Enfermedades infecciosas y microbiología clínica
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Enferm. Infecc. Microbiol. Clin. · Mar 2011
Review[Drug interactions in critically-ill patients. An important factor in the use of micafungin?].
Currently there are three main drug groups for the prevention and treatment of fungal infections: polyenes (amphotericin B deoxycholate or its lipid formulations), azoles (fluconazole, itraconazole or posaconazole) and echinocandins (caspofungin, micafungin and anidulafungin). However, a major characteristic to be evaluated when choosing an antifungal agent -apart from antifungal spectrum, pharmacokinetics and adverse effects- is the absence of significant drug interactions. Amphotericin B lacks interactions but may cause renal dysfunction, leading to the accumulation of renally metabolized drugs. ⋯ The echinocandin with the highest number of interactions is caspofungin. Micafungin is an echinocandin lacking in relevant interactions and consequently its dosage requires no adjustment in any of its indications. This drug can be used both in adults and in the pediatric population, including neonates.
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Enferm. Infecc. Microbiol. Clin. · Apr 2010
ReviewInterferon gamma release assays: principles and practice.
The last decade has witnessed significant advances in mycobacterial genomics and cellular research which have resulted in the development of two new blood tests, the enzyme-linked immunospot assay (ELISpot) (TSPOT. TB, Oxford Immunotec, Oxford, UK) and the enzyme-linked immunosorbent assay (ELISA) (QuantiFERON-TB Gold In-Tube, Cellestis, Carnegie, Australia). These tests, which are collectively known as interferon gamma release assays (IGRAs), detect latent tuberculosis infection (LTBI) by measuring interferon (IFN)-gamma release in response to antigens present in Mycobacterium tuberculosis, but not bacille Calmette-Guerin (BCG) vaccine and most nontuberculous mycobacteria. ⋯ Their high specificity means that BCG-vaccinated individuals with a false-positive TST will not receive unnecessary preventive treatment, whereas improved sensitivity in individuals with weakened cellular immunity at highest risk of progressing to active TB (for example HIV-positive individuals) enables more reliable targeted testing and treatment of these vulnerable groups. The role of IGRAs in active TB is less clear but they may be useful as adjunctive tests in the diagnostic work-up of an individual with suspected TB. Finally, recent developments and future directions in IGRA development are reviewed.
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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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Enferm. Infecc. Microbiol. Clin. · Oct 2012
Review[Candidemia and invasive candidiasis in the adult: clinical forms and treatment].
Invasive candidiasis is progressively increasing in frequency as a complication of the hospitalised adult patient. The availability of new antifungal drugs with lower toxicity and high efficacy has increased the complexity of managing of these infections. ⋯ Finding of a balance between the best benefit for the patient with the less costs is, nowadays, one of the main objectives of the current recommendations for the management of invasive candidiasis. In this review, the recommendations for the management of candidemia and other forms of invasive candidiasis (esophagitis, peritonitis, ocular, cardiovascular and osteoarticular candidiasis, central nervous system and urinary tract candidiasis, and chronic disseminated candidiasis) are analysed.
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Enferm. Infecc. Microbiol. Clin. · Sep 2010
Review[Duration of antibiotic therapy in intraabdominal infections].
The duration of antibiotic treatment in patients with an infectious process is based on empirical considerations and those with intraabdominal infections are no exception. Therefore, the recommended duration of antibiotic therapy in intraabdominal infection is controversial and no consensus has been reached due to the lack of controlled studies that would provide sufficient scientific evidence. ⋯ These considerations have led to the exploration of "short-term treatment" strategies, lasting 3-5 days, with encouraging results. However, the development of biomarkers such as procalcitonin opens the door to individualized treatment that might allow the duration of antibiotic treatment in intraabdominal and other infections to be individually tailed to patient response.