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44023 E B Cover 15/4/03 12:10 pm Page 1 I F N R C E L E U C D D E S R O M EVIDENCE-BASED INFECTIOUS DISEASES Edited by Mark Loeb, Marek Smieja, Fiona Smaill Evidence-based Infectious Diseases Evidence-based Infectious Diseases Edited by Mark Loeb Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Marek Smieja Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, Department of Medicine, McMaster University, Hamilton, Ontario, Canada Fiona Smaill Department of Pathology and Molecular Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada © BMJ Publishing Group Ltd 2004 BMJ Books is an imprint of the BMJ Publishing Group Ltd All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission of the publishers. First published in 2004 by BMJ Books, BMA House, Tavistock Square, London WC1H 9JR www.bmjbooks.com British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN 0 7279 1691 2 Typeset by SIVA Math Setters, Chennai, India Printed and bound by MPG Books, Bodmin, Cornwall Contents Contributors vi Preface ix Evidence-based Infectious Diseases CD Rom x Abbreviations xi 1. Introduction to evidence-based infectious diseases 1 Mark Loeb, Marek Smieja, Fiona Smaill Part 1 Specific diseases 11 2. Skin and soft-tissue infections 13 Doug Austgarden 3. Bone and joint infections 26 William J Gillespie 4. Infective endocarditis 37 Scott D Halpern, Elias Abrutyn, Brian L Strom 5. Meningitis and encephalitis 52 Carolyn V Gould, Ebbing Lautenbach 6. Community-acquired pneumonia 71 David C Rhew 7. Tuberculosis 86 Manjula Datta, Marek Smieja 8. Diarrhea 102 Guy de Bruyn, Alain Bouckenooghe 9. Urinary tract infections 120 Thomas Fekete 10 Sexually transmitted infections 141 David N Fisman 11. Human immunodeficiency virus (HIV) 187 Brian J Angus, Timothy EA Peto Part 2 Special populations 221 12. Infection control 223 Eli Perencevich, Anthony Harris v Evidence-based Infectious Diseases 13. Infections in neutropenic hosts 241 Stuart J Rosser, Eric J Bow 14. Infections in general surgery 257 Christine H Lee 15. Infections in the thermally injured patient 269 Edward E Tredget, Robert Rennie, Robert E Burrell, Sarvesh Logsetty 16. Infections in healthcare workers 283 Brian J Angus, Fiona Smaill Index 294 vi Contributors Elias Abrutyn Department of Medicine, MCP Hahnemann School of Medicine, Philadelphia, PA, USA Brian J Angus Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK Doug Austgarden Department of Emergency Medicine and Critical Care, York Central Hospital, Richmond Hill, Ontario, Canada A Bouckenooghe Regulatory Affairs, Merck Sharp & Dohme (Europe) Inc., Brussels, Belgium Eric J Bow Sections of Infectious Diseases and Haematology/Oncology, University of Manitoba, Canada Guy de Bruyn Program in Infectious Diseases, Fred Hutchinson Cancer Research Center; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA Robert Burrell Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada Manjula Datta Department of Epidemiology, The Tamilnadu Dr M.G.R. Medical University, Chennai, India Thomas Fekete Section of Infectious Diseases, Temple University School of Medicine, Philadelphia, USA David N Fisman Drexel University School of Public Health and Drexel University College of Medicine, Philadelphia, PA, USA William Gillespie The Hull York Medical School, UK Carolyn V Gould Department of Medicine, Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, PA, USA Scott D Halpern Center for Clinical Epidemiology and Biostatistics; Department of Biostatistics and Epidemiology; Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA Anthony Harris University of Maryland, VA Maryland Health Care System, Baltimore, Maryland, USA vii Evidence-based Infectious Diseases Ebbing L Lautenbach Department of Medicine, Division of Infectious Diseases; Department of Biostatistics and Epidemiology; Center for Clinical Epidemiology and Biostatistics; Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA Christine H Lee Department of Pathology and Molecular Medicine; Department of Medicine, McMaster University, Hamilton, Ontario, Canada Mark Loeb Department of Pathology and Molecular Medicine; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Sarvesh Logsetty Department of Surgery and Firefighters’ Burns Treatment Unit, University of Alberta, Edmonton, Alberta, Canada Eli Perencevich University of Maryland, VA Maryland Health Care System, Baltimore, Maryland, USA Timothy Peto Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK Robert Rennie Medical Microbiology, University of Alberta Hospital, Edmonton, Alberta, Canada David C Rhew Zynx Health Incorporated, Beverly Hills, California, USA Stuart Rosser Sections of Infectious Diseases and Critical Care, University of Manitoba, Canada Fiona Smaill Department of Pathology and Molecular Medicine; Department of Medicine, McMaster University, Hamilton, Ontario, Canada Marek Smieja Department of Pathology & Molecular Medicine; Department of Clinical Epidemiology & Biostatistics; Department of Medicine, McMaster University, Hamilton, Ontario, Canada Brian L Strom Center for Clinical Epidemiology and Biostatistics; Department of Biostatistics and Epidemiology; Center for Education and Research on Therapeutics; Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA Edward E Tredget Dept of Surgery, University of Alberta, Edmonton, Alberta, Canada viii Preface As busy academic physicians we are often approached about assuming new roles and responsibilities, and frankly are sometimes hesitant about placing yet another item on the “to do” list. However, when we were first approached about editing this book, our reaction was different. The idea of editing the first book about evidence-based infectious diseases was exciting. Although there are many standard textbooks on infectious diseases, none that we were aware of use an “evidence-based” approach. We emphasize in this book both the methodological issues in assessing the quality of evidence, as well as the “best evidence” for practicing infectious diseases. We have divided the book into two parts. In Part I, we focus on specific infections, including skin and soft tissue infections, bone and joint infections, infective endocarditis, meningitis and encephalitis, community-acquired pneumonia, tuberculosis, diarrhea, urinary tract infections, sexually transmitted infections, and human immunodeficiency virus (HIV). In Part II, we focus on infections that occur in specific populations and settings. These include infection control, infections in the neutropenic host, surgical infections, the thermally injured patient, and infection in healthcare workers. We have asked chapter authors to begin with a clinical scenario, to help focus on relevant clinical questions, and then to briefly summarize the burden of illness or background epidemiology. The remainder of each chapter summarizes the best evidence with respect to diagnosis, prognosis, treatment, and prevention, with a focus, where possible, on systematic reviews. As we discuss in the introductory chapter, we believe that important clinical questions that arise should be approached in a systematic fashion. The chapters in this book will never be as up to date as the information that you can derive by searching the most recent literature. This is particularly relevant when we are faced with new emerging infections, such as severe acute respiratory syndrome (SARS). However, browsing through these chapters will give a good context and will provide you with key evidence that you can update by conducting a search to see if there is any useful new information. While evidence from well- designed studies informs the decision-making process, it obviously does not replace it. The outcomes of a clinical trial, for example, may suggest a default antibiotic to use for pneumonia, but does not preclude our individualizing treatment based on patient allergies, the biology of the responsible organism, or the pharmacokinetics and pharmacodynamics of the drugs to be administered in that patient. We hope that our approach will help to emphasize aspects of diagnosis, prognosis, treatment, or prevention in which there is already excellent evidence, while highlighting areas in which more compelling evidence is needed. In these latter areas in which our confidence is limited, the reader should be particularly careful to look for newer published data when faced with a similar clinical problem. We are grateful to the chapter authors who made this book possible. We appreciate the guidance (and patience) of Christina Karaviotis and Mary Banks from BMJ Books. We thank our families (Andrea, Julia, and Nathalie Loeb; Cathy Marchetti and Daniel, Nicole, and Benjamin Smieja; Peter Seary) for their patience and support. We hope you find this book informative and stimulating, and we shall certainly appreciate any feedback. Mark Loeb Marek Smieja Fiona Smaill ix