Current opinion in infectious diseases
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Curr. Opin. Infect. Dis. · Jun 2008
ReviewEffectiveness of impregnated central venous catheters for catheter related blood stream infection: a systematic review.
Clinicians need information on the relative effectiveness of different types of impregnated central venous catheter for serious infection and their relative costs and adverse effects in order to decide which type, if any, to use. ⋯ The most promising options for reducing catheter-related blood stream infection are heparin-coated or antibiotic-impregnated central venous catheters. Large, high-quality randomized controlled trials are needed to evaluate which of these methods is most effective for reducing clinically important consequences of catheter-associated infection.
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Curr. Opin. Infect. Dis. · Apr 2008
ReviewCommunity-associated methicillin-resistant Staphylococcus aureus skin infections: advances toward identifying the key virulence factors.
In recent years there has been an increase in the incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in healthy individuals, the cause of which is largely unknown. CA-MRSA primarily causes skin and soft-tissue infections but certain strains are also associated with unusually severe pathology. The purpose of this review is to provide a critical analysis of our current knowledge of virulence factors contributing to skin and soft-tissue infections caused by CA-MRSA. ⋯ Although we have only a cursory understanding of the molecular mechanisms of CA-MRSA virulence, studies using clinically relevant CA-MRSA isolates are beginning to identify virulence determinants specific to this pathogen. Identifying CA-MRSA virulence determinants and the concerted regulation of these factors will foster development of vaccines and therapeutics designed to control CA-MRSA skin infections.
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The aim of this article is to review relevant studies on the topic of selective decontamination of the digestive tract published in 2006 and 2007. ⋯ The evidence that selective decontamination of the digestive tract improves patient outcome in mixed ICU patients is still based upon meta-analysis and two single centre studies in MRSA-naïve settings. Larger and preferably multicentre studies are needed to confirm these observations. Further remaining questions are whether oropharyngeal decontamination alone is as effective as the full selective decontamination of the digestive tract regimen and whether selective decontamination could be applied successfully in settings with high levels of antibiotic resistance.
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Curr. Opin. Infect. Dis. · Apr 2008
ReviewSerum markers in community-acquired pneumonia and ventilator-associated pneumonia.
This article reviews recent data on the usefulness of serum markers in community-acquired pneumonia and ventilator-associated pneumonia. The focus is on clinical studies, with an emphasis on adult critically ill patients. ⋯ Serum markers should only be used as a complementary tool to support the current clinical approach. Use of serum markers, in particular procalcitonin and C-reactive protein, represents a promising strategy in the clinical decision-making process in patients in whom pneumonia is suspected. Specifically, these markers can be used to guide culture sampling and empirical antibiotic prescription, and to monitor the clinical course, adjust the duration of antibiotic therapy and identify nonresponders, in whom an aggressive diagnostic and therapeutic approach may prevent further clinical deterioration.
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Curr. Opin. Infect. Dis. · Apr 2008
ReviewDiagnosis of ventilator-associated pneumonia: is there a gold standard and a simple approach?
Diagnosis of ventilator-associated pneumonia remains controversial. Different approaches are advocated, but none has yet demonstrated superiority. Diagnosis based on clinical data and aetiological diagnosis of ventilator-associated pneumonia episodes are two concepts that should be combined in an integrative evaluation for ventilator-associated pneumonia. Recent findings in diagnosis are reviewed here. ⋯ Microbiological data should always be used in association with clinical data when assessing patients with suspected ventilator-associated pneumonia. Integration of these data might be the most simple and effective strategy for diagnosing ventilator-associated pneumonia.