International journal of antimicrobial agents
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Int. J. Antimicrob. Agents · Dec 2013
ReviewMinocycline, often forgotten but preferred to trimethoprim-sulfamethoxazole or doxycycline for the treatment of community-acquired meticillin-resistant Staphylococcus aureus skin and soft-tissue infections.
Treatment of uncomplicated skin and soft-tissue abscesses caused by meticillin-sensitive Staphylococcus aureus or meticillin-resistant S. aureus (MRSA) is problematic. Incision and drainage aside, oral antibiotic therapy for uncomplicated community-acquired MRSA (CA-MRSA) is limited and frequent choices include clindamycin, doxycycline or trimethoprim-sulfamethoxazole (TMP-SMX). ⋯ With MRSA, in vitro susceptibilities do not always predict in vivo effectiveness. In situations where doxycycline or TMP-SMX fails in the treatment of uncomplicated cutaneous abscesses due to CA-MRSA, minocycline is reliably effective.
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Int. J. Antimicrob. Agents · Dec 2013
Case ReportsStrongyloides disseminated infection successfully treated with parenteral ivermectin: case report with drug concentration measurements and review of the literature.
We report the case of an immunosuppressed patient with Strongyloides disseminated infection who was successfully treated with the veterinary parenteral form of ivermectin. A kidney transplant recipient developed disseminated infection with Strongyloides stercoralis. ⋯ Serum ivermectin concentrations were between 15.6 ng/mL and 19.7 ng/mL during the 9 days of therapy; however, drug accumulation (plasma levels >40 ng/mL) 48 h after discontinuation of therapy was associated with the development with encephalopathy. We also review all cases of human disseminated Strongyloides infection treated with parenteral ivermectin.
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Int. J. Antimicrob. Agents · Nov 2013
Can changes in renal function predict variations in β-lactam concentrations in septic patients?
This study investigated whether variations in creatinine clearance (CLCr) are correlated with changes in β-lactam concentrations or pharmacokinetics in septic patients. Data for 56 adult patients admitted to the ICU in whom routine therapeutic drug monitoring (TDM) of broad-spectrum β-lactams (ceftazidime, cefepime, piperacillin or meropenem) was performed were reviewed. Patients were included if they had at least two TDM during their ICU stay for the same antibiotic and were not concomitantly treated with any extracorporeal replacement therapy. ⋯ The proportion of patients with insufficient β-lactam concentrations at the first and second TDM were 39% and 30%, respectively, and increased proportionally to CLCr. Although CLCr was significantly correlated with concentrations and clearance of broad-spectrum β-lactams, changes in CLCr did not reliably predict variations in drug pharmacokinetics/pharmacodynamics. Routine TDM should be considered to adapt β-lactam doses in this setting.
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Int. J. Antimicrob. Agents · Nov 2013
High vancomycin minimum inhibitory concentrations with heteroresistant vancomycin-intermediate Staphylococcus aureus in meticillin-resistant S. aureus bacteraemia patients.
Patients with high vancomycin minimum inhibitory concentrations (MICs) and heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) infection are associated with treatment failure and poor outcomes. The main purpose of this study was to investigate the effect of hVISA on patient outcome, considering both the high vancomycin MIC and the existence of heteroresistant phenotypes. From January 2005 to December 2009, consecutive meticillin-resistant S. aureus (MRSA) isolates from 284 cases of MRSA bacteraemia receiving glycopeptide therapy were collected for further MIC and hVISA testing. ⋯ The high MIC with hVISA phenotype was not associated with higher mortality but was independently associated with persistent MRSA bacteraemia (OR=5.996, 95% CI 1.438-25.005). To summarise, although hVISA is correlated with persistent bacteraemia, higher mortality in high vancomycin MIC infections could not be explained by the existing hVISA phenotype. Facing persistent bacteraemia under glycopeptide therapy for 7 days, clinicians should consider shifting to an alternative class of antibiotics to treat hVISA infection.
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Int. J. Antimicrob. Agents · Oct 2013
ReviewCandidaemia in the non-neutropenic patient: a critique of the guidelines.
Several guidelines have been published on the management of candidaemia. These guidelines vary in their recommendations, and the lack of consistency between the guidelines has implications for the management of candidaemia. ⋯ We found that too much emphasis has been placed on themes such as predicting the infecting species (and therefore fluconazole susceptibility) or the need for investigations such as echocardiography. We also stress that guidelines fail to provide adequate information (due to lack of evidence) on the most relevant issues that clinicians face when managing candidaemia, such as the place for fluconazole in the treatment of C. glabrata, the clinical relevance of dose-dependent susceptibility to fluconazole, and the timing of step-down therapy.