Current opinion in infectious diseases
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Nosocomial tracheobronchitis is common among intubated critically ill patients. Ventilator-associated tracheobronchitis (VAT) represents an intermediate process between lower respiratory tract colonization and ventilator-associated pneumonia. The aim of this review is to discuss recent findings on VAT. ⋯ Antibiotic treatment is beneficial in VAT patients. Future studies should confirm these promising results and determine the best duration of antimicrobial therapy in these patients.
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Curr. Opin. Infect. Dis. · Apr 2009
ReviewAerosolized antibiotics to treat ventilator-associated pneumonia.
This review summarizes the recent data on antibiotic aerosolization to treat ventilator-associated pneumonia. ⋯ Despite recent promising findings, the widespread use of aerosolized antibiotics to treat ventilator-associated pneumonia cannot be recommended. It should be restricted to the treatment of multidrug-resistant Gram-negative ventilator-associated pneumonia.
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This review summarizes recent developments in the diagnosis and treatment of fungal pneumonia, with an emphasis on invasive pulmonary aspergillosis. ⋯ Galactomannan antigen detection is a valuable tool for evaluating patients at risk for invasive aspergillosis (as a screening assay on serum samples from neutropenic patients or as a confirmatory assay on bronchoalveolar lavage fluid samples, in general), but should be used in conjunction with modern imaging techniques. beta-D-Glucan and PCR assays are still investigational. Voriconazole is the drug of choice for invasive aspergillosis, whereas liposomal amphotericin B at 3 mg/kg per day is the preferred alternative in case of contraindication, drug-related side-effects, or intolerance. Whenever possible, optimal antifungal therapy should be complemented by surgical debridement of necrotic tissue. The added value of combination therapy is still unproven. Therapeutic drug monitoring of mold-active azoles should be implemented in order to minimize toxicity and maximize efficacy. Lipid-based formulations of amphotericin B, and to a lesser extent voriconazole, are the drugs of choice for non-Aspergillus related fungal pneumonia. Although active in prophylaxis, the efficacy of posaconazole in confirmed infections remains controversial.
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Largely due to its recognition as a biological threat agent, current knowledge on melioidosis, caused by the Gram-negative bacterium Burkholderia pseudomallei, has increased tremendously over the last years. This review summarizes current understanding on the molecular characterization of B. pseudomallei and the immunology of melioidosis. ⋯ Severe melioidosis can probably be seen as the clinical manifestation of a pathogen recognition receptor mediated dysregulation of the immune response to invading B. pseudomallei. B. pseudomallei employs numerous tactics to evade the immune response. Studies on host-pathogen interactions in melioidosis have identified a whole range of potential new treatment targets.
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Curr. Opin. Infect. Dis. · Apr 2009
ReviewBundles to prevent ventilator-associated pneumonia: how valuable are they?
To review the value of care bundles to prevent ventilator-associated pneumonia (VAP). ⋯ The Ventilator Bundle is an effective method to reduce VAP rates in ICUs. The ventilator bundle should be modified and expanded to include specific processes of care that have been definitively demonstrated to be effective in VAP reduction or a specific VAP bundle created to focus on VAP prevention.