Current opinion in infectious diseases
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In the majority of countries costs for health care are increasing and strategies to reduce adverse events in medical treatment have an increasing importance. Nosocomial infection remains the most common type of complication affecting hospitalized patients. As preventive strategies have indeed become more important they now have to show not only that they are effective in reducing nosocomial infections but also that they are cost effective. This paper investigates the contribution made by articles published in the last year to the development of nosocomial-infection surveillance and control policies. ⋯ The predominant opinion voiced in the studies was that in many medical institutions some 30% or more of nosocomial infections could be prevented.
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Extensive reviews of our current understanding of vascular catheter infections have recently been published. This update highlights 22 primary research articles selected from 415 randomized clinical trials and over 2500 other articles on vascular catheter infections published between January 2002 and March 2004. ⋯ Abundant evidence now exists that there are many interventions that can reduce the risk of vascular catheter infections. The next phase of our understanding should include determining how many of these many interventions are necessary and under what circumstances.
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Curr. Opin. Infect. Dis. · Jun 2004
ReviewActivated protein C in sepsis: emerging insights regarding its mechanism of action and clinical effectiveness.
Dysregulation of endogenous coagulant and anticoagulant systems is now believed to play an important role in the pathogenesis of sepsis and septic shock. Reductions in host activated protein C levels and resultant microvascular thrombosis provided a basis for the use of recombinant human activated protein C in sepsis. Although controversial, the findings from an initial phase III trial testing this agent resulted in its approval for use in patients with severe sepsis and high risk of death. This review highlights emerging insights into the biology of protein C and activated protein C in sepsis, summarizes additional analysis growing out of the phase III trial testing recombinant human activated protein C, and assesses the cost-effectiveness that the clinical use of the agent has had thus far. ⋯ The protein C pathway is important both to coagulant and inflammatory pathways during sepsis. Based on emerging investigations, its actions appear to be increasingly complex ones. Despite potentially promising results in an initial phase III trial, the role of recombinant human activated protein C in the treatment of septic patients must continue to be evaluated.
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Curr. Opin. Infect. Dis. · Aug 2003
ReviewInfection in critically ill patients: clinical impact and management.
The aim of this review is to summarize recent developments in the epidemiology, diagnosis and management of infection in critically ill patients. ⋯ Improved characterization of septic patients will help target and monitor new therapies. Newly developed immunomodulatory strategies and others currently undergoing clinical testing will help reduce the high mortality rates seen in this disease
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Curr. Opin. Infect. Dis. · Jun 2003
ReviewTreatment of community-acquired methicillin-resistant Staphylococcus aureus in children.
The concept of methicillin-resistant Staphylococcus aureus (MRSA) associated with broad resistance, nosocomial acquisition, and known risk factors has recently been expanded. A new type of MRSA that is resistant to fewer antibiotics has emerged in pediatric practice since the mid-1990s. These isolates are community acquired and have been reported from diverse geographic regions. Awareness of these organisms is important for appropriate treatment of S. aureus infections in children. ⋯ The appearance of CA-MRSA has important implications for therapy of infections caused by S. aureus in children. Three specific issues are the development of resistance during clindamycin therapy, insufficient data on the use of trimethoprim-sulfamethoxazole in serious CA-MRSA infections, and the appropriate role for newer antibiotics such as linezolid.