Expert review of anti-infective therapy
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Expert Rev Anti Infect Ther · Jun 2012
ReviewSepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes.
Sepsis has been around since the dawn of time, having been described for more than 2000 years, although clinical definitions are recent. The consensus sepsis definitions have permitted worldwide epidemiological studies of sepsis to be conducted. We now recognize the common nature of sepsis and the consistency of its disease - particularly severe sepsis and septic shock. ⋯ We have made progress over the past half-century in identifying and treating patients with sepsis, and decreasing fatality rates reflect this progress. However, owing to the increasing incidence of sepsis, the number of people who die each year continues to increase. The mortality with sepsis, particularly related to treating organ dysfunction, remains a priority to clinicians worldwide and is deserving of greater public health attention.
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Expert Rev Anti Infect Ther · May 2012
ReviewManagement of ventilator-associated pneumonia: epidemiology, diagnosis and antimicrobial therapy.
Ventilator-associated pneumonia (VAP) is the most frequent infection among patients hospitalized in intensive care units, maintaining a high morbidity and mortality. The global incidence of VAP ranges from 8 to 28%. ⋯ The Clinical Infection Pulmonary Score has been proposed to overcome the difficulties related to the diagnosis, but is not applicable to all patient categories. A continuous evaluation of the antimicrobial therapeutic options, along with their pharmacodynamic and pharmacokinetic profiles, is mandatory to create therapeutic protocols and reduce VAP-related mortality.
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Expert Rev Anti Infect Ther · Apr 2012
ReviewIdentification and treatment of infected total hip arthroplasty.
Periprosthetic joint infection (PJI) in the hip following prosthetic joint placement is a devastating outcome of an otherwise often successful surgical treatment (total-hip arthroplasty). Management of PJI is dependent upon accurate diagnosis and successful treatment, both of which are challenging. Recently, great strides have been made in improving the diagnosis of PJI, which has no 'gold standard' diagnostic tool. ⋯ Upon complete biofilm formation, successful treatment requires prosthetic resection with immediate or delayed reimplantation. Even with the most aggressive surgical treatment, PJI eradication currently has a success rate of approximately 80%. Unfortunately, technologies to improve the local delivery of antibiotics are not expected to be available in the near future.
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Expert Rev Anti Infect Ther · Mar 2012
ReviewThe immune response to severe bacterial infections: consequences for therapy.
The immune response to a bacterial stimulus starts when pathogen-associated molecular patterns of the bacterial pathogens activate pattern recognition receptors of the innate immune system. This leads to production of proinflammatory and anti-inflammatory mediators aiming to contain infection and drive the clinical signs of sepsis. ⋯ The majority of therapies targeting the immune responses have failed to provide clinical benefit. Immunostimulation with IFN-γ and leukocyte growth factors, hemoperfusion with polymyxin B-embedded fiber column, and macrolides remain the most promising immunomodulators in clinical practice.