European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
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Eur. J. Clin. Microbiol. Infect. Dis. · Apr 2003
Usefulness of Gram stain for diagnosis of lower respiratory tract infection or urinary tract infection and as an aid in guiding treatment.
During a prospective study of 8 months duration conducted in the Department of Internal Medicine and the Department of Pulmonary Diseases of the Academic Medical Centre, Amsterdam, Gram stainings of sputa and urine were performed for all patients whose clinical symptoms indicated an acute urinary tract infection or pulmonary infection. On the test request, the physician reported which antibiotic treatment he would prescribe if a microscopic examination was not available. The results of the Gram stain were discussed by the microbiologist with the physician, and the antibiotic therapy recommended by the microbiologist was recorded. ⋯ The microbiologist's advice on antibiotic treatment was followed in 79% of the cases of respiratory tract infection and in 65% of the cases of urinary tract infection. The antibiotic treatment was adjusted to the final results of culture and antimicrobial susceptibility testing in 54% of the urinary tract infections and in 31% of the respiratory tract infections. The results indicate that the examination of sputa and urine in patients suspected to have an infection of the respiratory tract or urinary tract influences the antibiotic choice considerably.
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Eur. J. Clin. Microbiol. Infect. Dis. · Jan 2003
ReviewIncreasing the efficacy of anti-inflammatory agents used in the treatment of sepsis.
Excessive production of inflammatory mediators during invasive infection plays a key role in the pathogenesis of septic shock. In an attempt to improve survival of patients with this lethal syndrome, agents were developed to selectively inhibit mediators in this inflammatory response. Despite promising preclinical results, several different mediator-specific anti-inflammatory agents failed to demonstrate significant benefit in patients. ⋯ However, glucocorticoids were studied only in patients with vasopressor-dependent septic shock, which is associated with a high control mortality rate (i.e. 61%) similar to the level at which mediator-specific agents would have been expected to be markedly beneficial. Furthermore, consistent with earlier findings for mediator-specific anti-inflammatory agents, analysis of the activated protein C study also demonstrated a relationship between risk of death and effect of treatment. Developing better methods to define high-risk septic populations for treatment with anti-inflammatory agents will increase the efficacy of this therapeutic approach and minimize its potential for harm.
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Eur. J. Clin. Microbiol. Infect. Dis. · Jan 2003
Comparative StudyNosocomial and community-acquired spontaneous bacterial peritonitis: comparative microbiology and therapeutic implications.
In order to compare the microbiological characteristics of nosocomial and community-acquired episodes of bacterial peritonitis, 95 consecutive, spontaneous episodes were reviewed. Seventy of these episodes were bacteriologically documented. Fifty-three (55.8%) episodes were nosocomial and 42 (44.2%) were community acquired. ⋯ Gram-negative bacilli were significantly more frequent in nosocomial episodes than in community-acquired episodes (56.4% vs. 33.3%, P<0.05). Nosocomial isolates were significantly more resistant to amoxicillin-clavulanic acid (48.7% vs. 18.4%, P<0.01) and cefotaxime (33.3% vs. 13.2%, P<0.05) than community-acquired isolates, but no difference was detected regarding resistance to ciprofloxacin. The results indicate that the empirical treatment of spontaneous bacterial peritonitis should differ for nosocomial and community-acquired cases.
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Eur. J. Clin. Microbiol. Infect. Dis. · Nov 2002
Case ReportsRapid PCR-based diagnosis of disseminated histoplasmosis in an AIDS patient.
Disseminated histoplasmosis is an unusual opportunistic infection in patients with advanced HIV infection living outside endemic areas. Diagnosis usually is made on the basis of isolation of Histoplasma capsulatum from clinical specimens or histologic examination. ⋯ The patient recovered under antifungal treatment and remained asymptomatic up to the last follow-up visit 6 months later. The polymerase chain reaction assay might be a powerful and rapid diagnostic tool for the diagnosis of non-European invasive fungal infections and should be further evaluated.
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Eur. J. Clin. Microbiol. Infect. Dis. · Oct 2002
Antimicrobial susceptibility profiles of clinically relevant blood culture isolates from nine surgical intensive care units, 1996-2000.
In order to elucidate trends in the incidence and susceptibility profiles of causative agents of bacteremia/fungemia in nine surgical intensive care units, a total of 744 isolates obtained during a 5-year period (1996-2000) were studied. The isolates included 698 bacteria and 46 fungi obtained from 523 positive blood cultures, representing 317 episodes of bacteremia/fungemia. ⋯ Ciprofloxacin resistance in Pseudomonas aeruginosa decreased from 36% in 1996 to 20% in 2000, and resistance to third-generation cephalosporins decreased from 40% in 1996 to 9% in 2000. In light of differences between these results and those found elsewhere, these findings might prove useful for making infection control policy decisions in intensive care units.