Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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The changing prevalence of drug-resistant community-acquired urinary tract infection (UTI) is often attributed to local antimicrobial drug use or prescribing practices. However, recent molecular epidemiologic studies of community-acquired UTI suggest that other factors may play a greater role. ⋯ This study revealed no obvious trend in the prevalence of drug-resistant community-acquired UTI in a single community. Prevalence at any time was influenced by a small number of E. coli clonal groups. This observation suggests that the introduction of strains that are drug resistant into a community plays a greater role in changing the prevalence of drug-resistant UTI than does the drug use or prescribing habits in that community.
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Antimicrobial resistance is frequently associated with clinical use of antibiotics. This close association suggests that efforts to manage our use of these potent agents can have an impact on the prevalence of resistance. Unfortunately, one size does not fit all when considering the response of bacterial pathogens to antimicrobial exposure. ⋯ The simplest approach is to use fewer antibiotics and thereby apply less selective pressure to the prevalent flora. Among available strategies to reduce use, reductions in length of antimicrobial regimens are the safest and are likely to be the most palatable to practicing clinicians. Studies are urgently needed to define minimal lengths of therapy to ensure that efforts at reduced use are safe and effective.
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Recent studies have suggested a link between iron-deficiency anemia and Helicobacter pylori infection. In the current study, strains of H. pylori derived from patients with iron-deficiency anemia showed enhanced Fe ion uptake and Fe ion-dependent rapid growth compared with those from patients with non-iron-deficiency anemia. H. pylori with enhanced Fe ion-uptake ability may be a causative factor for iron-deficiency anemia.
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The increasing prevalence of drug-resistant gram-positive cocci, such as methicillin-resistant Staphylococcus aureus, has underscored the need for new agents for the treatment of this type of infection. Dalbavancin, a new lipoglycopeptide, has the desirable characteristics of increased in vitro activity, compared with vancomycin, for most gram-positive pathogenic bacteria, as well as an extremely long half-life, permitting once-weekly intravenous dosing. ⋯ It has an excellent safety profile in studies to date. Dalbavancin will likely have a significant role in outpatient intravenous therapy for patients with potentially serious drug-resistant gram-positive coccal infections.
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Acute otitis media occurs mostly after upper respiratory tract infection; the causative bacteria are those colonized in the nasopharynx. We studied 709 episodes of upper respiratory tract infection and found that children with no bacteria in the nasopharynx were at low risk for acute otitis media, whereas children with 3 pathogenic bacteria were at the greatest risk.