International journal of antimicrobial agents
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Int. J. Antimicrob. Agents · Jun 2013
ReviewAntimicrobial resistance: action to combat the rising microbial challenges.
Antimicrobial therapy transformed medical practice from a merely diagnosis-focused approach 80 years ago to a treatment-focused approach, saving millions of lives in the years to follow. Today, numerous medical advances made possible by effective antibiotics are being threatened by the relentlessly rising rates of bacteria resistant to all currently available antibiotics. This phenomenon is a consequence of antibiotic misuse, which exerts undue selective pressure on micro-organisms, combined with defective infection control practices that accelerate their spread. ⋯ It should include actions aiming at optimising antibiotic use, strengthening surveillance and infection control, and improving healthcare worker and public education with regard to antibiotics. Research efforts to bring new effective antibiotics to patients need to be fostered in order to negate the consequences of the current lack of antimicrobial therapy options. A holistic view of AMR as well as intersectoral collaboration between human and veterinary medicine is required to best address the problem.
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Int. J. Antimicrob. Agents · Jun 2013
ReviewIntraventricular and intrathecal colistin as the last therapeutic resort for the treatment of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii ventriculitis and meningitis: a literature review.
Acinetobacter baumannii ventriculitis/meningitis due to the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains has become a clinical entity of considerable importance in recent years. A review of the available literature regarding intraventricular (IVT) or intrathecal (ITH) administration of colistin in MDR and XDR A. baumannii ventriculitis/meningitis was conducted and a total of 83 episodes in 81 patients were identified (71 cases in adults and 10 in children and neonates). Colistin was administered via the IVT and ITH route in 52 and 22 cases, respectively, whilst in 7 cases the exact route was not identified. ⋯ The median duration of treatment of IVT/ITH polymyxin E was 18.5 days, whilst the median time to achieve sterilisation of cerebrospinal fluid was 4 days. The rate of successful outcome was 89%, and toxicity related to treatment mainly manifested as reversible chemical ventriculitis/meningitis was reported in nine cases (11%). Nowadays, IVT and ITH colistin represents the last resort treatment of MDR and XDR A. baumannii ventriculitis/meningitis, offering a unique, rather safe and successful mode of therapy.
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The failure of the PROWESS-SHOCK study of recombinant human activated protein C (drotrecogin alfa) has generated much scepticism about the future of immunomodulatory interventions in sepsis. This review presents a summary of the few remaining promising strategies for immunointervention. ⋯ This approach comprises: septic shock and multiple organ dysfunction syndrome arising in the field of ventilator-associated pneumonia as an indication for intravenous clarithromycin; abdominal severe sepsis/shock for PMX-B haemoperfusion; sepsis and acute coagulopathy for rTM; and early septic shock for IgMA. However, specific diagnostic tools should be developed to make this personalised approach more robust.
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Int. J. Antimicrob. Agents · Apr 2013
Review Meta Analysisβ-Lactam plus aminoglycoside or fluoroquinolone combination versus β-lactam monotherapy for Pseudomonas aeruginosa infections: a meta-analysis.
The objective of this review was to compare the effectiveness and safety of β-lactam combined with aminoglycoside or fluoroquinolone with that of β-lactam monotherapy for the treatment of Pseudomonas aeruginosa infections. We searched Scopus and PubMed databases and synthesised the outcomes of the individual studies in a meta-analysis. Both non-randomised studies and randomised controlled trials (RCTs) that evaluated outcomes of patients with P. aeruginosa infections receiving treatment with β-lactams alone or in combination with an aminoglycoside or a fluoroquinolone were included. ⋯ There was no difference in clinical cure either for RCTs (1.29, 0.91-1.83) or for non-randomised studies (1.18, 0.97-1.45). In conclusion, no benefit in mortality was observed in patients receiving combination therapy for P. aeruginosa infections. A well-designed multicentre RCT is warranted to address this important issue.
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Int. J. Antimicrob. Agents · Oct 2012
ReviewProbiotics for infectious diseases: more drugs, less dietary supplementation.
According to current definitions, probiotics are live microorganisms that, when ingested in adequate quantities, exert a health benefit to the host. The action of probiotics in the host is exerted by three mechanisms: modulation of the content of gut microbiota; maintenance of the integrity of the gut barrier and prevention of bacterial translocation; and modulation of the local immune response by the gut-associated immune system. Regarding their role for the prevention and treatment of infectious diseases, adequate evidence coming from randomised clinical trials (RCTs) is available for antibiotic-associated diarrhoea (AAD), Clostridium difficile infection (CDI), acute gastroenteritis and infectious complications following admission to the Intensive Care Unit (ICU). ⋯ Available evidence is not sufficient to support administration for the management of CDI. Regarding populations of critically ill patients, data from many RCTs suggest a decrease of infectious complications by starting feeding with probiotics following ICU admission, with the exception of patients suffering from severe pancreatitis. However, it should be underscored that all analysed RCTs are characterised by marked heterogeneity regarding the type of administered probiotic species, precluding robust recommendations.