Expert review of anti-infective therapy
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Expert Rev Anti Infect Ther · Sep 2013
ReviewPrediction of prognosis by markers in community-acquired pneumonia.
Early identification of patients with community-acquired pneumonia (CAP) at risk of poor outcome is critical for defining site of care and may impact on hospital resource consumption and prognosis. The Pneumonia Severity Index and CURB-65 are clinical rules that accurately identify individuals at risk of death. ⋯ Nevertheless, the use of biomarkers in this context needs to be validated in prospective trials so as to elucidate how they can best be applied in practice. This review examines the usefulness of biomarkers, whether used alone or in conjunction with other clinical severity of illness scores, for identifying CAP patients at risk of short- and long-term mortality and for predicting both the need for intensive care unit admission and the potential for treatment failure.
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Expert Rev Anti Infect Ther · Sep 2013
CommentIs there really no benefit to combination therapy with colistin?
Despite many theoretical and in vitro advantages, clinical data comparing combination therapy with colistin + rifampicin to colistin alone for infection due to extremely-drug resistant (XDR) Acinetobacter baumanni are scarce and limited by small numbers and/or low quality evidence. This article represents the first large, randomized, controlled, prospective study comparing colistin monotherapy and combination therapy. ⋯ This study adds important new data to the literature and sets the stage for future studies that can be designed to overcome the limitations of this study, which are discussed in detail below. Based on this study, we cannot say definitively that combination therapy is not warranted for treatment of invasive infection due to A. baumannii, but the results do suggest that rifampicin is not an ideal agent to be combined with colistin.
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Expert Rev Anti Infect Ther · Aug 2013
ReviewStreptococcus pneumoniae infection: a Canadian perspective.
Streptococcus pneumoniae infections have resulted in significant morbidity and mortality worldwide in children and adults. In Canada, Streptococcus pneumoniae remains one of the leading causes of infectious disease including pneumonia, meningitis, bacteremia and otitis media. Although the widespread use of pneumococcal conjugate vaccines (PCVs) in Canadian children has reduced the incidence of pneumococcal diseases associated with vaccine-serotypes, rapid increase of non-vaccine serotypes in carriage and pneumococcal infections is of great concern to clinicians. ⋯ The effects of PCV vaccines on incidence, serotype distribution, antibiotic resistance of pneumococcal infections and nasopharyngeal (NP) carriage are discussed. We also examined historical outbreaks of Streptococcus pneumoniae and their public health impact. Recent developments in universal protein vaccines against pneumococcus show promise.
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Expert Rev Anti Infect Ther · Aug 2013
CommentAntimicrobial activity against CA-MRSA and treatment of uncomplicated nonpurulent cellulitis.
Evaluation of: Pallin DJ, Binder WD, Allen MB et al. ⋯ comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clin. Infect. Dis. 56(12), 1754-1762 (2013). The rise of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has complicated the empirical antimicrobial treatment of cellulitis. CA-MRSA is frequently the cause of purulent infections, to include purulent cellulitis. The role of CA-MRSA in nonpurulent cellulitis is less clear. Published clinical practice guidelines suggest that CA-MRSA plays only a minor role in nonpurulent cellulitis and that initial treatment should be primarily directed at β-hemolytic streptococci. Until now, there have been no data from prospective randomized control trials to support this recommendation. In this review, we examine the findings from a recent prospective, double-blind, randomized controlled trial that refutes the need for empirical coverage of CA-MRSA when treating nonpurulent cellulitis.