1,721,320 research outputs found
Current and emerging serious Gram-positive infections
No full textABSTRACTSerious infections caused by Gram-positive pathogens are increasingly difficult to treat because of pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and penicillin-resistant Streptococcus pneumoniae. The more recent emergence of vancomycin-intermediate and -resistant MRSA (VISA and VRSA) has further compromised treatment options. Reports of resistance to, and clinical failures with newer antimicrobial agents such as linezolid and quinupristin/dalfopristin are also emerging. Consequently, there is a clinical need for new antimicrobial agents that have suitable pharmacokinetic properties and safety profiles, with activity against these Gram-positive pathogens
Tigecycline: a new treatment option for intra-abdominal infections
No full textTigecycline is the first of a new class of antibiotics, the glycylcyclines, with properties which can overcome many common resistance mechanisms, making it appropriate for treatment of many serious and life-threatening infections for which other antibiotics are no longer appropriate. its wide antibacterial spectrum includes most methicillin-resistant staphylococci, vancomycin-resistant enterococci, ESBL-producing and other multi-resistant Gram-negative bacteria such as Acinetobacter and Stenotrophomonas spp. it is also active against anaerobes and atypical pathogens. Tigecycline is available only as parenteral formulation. it has a high volume of distribution (>10 L/kg) and long half-life (36 h). It is approved in the USA and europe for treatment of complicated skin and soft tissue infections and complicated communityacquired intra-abdominal infections. Phase II studies for treatment of community- and nosocomial-acquired pneumonia and sepsis due to multidrug resistant pathogens are ongoing
The role of teicoplanin in the treatment of febrile neutropenia
No full textThe clinical and microbiological efficacy, cost-per-patient and tolerability of teicoplanin were compared with those of vancomycin as empirical or second-line treatment of febrile neutropenic episodes in patients with hematologic malignancy or solid tumors. In terms of efficacy and cost teicoplanin and vancomycin were found equivalent, while teicoplanin is better tolerated and may be used effectively for treatment of out-patients
[Nosocomial infections: back to the future]
No full textThe increasing rate of nosocomial infections seems to be related to the wider use of invasive procedures. Evaluation of the patient risk factors for infection, use of SIRS classification and knowledge of the setting care should be utilized for the diagnostic approach. The empiric antibiotic therapy should take in account the site of the infection (bacteremia, pneumonia, urinary tract infection etc.) and the presumed pathogen; knowledge of the local epidemiology is a pre-requisite for the antibiotics choice. Among gram-positive microorganisms, methicillin-resistant staphylococci and vancomycin-resistant enterococci are responsible of difficult to treat infections; penicillin-resistant pneumococci, largely present in some european countries, might become an emerging pathogen also in Italy. The knowledge and ability of infectious diseases specialist encompasses clinical, microbiological and epidemiological fields to play a key role in the prevention and management of nosocomial infections
Definition and classification of intra-abdominal infections
No full textIntra-abdominal infections represent a wide variety of pathological conditions that involve lesions of all the intra-abdominal organs. They include both inflammation of single organs and any sort of peritonitis (primary, secondary, tertiary), where the severity of the disease often depends on the extension of the inflammation (local or diffuse peritonitis). They also include intraperitoneal, retroperitoneal and parenchymal abscesses. the aim of this article is to analyze the current definitions and classifications of intra-abdominal infections
The role of gram-positive therapy in the neutropenic patient
No full textThe increasing prevalence of Gram-positive infections in neutropenic cancer patients seems to be related to the use of central venous catheters, chemotherapy-induced oral and gastrointestinal mucositis, and the prophylactic use of fluoroquinolones. The need for anti-Gram-positive therapy in the neutropenic patient is supported by the increasing prevalence and the changing resistance of Gram-positive pathogens, as well as by the poor response of Gram-positive bacteraemia to aminoglycoside plus beta-lactam regimens. Combined therapy with either vancomycin or teicoplanin and other empirical antibiotics, has proved efficacious in adults and children with neutropenia, fever and Gram-positive infection. Vancomycin exerts greater antibacterial activity against strains of coagulase-negative staphylococci than teicoplanin and there is more data on its routine clinical use. In its favour, teicoplanin is less toxic and easier to administer. The time when a glycopeptide antibiotic should be introduced is still a matter of debate; support for both initial therapy and subsequent rescue therapy is found in the current literature. Large clinical trials are warranted to clarify further the role of anti-Gram-positive therapy in the neutropenic patient
The new fluorinated quinolones for antimicrobial prophylaxis in neutropenic cancer patients
No full textFluoroquinolones are the most attractive agents for prophylactic use in neutropenic cancer patients, due to their broad antimicrobial spectrum, high concentration in the faeces, systemic bactericidal activity, uncommon emergence of resistant strains and good tolerability. They have proved to be more effective than placebo, oral non-absorbable antibiotics or cotrimoxazole in the prevention of Gram-negative infections. In a prospective, randomised multicentre study performed by the GIMEMA infection program, ciprofloxacin was demonstrated to be more effective than norfloxacin for the reduction of febrile episodes, use of systemic antibiotics, and Gram-negative infections in neutropenic patients with haematological malignancies. The greater efficacy may be related to its better systemic or greater antibacterial activity. The potential problems related to the prophylactic use of fluoroquinolones are the increasing prevalence of Gram-positive infections caused by streptococci and coagulase-negative staphylococci; the reported emergence and nosocomial spread of resistant strains, especially among coagulase-negative staphylococci; the lack of their usefulness as empirical therapy in febrile neutropenic patients. Fluoroquinolones are today the better choice for preventing Gram-negative infections in neutropenic patients and ciprofloxacin should probably be preferred. More information on their efficacy and their relationship to the overall susceptibility of micro-organisms in patients with cancer would be valuable, and careful monitoring of patients treated with these drugs is therefore warranted
- …
