Background: Limited data is present regarding long-term outcomes in chronic kidney disease (CKD) patients presenting with stent thrombosis (ST). We evaluated the possible implications of CKD on long-term mortality in patients presenting with ST-segment elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention (PCI), and its interaction with the presence of ST. Methods: We retrospectively studied 1,722 STEMI patients treated with primary PCI. Baseline CKD was categorized as an estimated glomerular filtration rate <60 mL/min/1.73 m² at presentation. The presence of ST was determined using the Academic Research Consortium definitions. Patients were evaluated for the presence of CKD and ST, as well as for long-term mortality. Results: A total of 448/1,722 (26%) patients had baseline CKD. Patients with CKD were older and had more comorbidities and a higher rate of ST (4 vs. 7%, respectively, p < 0.001). In a univariate analysis, long-term mortality was significantly higher among those with CKD compared to those without CKD (17.6 vs. 2.7%, p < 0.001). The presence of ST did not alter long-term mortality in both CKD and no-CKD patients. In a Cox regression model, CKD was an independent predictor of long-term mortality (hazard ratio 2.04, 95% confidence interval 1.17-3.56, p = 0.01), while ST as a covariate was not significantly associated with long-term mortality. Conclusion: Among STEMI patients, CKD, but not ST, is a predictor of long-term mortality.

Forty patients with acute lower respiratory tract infection requiring hospital admission were treated with ceftazidime. One patient developed acute dyspnoea after the first dose of the drug which was considered to be drug related and treatment was discontinued. All remaining patients were clinically assessed as being either cured or improved. In all cases that were bacteriologically assessable the pathogens were eradicated. One patient developed erythema multiforme after the end of ceftazidime treatment; this was considered to be possibly drug related.

IntroductionA Clostridium difficile Management Team was created at Mayday University Hospital in October 2008 in accordance with HPA (Health Protection Agency) guidance.1 It consists of a Consultant Gastroenterologist, as well as three other Consultants (Elderly Care, Surgical and Microbiology), four Clinical Nurse Specialists, an Antibiotic Pharmacist and a Dietician, working across the directorates. The Team reviews all patients with C.difficile infection and also implements infection control measures. We report our progress at 1-year post initiation.MethodsAll patients diagnosed with C difficile infection from October 2007 to October 2009 were included. These were classified as either Hospital Acquired Infections (HAIs) or Community Acquired Infections (CAIs). Information on deaths due to C difficile (either directly linked, or as a contributory factor) were extracted from the infection control surveillance system over the same period.ResultsA total of 540 C difficile cases were identified from January 2007 to October 2009. 330 HAIs occurred in the 21 months before intervention, averaging 16 cases/month. This fell to 5 cases/month in the intervention year from October 2008 to Oct '09 (a 69% reduction). CAI rates averaged 6/month in 2007, and 3/month in 2008, and remained unchanged at 3/month in the intervention year. Mortality figures showed 24 deaths in the 21 months pre-introduction, and 6 deaths in the intervention year (a 57% reduction compared to the preceding October 2007 to Oct '08).ConclusionUtilising a multidisciplinary team in the management of Clostridium difficile infection is recommended by the HPA.1 Our dedicated team focuses on optimising care, as well as ensuring the isolation and prompt clinical and laboratory diagnosis of suspected cases. The team also provides education to hospital staff and General Practitioners. This, together with other existing measures1 3 such as restrictive antibiotic prescribing, chlorine-based environmental cleaning and effective hand hygiene promotion has had a significant effect in reducing the burden of C difficile in our Trust.