Scandinavian journal of infectious diseases
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Scand. J. Infect. Dis. · Mar 2013
Severe sepsis and systemic inflammatory response syndrome in emergency department patients with suspected severe infection.
Severe sepsis is a common condition with a reported high mortality, but most studies have been confined to intensive care unit (ICU) populations. The systemic inflammatory response syndrome (SIRS) has been used to define sepsis, however its usefulness has been questioned. Our aim was to describe the prevalence and clinical impact of severe sepsis and SIRS in patients admitted from the emergency department (ED) with a suspected serious infection. ⋯ Severe sepsis was a common condition among ED patients with a clinically suspected serious infection. Mortality was low compared with results from the ICU setting, suggesting that severe sepsis is a more benign disease than earlier reported. As a tool for the definition of sepsis and for the selection of patients for clinical sepsis trials, SIRS lacks acceptable discriminative ability in an ED population with a high prevalence of serious infections.
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Scand. J. Infect. Dis. · Mar 2013
Clinical impact of inappropriate initial antimicrobial therapy on outcome in bacteremic biliary tract infections.
The marked increase in the incidence of biliary tract infections due to antimicrobial-resistant pathogens in recent years is of great concern, as patients infected by these isolates might initially receive antibiotics ineffective against the responsible pathogens. ⋯ Our findings suggest that the administration of inappropriate initial antimicrobial therapy might be associated with an adverse outcome in patients experiencing bacteremic biliary tract infections, and that the impact of inappropriate therapy on the outcome may be dependent on therapeutic drainage and appropriate definitive antimicrobial therapy.
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Scand. J. Infect. Dis. · Feb 2013
Case ReportsA case of endogenous endophthalmitis complicated by neutropenia following bacteremia with Streptococcus mitis resistant to beta-lactam antibiotics.
This report is focused on a case of endogenous endophthalmitis following Streptococcus mitis bacteremia that occurred during chemotherapy for acute myeloid leukemia, despite broad-spectrum beta-lactam antibiotics and vancomycin. The patient partially recovered visual acuity. In conclusion, Streptococcus mitis bacteremia complicated by febrile neutropenia may cause endogenous endophthalmitis within a very short timeframe.
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Scand. J. Infect. Dis. · Jan 2013
Case ReportsA reduced linezolid dosage maintains favorable efficacy with minimal hematologic toxicity in a methicillin-resistant Staphylococcus aureus-infected patient with renal insufficiency.
The optimal dosage of linezolid to avoid hematologic toxicity is unknown. We report the case of an 87-y-old woman with renal insufficiency who developed a surgical site infection with refractory methicillin-resistant Staphylococcus aureus. The standard dosage of linezolid (1200 mg daily) was not initially tolerated by the patient due to severe thrombocytopenia, but she was successfully treated when the dose was reduced by half (600 mg daily) based on a population pharmacokinetic-pharmacodynamic model. Appropriate dose adjustments can be made to optimize linezolid therapy especially in cases with preexisting renal dysfunction.
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Scand. J. Infect. Dis. · Dec 2012
Surgical site infection prophylaxis strategies for cardiothoracic surgery: a decision-analytic model.
Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of invasive surgical site infection (SSI) in the USA. Antimicrobial prophylaxis for SSI typically includes a cephalosporin. Vancomycin is used to provide MRSA coverage, but the timing of administration is challenging. Linezolid is an attractive agent for SSI prophylaxis, particularly for the prevention of SSI due to MRSA. ⋯ This simulation indicates that linezolid may offer benefits for SSI prophylaxis over existing prophylactic agents, particularly for the prevention of SSI due to Gram-positive methicillin-resistant pathogens.