The Journal of antimicrobial chemotherapy
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Community-acquired pneumonia (CAP) is a serious condition associated with significant morbidity and potential long-term mortality. Although the majority of patients with CAP are treated as outpatients, the greatest proportion of pneumonia-related mortality and healthcare expenditure occurs among the patients who are hospitalized. There has been considerable interest in determining risk factors and severity criteria assessments to assist with site-of-care decisions. ⋯ Atypical pathogens, Gram-negative bacilli, methicillin-resistant Staphylococcus aureus (MRSA) and viruses are also recognized aetiological agents of CAP. Despite the availability of antimicrobial therapies, the recent emergence of drug-resistant pneumococcal and staphylococcal isolates has limited the effectiveness of currently available agents. Because early and rapid initiation of empirical antimicrobial treatment is critical for achieving a favourable outcome in CAP, newer agents with activity against drug-resistant strains of S. pneumoniae and MRSA are needed for the management of patients with CAP.
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J. Antimicrob. Chemother. · Apr 2011
ReviewHas decolonization played a central role in the decline in UK methicillin-resistant Staphylococcus aureus transmission? A focus on evidence from intensive care.
The UK has seen a dramatic reduction in methicillin-resistant Staphylococcus aureus (MRSA) infection and transmission over the past few years in response to the mandatory MRSA bacteraemia surveillance scheme. Healthcare institutions have re-enforced basic infection control practice, such as universal hand hygiene, contact precautions and admission screening; however, the precipitous decline suggests other contributing factors. The intensive care unit (ICU), with its high endemic rates and complex patient population, is an important reservoir for seeding MRSA around the hospital and has understandably been at the forefront of MRSA control programmes. ⋯ Likewise, although there is little published evidence on decolonization efficacy or practice on UK general wards, it is now recommended for all MRSA-colonized patients and uptake is probably widespread. The recent observation that MRSA strains carrying the antiseptic resistance genes qacA/B can be clinically resistant to chlorhexidine raises a note of caution against its unfettered use. The dissemination of chlorhexidine-resistant MRSA would have implications for the decolonization of individual patients and for preventing transmission.
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Early and effective antibiotic therapy is essential in the management of infection in critical illness. The loading dose is probably the most important dose and is a function of the volume of distribution of the drug and the desired plasma concentration but independent of renal function. Antibiotics are classified in a number of ways that have implications for dosing. ⋯ Knowledge of these factors is essential. Patient safety and prevention of unnecessary harm is a weighty consideration in critical illness. To ensure effective treatment and minimize adverse effects, therapy should be reviewed daily and adjusted in the light of changes in patient organ function and underlying pathology.
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J. Antimicrob. Chemother. · Apr 2011
Randomized Controlled Trial Multicenter Study Comparative StudyFOCUS 1: a randomized, double-blinded, multicentre, Phase III trial of the efficacy and safety of ceftaroline fosamil versus ceftriaxone in community-acquired pneumonia.
Ceftaroline, the active form of the prodrug ceftaroline fosamil, is a novel cephalosporin with bactericidal activity against important pathogens associated with community-acquired pneumonia (CAP), including Streptococcus pneumoniae and common Gram-negative pathogens. FOCUS 1 is a randomized, double-blinded, Phase III study that was conducted to evaluate the efficacy and safety of ceftaroline fosamil in treating patients with CAP. The primary objective was to determine non-inferiority [lower limit of 95% confidence interval (CI) ≥ -10%] in clinical cure rates achieved with ceftaroline fosamil compared with those achieved with ceftriaxone in the clinically evaluable (CE) and modified intent-to-treat efficacy (MITTE) populations. ⋯ Ceftaroline fosamil demonstrated high clinical cure and microbiological response rates in hospitalized patients with CAP of PORT risk class III or IV. Ceftaroline fosamil was well tolerated, with a safety profile similar to that of ceftriaxone and consistent with the cephalosporin class. In this study, ceftaroline fosamil was an effective and well-tolerated treatment option for CAP.