1,721,058 research outputs found
Antimicrobial-resistant Gram-negative bacteria in febrile neutropenic patients with cancer: current epidemiology and clinical impact
No full textIn the recent years, several studies involving cancer patients have demonstrated a clear trend in the epidemiology of bacterial infections showing a shift in the prevalence from Gram-positive to Gram-negative bacteria and the extensive emergence of antimicrobial-resistant strains among Gram-negatives isolated from the blood. The aim of this systematic review was to examine the recent trends in epidemiology and antimicrobial resistance in Gram-negatives recovered from neutropenic cancer patients, with particular emphasis on the impact of antimicrobial resistance on the clinical outcome of severe infections caused by such microorganisms
Detecting risk and predicting patient mortality in patients with extended-spectrum β-lactamase-producing Enterobacteriaceae bloodstream infections
No full textExtended-spectrum β-lactamases (ESBLs) have been increasingly described worldwide, especially among Enterobacteriaceae isolates, and recently not only in the nosocomial, but also in the community setting. Bloodstream infections (BSIs) caused by ESBL-producing Enterobacteriaceae have been associated with increased rates of treatment failure, mortality and hospital costs. Any delay in the initiation of adequate antibiotic therapy is potentially lethal for patients with BSIs caused by ESBL-producing Enterobacteriaceae. The awareness of changes in bacterial resistance patterns, the careful knowledge of risk factors for ESBL infection and of factors facilitating adverse outcome, giving attention to local epidemiology, can improve the efficacy of empirical treatment protocols. The aim of this review is to focus on the main characteristics of BSIs caused by ESBL-producing Enterobacteriaceae, with particular emphasis on risk factors for these infections and factors related to mortality
Therapeutic options for carbapenem-resistant Enterobacteriaceae infections
No full textIn recent years, carbapenem resistance among Enterobacteriaceae has dramatically increased and represents an important threat to global health. The optimal therapeutic management of carbapenem-resistant Enterobacteriaceae (CRE) infections has not been established, because to date, no clinical trials have been performed with this objective. We aimed to summarize in the present review data provided by previous observational clinical studies that have investigated the impact of different treatment strategies on the outcome of CRE infections. Most of these studies reported that combination therapy with 2 or more drugs is superior to monotherapy in providing a survival benefit. The use of carbapenems in association with other active drugs is likely ineffective for CRE isolates with carbapenem Minimum Inhibitory Concentrations (MICs) >8 mg/l. The effectiveness of further therapeutic options for the treatment of extensively or pan-drug-resistant Enterobacteriaceae infections has been reported in vivo and in vitro, although few cases/case series have been reported. Novel antimicrobials that are effective against CRE are urgently needed
Tuberculous spondylodiscitis: epidemiology, clinical features, treatment, and outcome
No full textAbstract
BACKGROUND:
Tuberculous spondylodiscitis (TS) is a rare but serious clinical condition which may lead to severe deformity and early or late neurological complications.
AIM:
To discuss certain aspects of the approach to TSs, focusing upon epidemiology, diagnosis, and treatment outcome.
MATERIALS AND METHODS:
For the purpose of this review, a literature search was performed using the Pubmed database through to 19th October 2011 to identify studies published in the last 20 years, concerned in epidemiological, clinical, diagnostic, and therapeutical aspects of TS in adults. Only studies drafted in English language and reporting case series of more than 20 patients have been included.
RESULTS:
TS has been reported to accounts for 1-5% of all TB cases, and for about 50% of the cases of articulo-skeletal TB infections. Despite the actual availability of more effective diagnostic tools, early recognition of TS remains difficult and a high index of suspicion is needed due to the chronic nature of the disease and its insidious and variable clinical presentation. A prompt diagnosis is required to improve long term outcome, and a microbiological confirmation is recommended to enable appropriate choice of anti-mycobacterial agents. Surgery has an important role in alleviating pain, correcting deformities and neurological impairment, and restoring function.
CONCLUSIONS:
Further studies are required to assess the appropriate duration of anti-microbial treatment, also in regarding of a combined surgical approach
Fluconazole use as an important risk factor in the emergence of fluconazole-resistant Candida glabrata fungemia
No full textFluconazole use as an
important risk factor in the emergence of fluconazole-resistant Candida glabrata
fungemi
Epidemiological and clinical features of pyogenic spondylodiscitis.
No full textPyogenic spondylodiscitis (PS) is an uncommon but important infection, that represents 3-5% of all cases of osteomyelitis. The annual incidence in Europe has been estimated to be from 0.4 to 2.4/100,000. A has been reported, with peaks at age less than 20 years and in the group aged 50-70 years. The incidence of PS seems to be increasing in the last years as a result of the higher life expectancy of older patients with chronic debilitating diseases, the rise in the prevalence of immunosuppressed patients, intravenous drug abuse, and the increase in spinal instrumentation and surgery. PS is in most cases a hematogenous infection. Staphylococcus aureus is the most frequent causative microorganism, accounting for about one half of the cases of PS. Gram-negative rods are causative agents in 7-33% of PS cases. Coagulase-negative staphylococci (CoNS) have been reported in 5-16% of cases. Staphylococcus epidermidis is often related to post-operative infections and intracardiac device-related bacteremia. Unremitting back pain, characteristically worsening during the night, is the most common presenting symptom, followed by fever that is present in about one half of the cases. The mortality of PS ranges from 0 to 11%. In a significant number of cases, recrudescence, residual neurological defects or persistent pain may occur
High-dose daptomycin for cardiac implantable electronic device-related infective endocarditis caused by staphylococcal small-colony variants
No full textHigh-Dose Daptomycin for Cardiac Implantable Electronic Device–Related Infective Endocarditis Caused by Staphylococcal Small-Colony Variant
Multidrug resistant Pseudomonas aeruginosa bloodstream infection in adult patients with hematologic malignancies
No full textIsavuconazole-Animal Data and Clinical Data
Full text linkThe treatment of invasive fungal infections has deeply evolved in the last years with the inclusion of new antifungals, mainly new azoles (i.e., posaconazole, isavuconazole), to the therapeutic armamentarium. This review focuses on the role of isavuconazole for treating the most important invasive fungal infections both in animals and humans (hematological and non-hematological patients)
Pharmacokinetics of etravirine in HIV-infected patients concomitantly treated with rifampin for tuberculosis
No full textEtravirine is metabolized by three cytochrome P450 enzymes that are in turn induced by rifampin. Consequently, co-administration of etravirine and rifampin is not recommended. To date, however, no clinical studies exploring the drug-drug interaction of this combination have been conducted. Here we report two cases of off-label etravirine use concurrently with antitubercular treatment, dictated by the unavailability of other treatments. Plasma drug concentrations were monitored by regular measurements. Our results appear to confirm the increased metabolism of etravirine through the induction of cytochrome P450 enzymes, but the adequacy of drug levels in all of the measurements and subsequent virological suppression suggest that this drug interaction may not be clinically relevant
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