1,721,693 research outputs found
What is the Role of Fluoroquinolones in Intensive Care?
No full textFluoroquinolones are a class of antibiotics that are widely used in the treatment of a number of severe infections frequently observed in intensive care units (ICU). From a pharmacodynamic point of view, the optimal conditions for guaranteeing clinical recovery and preventing the occurrence of resistance to this class of antibiotics are represented by the ratios of C max/MIC >12.2 and AUC24h/MlC equal to 100-125 hours for Gram-negative bacteria, and about 30-40 hours for Gram-positive cocci. Taking this into consideration, the pharmacokinetics and pharmacodynamics shown in healthy volunteers suggest that with the use of standard doses of the various fluoroquinolones, an optimal AUCfree/MIC ratio for Gram-negative bacteria may be ensured with a minimum inhibitory concentration (MIC) <0.25-0.5 mg/L and for Gram-positive bacteria with an MIC <0.5-1 mg/L. The need to increase the dosage, or to combine them with other antibiotics is therefore recognized, when it is necessary to ensure adequate coverage of intermediately sensitive microorganisms (MIC 1-2 mg/L). In addition, patients recovered in the ICU often present some peculiar pathophysiological conditions that increase the distribution volume and/or the renal clearance of the drug. Thus it is likely that in this situation it would be reasonable to increase daily dosages, independent of the in vitro pattern of drug sensitivity (e.g. 500 mg b.i.d. for levofloxacin). Data from various clinical and pharmacological studies suggesting a potential role for fluoroquinolones both in monotherapy and combination therapy in the treatment of different clinically severe conditions are presented and discussed. This offers the dual opportunity to evaluate the role of quinolones as an alternative to aminoglycosides in combination with a beta-lactam and, at the same time, to consider their use in a periodic rotation program of anti-Gram-negative antibiotic therapy when there is a high risk of resistance selection, such as in the ICU. In conclusion, the role of fluoroquinolones in the treatment of multiple infectious diseases, such as bacteremia/sepsis, pneumonia and severe urinary tract infections in an environment such as the ICU is growing stronger, while there are convincing data indicating that these molecules might play a role in the treatment of meningitis in the near future
Antimicrobial agents in elective surgery: Prophylaxis or "early therapy"?
No full textA lack of a clear distinction between antimicrobial prophylaxis and therapy still exists in the surgical setting. Major concerns are: 1) Which surgical procedures are eligible for antimicrobial prophylaxis? 2) Which kind of antimicrobial agent should be used for surgical prophylaxis? 3) What is the optimal timing for administering antimicrobial prophylaxis and how long should administration be continued? In this paper we assess the rationales leading to the following answers: 1) Only clean-contaminated and prosthetic clean operations should be eligible for antimicrobial prophylaxis, whereas contaminated or dirty operations should be eligible for "early therapy". 2) First- or second-generation cephalosporins or aminopenicillin/beta-lactamase inhibitors are optimal choices for surgical prophylaxis, depending on location of the surgical wound. 3) The highest licensed dosage of the chosen antimicrobial agent should be administered at induction of anesthesia and redosing should be considered when the intervention lasts more than 2 antibiotic half-lives. This allows maintenance of optimal drug exposure against the potential pathogens in plasma and in the extracellular environment of the potentially contaminated tissues for the entire procedure and for some hours after wound closure. Post-surgical doses are not recommended in most cases whereas ultra-short prophylaxis is preferred
Progression From Carriage to Bloodstream Infection and Fatality by Different Enterobacterales Species, Carbapenemases, and Host Settings: Deciphering the Melting Pot
No full textN
Relationship Between Vitamin D Deficiency and Nonalcoholic Fatty Liver Disease in Patients With HIV-1 Infection.
No full textNon
‘Treatment duration for Escherichia coli bloodstream infection and outcomes’ – Author's reply
No full textLiver Transplant in Patients with HIV: Infection Risk Associated with HIV and Post-transplant Immunosuppression
No full textMDR/XDR/PDR or DTR? Which definition best fits the resistance profile of Pseudomonas aeruginosa ?
Full text linkPurpose of reviewThe aim of this narrative review is to compare the prognostic utility of the new definition of difficult-to-treat resistance (DTR) vs. established definitions in patients with Pseudomonas aeruginosa infection to understand the therapeutic implications of resistance classification and its impact on clinical outcome.Recent findingsAmong Gram-negative bacteria (GNB), P. aeruginosa (PA) is associated with high rates of morbidity and mortality, mostly related to its intrinsic capacity of developing antibiotic resistance. Several classifications of antibiotic resistance have been proposed in the last 15 years. The most common used is that from Magiorakos et al. including multidrug resistance (MDR), extensively drug-resistant (XDR) and pan drug resistance (PDR) according to the number of antibiotic classes showing in vitro activity. A further classification based on the resistance to specific antibiotic classes (i.e. fluoroquinolones, cephalosporins, carbapenem resistance) was also proposed. However, both of them have been criticized because of limited usefulness in clinical practice and for poor correlation with patient outcome, mainly in infections due to PA. More recently the new definition of difficult-to-treat resistance (DTR) has been proposed referring to nonsusceptibility to all first-line agents showing high-efficacy and low-toxicity (i.e. carbapenems, β-lactam-β-lactamase inhibitor combinations, and fluoroquinolones). Studies including large cohorts of patients with GNB bloodstream infections have confirmed the prognostic value of DTR classification and its clinical usefulness mainly in infections due to PA. Indeed, in the recent documents from the Infectious Diseases Society of America (IDSA) on the management of antibiotic resistant GNB infections, the DTR classification was applied to PA.SummaryDTR definition seems to identify better than MDR/XDR/PDR and single class resistant categories the cases of PA with limited treatment options. It requires periodic revision in order to remain up-to-date with the introduction of new antibiotics and the evolving pattern of resistance
Recurrence of skin and soft tissue infections: identifying risk factors and treatment strategies
Full text linkPurpose of reviewRecurrent skin and soft tissue infections (RSSTIs) are challenging for the clinicians due to morbidity and healthcare-related costs. Here, we review updates on risk factors and management.Recent findingsRSSTIs rates range between 7 and 45%. Local and systemic conditions can favour RSSTIs, with comorbidities such as obesity, diabetes, cancer and immunosuppressive disease becoming increasingly relevant. Streptococcus spp. and Staphylococcus aures (including methicillin resistant, MRSA) are the leading causative pathogens of RSSTIs, but also Gram-negative bacteria and polymicrobial infection should be considered. To prevent recurrences, treatment of underlying predisposing factor, complete source control and appropriate antibiotic therapy are crucial. Antibiotic prophylaxis for recurrent erysipelas and decolonization for MRSA carriers demonstrated some advantages, but also long-term loss of efficacy and possible adverse effects. Clinical score and patients risk stratification could be useful tools to target prophylaxis and decolonization strategies. To reduce hospitalization rates and costs, outpatient oral and parenteral antibiotic therapy (OPAT) and long-acting antibiotics are being implemented.SummaryManagement of RSSTIs requires both preventive interventions on modifiable risk factors and pharmacological strategies, with a patient tailored approach
- …
