International journal of antimicrobial agents
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Int. J. Antimicrob. Agents · Dec 2011
ReviewPragmatic management of Panton-Valentine leukocidin-associated staphylococcal diseases.
Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus is associated with a broad spectrum of diseases, ranging from common uncomplicated soft tissue infections to severe diseases such as complicated soft tissue infections, extensive bone and joint infections, and necrotising pneumonia. Specialised management of infection based on the presence of PVL may not be required for mild infections, whereas it could be lifesaving in other settings. ⋯ Thus, recommendations are based on expert opinions, which are elaborated based on theory, in vitro data and analogies with other toxin-mediated diseases. In this review, we consider the potential need for specialised PVL-based management and, if required, which tools should be used to achieve optimal management.
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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 · 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 · 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 · Oct 2011
Activity of an Intralipid formulation of nystatin in murine systemic candidiasis.
Since nystatin (NYT) is used only topically owing to its toxicity upon systemic administration, a study was initiated aiming to develop a formulation of NYT that could be used systemically against invasive mycoses. The present research is a continuation of previous in vitro investigation of the antifungal effect of nystatin-Intralipid (NYT-IL) against Candida, exploring its in vivo activity. NYT-IL was tested in murine systemic candidiasis induced in naïve as well as cyclophosphamide-immunosuppressed female ICR mice. ⋯ The efficacy of NYT-IL was expressed in treated naïve and immunosuppressed mice by increased SR, prolonged MST and reduced fungal organ colonisation. Early initiation of treatment increased efficacy. In summary, the Intralipid formulation of NYT can be administered parenterally and is effective against systemic experimental Candida infection.