Expert review of anti-infective therapy
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Systemic infection is often revealed by or associated with brain dysfunction, which is characterized by alteration of consciousness, ranging from delirium to coma, seizure or focal neurological signs. Its pathophysiology involves an ischemic process, secondary to impairment of cerebral perfusion and its determinants and a neuroinflammatory process that includes endothelial activation, alteration of the blood-brain barrier and passage of neurotoxic mediators. Microcirculatory dysfunction is common to these two processes. ⋯ Currently, treatment consists mainly of controlling sepsis. The effects of insulin therapy and steroids need to be assessed. Various drugs acting on sepsis-induced blood-brain barrier dysfunction, brain oxidative stress and inflammation have been tested in septic animals but not yet in patients.
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Expert Rev Anti Infect Ther · Feb 2013
Carbapenem-resistant Gram-negative bacteria: how to prioritize infection prevention and control interventions in resource-limited settings?
Emergences of carbapenem-resistant Gram-negative bacteria (CRGNB) have heightened global awareness of the prioritization of infection prevention and control (IPC) interventions to minimize infections attributed to these bacteria. Effective new antibiotic drugs for CRGNB are estimated to be at least 5 years off completion of trials and approval for use. Hence, effective IPC strategies remain at the core of clinical care and research for patients with CRGNB infection. The authors summarize current evidence and viewpoints for IPC strategies as related to the emergence, transmission and prevention of CRGNB.