Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
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Clin. Microbiol. Infect. · Jul 2011
Comparative StudyA prospective comparison of galactomannan in bronchoalveolar lavage fluid for the diagnosis of pulmonary invasive aspergillosis in medical patients under intensive care: comparison with the diagnostic performance of galactomannan and of (1→ 3)-β-d-glucan chromogenic assay in serum samples.
Diagnosis of fungal pneumonia (FP) in critically ill patients is challenging. Circulating biomarkers for the diagnosis of FP have limitations and the combination of different assays in serum samples and directly from the target organ may further improve the diagnosis of FP. We prospectively assessed the diagnostic utility of paired galactomannan (GM) in bronchoalveolar lavage fluid (BAL) and serum GM and (1→3)-β-D-glucan (BG) assays in critically ill patients at risk of FP. ⋯ In one of four proven and one of six probable IA cases, GM in serum remained negative, whereas GM in BAL was positive. In patients with IA, GM (90%) and BG (80%) appeared a mean of 4.3 days (range, 1-10 days) before Aspergillus was cultured. GM detection in BAL appears to improve the diagnosis of IA in critical patients.
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Clin. Microbiol. Infect. · Jul 2011
A multicentre study of antifungal strategies and outcome of Candida spp. peritonitis in intensive-care units.
Information on the species causing Candida peritonitis, their in vitro susceptibility, antifungal strategies in this setting and patient outcome is still scarce. AmarCand was a prospective, non-interventional study in 271 adult intensive-care unit (ICU) patients with proven invasive Candida infection who received systemic antifungal therapy (France, 2005-2006). Of these ICU patients, 93 (median age 65 years, simplified acute physiology score II 52) had Candida peritonitis, including 73 nosocomial peritonitis, 53 concomitant bacterial peritoneal infections and 26 candidaemias. ⋯ In summary, a high proportion of fluconazole-resistant or susceptible dose-dependent strains was cultured. These results confirm the high mortality rates of Candida peritonitis and plead for additional investigation in this population. Antifungal treatment for severe cases of Candida peritonitis in ICU patients remains the standard care.
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Clin. Microbiol. Infect. · Jun 2011
ReviewMolecular epidemiology of multidrug-resistant strains of Mycobacterium tuberculosis.
Genotyping of Mycobacterium tuberculosis has been extensively used for investigating epidemics of multidrug-resistant strains of M. tuberculosis, in order to identify the factors involved in the transmission of such strains and determine effective control programmes to limit their expansion at both the individual and population levels. Here, we review the methods currently used to study the molecular epidemiology of multidrug-resistant M. tuberculosis strains, and the insights provided by these techniques regarding global trends and the transmission dynamics of multidrug-resistant tuberculosis at a world scale.
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Clin. Microbiol. Infect. · Jun 2011
The MRSA-import in ICUs is an important predictor for the occurrence of nosocomial MRSA cases.
Nosocomial infections with methicillin-resistant Staphylococcus aureus (MRSA) account for increased morbidity, mortality and healthcare costs in critically ill patients worldwide. The intensive care unit (ICU) component of the German surveillance system for nosocomial infections (Krankenhaus-Infektions-Surveillance-System, KISS) has been supplemented with a module targeting the surveillance of multiresistant pathogens [Multiresistente Erreger (MRE)-KISS] in order to account for the increasing burden of antibiotic-resistant bacteria. The aim of this study was to assess the association between structural and organizational characteristics of ICUs and the number of nosocomial MRSA cases. ⋯ Multivariable analysis using negative binominal regression models shows that a stay on a medical ICU has a protective effect (incidence rate ratio, 0.42; 95% confidence interval, 0.24-0.74; p = 0.003), whereas the imported MRSA incidence is significantly associated with the number of nosocomial MRSA cases (incidence rate ratio, 1.74; 95% confidence interval, 1.23-2.45; p = 0.002). Structure and process parameters do not show any effect. ICU type and imported MRSA incidence should be considered for benchmarking between hospitals.