MedWorm: Antibiotic Therapy

Short Course of Antibiotics Insufficient for VAPShort Course of Antibiotics Insufficient for VAP

Medscape Today Headlines — Tue, 07 Feb 2012 15:18:19 +0100

Eight days of antimicrobial therapy for ventilator-associated pneumonia (VAP) are not enough when the infecting pathogens are nonlactose-fermenting Gram-negative bacilli. Medscape Medical News (Source: Medscape Today Headlines)

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Pneumonia wonder drug: Zinc saves lives

EurekAlert! - Infectious and Emerging Diseases — Tue, 07 Feb 2012 05:00:00 +0100

(BioMed Central) Respiratory tract infections, including pneumonia, are the most common cause of death in children under the age of five. In a study looking at children given standard antibiotic therapy, new research published in BioMed Central's open-access journal BMC Medicine shows how zinc supplements drastically improved children's chances of surviving the infection. The increase in survival due to zinc (on top of antibiotics) was even greater for HIV-infected children. (Source: EurekAlert! - Infectious and Emerging Diseases)

Pathogenesis and treatment concepts of orthopaedic biofilm infections

FEMS Immunology and Medical Microbiology — Mon, 06 Feb 2012 05:00:00 +0100

AbstractImplant‐associated infection is caused by surface adhering bacteria persisting as biofilm. Periprosthetic joint infection is difficult to diagnose and to treat. The high susceptibility of implanted devices to infection is due to a locally acquired host defense defect, and persistence is mainly due to the rapid formation of a biofilm resistant to host defense and antimicrobial agents. Successful treatment of periprosthetic joint infection requires the optimal surgical procedure combined with long‐term antimicrobial therapy directed against surface‐adhering microorganisms. Surgical treatment according to an algorithm has been validated in several observational studies. The role of rifampin against device‐associated staphylococcal infection has been evaluated in an animal mode...

An observational study on bloodstream extended-spectrum beta-lactamase infection in critical care unit: Incidence, risk factors and its impact on outcome.

European Journal of Internal Medicine — Fri, 03 Feb 2012 00:25:53 +0100

CONCLUSION: There is a high incidence of ESBL producing organisms causing blood stream infections in critically ill patients. Transfer from other hospitals and previous antibiotic usage are important risk factors for ESBL production. However ESBL production may not be associated with a poorer outcome if appropriate early antibiotic therapy is instituted. PMID: 22284253 [PubMed - in process] (Source: European Journal of Internal Medicine)

Clinical and epidemiological characteristics of adult patients hospitalized for erysipelas and cellulitis

European Journal of Clinical Microbiology and Infectious Diseases — Thu, 02 Feb 2012 06:54:16 +0100

Abstract The purpose of this investigation was to analyze the clinical and epidemiological aspects of all cases of erysipelas and infectious cellulitis admitted to a tertiary hospital during a period of five years. All patients admitted with the main diagnosis of erysipelas or cellulitis to the Department of Dermatology of the author’s institution from January 2005 to May 2010 were included. Seventy patients were identified and their medical records were retrospectively reviewed so as to record the epidemiological and clinical data. Univariate and multivariable analyses were performed to analyze variables that predicted longer length of stay. The frequency of cellulitis in the lower limbs was higher in men and patients older than 65 years. Moderate/severe cellulitis in p...

A toothbrush impalement injury of the floor of mouth in autism child

Dental Traumatology — Thu, 02 Feb 2012 05:00:00 +0100

We report a case of a toothbrush impalement injury of the floor of the mouth in a child with autism. A 5‐year‐old boy with autism presented with an accidentally impaled toothbrush in the oral cavity. He was taken to the operation room and examined under general anesthesia. The handle of the toothbrush was cut off using rib scissors for mask ventilation, and intra‐oral intubation was performed. The toothbrush was located approximately 2.5 cm into the floor of the mouth. The toothbrush was removed uneventfully. Intravenous antibiotic therapy was instituted during hospitalization, and discharge from the hospital occurred 4 days after the operation. (Source: Dental Traumatology)

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The neonate presenting with temperature symptoms: Role in the diagnosis of early onset sepsis

Pediatrics International — Thu, 02 Feb 2012 05:00:00 +0100

Conclusions: Every seventh newborn hospitalized at our neonatal intensive care unit developed fever, hypothermia and/or temperature instability during the first three days of life. Two thirds of them had culture proven or clinical sepsis. Temperature symptoms were rarely observed in EOS negative newborns (8%) but despite low sensitivity highly specific for bacterial infection in preterm and term newborns.© 2012 The Authors. Pediatrics International © 2012 Japan Pediatric Society (Source: Pediatrics International)

Antibiotic Therapy and Early Onset Sepsis

NeoReviews recent issues — Wed, 01 Feb 2012 05:00:00 +0100

Early onset sepsis in the newborn infant continues to be an important clinical problem for neonatologists everywhere in the world. Different routes of transmission, changes in causative agents, and potential antibiotic resistance all influence the choice of antibiotic therapy. Group B Streptococcus and Escherichia coli continue to be the major pathogens dictating antibiotic therapy in the United States. Ampicillin and gentamicin are the antibiotics used by most for empirical therapy; cephalosporins are used in certain clinical situations. In this review, we address the reasons for these choices while highlighting clinically relevant aspects of the antibiotics commonly used in the treatment of early onset sepsis in the newborn. (Source: NeoReviews recent issues)

Antimicrobial Therapy and Late Onset Sepsis

NeoReviews recent issues — Wed, 01 Feb 2012 05:00:00 +0100

Late onset sepsis infections contribute a significant proportion of the morbidity and mortality of hospitalized infants, especially in very low birth weight infants. Although it is fairly clear which infants are at higher risk of developing sepsis, it is less clear whether a standard for diagnostic evaluation exists and is being used consistently across institutions. In the current setting of changing epidemiology and emergence of antibiotic-resistant organisms, it is important to evaluate the antimicrobial agents used for empirical therapy and to emphasize the importance of antimicrobial stewardship. In addition, it is imperative to evaluate possible methods for prevention of these infections. (Source: NeoReviews recent issues)

Bronchoscopic Findings in Children With Chronic Wet Cough

PEDIATRICS — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSIONS: Children who present with chronic wet cough are often found to have evidence of purulent bronchitis on bronchoscopy. This finding is often indicative of a bacterial lower airway infection in these children. (Source: PEDIATRICS)

The utility of Gram stains and culture in the management of limb ulcers in persons with diabetes

International Wound Journal — Wed, 01 Feb 2012 05:00:00 +0100

In Tanzania, limited laboratory services often preclude routine identification of microorganisms that cause infections in persons with diabetes. Thus, we carried out this study to determine the utility of a Gram stain alone versus culture in guiding appropriate antimicrobial therapy. During February 2006 to December 2007 (study period), deep tissue biopsies were obtained from persons with diabetes presenting to the Muhimbili National Hospital (MNH) with infected limb ulcers. Specimens were Gram‐stained then cultured for bacteria and fungi. Biopsies were obtained from 128 patients. Of 128 cultures, 118 (92%) yielded bacterial or fungal growth; 59 (50%) of these 118 cultures yielded mixed growth (80% included Gram‐negative organisms); 38 (32%) and 20 (17%) yielded Gram‐negative and Gra...

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Infected Abdominal Aneurysm due to Salmonella Sepsis: Report of a Unique Case Treated Using the Superficial Femoral Vein

Annals of Vascular Surgery — Wed, 01 Feb 2012 05:00:00 +0100

We describe a 61-year-old patient with an infected aneurysm of the abdominal aorta due to Salmonella sepsis. Treatment was successful and included aneurysm resection, extensive debridement, and reconstruction of the abdominal aorta using the superficial femoral vein, combined with long-term antibiotic therapy. (Source: Annals of Vascular Surgery)

Does Vaginal Irrigation with Saline Solution in Women with Infectious Vaginitis Contribute to the Clinical and Microbiological Results of Antibiotic Therapy

Gynecologic and Obstetric Investigation — Tue, 31 Jan 2012 23:00:00 +0100

Gynecol Obstet Invest (DOI:10.1159/000332396) (Source: Gynecologic and Obstetric Investigation)

Efficacy of a porous‐structured titanium subdermal barrier for preventing infection in percutaneous osseointegrated prostheses

Journal of Orthopaedic Research — Tue, 31 Jan 2012 05:00:00 +0100

AbstractInfections of percutaneous osseointegrated prostheses (POP) cause prolonged morbidity and device failure because once established, they are refractory to antibiotic therapy. To date, only limited translational animal studies have investigated the efficacy of POP designs in preventing infections. We developed an animal model to evaluate the efficacy of a porous‐coated titanium (Ti) subdermal barrier to achieve skin–implant integration and to prevent periprosthetic infection. In a single‐stage “amputation and implantation” surgery, 14 sheep were fitted with percutaneous devices with an attached porous‐coated Ti subdermal barrier. Nine sheep were implanted with a smooth Ti subdermal barrier construct and served as controls, with one control sheep removed from the study due...

Isolation and identification of a bacteriocin with antibacterial and antibiofilm activity from Citrobacter freundii.

Archives of Microbiology — Tue, 31 Jan 2012 05:00:00 +0100

This study suggests that bacteriocins can be an effective way to control surface-attached pathogenic bacteria. PMID: 22290290 [PubMed - as supplied by publisher] (Source: Archives of Microbiology)

A bad experience with endovascular treatment of an aortobronchial fistula.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:18:43 +0100

Authors: Eldien AS, Deo S, Nichols FC, Greason KL Abstract A 35-year-old woman presented with an aortobronchial fistula after polyester graft replacement of coarctation of the descending thoracic aortic. Treatment of the fistula included antibiotic therapy and stent graft placement. Life-threatening sepsis developed in the postoperative period. Subsequent treatment required excision of the infected graft complex with extra-anatomic reconstruction of the thoracic aorta. The patient had a very stormy postoperative course and required heroic measures, including mechanical circulatory support, to achieve survival. The present case demonstrates failure of endovascular therapy of an aortobronchial fistula. The case should serve as a cautious reminder that the underlying cause for infecti...

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Vascular Graft Infections

Infectious Diseases Clinics of North America — Sun, 29 Jan 2012 22:43:12 +0100

This article reviews the pathogenesis of VGI, in particular the role of biofilms, as well as the current state of clinical management including diagnostic modalities, surgical options for treatment, antimicrobial therapy, and preventive measures. (Source: Infectious Diseases Clinics of North America)

Successful Utilization of High-Flux Hemodialysis for Treatment of Vancomycin Toxicity in a Child

Advances in Pharmacological Sciences — Sun, 29 Jan 2012 18:41:46 +0100

We report a case of a pediatric patient who developed vancomycin toxicity and associated oliguric renal failure who was treated effectively with high-flux hemodialysis for vancomycin toxicity, clearing serum concentrations of vancomycin by over 75% in only 6 hours (213.2 mcg/mL to 51.8 mcg/mL) with subsequent return to baseline renal function and without adverse sequelae. While not historically considered a viable option for drug removal in cases of toxicity, new high-flux hemodialysis techniques can remove significant percentages of vancomycin in short periods of time. (Source: Advances in Pharmacological Sciences)

Stealthy leprosy pathogen evades critical vitamin D-dependent immune response

UCLA Newsroom: Health Sciences — Sun, 29 Jan 2012 18:00:00 +0100

A team of UCLA scientists has found that the pathogen that causes leprosy has a remarkable ability to avoid the human immune system by inhibiting the antimicrobial responses important to our defenses. In one of the first laboratory studies of its kind, researchers discovered that the leprosy pathogen Mycobacterium leprae was able to reduce and evade immune activity that is dependent on vitamin D, a natural hormone that plays an essential role in the body's fight against infections. The pathogen manipulated micro-RNAs, tiny molecules made of ribonucleic acids that carry information and that help regulate genes to direct cell activity, including immune system defenses. Micro-RNAs are short RNAs that do not code information for proteins, which carry out all cell activity; ...

Dacryocystitis: Systematic Approach to Diagnosis and Therapy

Current Infectious Disease Reports — Sat, 28 Jan 2012 16:50:36 +0100

The objective of this paper is to review the main findings of the largest studies on the etiopathogenesis and microbiology of the development of dacryocystitis and to formulate clinical and surgical guidelines based on said studies and on our experience at Cruces Hospital, the Basque Country, Spain. The most common sign of this entity is the distal nasolacrimal duct obstruction, and this should be treated to prevent clinical relapse. The time when surgery should be indicated mainly depends on the clinical signs and symptoms, age and general status of a patient. Given the germs isolated in cases of dacryocystitis, antibiotic therapy against Gram positive (S. aureus, S. pneumoniae, S. epidermidis) and Gram negative bacteria (H. influenzae, P. aeruginosa) should be administered, orally i...

Guidelines for the management of accidental tetanus in adult patients

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

O tétano acidental, a despeito de ser uma doença prevenível por imunização, ainda é frequente nos países subdesenvolvidos e em desenvolvimento. Sua letalidade ainda é elevada e os estudos sobre a melhor forma de tratamento são escassos. Tendo em vista esta escassez e a importância clínica dessa doença, um grupo de especialistas reunidos pela Associação de Medicina Intensiva Brasileira (AMIB), desenvolveu recomendações baseadas na melhor evidencia disponível para o manejo do tétano no paciente necessitando cuidados intensivos. As recomendações incluem aspectos relativos à admissão do paciente tetânico na unidade de terapia intensiva, tratamento com imunoglobulinas, tratamento antibiótico, manejo da analgossedação e bloqueio neuromuscular, manejo da disautonomia e e...

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Lethality and osteomuscular and cardiovascular complications in tetanus

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

CONCLUSION: The present study demonstrates the failure of primary medical care in vaccination and post-traumatic tetanus prophylaxis. Despite improvements in intensive care support, cardiovascular complications are still frequent in these patients. Individuals exhibiting high APACHE II scores and severe clinical forms of tetanus should be monitored closely due to a risk of death and cardiovascular complications. (Source: Revista Brasileira de Terapia Intensiva)

Diagnosis and Management of Necrotizing Fasciitis of the Head and Neck

Current Infectious Disease Reports — Fri, 27 Jan 2012 06:53:37 +0100

Abstract Necrotizing fasciitis is a rapidly progressing and life-threatening soft tissue infection that often affects the abdominal wall, perineum, or extremities following surgery or trauma. It predominantly occurs in elderly and immunocompromised patients. It is rarely seen in the head and neck region. Necrotizing fasciitis of the head and neck carries high rates of morbidity and mortality. Symptoms usually develop quickly and well-timed diagnosis is critical to optimizing outcome. Diagnosis is based on a combination of clinical history, Gram staining and culture, imaging and surgical exploration. Early and aggressive surgical management and urgent parenteral antibiotic therapy are critical to optimizing outcome. Content Type Journal ArticleCategory Upper Respiratory...

Antibiotic therapy for preventing infections in patients with acute stroke.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: In this meta-analysis, preventive antibiotic therapy seemed to reduce the risk of infection, but did not reduce the number of dependent or deceased patients. However, the included studies were small and heterogeneous. Large randomised trials are urgently needed. PMID: 22258987 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Bacteriuria and antibiotic resistance in catheter urine specimens following radical prostatectomy.

Urologic Oncology — Wed, 25 Jan 2012 05:00:00 +0100

CONCLUSIONS: A substantial proportion of RP patients have positive urine cultures at the time of catheter removal, despite the administration of prophylactic fluoroquinolone antibiotics. Potentially virulent organisms are commonly cultured, and ciprofloxacin resistance is frequent. However, outcomes are favorable when culture-specific oral antibiotic therapy is initiated. PMID: 22285005 [PubMed - as supplied by publisher] (Source: Urologic Oncology)

A Bad Experience With Endovascular Treatment of an Aortobronchial Fistula [CASE REPORTS]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

A 35-year-old woman presented with an aortobronchial fistula after polyester graft replacement of coarctation of the descending thoracic aortic. Treatment of the fistula included antibiotic therapy and stent graft placement. Life-threatening sepsis developed in the postoperative period. Subsequent treatment required excision of the infected graft complex with extra-anatomic reconstruction of the thoracic aorta. The patient had a very stormy postoperative course and required heroic measures, including mechanical circulatory support, to achieve survival. The present case demonstrates failure of endovascular therapy of an aortobronchial fistula. The case should serve as a cautious reminder that the underlying cause for infection remains even after apparent successful endovascular therapy. (So...

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Indications for antimicrobial prescribing in European nursing homes: results from a point prevalence survey

Pharmacoepidemiology and Drug Safety — Tue, 24 Jan 2012 05:00:00 +0100

ConclusionsThe indications for antimicrobial prescribing varied markedly between countries. We identified uroprophylaxis as a possible target for quality improvement. Copyright © 2012 John Wiley & Sons, Ltd. (Source: Pharmacoepidemiology and Drug Safety)

BSAC issues updated guidelines on the diagnosis and antibiotic treatment of endocarditis in adults

NeLM - News — Mon, 23 Jan 2012 05:00:00 +0100

Source: Journal of Antimicrobial Chemotherapy Area: News The British Society for Antimicrobial Chemotherapy (BSAC) has published updated and extended guidelines on the treatment of infectious endocarditis (IE), reflecting developments in diagnostics, new trial data and the availability of new antibiotics. As randomised controlled trials (RCTs) in this area are still lacking, a consensus approach has again been adopted for most recommendations; evidence is however graded where possible. Several treatment options are provided for most scenarios, as it is well recognized that patients can develop adverse drug reactions to the recommended regimens and/or fail to respond to initial antimicrobial therapy and may require a change in therapy. (Source: NeLM - News)

Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient

BMC Infectious Diseases — Mon, 23 Jan 2012 05:00:00 +0100

Conclusion: The diagnosis of hepatic bartonellosis is exceedingly difficult to establish and requires a high degree of clinical suspicion. Recently developed, PCR-based approaches may be required in select patients to make the diagnosis. The optimal antimicrobial therapy for hepatic bartonellosis has not been established, and close follow-up is needed to ensure successful eradication of the infection.KeywordsGranulomatous hepatitis, Bartonella henselae, Diagnosis, Treatment (Source: BMC Infectious Diseases)

Bloodstream infections as a marker of community‐acquired sepsis severity. Results from the Portuguese Community‐Acquired Sepsis Study (SACiUCI study)

Clinical Microbiology and Infection — Mon, 23 Jan 2012 05:00:00 +0100

AbstractThe impact of bloodstream infection (BSI) on admission to the hospital on the outcome of patients with Community‐Acquired Sepsis (CAS) admitted in Intensive Care Units (ICU) is largely unknown. We selected 803 adult patients consecutively admitted with CAS to one of 17 Portuguese ICU, in whom blood cultures were collected before initiation of antibiotic therapy during a 12‐month period. A bloodstream infection (BSI) was identified on hospital admission in 160 (19.9%) patients. Those with and without BSI had similar mean Simplified Acute Physiology Score (SAPS) II and age. The presence of BSI was independently associated with mortality in ICU [Adjusted Odds Ratio (AOR)=1.86; 95% confidence interval (CI): 1.20–2.89; p=0.005]. On the fourth ICU day, BSI patients were found to be...

First‐day step‐down to oral outpatient treatment versus continued standard treatment in children with cancer and low‐risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study

Pediatric Blood and Cancer — Mon, 23 Jan 2012 05:00:00 +0100

ConclusionsIn children with low‐risk FN, the efficacy of first‐day step‐down to oral antimicrobial therapy with amoxicillin and ciprofloxacin in an outpatient setting was non‐inferior to continued hospitalization and intravenous antimicrobial therapy. The safety of this procedure, however, was not assessable with sufficient power. Pediatr Blood Cancer © 2012 Wiley Periodicals, Inc. (Source: Pediatric Blood and Cancer)

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Treatment of lepromatous ulcers using citric acid as a sole antimicrobial agent

International Wound Journal — Sat, 21 Jan 2012 10:46:19 +0100

A prospective study was carried out to assess the role of citric acid as a sole antimicrobial agent in the management of lepromatous ulcers. Thirty‐four known cases of lepromatous ulcers not responding to conventional antibiotic therapies for long duration were investigated for culture and susceptibility studies. Staphylococcus aureus (25·00%) and Klebsiella spp. (23·43%) were found to be the most common isolates. Amikacin (68·75%) and ciprofloxacin (67·18%) were found to be the most effective antimicrobial agents. Topical application of citric acid ointment resulted in complete healing in 25 (73·52%) cases. In eight cases (26·48%), there was elimination of infective agent from ulcer site and formation of healthy granulation, but no complete healing of ulcer was seen. Results indic...

Prosthetic Vascular Graft Infections Between Blood and Concordance of Graft Culture Pathogen.

The American Journal of the Medical Sciences — Fri, 20 Jan 2012 05:00:00 +0100

CONCLUSION: The yield of blood cultures in late-onset abdominal PVGIs is low. Presence of microorganisms in blood cultures does not necessarily indicate a causal relationship with graft infection. An empirical broad-spectrum antimicrobial therapy is advised in all suspected cases until a definitive etiology has been made. PMID: 22270396 [PubMed - as supplied by publisher] (Source: The American Journal of the Medical Sciences)

Inhaled antibiotics for nosocomial pneumonia.

Inflammation and Allergy Drug Targets — Fri, 20 Jan 2012 05:00:00 +0100

In this report, we reviewed available evidence from animal and human clinical studies in respect of the role of inhaled antibiotic therapy in pneumonia. In most studies, pneumonia cure rates were found to be comparable to that of systemic antibiotic only therapy and occasionally better. Inhaled antibiotic therapy was found to have an acceptable safety profile by avoiding systemic toxicity; despite previous concerns regarding the emergence of antimicrobial resistance, recent studies did not support such concerns. However, in respect of the sparity of data larger randomized trial are needed to shed more light in this promising form of treatment. PMID: 22280234 [PubMed - as supplied by publisher] (Source: Inflammation and Allergy Drug Targets)

Potential New Targets For Antibiotic Therapy Revealed By Polar Growth At The Bacterial Scale

Health News from Medical News Today — Thu, 19 Jan 2012 09:00:00 +0100

An international team of microbiologists led by Indiana University researchers has identified a new bacterial growth process - one that occurs at a single end or pole of the cell instead of uniform, dispersed growth along the long axis of the cell - that could have implications in the development of new antibacterial strategies... (Source: Health News from Medical News Today)

Treatment of a Mycotic Descending Thoracic Aortic Aneurysm Using Endovascular Stent-Graft Placement and Rifampin Infusion With Postoperative Aspiration of the Aneurysm Sac

Vascular and Endovascular Surgery — Thu, 19 Jan 2012 05:00:00 +0100

Conclusion: By combining traditional surgical strategies with a contemporary endovascular approach, the perioperative mortality and long-term risk of infection associated with mycotic thoracic aneurysms can potentially be decreased. (Source: Vascular and Endovascular Surgery)

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A case report of severe congenital neutropenia in a young infant

Revista Paulista de Pediatria — Wed, 18 Jan 2012 06:37:28 +0100

OBJETIVO:Relatar um caso de neutropenia congênita grave e alertar os pediatras sobre tal diagnóstico em pacientes jovens, com infecções recorrentes. DESCRIÇÃO DO CASO: Lactente jovem com 45 dias de vida, com história de febre alta, letargia, recusa alimentar e hemogramas repetidos com leucopenia importante à custa de polimorfonucleares. A hipótese diagnóstica foi confirmada pelo aspirado de medula óssea, que mostrou hipoplasia de série granulocítica e completa ausência de neutrófilos maduros. Foi introduzida antibioticoterapia de largo espectro e estimulador da formação de colônias de granulócitos. O paciente evoluiu para óbito em decorrência de complicações infecciosas após 21 dias de internação. COMENTÁRIOS: Trata-se de um lactente jovem, portador de uma rara d...

Tuberculosis-related choriocapillaritis (multifocal–serpiginous choroiditis): follow-up and precise monitoring of therapy by indocyanine green angiography

International Ophthalmology — Tue, 17 Jan 2012 07:12:50 +0100

Abstract To report the case of a patient initially diagnosed with acute posterior multifocal placoid pigment epitheliopathy (APMPPE), characterized by relentless evolution despite high-dose steroid therapy. An interferon-gamma release assay (IGRA) indicated a diagnosis of suspected tuberculous choriocapillaritis and the disease responded only to massive inflammation suppressive therapy and antibiotic therapy. Case report. Review of clinical features and investigational procedures. Smoldering relentless evolution and subsequent arrest of progression could be precisely monitored by indocyanine green angiography (ICGA). The patient did not recover after standard anti-tubercolosis (TB) therapy combined with corticosteroid. A fourth antibiotic had to be added in order to stop t...

Treatment Outcome of Bacteremia due to KPC-Producing Klebsiella pneumoniae: Superiority of Combination Antimicrobial Regimens.

Antimicrobial Agents and Chemotherapy — Tue, 17 Jan 2012 05:00:00 +0100

Authors: Qureshi ZA, Paterson DL, Potoski BA, Kilayko MC, Sandovsky G, Sordillo E, Polsky B, Adams-Haduch JM, Doi Y Abstract Klebsiella pneumoniae producing Klebsiella pneumoniae carbapenamase (KPC) has been associated with serious infections and high mortality. The optimal antimicrobial therapy for infection due to KPC-producing K. pneumoniae is not well established. We conducted a retrospective cohort study to evaluate the clinical outcome of patients with bacteremia caused by KPC-producing K. pneumoniae. A total of 41 unique patients with blood cultures growing KPC-producing K. pneumoniae were identified at two medical centers in the United States. Most of the infections were hospital-acquired (32; 78%), while the rest of cases were healthcare-associated (9; 22%). The overall 28...

[Sickle cell disease and invasive osteoarticular Salmonella infections.]

Archives de Pediatrie — Tue, 17 Jan 2012 05:00:00 +0100

We describe the cases of 2 children with sickle cell disease who presented paucisymptomatic Salmonella osteoarticular infections on returning from North Africa. Progression was favorable in both cases after appropriate systemic antibiotic therapy, although one Salmonella was multidrug-resistant. Invasive salmonellosis remains rare in France, but, because of its severity, it should be suspected in any patient with sickle cell disease presenting fever, especially in the context of recent trips in Africa countries. Early clinical diagnosis is essential to start appropriate empirical treatment without waiting for bacteriological results. PMID: 22261260 [PubMed - as supplied by publisher] (Source: Archives de Pediatrie)

Can Vancomycin or Ampicillin Prevent Development of Staphylococcus Aureus Biofilms?

Journal of Surgical Research — Sat, 14 Jan 2012 22:30:02 +0100

Introduction:Biofilms are populations of microbes growing on a surface and surrounded by a complex polymeric matrix. Biofilm-associated bacteria are typically more antibiotic resistant compared to their planktonic (free-living) counterparts. Biofilm infections are often recalcitrant to antibiotic therapy, but there is little information on the ability of prophylactic antibiotics to prevent biofilm development. We assessed the ability of vancomycin and ampicillin to inhibit the formation of Staphylococcus aureus biofilms cultivated on surgical suture. Methods: High (107) or low (104) numbers of S. aureus RN6390 or ATCC 25923 were incubated 16 hr with 1-cm segments of 3-0 silk suture. the incubation medium was 0.66% tryptic soy broth supplemented with 0.2% glucose and additionally supplemen...

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Life-threatening Necrotizing Fasciitis Due to 'Bath Salts' Injection.

Orthopedics — Sat, 14 Jan 2012 15:24:05 +0100

This article reports a new source of necrotizing fasciitis in an intramuscular injection of "bath salts," a rapidly emerging street drug that is legal in some states and evades authorities with its innocuous name.The patient presented 2 days after injection of bath salts with extensive cellulitis extending to the mid portion of her upper arm. The cellulitis initially responded to broad-spectrum intravenous antibiotics, but rapidly deteriorated 48 hours later, leading to a forequarter amputation with radical mastectomy and chest wall debridement to obtain healthy tissue margins and control the disease. The patient made a full recovery after further minor debridements, negative pressure dressings, directed antibiotic therapy, and skin grafting.The recent emerging popularity of this highly ob...

Diabetes mellitus and spinal epidural abscess: clinical or surgical treatment?

Arquivos Brasileiros de Endocrinologia e Metabologia — Sat, 14 Jan 2012 00:35:00 +0100

We describe a SEA case in a 23-year old white woman with diabetes for 14 years, who was successfully treated only with antibiotics, and achieved full recovery at the fourth month of follow-up.O abscesso epidural espinhal (AEE) é uma doença incomum e o diabetes melito é o seu fator predisponente mais importante. O tratamento de escolha é a imediata drenagem cirúrgica, seguida de antibioticoterapia, entretanto, casos já foram relatados em que o AEE foi tratado clinicamente com sucesso. Descrevemos um caso de AEE em um paciente diabético tratado satisfatoriamente com uso isolado de antibióticos e que evoluiu com recuperação total no quarto mês de seguimento. (Source: Arquivos Brasileiros de Endocrinologia e Metabologia)

Laboratory diagnosis of acromegaly

Arquivos Brasileiros de Endocrinologia e Metabologia — Sat, 14 Jan 2012 00:35:00 +0100

Recommendations of Neuroendocrinology Department from Brazilian Society of Endocrinology and Metabolism for Diagnosis and Treatment of Acromegaly in Brazil

Arquivos Brasileiros de Endocrinologia e Metabologia — Sat, 14 Jan 2012 00:35:00 +0100

Insulin resistance and chronic hepatitis C in non-diabetic patients

Arquivos Brasileiros de Endocrinologia e Metabologia — Sat, 14 Jan 2012 00:35:00 +0100

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Reply to: insulin resistance and chronic hepatitis C in non-diabetic patients

Arquivos Brasileiros de Endocrinologia e Metabologia — Sat, 14 Jan 2012 00:35:00 +0100

Tracheostomy Wound Myiasis in a Child: Case Report and Review of the Literature

Computational Intelligence and Neuroscience — Thu, 12 Jan 2012 11:11:41 +0100

An 8-year-old tracheostomized, gastrostomized, and with cerebral palsy boy was admitted for tracheostomy wound myiasis and cellulitis. Ether was applied in the wound, and then all the accessible larvae were removed. Antibiotic therapy was initiated. The procedure had to be repeated three more times to extract all the larvae. An airway endoscopy was performed and ruled out the presence of larvae in the airway, as well as any damage to the wall of the trachea. The patient recovered uneventfully and was discharged. (Source: Computational Intelligence and Neuroscience)

Lyme Disease as an Underlying Cause of Supraspinatus Tendinopathy in an Overhead Athlete.

Physical Therapy — Thu, 12 Jan 2012 05:00:00 +0100

DISCUSSION:/b>Many active patients spend time in the outdoors increasing their risk of exposure to a vector for Borrelia burgdorferi. Physical therapists spend a larger portion of time with patients than other health care professionals, and due to this extended contact and musculoskeletal knowledge are able to recognize atypical musculoskeletal disorders or musculoskeletal manifestations of unusual pathologies including Lyme disease. PMID: 22247404 [PubMed - as supplied by publisher] (Source: Physical Therapy)

Role of moxifloxacin for the treatment of commmunity-acquired complicated intra-abdominal infections in Taiwan.

Journal of Microbiology, Immunology, and Infection — Wed, 11 Jan 2012 05:00:00 +0100

Authors: Lau YJ, Chen YH, Huang CT, Lee WS, Liu CY, Liu JW, Liu HD, Lee YJ, Chen CW, Ko WC, Hsueh PR Abstract Complicated intra-abdominal infections (cIAIs) are common yet serious infections that can potentially lead to substantial morbidity and morbidity. As an essential adjunct to source control, the goals of antimicrobial therapy are to promote patient recovery, reduce recurrence risk, and prevent antimicrobial resistance. The current international guidelines on the empirical treatment of community-acquired complicated IAIs were published by the Infectious Diseases Society of America (IDSA) and Surgical Infections Society (SIS) in 2010. These guidelines all recommend the use of a fluoroquinolone (ciprofloxacin or levofloxacin) plus metronidazole for mild-to-moderate- and high-se...

Audit of antibiotic duration of therapy, appropriateness and outcome in patients with nosocomial pneumonia following the removal of an automatic stop-date policy

European Journal of Clinical Microbiology and Infectious Diseases — Tue, 10 Jan 2012 17:00:00 +0100

The objective of this study was to evaluate the impact of revoking the ASO policy on the duration of antibiotic therapy, infection-related outcome (cure vs failure), relapsing infection, occurrence of resistant bacteria and superinfection in patients with nosocomial pneumonia. A retrospective chart review of adult patients (≥ 18 years old) admitted to Sunnybrook Health Sciences Centre with nosocomial pneumonia requiring antibiotic therapy was conducted. Duration of antibiotic therapy, infection-related outcome (cure vs failure), rate of relapsing infection, resistant organisms and superinfection were determined for each cohort. Forty-two eligible adults with nosocomial pneumonia per cohort were included. Duration of antibiotic therapy was not significantly different in the pre...

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Antibiotic therapy for necrotizing fasciitis caused by Vibrio vulnificus: retrospective analysis of an 8 year period

Journal of Antimicrobial Chemotherapy — Tue, 10 Jan 2012 05:00:00 +0100

Conclusions Our data suggested that, in addition to primary surgery, fluoroquinolones or third-generation cephalosporins plus minocycline are the best option for antibiotic treatment of NF caused by V. vulnificus. (Source: Journal of Antimicrobial Chemotherapy)

Lactic acid bacteria from raw milk as potentially beneficial strains to prevent bovine mastitis.

Anaerobe — Tue, 10 Jan 2012 05:00:00 +0100

Authors: Espeche MC, Pellegrino M, Frola I, Larriestra A, Bogni C, Nader-Macías ME Abstract Bovine mastitis produces a wide variety of problems in the dairy farm. The treatment of this disease is based on the use of antibiotics which are not always effective. These drugs are also responsible for the presence of residues in the milk and the increase of antibiotic-resistant strains. Probiotic products were proposed as a valid alternative to antibiotic therapies and are also useful for the prevention of infectious syndromes. With the aim of designing a probiotic product to prevent bovine mastitis, lactic acid bacteria (LAB) were isolated from foremilk samples from different dairy farms in Córdoba-Argentina. One hundred and seventeen LAB were isolated and their beneficial characteris...

Duration of antibiotic therapy in bacteraemia

Critical Care — Mon, 09 Jan 2012 05:00:00 +0100

No abstract as 250 word letter (Source: Critical Care)

Fosfomycin enhances the active transport of tobramycin in Pseudomonas aeruginosa.

Antimicrobial Agents and Chemotherapy — Mon, 09 Jan 2012 05:00:00 +0100

Authors: Macleod DL, Velayudhan J, Kenney TF, Therrien JH, Sutherland JL, Barker LM, Baker WR Abstract Elevated levels of mucins present in bronchiectatic airways predispose patients to bacterial infections and reduce the effectiveness of antibiotic therapies by directly inactivating antibiotics. Consequently, new antibiotics that are not inhibited by mucins are needed to treat chronic respiratory infections caused by Pseudomonas aeruginosa and Staphylococcus aureus. In these studies, we demonstrate that fosfomycin synergistically enhances the activity of tobramycin in the presence of mucin. The bactericidal killing of a novel 4:1 (wt/wt) combination of fosfomycin:tobramycin (FTI) is superior (>9-log(10) CFU/mL) relative to its individual components fosfomycin and tobramycin. Ad...

Coordinate regulation of Gram-positive cell surface components.

Current Opinion in Microbiology — Mon, 09 Jan 2012 05:00:00 +0100

Authors: Hanson BR, Neely MN Abstract The cell surface of Gram-positive pathogens represents a complex association of glycopolymers that control cell division, homeostasis, immune evasion, tissue invasion, and resistance to antimicrobials. These glycopolymers include the peptidoglycan cell wall, wall-teichoic acids, lipoteichoic acids, and capsular polysaccharide. Disruption of individual factors often results in pleiotropic effects, making it difficult to discern regulation and function. In this review we collate recent work describing these pleiotropic phenotypes, and propose that this is due to coordinated regulation of biosynthesis or modification of these cell surface components. A better understanding of the regulatory networks that control the relative prevalence of each fac...

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Synergistic antibiotic activity of volatile compounds from the essential oil of Lippia sidoides and thymol.

Fitoterapia — Sun, 08 Jan 2012 05:00:00 +0100

The objective of this work was to verify the chemical composition and antibiotic modifying activity of the essential oil extracted from the leaves of L. sidoides and its major component thymol. The essential oil was obtained by hydrodistillation and analyzed by GC/MS. The synergistic activity was evaluated using gaseous contact method. The essential oil was obtained (yield of 1.06%) and the GC/MS analysis identified the main constituents: thymol (84.9%) and p-cymene (5.33%). The antibiotic modifying activity was verified using the minimal inhibitory dose method and gaseous contact. It verified the interference of essential oil and thymol against all tested aminoglycosides. There were no statistical differences between the activity of the essential oil and thymol against Pseudomonas aerugin...

Osteomyelitis of the Patella in Eight Foals

Veterinary Surgery — Fri, 06 Jan 2012 05:00:00 +0100

ConclusionsPrompt medical and surgical therapy for osteomyelitis of the patella can result in a good prognosis for soundness and a potential athletic career. Concurrent septicemia or other systemic perinatal disease can result in prolonged therapy and delayed recovery. (Source: Veterinary Surgery)

Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis

NeLM - News — Fri, 06 Jan 2012 05:00:00 +0100

Source: Lancet Area: News The authors of this research note that Group B streptococcus is the most common cause of neonatal sepsis in high-income countries, acquired either from the mother or from environmental sources. Case fatality is high, even with antibiotic therapy, and it is also an important cause of preterm delivery, antepartum and intrapartum stillbirth, and puerperal sepsis. Prophylaxis, with antibiotics given to pregnant women with risk factors or known carriage of the bacteria, has been implemented in most high-income countries since the late 1990s, but has been difficult to implement in many low- and middle-income countries. Despite widespread use of intrapartum antibiotic prophylaxis, group B streptococcus remains a leading cause of morbidity and mort...

Management of infectious discitis. Outcome in one hundred and eight patients in a University Hospital

International Orthopaedics — Wed, 04 Jan 2012 06:48:06 +0100

Conclusion Early diagnosis is a major challenge. Heightened awareness and the prompt use of MRI are necessary to avoid diagnostic delay. Prolonged antimicrobial therapy and the judicious application of timely surgical intervention are essential for an optimal outcome. Content Type Journal ArticleCategory Original PaperPages 1-6DOI 10.1007/s00264-011-1445-xAuthors Juan Luis Cebrián Parra, Department of Orthopaedics & Traumatology, Hospital Clínico San Carlos, C. Prof. Martin Lagos s/n, 28040 Madrid, SpainAlvaro Saez-Arenillas Martín, Department of Orthopaedics & Traumatology, Hospital Clínico San Carlos, C. Prof. Martin Lagos s/n, 28040 Madrid, SpainAntonio L. Urda Martínez-Aedo, Department of Orthopaedics & Traumatology, Hospital Clínico San Carlos, C. Prof. M...

Full-mouth disinfection and systemic antimicrobial therapy in generalized aggressive periodontitis: a randomized, placebo-controlled trial.

Journal of Clinical Periodontology — Wed, 04 Jan 2012 05:00:00 +0100

CONCLUSIONS: Systemic administration of metronidazole and amoxicillin as an adjunct to OSFMD therapy significantly improved clinical and microbiological outcomes in patients with G-AgP over a 6-month period. PMID: 22220822 [PubMed - as supplied by publisher] (Source: Journal of Clinical Periodontology)

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Bacterial skin and soft tissue infections: review of the epidemiology, microbiology, aetiopathogenesis and treatment

Journal of the European Academy of Dermatology and Venereology — Tue, 03 Jan 2012 05:00:00 +0100

AbstractBacterial skin and soft tissues infections (SSTI) often determine acute disease and frequent emergency recovering, and they are one of the most common causes of infection among groups of different ages. Given the variable presentation of SSTI, a thorough assessment of their incidence and prevalence is difficult. The presence of patient‐related (local or systemic) or environmental risk factors, along with the emergence of multi‐drug resistant pathogens, can promote SSTI. These infections may present with a wide spectrum of clinical features and different severity, and can be classified according to various criteria. Many bacterial species can cause SSTI, but Gram‐positive bacteria are the most frequently isolated, with a predominance of Staphylococcus aureus and Streptococcus ...

Bronchiolitis Obliterans Organizing Pneumonia after Radiofrequency Ablation of Lung Cancer: Report of Three Cases

Journal of Vascular and Interventional Radiology : JVIR — Sun, 01 Jan 2012 05:00:00 +0100

Abstract: The present report describes three cases of a bronchiolitis obliterans organizing pneumonia (BOOP)–like reactive pneumonitis following radiofrequency (RF) ablation for lung cancer. The incidence of BOOP-like reactive pneumonitis after RF ablation at the authors' institution was estimated to be approximately 0.4% (three of 840 sessions). The patients presented with nonspecific symptoms. Computed tomography images showed consolidation or ground-glass opacity in a peripheral-dominant distribution and/or patchy air-space opacities. The disease was nonresponsive to antibiotic therapy but responded favorably to pulse therapy of steroids. BOOP-like reactive pneumonitis should be recognized as a complication following lung RF ablation. (Source: Journal of Vascular and Interventional R...

The effects of systemic isotretinoin and antibiotic therapy on the microbial floras in patients with acne vulgaris

Journal of the European Academy of Dermatology and Venereology — Sun, 01 Jan 2012 05:00:00 +0100

Conclusions Systemic isotretinoin and antibiotic treatments in acne patients precisely caused variations in the microbial floras of several sites of the body, while isotretinoin was commonly more responsible than antibiotics. Knowing that alterations in the microbial colonization of the flora regions may preceede infectious disease and bacterial resistance, treatment options and follow‐up procedures in acne vulgaris should be carefully determined to reduce the risk of destruction of the microbial flora. (Source: Journal of the European Academy of Dermatology and Venereology)

Posttransplant Lymphoproliferative Disorder Presenting as Multiple Cystic Lesions in a Renal Transplant Recipient

American Journal of Transplantation — Sun, 01 Jan 2012 05:00:00 +0100

We report a case of a 67‐year‐old man who experienced allograft dysfunction following a renal transplantation from a donation after cardiac death. The postoperative course was initially complicated by episodes of E. coli urinary sepsis causing pyrexia and a raised creatinine level. Ultrasound scanning 5 weeks posttransplant revealed mild hydronephrosis with several parenchymal cystic areas measuring up to 2 cm with appearances suggestive of fungal balls. Aspirated fluid again grew Escherichia coli, and this was treated with the appropriate antimicrobial therapy. The patient continued to have episodes of culture‐negative sepsis; therefore, a computed tomography scan was performed 6 months posttransplant, which revealed multiple lesions in the renal cortex as well as liver and spleen. ...

Predictive value of Escherichia coli susceptibility in strains causing asymptomatic bacteriuria for women with recurrent symptomatic urinary tract infections receiving prophylaxis

Clinical Microbiology and Infection — Sun, 01 Jan 2012 05:00:00 +0100

AbstractA significant proportion of women develop a recurrence following an initial urinary tract infection (UTI). In women with recurrent UTI (rUTI), the predictive value of asymptomatic bacteriuria (ASB) for the development of a subsequent UTI has not yet been established and it is not known whether information from an asymptomatic sample is useful in guiding antimicrobial therapy. To address these questions, we used data that originated from the ‘Non‐antibiotic prophylaxis for recurrent urinary tract infections’ (NAPRUTI) study: two randomized controlled trials on prevention of rUTI in non‐hospitalized pre‐ and postmenopausal women (n=445). During 15 months of follow‐up, no difference was observed in the time to a subsequent UTI between women with and without ASB at baseline...

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[Therapy of chronic osteomyelitis : Soft tissues as "key to success"].

Der Orthopade — Sun, 01 Jan 2012 05:00:00 +0100

[Therapy of chronic osteomyelitis : Soft tissues as "key to success"]. Orthopade. 2012 Jan;41(1):43-50 Authors: Sellei RM, Kobbe P, Knobe M, Lichte P, Dienstknecht T, Lemmen SW, Pape HC Abstract Chronic osteomyelitis is a severe complication characterized by soft tissue and bone pathogenic infection resulting in osseous destruction. Surgical management is demanding and poses a challenge in achieving the goals of treatment, which are control of infection, bone healing as well as satisfactory functional outcome. Therapeutic strategies are based on a combined application of radical surgery and systemic antibiotic therapy. The bony defects which remain after extensive debridement have to be reconstructed with bone grafting after soft tissue coverage and the healing process is d...

[Logistic requirements and biopsy of periprosthetic infections : What should be taken into consideration?].

Der Orthopade — Sun, 01 Jan 2012 05:00:00 +0100

[Logistic requirements and biopsy of periprosthetic infections : What should be taken into consideration?]. Orthopade. 2012 Jan;41(1):15-9 Authors: Fink B, Schäfer P, Frommelt L Abstract Preoperative diagnosis of periprosthetic infections is particularly important before revision of knee and hip arthroplasties because of the therapeutic consequences. Therefore, periprosthetic infections should be ruled out before any revision surgery is performed. Of the different diagnostic methods direct techniques which allow the direct detection of microorganisms with testing of antibiotic sensitivity are recommended. This allows microorganism-specific systemic and local antibiotic therapies and helps to reduce the risk of development of resistance. In our studies it could be shown tha...

[Prevention of wound infections : Basic measures].

Der Orthopade — Sun, 01 Jan 2012 05:00:00 +0100

[Prevention of wound infections : Basic measures]. Orthopade. 2012 Jan;41(1):11-4 Authors: Lewalter K, Lemmen S Abstract Individual patient risk factors for wound infections, such as alcohol abuse, smoking or obesity can usually only be modified to a small extent. Studies have shown a reduction of surgical site infections due to the implementation of a benchmarking surveillance system. In order to prevent surgical site infections a variety of interventions are available, such as glucose control, correction of anemia and malnutrition and antibiotic therapy of infections before elective surgery. Reduction of the microbial skin flora by whole body washing procedures, avoidance of sharp razor shaving, application of antibiotic prophylaxis and correct surgical hand disinfection ...

Comparative Effectiveness of Antibiotic Treatment Strategies for Pediatric Skin and Soft-tissue Infections: Williams DJ, Cooper WO, Kaltenbach LA, et al. Pediatrics 2011;128:479–87.

The Journal of Emergency Medicine — Sun, 01 Jan 2012 05:00:00 +0100

This was a retrospective cohort study of 47,501 children aged 0–17 years comparing the effectiveness of treatment with trimethoprim-sulfamethoxazole (TMP-SMX) or a β-lactam vs. clindamycin in drained and undrained skin and soft-tissue infections (SSTI). Children with an SSTI and prescription for either clindamycin (reference treatment), trimethoprim-sulfamethoxazole, or a β-lactam (penicillin or cephalosporin) filled within 2 days of the SSTI were included in the study and grouped based on drainage status. Exclusion criteria included: SSTI within the last 365 days, treatment with multiple agents, treatment with topical antibiotics, SSTI requiring hospital admission, burns, foreign bodies, or surgical-site infections. Effectiveness of each antibiotic therapy was defined with respect to ...

Impact of enterococcus on immunocompetent and immunosuppressed patients with perforation of the small or large bowel.

Technology and Health Care — Sun, 01 Jan 2012 05:00:00 +0100

Conclusion: Enterococci seem to play a minor role in uncomplicated intraabdominal infections. Our results suggest that enterococci play a role in the severity of postoperative complications. In particular, detection of enterococci in patients with anastomotic leakage are suggested to be an indicator of severe illness. We found significantly higher rates of E. faecium than described before, but no significant differences in clinical outcome between E. faecalis and E. faecium. When empirical therapy against enterococci is recommended, E. faecalis and E. faecium should both be covered. PMID: 22297712 [PubMed - in process] (Source: Technology and Health Care)

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Evidence-Based Guidelines For Evaluation And Antimicrobial Therapy For Common Emergency Department Infections

Emergency Medicine Practice — Sat, 31 Dec 2011 08:46:52 +0100

This issue of Emergency Medicine Practice reviews the available evidence and consensus guidelines for the management of common infectious diseases presenting to the ED and presents recommendations for treatment. (Source: Emergency Medicine Practice)

Pulmonary embolism and reactivation of tuberculosis during everolimus therapy in a kidney transplant recipient.

Annals of Transplantation — Fri, 30 Dec 2011 05:00:00 +0100

Conclusions: This case shows that kidney transplanted patients treated with everolimus presenting symptoms of pneumonia should also be screened for pulmonary embolism. Patients treated with PSIs may be prone to reactivation of tuberculosis. When tuberculosis treatment is started, much larger doses of everolimus are required.<br /> PMID: 22210429 [PubMed - in process] (Source: Annals of Transplantation)

The Importance of Early Diagnosis and Appropriate Treatment in Grisel's Syndrome: Report of Two Cases.

Turkish Neurosurgery — Thu, 29 Dec 2011 18:00:03 +0100

We report two cases of Grisel's syndrome which emphasize on the importance of early diagnosis for appropriate and successful treatment. PMID: 22194139 [PubMed - in process] (Source: Turkish Neurosurgery)

Subtentorial subdural empyema: report of two cases and review of the literatures.

Turkish Neurosurgery — Thu, 29 Dec 2011 18:00:03 +0100

Authors: Taha MM, Hassanaın S Abstract Subtentorial subdural empyema is a rare form of intracranial suppuration. We present two cases treated at our department within the last 11 years. The common source was an ear infection. Both patients presented with headache, fever, vomiting and stiff neck. Only one patient had disturbed consciousness. Both patients received aggressive antibiotic therapy. The first patient was treated with suboccipital craniectomy and evacuation of pus collection, while the second patient was treated conservatively with antibiotics and ventriculoperitoneal shunt for his associated supratentorial hydrocephalus. Both blood cultures and empyema collection were sterile. Neuroimaging with computed tomography and magnetic resonance imaging permitt...

MRSA eradication in dermatologic outpatients

JDDG — Thu, 29 Dec 2011 05:00:00 +0100

Conclusions: We report successful MRSA eradication in outpatients. Systemic antibiotics are unnecessary in the majority of patients. A combined anti‐MRSA strategy for inpatients and outpatients is recommended. (Source: JDDG)

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Neck abscess: an unusual presentation of actinomycosis

Journal of Pakistan Medical Students — Thu, 29 Dec 2011 05:00:00 +0100

CONCLUSION Cervicofacial AM is an uncommon disease. However, it can mimic various other common conditions. A high index of suspicion, proper investigations and long term treatment are needed for complete eradication. Therefore, AM should be suspected in any soft tissue swelling not responding to conventional treatment REFRENCES Miller M, Haddad AJ. Cervicofacial actinomycosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85:496-508. Bennhoff DF. Actinomycosis: diagnostic and therapeutic considerations and a review of 32 cases. Laryngoscope. 1984; 94:1198-217. Honda H, Bankowski MJ, Kajioka EH, Chokrungvaranon N, Kim W, Gallacher ST. Thoracic vertebral actinomycosis: Actinomyces israelii and Fusobacterium nucleatum. J Clin Microbiol. 2008; 46:2009-2014. Lancella A, Abba...

Antimicrobial susceptibility profiling and genomic diversity of multidrug-resistant Acinetobacter baumannii isolates from a teaching hospital in Malaysia.

Japanese Journal of Infectious Diseases — Sun, 25 Dec 2011 15:27:37 +0100

Authors: Kong BH, Hanifah YA, Yusof MY, Thong KL Abstract The resistance phenotypes and genomic diversity of 185 Acinetobacter baumannii isolates obtained from the intensive care unit (ICU) of a local teaching hospital in Kuala Lumpur from 2006 to 2009 were determined using antimicrobial susceptibility testing and pulsed-field gel electrophoresis (PFGE). Antibiogram analyses showed that the isolates were fully resistant to β-lactam antimicrobials and had high resistance rates to the other antimicrobial agents tested. However, the isolates were susceptible to polymyxin B. Resistance to cefoperazone/sulbactam was only detected in strains isolated from 2007 to 2009. Some environmental isolates and an isolate from the hands of a healthcare worker (HCW) had identical resistance profile...

Aerosolized amikacin in patients with difficult-to-treat pulmonary nontuberculous mycobacteriosis

European Journal of Clinical Microbiology and Infectious Diseases — Sat, 24 Dec 2011 06:41:52 +0100

Abstract Patients with pulmonary nontuberculous mycobacteriosis (pNTM) may have suboptimum response to conventional antimicrobial therapy. Aerosolized amikacin (aeAmk) was given to nine patients who had failed standard combination oral antimycobacterial drugs. A favorable toxicity profile, even in patients given aeAmk for an extended duration, median 75 ± 85 (range, 18–277) days and total cumulative dose 35,400 ± 30,568 (range, 7,600–95,400) mg, was encouraging, as was the clinical response and resolution of symptoms in 8 of 9 patients. The patient who failed therapy died due to complications arising from prior hematopoietic transplantation. The feasibility and efficacy of aeAmk in combination with oral anti-NTM drug(s) for treatment-refractory disease and, i...

Enterovenous fistulization: A rare complication of Crohn's disease.

World Journal of Gastroenterology : WJG — Wed, 21 Dec 2011 05:00:00 +0100

We describe a 32-year-old man with Crohn's ileocolitis who presented with hypotension and fever associated with HPVG, as well as superior mesenteric vein thrombosis, possibly caused by enterovenous fistula, who was successfully managed by surgery. We also review the literature concerning portal venous gas associated with Crohn's disease. PMID: 22215949 [PubMed - in process] (Source: World Journal of Gastroenterology : WJG)

Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: A prospective study

Hepatology — Tue, 20 Dec 2011 05:00:00 +0100

Conclusions:Multiresistant bacteria, especially ESBL‐producing Enterobacteriaceae, are frequently isolated in nosocomial and to a lesser extent health care‐associated infections in cirrhosis, rendering third‐generation cephalosporins clinically ineffective. New antibiotic strategies tailored according to the local epidemiological patterns are needed for the empirical treatment of nosocomial infections in cirrhosis. (HEPATOLOGY 2011.) (Source: Hepatology)

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MRSA and Non-MRSA Otorrhea in Children: A Comparative Study of Clinical Course [Original Article]

Archives of Otolaryngology — Mon, 19 Dec 2011 05:00:00 +0100

Conclusion In this study, a diagnosis of otorrhea due to MRSA did not carry an increased risk for surgical procedures or infection-associated sequelae compared with a diagnosis of non-MRSA otorrhea. (Source: Archives of Otolaryngology)

The Norwegian experience with penicillin G plus an aminoglycoside as initial empiric therapy in febrile neutropenia; a review.

Acta Oncologica — Mon, 19 Dec 2011 05:00:00 +0100

Conclusion. Many countries use a broad-spectrum β-lactam as initial therapy in FN. International experts are sceptic towards the Norwegian recommendations. We discuss the arguments for and against penicillin G plus an aminoglycoside in FN. The main arguments to continue the Norwegian treatment tradition are the satisfactory clinical results and the reason to believe that it contributes to the low levels of antibiotic resistance in Norway. PMID: 22175253 [PubMed - as supplied by publisher] (Source: Acta Oncologica)

Ventilator-Associated Tracheitis and Antibiotic Duration Ventilator-Associated Tracheitis and Antibiotic Duration

Medscape Today Headlines — Mon, 19 Dec 2011 03:18:12 +0100

Antibiotics may be misused in patients on mechanical ventilation. Learn about new research on the appropriate duration of antibiotic therapy in the NICU and PICU. Medscape Infectious Diseases (Source: Medscape Today Headlines)

The Daschner Guide to In-Hospital Antibiotic Therapy(Frank et al.)

Springer Medicine titles — Sat, 17 Dec 2011 00:04:15 +0100

European StandardsHandy – concise – clearThe “always on-hand” pocket guide to the treatment of infectious diseases.- The most important antibiotics and antimycotics:Spectrum – dosage – side-effects- Numerous tables sorted by substances, pathogens, indications- Administration of antibiotics during pregnancy, renal and hepatic insufficiency, dialysis- Including statements on the cost of therapyNumerous tips and ... (Source: Springer Medicine titles)

[Diagnostic strategies for acute tonsillitis in France: A cost-effectiveness study.]

Presse Medicale — Fri, 16 Dec 2011 05:00:00 +0100

CONCLUSION: In acute tonsillitis, in both adults and children, RDT testing by practitioners is the more efficient strategy to identify and treat patients with GAS tonsillitis. Combining RDT testing with throat culture can provide additional effectiveness, but at the cost of a significant extra charge for the community. PMID: 22178558 [PubMed - as supplied by publisher] (Source: Presse Medicale)

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Azithromycin Beats Tetracycline in Trichiasis Surgery TrialAzithromycin Beats Tetracycline in Trichiasis Surgery Trial

Medscape Today Headlines — Thu, 15 Dec 2011 16:31:00 +0100

In a study of antibiotic therapy after surgery for trichiasis, the recurrence rate at 3 years was 10% after oral azithromycin compared with 13% for topical tetracycline. Medscape Medical News (Source: Medscape Today Headlines)

Atraumatic splenic rupture in patients with myelodysplastic syndromes: Report of a case occurred during treatment with 5-azacitidine and review of the literature

Leukemia Research — Thu, 15 Dec 2011 05:00:00 +0100

A 62-year old Caucasian woman with a previous history of arterial hypertension, dilative cardiomyopathy and cerebral transient ischemic attack, was admitted to our Department because of marked fatigue, in the absence of fever or hemorrhage. The complete blood count (CBC) revealed pancytopenia, with white blood cell (WBC) count 0.8×109/L in the absence of circulating blasts, hemoglobin (Hb) level 5.4g/dl and platelet (Plt) count 78×109/L, without signs of coagulopathy. Neither hepatomegaly nor splenomegaly were observed on abdominal ultrasonography. The morphological, cytochemical and immunophenotypic analyses performed on peripheral blood and bone marrow aspirate and trephine biopsy documented features consistent with a myelodysplastic syndrome (MDS). Conventional G-banding showed a norm...

Surgical Management of Mitral Valve Infective Endocarditis

Seminars in Thoracic and Cardiovascular Surgery — Wed, 14 Dec 2011 22:48:01 +0100

Active mitral valve infective endocarditis is a challenging clinical problem with a high rate of mortality. Surgery is currently performed in more than 40% of patients, and selecting those patients who will benefit from surgical intervention and performing a technically sound operation at the proper time are keys to optimizing outcomes. Moderate-to-severe and severe mitral regurgitation, large, mobile vegetations, paravalvular abscess, embolic events, failure of antibiotic therapy, and infection with a fungal organism are indications for prompt operation. The use of computed tomography imaging is important to determine whether there are noncardiac sources of infection, and transesophageal echocardiography is essential to delineate valvular dysfunction, identify paravalvular abscesses, rule...

Bilateral xanthogranulomatous orchitis in a tetraplegic patient.

Pathology, Research and Practice — Wed, 14 Dec 2011 05:00:00 +0100

We present herein the case of a 55-year-old man who had sustained complete tetraplegia at C-6 level and neuropathic bladder for 21 years. After repeated episodes of urinary tract infection, the patient developed a bilateral XGO and a right xanthogranulomatous epididymitis (XGE) that were treated with bilateral orchiepididymectomy. To our knowledge, a bilateral XGO has not yet been reported. Repeated episodes of high-pressure urinary reflux along the vas deferens during dyssynergic voiding possibly led to retrograde extension from the urinary tract by common urinary pathogens and development of bilateral XGO and right XGE. Since tissue destruction is a feature of this process, curative treatment required antibiotic therapy followed by bilateral excision of testes and epididymes. PMID: 2...

Preventing Trichiasis Recurrence After Surgery - Study Looks At Antibiotic Therapy

Health News from Medical News Today — Tue, 13 Dec 2011 17:00:00 +0100

A study being published Online First by the Archives of Ophthalmology, one of the JAMA/Archives journals reveals that, 10% of patients who received a single dose of oral azithromycin (antibiotic) after surgery for trichiasis (a significant worldwide eye problem) experience trichiasis again compared to 13% of patients who received topical tetracycline therapy, with the protective effects apparent for up to 3 years after surgery, although not considerably different between the two medications... (Source: Health News from Medical News Today)

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Best Use of Antibiotics for Hospital-Acquired PneumoniaBest Use of Antibiotics for Hospital-Acquired Pneumonia

Medscape Today Headlines — Mon, 12 Dec 2011 15:56:40 +0100

Is a short or prolonged course of antibiotic therapy best for hospital-acquired pneumonia in critically ill patients? Medscape Critical Care (Source: Medscape Today Headlines)

Acute pyelonephritis in women (2011 review)

Clinical Cases and Images — Mon, 12 Dec 2011 13:26:00 +0100

This is a 2011 review from the official journal of the AAFP, American Family Physician:Acute pyelonephritis is a bacterial infection of the renal pelvis and kidney most often seen in young women.Symptoms of acute pyelonephritisMost patients have fever, although it may be absent early in the illness. Flank pain is nearly universal.Tests for acute pyelonephritisA positive urinalysis confirms the diagnosis.Urine culture should be obtained in all patients to guide antibiotic therapy if the patient does not respond to initial empiric antibiotic regimens.Escherichia coli is the most common pathogen in acute pyelonephritis. In the past decade, there has been an increasing rate of E. coli resistance to extended-spectrum beta-lactam antibiotics.Imaging, usually with contrast-enhanced CT is not nece...

Poststreptococcal syndrome uveitis in South African children

British Journal of Ophthalmology — Mon, 12 Dec 2011 05:00:00 +0100

Conclusion This case series significantly increases the evidence for PSU currently available in the world literature. The condition can manifest with the full spectrum of ocular inflammation, and most cases respond well to standard uveitis regimens. The role of antibiotic therapy remains unclear and requires further investigation. (Source: British Journal of Ophthalmology)

Impact of Spores on the Comparative Efficacies of Five Antibiotics For the Treatment of Bacillus anthracis in an In Vitro Hollow Fiber Pharmacodynamic Model.

Antimicrobial Agents and Chemotherapy — Mon, 12 Dec 2011 05:00:00 +0100

Conclusions: Spores have a profound impact on the rate and extent of kill of BA. Against spore-forming BA, the five antibiotics killed the total (spore and vegetative) bacterial population at similar rates (within 1 log(10)CFU/mL of each other). However, bactericidal antibiotics killed vegetative BA faster than bacteriostatic drugs. Since only vegetative-phase BA produce the toxins that may kill the infected host, the rate and mechanism of kill of an antibiotic may determine its overall in vivo efficacy. Further studies are needed to examine this important observation. PMID: 22155821 [PubMed - as supplied by publisher] (Source: Antimicrobial Agents and Chemotherapy)

Postoperative infections of the lumbar spine: presentation and management

International Orthopaedics — Fri, 09 Dec 2011 17:04:20 +0100

Conclusions Risk factors for SSI include: 1) factors related to the nature of the spinal pathology and the surgical procedure and 2) factors related to the systemic health of the patient. Staphylococcus aureus is the most common infectious organism in reported series. Proven methods to prevent SSI include prophylactic antibiotics, meticulous adherence to aseptic technique and frequent release of retractors to prevent myonecrosis. The presentation of SSI is varied depending on the virulence of the infectious organism. Frequently, increasing pain is the only presenting complaint and can lead to a delay in diagnosis. Magnetic resonance imaging and the use of C-reactive protein laboratory studies are useful to establish the diagnosis. Treatment of SSI is centered on surgical d...

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Complicated Intra-Abdominal Infections Observational European Study (CIAO Study)

World Journal of Emergency Surgery — Fri, 09 Dec 2011 05:00:00 +0100

Complicated intra-abdominal infections are frequently associated with poor prognoses and high morbidity and mortality rates.Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high.In order to describe the clinical, microbiological, and management-related profiles of both community-acquired and healthcare-acquired complicated intra-abdominal infections (IAIs), the World Society of Emergency Surgery (WSES), in collaboration with the Surgical Infections Society of Europe (SIS-E) and other prominent European surgical societies, has designed the CIAO study.The CIAO study is a multicenter, observational study and will be carried out in various surgical departments throughout Europe. The stud...

Cardiac Device‐Related Endocarditis Complicated by Spinal Abscess

Pacing and Clinical Electrophysiology : PACE — Thu, 08 Dec 2011 05:00:00 +0100

Conclusion:Device‐related endocarditis must be considered in patients who present with a spinal abscess and bacteremia. Early recognition of this scenario is imperative in order to avoid permanent neurological sequelae and patient mortality. Early imaging, appropriate parenteral antimicrobial therapy, and expedited removal of all cardiac hardware are pivotal for optimal management. (PACE 2011;1–7) (Source: Pacing and Clinical Electrophysiology : PACE)

Early implementation of antifungal therapy in the management of febrile neutropenia is associated with favourable outcome during induction chemotherapy for acute leukaemias

Internal Medicine Journal — Thu, 08 Dec 2011 05:00:00 +0100

ABSTRACTMortality related to induction chemotherapy during the treatment of acute leukaemias (AL) has been estimated at 5‐20%, and this increases with age. Fungal infection remains one of the major causes of morbidity and mortality and is considered an obstacle to the successful management of acute leukaemias.We retrospectively analysed all patients treated for acute leukaemias at a single institution between July 2006 and January 2009, to assess the impact of early antifungal therapy on outcome during induction chemotherapy. There were 44 episodes of induction chemotherapy, with a median age of patients of 61 years (range 18‐81), including 29 patients with acute myeloid leukaemia, 9 with acute lymphoblastic leukaemia, and 6 with relapsed AL. The median age was 61 years (range 18‐81)...

Shewanella putrefaciens, a rare cause of splenic abscess.

Journal of Microbiology, Immunology, and Infection — Thu, 08 Dec 2011 05:00:00 +0100

We report a case of a 22-year-old female who presented with S. putrefaciens splenic abscesses as the first manifestation of diabetes mellitus, which was successfully managed with a course of antibiotic therapy. PMID: 22154677 [PubMed - as supplied by publisher] (Source: Journal of Microbiology, Immunology, and Infection)

Antimicrobial resistance of Moraxella catarrhalis isolates in Taiwan.

Journal of Microbiology, Immunology, and Infection — Thu, 08 Dec 2011 05:00:00 +0100

CONCLUSION: The rates of resistance to cefaclor, cefuroxime, tetracycline and SXT are now increasing in Taiwan. Molecular typing showed that at least two closely related BRO-1 clones are circulating. Although amoxicillin + clavulanate remains the antimicrobial therapy of choice for M. catarrhalis infections, continued surveillance of antimicrobial susceptibility and application of control measures against further transmission are required to inhibit the emergence of the resistant strains. PMID: 22154675 [PubMed - as supplied by publisher] (Source: Journal of Microbiology, Immunology, and Infection)

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Recurrent bacterial meningitis by three different pathogens in an isolated asplenic child

Journal of Infection and Chemotherapy — Tue, 06 Dec 2011 17:03:18 +0100

We describe a girl with ICA who developed recurrent meningitis by three different pathogens. The first, meningitis by Escherichia coli, occurred 4 days after premature birth. The other two pathogens were serotype 6B Streptococcus pneumoniae and Haemophilus influenzae type b (Hib), at 18 and 25 months of age, respectively. The patient was successfully treated with prompt antimicrobial therapy in all episodes. Serum anti-polyribosylribitol phosphate (PRP) and anti-6B-type pneumococcal antibodies were below the levels for protective activity after natural infections. Although anti-PRP antibody was significantly increased after Hib vaccination, two (6B and 19F) of seven serotype-specific pneumococcal antibodies were not elevated to protective levels after the second 7-valent pn...

Suitability of initial antibiotic therapy for the treatment of bloodstream infections and the potential role of antibiotic management teams in improving it

European Journal of Clinical Microbiology and Infectious Diseases — Thu, 01 Dec 2011 19:30:35 +0100

The objective of this investigation was to evaluate the appropriateness of antibiotic therapy (AT) for bloodstream infections (BSIs) at a 950-bed university teaching hospital, and assess the role of an AMT in improving it. A prospective analysis of all significant BSIs occurring outside of the intensive care unit (ICU) during an 18-month period was carried out. AT was deemed effective if at least one prescribed antibiotic was effective in vitro, and appropriate if it was consistent with local recommendations. Out of 574 BSIs, 512 were evaluated: 231 community-acquired, 206 nosocomial, and 75 healthcare-associated. For 219 (42.8%) BSIs, the AT initiated prior to AMT intervention proved to be effective and appropriate, inappropriate but effective in 136 (26.5%), and ineffective or abse...

The first reported case of compound heterozygous IL1RN mutations causing deficiency of the interleukin‐1 receptor antagonist

Arthritis and Rheumatism — Thu, 01 Dec 2011 05:00:00 +0100

We report the case of a 2‐week‐old male who presented with a swollen, erythematous left index finger and elevated serum markers of inflammation. He later developed cyclical fevers, diffuse pustular skin lesions, and thrombus formation. After not responding to broad‐spectrum antimicrobial therapy and achieving only moderate success with systemic steroid therapy, he was ultimately treated with recombinant IL‐1Ra, anakinra, and experienced significant clinical improvement. Sequencing of his IL1RN gene revealed that the patient was compound heterozygous for a known mutation (E77X) associated with IL‐1Ra deficiency and a novel mutation in exon 2 of the gene (c.140delC; p.T47TfsX4). His case highlights IL‐1Ra deficiency as an autoinflammatory disease that is distinct from neonatal‐...

Detecting Delayed Microbiology Results After Hospital Discharge: Improving Patient Safety Through an Automated Medical Informatics Tool

Mayo Clinic Proceedings — Thu, 01 Dec 2011 05:00:00 +0100

We developed a computerized medical informatics tool to identify patients who had a culture performed on a sterile body site specimen during their hospitalization that subsequently turned positive after hospital dismissal. During a 13-month period, 533 patients had a positive culture identified by our Computer-Based Antimicrobial Monitoring (CBAM) program after hospital dismissal, and 112 (21%) of these culture results necessitated an intervention and communication with the primary health care professional. Thirty-two (29%) of positive cultures were from the blood. Thirty-eight (34%) of the CBAM interventions with available outcome data resulted in initiation of, change in, or prolongation of outpatient antimicrobial therapy. The CBAM program serves an important role in optimizing patient ...

Current Concepts in Antimicrobial Therapy Against Select Gram-Positive Organisms: Methicillin-Resistant Staphylococcus aureus, Penicillin-Resistant Pneumococci, and Vancomycin-Resistant Enterococci

Mayo Clinic Proceedings — Thu, 01 Dec 2011 05:00:00 +0100

Gram-positive bacteria cause a broad spectrum of disease in immunocompetent and immunocompromised hosts. Despite increasing knowledge about resistance transmission patterns and new antibiotics, these organisms continue to cause significant morbidity and mortality, especially in the health care setting. Methicillin-resistant Staphylococcus aureus poses major problems worldwide as a cause of nosocomial infection and has emerged as a cause of community-acquired infections. This change in epidemiology affects choices of empirical antibiotics for skin and skin-structure infections and community-acquired pneumonia in many settings. Throughout the world, the treatment of community-acquired pneumonia and other respiratory tract infections caused by penicillin-resistant Streptococcus pneumoniae has...

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The Timing of Antibiotics at Cesarean: A Randomized Controlled Trial

American Journal of Perinatology — Thu, 01 Dec 2011 05:00:00 +0100

Amer J PerinatolDOI: 10.1055/s-0031-1295657We compared maternal and neonatal outcomes in women who received prophylactic antibiotics prior to skin incision to those who received antibiotics at cord clamp. We performed a randomized clinical trial at two sites. Eligible women included those undergoing nonemergency cesarean at 36 weeks’ gestation or greater. Subjects were randomized (permuted blocks) into one of two treatments: “preoperative antibiotics” (cefazolin 1 g given <30 minutes prior to skin incision) or “intraoperative antibiotics” (cefazolin 1 g at cord clamping). Patients who reported an allergy to penicillin received clindamycin 900 mg. The trial primary outcome was a composite of maternal infectious morbidities, defined as having any one of the following: (1) postop...

Empirical Treatment of Low-level Leukocytospermia With Doxycycline in Male Infertility Patients

Urology — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion: Low-level leukocytospermia might have deleterious effects on male fertility, and antibiotic therapy for such a condition might improve the natural pregnancy rate among infertile couples. (Source: Urology)

High Frequency of False Positive IgM Immunoblots for Borrelia burgdorferi in Clinical Practice

Clinical Microbiology and Infection — Thu, 01 Dec 2011 05:00:00 +0100

AbstractAlthough it is known that two‐tier serologic testing for Lyme disease may be associated with false positive results on the IgM immunoblot, this problem has never been systematically studied in the clinical practice setting. In a retrospective investigation of patients referred to the private adult practice of an Infectious Diseases physician for possible for Lyme disease, 50 of 182 patients (27.5%, 95% CI: 21.1‐34.6) were found to have a false positive IgM immunoblot. 78.0% of these patients had received unnecessary antibiotic therapy. False positive results were not restricted to any single commercial laboratory. Research on alternative testing strategies that eliminate the IgM immunoblot entirely is warranted. (Source: Clinical Microbiology and Infection)

Consensus document on treatment of infections in diabetic foot.

Revista Espanola de Quimioterapia — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Blanes JI, Abstract Diabetic foot infection, particularly if it is associated to ischaemia,is the most common cause of lower limb amputation, in the general population, of hospital admissions, and a decrease in the quality of life in diabetics. Of all diabetics, 15% of them are going to suffer from a foot infection during their life, with an annual incidence of 1-4%, preceded by a foot ulcer in more than 80% of cases. They are complex infections and the prognosis is influenced by many factors, depending on the ulcer (location, extension, whether chronic or not, previous amputation, ischaemia grade), and the patient (age, renal impairment, time of onset of diabetes, associated comorbidity). All these must be taken into account when establishing its treatment. The infection...

Ampicillin versus penicillin in the empiric therapy of extremely low‐birthweight neonates at risk of early onset sepsis

Pediatrics International — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion: Preliminary data indicate an urgent need for adequately powered studies of early antibiotic therapy in the subpopulation of ELBW neonates at risk of EOS. (Source: Pediatrics International)

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Laser irradiation effect on Staphylococcus aureus and Pseudomonas aeruginosa biofilms isolated from venous leg ulcer

International Wound Journal — Thu, 01 Dec 2011 05:00:00 +0100

Chronic wounds, including diabetic foot ulcers, pressure ulcers and venous leg ulcers, represent a significant cause of morbidity in developed countries, predominantly in older patients. The aetiology of these wounds is probably multifactorial, but the role of bacteria in their pathogenesis is still unclear. Moreover, the presence of bacterial biofilms has been considered an important factor responsible for wounds chronicity. We aimed to investigate the laser action as a possible biofilm eradicating strategy, in order to attempt an additional treatment to antibiotic therapy to improve wound healing. In this work, the effect of near‐infrared (NIR) laser was evaluated on mono and polymicrobial biofilms produced by two pathogenic bacterial strains, Staphylococcus aureus PECHA10 and Pseudomo...

Antibiotic desensitization therapy in secondary syphilis and listeria infection: case reports and review of desensitization therapy.

Hawaii Medical Journal — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Magpantay G, Cardile AP, Madar CS, Hsue G, Belnap C Abstract Two adult cases, one of secondary syphilis and one of Listeria monocytogenes bacteremia, in which antibiotic desensitization therapy was utilized to assist treatment of active infection in the face of severe penicillin allergy. Clinical considerations are discussed that led to the decision to employ a formal desensitization procedure. Antibiotic desensitization protocols can facilitate optimal and safe antibiotic therapy in the appropriate clinical setting. PMID: 22187514 [PubMed - in process] (Source: Hawaii Medical Journal)

Liver abscess as the presenting manifestation of chronic granulomatous disease.

Acta Microbiologica et Immunologica Hungarica — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Mamishi S, Ahmadi F, Ahmadi M, Rezaei N Abstract Chronic granulomatous disease (CGD) is a rare primary immunodeficiency disease, affecting phagocytic blood cells, which predispose patients to recurrent infectious complications. Herein, an 11-year-old girl is described who presented with liver abscess at the age of 9 years. Positive dihydrorhodamine (DHR) and nitrobluetetrazolium (NBT) tests confirmed the diagnosis of CGD for the patient. Anti-tuberculosis drugs and parenteral antibiotic therapy were started. Unusual visceral abscess and recurrent infections should be considered as an alarm for primary immunodeficiency diseases, while early diagnosis and appropriate treatment could prevent severe complications and even death in this group of patients. PMID: 22207288 [Pu...

Antimicrobial susceptibility profiles associated with bacterial meningitis among children: A referral hospital-based study in Iran.

Acta Microbiologica et Immunologica Hungarica — Thu, 01 Dec 2011 05:00:00 +0100

In conclusion, despite the advances in antibiotic therapy and vaccine development, bacterial meningitis still is a health problem. S. pneumoniae, H. influenzae, and N. meningitidis are the main sources of bacterial meningitis, but other organisms such as E. coli should also be suspected, when a case is admitted to a referral pediatric hospital. PMID: 22207285 [PubMed - in process] (Source: Acta Microbiologica et Immunologica Hungarica)

Neglected esophageal perforation after upper thoracic vertebral fracture

The Spine Journal — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: Esophageal perforation after upper thoracic vertebral fracture can develop when the fracture fragment pierces the posterior wall of the esophagus. In addition to periesophageal-free air, crushing, distortion, or marked displacement of the esophagus at the cervicothoracic junction on CT or MRI is a clue to potential esophageal injury. If not identified early, patients may present with chronic osteomyelitis extending to adjacent vertebrae. (Source: The Spine Journal)

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Antibiotic Therapy of Aortic Graft Infection: Treatment and Prevention Recommendations

Seminars in Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Surgical site infection (SSI) after aortic intervention, an uncommon but serious vascular condition, requires patient-specific antibiotic therapy. Effective treatment and prevention requires the vascular surgeon to be cognizant of changing SSI microbiology, advances in antibiotic delivery, and patient characteristics. The majority of aortic graft infections are caused by Gram-positive bacteria, with methicillin-resistant Staphylococcus aureus now the prevalent pathogen. Nasal carriage of methicillin-sensitive or methicillin-resistant S aureus strains, diabetes mellitus, recent hospitalization, a failed arterial reconstruction, and the presence of a groin incision are important SSI risk factors. Overall, the aortic SSI rate is higher than predicted by the Centers for Disease Control and Pre...

Bacterial colonization or infection in chronic sinusitis.

Wiener Klinische Wochenschrift — Wed, 30 Nov 2011 05:00:00 +0100

Authors: Pandak N, Pajić-Penavić I, Sekelj A, Tomić-Paradžik M, Cabraja I, Miklaušić B Abstract The aim of this study was the determination of bacteria present in maxillary and ethmoid cavities in patients with chronic sinusitis and to correlate these findings with bacteria simultaneously present in their nasopharynx. The purpose of this correlation was to establish the role of bacteria found in chronically inflamed sinuses and to evaluate if the bacteria present colonized or infected sinus mucosa. Nasopharyngeal and sinus swabs of 65 patients that underwent functional endoscopic sinus surgery were cultivated and at the same time the presence of leukocytes were determined in each swab. The most frequently found bacteria in nasopharynx were Staphylococcus aureus, Staphylococcu...

Catheter-Related Infection and Pathogens of Umbilical Venous Catheterization in a Neonatal Intensive Care Unit in China

American Journal of Perinatology — Wed, 30 Nov 2011 05:00:00 +0100

Amer J PerinatolDOI: 10.1055/s-0031-1295650We studied the incidence of umbilical venous catheterization (UVC)-related infection and pathogens in a neonatal intensive care unit (NICU) in China. Patients were grouped into <2000-g UVC or <2000-g non-UVC groups or ≥2001-g UVC or ≥2001-g non-UVC groups. Blood culture and umbilical root skin swab culture were taken following UVC insertion and extraction. UVCs were removed after 7 days and cultures of UVC tips were performed then. A total of 516 patients were enrolled. The incidence of UVC-related septicemia was 9.5%. The incidence of UVC-related septicemia per 1000 UVC days was 13.6. No significant difference was noted between <2000-g UVC and <2000-g non-UVC groups and between ≥2001-g UVC group and ≥2001-g non-UVC groups, in ...

Percutaneous Cholecystostomy for Acute Cholecystitis: Ten-Year Experience

Journal of Vascular and Interventional Radiology : JVIR — Wed, 30 Nov 2011 05:00:00 +0100

Conclusions: Outcomes after percutaneous cholecystostomy for acute cholecystitis are better when the disease is primary and not precipitated by concurrent illness. (Source: Journal of Vascular and Interventional Radiology : JVIR)

Kytoccocus shroeteri endocarditis successfully managed with daptomycin: Category: Clinical lesson

Journal of Infection — Fri, 25 Nov 2011 11:05:46 +0100

We describe a sixth case of K. shroeteri endocarditis but the first case to be treated successfully with daptomycin. (Source: Journal of Infection)

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Enteric Fever treated via Outpatient Parenteral Antibiotic Therapy (OPAT): Experience from a UK Infectious Diseases Unit: Category: Clinical lesson

Journal of Infection — Fri, 25 Nov 2011 11:05:46 +0100

Enteric fever is an important cause of morbidity in the returning traveller to the UK, with an incidence of approximately 500 cases per year in England and Wales. Most infections are acquired in the Indian Sub-continent where quinolone resistance is common in both Salmonella typhi (70%) and S. paratyphi (96%). (Source: Journal of Infection)

Patient/carer retention of training in self-administration of Outpatient Parenteral Antibiotic Therapy (OPAT): a prospective study: Category: Scientific free paper

Journal of Infection — Fri, 25 Nov 2011 11:05:46 +0100

Outpatient Parenteral Antibiotic Therapy (OPAT) allows outpatient/community-based administration of intravenous (IV) antibiotics as an alternative to inpatient care. Therapy may be administered by a nurse, or alternatively patients (or a carer) may be trained to self-administer; the latter option allows greater flexibility for patients, and facilitates administration of multiple daily doses. Patient-administered OPAT has been shown to be as safe as nurse-administered therapy in large studies, but to date there has been no formal assessment of individual patient/carer retention of training in antibiotic administration over a prolonged treatment course. (Source: Journal of Infection)

Malignant otitis externa- a case series: Category: Clinical lesson

Journal of Infection — Fri, 25 Nov 2011 11:05:46 +0100

Background: Malignant otitis externa is a serious infection affecting the external auditory canal & the temporal bone. It is an uncommon complication of both acute & chronic otitis externa. Ear polyps can be a cause or consequence of malignant otitis externa. Delay in diagnosis can lead to serious complications. Prolonged parenteral antibiotics are required and inadequate treatment courses may result in disease progression. Only minimal published information is available on OPAT (Outpatient Parenteral Antimicrobial Therapy) in the management of malignant otitis externa. Here we present a case series of malignant otitis externa managed in our department. (Source: Journal of Infection)

Management of infective endocarditis in the OPAT setting; a descriptive analysis: Category: Scientific free paper

Journal of Infection — Fri, 25 Nov 2011 11:05:46 +0100

Out-patient parenteral antimicrobial therapy (OPAT) is appealing because it reduces hospitalisation, lowers healthcare costs and limits nosocomial infection. Models of OPAT delivery include hospital clinic-based infusion, self-administration, or home-infusion services. OPAT has been used to manage serious infections such as infective endocarditis (IE) for several years. (Source: Journal of Infection)

An audit of blood culture contamination rates following introduction of trust guidelines: Category: Lesson in Microbiology & Infection Control

Journal of Infection — Fri, 25 Nov 2011 11:05:46 +0100

Blood cultures represent important laboratory investigations in diagnosing bacteraemia, thus guiding clinicians to appropriate antimicrobial therapy. Contamination through poor technique may lead to incorrect diagnosis, unnecessary and costly treatment, and prolonged hospital admission. This was recognised in Department of Health (DOH) guidelines published in 2007. An audit across our trust between April 2005-2007 showed blood culture contamination rates were 0.08. The aim of this study was to assess whether contamination rates had been reduced following implementation of new trust guidelines in 2007. (Source: Journal of Infection)

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Skin and soft tissue infection - inadequate guideline policy leads to both poor in-patient and out-patient care: Category: Scientific free paper

Journal of Infection — Fri, 25 Nov 2011 11:05:46 +0100

Few data currently exist relating to appropriate assessment and management of skin and soft tissue infection (SSTI). A recent Cochrane review was unable to define best treatment for cellulitis and underlined the need for trials to evaluate efficacy of oral antibiotics against intravenous antibiotics in the community setting. Out-patient Home Antibiotic Therapy (OPHAT) is increasingly used for SSTI with high patient satisfaction scores and can markedly reduce hospital in-patient burden. However, it is unclear as to which patients are most appropriate for in or out patient overall management. Furthermore, in many regions, including ours, poor links exist between community and hospital which could improve assessment, management and follow up. (Source: Journal of Infection)

Epidemiology, laboratory characteristics and outcome of blood stream infections in a regional oncology unit: Category: Lesson in Microbiology & Infection Control

Journal of Infection — Fri, 25 Nov 2011 11:05:46 +0100

Infection is a common cause of morbidity and mortality in oncology patients. The most important risk factor is neutropenia secondary to cytotoxic chemotherapy, although other treatment associated risk factors such as surgery, radiotherapy and use of invasive devices, as well as tumour associated risk factors are important. This immunocompromised group of patients are predisposed to severe, rapidly progressive infections often without development of concurrent inflammation. This, in conjunction with the constantly changing epidemiology of microorganisms, means it is crucial to ensure that locally appropriate empirical antibiotic therapy guidelines are in place. (Source: Journal of Infection)

Efficacy of the biocide, STERI-7, against common bacterial pathogens associated with cystic fibrosis (CF) Category: Lesson in Microbiology & Infection Control

Journal of Infection — Fri, 25 Nov 2011 11:05:46 +0100

Cystic fibrosis (CF) is the most commonly inherited disease in persons originating from a white and European background and has a genetic carriage rate of 1 in 20 persons. The most common complication of CF is the recurrence of chronic chest infections usually caused by bacterial pathogens (e.g. Pseudomonas aeruginosa, Burkholderia cepacia complex and Stenotrophomonas maltophilia). It is therefore imperative that stringent disinfection measures are taken to prevent colonization of the lung with these and other organisms, both by the patient, as well as by the health care professional in conjunction with infection control guidelines. Although combinational antibiotic therapy is the cornerstone of the treatment of such infections, once the CF patienr has acquired them, high levels of resista...

Implementing the Sepsis Resuscitation Bundle: Education Improves Antimicrobial Administration in the Emergency Department: Category: Lesson in Microbiology & Infection Control

Journal of Infection — Fri, 25 Nov 2011 11:05:46 +0100

The Surviving Sepsis Campaign is an international initiative, which aims to improve the management of sepsis. The guidelines recommend that appropriate antimicrobials are administered to patients with sepsis within 3 hours of arrival to the Emergency Department and within 1 hour for patients with septic shock (Grade 1B) or severe sepsis without shock (Grade 1D). Antimicrobial prescribing in sepsis was audited in our Emergency Department in 2008. 73 patients were found to have positive blood cultures. Of those with sepsis, as defined by two or more systemic inflammatory response syndrome (SIRS) criteria, the mean and median times to administration of antimicrobials failed to meet recommendations. Similarly, those with severe sepsis or septic shock did not receive antimicrobials within guide...

Improving the Diagnosis of Bacterial Respiratory Tract Infections

Journal of Infection — Fri, 25 Nov 2011 11:05:45 +0100

We report the development and evaluation of such an approach. (Source: Journal of Infection)

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Venous thromboembolism risk assessment of patients with cellulitis receiving Outpatient Parenteral Antibiotic Therapy (OPAT)

Journal of Infection — Fri, 25 Nov 2011 11:05:45 +0100

Hospital inpatients are at increased risk of venous thromboembolism (VTE) compared to the general population: this risk can be reduced by thromboprophylaxis with subcutaneous heparin. There is now increasing recognition that ill patients in the community are also at increased risk. This risk is increased by factors such as increasing age, restricted mobility and acute infection. Outpatient Parenteral Antibiotic Therapy (OPAT) allows patients who require intravenous (IV) antibiotics to receive home/outpatient-based care as an alternative to hospital admission. Such patients are at increased risk of VTE, but no data exist as to the extent of this risk compared to hospital inpatients or community patients receiving oral antibiotic therapy. Furthermore, the optimal strategy with respect to thr...

Antibiotic susceptibility monitoring using a Microsoft Access database: Category: Lesson in Microbiology & Infection Control

Journal of Infection — Fri, 25 Nov 2011 11:05:45 +0100

The clinical effectiveness of antimicrobial therapy is constantly being undermined by the development of antimicrobial resistance. Appropriate antibiotic prescribing is critical to good patient outcomes and a significant factor in the battle against emerging resistance. As resistance is a constantly evolving problem active, real time surveillance of susceptibility rates is necessary to optimise empirical treatment and prophylactic regimens. We aimed to develop a local surveillance system for monitoring our susceptibility rates and present here the tool and some initial findings. (Source: Journal of Infection)

Old forgotten antibiotics: Do we need them? Category: Scientific free paper

Journal of Infection — Fri, 25 Nov 2011 11:05:45 +0100

The continuously increasing problem of antibacterial resistance is well understood and much feared for its potential consequences . Clinicians often face problems in choosing appropriate antibiotic therapy for treating infections caused by both gram-positive and gram-negative bacteria, because these pathogens are often resistant to several classes of antibiotics. Drug-resistant bacteria, such as methicillin-resistant Staphylococcus aureus(MRSA), extended spectrum beta-lactamases (ESBLs), multidrug-resistant Pseudomonas aeruginosa and Acinetobacter spp,, are increasingly isolated from patients with serious infections and are associated with considerable mortality. New effective treatment solutions are not likely to be forthcoming in the foreseeable future so we should re-evaluate forgotten ...

The Clock is Ticking - Time to Antibiotics in Sepsis: Category: Clinical lesson

Journal of Infection — Fri, 25 Nov 2011 11:05:45 +0100

Severe sepsis carries a mortality rate of 30-35%, which increases further still to 50% in septic shock. What's more, in septic shock, each hour's delay to administration of effective antibiotics is associated with an increase in mortality. The Surviving Sepsis Campaign guidelines are the only guidelines, to the best of our knowledge, which recommend a minimum time to initiation of empirical antimicrobial therapy. They recommend administration of appropriate antibiotics within 1 hour of the identification of severe sepsis or septic shock. We undertook a retrospective audit of patients admitted to our hospital between June and July 2010, the aim of which was to collect information regarding the time between diagnosis of sepsis and administration of antibiotics. A total of 36 patients were an...

Using Real Time PCR to Decrease the Time to Appropriate Management with Staphylococcal Blood Cultures: Category: Clinical lesson

Journal of Infection — Fri, 25 Nov 2011 11:05:45 +0100

Blood cultures (BCs) are key in directing antibiotic therapy, often affecting the sickest patients in hospital. Staphylococci are the most common organism seen in Gram stain. Data from University Hospital Coventry and Warwick, June-August 2008, showed roughly 80% of these are contaminants. At the time of phoning the clinician to discuss an unwell patient, it can be difficult to differentiate a contaminant, a possible methicillin sensitive Staphylococcus aureus(MSSA) or methicillin resistant Staphylococcus aureus(MRSA). (Source: Journal of Infection)

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Treatment of infective endocarditis with daptomycin: UK registry experience: Category: Scientific free paper

Journal of Infection — Fri, 25 Nov 2011 11:05:45 +0100

We present the data from the first 2.5 years of DAP use for the treatment of endocarditis in the UK since marketing authorisation in January 2006. These data were taken from eight UK institutions participating in EU-CORESM. Data were collected on demographics, antibiotic usage, microbiological and clinical outcomes and adverse events from pts treated between January 2006 and August 2009. Patients (pts) were categorised by severity and the anatomical site of the primary infection. All pts included in the registry had received at least one dose of DAP. Outcomes were assessed by investigators as cured, improved, failure and non-evaluable. (Source: Journal of Infection)

Review of Antibiotics and Indications for Prophylaxis

Dental Clinics of North America — Fri, 25 Nov 2011 05:12:42 +0100

Antibiotic prophylaxis to prevent infective endocarditis has been controversial through the years, with various changes made to recommendations provided to treating physicians and dentists. The dentist must always use his or her best judgment when applying any guideline. However, it is important to remember that the guidelines may be cited in any malpractice litigation as evidence of the standard of care. Early diagnosis with prompt treatment with effective antimicrobial therapy is the best way to lower the mortality and morbidity. When prescribing antibiotics, the clinician must realize that the overprescription of antibiotics has led to resistance to antibiotic regimens and the rise of antibiotic-resistant bacteria. (Source: Dental Clinics of North America)

Emergency versus elective living-donor liver transplantation: a comparison of a single center analysis

Surgery Today — Thu, 24 Nov 2011 17:49:42 +0100

Conclusion Careful perioperative management, including preoperative investigation of aspergillosis and empiric antibiotic therapy, should be considered for emergency LDLT patients who fulfill IPA risk factors. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00595-011-0040-5Authors Kazuhisa Takeda, Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 JapanKuniya Tanaka, Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 JapanTakafumi Kumamoto, Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, ...

A lingual abscess caused by Streptococcus intermedius.

Journal of Medical Microbiology — Thu, 24 Nov 2011 05:00:00 +0100

We describe a case in a healthy female with no recent history of trauma. The organism recovered by culture of drainage material collected prior to antibiotic treatment was Streptococcus intermedius, an organism recognized as flora of the oropharynx and associated with abscess formation. The isolate was resistant to clindamycin, which was the antibiotic therapy that the patient received. PMID: 22116986 [PubMed - as supplied by publisher] (Source: Journal of Medical Microbiology)

Clostridium difficile: a problem of concern in developed countries and still a mystery in Latin America.

Journal of Medical Microbiology — Thu, 24 Nov 2011 05:00:00 +0100

Authors: Balassiano IT, Yates EA, Domingues RM, Ferreira ED Abstract Clostridium difficile-associated disease (CDAD) is caused by a spore-forming bacterium and can result in highly variable disease, ranging from mild diarrhoea to severe clinical manifestations. Infections are most commonly seen in hospital settings and are often associated with on-going antibiotic therapy. Incidences of CDAD have shown a sustained increase worldwide over the last ten years and a hyper-virulent C. difficile strain, PCR ribotype 027/REA type BI/North American pulsed-field (NAP) type 1 (027/BI/NAP-1), has caused outbreaks in North America and Europe. In contrast, only a few reports of cases in Latin America have been published and the hyper-virulent strain 027/BI/NAP-1 has, so far, only been reported ...

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Enteric fever in returning travellers: Role of outpatient parenteral antibiotic therapy

Journal of Infection — Thu, 24 Nov 2011 05:00:00 +0100

In a recent review of imported enteric fever in Leicester, UK, a shift in therapy from ciprofloxacin to ceftriaxone and azithromycin was observed between 1999 and 2009, reflecting reduced ciprofloxacin sensitivity (MIC 0.125–1 mg/L) amongst Salmonella enterica isolates across Asia. (Source: Journal of Infection)

Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies

BMC Infectious Diseases — Wed, 23 Nov 2011 05:00:00 +0100

Conclusions: TB disease is not uncommon among patients with hematological malignancies in Taiwan. Patients who received a diagnosis of extra-pulmonary TB suffered higher mortality than those with pulmonary TB alone. Clinicians should consider TB in the differential diagnoses of prolonged fever in patients with hematological malignancies, particularly in regions of high endemicity. (Source: BMC Infectious Diseases)

Neuroinfectious Diseases in Pregnancy

Seminars in Neurology — Wed, 23 Nov 2011 05:00:00 +0100

Semin Neurol 2011; 31: 404-412DOI: 10.1055/s-0031-1293540ABSTRACTPregnancy is associated with impaired T-cell-mediated immunity putting the woman at risk for infectious diseases not typically seen in immunocompetent individuals. When maternal infection is severe, and when a primary herpesvirus infection is acquired during pregnancy, there is a risk of fetal loss, maternal death, neonatal death, or congenital abnormalities from intrauterine infection. In this review, the authors emphasize specific neurologic infectious diseases that occur in pregnancy, the safety of the antimicrobial therapy of these diseases during pregnancy, as well as the congenital and neonatal sequelae of infection.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents | Abstract | F...

Periodontal pharmacotherapy - an updated review.

Advances in Medical Sciences — Wed, 23 Nov 2011 05:00:00 +0100

Authors: Leszczyńska A, Buczko P, Buczko W, Pietruska M Abstract Periodontal disease is mainly associated with the activity of bacteria which adhere to the tooth surface and form specific structure of bacterial biofilm. Periodontal bacteria cause inflammation of the gums and aggressive immune response, affecting the periodontium. The first phase of initial therapy - mechanical removal of dental plaque and calculus - is necessary. If this non-surgical therapy has proved to be unsuccessful, an alternative treatment with antimicrobial agents is then considered. Pharmacotherapy is based on systemic or local antibiotics and/or antiseptics, which are applied according to the severity of the disease. A number of recent periodontal studies present some of the pharmacological agents, that ...

Editorial Comment

The Journal of Urology — Wed, 23 Nov 2011 05:00:00 +0100

This is an important article, as there is a paucity of studies on the pathogenesis of UTI caused by Pseudomonas aeruginosa (reference 10 in article). The authors report on children with community acquired UTI due to P. aeruginosa, an uncommon pathogen responsible for infections in healthy children, and compare them to a group of children with UTI caused by E. coli. Although this study emphasizes the variables associated with P. aeruginosa UTIs, it is noteworthy that this type of UTI is associated with unfavorable outcomes. This group of patients had a significantly higher occurrence of inappropriate initial antibiotic therapy, longer hospitalization and need for surgery. Although these differences may be explained partly by the increased occurrence of VUR in the Pseudomonas group, this art...

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Emergence of resistance to carbapenems in Acinetobacter baumannii in Europe: clinical impact and therapeutic options

International Journal of Antimicrobial Agents — Wed, 23 Nov 2011 05:00:00 +0100

Abstract: Despite having a reputation of low virulence, Acinetobacter baumannii is an emerging multidrug-resistant (MDR) pathogen responsible for community- and hospital-acquired infections that are difficult to control and treat. Interest in this pathogen emerged about one decade ago because of its natural MDR phenotype, its capability of acquiring new mechanisms of resistance and the existence of nosocomial outbreaks. Recent advances in molecular biology, including full genome sequencing of several A. baumannii isolates, has led to the discovery of the extraordinary plasticity of their genomes, which is linked to their great propensity to adapt to any environment, including hospitals. In this context, as well as the increasing antimicrobial resistance amongst A. baumannii isolates to the...

Dose of intravenous lipids and rate of bacterial clearance in preterm infants with blood stream infections

European Journal of Pediatrics — Mon, 21 Nov 2011 18:05:57 +0100

Conclusions Restriction of the dose of IVLE to 1 g kg−1 day−1 in preterm infants with BSI is associated with earlier negative blood cultures and reduced duration of antibiotic therapy but was associated with a lower daily weight increments. Content Type Journal ArticleCategory Original PaperPages 1-6DOI 10.1007/s00431-011-1619-yAuthors Basma Shouman, Neonatal Intensive Care Unit, Mansoura University Children’s Hospital, Mansoura, EgyptHesham Abdel-Hady, Neonatal Intensive Care Unit, Mansoura University Children’s Hospital, Mansoura, EgyptRawia I. Badr, Department of Medical Microbiology and Immunology, Mansoura Faculty of Medicine, Mansoura, EgyptEnas Hammad, Department of Medical Microbiology and Immunology, Mansoura Faculty of Medicine, Manso...

Clinical outcome of pneumococcal meningitis during the emergence of pencillin-resistant Streptococcus pneumoniae: an observational study

BMC Infectious Diseases — Mon, 21 Nov 2011 05:00:00 +0100

Conclusions: Findings support the use of third generation cephalosporin antibiotics for treatment of suspected pneumococcal meningitis even at low prevalence of pneumococcal resistance to penicillins. (Source: BMC Infectious Diseases)

Evaluation of 3 different rapid automated systems for diagnosis of urinary tract infections

Diagnostic Microbiology and Infectious Disease — Mon, 21 Nov 2011 05:00:00 +0100

Abstract: Urinary tract infections (UTI) are one of the most common infections in both hospitalised and ambulant patients. Rapid diagnostic of UTIs is necessary to provide early information about the presence of bacteria and the indication to administer an antibiotic therapy. Here we report on a study comparing 3 different rapid automated systems with the semiquantitative plate culture reference method in a university hospital with a highly complex patient population. In total, 2230 urine samples were consecutively tested using the UroQuick (Alifax), the BACSYS-40i (Sysmex), and the UF-1000i (Sysmex) system. In comparison to the results obtained by culture techniques, the automated systems showed a sensitivity of 73.0–80.9% and a specificity ranging between 61.8% and 92.8%. Additionally,...