The Journal of infection
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Nosocomial pneumonia, which includes hospital-acquired pneumonia, ventilator-associated pneumonia, and health care associated pneumonia, remains an important cause of morbidity and mortality. The continuing emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a nosocomial pneumonia pathogen is particularly problematic not only because of its prevalence, but also because antimicrobial resistance is increasingly associated with inappropriate empirical antibiotic therapy. ⋯ These competing goals can be achieved by using an approach that initially delivers liberal broad-spectrum coverage followed by de-escalation once culture results and serial clinical observations become available. In ventilator-associated pneumonia, linezolid has demonstrated favorable activity against Gram-positive bacteria, including MRSA, and is recommended in evidence-based guidelines as an alternative to vancomycin, particularly when MRSA is documented as the etiology.
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The Journal of infection · Sep 2009
Practice GuidelineBritish Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children.
SUMMARY AND KEY RECOMMENDATIONS: The aim of these guidelines is to describe a practical but evidence-based approach to the diagnosis and treatment of central nervous system tuberculosis in children and adults. We have presented guidance on tuberculous meningitis (TBM), intra-cerebral tuberculoma without meningitis, and tuberculosis affecting the spinal cord. Our key recommendations are as follows: 1. ⋯ The principles of CNS tuberculosis diagnosis and treatment are the same for HIV infected and uninfected individuals, although HIV infection broadens the differential diagnosis and anti-retroviral treatment complicates management. Tuberculosis in HIV infected patients should be managed either within specialist units by physicians with expertise in both HIV and tuberculosis, or in a combined approach between HIV and tuberculosis experts. The co-administration of anti-retroviral and anti-tuberculosis drugs should follow guidance issued by the British HIV association (www.bhiva.org).