Current opinion in infectious diseases
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In the majority of countries costs for health care are increasing and strategies to reduce adverse events in medical treatment have an increasing importance. Nosocomial infection remains the most common type of complication affecting hospitalized patients. As preventive strategies have indeed become more important they now have to show not only that they are effective in reducing nosocomial infections but also that they are cost effective. This paper investigates the contribution made by articles published in the last year to the development of nosocomial-infection surveillance and control policies. ⋯ The predominant opinion voiced in the studies was that in many medical institutions some 30% or more of nosocomial infections could be prevented.
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Extensive reviews of our current understanding of vascular catheter infections have recently been published. This update highlights 22 primary research articles selected from 415 randomized clinical trials and over 2500 other articles on vascular catheter infections published between January 2002 and March 2004. ⋯ Abundant evidence now exists that there are many interventions that can reduce the risk of vascular catheter infections. The next phase of our understanding should include determining how many of these many interventions are necessary and under what circumstances.
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Curr. Opin. Infect. Dis. · Jun 2004
ReviewActivated protein C in sepsis: emerging insights regarding its mechanism of action and clinical effectiveness.
Dysregulation of endogenous coagulant and anticoagulant systems is now believed to play an important role in the pathogenesis of sepsis and septic shock. Reductions in host activated protein C levels and resultant microvascular thrombosis provided a basis for the use of recombinant human activated protein C in sepsis. Although controversial, the findings from an initial phase III trial testing this agent resulted in its approval for use in patients with severe sepsis and high risk of death. This review highlights emerging insights into the biology of protein C and activated protein C in sepsis, summarizes additional analysis growing out of the phase III trial testing recombinant human activated protein C, and assesses the cost-effectiveness that the clinical use of the agent has had thus far. ⋯ The protein C pathway is important both to coagulant and inflammatory pathways during sepsis. Based on emerging investigations, its actions appear to be increasingly complex ones. Despite potentially promising results in an initial phase III trial, the role of recombinant human activated protein C in the treatment of septic patients must continue to be evaluated.
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Curr. Opin. Infect. Dis. · Aug 2003
ReviewInfection in critically ill patients: clinical impact and management.
The aim of this review is to summarize recent developments in the epidemiology, diagnosis and management of infection in critically ill patients. ⋯ Improved characterization of septic patients will help target and monitor new therapies. Newly developed immunomodulatory strategies and others currently undergoing clinical testing will help reduce the high mortality rates seen in this disease
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Toll-like receptors (TLRs) are a family of pattern recognition receptors that are activated by specific components of microbes and certain host molecules. They constitute the first line of defense against many pathogens and play a crucial role in the function of the innate immune system. Recently, TLRs were observed to influence the development of adaptive immune responses, presumably by activating antigen-presenting cells. This has important implications for our understanding of how the host tailors its immune response as a function of specific pathogen recognition. The present review discusses the recent studies that demonstrate the role of TLRs in the regulation of adaptive T-helper-1 (Th1) and Th2 responses, and the mechanisms by which the effects are carried out. ⋯ A greater understanding of the processes by which TLRs regulate adaptive immunity may yield not only improved ways to treat infectious diseases but also new approaches to the treatment and prevention of allergic and certain autoimmune disorders.