Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
-
Clin. Microbiol. Infect. · Mar 2009
ReviewEpidemiological and resistance issues in multidrug-resistant staphylococci and enterococci.
The spread of methicillin-resistant Staphylococcus aureus is continuous. The emergence of community-acquired methicillin-resistant S. aureus (CA-MRSA) was rapidly followed by its introduction into and dissemination in hospitals in countries where CA-MRSA prevalence is high. ⋯ Although new antimicrobials have been recently introduced into therapy to fight multidrug-resistant Gram-positive cocci, resistance to these compounds has already emerged in rare strains. This review presents recent data concerning the advance of our knowledge related to these problems.
-
Clin. Microbiol. Infect. · Feb 2009
Chronic antiplatelet therapy and mortality among patients with infective endocarditis.
Whether antiplatelet therapy is associated with better outcomes among patients with infective endocarditis (IE) remains controversial. A retrospective study was conducted concerning all patients with IE, treated in a tertiary-care centre of Canada between 1991 and 2006, who satisfied the modified Duke criteria for a definite or possible IE. The primary outcome was all-cause mortality within 90 days of diagnosis. ⋯ Chronic antiplatelet therapy was not associated with a significantly lower risk of major embolism. In conclusion, chronic antiplatelet therapy was associated with lower mortality among patients with IE, independently of any effect on major embolism. Whether or not a beneficial effect could be replicated by initiating antiplatelet therapy at the time of diagnosis remains unproven.
-
Clin. Microbiol. Infect. · Oct 2008
EditorialAll EU hands to the EU pumps: the Science Academies of Europe (EASAC) recommend strong support of research to tackle antibacterial resistance.
Despite many European Union (EU) conferences on fighting microbial resistance, rates of resistance in Europe continue to increase. Although research is catching up with discovery, the development of new antimicrobials is threatened by economic factors, in particular the need for a return of investment via high-volume sales. The EU should invest in independent research into the economic and business aspects of antibiotic development. Multidisciplinary input from the fields of finance, law, marketing, sociology and psychology will inform a broad agenda for change at the regulatory, academic and commercial levels and identify new options for novel anti-infective research and development, as recently recommended by the Science Academies of Europe (EASAC).
-
Clin. Microbiol. Infect. · Jun 2008
Efficacy of amoxycillin-clavulanate in an experimental model of murine pneumonia caused by AmpC-non-hyperproducing clinical isolates of Escherichia coli resistant to cefoxitin.
The algorithms included in most automated systems used for antimicrobial susceptibility testing (e.g., Vitek 2) consider that Escherichia coli isolates resistant to cefoxitin are AmpC-hyperproducers and, consequently, resistant also to amoxycillin-clavulanate. However, a recent study revealed that 30% of E. coli clinical isolates resistant to cefoxitin remained susceptible in vitro to amoxycillin-clavulanate. The aim of the present study was to evaluate the in-vivo efficacy of amoxycillin-clavulanate in the treatment of an experimental model of pneumonia, using two clonally related isolates (with identical repetitive extragenic palindromic sequence (REP)-PCR patterns) of AmpC-non-hyperproducing and OmpF-lacking E. coli (Ec985 and Ec571) that were resistant to cefoxitin and susceptible to cefotaxime and amoxycillin-clavulanate. ⋯ Amoxycillin, amoxycillin-clavulanate and cefotaxime were bactericidal for Ec985, and amoxycillin-clavulanate and cefotaxime were bactericidal for Ec571 at different concentrations and time-points, as determined using time-kill assays. Treatment with amoxycillin, amoxycillin-clavulanate and cefotaxime reduced the bacterial lung concentration of Ec985 compared with non-treated controls (p <0.05), whereas amoxycillin-clavulanate and cefotaxime showed efficacy against Ec571 when compared with the control and amoxycillin groups (p <0.05). Regardless of the exact underlying mechanism(s) of resistance, amoxycillin-clavulanate was effective in the experimental murine model in the treatment of pneumonia caused by AmpC-non-hyperproducing strains of E. coli resistant to cefoxitin.