Enfermedades infecciosas y microbiología clínica
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Enferm. Infecc. Microbiol. Clin. · Feb 2009
Review Practice Guideline[Consensus document for the treatment of bacteremia and endocarditis caused by methicillin-resistent Staphylococcus aureus. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica].
Bacteremia and endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA) are prevalent and clinically important. The rise in MRSA bacteremia and endocarditis is related with the increasing use of venous catheters and other vascular procedures. Glycopeptides have been the reference drugs for treating these infections. ⋯ The development of new antibiotics, such as linezolid and daptomycin, and the promise of future compounds (dalvabancin, ceftobiprole and telavancin) may change the expectatives in this field. The principal aim of this consensus document was to formulate several recommendations to improve the outcome of MRSA bacteremia and endocarditis, based on the latest reported scientific evidence. This document specifically analyzes the approach for three clinical situations: venous catheter-related bacteremia, persistent bacteremia, and infective endocarditis due to MRSA.
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Despite the specialist activity of Infectious Diseases not being officially recognised, the majority of the hospitals in the autonomous communities of Spain are equipped with structures, with significant heterogeneity among them, to be able to offer high quality care in these diseases. The main characteristics of and Infectious Diseases Department is its important healthcare activity, more than in other officially recognised medical specialities, and also its important interrelationship with other services in the hospital which is clearly horizontal healthcare. Furthermore, the aforementioned infectious disease care units have developed important activities in the arena of community and public health and, in collaboration with health authorities, contribute to the rational use of antimicrobials and the relationship with Primary Care. The future of specialists in infectious diseases, when they are officially recognised, will be the creation of clinical management units in every health institution with the objective of coordinating all the specialised health care, both in the hospital environment and in its health area of influence.
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Enferm. Infecc. Microbiol. Clin. · Dec 2008
Review[Current status of invasive fungal infections. New diagnostic techniques and antifungal agents].
In the last few years, major advances in the treatment of transplant recipients, with hemato-oncological diseases or admitted to the intensive care unit, has been accompanied by an increase in classical fungal infections and by the emergence of uncommon fungal infections. Despite the development of new diagnostic techniques such as galactomannan detection and the availability of new antifungal agents, these opportunistic infections continue to pose a diagnostic challenge, prolong length of hospital stay, and increase costs. In addition, mortality from these infections is high. The present chapter provides a brief review of the epidemiology of these infections, diagnostic advances, and the new antifungal agents that have been developed in the last few years.
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The emergence and spread of Mycobacterium tuberculosis strains resistant to multiple drugs represent a threat for global tuberculosis control. The World Health Organization (WHO) estimates that almost 500,000 cases of M. tuberculosis resistant to isoniazid and rifampicin (multidrug-resistant, or MDR-TB), at least, emerged in 2006. In addition, new cases of extensively drug-resistant tuberculosis (XDR-TB), defined as MDR-TB with resistance to a fluoroquinolone and at least one second line injectable agent, have been reported in 45 countries in all five continents. ⋯ This situation poses a serious problem for low income countries, especially those with a high prevalence of human immunodeficiency virus type 1 (HIV-1) infection. MDR-TB and XDR-TB are also of special concern in wealthy countries, due to mass immigration. Therefore, tuberculosis resistant to multiple drugs should be given high priority in global public health and biomedical research.
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Enferm. Infecc. Microbiol. Clin. · Nov 2008
Review[Role of the new molecules in antiretroviral therapy. Position of raltegravir].
Antiretroviral rescue therapy has been revolutionized by the development of new drugs in the last few years: enfuvirtide (a fusion inhibitor), tipranavir/ritonavir (a high genetic barrier protease inhibitor), darunavir/ritonavir (a high genetic barrier protease inhibitor), etravirine (a non-nucleoside reverse transcriptase inhibitor active against nevirapine- and efavirenz- resistant HIV), maraviroc (a CCR5 coreceptor inhibitor) and raltegravir (an integrase inhibitor). The use of these drugs in rescue regimens has allowed the goal of antiretroviral rescue therapy to be the same as that in treatment naive-patients: to achieve a viral load lower than 50 copies of RNA of HIV/ml. Raltegravir is the first integrase inhibitor available for clinical use in Spain. ⋯ Raltegravir has been demonstrated to have high efficacy in two large clinical trials of rescue therapy, especially when combined with darunavir/ritonavir and enfuvirtide. Preliminary data suggest that raltegravir could also be an effective drug in treatment-naive patients and as substitution therapy in patients with toxicity due to boosted protease inhibitor therapy. The drug's unusual mechanism of action has reopened the possibility of a positive effect on latent HIV reservoirs.