Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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BACKGROUND" Fluoroquinolone (FLQ) antibiotics are not uncommonly prescribed for community-acquired pneumonia that is later proven to be pulmonary tuberculosis (TB). Such FLQ monotherapy may result in FLQ-resistant pulmonary TB. ⋯ Outpatient FLQ use, ostensibly for community-acquired pneumonia, is not uncommon among patients with pulmonary TB, especially older patients. Single FLQ prescriptions were not associated with FLQ-resistant M. tuberculosis, whereas multiple FLQ prescriptions were associated with FLQ resistance.
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Staphylococcus aureus is a major cause of bacteremia, and S. aureus bacteremia is associated with higher morbidity and mortality, compared with bacteremia caused by other pathogens. The burden of S. aureus bacteremia, particularly methicillin-resistant S. aureus bacteremia, in terms of cost and resource use is high. ⋯ The incidence of S. aureus bacteremia and its complications has increased sharply in recent years because of the increased frequency of invasive procedures, increased numbers of immunocompromised patients, and increased resistance of S. aureus strains to available antibiotics. This changing epidemiology of S. aureus bacteremia, in combination with the inherent virulence of the pathogen, is driving an urgent need for improved strategies and better antibiotics to prevent and treat S. aureus bacteremia and its complications.
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Editorial Comment
Risk perception and inappropriate antimicrobial use: yes, it can hurt.
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Although influenza vaccine can prevent influenza virus infection, the only therapeutic options to treat influenza virus infection are antiviral agents. At the current time, nearly all influenza A/H3N2 viruses and a percentage of influenza A/H1N1 viruses are adamantane resistant, which leaves only neuraminidase inhibitors available for treatment of infection with these viruses. In December 2008, the Centers for Disease Control and Prevention released new data demonstrating that a high percentage of circulating influenza A/H1N1 viruses are now resistant to oseltamivir. ⋯ Thus, use of monotherapy for influenza virus infection is irrational and may contribute to mutational pressure for further selection of antiviral-resistant strains. History has demonstrated that monotherapy for influenza virus infection leads to resistance, resulting in the use of a new monotherapy agent followed by resistance to that new agent and thus resulting in a background of viruses resistant to both drugs. We argue that combination antiviral therapy, new guidelines for indications for treatment, point-of-care diagnostic testing, and a universal influenza vaccination recommendation are critical to protecting the population against influenza virus and to preserving the benefits of antiviral agents.
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Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital.
Evidence-based guidelines state that asymptomatic bacteriuria is not a clinically significant condition in men and nonpregnant women and that treatment is unlikely to confer clinical benefit. We hypothesized that, among patients with indwelling catheters or condom collection systems, many who receive a diagnosis of and are treated for catheter-associated urinary tract infection (CAUTI) actually have asymptomatic bacteriuria and, therefore, that antibiotic therapy is inappropriate. ⋯ Better recognition of CAABU and the distinction between this condition and CAUTI, consistent with evidence-based guidelines, may play a key role in reducing unneeded antibiotic usage in hospitalized patients.