Doug Brunk

SAN FRANCISCO — The isolation of methicillin-resistant Staphylococcus aureus, either alone or as part of a polymicrobial infection, was associated with treatment failure in 35% of patients with a diabetic foot infection, Dr. Matthew E. Falagas reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The finding comes from an analysis of 15 randomized, controlled trials that compared the use of different antibiotics for treating diabetic foot infections.

The analysis showed that “a considerable proportion of patients with diabetes who have infection in [the] foot would not be treated effectively with current [antimicrobial] management,” Dr. Falagas of the Alfa Institute of Biomedical Sciences in Athens, Greece, said in an interview. “As a matter of fact, about one-fourth of all patients fail to be cured with the current antimicrobial regimens and treatment.”

He and his associates found that different regimens of appropriate antibiotics—including penicillins, carbapenems, cephalosporins, and fluoroquinolones—were associated with similar treatment failures. However, in the 68 patients whose infections were caused by methicillin-resistant Staphylococcus aureus (MRSA) alone or as part of a polymicrobial infection, treatment failure was 35%, compared with 23% in the 1,522 patients whose infections were caused by different bacteria.

In patients with infections caused by MRSA, the use of linezolid was not associated with a significantly lower failure rate, compared with other antibiotics (32% vs. 37%, respectively).

The researchers also observed no significant differences in overall treatment failure when they compared patients who had osteomyelitis with those who did not (27% vs. 23%, respectively).

The treatment failures were not a matter of patient compliance “because most of these patients were treated in the hospital with [intravenous] antimicrobial agents,” Dr. Falagas said at the conference, sponsored by the American Society for Microbiology.

Dr. Falagas added that the patients who took carbapenems had fewer treatment failures, a finding he did not expect.

Treatment failure occurred in 35% of foot infection patients such as this patient, who has an infection caused by MRSA, vs. 23% of patients with other types of foot infections. Courtesy Dr. Matthew Falagas

SAN FRANCISCO — The isolation of methicillin-resistant Staphylococcus aureus, either alone or as part of a polymicrobial infection, was associated with treatment failure in 35% of patients with a diabetic foot infection, Dr. Matthew E. Falagas reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The finding comes from an analysis of 15 randomized, controlled trials that compared the use of different antibiotics for treating diabetic foot infections.

The analysis showed that “a considerable proportion of patients with diabetes who have infection in [the] foot would not be treated effectively with current [antimicrobial] management,” Dr. Falagas of the Alfa Institute of Biomedical Sciences in Athens, Greece, said in an interview. “As a matter of fact, about one-fourth of all patients fail to be cured with the current antimicrobial regimens and treatment.”

He and his associates found that different regimens of appropriate antibiotics—including penicillins, carbapenems, cephalosporins, and fluoroquinolones—were associated with similar treatment failures. However, in the 68 patients whose infections were caused by methicillin-resistant Staphylococcus aureus (MRSA) alone or as part of a polymicrobial infection, treatment failure was 35%, compared with 23% in the 1,522 patients whose infections were caused by different bacteria.

In patients with infections caused by MRSA, the use of linezolid was not associated with a significantly lower failure rate, compared with other antibiotics (32% vs. 37%, respectively).

The researchers also observed no significant differences in overall treatment failure when they compared patients who had osteomyelitis with those who did not (27% vs. 23%, respectively).

The treatment failures were not a matter of patient compliance “because most of these patients were treated in the hospital with [intravenous] antimicrobial agents,” Dr. Falagas said at the conference, sponsored by the American Society for Microbiology.

Dr. Falagas added that the patients who took carbapenems had fewer treatment failures, a finding he did not expect.

Treatment failure occurred in 35% of foot infection patients such as this patient, who has an infection caused by MRSA, vs. 23% of patients with other types of foot infections. Courtesy Dr. Matthew Falagas

SAN FRANCISCO — The isolation of methicillin-resistant Staphylococcus aureus, either alone or as part of a polymicrobial infection, was associated with treatment failure in 35% of patients with a diabetic foot infection, Dr. Matthew E. Falagas reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The finding comes from an analysis of 15 randomized, controlled trials that compared the use of different antibiotics for treating diabetic foot infections.

The analysis showed that “a considerable proportion of patients with diabetes who have infection in [the] foot would not be treated effectively with current [antimicrobial] management,” Dr. Falagas of the Alfa Institute of Biomedical Sciences in Athens, Greece, said in an interview. “As a matter of fact, about one-fourth of all patients fail to be cured with the current antimicrobial regimens and treatment.”

He and his associates found that different regimens of appropriate antibiotics—including penicillins, carbapenems, cephalosporins, and fluoroquinolones—were associated with similar treatment failures. However, in the 68 patients whose infections were caused by methicillin-resistant Staphylococcus aureus (MRSA) alone or as part of a polymicrobial infection, treatment failure was 35%, compared with 23% in the 1,522 patients whose infections were caused by different bacteria.

In patients with infections caused by MRSA, the use of linezolid was not associated with a significantly lower failure rate, compared with other antibiotics (32% vs. 37%, respectively).

The researchers also observed no significant differences in overall treatment failure when they compared patients who had osteomyelitis with those who did not (27% vs. 23%, respectively).

The treatment failures were not a matter of patient compliance “because most of these patients were treated in the hospital with [intravenous] antimicrobial agents,” Dr. Falagas said at the conference, sponsored by the American Society for Microbiology.

Dr. Falagas added that the patients who took carbapenems had fewer treatment failures, a finding he did not expect.

Treatment failure occurred in 35% of foot infection patients such as this patient, who has an infection caused by MRSA, vs. 23% of patients with other types of foot infections. Courtesy Dr. Matthew Falagas

SAN FRANCISCO — Immunizing pregnant women with the trivalent inactivated influenza vaccine instead of the pneumococcal polysaccharide vaccine was associated with better outcomes in the women and their infants, based on preliminary results from a randomized, controlled trial presented in a poster at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Compared with women immunized with the pneumococcal polysaccharide vaccine, those given the trivalent inactivated vaccine had 28% fewer cases of respiratory illness with fever. Among their infants, those born to women given the trivalent vaccine had a 62% reduction in proven influenza illness and 38% fewer cases of respiratory illness with fever.

Influenza immunization of pregnant women in the third trimester is recommended in the United States; however, “there appears to be no prospective evaluation of this strategy and its effect on illness in women and their infants,” a group of researchers led by Dr. Mark C. Steinhoff wrote in their poster presentation.

As part of a study on maternal immunization practices in Dhaka, Bangladesh, Dr. Steinhoff and his associates at the Johns Hopkins University School of Hygiene and Public Health, Baltimore, randomized 340 women in their third trimester to receive either trivalent inactivated influenza vaccine (Fluarix) or pneumococcal polysaccharide vaccine (Pneumovax) between August 2004 and March 2005. The researchers conducted weekly interviews with the mothers and followed the mothers and their infants for 6 months after birth to record illnesses. They also asked the mothers to bring infants with illness to a clinic for evaluation and treatment.

When acute febrile respiratory illnesses occurred, the researchers collected nasal swabs and conducted rapid testing for influenza A and B.

Throughout the study period, 25 of the 137 influenza tests were positive in the infants. Of these, 18 occurred in infants whose mothers received the pneumococcal polysaccharide vaccine and 7 were in those whose mothers got the trivalent inactivated influenza vaccine. This difference represented a 62% reduction in proven influenza illness for infants whose mothers received the influenza vaccine.

In the influenza vaccine group, 145 infants developed respiratory illness during the course of the study, compared with 232 infants in the pneumococcal polysaccharide vaccine group. The difference represented 38% fewer cases of respiratory illness with fever in infants whose mothers who took the influenza vaccine.

In addition, 83 mothers in the influenza vaccine group developed respiratory illness with fever during the course of the study, compared with 114 mothers in the pneumococcal polysaccharide vaccine group. This translated into 28% fewer cases of respiratory illness with fever in mothers who took the influenza vaccine.

Neither vaccine had a substantial clinical impact on diarrheal illnesses in the infants and mothers.

The researchers have not yet analyzed the serologic data collected for the study.

Dr. Steinhoff is a professor of pediatrics and international health at Johns Hopkins University School of Hygiene and Public Health.

SAN FRANCISCO — Immunizing pregnant women with the trivalent inactivated influenza vaccine instead of the pneumococcal polysaccharide vaccine was associated with better outcomes in the women and their infants, based on preliminary results from a randomized, controlled trial presented in a poster at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Compared with women immunized with the pneumococcal polysaccharide vaccine, those given the trivalent inactivated vaccine had 28% fewer cases of respiratory illness with fever. Among their infants, those born to women given the trivalent vaccine had a 62% reduction in proven influenza illness and 38% fewer cases of respiratory illness with fever.

Influenza immunization of pregnant women in the third trimester is recommended in the United States; however, “there appears to be no prospective evaluation of this strategy and its effect on illness in women and their infants,” a group of researchers led by Dr. Mark C. Steinhoff wrote in their poster presentation.

As part of a study on maternal immunization practices in Dhaka, Bangladesh, Dr. Steinhoff and his associates at the Johns Hopkins University School of Hygiene and Public Health, Baltimore, randomized 340 women in their third trimester to receive either trivalent inactivated influenza vaccine (Fluarix) or pneumococcal polysaccharide vaccine (Pneumovax) between August 2004 and March 2005. The researchers conducted weekly interviews with the mothers and followed the mothers and their infants for 6 months after birth to record illnesses. They also asked the mothers to bring infants with illness to a clinic for evaluation and treatment.

When acute febrile respiratory illnesses occurred, the researchers collected nasal swabs and conducted rapid testing for influenza A and B.

Throughout the study period, 25 of the 137 influenza tests were positive in the infants. Of these, 18 occurred in infants whose mothers received the pneumococcal polysaccharide vaccine and 7 were in those whose mothers got the trivalent inactivated influenza vaccine. This difference represented a 62% reduction in proven influenza illness for infants whose mothers received the influenza vaccine.

In the influenza vaccine group, 145 infants developed respiratory illness during the course of the study, compared with 232 infants in the pneumococcal polysaccharide vaccine group. The difference represented 38% fewer cases of respiratory illness with fever in infants whose mothers who took the influenza vaccine.

In addition, 83 mothers in the influenza vaccine group developed respiratory illness with fever during the course of the study, compared with 114 mothers in the pneumococcal polysaccharide vaccine group. This translated into 28% fewer cases of respiratory illness with fever in mothers who took the influenza vaccine.

Neither vaccine had a substantial clinical impact on diarrheal illnesses in the infants and mothers.

The researchers have not yet analyzed the serologic data collected for the study.

Dr. Steinhoff is a professor of pediatrics and international health at Johns Hopkins University School of Hygiene and Public Health.

SAN FRANCISCO — Immunizing pregnant women with the trivalent inactivated influenza vaccine instead of the pneumococcal polysaccharide vaccine was associated with better outcomes in the women and their infants, based on preliminary results from a randomized, controlled trial presented in a poster at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Compared with women immunized with the pneumococcal polysaccharide vaccine, those given the trivalent inactivated vaccine had 28% fewer cases of respiratory illness with fever. Among their infants, those born to women given the trivalent vaccine had a 62% reduction in proven influenza illness and 38% fewer cases of respiratory illness with fever.

Influenza immunization of pregnant women in the third trimester is recommended in the United States; however, “there appears to be no prospective evaluation of this strategy and its effect on illness in women and their infants,” a group of researchers led by Dr. Mark C. Steinhoff wrote in their poster presentation.

As part of a study on maternal immunization practices in Dhaka, Bangladesh, Dr. Steinhoff and his associates at the Johns Hopkins University School of Hygiene and Public Health, Baltimore, randomized 340 women in their third trimester to receive either trivalent inactivated influenza vaccine (Fluarix) or pneumococcal polysaccharide vaccine (Pneumovax) between August 2004 and March 2005. The researchers conducted weekly interviews with the mothers and followed the mothers and their infants for 6 months after birth to record illnesses. They also asked the mothers to bring infants with illness to a clinic for evaluation and treatment.

When acute febrile respiratory illnesses occurred, the researchers collected nasal swabs and conducted rapid testing for influenza A and B.

Throughout the study period, 25 of the 137 influenza tests were positive in the infants. Of these, 18 occurred in infants whose mothers received the pneumococcal polysaccharide vaccine and 7 were in those whose mothers got the trivalent inactivated influenza vaccine. This difference represented a 62% reduction in proven influenza illness for infants whose mothers received the influenza vaccine.

In the influenza vaccine group, 145 infants developed respiratory illness during the course of the study, compared with 232 infants in the pneumococcal polysaccharide vaccine group. The difference represented 38% fewer cases of respiratory illness with fever in infants whose mothers who took the influenza vaccine.

In addition, 83 mothers in the influenza vaccine group developed respiratory illness with fever during the course of the study, compared with 114 mothers in the pneumococcal polysaccharide vaccine group. This translated into 28% fewer cases of respiratory illness with fever in mothers who took the influenza vaccine.

Neither vaccine had a substantial clinical impact on diarrheal illnesses in the infants and mothers.

The researchers have not yet analyzed the serologic data collected for the study.

Dr. Steinhoff is a professor of pediatrics and international health at Johns Hopkins University School of Hygiene and Public Health.

SAN FRANCISCO — The highest rates of invasive pneumococcal disease were seen in children younger than 2 years of age in a Massachusetts study, Dr. Katherine K. Hsu reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The results also showed that black and Hispanic children remain especially vulnerable to nonvaccine-type invasive pneumococcal disease (IPD), compared with white children.

“The implications in Massachusetts are that despite advances with pneumococcal conjugate vaccine and huge declines in invasive pneumococcal disease, there still are some children at risk,” Dr. Hsu said in an interview.

Using microbiology reports of pneumococcal isolates from the Massachusetts Department of Public Health, the researchers identified 357 cases of IPD in children younger than 18 years of age between Oct. 1, 2001, and Sept. 30, 2005. Demographic data was confirmed with follow-up telephone interviews with primary care providers and/or adult caregivers. Incidence rates were derived using Census 2000 denominators.

Dr. Hsu and her associates found that the relative risk of IPD was 15.9 for children younger than 6 months, 16.8 for those aged 6–12 months, and 12.7 for those aged 12–24 months, compared with a relative risk of only 4.5 for children aged 24–60 months. Dr. Hsu did not give any data on older children.

The researchers also found that black and Hispanic children were two times more likely than their white counterparts to have IPD, particularly the nonvaccine type. Dr. Hsu, of the section of pediatric infectious diseases at Boston Medical Center, noted that these differences could not be attributed to unequal vaccination coverage rates. “Are these children perhaps more at risk because they're colonized more in the nasopharynx?” she asked. “Are they from different socioeconomic classes where there's more crowding or more smoking, or are there other risk factors for invasive disease such as HIV infection that are more dominant in those populations? We don't know the answer.”

The study was supported by Wyeth.

Higher risk of IPD in black and Hispanic children could not be attributed to unequal vaccination. DR. HSU

SAN FRANCISCO — The highest rates of invasive pneumococcal disease were seen in children younger than 2 years of age in a Massachusetts study, Dr. Katherine K. Hsu reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The results also showed that black and Hispanic children remain especially vulnerable to nonvaccine-type invasive pneumococcal disease (IPD), compared with white children.

“The implications in Massachusetts are that despite advances with pneumococcal conjugate vaccine and huge declines in invasive pneumococcal disease, there still are some children at risk,” Dr. Hsu said in an interview.

Using microbiology reports of pneumococcal isolates from the Massachusetts Department of Public Health, the researchers identified 357 cases of IPD in children younger than 18 years of age between Oct. 1, 2001, and Sept. 30, 2005. Demographic data was confirmed with follow-up telephone interviews with primary care providers and/or adult caregivers. Incidence rates were derived using Census 2000 denominators.

Dr. Hsu and her associates found that the relative risk of IPD was 15.9 for children younger than 6 months, 16.8 for those aged 6–12 months, and 12.7 for those aged 12–24 months, compared with a relative risk of only 4.5 for children aged 24–60 months. Dr. Hsu did not give any data on older children.

The researchers also found that black and Hispanic children were two times more likely than their white counterparts to have IPD, particularly the nonvaccine type. Dr. Hsu, of the section of pediatric infectious diseases at Boston Medical Center, noted that these differences could not be attributed to unequal vaccination coverage rates. “Are these children perhaps more at risk because they're colonized more in the nasopharynx?” she asked. “Are they from different socioeconomic classes where there's more crowding or more smoking, or are there other risk factors for invasive disease such as HIV infection that are more dominant in those populations? We don't know the answer.”

The study was supported by Wyeth.

Higher risk of IPD in black and Hispanic children could not be attributed to unequal vaccination. DR. HSU

SAN FRANCISCO — The highest rates of invasive pneumococcal disease were seen in children younger than 2 years of age in a Massachusetts study, Dr. Katherine K. Hsu reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The results also showed that black and Hispanic children remain especially vulnerable to nonvaccine-type invasive pneumococcal disease (IPD), compared with white children.

“The implications in Massachusetts are that despite advances with pneumococcal conjugate vaccine and huge declines in invasive pneumococcal disease, there still are some children at risk,” Dr. Hsu said in an interview.

Using microbiology reports of pneumococcal isolates from the Massachusetts Department of Public Health, the researchers identified 357 cases of IPD in children younger than 18 years of age between Oct. 1, 2001, and Sept. 30, 2005. Demographic data was confirmed with follow-up telephone interviews with primary care providers and/or adult caregivers. Incidence rates were derived using Census 2000 denominators.

Dr. Hsu and her associates found that the relative risk of IPD was 15.9 for children younger than 6 months, 16.8 for those aged 6–12 months, and 12.7 for those aged 12–24 months, compared with a relative risk of only 4.5 for children aged 24–60 months. Dr. Hsu did not give any data on older children.

The researchers also found that black and Hispanic children were two times more likely than their white counterparts to have IPD, particularly the nonvaccine type. Dr. Hsu, of the section of pediatric infectious diseases at Boston Medical Center, noted that these differences could not be attributed to unequal vaccination coverage rates. “Are these children perhaps more at risk because they're colonized more in the nasopharynx?” she asked. “Are they from different socioeconomic classes where there's more crowding or more smoking, or are there other risk factors for invasive disease such as HIV infection that are more dominant in those populations? We don't know the answer.”

The study was supported by Wyeth.

Higher risk of IPD in black and Hispanic children could not be attributed to unequal vaccination. DR. HSU

Antihistamines and/or decongestants serve no benefit for children who have otitis media with effusion, a Cochrane review of medical literature has concluded.

In fact, children who used them experienced an 11% spike in side effects such as gastrointestinal upset and drowsiness, compared with those who did not use them.

“Because we found no benefit for any of the studied interventions for any of the outcomes measured and we found harm from the side effects of the interventions, we recommend that practitioners not use antihistamines, decongestants, or antihistamine/decongestant combinations to treat otitis media with effusion in children,” wrote the researchers, who were led by Dr. Glenn Griffin of Quinte West Medical Center in Trenton, Ont.

They noted that the findings mirror the current joint guidelines on the management of otitis media with effusion (OME) from the American Academy of Family Physicians, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Academy of Pediatrics (Pediatrics 2004;113:1412–29).

For the review, which appears in the Oct. 18 issue of the Cochrane Database of Systematic Reviews (2006, Issue 4), Dr. Griffin and his associates studied 15 randomized, controlled trials of 1,516 children with OME that compared antihistamines, decongestants, or a combination of the two and that appeared in the medical literature through March 2006. Studies that randomized children based on acute otitis media were not included in the analysis (Epub doi:10.1002/14651858.CD003423).

The researchers found no benefit of taking decongestants alone or in combination with antihistamines in terms of being cured within 1 month, lessening hearing loss, risk of OME recurrence, development of otitis media, and the need for tympanostomy.

Six of the studies in the analysis measured side effects of medications. In these, 17% of children who received decongestants alone or in combination with antihistamines suffered side effects such as gastrointestinal upset and drowsiness, compared with only 6% of children who took placebo, a difference of 11%. The researchers estimated that for every nine children treated with the drugs, one would be harmed.

The investigators acknowledged that a key limitation of the review was the small number of studies found, but “the studies were so consistent in their findings that even if we missed a study, the summary results are unlikely to be overturned.”

Antihistamines and/or decongestants serve no benefit for children who have otitis media with effusion, a Cochrane review of medical literature has concluded.

In fact, children who used them experienced an 11% spike in side effects such as gastrointestinal upset and drowsiness, compared with those who did not use them.

“Because we found no benefit for any of the studied interventions for any of the outcomes measured and we found harm from the side effects of the interventions, we recommend that practitioners not use antihistamines, decongestants, or antihistamine/decongestant combinations to treat otitis media with effusion in children,” wrote the researchers, who were led by Dr. Glenn Griffin of Quinte West Medical Center in Trenton, Ont.

They noted that the findings mirror the current joint guidelines on the management of otitis media with effusion (OME) from the American Academy of Family Physicians, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Academy of Pediatrics (Pediatrics 2004;113:1412–29).

For the review, which appears in the Oct. 18 issue of the Cochrane Database of Systematic Reviews (2006, Issue 4), Dr. Griffin and his associates studied 15 randomized, controlled trials of 1,516 children with OME that compared antihistamines, decongestants, or a combination of the two and that appeared in the medical literature through March 2006. Studies that randomized children based on acute otitis media were not included in the analysis (Epub doi:10.1002/14651858.CD003423).

The researchers found no benefit of taking decongestants alone or in combination with antihistamines in terms of being cured within 1 month, lessening hearing loss, risk of OME recurrence, development of otitis media, and the need for tympanostomy.

Six of the studies in the analysis measured side effects of medications. In these, 17% of children who received decongestants alone or in combination with antihistamines suffered side effects such as gastrointestinal upset and drowsiness, compared with only 6% of children who took placebo, a difference of 11%. The researchers estimated that for every nine children treated with the drugs, one would be harmed.

The investigators acknowledged that a key limitation of the review was the small number of studies found, but “the studies were so consistent in their findings that even if we missed a study, the summary results are unlikely to be overturned.”

Antihistamines and/or decongestants serve no benefit for children who have otitis media with effusion, a Cochrane review of medical literature has concluded.

In fact, children who used them experienced an 11% spike in side effects such as gastrointestinal upset and drowsiness, compared with those who did not use them.

“Because we found no benefit for any of the studied interventions for any of the outcomes measured and we found harm from the side effects of the interventions, we recommend that practitioners not use antihistamines, decongestants, or antihistamine/decongestant combinations to treat otitis media with effusion in children,” wrote the researchers, who were led by Dr. Glenn Griffin of Quinte West Medical Center in Trenton, Ont.

They noted that the findings mirror the current joint guidelines on the management of otitis media with effusion (OME) from the American Academy of Family Physicians, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Academy of Pediatrics (Pediatrics 2004;113:1412–29).

For the review, which appears in the Oct. 18 issue of the Cochrane Database of Systematic Reviews (2006, Issue 4), Dr. Griffin and his associates studied 15 randomized, controlled trials of 1,516 children with OME that compared antihistamines, decongestants, or a combination of the two and that appeared in the medical literature through March 2006. Studies that randomized children based on acute otitis media were not included in the analysis (Epub doi:10.1002/14651858.CD003423).

The researchers found no benefit of taking decongestants alone or in combination with antihistamines in terms of being cured within 1 month, lessening hearing loss, risk of OME recurrence, development of otitis media, and the need for tympanostomy.

Six of the studies in the analysis measured side effects of medications. In these, 17% of children who received decongestants alone or in combination with antihistamines suffered side effects such as gastrointestinal upset and drowsiness, compared with only 6% of children who took placebo, a difference of 11%. The researchers estimated that for every nine children treated with the drugs, one would be harmed.

The investigators acknowledged that a key limitation of the review was the small number of studies found, but “the studies were so consistent in their findings that even if we missed a study, the summary results are unlikely to be overturned.”

SAN FRANCISCO — The isolation of methicillin-resistant Staphylococcus aureus, either alone or as part of a polymicrobial infection, was associated with treatment failure in 35% of patients with a diabetic foot infection, Dr. Matthew E. Falagas noted in a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The finding comes from an analysis of 15 randomized, controlled trials that compared the use of different antibiotics for treating diabetic foot infections.

The analysis showed “a considerable proportion of patients with diabetes who have infection in their foot would not be treated effectively with current [antimicrobial] management,” Dr. Falagas of the Alfa Institute of Biomedical Sciences in Athens, Greece, said in an interview. “About one-fourth of patients fail to be cured with the current antimicrobial regimens and treatment.”

He and his associates found that different regimens of appropriate antibiotics (including penicillins, carbapenems, cephalosporins, and fluoroquinolones) were associated with similar treatment failures. But in the 68 patients whose infections were caused by methicillin-resistant Staphylococcus aureus (MRSA) alone or as part of a polymicrobial infection, treatment failure was 35%, compared with 23% in the 1,522 patients whose infections were caused by different bacteria.

In patients with infections caused by MRSA, the use of linezolid was not associated with a significantly lower failure rate, compared with other antibiotics (32% vs. 37%, respectively). The researchers also observed no significant differences in overall treatment failure when they compared patients who had osteomyelitis with those who did not (27% vs. 23%, respectively).

The treatment failures seen in the study were not a matter of patient compliance “because most of these patients were treated in the hospital with [intravenous] antimicrobial agents,” said Dr. Falagas, who is also with the department of medicine at Tufts University, Boston. Patients who took carbapenems had fewer treatment failures, he added.

Treatment failure occurred in 35% of patients with an MRSA infection. Courtesy Dr. Matthew E. Falagas

SAN FRANCISCO — The isolation of methicillin-resistant Staphylococcus aureus, either alone or as part of a polymicrobial infection, was associated with treatment failure in 35% of patients with a diabetic foot infection, Dr. Matthew E. Falagas noted in a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The finding comes from an analysis of 15 randomized, controlled trials that compared the use of different antibiotics for treating diabetic foot infections.

The analysis showed “a considerable proportion of patients with diabetes who have infection in their foot would not be treated effectively with current [antimicrobial] management,” Dr. Falagas of the Alfa Institute of Biomedical Sciences in Athens, Greece, said in an interview. “About one-fourth of patients fail to be cured with the current antimicrobial regimens and treatment.”

He and his associates found that different regimens of appropriate antibiotics (including penicillins, carbapenems, cephalosporins, and fluoroquinolones) were associated with similar treatment failures. But in the 68 patients whose infections were caused by methicillin-resistant Staphylococcus aureus (MRSA) alone or as part of a polymicrobial infection, treatment failure was 35%, compared with 23% in the 1,522 patients whose infections were caused by different bacteria.

In patients with infections caused by MRSA, the use of linezolid was not associated with a significantly lower failure rate, compared with other antibiotics (32% vs. 37%, respectively). The researchers also observed no significant differences in overall treatment failure when they compared patients who had osteomyelitis with those who did not (27% vs. 23%, respectively).

The treatment failures seen in the study were not a matter of patient compliance “because most of these patients were treated in the hospital with [intravenous] antimicrobial agents,” said Dr. Falagas, who is also with the department of medicine at Tufts University, Boston. Patients who took carbapenems had fewer treatment failures, he added.

Treatment failure occurred in 35% of patients with an MRSA infection. Courtesy Dr. Matthew E. Falagas

SAN FRANCISCO — The isolation of methicillin-resistant Staphylococcus aureus, either alone or as part of a polymicrobial infection, was associated with treatment failure in 35% of patients with a diabetic foot infection, Dr. Matthew E. Falagas noted in a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The finding comes from an analysis of 15 randomized, controlled trials that compared the use of different antibiotics for treating diabetic foot infections.

The analysis showed “a considerable proportion of patients with diabetes who have infection in their foot would not be treated effectively with current [antimicrobial] management,” Dr. Falagas of the Alfa Institute of Biomedical Sciences in Athens, Greece, said in an interview. “About one-fourth of patients fail to be cured with the current antimicrobial regimens and treatment.”

He and his associates found that different regimens of appropriate antibiotics (including penicillins, carbapenems, cephalosporins, and fluoroquinolones) were associated with similar treatment failures. But in the 68 patients whose infections were caused by methicillin-resistant Staphylococcus aureus (MRSA) alone or as part of a polymicrobial infection, treatment failure was 35%, compared with 23% in the 1,522 patients whose infections were caused by different bacteria.

In patients with infections caused by MRSA, the use of linezolid was not associated with a significantly lower failure rate, compared with other antibiotics (32% vs. 37%, respectively). The researchers also observed no significant differences in overall treatment failure when they compared patients who had osteomyelitis with those who did not (27% vs. 23%, respectively).

The treatment failures seen in the study were not a matter of patient compliance “because most of these patients were treated in the hospital with [intravenous] antimicrobial agents,” said Dr. Falagas, who is also with the department of medicine at Tufts University, Boston. Patients who took carbapenems had fewer treatment failures, he added.

Treatment failure occurred in 35% of patients with an MRSA infection. Courtesy Dr. Matthew E. Falagas

CALGARY, ALTA. — The incidence of well-differentiated thyroid carcinoma in Ontario, Canada, jumped 230% between January 1990 and December 2001, apparently because of an increase in small tumors in female patients, researchers reported during a poster session at the annual Canadian Surgery Forum.

“This phenomenon may be explained by the identification and resection of clinically relevant occult microcarcinomas incidentally found in women, who are more likely to see their primary care physician and undergo radiological investigations,” wrote Dr. Stephen Frederick Hall of the department of otolaryngology at Queen's University, Kingston, Ontario, and colleagues. “Alternatively, it may be that females have selectively been exposed to an environmental carcinogen or hormonal factor that has resulted in thyroid cancer.”

The researchers identified 8,100 cases of well-differentiated thyroid cancer from the Ontario Cancer Registry between January 1, 1990 and December 31, 2001. They compared the incidence of disease across the time period and obtained pathology reports from a random 10% of cases.

Incidence of the cancer increased 230% during that period, but the mean tumor size decreased, with significantly more small tumors (less than 2 cm) being resected in 2001 than in 1990. When male and female patients were compared, this effect was only seen in the female population.

CALGARY, ALTA. — The incidence of well-differentiated thyroid carcinoma in Ontario, Canada, jumped 230% between January 1990 and December 2001, apparently because of an increase in small tumors in female patients, researchers reported during a poster session at the annual Canadian Surgery Forum.

“This phenomenon may be explained by the identification and resection of clinically relevant occult microcarcinomas incidentally found in women, who are more likely to see their primary care physician and undergo radiological investigations,” wrote Dr. Stephen Frederick Hall of the department of otolaryngology at Queen's University, Kingston, Ontario, and colleagues. “Alternatively, it may be that females have selectively been exposed to an environmental carcinogen or hormonal factor that has resulted in thyroid cancer.”

The researchers identified 8,100 cases of well-differentiated thyroid cancer from the Ontario Cancer Registry between January 1, 1990 and December 31, 2001. They compared the incidence of disease across the time period and obtained pathology reports from a random 10% of cases.

Incidence of the cancer increased 230% during that period, but the mean tumor size decreased, with significantly more small tumors (less than 2 cm) being resected in 2001 than in 1990. When male and female patients were compared, this effect was only seen in the female population.

CALGARY, ALTA. — The incidence of well-differentiated thyroid carcinoma in Ontario, Canada, jumped 230% between January 1990 and December 2001, apparently because of an increase in small tumors in female patients, researchers reported during a poster session at the annual Canadian Surgery Forum.

“This phenomenon may be explained by the identification and resection of clinically relevant occult microcarcinomas incidentally found in women, who are more likely to see their primary care physician and undergo radiological investigations,” wrote Dr. Stephen Frederick Hall of the department of otolaryngology at Queen's University, Kingston, Ontario, and colleagues. “Alternatively, it may be that females have selectively been exposed to an environmental carcinogen or hormonal factor that has resulted in thyroid cancer.”

The researchers identified 8,100 cases of well-differentiated thyroid cancer from the Ontario Cancer Registry between January 1, 1990 and December 31, 2001. They compared the incidence of disease across the time period and obtained pathology reports from a random 10% of cases.

Incidence of the cancer increased 230% during that period, but the mean tumor size decreased, with significantly more small tumors (less than 2 cm) being resected in 2001 than in 1990. When male and female patients were compared, this effect was only seen in the female population.

SAN DIEGO — Patients with stage I thyroid cancer who have a negative first follow-up test performed within 1 year after iodine-131 ablation have a low risk of recurrence and do not require further thyroid stimulation tests, results from a single-center French study showed.

“Some authors suggest periodic testing [with] recombinant human thyroid-stimulating hormone [rhTSH] in all thyroid cancer patients, but there is no consensus” on the issue, Dr. Paolo Zanotti-Fregonara said at the annual meeting of the Society of Nuclear Medicine. “Follow-up recommendations are likely to have economic consequences.”

He and his associates evaluated 129 thyroid cancer patients referred to the department of nuclear medicine at Saint Antoine University Hospital, Paris, between 2002 and 2004 for rhTSH testing. They classified the patients into three groups based on the International Union Against Cancer TNM (primary tumor, regional lymph nodes, distant metastasis) risk classification and the results of their first control test.

All patients had undergone a first control test after thyroxine withdrawal within 1 year of

Of the 129 patients, 75 had stage I thyroid cancer and a negative first control (group 1), 19 had stage I disease and a positive first control (group 2), and 35 had stage II-IV disease (group 3). The researchers performed rhTSH testing an average of 6 years after the first control test.

Dr. Zanotti-Fregonara reported that diagnostic scanning after rhTSH was negative in all patients in group 1. Only one patient in this group had detectable thyroglobulin after rhTSH injection. However, this patient's level of thyroglobulin at baseline was the same as that after stimulation. Therefore, it was considered a false-positive result, probably due to antibody interference.

Seven patients in group 2 had residual thyroglobulin and two had residual

He concluded rhTSH testing is not necessary in stage I thyroid cancer patients who have a negative first follow-up test 1 year after

SAN DIEGO — Patients with stage I thyroid cancer who have a negative first follow-up test performed within 1 year after iodine-131 ablation have a low risk of recurrence and do not require further thyroid stimulation tests, results from a single-center French study showed.

“Some authors suggest periodic testing [with] recombinant human thyroid-stimulating hormone [rhTSH] in all thyroid cancer patients, but there is no consensus” on the issue, Dr. Paolo Zanotti-Fregonara said at the annual meeting of the Society of Nuclear Medicine. “Follow-up recommendations are likely to have economic consequences.”

He and his associates evaluated 129 thyroid cancer patients referred to the department of nuclear medicine at Saint Antoine University Hospital, Paris, between 2002 and 2004 for rhTSH testing. They classified the patients into three groups based on the International Union Against Cancer TNM (primary tumor, regional lymph nodes, distant metastasis) risk classification and the results of their first control test.

All patients had undergone a first control test after thyroxine withdrawal within 1 year of

Of the 129 patients, 75 had stage I thyroid cancer and a negative first control (group 1), 19 had stage I disease and a positive first control (group 2), and 35 had stage II-IV disease (group 3). The researchers performed rhTSH testing an average of 6 years after the first control test.

Dr. Zanotti-Fregonara reported that diagnostic scanning after rhTSH was negative in all patients in group 1. Only one patient in this group had detectable thyroglobulin after rhTSH injection. However, this patient's level of thyroglobulin at baseline was the same as that after stimulation. Therefore, it was considered a false-positive result, probably due to antibody interference.

Seven patients in group 2 had residual thyroglobulin and two had residual

He concluded rhTSH testing is not necessary in stage I thyroid cancer patients who have a negative first follow-up test 1 year after

SAN DIEGO — Patients with stage I thyroid cancer who have a negative first follow-up test performed within 1 year after iodine-131 ablation have a low risk of recurrence and do not require further thyroid stimulation tests, results from a single-center French study showed.

“Some authors suggest periodic testing [with] recombinant human thyroid-stimulating hormone [rhTSH] in all thyroid cancer patients, but there is no consensus” on the issue, Dr. Paolo Zanotti-Fregonara said at the annual meeting of the Society of Nuclear Medicine. “Follow-up recommendations are likely to have economic consequences.”

He and his associates evaluated 129 thyroid cancer patients referred to the department of nuclear medicine at Saint Antoine University Hospital, Paris, between 2002 and 2004 for rhTSH testing. They classified the patients into three groups based on the International Union Against Cancer TNM (primary tumor, regional lymph nodes, distant metastasis) risk classification and the results of their first control test.

All patients had undergone a first control test after thyroxine withdrawal within 1 year of

Of the 129 patients, 75 had stage I thyroid cancer and a negative first control (group 1), 19 had stage I disease and a positive first control (group 2), and 35 had stage II-IV disease (group 3). The researchers performed rhTSH testing an average of 6 years after the first control test.

Dr. Zanotti-Fregonara reported that diagnostic scanning after rhTSH was negative in all patients in group 1. Only one patient in this group had detectable thyroglobulin after rhTSH injection. However, this patient's level of thyroglobulin at baseline was the same as that after stimulation. Therefore, it was considered a false-positive result, probably due to antibody interference.

Seven patients in group 2 had residual thyroglobulin and two had residual

He concluded rhTSH testing is not necessary in stage I thyroid cancer patients who have a negative first follow-up test 1 year after

LOS ANGELES — Coadministration of daily low-dose aspirin plus celecoxib for 1 week resulted in fewer endoscopically confirmed gastric and/or duodenal ulcers, compared with coadministration with naproxen, Dr. Jay L. Goldstein said at the annual Digestive Disease Week.

Dr. Goldstein and associates at the University of Illinois, Chicago, randomized 661 patients aged 50–75 years in a 2:2:1 fashion into one of three treatment arms after baseline endoscopy: celecoxib 200 mg once daily plus aspirin 81 mg daily (celecoxib group), naproxen 500 mg b.i.d. plus aspirin 81 mg daily (naproxen group), or placebo plus aspirin 81 mg daily (placebo group). Patients took the drugs for 7 days and underwent final endoscopy on day 7.

Exclusion criteria included any NSAID use prior to baseline endoscopy; being seropositive for Helicobacter pylori if baseline endoscopy revealed more than five erosions in the stomach or duodenum; any gastric, pyloric channel, or duodenal ulcer 3 mm or greater in diameter; or any esophageal ulcers or erosions. The primary end point was the incidence of at least one gastric or duodenal ulcer on day 7. An ulcer was defined as being 3 mm or greater in diameter.

The majority of patients in the trial were female and the mean age was 58 years, Dr. Goldstein reported.

By day 7, only 7% of patients in the celecoxib group had gastric and/or duodenal ulcers, compared with 25% of those in the naproxen group and 2% of those in the placebo group.

Compared with the naproxen group, the relative risk (RR) of developing a gastric and/or duodenal ulcer in the celecoxib group was 0.28. When they compared the celecoxib group with the placebo group, the RR was 4.78. When they compared the naproxen group with the placebo group, the RR was 16.01.

More patients taking celecoxib developed gastric ulcers, compared with those in the placebo, but there was no significant difference between the two groups in terms of the incidence of duodenal ulcers.

“These data suggest the possibility that lower doses of aspirin may not entirely negate the potential effect or benefit of a [cyclooxygenase-2] inhibitor as measured by endoscopic ulcer rates,” Dr. Goldstein said.

The study was funded by Pfizer Inc. Dr. Goldstein disclosed that he is on the speakers' bureau for Pfizer.

LOS ANGELES — Coadministration of daily low-dose aspirin plus celecoxib for 1 week resulted in fewer endoscopically confirmed gastric and/or duodenal ulcers, compared with coadministration with naproxen, Dr. Jay L. Goldstein said at the annual Digestive Disease Week.

Dr. Goldstein and associates at the University of Illinois, Chicago, randomized 661 patients aged 50–75 years in a 2:2:1 fashion into one of three treatment arms after baseline endoscopy: celecoxib 200 mg once daily plus aspirin 81 mg daily (celecoxib group), naproxen 500 mg b.i.d. plus aspirin 81 mg daily (naproxen group), or placebo plus aspirin 81 mg daily (placebo group). Patients took the drugs for 7 days and underwent final endoscopy on day 7.

Exclusion criteria included any NSAID use prior to baseline endoscopy; being seropositive for Helicobacter pylori if baseline endoscopy revealed more than five erosions in the stomach or duodenum; any gastric, pyloric channel, or duodenal ulcer 3 mm or greater in diameter; or any esophageal ulcers or erosions. The primary end point was the incidence of at least one gastric or duodenal ulcer on day 7. An ulcer was defined as being 3 mm or greater in diameter.

The majority of patients in the trial were female and the mean age was 58 years, Dr. Goldstein reported.

By day 7, only 7% of patients in the celecoxib group had gastric and/or duodenal ulcers, compared with 25% of those in the naproxen group and 2% of those in the placebo group.

Compared with the naproxen group, the relative risk (RR) of developing a gastric and/or duodenal ulcer in the celecoxib group was 0.28. When they compared the celecoxib group with the placebo group, the RR was 4.78. When they compared the naproxen group with the placebo group, the RR was 16.01.

More patients taking celecoxib developed gastric ulcers, compared with those in the placebo, but there was no significant difference between the two groups in terms of the incidence of duodenal ulcers.

“These data suggest the possibility that lower doses of aspirin may not entirely negate the potential effect or benefit of a [cyclooxygenase-2] inhibitor as measured by endoscopic ulcer rates,” Dr. Goldstein said.

The study was funded by Pfizer Inc. Dr. Goldstein disclosed that he is on the speakers' bureau for Pfizer.

LOS ANGELES — Coadministration of daily low-dose aspirin plus celecoxib for 1 week resulted in fewer endoscopically confirmed gastric and/or duodenal ulcers, compared with coadministration with naproxen, Dr. Jay L. Goldstein said at the annual Digestive Disease Week.

Dr. Goldstein and associates at the University of Illinois, Chicago, randomized 661 patients aged 50–75 years in a 2:2:1 fashion into one of three treatment arms after baseline endoscopy: celecoxib 200 mg once daily plus aspirin 81 mg daily (celecoxib group), naproxen 500 mg b.i.d. plus aspirin 81 mg daily (naproxen group), or placebo plus aspirin 81 mg daily (placebo group). Patients took the drugs for 7 days and underwent final endoscopy on day 7.

Exclusion criteria included any NSAID use prior to baseline endoscopy; being seropositive for Helicobacter pylori if baseline endoscopy revealed more than five erosions in the stomach or duodenum; any gastric, pyloric channel, or duodenal ulcer 3 mm or greater in diameter; or any esophageal ulcers or erosions. The primary end point was the incidence of at least one gastric or duodenal ulcer on day 7. An ulcer was defined as being 3 mm or greater in diameter.

The majority of patients in the trial were female and the mean age was 58 years, Dr. Goldstein reported.

By day 7, only 7% of patients in the celecoxib group had gastric and/or duodenal ulcers, compared with 25% of those in the naproxen group and 2% of those in the placebo group.

Compared with the naproxen group, the relative risk (RR) of developing a gastric and/or duodenal ulcer in the celecoxib group was 0.28. When they compared the celecoxib group with the placebo group, the RR was 4.78. When they compared the naproxen group with the placebo group, the RR was 16.01.

More patients taking celecoxib developed gastric ulcers, compared with those in the placebo, but there was no significant difference between the two groups in terms of the incidence of duodenal ulcers.

“These data suggest the possibility that lower doses of aspirin may not entirely negate the potential effect or benefit of a [cyclooxygenase-2] inhibitor as measured by endoscopic ulcer rates,” Dr. Goldstein said.

The study was funded by Pfizer Inc. Dr. Goldstein disclosed that he is on the speakers' bureau for Pfizer.

LOS ANGELES — Among patients with iron-deficiency anemia, significant ethnic differences were found in the frequency, type, and distribution of clinically important gastrointestinal lesions, Dr. Bani Chander reported during a poster session at the annual Digestive Disease Week.

Specifically, whites with iron deficiency had lower rates of clinically important lesions in the lower GI tract, compared with blacks, Hispanics, and other ethnic groups, results from a study of Veterans Affairs patients showed.

“We might have to be more aggressive in terms of colorectal screenings in blacks and Hispanics,” Dr. Chander, a recent graduate of New York University, said in an interview. “Not only do they have more advanced lesions, but their lesions also tend to be proximal. So instead of doing a flexible sigmoidoscopy every 3–5 years in blacks and Hispanics, we might have to advocate that we should only do colonoscopy, so we can get to the proximal colon as well.”

She and her associates evaluated demographic and clinical data from 1,081 consecutive patients referred to the VA New York Harbor Healthcare System for evaluation of iron-deficiency anemia. Of the 1,081 patients, 406 were white, 442 were black, 168 were Hispanic, and 65 were from other ethnic groups.

Iron deficiency was defined as a transferrin saturation below 15% and a ferritin level below 20 μg/L. Anemia was defined as a hemoglobin level below 13 g/dL in men and below 12 g/dL in women. All patients had a same-day esophagogastroduodenoscopy and colonoscopy.

The researchers identified one or more clinically important GI lesions in 54% of whites, 65% of blacks, 63% of Hispanics, and 69% of patients from other ethnic groups.

About 33% of whites had clinically important lesions in the upper GI tract, compared with 32% of blacks, 43% of Hispanics, and 54% of patients from other ethnic groups.

In addition, 32% of whites had clinically important lesions in the lower GI tract, compared with 48% of blacks, 43% of Hispanics, and 42% of patients from other ethnic groups.

Both upper and lower GI lesions were identified in 11% of whites, 15% of blacks, 23% of Hispanics, and 26% of patients from other ethnic groups.

In addition, Dr. Chander and her associates observed that the frequency of clinically important lesions that were proximal to the splenic flexure was significantly higher in blacks (35%) and Hispanics (27%), compared with whites (13%) and patients from other ethnic groups (8%).

Of the patients who had colorectal cancer, the prevalence of advanced lesions was significantly higher in blacks (86%) and Hispanics (100%) than in whites (63%) and in patients from other ethnic groups (75%).

“Most likely Hispanics are seeking less health care than the other groups,” Dr. Chander hypothesized. “But on top of that, I'm sure that diet and other lifestyle choices have probably played a role.”

However, she noted certain limitations of the study, including the fact that it was a single-center study in which most of the subjects were older men. “We can't make generalizations about women in this study, nor can we about a younger population,” she said.

LOS ANGELES — Among patients with iron-deficiency anemia, significant ethnic differences were found in the frequency, type, and distribution of clinically important gastrointestinal lesions, Dr. Bani Chander reported during a poster session at the annual Digestive Disease Week.

Specifically, whites with iron deficiency had lower rates of clinically important lesions in the lower GI tract, compared with blacks, Hispanics, and other ethnic groups, results from a study of Veterans Affairs patients showed.

“We might have to be more aggressive in terms of colorectal screenings in blacks and Hispanics,” Dr. Chander, a recent graduate of New York University, said in an interview. “Not only do they have more advanced lesions, but their lesions also tend to be proximal. So instead of doing a flexible sigmoidoscopy every 3–5 years in blacks and Hispanics, we might have to advocate that we should only do colonoscopy, so we can get to the proximal colon as well.”

She and her associates evaluated demographic and clinical data from 1,081 consecutive patients referred to the VA New York Harbor Healthcare System for evaluation of iron-deficiency anemia. Of the 1,081 patients, 406 were white, 442 were black, 168 were Hispanic, and 65 were from other ethnic groups.

Iron deficiency was defined as a transferrin saturation below 15% and a ferritin level below 20 μg/L. Anemia was defined as a hemoglobin level below 13 g/dL in men and below 12 g/dL in women. All patients had a same-day esophagogastroduodenoscopy and colonoscopy.

The researchers identified one or more clinically important GI lesions in 54% of whites, 65% of blacks, 63% of Hispanics, and 69% of patients from other ethnic groups.

About 33% of whites had clinically important lesions in the upper GI tract, compared with 32% of blacks, 43% of Hispanics, and 54% of patients from other ethnic groups.

In addition, 32% of whites had clinically important lesions in the lower GI tract, compared with 48% of blacks, 43% of Hispanics, and 42% of patients from other ethnic groups.

Both upper and lower GI lesions were identified in 11% of whites, 15% of blacks, 23% of Hispanics, and 26% of patients from other ethnic groups.

In addition, Dr. Chander and her associates observed that the frequency of clinically important lesions that were proximal to the splenic flexure was significantly higher in blacks (35%) and Hispanics (27%), compared with whites (13%) and patients from other ethnic groups (8%).

Of the patients who had colorectal cancer, the prevalence of advanced lesions was significantly higher in blacks (86%) and Hispanics (100%) than in whites (63%) and in patients from other ethnic groups (75%).

“Most likely Hispanics are seeking less health care than the other groups,” Dr. Chander hypothesized. “But on top of that, I'm sure that diet and other lifestyle choices have probably played a role.”

However, she noted certain limitations of the study, including the fact that it was a single-center study in which most of the subjects were older men. “We can't make generalizations about women in this study, nor can we about a younger population,” she said.

LOS ANGELES — Among patients with iron-deficiency anemia, significant ethnic differences were found in the frequency, type, and distribution of clinically important gastrointestinal lesions, Dr. Bani Chander reported during a poster session at the annual Digestive Disease Week.

Specifically, whites with iron deficiency had lower rates of clinically important lesions in the lower GI tract, compared with blacks, Hispanics, and other ethnic groups, results from a study of Veterans Affairs patients showed.

“We might have to be more aggressive in terms of colorectal screenings in blacks and Hispanics,” Dr. Chander, a recent graduate of New York University, said in an interview. “Not only do they have more advanced lesions, but their lesions also tend to be proximal. So instead of doing a flexible sigmoidoscopy every 3–5 years in blacks and Hispanics, we might have to advocate that we should only do colonoscopy, so we can get to the proximal colon as well.”

She and her associates evaluated demographic and clinical data from 1,081 consecutive patients referred to the VA New York Harbor Healthcare System for evaluation of iron-deficiency anemia. Of the 1,081 patients, 406 were white, 442 were black, 168 were Hispanic, and 65 were from other ethnic groups.

Iron deficiency was defined as a transferrin saturation below 15% and a ferritin level below 20 μg/L. Anemia was defined as a hemoglobin level below 13 g/dL in men and below 12 g/dL in women. All patients had a same-day esophagogastroduodenoscopy and colonoscopy.

The researchers identified one or more clinically important GI lesions in 54% of whites, 65% of blacks, 63% of Hispanics, and 69% of patients from other ethnic groups.

About 33% of whites had clinically important lesions in the upper GI tract, compared with 32% of blacks, 43% of Hispanics, and 54% of patients from other ethnic groups.

In addition, 32% of whites had clinically important lesions in the lower GI tract, compared with 48% of blacks, 43% of Hispanics, and 42% of patients from other ethnic groups.

Both upper and lower GI lesions were identified in 11% of whites, 15% of blacks, 23% of Hispanics, and 26% of patients from other ethnic groups.

In addition, Dr. Chander and her associates observed that the frequency of clinically important lesions that were proximal to the splenic flexure was significantly higher in blacks (35%) and Hispanics (27%), compared with whites (13%) and patients from other ethnic groups (8%).

Of the patients who had colorectal cancer, the prevalence of advanced lesions was significantly higher in blacks (86%) and Hispanics (100%) than in whites (63%) and in patients from other ethnic groups (75%).

“Most likely Hispanics are seeking less health care than the other groups,” Dr. Chander hypothesized. “But on top of that, I'm sure that diet and other lifestyle choices have probably played a role.”

However, she noted certain limitations of the study, including the fact that it was a single-center study in which most of the subjects were older men. “We can't make generalizations about women in this study, nor can we about a younger population,” she said.

SAN FRANCISCO — The isolation of methicillin-resistant Staphylococcus aureus, either alone or as part of a polymicrobial infection, was associated with treatment failure in 35% of patients with a diabetic foot infection, Dr. Matthew E. Falagas reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The finding comes from an analysis of 15 randomized, controlled trials that compared the use of different antibiotics for treating foot infections in diabetic patients.

The analysis showed that “a considerable proportion of patients with diabetes who have infection in their foot would not be treated effectively with current [antimicrobial] management,” Dr. Falagas of the Alfa Institute of Biomedical Sciences in Athens, Greece, said in an interview. “As a matter of fact, about one-fourth of all patients fail to be cured with the current antimicrobial regimens and treatment.”

He and his associates found that different regimens of appropriate antibiotics—including penicillins, carbapenems, cephalosporins, and fluoroquinolones—were associated with similar treatment failures.

However, in the 68 patients whose infections were caused by methicillin-resistant Staphylococcus aureus (MRSA) alone or as part of a polymicrobial infection, treatment failure was 35%, compared with 23% in the 1,522 patients whose infections were caused by different bacteria.

In patients with infections caused by MRSA, the use of linezolid was not associated with a significantly lower failure rate, compared with other antibiotics (32% versus 37%, respectively).

The researchers also observed no significant differences in overall treatment failure when they compared patients who had osteomyelitis with those who did not (27% versus 23%, respectively).

The treatment failures seen in the study were not a matter of patient compliance “because most of these patients were treated in the hospital with [intravenous] antimicrobial agents,” said Dr. Falagas, who is also with the department of medicine at Tufts University, Boston.

He added that, overall, patients who took carbapenems had fewer treatment failures, a finding he did not expect.

Treatment failure occurred in 35% of patients such as this one with an infection caused by MRSA, vs. 23% with other infections.

SAN FRANCISCO — The isolation of methicillin-resistant Staphylococcus aureus, either alone or as part of a polymicrobial infection, was associated with treatment failure in 35% of patients with a diabetic foot infection, Dr. Matthew E. Falagas reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The finding comes from an analysis of 15 randomized, controlled trials that compared the use of different antibiotics for treating foot infections in diabetic patients.

The analysis showed that “a considerable proportion of patients with diabetes who have infection in their foot would not be treated effectively with current [antimicrobial] management,” Dr. Falagas of the Alfa Institute of Biomedical Sciences in Athens, Greece, said in an interview. “As a matter of fact, about one-fourth of all patients fail to be cured with the current antimicrobial regimens and treatment.”

He and his associates found that different regimens of appropriate antibiotics—including penicillins, carbapenems, cephalosporins, and fluoroquinolones—were associated with similar treatment failures.

However, in the 68 patients whose infections were caused by methicillin-resistant Staphylococcus aureus (MRSA) alone or as part of a polymicrobial infection, treatment failure was 35%, compared with 23% in the 1,522 patients whose infections were caused by different bacteria.

In patients with infections caused by MRSA, the use of linezolid was not associated with a significantly lower failure rate, compared with other antibiotics (32% versus 37%, respectively).

The researchers also observed no significant differences in overall treatment failure when they compared patients who had osteomyelitis with those who did not (27% versus 23%, respectively).

The treatment failures seen in the study were not a matter of patient compliance “because most of these patients were treated in the hospital with [intravenous] antimicrobial agents,” said Dr. Falagas, who is also with the department of medicine at Tufts University, Boston.

He added that, overall, patients who took carbapenems had fewer treatment failures, a finding he did not expect.

Treatment failure occurred in 35% of patients such as this one with an infection caused by MRSA, vs. 23% with other infections.

SAN FRANCISCO — The isolation of methicillin-resistant Staphylococcus aureus, either alone or as part of a polymicrobial infection, was associated with treatment failure in 35% of patients with a diabetic foot infection, Dr. Matthew E. Falagas reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The finding comes from an analysis of 15 randomized, controlled trials that compared the use of different antibiotics for treating foot infections in diabetic patients.

The analysis showed that “a considerable proportion of patients with diabetes who have infection in their foot would not be treated effectively with current [antimicrobial] management,” Dr. Falagas of the Alfa Institute of Biomedical Sciences in Athens, Greece, said in an interview. “As a matter of fact, about one-fourth of all patients fail to be cured with the current antimicrobial regimens and treatment.”

He and his associates found that different regimens of appropriate antibiotics—including penicillins, carbapenems, cephalosporins, and fluoroquinolones—were associated with similar treatment failures.

However, in the 68 patients whose infections were caused by methicillin-resistant Staphylococcus aureus (MRSA) alone or as part of a polymicrobial infection, treatment failure was 35%, compared with 23% in the 1,522 patients whose infections were caused by different bacteria.

In patients with infections caused by MRSA, the use of linezolid was not associated with a significantly lower failure rate, compared with other antibiotics (32% versus 37%, respectively).

The researchers also observed no significant differences in overall treatment failure when they compared patients who had osteomyelitis with those who did not (27% versus 23%, respectively).

The treatment failures seen in the study were not a matter of patient compliance “because most of these patients were treated in the hospital with [intravenous] antimicrobial agents,” said Dr. Falagas, who is also with the department of medicine at Tufts University, Boston.

He added that, overall, patients who took carbapenems had fewer treatment failures, a finding he did not expect.

Treatment failure occurred in 35% of patients such as this one with an infection caused by MRSA, vs. 23% with other infections.