44 research outputs found
Gut Microbiota, Antibiotic Therapy and Antimicrobial Resistance: A Narrative Review
No full textAntimicrobial resistance is a major concern. Epidemiological studies have demonstrated direct relationships between antibiotic consumption and emergence/dissemination of resistant strains. Within the last decade, authors confounded spectrum activity and ecological effects and did not take into account several other factors playing important roles, such as impact on anaerobic flora, biliary elimination and sub-inhibitory concentration. The ecological impact of antibiotics on the gut microbiota by direct or indirect mechanisms reflects the breaking of the resistance barrier to colonization. To limit the impact of antibiotic therapy on gut microbiota, consideration of the spectrum of activity and route of elimination must be integrated into the decision. Various strategies to prevent (antimicrobial stewardship, action on residual antibiotics at colonic level) or cure dysbiosis (prebiotic, probiotic and fecal microbiota transplantation) have been introduced or are currently being developed
Mucormycoses
No full textLes mucormycoses sont des infections fongiques invasives survenant principalement sur des terrains immunodéprimés (hémopathie maligne, transplantation d’organe solide, diabète) et grevées d’une lourde morbi-mortalité. Les localisations les plus fréquentes de ces infections fongiques angio-invasives sont pulmonaires, rhino-cérébrales, cutanées et enfin disséminées. Le traitement de ces infections repose sur un tryptique associant un contrôle strict des facteurs de risque, notamment une équilibration rigoureuse d’un diabète sous-jacent, une prise en charge chirurgicale précoce avec exérèse des tissus nécrosés et, enfin, une prise en charge médicamenteuse avec utilisation de polyènes à forte dose (amphotéricine B liposomale ≥ 5 mg/kg/jour). Il paraît actuellement légitime de proposer un traitement d’attaque par polyène pour une durée minimale de 6 à 8 semaines et jusqu’à résolution des lésions, suivi d’un traitement d’entretien, pour les patients restant immunodéprimés, par posaconazole avec une surveillance étroite des taux résiduels
Recent advances in the understanding and management of mucormycosis [version 1; referees: 2 approved]
Get PDFMucormycoses were difficult-to-manage infections owing to limited diagnostic tools and therapeutic options. We review here advances in pathology understanding, diagnostic tools including computed tomography, and serum polymerase chain reaction and therapeutic options
How Should We Treat Hospital-Acquired and Ventilator-Associated Pneumonia Caused by Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae?
No full textAbstractHospital-acquired and ventilator-associated pneumonia (HAP/VAP) due to extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-PE) represent a growing problem. Indeed, ESBL-PE is endemic in many countries, and 5 to 25% of intensive care unit (ICU) patients are ESBL-PE carrier on ICU admission. ESBL-PE HAP/VAP is associated with a higher mortality than HAP/VAP due to susceptible Enterobacteriaceae because the resistance profile decreases the adequacy rate of empiric therapy. ESBL-PE should be considered in the empirical treatment in case of the high burden of ESBL-PE in the unit, in the case of previous ESBL-PE colonization, when the HAP/VAP occurs late, and in patients with shock. A negative active systematic surveillance culture on rectal swab reduced the risk of ESBL-PE VAP to less than 1%. Rapid diagnostic tests are now able to confirm the presence of ESBL-PE in VAP within 24 hours; new molecular methods will provide results within few hours.Adequate treatment usually required carbapenems. The alternative β-lactams such as β-lactams/β-lactamases inhibitor combinations could be proposed as a step-down therapy according to the antibiotic susceptibility result. Optimization of pharmacokinetics requires high dosage and continuous or prolonged infusions for β-lactams. When the patient is stabilized, a therapy of duration 7 to 8 days is recommended.</jats:p
Clinical evaluation of subcutaneous administration of cefepime
No full textInternational audienceObjectives. – Cefepime is a fourth-generation cephalosporin active against Pseudomonas aeruginosa andmost Enterobacteriaceae. Intravenous (IV) administration is the standard route of prescription. However,subcutaneous administration (SC) may represent an interesting alternative. We aimed to evaluate SCadministration of cefepime versus the IV route in geriatric patients.Patients and methods. – Multicenter retrospective analysis in patients treated with cefepime by SC routewho underwent plasma concentration monitoring.Results. – Twelve patients were included in the SC group and matched to 12 patients in the IV group.The median and mean Cmin levels were 29.05 mg/L [14.2–48.2]; 33.4 mg/L (± 21.8) in the SC groupand 31.9 mg/L [26.5–51.7]; 39.6 mg/L (± 27) (P = NS) in the IV group. No local SC administration-relatedcomplications were reported. No relapse was observed over six months of follow up.Conclusion. – Subcutaneous use of cefepime seems to have the same clinical and microbiological effectiveness as parenteral administration
Piperacillin-tazobactam as alternative to carbapenems for ICU patients
No full textSeveral studies suggest that alternatives to carbapenems, and particulary beta-lactam/beta-lactamase inhibitor combinations, can be used for therapy of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE)-related infections in non-ICU patients. Little is known concerning ICU patients in whom achieving the desired plasmatic pharmacokinetic/pharmacodynamic (PK/PD) target may be difficult. Also, in vitro susceptibility to beta-lactamase inhibitors might not translate into clinical efficacy. We reviewed the recent clinical studies examining the use of BL/BLI as alternatives to carbapenems for therapy of bloodstream infection, PK/PD data and discuss potential ecological benefit from avoiding the use of carbapenems. With the lack of prospective randomized studies, treating ICU patients with ESBL-PE-related infections using piperacillin-tazobactam should be done with caution. Current data suggest that BL/BLI empirical use should be avoided for therapy of ESBL-PE-related infection. Also, definitive therapy should be reserved to patients in clinical stable condition, after microbial documentation and results of susceptibility tests. Optimization of administration and higher dosage should be used in order to reach pharmacological targets
Legionnaire's Disease in Compromised Hosts
No full textInternational audienceLegionnaire's disease (LD) is mainly reported in apparently immunocompetent patients. Among them, risk factors include chronic lung disease and smoking. However, LD is also well reported among immunocompromised patients, particularly those treated with anti-tumor necrosis factor alpha therapy, patients with hematological malignancy, and transplant patients. This article discusses the available data on immunity against Legionella spp, epidemiology, clinical presentation, diagnosis, and treatment of LD in immunocompromised patients
Pharmacological data for optimisation of temocillin use according to recent EUCAST breakpoints
No full textInternational audienc
