1,721,116 research outputs found
Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions.
No full textPatients with liver cirrhosis are susceptible to infections due to various mechanisms, including abnormalities of humoral and cell-mediated immunity and occurrence of bacterial translocation from the intestine. Bacterial infections are common and represent a reason for progression to liver failure and increased mortality. Fungal infections, mainly caused by Candida spp., are often associated to delayed diagnosis and high mortality rates. High level of suspicion along with prompt diagnosis and treatment of infections are warranted. Bacterial and fungal infections negatively affect the outcomes of liver transplant candidates and recipients, causing disease progression among patients on the waiting list and increasing mortality, especially in the early post-transplant period. Abdominal, biliary tract, and bloodstream infections caused by Gram-negative bacteria [e.g., Enterobacteriaceae and Pseudomonas aeruginosa (P. aeruginosa)] and Staphylococcus spp. are commonly encountered in liver transplant recipients. Due to frequent exposure to broad-spectrum antibiotics, invasive procedures, and prolonged hospitalizations, these patients are especially at risk of developing infections caused by multidrug resistant bacteria. The increase in antimicrobial resistance hampers the choice of an adequate empiric therapy and warrants the knowledge of the local microbial epidemiology and the implementation of infection control measures. The main characteristics and the management of bacterial and fungal infections in patients with liver cirrhosis and liver transplant recipients are presente
Fungal pulmonary infections: the conservative approach,
No full textInvasive fungal infections have increased worldwide and represent a threat for immunocompromised patients, including those who are HIV infected, recipients of solid organ and stem cell transplants, and patients receiving immunosuppressive therapies. High mortality rates and difficulties in early diagnosis characterise pulmonary fungal infections. In this chapter, invasive pulmonary aspergillosis, cryptococcosis and Pneumocystis jirovecii pneumonia have been reviewed, focusing on clinical aspects and therapeutic management. Although new compounds have become available in recent years (e.g. amphotericin B lipid formulations, third-generation azoles and echinocandins), new diagnostic tools and careful therapeutic management are mandatory to ensure an early appropriate targeted treatment, which is the key to a successful conservative approach in respiratory fungal infections
Antibiotics for pulmonary infections: an overview
No full textPulmonary infections represent an important cause of morbidity and mortality, and require prompt antimicrobial treatment. The correct choice of an empirical regimen is paramount in managing LRTIs due to the difficulty in obtaining a microbial diagnosis. Classic antimicrobials used in the treatment of pulmonary infections include β-lactams (with or without β-lactamase inhibitors), macrolides, tetracyclines and fluoroquinolones. Vancomycin and linezolid are the antimicrobials of choice for the treatment of nosocomial pneumonia caused by MRSA. New compounds have been studied to target pulmonary infections, including those caused by pathogens that are resistant to commonly used antimicrobials. A broad spectrum of activity, penetration into lung tissue, good tolerability, and availability of both oral and intravenous formulations represent key features of the compounds used in the treatment of LRTIs. In this chapter, we summarise the characteristics of commonly used molecules for the treatment of pulmonary infections in adult patients and discuss new options for their treatment
Enriching the antibiotic armamentarium for acute bacterial skin and skin structure infections
No full textno abstract available: Commen
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
Multidrug-resistant bacteria: what is the threat?
No full textDespite big advances in antimicrobial therapies and infection strategies, the emergence of antibiotic resistance represents an emergency situation, especially in immunocompromised hosts. Specifically, infections due to multidrug resistant, gram-negative pathogens are responsible for high mortality rates and may leave few effective antimicrobial options. Furthermore, although new compounds are available for severe methicillin-resistant staphylococcal infections, there is a paucity of novel classes of antimicrobials to target resistant gram-negatives. A careful assessment of the clinical conditions and underlying comorbidities, along with knowledge about the previous history of colonization or infections due to multidrug-resistant bacteria, represent key points in approaching the hematological patient with signs of infection. A de-escalation therapy with initial use of wide-spectrum antimicrobials followed by a reassessment after 72 hours of treatment may represent a good option in severe infections if a resistant pathogen is suspected. Prompt empiric or targeted therapy using combination regimens (ie, antipseudomonal beta-lactam plus an aminoglycoside or a quinolone) with the addition of colistin, along with increased dosage and therapeutic drug monitoring, represent options for these life-threatening infections. Continuous epidemiological surveillance of local bacteremias is necessary, along with stringent enforcement of antibiotic stewardship programs in cancer patients
Current and future treatment options for infections caused by multidrug-resistant Gram-negative pathogens
No full textThe spread of multidrug-resistant, extensively drug-resistant and pan-drug-resistant pathogens is causing an unprecedented public health crisis. The limited current therapeutic options led to the revival of two 'old' antibiotics - colistin and fosfomycin - for which a better understanding of their pharmacokinetics in the critically ill patient and in specific body compartments is required. Tigecycline's use in clinical practice for nonapproved indication based on its in vitro activity against problematic pathogens requires caution and probably higher doses. Furthermore, all three antibiotics should be used as part of combination regimens in order to prevent resistance and optimize outcomes. The development of new antibacterials in the near future, namely combinations of avibactam, ceftolozane/tazobactam and plazomicin, seems promising; however, they will only partially address current mechanisms of resistanc
Dalbavancin in the treatment of acute bacterial skin and skin structure and other infections: a safety evaluation
No full textDalbavancin is a second-generation lipoglycopeptide approved since 2014 to treat acute bacterial skin and skin-structure infections (ABSSSI). Dalbavancin is characterized by Gram-positive activity and novel pharmacokinetic properties allowing prolonged terminal half-life andonce weekly dosing . A good safety profile was reported in clinical trials
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