1,720,990 research outputs found
AIDS and the lung
No full textDespite the numerous bacteria, fungi, virus and protozoa present in the air we breathe, our respiratory system is equipped with such efficient defence mechanisms that lung infections are a rare event. AIDS was identified for the first time when some previously healthy subjects developed pneumonia from Pneumocystis carinii; in fact the level of immune deficit induced by HIV infection is the factor that determines the risk of developing specific lung diseases, both infective and non infective. Before the advent of combined antiretroviral therapy (cART) bacterial pneumonia, tuberculosis and pneumonia from Pneumocystis carinii (PCP) - today Pneumocystis jirovencii - were the most frequent lung infections. With the advent of cART, opportunistic lung infections now remain the heritage of those subjects who do not undergo therapy, either because they are unaware of their condition of HIV infection or because they refuse or do not tolerate such polypharmacological treatments, or because their infection is due to a virus that is polyresitant to antiretroviral drugs. In any case, the large body of knowledge now acquired is useful in the clinical management of the ever increasing number of patients with immunodepression due to onco-hematological chemotherapy or to anti-rejection therapies in organ transplantation
Epidemiology, incidence and risk factors for invasive candidiasis in high risk patients
No full textCandida spp. are an increasing cause of bloodstream infections, and are associated with high morbidity and mortality in both neutropenic and non-neutropenic critically ill patients. Risk factors associated with candidaemia are diverse and include exposure to broad spectrum antimicrobial agents, mucosal colonization by Candida spp., indwelling vascular catheters, prior surgery and cancer chemotherapy. During the last 20 years, there has been an increasing incidence worldwide in invasive candidiasis, but differences in geographical epidemiology are emerging, in particular regarding a shift towards non-albicans species. This shift has been correlated with routine fluconazole prophylaxis adopted in some patients, and the intrinsic/acquired azole resistance of Candida spp., which represents a very real problem, in terms of both selecting the appropriate empirical therapeutic approach and making prophylactic choices
Terapia empirica delle infezioni batteriche. Profilassi antibiotica in medicina e chirurgia
No full textNegli ultimi anni si è assistito, nell’ambito della terapia antinfettiva, a un costante incremento delle resistenze sia nella patologia di comunità che, soprattutto, nei reparti ospedalieri.Anche nelle lungodegenze per anziani si ritrovano, con frequenza crescente, batteri multi resistenti. A fronte di questa evoluzione delle resistenze si riscontra un netto decremento nella ricerca e nella commercializzazione di nuovi antibiotici.E’ quindi fondamentale che i medici utilizzino al meglio i vecchi e i pochi nuovi farmaci sia in terapia che in profilassi. La terapia antibiotica, sia essa empirica o mirata, deve essere basata su dati microbiologici, farmacologici e clinici.Le recenti conoscenze di farmacocinetica e farmacodinamica hanno consentito di ottimizzare la posologia e il ritmo di somministrazione degli antibiotici.Non si devono dimenticare, nel contesto dei criteri di scelta, le conoscenze di farmaco economia, nonché l’impatto degli antibiotici sulla ecologia dell’ospedale.Il testo che abbiamo approntato rappresenta una revisione della terapia empirica e della profilassi antibiotica ed è rivolto sia ai medici che operano sul territorio che a quelli che lavorano in ospedale
Role of new antibiotics for KPC-producing Klebsiella pneumoniae
No full textKlebsiella pneumoniae has accumulated a wide range of resistance determinants and has evolved into a difficult-to-treat pathogen that poses an increasing healthcare threat. KPC is an important marker for extensively drug-resistant (XDR) organisms with limited treatment options. In response to the medical need for new treatment options, several new antibiotics have been developed and registered recently. The β-lactamase inhibitor (BLI) combinations ceftazidime/avibactam, meropenem/vaborbactam and imipenem/relebactam, the cephalosporin-siderophore conjugate cefiderocol, the aminoglycoside derivative plazomicin and the tetracycline derivative eravacycline, focus on carbapenem-resistant Enterobacterales. These modified agents from old antibiotic classes illustrate the challenges of this requirement to address class-specific resistance mechanisms while critical gaps and some cross-resistance within a class, or to unrelated antibiotic classes, remain. The diverse molecular mechanisms and increasing diversification of carbapenem resistance among Klebsiella isolates requires improved rapid molecular diagnostic capabilities and stringent stewardship programmes to preserve the efficacy of new antibiotics for as long as possible
The role of antimicrobial stewardship in preventing KPC-producing Klebsiella pneumoniae
No full textAntimicrobial stewardship programmes are widely considered to be a core component of the response to the antimicrobial resistance threat. However, a positive impact of these interventions in terms of microbiological outcomes remains difficult to demonstrate, especially when focusing on specific resistant phenotypes. The first part of this review aims to explore the complex relationship between antibiotic exposure and resistance development in KPC-producing Klebsiella pneumoniae. In the second part we aim to summarize published examples of antimicrobial stewardship interventions intended to impact on the epidemiology of KPC-producing K. pneumoniae. For this purpose, a literature search was performed and seven studies were included in the review. Both restrictive and non-restrictive interventions were associated with an overall reduction in antibiotic consumption, and a decrease in carbapenem resistance rates was observed in five studies. The overall quality of the evidence was low, mainly due to the poor reporting of microbiological outcomes, lack of a control group and suboptimal study design. Although the link between antibiotic use and resistance development is supported by strong evidence, demonstrating the impact of antimicrobial stewardship interventions on microbiological outcomes remains difficult. Studies with adequate design and appropriate outcome measures are needed to further promote antimicrobial stewardship and elucidate which interventions are more successful for controlling the spread of KPC-producing K. pneumoniae
Carbapenemase-producing Enterobacteriaceae in transplant patients
No full textCarbapenemase-producing Enterobacteriaceae (CPE) are a serious public health concern and represent a major threat to immunocompromised hosts, including solid organ (SOT) and stem cell transplant (HSCT) recipients. Transplant patients are at particular risk of developing CPE colonization and/or infection due to their frequent exposure to prolonged courses of broad-spectrum antibiotics, altered immunocompetence and exposure to invasive procedures and immunosuppressive drugs. Gut colonization with CPE, in particular carbapenem-resistant Klebsiella pneumoniae, may occur before or after SOT in 2%-27% of patients and among 2%-9% of HSCT and has been associated with increased risk of developing CPE infections. In endemic areas, CPE infections occur in up to 18% of SOT, and HSCT patients can account for 5%-18% of all patients with CPE bacteraemia. Mortality rates up to 70% have been associated with CPE infections in both patient populations. The rapid initiation of an active therapy against CPE is advocated in these infections. Therapeutic options, however, are limited by the paucity of novel compounds that are currently available and by potential antibiotic-associated toxicities. Therefore, a multidisciplinary approach involving infection control and antimicrobial stewardship programmes still represents the mainstay for the management of CPE infections among transplant patients. The evidence for the use of prevention strategies such as CPE-targeted perioperative prophylaxis or gut decolonization is still scarce. Large, multicentre trials are required to better define prevention strategies and to guide the management of CPE infections in the transplant setting
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