Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
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Clin. Microbiol. Infect. · May 2006
ReviewClinical experience in the management of community-acquired pneumonia: lessons from the use of fluoroquinolones.
Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality worldwide. The treatment of CAP has been complicated by several factors, including the expanding spectrum of causative organisms and the rising prevalence of antibiotic resistance among respiratory pathogens. ⋯ Respiratory fluoroquinolones, such as levofloxacin, are the only antimicrobials that are highly active against the pathogens most frequently implicated in CAP, including macrolide-resistant and penicillin-resistant pneumococci, Haemophilus influenzae, Legionella spp., and atypical agents. This paper reviews recent studies involving adult patients with CAP that suggest that levofloxacin, as compared with other conventional antibiotic treatments, may be associated with better clinical outcomes.
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Infective endocarditis is a microbial infection of the endocardial surface and, despite improvements in diagnostic accuracy, medical therapy and surgical techniques, mortality remains high. This review focuses on changes in epidemiology, microbiology and diagnosis, as well as changes in medical and surgical management of infective endocarditis affecting native and prosthetic valves in adults, that have evolved during the past two decades. ⋯ Topics still requiring study include whether and when valve replacement should be performed, and how to predict perivalvular complications or embolisation based on echocardiography findings. Optimisation of antimicrobial treatment schemes (choice of the antibiotic, dose and duration) also requires further investigation.
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Clin. Microbiol. Infect. · Nov 2005
ReviewThe therapeutic challenge of Gram-negative sepsis: prolonging the lifespan of a scarce resource.
Mortality from severe bacterial sepsis remains high. The pathogenesis involves production of pro and anti-inflammatory cytokines which mediate: neutrophil adhesion to the endothelium, diffuse capillary leak, disseminated intravascular coagulation, vasodilatation and mitochondrial dysfunction, all of which culminate in microcirculatory failure. Therapy is multifaceted. ⋯ De-escalation strategies should be consistently employed and the duration of therapy should be tailored to clinical response. Continuation beyond 8 days is generally detrimental in terms of the potential for superinfection with resistant organisms. Failure of response necessitates, initially, a re-evaluation of source control and obsessive culturing of likely sites of sepsis prior to random antibiotic changes.
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Clin. Microbiol. Infect. · Oct 2005
ReviewAdvances in the management of pneumonia in the intensive care unit: review of current thinking.
Interventions to prevent pneumonia in the intensive care unit should combine multiple measures targeting the invasive devices, microorganisms and protection of the patient. Microbiological investigation is useful for evaluating the quality of the respiratory sample, and permits early modification of the regimen in light of the microbiological findings. ⋯ Three questions should be formulated: (1) is the patient at risk of acquiring methicillin-resistant Staphylococcus aureus, (2) is Acinetobacter baumannii a problem in the institution, and (3) is the patient at risk of acquiring Pseudomonas aeruginosa? Antibiotic therapy should be started immediately and must circumvent any pathogen resistance mechanisms developed after previous antibiotic exposure. Therefore, antibiotic choice should be institution-specific and patient-oriented.
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Clin. Microbiol. Infect. · Apr 2005
ReviewThe European Union of Medical Specialties core training curriculum in infectious diseases: overview of national systems and distribution of specialists.
The European Union of Medical Specialities (UEMS) Section of Infectious Diseases agreed on an infectious disease training programme in 1999, which was updated in 2002. Although the provision of infection services throughout Europe is not uniform, with variation in the roles of infectious disease physicians and microbiologists, there are, nonetheless, physicians with a predominant responsibility for clinical infectious diseases (and tropical medicine) in most countries. However, infectious diseases is formally recognised as a specific discipline by most, but not yet all, European countries. ⋯ The numbers of infection specialists (infectious diseases and microbiology) per million population show considerable variation. The UEMS Sections have recognised the importance of working closely with European specialist societies involved with training. The Section for Infectious Diseases has, in partnership with the ESCMID, established a Board for the accreditation of continuing medical education/continuing professional development.