1,721,154 research outputs found
[New options for treatment of intraabdominal infections: tigecycline]
No full textTigecycline is a new antimicrobial agent; it is the first in a new class of antibiotics, the glycylcyclines, with properties conferring the ability to overcome many common resistance mechanisms, thus allowing its use for many serious and life-threatening infections for which the use of other antibiotics is no longer appropriate. It has a wide antibacterial spectrum including most methicillin-resistant Staphylococci, vancomycin-resistant Enterococci, ESBL-producing Gram negative bacteria, and other MDR Gram negative bacteria such as Acinetobacter, and Stenotrophomonas. It has good antibacterial activity also 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 hrs). It has been approved in USA and Europe for the treatment of complicated skin and soft tissue infections and for the complicated community acquired intra-abdominal infections. Phase III studies for treatment of community acquired and nosocomial acquire pneumonia, and sepsis sustained by multi-drug-resistant pathogens are ongoing
Anidulafungin, a new echinocandin: effectiveness and tolerability
No full textAnidulafungin is a new echinocandin with potent in vitro activity against Aspergillus and Candida species, including those resistant to fluconazole and amphotericin B. Results of several clinical trials indicate that anidulafungin is effective in treating oesophageal candidiasis, including azole-refractory disease. The results of a single randomized clinical trial comparing fluconazole and anidulafungin demonstrated that anidulafungin was noninferior to fluconazole in the treatment of candidaemia and invasive candidiasis. Studies evaluating the concomitant use of anidulafungin and either amphotericin B, voriconazole or ciclosporin did not demonstrate significant drug-drug interactions or adverse events. Anidulafungin appears to have an excellent safety profile: alterations of liver enzymes have been reported and slow infusion is recommended to prevent histamine-like reactions. On the basis of early clinical experience, it appears that anidulafungin will be a valuable option in the management of serious and difficult-to-treat fungal infections
[Skin and skin tissue infections: main clinical patterns/pictures]
No full textSkin and soft tissue infections represent a heterogeneous group of clinical entities that require to be accurately identified for an appropriate and immediate management. Clinicians are challenged by the need to rapidly select those patients requiring hospitalization and medical therapy only and those to be immediately submitted to surgery. Erysipelas and several forms of cellulitis, involving the superficial structures of epidermis and dermis, are medical conditions; some cutaneous abscess may require surgical drainage, and all the necrotizing infections, involving the subcutaneous tissue (necrotizing fasciitis) or muscles (myonecrosis) are surgical conditions. Among the clinical clues useful for the diagnosis are the presence of severe pain disproportionate to the clinical evidence of the lesion (necrotizing fasciitis), the presence of crepitus (gas gangrene) and signs of systemic toxicity (high fever, hypotension, tachycardia, shock and multiple organ failure)
Infectious complications in neutropenic cancer patients
No full textCancer patients are at risk of infectious complications due to neutropenia following chemotherapy or early post-HSCT (Hemato Stem Cell Transplantation). The first episode of fever during recent onset neutropenia is caused mostly by bacteria, while subsequent episodes are mainly fungal in nature. Proper management of infectious complications in neutropenic cancer patients requires classification into the appropriate risk category and knowledge of the local epidemiology of infections, of the causative organisms and their resistance phenotype. © 2010 SIMI
How to improve the design of trials of antifungal prophylaxis among neutropenic adults with acute leukemia
No full textThe risk for invasive fungal infections in patients with acute leukemia is generally low (4%-8%), and the routine use of fungal prophylaxis is not warranted except in specific high-risk groups that should be identified among this population. In a prophylactic study with a new agent, fluconazole or itraconazole oral solution represent good choices for the comparator because they are proven better than placebo or oral nonabsorbable antifungal agents in reducing the risk of invasive fungal infections in patients with acute leukemia. Because prophylaxis is most valuable when the risk of infection is high, patients with well-understood risk factors (severe mucosal disruption caused by chemotherapy, impaired cell-mediated immunity caused by steroids or fludarabine, use of a central venous catheter, and colonization by Candida species) should be selected. The end points for antifungal prophylactic trials should focus on proven and probable invasive fungal infections. Superficial and mucosal fungal infections do not represent a primary end point for these studies. Poor compliance should be considered as an interruption of treatment due to side effects and should be included in the criteria for failure. Fungus-related mortality should be evaluated as a failure of prophylaxis, whereas overall mortality may be influenced by many other cofactors. Differences in gastrointestinal toxicity of antifungal agents may limit the use of double-blind designs in some situations
Antimicrobial resistance in internal medicine wards
No full textAntimicrobial resistance is a global medical problem, affecting most bacterial pathogens. The major challenges are currently posed by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Enterobacteriaceae producing extended-spectrum-beta-lactamases (ESBL) and carbapenemases, and multi-resistant strains of Pseudomonas aeruginosa and Acinetobacter baumannii. Therapeutic options are very limited and, in some cases, virtually unavailable. This article provides an overview of the recent epidemiological trends exhibited by the most important multi-resistant pathogens, and of the treatment options that are currently available for these infections. © 2012 SIMI
Treatment of invasive candidiasis: Between guidelines and daily clinical practice
No full textInvasive candidiasis, including candidemia (IC/C), is a major cause of morbidity and mortality among hospitalized patients. While incidence is higher in intensive care units, the majority of cases of candidemia are documented in medical wards. Although Candida albicans is still the most frequently isolated species, IC/C due to non-albicans species, usually less susceptible to fluconazole, is increasing. Early identification of patients at risk, knowledge of local epidemiology and prompt efforts to define etiologic diagnosis play a pivotal role for appropriateness. Starting therapy with an echinocandin, switching then to fluconazole when possible, seems to represent a potentially useful strategy for the management of IC/C. The choice between the three echinocandins should be based on the specific indications, pharmacokinetic/pharmacodynamic profile, clinical experience and relative cost
[Intra-abdominal infections: definitions and classification]
No full textIntraabdominal infections (IAIs) 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 from the extension of the inflammation ((local or diffuse peritonitis). They include also the intra-peritoneal, retroperitoneal and parenchymal abscesses. The aim of current review is that of analyse the current definitions and classifications of intraabdominal infections
Interpreting procalcitonin in patients undergoing hemodialysis: a reliable or a misleading marker?
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