake of Neisseria gonorrhoeae’s decreased susceptibility to cephalosporins and other antimicrobials. In 2007 the CDC recommended that fluoroquinolones not be used for gonorrhea treatment because of resistance to that class of antimicrobials (MMWR 2007;56:332-6).

"What we’ve been seeing over the past number of decades is change in the N. gonorrhoeae organism in different parts of the world," Dr. Workowski said in an interview. "There have been increasing reports of isolates resistant to cephalosporins from Southeast Asia and from Norway."

Because of these developments, patients who present with an uncomplicated urogenital gonorrheal infection should be treated with a single 250-mg intramuscular injection of ceftriaxone. If this is not an option, consider a single 400-mg tablet of cefixime, or a single-dose cephalosporin regimen. To prevent co-infection with Chlamydia trachomatis, treatment with azithromycin 1 mg orally in a single dose or doxycycline 100 mg twice a day* for 7 days is recommended.

Other changes that differ from the 2006 guidelines include:

• New treatment regimens for genital warts and bacterial vaginosis. The list of patient-applied options for treating external genital warts now includes sinecatechins 15% ointment, a green-tea extract. "We don’t know exactly how it works from a scientific standpoint," said Dr. Workowski, who is also an associate professor of medicine at Emory University, Atlanta. "But in published studies it has done well for genital warts, so it’s another alternative."

The guidelines recommend applying a 0.5-cm strand of ointment to each wart three times per day until complete clearance of warts. "This product should not be continued for longer than 16 weeks," the recommendations state. "The medication should not be washed off after use. Sexual (i.e., genital, anal, or oral) contact should be avoided while the ointment is on the skin. The most common side effects of sinecatechins 15% are erythema, pruritus/burning, pain, ulceration, edema, induration, and vesicular rash."

The list of alternative regimens for treating bacterial vaginosis now includes tinidazole 2 g orally once daily for 2** days or tinidazole 1 g orally once daily for 5 days.

• Increasing awareness of lymphogranuloma venereum proctocolitis. Lymphogranuloma venereum is a disease that causes enlarged lymph nodes in the inguinal-femoral area, and it can also cause an infection in the rectum, Dr. Workowski said. Lymphogranuloma venereum proctocolitis can present as rectal bleeding or rectal pain "and is being increasingly recognized in men who have sex with men, particularly in HIV-infected men who have sex with men," she said. "It can also occur in women who engage in receptive rectal intercourse," and should be part of the differential diagnosis in anyone who engages in receptive anal intercourse and presents with a bloody discharge or pain around the rectal area.

• The emergence of azithromycin-resistant Treponema pallidum. Penicillin remains the treatment of choice for syphilis. In those with allergy to penicillin, a 14-day course of doxycycline 100 mg orally twice daily or a 14-day course of tetracycline 500 mg four times daily is recommended. "Azithromycin as a single 2-g oral dose is effective for treating early syphilis," according to the guidelines. "However, T. pallidum chromosomal mutations associated with azithromycin resistance and treatment failures have been documented in several areas in the United States. As such, azithromycin should be used with caution only when treatment with penicillin or doxycycline is not feasible."

• Discussion of the role of Mycoplasma genitalium and trichomoniasis in the evaluation of urethritis and cervicitis and treatment-related implications. While N. gonorrhoeae and C. trachomatis are well established as clinically important infectious causes of urethritis, M. genitalium has also been associated with urethritis. "If clinic-based diagnostic tools (e.g., Gram-stain microscopy, first void urine with microscopy, and leukocyte esterase) are not available, patients should be treated with drug regimens effective against both gonorrhea and chlamydia," the guidelines state. "Further testing to determine the specific etiology is recommended because both chlamydia and gonorrhea are reportable to health departments and a specific diagnosis might improve partner notification and treatment."

The guidelines note that culture, nucleic acid hybridization tests, and nucleic acid amplification testing (NAAT) are available for the detection of both N. gonorrhoeae and C. trachomatis. "Culture and hybridization tests require urethral swab specimens, whereas NAATs can be performed on urine specimens. Because of their higher sensitivity, NAATs are preferred for the detection of C. trachomatis."

• Revised guidance on the evaluation of neurosyphilis. Laboratory diagnosis of neurosyphilis usually depends on various combinations of reactive serologic test results, cerebrospinal fluid cell (CSF) count or protein, and a reactive CSF-Venereal Disease Research Lab [VDRL] test with or without clinical manifestations. "Among persons with HIV infection, the CSF leukocyte count usually is elevated (greater than 5 white blood cell count/mm3); using a higher cutoff (greater than 20 white blood cell count/mm3) might improve the specificity of neurosyphilis diagnosis," the guidelines state. "The CSF-VDRL might be nonreactive even when neurosyphilis is present; therefore, additional evaluation using FTA-ABS [fluorescent treponemal antibody absorbed] testing on CSF can be considered. The CSF FTA-ABS test is less specific for neurosyphilis than the CSF-VDRL but is highly sensitive; neurosyphilis is highly unlikely with a negative CSF FTA-ABS test."

Dr. Workowski and Dr. Berman emphasized that the guidelines "should be regarded as a source of clinical guidance and not prescriptive standards; health care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. They are applicable to various patient-care settings, including family-planning clinics, private physicians’ offices, managed care organizations, and other primary care facilities."

Expanded STD prevention recommendations and revised gonorrhea treatment regimens are key features in the updated Sexually Transmitted Diseases Treatment Guidelines released in December 2010 by the Centers for Disease Control and Prevention.

Dr. Kimberly A. Workowski, of the division of STD prevention at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, chaired the effort and wrote the guidelines with her colleague, Dr. Stuart Berman, after consulting with numerous experts. The guidelines, last updated in 2006, are available online or by contacting CDC-INFO at 800-232-4636.

Expanded STD prevention recommendations include support for the pre-exposure human papillomavirus (HPV) vaccine, which the report calls "one of the most effective methods for preventing transmission of some STDs." Two vaccines are currently available: the quadrivalent HPV vaccine (Gardasil; Merck), which also prevents genital warts, and the bivalent HPV vaccine (Cervarix; GlaxoSmithKline). Routine vaccination of females aged 11 or 12 years is recommended with either vaccine, as is catch-up vaccination for females aged 13-26 years. More information regarding HPV vaccination can be found at the CDC website.

The guidelines also include revised gonorrhea treatment regimens in the wake of Neisseria gonorrhoeae’s decreased susceptibility to cephalosporins and other antimicrobials. In 2007 the CDC recommended that fluoroquinolones not be used for gonorrhea treatment because of resistance to that class of antimicrobials (MMWR 2007;56:332-6).

"What we’ve been seeing over the past number of decades is change in the N. gonorrhoeae organism in different parts of the world," Dr. Workowski said in an interview. "There have been increasing reports of isolates resistant to cephalosporins from Southeast Asia and from Norway."

Because of these developments, patients who present with an uncomplicated urogenital gonorrheal infection should be treated with a single 250-mg intramuscular injection of ceftriaxone. If this is not an option, consider a single 400-mg tablet of cefixime, or a single-dose cephalosporin regimen. To prevent co-infection with Chlamydia trachomatis, treatment with azithromycin 1 mg orally in a single dose or doxycycline 100 mg twice a day* for 7 days is recommended.

Other changes that differ from the 2006 guidelines include:

• New treatment regimens for genital warts and bacterial vaginosis. The list of patient-applied options for treating external genital warts now includes sinecatechins 15% ointment, a green-tea extract. "We don’t know exactly how it works from a scientific standpoint," said Dr. Workowski, who is also an associate professor of medicine at Emory University, Atlanta. "But in published studies it has done well for genital warts, so it’s another alternative."

The guidelines recommend applying a 0.5-cm strand of ointment to each wart three times per day until complete clearance of warts. "This product should not be continued for longer than 16 weeks," the recommendations state. "The medication should not be washed off after use. Sexual (i.e., genital, anal, or oral) contact should be avoided while the ointment is on the skin. The most common side effects of sinecatechins 15% are erythema, pruritus/burning, pain, ulceration, edema, induration, and vesicular rash."

The list of alternative regimens for treating bacterial vaginosis now includes tinidazole 2 g orally once daily for 2** days or tinidazole 1 g orally once daily for 5 days.

• Increasing awareness of lymphogranuloma venereum proctocolitis. Lymphogranuloma venereum is a disease that causes enlarged lymph nodes in the inguinal-femoral area, and it can also cause an infection in the rectum, Dr. Workowski said. Lymphogranuloma venereum proctocolitis can present as rectal bleeding or rectal pain "and is being increasingly recognized in men who have sex with men, particularly in HIV-infected men who have sex with men," she said. "It can also occur in women who engage in receptive rectal intercourse," and should be part of the differential diagnosis in anyone who engages in receptive anal intercourse and presents with a bloody discharge or pain around the rectal area.

• The emergence of azithromycin-resistant Treponema pallidum. Penicillin remains the treatment of choice for syphilis. In those with allergy to penicillin, a 14-day course of doxycycline 100 mg orally twice daily or a 14-day course of tetracycline 500 mg four times daily is recommended. "Azithromycin as a single 2-g oral dose is effective for treating early syphilis," according to the guidelines. "However, T. pallidum chromosomal mutations associated with azithromycin resistance and treatment failures have been documented in several areas in the United States. As such, azithromycin should be used with caution only when treatment with penicillin or doxycycline is not feasible."

• Discussion of the role of Mycoplasma genitalium and trichomoniasis in the evaluation of urethritis and cervicitis and treatment-related implications. While N. gonorrhoeae and C. trachomatis are well established as clinically important infectious causes of urethritis, M. genitalium has also been associated with urethritis. "If clinic-based diagnostic tools (e.g., Gram-stain microscopy, first void urine with microscopy, and leukocyte esterase) are not available, patients should be treated with drug regimens effective against both gonorrhea and chlamydia," the guidelines state. "Further testing to determine the specific etiology is recommended because both chlamydia and gonorrhea are reportable to health departments and a specific diagnosis might improve partner notification and treatment."

The guidelines note that culture, nucleic acid hybridization tests, and nucleic acid amplification testing (NAAT) are available for the detection of both N. gonorrhoeae and C. trachomatis. "Culture and hybridization tests require urethral swab specimens, whereas NAATs can be performed on urine specimens. Because of their higher sensitivity, NAATs are preferred for the detection of C. trachomatis."

• Revised guidance on the evaluation of neurosyphilis. Laboratory diagnosis of neurosyphilis usually depends on various combinations of reactive serologic test results, cerebrospinal fluid cell (CSF) count or protein, and a reactive CSF-Venereal Disease Research Lab [VDRL] test with or without clinical manifestations. "Among persons with HIV infection, the CSF leukocyte count usually is elevated (greater than 5 white blood cell count/mm3); using a higher cutoff (greater than 20 white blood cell count/mm3) might improve the specificity of neurosyphilis diagnosis," the guidelines state. "The CSF-VDRL might be nonreactive even when neurosyphilis is present; therefore, additional evaluation using FTA-ABS [fluorescent treponemal antibody absorbed] testing on CSF can be considered. The CSF FTA-ABS test is less specific for neurosyphilis than the CSF-VDRL but is highly sensitive; neurosyphilis is highly unlikely with a negative CSF FTA-ABS test."

Dr. Workowski and Dr. Berman emphasized that the guidelines "should be regarded as a source of clinical guidance and not prescriptive standards; health care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. They are applicable to various patient-care settings, including family-planning clinics, private physicians’ offices, managed care organizations, and other primary care facilities."

Expanded STD prevention recommendations and revised gonorrhea treatment regimens are key features in the updated Sexually Transmitted Diseases Treatment Guidelines released in December 2010 by the Centers for Disease Control and Prevention.

Dr. Kimberly A. Workowski, of the division of STD prevention at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, chaired the effort and wrote the guidelines with her colleague, Dr. Stuart Berman, after consulting with numerous experts. The guidelines, last updated in 2006, are available online or by contacting CDC-INFO at 800-232-4636.

Expanded STD prevention recommendations include support for the pre-exposure human papillomavirus (HPV) vaccine, which the report calls "one of the most effective methods for preventing transmission of some STDs." Two vaccines are currently available: the quadrivalent HPV vaccine (Gardasil; Merck), which also prevents genital warts, and the bivalent HPV vaccine (Cervarix; GlaxoSmithKline). Routine vaccination of females aged 11 or 12 years is recommended with either vaccine, as is catch-up vaccination for females aged 13-26 years. More information regarding HPV vaccination can be found at the CDC website.

The guidelines also include revised gonorrhea treatment regimens in the wake of Neisseria gonorrhoeae’s decreased susceptibility to cephalosporins and other antimicrobials. In 2007 the CDC recommended that fluoroquinolones not be used for gonorrhea treatment because of resistance to that class of antimicrobials (MMWR 2007;56:332-6).

"What we’ve been seeing over the past number of decades is change in the N. gonorrhoeae organism in different parts of the world," Dr. Workowski said in an interview. "There have been increasing reports of isolates resistant to cephalosporins from Southeast Asia and from Norway."

Because of these developments, patients who present with an uncomplicated urogenital gonorrheal infection should be treated with a single 250-mg intramuscular injection of ceftriaxone. If this is not an option, consider a single 400-mg tablet of cefixime, or a single-dose cephalosporin regimen. To prevent co-infection with Chlamydia trachomatis, treatment with azithromycin 1 mg orally in a single dose or doxycycline 100 mg twice a day* for 7 days is recommended.

Other changes that differ from the 2006 guidelines include:

• New treatment regimens for genital warts and bacterial vaginosis. The list of patient-applied options for treating external genital warts now includes sinecatechins 15% ointment, a green-tea extract. "We don’t know exactly how it works from a scientific standpoint," said Dr. Workowski, who is also an associate professor of medicine at Emory University, Atlanta. "But in published studies it has done well for genital warts, so it’s another alternative."

The guidelines recommend applying a 0.5-cm strand of ointment to each wart three times per day until complete clearance of warts. "This product should not be continued for longer than 16 weeks," the recommendations state. "The medication should not be washed off after use. Sexual (i.e., genital, anal, or oral) contact should be avoided while the ointment is on the skin. The most common side effects of sinecatechins 15% are erythema, pruritus/burning, pain, ulceration, edema, induration, and vesicular rash."

The list of alternative regimens for treating bacterial vaginosis now includes tinidazole 2 g orally once daily for 2** days or tinidazole 1 g orally once daily for 5 days.

• Increasing awareness of lymphogranuloma venereum proctocolitis. Lymphogranuloma venereum is a disease that causes enlarged lymph nodes in the inguinal-femoral area, and it can also cause an infection in the rectum, Dr. Workowski said. Lymphogranuloma venereum proctocolitis can present as rectal bleeding or rectal pain "and is being increasingly recognized in men who have sex with men, particularly in HIV-infected men who have sex with men," she said. "It can also occur in women who engage in receptive rectal intercourse," and should be part of the differential diagnosis in anyone who engages in receptive anal intercourse and presents with a bloody discharge or pain around the rectal area.

• The emergence of azithromycin-resistant Treponema pallidum. Penicillin remains the treatment of choice for syphilis. In those with allergy to penicillin, a 14-day course of doxycycline 100 mg orally twice daily or a 14-day course of tetracycline 500 mg four times daily is recommended. "Azithromycin as a single 2-g oral dose is effective for treating early syphilis," according to the guidelines. "However, T. pallidum chromosomal mutations associated with azithromycin resistance and treatment failures have been documented in several areas in the United States. As such, azithromycin should be used with caution only when treatment with penicillin or doxycycline is not feasible."

• Discussion of the role of Mycoplasma genitalium and trichomoniasis in the evaluation of urethritis and cervicitis and treatment-related implications. While N. gonorrhoeae and C. trachomatis are well established as clinically important infectious causes of urethritis, M. genitalium has also been associated with urethritis. "If clinic-based diagnostic tools (e.g., Gram-stain microscopy, first void urine with microscopy, and leukocyte esterase) are not available, patients should be treated with drug regimens effective against both gonorrhea and chlamydia," the guidelines state. "Further testing to determine the specific etiology is recommended because both chlamydia and gonorrhea are reportable to health departments and a specific diagnosis might improve partner notification and treatment."

The guidelines note that culture, nucleic acid hybridization tests, and nucleic acid amplification testing (NAAT) are available for the detection of both N. gonorrhoeae and C. trachomatis. "Culture and hybridization tests require urethral swab specimens, whereas NAATs can be performed on urine specimens. Because of their higher sensitivity, NAATs are preferred for the detection of C. trachomatis."

• Revised guidance on the evaluation of neurosyphilis. Laboratory diagnosis of neurosyphilis usually depends on various combinations of reactive serologic test results, cerebrospinal fluid cell (CSF) count or protein, and a reactive CSF-Venereal Disease Research Lab [VDRL] test with or without clinical manifestations. "Among persons with HIV infection, the CSF leukocyte count usually is elevated (greater than 5 white blood cell count/mm3); using a higher cutoff (greater than 20 white blood cell count/mm3) might improve the specificity of neurosyphilis diagnosis," the guidelines state. "The CSF-VDRL might be nonreactive even when neurosyphilis is present; therefore, additional evaluation using FTA-ABS [fluorescent treponemal antibody absorbed] testing on CSF can be considered. The CSF FTA-ABS test is less specific for neurosyphilis than the CSF-VDRL but is highly sensitive; neurosyphilis is highly unlikely with a negative CSF FTA-ABS test."

Dr. Workowski and Dr. Berman emphasized that the guidelines "should be regarded as a source of clinical guidance and not prescriptive standards; health care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. They are applicable to various patient-care settings, including family-planning clinics, private physicians’ offices, managed care organizations, and other primary care facilities."

Expanded STD prevention recommendations and revised gonorrhea treatment regimens are key features in the updated Sexually Transmitted Diseases Treatment Guidelines released in December 2010 by the Centers for Disease Control and Prevention.

Dr. Kimberly A. Workowski, of the division of STD prevention at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, chaired the effort and wrote the guidelines with her colleague, Dr. Stuart Berman, after consulting with numerous experts. The guidelines, last updated in 2006, are available online at www.cdc.gov/std/treatment/2010 or by contacting CDC-INFO at 800-232-4636.

Expanded STD prevention recommendations include support for the pre-exposure human papillomavirus (HPV) vaccine, which the report calls "one of the most effective methods for preventing transmission of some STDs." Two vaccines are currently available: the quadrivalent HPV vaccine (Gardasil; Merck), which also prevents genital warts, and the bivalent HPV vaccine (Cervarix; GlaxoSmithKline). Routine vaccination of females aged 11 or 12 years is recommended with either vaccine, as is catch-up vaccination for females aged 13-26 years. More information regarding HPV vaccination can be found at the CDC website.

The guidelines also include revised gonorrhea treatment regimens in the wake of Neisseria gonorrhoeae's decreased susceptibility to cephalosporins and other antimicrobials. In 2007 the CDC recommended that fluoroquinolones not be used for gonorrhea treatment because of resistance to that class of antimicrobials (MMWR 2007;56:332-6).

"What we've been seeing over the past number of decades is change in the N. gonorrhoeae organism in different parts of the world," Dr. Workowski said in an interview. "There have been increasing reports of isolates resistant to cephalosporins from Southeast Asia and from Norway."

Because of these developments, patients who present with an uncomplicated urogenital gonorrheal infection should be treated with a single 250-mg intramuscular injection of ceftriaxone. If this is not an option, consider a single 400-mg tablet of cefixime, or a single-dose cephalosporin regimen. To prevent co-infection with Chlamydia trachomatis, treatment with azithromycin 1 mg orally in a single dose or doxycycline 100 mg twice* a day for 7 days is recommended.

Other changes that differ from the 2006 guidelines include:

• New treatment regimens for genital warts and bacterial vaginosis. The list of patient-applied options for treating external genital warts now includes sinecatechins 15% ointment, a green-tea extract. "We don't know exactly how it works from a scientific standpoint," said Dr. Workowski, who is also an associate professor of medicine at Emory University, Atlanta. "But in published studies it has done well for genital warts, so it's another alternative."

The guidelines recommend applying a 0.5-cm strand of ointment to each wart three times per day until complete clearance of warts. "This product should not be continued for longer than 16 weeks," the recommendations state. "The medication should not be washed off after use. Sexual (i.e., genital, anal, or oral) contact should be avoided while the ointment is on the skin. The most common side effects of sinecatechins 15% are erythema, pruritus/burning, pain, ulceration, edema, induration, and vesicular rash."

The list of alternative regimens for treating bacterial vaginosis now includes tinidazole 2 g orally once daily for 2 days** or tinidazole 1 g orally once daily for 5 days.

• Increasing awareness of lymphogranuloma venereum proctocolitis. Lymphogranuloma venereum is a disease that causes enlarged lymph nodes in the inguinal-femoral area, and it can also cause an infection in the rectum, Dr. Workowski said. Lymphogranuloma venereum proctocolitis can present as rectal bleeding or rectal pain "and is being increasingly recognized in men who have sex with men, particularly in HIV-infected men who have sex with men," she said. "It can also occur in women who engage in receptive rectal intercourse," and should be part of the differential diagnosis in anyone who engages in receptive anal intercourse and presents with a bloody discharge or pain around the rectal area.

• The emergence of azithromycin-resistant Treponema pallidum. Penicillin remains the treatment of choice for syphilis. In those with allergy to penicillin, a 14-day course of doxycycline 100 mg orally twice daily or a 14-day course of tetracycline 500 mg four times daily is recommended. "Azithromycin as a single 2-g oral dose is effective for treating early syphilis," according to the guidelines. "However, T. pallidum chromosomal mutations associated with azithromycin resistance and treatment failures have been documented in several areas in the United States. As such, azithromycin should be used with caution only when treatment with penicillin or doxycycline is not feasible."

• Discussion of the role of Mycoplasma genitalium and trichomoniasis in the evaluation of urethritis and cervicitis and treatment-related implications. While N. gonorrhoeae and C. trachomatis are well established as clinically important infectious causes of urethritis, M. genitalium has also been associated with urethritis. "If clinic-based diagnostic tools (e.g., Gram-stain microscopy, first void urine with microscopy, and leukocyte esterase) are not available, patients should be treated with drug regimens effective against both gonorrhea and chlamydia," the guidelines state. "Further testing to determine the specific etiology is recommended because both chlamydia and gonorrhea are reportable to health departments and a specific diagnosis might improve partner notification and treatment."

The guidelines note that culture, nucleic acid hybridization tests, and nucleic acid amplification testing (NAAT) are available for the detection of both N. gonorrhoeae and C. trachomatis. "Culture and hybridization tests require urethral swab specimens, whereas NAATs can be performed on urine specimens. Because of their higher sensitivity, NAATs are preferred for the detection of C. trachomatis."

• Revised guidance on the evaluation of neurosyphilis. Laboratory diagnosis of neurosyphilis usually depends on various combinations of reactive serologic test results, cerebrospinal fluid cell (CSF) count or protein, and a reactive CSF-Venereal Disease Research Lab [VDRL] test with or without clinical manifestations. "Among persons with HIV infection, the CSF leukocyte count usually is elevated (greater than 5 white blood cell count/mm³); using a higher cutoff (greater than 20 white blood cell count/mm³) might improve the specificity of neurosyphilis diagnosis," the guidelines state. "The CSF-VDRL might be nonreactive even when neurosyphilis is present; therefore, additional evaluation using FTA-ABS [fluorescent treponemal antibody absorbed] testing on CSF can be considered. The CSF FTA-ABS test is less specific for neurosyphilis than the CSF-VDRL but is highly sensitive; neurosyphilis is highly unlikely with a negative CSF FTA-ABS test."

Dr. Workowski and Dr. Berman emphasized that the guidelines "should be regarded as a source of clinical guidance and not prescriptive standards; health care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. They are applicable to various patient-care settings, including family-planning clinics, private physicians' offices, managed care organizations, and other primary care facilities."

Expanded STD prevention recommendations and revised gonorrhea treatment regimens are key features in the updated Sexually Transmitted Diseases Treatment Guidelines released in December 2010 by the Centers for Disease Control and Prevention.

Dr. Kimberly A. Workowski, of the division of STD prevention at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, chaired the effort and wrote the guidelines with her colleague, Dr. Stuart Berman, after consulting with numerous experts. The guidelines, last updated in 2006, are available online at www.cdc.gov/std/treatment/2010 or by contacting CDC-INFO at 800-232-4636.

Expanded STD prevention recommendations include support for the pre-exposure human papillomavirus (HPV) vaccine, which the report calls "one of the most effective methods for preventing transmission of some STDs." Two vaccines are currently available: the quadrivalent HPV vaccine (Gardasil; Merck), which also prevents genital warts, and the bivalent HPV vaccine (Cervarix; GlaxoSmithKline). Routine vaccination of females aged 11 or 12 years is recommended with either vaccine, as is catch-up vaccination for females aged 13-26 years. More information regarding HPV vaccination can be found at the CDC website.

The guidelines also include revised gonorrhea treatment regimens in the wake of Neisseria gonorrhoeae's decreased susceptibility to cephalosporins and other antimicrobials. In 2007 the CDC recommended that fluoroquinolones not be used for gonorrhea treatment because of resistance to that class of antimicrobials (MMWR 2007;56:332-6).

"What we've been seeing over the past number of decades is change in the N. gonorrhoeae organism in different parts of the world," Dr. Workowski said in an interview. "There have been increasing reports of isolates resistant to cephalosporins from Southeast Asia and from Norway."

Because of these developments, patients who present with an uncomplicated urogenital gonorrheal infection should be treated with a single 250-mg intramuscular injection of ceftriaxone. If this is not an option, consider a single 400-mg tablet of cefixime, or a single-dose cephalosporin regimen. To prevent co-infection with Chlamydia trachomatis, treatment with azithromycin 1 mg orally in a single dose or doxycycline 100 mg twice* a day for 7 days is recommended.

Other changes that differ from the 2006 guidelines include:

• New treatment regimens for genital warts and bacterial vaginosis. The list of patient-applied options for treating external genital warts now includes sinecatechins 15% ointment, a green-tea extract. "We don't know exactly how it works from a scientific standpoint," said Dr. Workowski, who is also an associate professor of medicine at Emory University, Atlanta. "But in published studies it has done well for genital warts, so it's another alternative."

The guidelines recommend applying a 0.5-cm strand of ointment to each wart three times per day until complete clearance of warts. "This product should not be continued for longer than 16 weeks," the recommendations state. "The medication should not be washed off after use. Sexual (i.e., genital, anal, or oral) contact should be avoided while the ointment is on the skin. The most common side effects of sinecatechins 15% are erythema, pruritus/burning, pain, ulceration, edema, induration, and vesicular rash."

The list of alternative regimens for treating bacterial vaginosis now includes tinidazole 2 g orally once daily for 2 days** or tinidazole 1 g orally once daily for 5 days.

• Increasing awareness of lymphogranuloma venereum proctocolitis. Lymphogranuloma venereum is a disease that causes enlarged lymph nodes in the inguinal-femoral area, and it can also cause an infection in the rectum, Dr. Workowski said. Lymphogranuloma venereum proctocolitis can present as rectal bleeding or rectal pain "and is being increasingly recognized in men who have sex with men, particularly in HIV-infected men who have sex with men," she said. "It can also occur in women who engage in receptive rectal intercourse," and should be part of the differential diagnosis in anyone who engages in receptive anal intercourse and presents with a bloody discharge or pain around the rectal area.

• The emergence of azithromycin-resistant Treponema pallidum. Penicillin remains the treatment of choice for syphilis. In those with allergy to penicillin, a 14-day course of doxycycline 100 mg orally twice daily or a 14-day course of tetracycline 500 mg four times daily is recommended. "Azithromycin as a single 2-g oral dose is effective for treating early syphilis," according to the guidelines. "However, T. pallidum chromosomal mutations associated with azithromycin resistance and treatment failures have been documented in several areas in the United States. As such, azithromycin should be used with caution only when treatment with penicillin or doxycycline is not feasible."

• Discussion of the role of Mycoplasma genitalium and trichomoniasis in the evaluation of urethritis and cervicitis and treatment-related implications. While N. gonorrhoeae and C. trachomatis are well established as clinically important infectious causes of urethritis, M. genitalium has also been associated with urethritis. "If clinic-based diagnostic tools (e.g., Gram-stain microscopy, first void urine with microscopy, and leukocyte esterase) are not available, patients should be treated with drug regimens effective against both gonorrhea and chlamydia," the guidelines state. "Further testing to determine the specific etiology is recommended because both chlamydia and gonorrhea are reportable to health departments and a specific diagnosis might improve partner notification and treatment."

The guidelines note that culture, nucleic acid hybridization tests, and nucleic acid amplification testing (NAAT) are available for the detection of both N. gonorrhoeae and C. trachomatis. "Culture and hybridization tests require urethral swab specimens, whereas NAATs can be performed on urine specimens. Because of their higher sensitivity, NAATs are preferred for the detection of C. trachomatis."

• Revised guidance on the evaluation of neurosyphilis. Laboratory diagnosis of neurosyphilis usually depends on various combinations of reactive serologic test results, cerebrospinal fluid cell (CSF) count or protein, and a reactive CSF-Venereal Disease Research Lab [VDRL] test with or without clinical manifestations. "Among persons with HIV infection, the CSF leukocyte count usually is elevated (greater than 5 white blood cell count/mm³); using a higher cutoff (greater than 20 white blood cell count/mm³) might improve the specificity of neurosyphilis diagnosis," the guidelines state. "The CSF-VDRL might be nonreactive even when neurosyphilis is present; therefore, additional evaluation using FTA-ABS [fluorescent treponemal antibody absorbed] testing on CSF can be considered. The CSF FTA-ABS test is less specific for neurosyphilis than the CSF-VDRL but is highly sensitive; neurosyphilis is highly unlikely with a negative CSF FTA-ABS test."

Dr. Workowski and Dr. Berman emphasized that the guidelines "should be regarded as a source of clinical guidance and not prescriptive standards; health care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. They are applicable to various patient-care settings, including family-planning clinics, private physicians' offices, managed care organizations, and other primary care facilities."

Expanded STD prevention recommendations and revised gonorrhea treatment regimens are key features in the updated Sexually Transmitted Diseases Treatment Guidelines released in December 2010 by the Centers for Disease Control and Prevention.

Dr. Kimberly A. Workowski, of the division of STD prevention at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, chaired the effort and wrote the guidelines with her colleague, Dr. Stuart Berman, after consulting with numerous experts. The guidelines, last updated in 2006, are available online at www.cdc.gov/std/treatment/2010 or by contacting CDC-INFO at 800-232-4636.

Expanded STD prevention recommendations include support for the pre-exposure human papillomavirus (HPV) vaccine, which the report calls "one of the most effective methods for preventing transmission of some STDs." Two vaccines are currently available: the quadrivalent HPV vaccine (Gardasil; Merck), which also prevents genital warts, and the bivalent HPV vaccine (Cervarix; GlaxoSmithKline). Routine vaccination of females aged 11 or 12 years is recommended with either vaccine, as is catch-up vaccination for females aged 13-26 years. More information regarding HPV vaccination can be found at the CDC website.

The guidelines also include revised gonorrhea treatment regimens in the wake of Neisseria gonorrhoeae's decreased susceptibility to cephalosporins and other antimicrobials. In 2007 the CDC recommended that fluoroquinolones not be used for gonorrhea treatment because of resistance to that class of antimicrobials (MMWR 2007;56:332-6).

"What we've been seeing over the past number of decades is change in the N. gonorrhoeae organism in different parts of the world," Dr. Workowski said in an interview. "There have been increasing reports of isolates resistant to cephalosporins from Southeast Asia and from Norway."

Because of these developments, patients who present with an uncomplicated urogenital gonorrheal infection should be treated with a single 250-mg intramuscular injection of ceftriaxone. If this is not an option, consider a single 400-mg tablet of cefixime, or a single-dose cephalosporin regimen. To prevent co-infection with Chlamydia trachomatis, treatment with azithromycin 1 mg orally in a single dose or doxycycline 100 mg twice* a day for 7 days is recommended.

Other changes that differ from the 2006 guidelines include:

• New treatment regimens for genital warts and bacterial vaginosis. The list of patient-applied options for treating external genital warts now includes sinecatechins 15% ointment, a green-tea extract. "We don't know exactly how it works from a scientific standpoint," said Dr. Workowski, who is also an associate professor of medicine at Emory University, Atlanta. "But in published studies it has done well for genital warts, so it's another alternative."

The guidelines recommend applying a 0.5-cm strand of ointment to each wart three times per day until complete clearance of warts. "This product should not be continued for longer than 16 weeks," the recommendations state. "The medication should not be washed off after use. Sexual (i.e., genital, anal, or oral) contact should be avoided while the ointment is on the skin. The most common side effects of sinecatechins 15% are erythema, pruritus/burning, pain, ulceration, edema, induration, and vesicular rash."

The list of alternative regimens for treating bacterial vaginosis now includes tinidazole 2 g orally once daily for 2 days** or tinidazole 1 g orally once daily for 5 days.

• Increasing awareness of lymphogranuloma venereum proctocolitis. Lymphogranuloma venereum is a disease that causes enlarged lymph nodes in the inguinal-femoral area, and it can also cause an infection in the rectum, Dr. Workowski said. Lymphogranuloma venereum proctocolitis can present as rectal bleeding or rectal pain "and is being increasingly recognized in men who have sex with men, particularly in HIV-infected men who have sex with men," she said. "It can also occur in women who engage in receptive rectal intercourse," and should be part of the differential diagnosis in anyone who engages in receptive anal intercourse and presents with a bloody discharge or pain around the rectal area.

• The emergence of azithromycin-resistant Treponema pallidum. Penicillin remains the treatment of choice for syphilis. In those with allergy to penicillin, a 14-day course of doxycycline 100 mg orally twice daily or a 14-day course of tetracycline 500 mg four times daily is recommended. "Azithromycin as a single 2-g oral dose is effective for treating early syphilis," according to the guidelines. "However, T. pallidum chromosomal mutations associated with azithromycin resistance and treatment failures have been documented in several areas in the United States. As such, azithromycin should be used with caution only when treatment with penicillin or doxycycline is not feasible."

• Discussion of the role of Mycoplasma genitalium and trichomoniasis in the evaluation of urethritis and cervicitis and treatment-related implications. While N. gonorrhoeae and C. trachomatis are well established as clinically important infectious causes of urethritis, M. genitalium has also been associated with urethritis. "If clinic-based diagnostic tools (e.g., Gram-stain microscopy, first void urine with microscopy, and leukocyte esterase) are not available, patients should be treated with drug regimens effective against both gonorrhea and chlamydia," the guidelines state. "Further testing to determine the specific etiology is recommended because both chlamydia and gonorrhea are reportable to health departments and a specific diagnosis might improve partner notification and treatment."

The guidelines note that culture, nucleic acid hybridization tests, and nucleic acid amplification testing (NAAT) are available for the detection of both N. gonorrhoeae and C. trachomatis. "Culture and hybridization tests require urethral swab specimens, whereas NAATs can be performed on urine specimens. Because of their higher sensitivity, NAATs are preferred for the detection of C. trachomatis."

• Revised guidance on the evaluation of neurosyphilis. Laboratory diagnosis of neurosyphilis usually depends on various combinations of reactive serologic test results, cerebrospinal fluid cell (CSF) count or protein, and a reactive CSF-Venereal Disease Research Lab [VDRL] test with or without clinical manifestations. "Among persons with HIV infection, the CSF leukocyte count usually is elevated (greater than 5 white blood cell count/mm³); using a higher cutoff (greater than 20 white blood cell count/mm³) might improve the specificity of neurosyphilis diagnosis," the guidelines state. "The CSF-VDRL might be nonreactive even when neurosyphilis is present; therefore, additional evaluation using FTA-ABS [fluorescent treponemal antibody absorbed] testing on CSF can be considered. The CSF FTA-ABS test is less specific for neurosyphilis than the CSF-VDRL but is highly sensitive; neurosyphilis is highly unlikely with a negative CSF FTA-ABS test."

Dr. Workowski and Dr. Berman emphasized that the guidelines "should be regarded as a source of clinical guidance and not prescriptive standards; health care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. They are applicable to various patient-care settings, including family-planning clinics, private physicians' offices, managed care organizations, and other primary care facilities."

DENVER – Interleukin18 appears to reliably predict the need for renal replacement therapy in patients who develop acute kidney injury after cardiac surgery, according to results from a multicenter study.

While a number of biomarkers have been identified that may prove useful in determining which patients with acute kidney injury will require renal replacement therapy – especially proteins associated with inflammation, signaling, and tubular injury – these markers have not been compared and validated in a large group of patients with the condition.

Only about 10% of patients with acute kidney injury will go on to require dialysis, explained Dr. John M. Arthur of the division of nephrology at the Medical University of South Carolina, Charleston. "What we’re trying to do is figure out a test that clinicians could do in their hospitals that would help them determine which patients are likely to go on to require dialysis," he said at the annual meeting of the American Society of Nephrology. "That’s something that we don’t have right now. We’re still not there yet, but this is bringing us closer."

He presented results from a study of urine samples from 117 patients who developed at least stage 1 acute kidney injury after undergoing cardiac surgery at the Medical University of South Carolina; Duke University, Durham, N.C.; George Washington University, Washington; and the University of Tennessee, Memphis. The patients were assessed for an increase in serum creatinine of 50% or 0.3 mg/dL. The primary outcome measure was the requirement for renal replacement therapy.

Of the 117 patients, 11 required renal replacement therapy and 106 did not. Both groups were similar in gender (71% male among those who did not require renal replacement vs. 73% among those who did); age (a mean of 64 vs. 68 years, respectively); race (23% vs. 9% African American), proportion on bypass (85% vs. 73%); bypass time (2.47 hours vs. 2.36 hours), preoperative serum creatinine (1.2 vs. 1.3 mg/dL), and time of urine collection after surgery (1.4 days vs. 1.8 days).

Compared with their counterparts who did not undergo renal replacement therapy, those who did had significantly higher levels of serum creatinine at the time of collection (1.9 vs. 2.7 mg/dL) as well as mortality (3.80% vs. 72.70%).

Using a receiver operator characteristics area under the curve analysis, which is an indicator for the predictive quality of the marker, the researchers found that several markers significantly predicted the need for renal replacement therapy, including IL-18, vascular cell adhesion molecule (VCAM), N-acetyl-beta-D-glucosaminidase (NAG), IL-6, and liver-type fatty acid binding protein (L-FABP).

IL-18 was the strongest marker to predict the association, with an area under the curve of 0.86 and a positive predictive value of 60%, which Dr. Arthur said is good enough to help select patients for clinical trials in acute kidney injury.

He noted that a study of at least 1,000 patients is needed to confirm the findings.

Dr. Arthur said that he had no relevant financial conflicts to disclose. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and by a VA Merit award.

DENVER – Interleukin18 appears to reliably predict the need for renal replacement therapy in patients who develop acute kidney injury after cardiac surgery, according to results from a multicenter study.

While a number of biomarkers have been identified that may prove useful in determining which patients with acute kidney injury will require renal replacement therapy – especially proteins associated with inflammation, signaling, and tubular injury – these markers have not been compared and validated in a large group of patients with the condition.

Only about 10% of patients with acute kidney injury will go on to require dialysis, explained Dr. John M. Arthur of the division of nephrology at the Medical University of South Carolina, Charleston. "What we’re trying to do is figure out a test that clinicians could do in their hospitals that would help them determine which patients are likely to go on to require dialysis," he said at the annual meeting of the American Society of Nephrology. "That’s something that we don’t have right now. We’re still not there yet, but this is bringing us closer."

He presented results from a study of urine samples from 117 patients who developed at least stage 1 acute kidney injury after undergoing cardiac surgery at the Medical University of South Carolina; Duke University, Durham, N.C.; George Washington University, Washington; and the University of Tennessee, Memphis. The patients were assessed for an increase in serum creatinine of 50% or 0.3 mg/dL. The primary outcome measure was the requirement for renal replacement therapy.

Of the 117 patients, 11 required renal replacement therapy and 106 did not. Both groups were similar in gender (71% male among those who did not require renal replacement vs. 73% among those who did); age (a mean of 64 vs. 68 years, respectively); race (23% vs. 9% African American), proportion on bypass (85% vs. 73%); bypass time (2.47 hours vs. 2.36 hours), preoperative serum creatinine (1.2 vs. 1.3 mg/dL), and time of urine collection after surgery (1.4 days vs. 1.8 days).

Compared with their counterparts who did not undergo renal replacement therapy, those who did had significantly higher levels of serum creatinine at the time of collection (1.9 vs. 2.7 mg/dL) as well as mortality (3.80% vs. 72.70%).

Using a receiver operator characteristics area under the curve analysis, which is an indicator for the predictive quality of the marker, the researchers found that several markers significantly predicted the need for renal replacement therapy, including IL-18, vascular cell adhesion molecule (VCAM), N-acetyl-beta-D-glucosaminidase (NAG), IL-6, and liver-type fatty acid binding protein (L-FABP).

IL-18 was the strongest marker to predict the association, with an area under the curve of 0.86 and a positive predictive value of 60%, which Dr. Arthur said is good enough to help select patients for clinical trials in acute kidney injury.

He noted that a study of at least 1,000 patients is needed to confirm the findings.

Dr. Arthur said that he had no relevant financial conflicts to disclose. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and by a VA Merit award.

DENVER – Interleukin18 appears to reliably predict the need for renal replacement therapy in patients who develop acute kidney injury after cardiac surgery, according to results from a multicenter study.

While a number of biomarkers have been identified that may prove useful in determining which patients with acute kidney injury will require renal replacement therapy – especially proteins associated with inflammation, signaling, and tubular injury – these markers have not been compared and validated in a large group of patients with the condition.

Only about 10% of patients with acute kidney injury will go on to require dialysis, explained Dr. John M. Arthur of the division of nephrology at the Medical University of South Carolina, Charleston. "What we’re trying to do is figure out a test that clinicians could do in their hospitals that would help them determine which patients are likely to go on to require dialysis," he said at the annual meeting of the American Society of Nephrology. "That’s something that we don’t have right now. We’re still not there yet, but this is bringing us closer."

He presented results from a study of urine samples from 117 patients who developed at least stage 1 acute kidney injury after undergoing cardiac surgery at the Medical University of South Carolina; Duke University, Durham, N.C.; George Washington University, Washington; and the University of Tennessee, Memphis. The patients were assessed for an increase in serum creatinine of 50% or 0.3 mg/dL. The primary outcome measure was the requirement for renal replacement therapy.

Of the 117 patients, 11 required renal replacement therapy and 106 did not. Both groups were similar in gender (71% male among those who did not require renal replacement vs. 73% among those who did); age (a mean of 64 vs. 68 years, respectively); race (23% vs. 9% African American), proportion on bypass (85% vs. 73%); bypass time (2.47 hours vs. 2.36 hours), preoperative serum creatinine (1.2 vs. 1.3 mg/dL), and time of urine collection after surgery (1.4 days vs. 1.8 days).

Compared with their counterparts who did not undergo renal replacement therapy, those who did had significantly higher levels of serum creatinine at the time of collection (1.9 vs. 2.7 mg/dL) as well as mortality (3.80% vs. 72.70%).

Using a receiver operator characteristics area under the curve analysis, which is an indicator for the predictive quality of the marker, the researchers found that several markers significantly predicted the need for renal replacement therapy, including IL-18, vascular cell adhesion molecule (VCAM), N-acetyl-beta-D-glucosaminidase (NAG), IL-6, and liver-type fatty acid binding protein (L-FABP).

IL-18 was the strongest marker to predict the association, with an area under the curve of 0.86 and a positive predictive value of 60%, which Dr. Arthur said is good enough to help select patients for clinical trials in acute kidney injury.

He noted that a study of at least 1,000 patients is needed to confirm the findings.

Dr. Arthur said that he had no relevant financial conflicts to disclose. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and by a VA Merit award.

DENVER – Interleukin18 appears to reliably predict the need for renal replacement therapy in patients who develop acute kidney injury after cardiac surgery, according to results from a multicenter study.

While a number of biomarkers have been identified that may prove useful in determining which patients with acute kidney injury will require renal replacement therapy – especially proteins associated with inflammation, signaling, and tubular injury – these markers have not been compared and validated in a large group of patients with the condition.

Only about 10% of patients with acute kidney injury will go on to require dialysis, explained Dr. John M. Arthur of the division of nephrology at the Medical University of South Carolina, Charleston. "What we’re trying to do is figure out a test that clinicians could do in their hospitals that would help them determine which patients are likely to go on to require dialysis," he said at the annual meeting of the American Society of Nephrology. "That’s something that we don’t have right now. We’re still not there yet, but this is bringing us closer."

He presented results from a study of urine samples from 117 patients who developed at least stage 1 acute kidney injury after undergoing cardiac surgery at the Medical University of South Carolina; Duke University, Durham, N.C.; George Washington University, Washington; and the University of Tennessee, Memphis. The patients were assessed for an increase in serum creatinine of 50% or 0.3 mg/dL. The primary outcome measure was the requirement for renal replacement therapy.

Of the 117 patients, 11 required renal replacement therapy and 106 did not. Both groups were similar in gender (71% male among those who did not require renal replacement vs. 73% among those who did); age (a mean of 64 vs. 68 years, respectively); race (23% vs. 9% African American), proportion on bypass (85% vs. 73%); bypass time (2.47 hours vs. 2.36 hours), preoperative serum creatinine (1.2 vs. 1.3 mg/dL), and time of urine collection after surgery (1.4 days vs. 1.8 days).

Compared with their counterparts who did not undergo renal replacement therapy, those who did had significantly higher levels of serum creatinine at the time of collection (1.9 vs. 2.7 mg/dL) as well as mortality (3.80% vs. 72.70%).

Using a receiver operator characteristics area under the curve analysis, which is an indicator for the predictive quality of the marker, the researchers found that several markers significantly predicted the need for renal replacement therapy, including IL-18, vascular cell adhesion molecule (VCAM), N-acetyl-beta-D-glucosaminidase (NAG), IL-6, and liver-type fatty acid binding protein (L-FABP).

IL-18 was the strongest marker to predict the association, with an area under the curve of 0.86 and a positive predictive value of 60%, which Dr. Arthur said is good enough to help select patients for clinical trials in acute kidney injury.

He noted that a study of at least 1,000 patients is needed to confirm the findings.

Dr. Arthur said that he had no relevant financial conflicts to disclose. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and by a VA Merit award.

DENVER – Interleukin18 appears to reliably predict the need for renal replacement therapy in patients who develop acute kidney injury after cardiac surgery, according to results from a multicenter study.

While a number of biomarkers have been identified that may prove useful in determining which patients with acute kidney injury will require renal replacement therapy – especially proteins associated with inflammation, signaling, and tubular injury – these markers have not been compared and validated in a large group of patients with the condition.

Only about 10% of patients with acute kidney injury will go on to require dialysis, explained Dr. John M. Arthur of the division of nephrology at the Medical University of South Carolina, Charleston. "What we’re trying to do is figure out a test that clinicians could do in their hospitals that would help them determine which patients are likely to go on to require dialysis," he said at the annual meeting of the American Society of Nephrology. "That’s something that we don’t have right now. We’re still not there yet, but this is bringing us closer."

He presented results from a study of urine samples from 117 patients who developed at least stage 1 acute kidney injury after undergoing cardiac surgery at the Medical University of South Carolina; Duke University, Durham, N.C.; George Washington University, Washington; and the University of Tennessee, Memphis. The patients were assessed for an increase in serum creatinine of 50% or 0.3 mg/dL. The primary outcome measure was the requirement for renal replacement therapy.

Of the 117 patients, 11 required renal replacement therapy and 106 did not. Both groups were similar in gender (71% male among those who did not require renal replacement vs. 73% among those who did); age (a mean of 64 vs. 68 years, respectively); race (23% vs. 9% African American), proportion on bypass (85% vs. 73%); bypass time (2.47 hours vs. 2.36 hours), preoperative serum creatinine (1.2 vs. 1.3 mg/dL), and time of urine collection after surgery (1.4 days vs. 1.8 days).

Compared with their counterparts who did not undergo renal replacement therapy, those who did had significantly higher levels of serum creatinine at the time of collection (1.9 vs. 2.7 mg/dL) as well as mortality (3.80% vs. 72.70%).

Using a receiver operator characteristics area under the curve analysis, which is an indicator for the predictive quality of the marker, the researchers found that several markers significantly predicted the need for renal replacement therapy, including IL-18, vascular cell adhesion molecule (VCAM), N-acetyl-beta-D-glucosaminidase (NAG), IL-6, and liver-type fatty acid binding protein (L-FABP).

IL-18 was the strongest marker to predict the association, with an area under the curve of 0.86 and a positive predictive value of 60%, which Dr. Arthur said is good enough to help select patients for clinical trials in acute kidney injury.

He noted that a study of at least 1,000 patients is needed to confirm the findings.

Dr. Arthur said that he had no relevant financial conflicts to disclose. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and by a VA Merit award.

DENVER – Interleukin18 appears to reliably predict the need for renal replacement therapy in patients who develop acute kidney injury after cardiac surgery, according to results from a multicenter study.

While a number of biomarkers have been identified that may prove useful in determining which patients with acute kidney injury will require renal replacement therapy – especially proteins associated with inflammation, signaling, and tubular injury – these markers have not been compared and validated in a large group of patients with the condition.

Only about 10% of patients with acute kidney injury will go on to require dialysis, explained Dr. John M. Arthur of the division of nephrology at the Medical University of South Carolina, Charleston. "What we’re trying to do is figure out a test that clinicians could do in their hospitals that would help them determine which patients are likely to go on to require dialysis," he said at the annual meeting of the American Society of Nephrology. "That’s something that we don’t have right now. We’re still not there yet, but this is bringing us closer."

He presented results from a study of urine samples from 117 patients who developed at least stage 1 acute kidney injury after undergoing cardiac surgery at the Medical University of South Carolina; Duke University, Durham, N.C.; George Washington University, Washington; and the University of Tennessee, Memphis. The patients were assessed for an increase in serum creatinine of 50% or 0.3 mg/dL. The primary outcome measure was the requirement for renal replacement therapy.

Of the 117 patients, 11 required renal replacement therapy and 106 did not. Both groups were similar in gender (71% male among those who did not require renal replacement vs. 73% among those who did); age (a mean of 64 vs. 68 years, respectively); race (23% vs. 9% African American), proportion on bypass (85% vs. 73%); bypass time (2.47 hours vs. 2.36 hours), preoperative serum creatinine (1.2 vs. 1.3 mg/dL), and time of urine collection after surgery (1.4 days vs. 1.8 days).

Compared with their counterparts who did not undergo renal replacement therapy, those who did had significantly higher levels of serum creatinine at the time of collection (1.9 vs. 2.7 mg/dL) as well as mortality (3.80% vs. 72.70%).

Using a receiver operator characteristics area under the curve analysis, which is an indicator for the predictive quality of the marker, the researchers found that several markers significantly predicted the need for renal replacement therapy, including IL-18, vascular cell adhesion molecule (VCAM), N-acetyl-beta-D-glucosaminidase (NAG), IL-6, and liver-type fatty acid binding protein (L-FABP).

IL-18 was the strongest marker to predict the association, with an area under the curve of 0.86 and a positive predictive value of 60%, which Dr. Arthur said is good enough to help select patients for clinical trials in acute kidney injury.

He noted that a study of at least 1,000 patients is needed to confirm the findings.

Dr. Arthur said that he had no relevant financial conflicts to disclose. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and by a VA Merit award.