The Journal of antimicrobial chemotherapy
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J. Antimicrob. Chemother. · Nov 2012
ReviewApplying biomarkers to clinical practice: a guide for utilizing procalcitonin assays.
Prudent use of antimicrobial therapies is an important component in decreasing bacterial resistance. Procalcitonin (PCT) is a novel biomarker proposed as both a diagnostic and prognostic agent for use in various severe infections. Elevated PCT levels have a high sensitivity and specificity for diagnosing infections. ⋯ Determining the utility of PCT in practice requires a comprehensive evaluation of the impact this biomarker has on outcomes to the patient and healthcare system, as well as examining convenience and cost factors. PCT can be used to assist clinicians in initiating and guiding antimicrobial therapies for specific patient populations, as an adjunct to other diagnostic tools. Further studies examining long-term outcomes of PCT are needed to determine the effect of this intervention on resistance patterns and overall prescribing trends.
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J. Antimicrob. Chemother. · Nov 2012
Acute psychosis related to use of trimethoprim/sulfamethoxazole in the treatment of HIV-infected patients with Pneumocystis jirovecii pneumonia: a multicentre, retrospective study.
A recent study reported that trimethoprim/sulfamethoxazole caused acute psychosis in four renal transplant patients with Pneumocystis jirovecii pneumonia. We aimed to investigate the incidence of and factors associated with trimethoprim/sulfamethoxazole-related acute psychosis in HIV-infected patients with P. jirovecii pneumonia. ⋯ In this case series, 11.9% of HIV-infected patients developed acute psychosis while receiving trimethoprim/sulfamethoxazole for P. jirovecii pneumonia. While the study was limited by its retrospective design, the risk appeared to increase with increasing daily dose of trimethoprim/sulfamethoxazole in those vulnerable patients with multiple risks for acute psychosis.
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J. Antimicrob. Chemother. · Nov 2012
Monitoring of voriconazole plasma concentrations in immunocompromised paediatric patients.
Voriconazole is approved for management of invasive fungal diseases (IFDs) in paediatric patients. We analysed plasma trough concentrations and explored their association with endpoints of antifungal therapy. ⋯ Voriconazole had acceptable safety and useful efficacy in the management of paediatric IFDs. Pharmacokinetic variability was high and no predictable dose-concentration-effect relationships were observed.
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J. Antimicrob. Chemother. · Nov 2012
Acquisition of clarithromycin resistance mutations in the 23S rRNA gene of Mycobacterium abscessus in the presence of inducible erm(41).
Antibiotic therapy of pulmonary Mycobacterium abscessus infection is based on a combination treatment including clarithromycin. Recent data demonstrated that M. abscessus may carry a chromosomal, inducible erm gene coding for the ribosomal methylase Erm(41). The purpose of this study was to investigate whether in patients with chronic M. abscessus infection undergoing clarithromycin therapy, M. abscessus acquires clarithromycin resistance mutations in the rrl gene in addition to the presence of an inducible Erm(41) methylase. ⋯ Our results show that in M. abscessus, clarithromycin resistance mutations in the 23S rRNA peptidyltransferase region provide an additional selective advantage independent of a functional erm(41) gene.