Infectious disease clinics of North America
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Infect. Dis. Clin. North Am. · Dec 2003
ReviewAntimicrobial treatment of hospital-acquired pneumonia.
Rapid identification of infected patients and accurate selection of antimicrobial agents for initial treatment of hospital-acquired pneumonia represent important clinical goals, because it seems that better treatment of this infection might have a major impact on hospital-associated mortality and morbidity. Persistently high mortalities for pneumonia in the critical care unit argue, however, for a continued reassessment of the current modalities of therapy and definition of better protocols. ⋯ It should be emphasized that in the event that one or several specific etiologic agents are identified by a reliable technique, the choice of antimicrobial drugs is much easier, because the optimal treatment may be selected in light of the susceptibility pattern of the causative pathogens without resorting to broad-spectrum drugs or risking inappropriate treatment. Great efforts should be placed to obtain reliable pulmonary specimens for direct microscopic examination and cultures in each patient clinically suspected of having developed nosocomial pneumonia before new antibiotics are administered.
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Infect. Dis. Clin. North Am. · Dec 2003
ReviewHospital-acquired pneumonia: diagnostic strategies: lessons from clinical trials.
It should be emphasized that, for the management of VAP, like for all infectious diseases, the choice of antimicrobial treatment is much easier when the specific etiologic agents are identified by a reliable diagnostic technique. Before new antibiotics are administered, reliable pulmonary specimens (chosen according to the literature and within the capabilities of the local microbiology laboratory) must be obtained for direct examination and cultures from patients clinically suspected of having developed VAP.
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Infect. Dis. Clin. North Am. · Jun 2003
ReviewThe current management strategies for community-acquired urinary tract infection.
Acute uncomplicated UTI is one of the most common problems for which young women seek medical attention and accounts for considerable morbidity and health care costs. Acute cystitis or pyelonephritis in the adult patient should be considered uncomplicated if the patient is not pregnant or elderly, if there has been no recent instrumentation or antimicrobial treatment, and if there are no known functional or anatomic abnormalities of the genitourinary tract. Most of these infections are caused by E. coli, which are susceptible to many oral antimicrobials, although resistance is increasing to some of the commonly used agents, especially TMP-SMX. ⋯ Acute uncomplicated cystitis or pyelonephritis in healthy adult men is very uncommon but is generally caused by the same spectrum of uropathogens with the same antimicrobial susceptibility profile as that seen in women. The choice of antimicrobials is similar to that recommended for cystitis in women except that nitrofurantoin is not considered a good choice. Treatment duration should generally be longer than that recommended for women.
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Subcutaneous mycoses include a heterogeneous group of fungal infections that develop at the site of transcutaneous trauma. Infection slowly evolves as the etiologic agent survives and adapts to the adverse host tissue environment. Diagnosis rests on clinical presentation, histopathology, and culture of the etiologic agents. This article considers sporotrichosis, chromoblastomycosis, and mycetoma.
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The diagnosis of histoplasmosis depends on recognition of the different clinical manifestations of infection, accompanied by knowledge of the accuracy and limitations of tests used for diagnosis of fungal infections. Although most infections are asymptomatic, histoplasmosis can be severe, or even fatal, in patients who have experienced a heavy exposure, have underlying immune defects, or develop progressive disease that is not recognized and treated. This article provides an up-to-date clinical review of histoplasmosis, focusing on recognition, diagnosis, and management.