Journal of chemotherapy
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Journal of chemotherapy · Feb 2009
Clinical TrialLate onset ventilator-associated pneumonia due to multidrug-resistant Acinetobacter spp.: experience with tigecycline.
The aim of the study was to evaluate the clinical success rate of 73 patients with ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR)-Acinetobacter spp. treated with tigecycline in seven intensive Care Units in Argentina and to determine which predictor variables were significant in this context. Clinical success in our patients was 69.86% (Ci= 58.65-81.07%) 51/73, without significant differences between patients with VAP due to MDR-Acinetobacter spp. carbapenem-susceptible or carbapenem-resistant and only susceptible to colistin, minocyline and tigecycline (70% 44/73 vs. 69% 29/73 respectively, p=0.9006), and between patients who received <48h of prior antibiotics (including those who did not receive any) and those who received >48h of prior antibiotics (73.3% 22/30 vs 67.4% 29/43 respectively, p=0.7791). ⋯ Our results suggest that tigecycline may be an acceptable alternative for therapy in patients with VAP caused by MDR-Acinetobacter spp. Nevertheless, only controlled clinical trials will provide the evidence to support approval for new indications.
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Journal of chemotherapy · Dec 2008
ReviewInnate immunity in sepsis pathogenesis and its modulation: new immunomodulatory targets revealed.
Sepsis is complex clinical manifestation of an organism's overwhelming and unregulated immune response to infection. Despite more than 25 years of extensive research, sepsis and systemic inflammatory response syndrome (SIRS) remain the major causes of death in hospital intensive care units (ICUs). The mortality rate associated with sepsis varies from 30% to 70%. ⋯ The understanding of immunopathogenetic mechanisms involved in sepsis development has provided significant advances in the field of innate immunity, which plays an important role in the onset of sepsis and associated mortality. Not only have the pathways involved in sepsis development been defined but also various targets that can be used as an immunomodulatory approach during sepsis treatment. This review explores the role of innate immunity in the development of sepsis and its modulation as a future immunomodulatory approach for sepsis treatment.
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Journal of chemotherapy · Dec 2008
Prevalence of type III secretion protein exoenzymes and antimicrobial susceptibility patterns from bloodstream isolates of patients with Pseudomonas aeruginosa bacteremia.
The purpose of this study was to determine the prevalence of two type III secretion effector proteins, exoU and exoS from bloodstream isolates of hospitalized patients with Pseudomonas aeruginosa (PSA) bacteremia, to characterize antimicrobial susceptibility patterns, and to compare mortality rates. PSA bloodstream isolates and antibiotic susceptibility profiles were collected from a university-affiliated hospital. ExoS and exoU genes were detected by polymerase chain reaction. ⋯ Mortality was high in patients with PSA bacteremia and did not differ among patients infected with the exoS isolates (n=37; 43%) or exoU isolates (n=11; 35%). One of two type III secretion effector proteins were almost universally present in PSA bloodstream isolates. Isolates containing the exoU gene were more likely to be resistant to multiple antibiotics.
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Journal of chemotherapy · Oct 2008
Clinical TrialBimonthly chemotherapy with oxaliplatin, irinotecan, infusional 5-fluorouracil/folinic acid in patients with metastatic colorectal cancer pretreated with irinotecan- or oxaliplatin-based chemotherapy.
This study was conducted to assess the tolerability and efficacy of a ternary bimonthly irinotecan (CPT-11) - oxaliplatin (OHP) - infusional 5-fluorouracil (5-FU)/folinic acid (FA) combination in advanced colorectal cancer patients who had received prior CPT-11 and/or OHP-based chemotherapy regimen. Colorectal cancer patients were given bimonthly CPT-11 as a 90-min infusion, followed by OHP (85 mg/m(2)), FA (200 mg/m(2)) 2-h infusions and 5-FU (48-h infusion). CPT-11 and 5-FU doses were escalated as reported below. 26 patients were recruited. ⋯ Median overall survival was 18 months and median time-to-progression 5.5 months. This combination showed moderate toxicity and promising antitumor activity in CPT-11 and/or OHP pretreated colorectal cancer patients. The second dose level using CPT-11 at 120 mg/m(2) and 5-FU at 1800 mg/m(2) is recommended for further phase II studies in this patient population.