1,721,361 research outputs found
Clinical aspects of invasive candidiasis: endocarditis and other localized infections.
No full textCandida endocarditis was previously considered a rare disease. However, its incidence is increasing, partly as a consequence of increased use of prosthetic intravascular devices. In patients with prosthetic valve endocarditis, Candida infection may occur via a two-step process; firstly, post-operative transitory candidaemia occurs during the intensive care unit stay, leading to colonization of the prosthetic valve and subsequent biofilm formation, with reduced susceptibility to antifungal agents. This theory lends support for pre-emptive antifungal therapy with agents that display activity against biofilm-associated Candida in patients with prosthetic heart valves at risk of candidaemia.
Current guidelines recommend treatment with amphotericin B with or without 5-fluorocytosine, or an echinocandin, with valve replacement where possible. Recent data Suggest that amphotericin B shows reduced activity against Candida biofilm, and poor penetration into vegetations and blood clots in experimental models of infectious endocarditis, whereas echino-candins, and in particular anidulafungin, display potent ill vitro activity against sessile Candida cells within biofilms. The incidence of ocular candidiasis has been decreasing among inpatients with candidaemia, possibly because of earlier identification and treatment of candidaemia. The therapeutic approach includes prolonged treatment with fluconazole or voriconazole. The role of systemic echinocandins may be limited since they achieve undetectable vitreous concentrations. Vitrectomy with local instillation of amphotericin B, azoles or echinocandins may play a role in the treatment of chronic complications such as epiretinal membrane formation. The role of Candida in CNS infections is unclear. Diffuse encephalitis in candidaemia is misleading, since alterations of the mental status are generally attributed to candidaemia-associated sepsis syndrome, and neuroimaging studies and cerebrospinal fluid cultures are rarely performed as part of the diagnostic workup. Osteomyelitis caused by Candida is considered infrequent. In contrast, Candida is frequently implicated in nosocomial non-postneurosurgery spondylodiscitis. Optimal management of such cases may require surgical debridement and, after initial intravenous antifungal therapy, prolonged administration of oral azoles.
The role of Candida in endocarditis is fairly well established. With the increasing numbers of patients at risk of Candida endocarditis, there is a need for agents with potent efficacy against Candida biofilms. Echinocandins represent a potential therapeutic option in this setting. Antifungal agents may also be of use in the treatment of complications in patients with ocular candidiasis and in CNS infections
Case report 5: Intensive care unit patient assessed using the Candida Score
No full text[No abstract available
The importance of in-vitro susceptibility testing in the management of compromised hosts
No full textBacterial infection may be a life-threatening complication in the immunocompromised host, especially in the face of profound and persistent granulocytopenia induced by cytotoxicity. Under these circumstances, antibiotic therapy is started on an empirical basis; however, knowledge of the antibiotic susceptibilities of the offending pathogen may represent a useful guide for therapy adjustments in individuals who do not respond satisfactorily to initial antibiotics. Careful antimicrobial susceptibility testing may also represent the first step of epidemiology investigation of nosocomial outbreaks; moreover, knowledge of antibiotic susceptibility patterns of the prevalent pathogens in certain institutions mag. help clinicians to formulate empiric antimicrobial treatments for febrile granulocytopenic patients. Careful quantitative studies involving determination of the minimal inhibitory concentrations may help to evidence early, potentially clinically significant decreases in susceptibility to first choice antibiotics for important nosocomial pathogens. Relationships between appropriate or inappropriate treatment, based on in-vitro susceptibility testing results, and clinical outcome may help to define the clinical significance of some emerging bacterial pathogens in immunocompromised patients
Vancomycin susceptibility in enterococcal blood isolates in Italy: A multicenter retrospective analysis
No full textA retrospective, multicenter survey was performed to evaluate the frequency of vancomycin resistance among enterococcal blood isolates in Italian hospitals during 1993. Twenty-four laboratories, representing 21 cities, provided data on 177,623 blood cultures. Of 15,500 positive cultures, 778 (5%) yielded an Enterococcus. Of 362 evaluable cases of enterococcal bacteremia, a vancomycin resistant Enterococcus (VRE) was found in only 6 (1.6%). Based on these results, VRE bacteremia did nor appear to be a major problem in Italian hospitals in 1993
Overview of septicemia.
No full textDespite progress in antimicrobial therapy, septicemia remains a major problem of modern medicine. The clinical features and outcome may vary in different clinical settings and in a single setting during the years. As an example, gram-negative bacilli have been the prevalent cause of fulminant septicemia in granulocytopenic patients during the seventies. Nowdays, the use of indwelling central venous catheters and/or quinolone prophylaxis have favored the emergence of coagulase-negative staphylococci as a major cause of septicemia in these patients. As a consequence, the optimal management of febrile episodes in granulocytopenic patients should include not only a combination of a broad spectrum betalactam plus an aminoglycoside to prevent early death from gram-negative septicemia, but also antistaphylococcal antibiotics in cases not improving after 72 hours. The clinical spectrum of infective endocarditis continues to evolve. Infection of the right heart valves that was rare until a few decades ago, is now a frequent cause of staphylococcal septicemia in intravenous drug addicts. Along with prosthetic valve infection, new clinical syndromes of nosocomial endocarditis are emerging. Infections of permanent central venous catheters, ventriculoatrial shunts or pace-maker leads may in fact cause right-sided infective endocarditis. Septicemia will continue to challenge physicians in the future
Carbapenem-resistant Klebsiella pneumoniae transmission associated to endoscopy
No full text[No abstract available]However there is some evidence that: i) endoscopy procedures are associated to CRKP transmission both in epidemic 1, 2 and endemic conditions 3, 4; ii) endoscopy association to CRKP transmission is not limited to one single K. pneumoniae clone or resistance mechanism 1-4; iii) endoscopy association to CRKP transmission is reported also in presence of various endoscopy units .
What is MRSA?
No full textFor decades methicillin-resistant Staphylococcus aureus (MRSA) has been considered the prototype of multi-resistant nosocomial pathogens, causing infections in high-risk patients. Changes in the healthcare system, coupled with the evolution of this versatile microorganism, have transformed MRSA into a cause of community-onset infections, in both patients who have contact with the healthcare system and patients without such a risk factor. New lineages of MRSA, defined as community acquired (CA)-MRSA, have emerged that have a propensity to cause infections in young individuals without risk factors. CA-MRSA primarily causes skin infections and, rarely, necrotising pneumonia. In the USA, these strains belong to a single widespread clone, designated USA300, while in Europe they belong to a variety of clones. Most strains carry genes for the Panton-Valentine leukocidin, whose role in diseases is under debate. In subjects living in the community who have contact with the healthcare system, MRSA strains of the nosocomial type are a frequent cause of infection and of pneumonia in particular. The detection of a large MRSA reservoir in pigs and the finding that professionally exposed individuals are colonised, has further shown that it is necessary to closely follow the epidemiology of MRSA if we want to combat it effectively
- …
