Infection
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The objective of our study was to evaluate the presence of respiratory symptoms and chronic obstructive pulmonary disease (COPD) in a human immunodeficiency virus (HIV)-infected outpatient population and to further investigate the role of highly active antiretroviral therapy (HAART) and other possibly associated risk factors. ⋯ We evidenced a high prevalence of respiratory symptoms and COPD among HIV-infected patients. HIV infection, current cigarette smoking and previous bacterial pneumonia seem to play a significant role in the development of respiratory symptoms and COPD. Thus, our results suggest that the most at-risk HIV-infected patients should be screened for COPD to early identify those who may need specific treatment.
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This study was designed to compare the efficacy of polymyxin B with other antimicrobials in the treatment of ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT) by Pseudomonas aeruginosa or Acinetobacter baumannii. ⋯ Polymyxin B treatment in the currently recommended dosage may be inferior to other drugs in the treatment of VAP and VAT caused by organisms tested as susceptible in vitro to this agent.
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Clinical patterns of Klebsiella pneumoniae bacteraemia vary geographically. An invasive syndrome involving abscess formation has emerged in recent years. Putative virulence factors associated with this syndrome include colony hypermucoviscosity, and magA and rmpA genes. We studied epidemiologic and microbiologic characteristics of K. pneumoniae bacteraemia at two South Australian hospitals and identified cases of K. pneumoniae invasive syndrome. We determined the frequency of the hypermucoviscosity, magA and rmpA genes among bacteraemic and selected non-bacteraemic isolates. ⋯ This study augments understanding of local epidemiology and microbiology of K. pneumoniae bacteraemia. It confirms local emergence of K. pneumoniae invasive syndrome and implicates the role of magA and rmpA genes in its pathogenesis.
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The overall mortality rate among human immunodeficiency virus (HIV)-infected patients has significantly declined in the era of highly active antiretroviral therapy (HAART). However, little is known about the causes of death for HIV-infected patients who are hospitalized in acute care hospitals. ⋯ The mortality rate in our hospitalized HIV-infected patients remained low. Non-AIDS-related illnesses were the major causes of death, with sepsis being the most common. Low CD4+ T cell count and female sex were associated with deaths due to AIDS-related illness. Poor adherence to HAART was also noted in those patients to whom treatment was offered in the outpatient setting. Further prospective studies are needed in order to better define the epidemiology and outcomes for hospitalized HIV-infected patients in the era of HAART.
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Clinical spectrum and outcome of critically ill patients suffering from prosthetic joint infections.
To report the clinical characteristics and prognosis of prosthetic joint infections (PJIs) in Intensive care units (ICUs). ⋯ In our case series of critically ill patients suffering from PJI, factors associated with a poor outcome were diabetes mellitus, ASA score >3, and acute infection. Surgical strategies and surgical procedures had no significant impact on the ICU mortality. Adjustment of initial antibiotherapy according to previous microbiological findings should be made with caution.