International journal of antimicrobial agents
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Int. J. Antimicrob. Agents · Oct 2004
Experimental sepsis using Pseudomonas aeruginosa: the significance of multi-drug resistance.
In order to clarify whether susceptible and multidrug-resistant Pseudomonas aeruginosa differ in the mechanism of induction of sepsis, three different isolates were used; one susceptible (isolate A) and two (isolates B and C) multidrug-resistant. Isolate B had moderately elevated MICs of antipseudomonal antimicrobials and isolate C highly elevated MICs. Each isolate was infused by a catheter inserted into the right jugular vein of six rabbits. ⋯ The bacterial loads of the liver, lower right lung lobe, spleen and mesenteric lymph nodes were greater after challenge by isolate A than the other isolates. It is concluded that infection by multidrug-resistant P. aeruginosa is accompanied by increased survival compared with infection by susceptible isolates; that finding might be explained by the different mechanisms leading to sepsis. Further studies must be done to clarify the significance of these observations for therapeutics.
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Int. J. Antimicrob. Agents · Sep 2004
ReviewCatheter-associated urinary tract infections: diagnosis and prophylaxis.
Catheter-associated urinary tract infections (CAUTI) are the commonest nosocomial infections worldwide. While they are often asymptomatic and frequently cost less than nosocomial surgical site infections or nosocomial pneumonia, they are major reservoirs of antimicrobial resistant pathogens. Numerous strategies have been devised in an attempt to reduce the incidence of CAUTI but few have proven effective. Novel technologies such as the potential use of antiseptic or antimicrobial coatings on catheters hold promise for possibly reducing these infections in the fight against antimicrobial resistance.
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Int. J. Antimicrob. Agents · Aug 2004
Randomized Controlled Trial Comparative Study Clinical TrialComparative randomized pilot study of azithromycin and doxycycline efficacy in the treatment of prostate infection caused by Chlamydia trachomatis.
The study included 125 adult patients (> 18years of age) who had symptoms of chronic prostatitis and proven presence of Chlamydia trachomatis. The presence of C. trachomatis was confirmed in expressed prostatic secretion or in voided bladder urine collected immediately after prostatic massage by a DNA/RNA hybridization method and/or by isolation on McCoy culture and then by immunofluorescent typing with monoclonal antibodies. ⋯ Clinical and bacteriological efficacy was evaluated 4-6 weeks after the end of therapy. In the group of patients with chlamydial infection of the prostate, there was no significant difference between the eradication rates (azithromycin 65/82, doxycycline 33/43; P = 0.82) and the clinical cure rates (azithromycin 56/82, doxycycline 30/43; P = 0.94) of the two antimicrobials.
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Int. J. Antimicrob. Agents · Aug 2004
Clinical TrialEvaluation of genetic determinants involved in beta-lactam- and multiresistance in a surgical ICU.
Antibiotic resistance is a major and well-known problem in intensive care units (ICUs) world-wide and previously susceptible isolates become resistant through the acquisition of resistance determinants from other bacteria or the development of mutations, as is the case in beta-lactam resistance. We evaluated the presence of resistance determinants involved in beta-lactam resistance and multi-resistance in order to establish the contribution of horizontal gene transfer to the spread of resistance in a surgical ICU during an antibiotic rotation study. Pseudomonas aeruginosa and Enterobacteriaceae isolates were selected and iso-electric focusing (IEF), DNA-typing methods such as specific beta-lactamase and specific integron PCRs were performed to determine the presence of beta-lactamases. ⋯ The integrase PCR was positive for only five isolates from three patients and conserved segment PCR showed integrons of variable sizes (700, 900, 1,400 and 1,500 bp). Each patient had its own integron types. It can be concluded that integrons and associated resistance determinants played only a minor role in the surgical ICU and beta-lactam resistance among P. aeruginosa isolates was most likely due to the derepression of its AmpC gene.
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Int. J. Antimicrob. Agents · Jul 2004
ReviewClarithromycin in 2003: sustained efficacy and safety in an era of rising antibiotic resistance.
Data from surveillance studies show increasing prevalence of respiratory pathogens resistant to commonly used antibiotics. Thus, a Medline search was conducted to identify studies of clarithromycin, especially those addressing macrolide resistance. ⋯ The incidence of clarithromycin treatment failure in patients infected with Streptococcus pneumoniae is substantially less than that predicted by macrolide resistance rates from surveillance programmes. In summary, despite widespread use since its introduction, clarithromycin remains active both in vitro and in vivo against clinically relevant respiratory tract pathogens.