Current opinion in infectious diseases
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This review describes the most recent advances in the management and prevention of nosocomial pneumonia. The new ATS guidelines in particular are most likely to affect clinical practice outside the USA. ⋯ The updated ATS guidelines will considerably impact clinical approaches to nosocomial and healthcare-related pneumonia. Serial tracheobronchial aspirates can be used to guide selection of antimicrobial treatment in ventilator associated pneumonia. The combination of beta-lactams and aminoglycosides is likely to be abandoned in the future. New potent treatment options for pneumonia due to nonfermenters are urgently needed.
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Curr. Opin. Infect. Dis. · Jun 2006
ReviewNeonatal infection and long-term neurodevelopmental outcome in the preterm infant.
The relationship between infection, the inflammatory response and adverse neurodevelopmental outcome in preterm infants is slowly being elucidated. The developing brain, particularly the periventricular white matter, is vulnerable to cytotoxic and hypoxic/ischemic injury, which places these infants at increased risk for abnormal cognitive and motor functioning. This review summarizes current data evaluating associations between infection and neurodevelopmental outcome in the preterm infant. ⋯ Enhanced understanding of the interaction of infection, inflammation and brain injury will be critical to developing strategies to improve neurodevelopmental outcome in preterm infants.
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Curr. Opin. Infect. Dis. · Apr 2006
ReviewVentilator-associated pneumonia: gearing towards shorter-course therapy.
The studies that are reviewed in this article have all concluded that a shorter duration of antibiotic therapy (7-8 days) may be adequate in the treatment of the majority of patients with ventilator-associated pneumonia, and does not confer an increased incidence of mortality. ⋯ The minimum effective duration of antibiotic therapy, however, remains unclear. Further studies geared towards determining this are needed.
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Curr. Opin. Infect. Dis. · Apr 2006
ReviewAssociated inflammatory response in pneumonia: role of adjunctive therapy with glucocorticoids.
This article reviews the potential use of glucocorticoids as adjunctive therapy in the management of patients with severe bacterial pneumonia or pulmonary infections of other etiologies. ⋯ Although adjunctive treatment with glucocorticoids in severe pneumonia is probably indicated, further randomized clinical trials are urgently needed to confirm the preliminary positive results. In this regard, a proper evaluation of the inflammatory response is likely to be essential for the accurate selection of the target population.
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To analyze the relationships among different Malassezia species and pityriasis versicolor, the only human disease in which the etiologic role of these fungi is fully accepted (although the species implicated remains a matter of discussion). ⋯ Most of the studies published thus far now show that Malassezia globosa is the predominant species found in the lesions of pityriasis versicolor, at least in temperate climates. The authors' recent findings confirm these results. The etiologic role of M. globosa in pityriasis versicolor is based, even more than on its isolation in a high percentage of cultures, on its identification by direct microscopy as typical globose yeast cells producing pseudohyphae in almost 100% of cases. The confirmation of the pathogenic role of this species in pityriasis versicolor could help in understanding these conditions, which are still unclear, which promote its transformation from the saprophytic stage present in healthy skin to the parasitic one, and could also help in selecting the best therapeutic measures.