International journal of antimicrobial agents
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There is a clear association between antibiotic use and resistance both on individual and population levels. In the European Union, countries with large antibiotic consumption have higher resistance rates. Antibiotic resistance leads to failed treatments, prolonged hospitalisations, increased costs and deaths. ⋯ The purpose of this paper is to provide the evidence base of prudent antibiotic policy. Special emphasis is placed on urinary tract infections. The value and support of antibiotic committees, guidelines, ID consultants and/or antimicrobial stewardship teams to prolong the efficacy of available antibiotics will be discussed.
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Int. J. Antimicrob. Agents · Dec 2011
Antibiotic treatment duration for bloodstream infections in critically ill patients: a national survey of Canadian infectious diseases and critical care specialists.
An optimum duration of antibiotic therapy would eradicate infection whilst minimising adverse drug reactions, resistance and costs. However, there is a paucity of evidence guiding the duration of therapy for bloodstream infections. Canadian infectious diseases (ID) and critical care specialists were surveyed regarding their recommended antibiotic treatment durations for five common bacteraemic syndromes. ⋯ ID physicians recommended longer durations than critical care physicians for all five syndromes, but the majority of both specialist groups would enrol patients in a trial of shorter (7 day) versus longer (14 day) antibiotic therapy. In conclusion, significant practice variation exists amongst clinicians' recommended durations of antibiotic treatment for bacteraemia. There is equipoise for a randomised trial comparing shorter versus longer courses of antibiotics for most bacteraemic syndromes and pathogens.
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Int. J. Antimicrob. Agents · Nov 2011
Molecular characterisation of multiple drug-resistant Acinetobacter baumannii isolates in southern Taiwan.
The purpose of this study was to develop a multiplex polymerase chain reaction (mt-PCR) assay for synchronous detection of carbapenem resistance genes and/or pandrug resistance genes in clinical isolates of multidrug-resistant Acinetobacter baumannii (MDR-AB) and to investigate the association between the genetic make-up and a drug-resistant pattern. In total, 213 MDR-AB isolates were collected. All clinical isolates underwent antimicrobial susceptibility testing and were analysed for the presence of oxacillinase genes (bla(OXA-23), bla(OXA-24), bla(OXA-51)-like and bla(OXA-58)), class A and C β-lactamase genes (bla(TEM-1) and bla(AmpC), respectively), and an integron-associated antibiotic resistance gene (int1) by an in-house-designed mt-PCR assay. ⋯ In multivariate logistic regression, the presence of bla(OXA-23) and bla(TEM-1) had a statistically significant association with imipenem resistance [bla(OXA-23), P=0.004, odds ratio (OR)=10.52, 95% confidence interval (CI) 2.12-52.17; bla(TEM-1), P=0.005, OR=6.14, 95% CI 1.74-21.62]. These results suggest that detecting bla(OXA-23) and bla(TEM-1) genes could be used to predict imipenem resistance in MDR-AB isolates. A mt-PCR for detecting carbapenem resistance genes and pandrug resistance genes of A. baumannii isolates was developed to provide an assay to quickly screen for potential imipenem-resistant A. baumannii in the clinic.
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Int. J. Antimicrob. Agents · Nov 2011
In vitro activity of polymyxins in combination with β-lactams against clinical strains of Pseudomonas aeruginosa.
The emergence of multidrug-resistant (MDR) strains has made it difficult to treat infections caused by Pseudomonas aeruginosa. In order to develop new alternative therapies for the treatment of MDR P. aeruginosa infections, the antimicrobial activities of different antibiotic combinations have been studied in vitro and in vivo. In this study, the in vitro antimicrobial activities of six different combinations of polymyxins and β-lactams against 34 clinical isolates of P. aeruginosa were evaluated. ⋯ Combination with polymyxins resulted in reductions of the β-lactam MICs, with a change in the resistance category to susceptible in eight MDR strains. These results from the in vitro evaluation suggest that combinations of polymyxins and β-lactams may significantly reduce the MICs of the antibiotics tested. These combinations require further evaluation for use in medical practice.
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Int. J. Antimicrob. Agents · Oct 2011
Multicenter Study Clinical TrialIncreased mortality associated with methicillin-resistant Staphylococcus aureus (MRSA) infection in the intensive care unit: results from the EPIC II study.
Controversy continues regarding whether the presence of meticillin resistance increases mortality risk in Staphylococcus aureus infections. In this study, we assessed the role of meticillin resistance in survival of patients with S. aureus infection included in the EPIC II point-prevalence study of infection in critically ill patients performed on 8 May 2007. Demographic, physiological, bacteriological and therapeutic data were collected for 13796 adult patients in 1265 participating Intensive Care Units (ICUs) from 75 countries on the study day. ⋯ ICU mortality rates were 29.1% and 20.5%, respectively (P<0.01) and corresponding hospital mortality rates were 36.4% and 27.0% (P<0.01). Multivariate analysis of hospital mortality for MRSA infection showed an adjusted OR of 1.46 (95% CI 1.03-2.06) (P=0.03). In ICU patients, MRSA infection is therefore independently associated with an almost 50% higher likelihood of hospital death compared with MSSA infection.