Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
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Clin. Microbiol. Infect. · Mar 2009
ReviewEpidemiological and resistance issues in multidrug-resistant staphylococci and enterococci.
The spread of methicillin-resistant Staphylococcus aureus is continuous. The emergence of community-acquired methicillin-resistant S. aureus (CA-MRSA) was rapidly followed by its introduction into and dissemination in hospitals in countries where CA-MRSA prevalence is high. ⋯ Although new antimicrobials have been recently introduced into therapy to fight multidrug-resistant Gram-positive cocci, resistance to these compounds has already emerged in rare strains. This review presents recent data concerning the advance of our knowledge related to these problems.
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Clin. Microbiol. Infect. · Feb 2009
Chronic antiplatelet therapy and mortality among patients with infective endocarditis.
Whether antiplatelet therapy is associated with better outcomes among patients with infective endocarditis (IE) remains controversial. A retrospective study was conducted concerning all patients with IE, treated in a tertiary-care centre of Canada between 1991 and 2006, who satisfied the modified Duke criteria for a definite or possible IE. The primary outcome was all-cause mortality within 90 days of diagnosis. ⋯ Chronic antiplatelet therapy was not associated with a significantly lower risk of major embolism. In conclusion, chronic antiplatelet therapy was associated with lower mortality among patients with IE, independently of any effect on major embolism. Whether or not a beneficial effect could be replicated by initiating antiplatelet therapy at the time of diagnosis remains unproven.
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Clin. Microbiol. Infect. · Oct 2008
EditorialAll EU hands to the EU pumps: the Science Academies of Europe (EASAC) recommend strong support of research to tackle antibacterial resistance.
Despite many European Union (EU) conferences on fighting microbial resistance, rates of resistance in Europe continue to increase. Although research is catching up with discovery, the development of new antimicrobials is threatened by economic factors, in particular the need for a return of investment via high-volume sales. The EU should invest in independent research into the economic and business aspects of antibiotic development. Multidisciplinary input from the fields of finance, law, marketing, sociology and psychology will inform a broad agenda for change at the regulatory, academic and commercial levels and identify new options for novel anti-infective research and development, as recently recommended by the Science Academies of Europe (EASAC).
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Clin. Microbiol. Infect. · Jun 2008
Analysis of superantigenic toxin Vbeta T-cell signatures produced during cases of staphylococcal toxic shock syndrome and septic shock.
Most clinical isolates of Staphylococcus aureus harbour genes encoding superantigenic toxins that bind the Vbeta domain of T-cells, but little information is available concerning superantigenic toxin production during staphylococcal toxic shock syndrome (TSS) and septic shock. This prospective study investigated 14 patients with staphylococcal TSS or septic shock; the toxin gene profile of each isolate was determined and flow-cytometry was used to identify the discriminant Vbeta signature (DVbetaS) of each superantigenic toxin in vitro. Attempts were also made to identify in-vivo production of superantigenic toxin DVbetaS in patients' blood. ⋯ Detection of a superantigenic toxin DVbetaS may help to show which toxin is produced during staphylococcal TSS, thus confirming the diagnosis and hastening the administration of anti-toxin therapy. In contrast, this approach failed to demonstrate superantigenic toxin involvement in cases of septic shock. In this latter condition, a superantigenic toxin may not be produced by S. aureus, or its production may occur without expansion of targeted T-cells because of T-cell apoptosis and/or anergy.