Archive for April 11, 2011

Spondylodiscitis: update on diagnosis and management

Journal of Antimicrobial Chemotherapy  NOV.2010 V.65 N.Suppl.3  P.11-24

Theodore Gouliouris*, Sani H. Aliyu and Nicholas M. Brown

Clinical Microbiology and Public Health Laboratory, Addenbrooke’s Hospital, Cambridge CB2 0QW, UK


Spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, is the main manifestation of haematogenous osteomyelitis in patients aged over 50 years. Staphylococcus aureus is the predominant pathogen, accounting for about half of non-tuberculous cases. Diagnosis is difficult and often delayed or missed due to the rarity of the disease and the high frequency of low back pain in the general population. In this review of the published literature, we found no randomized trials on treatment and studies were too heterogeneous to allow comparison. Improvements in surgical and radiological techniques and the discovery of antimicrobial therapy have transformed the outlook for patients with this condition, but morbidity remains significant. Randomized trials are needed to assess optimal treatment duration, route of administration, and the role of combination therapy and newer agents.



April 11, 2011 at 1:04 pm Leave a comment

Increasing burden of liver disease in patients with HIV infection

LANCET  02 Apr 2011  V.377 N.9772 P.1198 – 1209

Deepak Joshi MRCP a, John O’Grady MD a, Prof Doug Dieterich MD b, Prof Brian Gazzard MD c, Dr Kosh Agarwal MD


Introduction of effective combined antiretroviral therapy has made HIV infection a chronic illness. Substantial reductions in the number of AIDS-related deaths have been accompanied by an increase in liver-related morbidity and mortality due to co-infection with chronic hepatitis B and C viruses. Increases in non-alcoholic fatty liver disease and drug-induced hepatotoxicity, together with development of hepatocellular carcinoma, also potentiate the burden of liver disease in individuals with HIV infection. We provide an overview of the key causes, disease mechanisms of pathogenesis, and recommendations for treatment options including the evolving role of liver transplantation.


April 11, 2011 at 1:02 pm Leave a comment

Viral pneumonia

Lancet 9 April 2011 V.377 N.9773 P.1264 – 1275

Prof Olli Ruuskanen MD a , Elina Lahti MD a, Lance C Jennings PhD b, Prof David R Murdoch MD b


About 200 million cases of viral community-acquired pneumonia occur every year—100 million in children and 100 million in adults. Molecular diagnostic tests have greatly increased our understanding of the role of viruses in pneumonia, and findings indicate that the incidence of viral pneumonia has been underestimated. In children, respiratory syncytial virus, rhinovirus, human metapneumovirus, human bocavirus, and parainfluenza viruses are the agents identified most frequently in both developed and developing countries. Dual viral infections are common, and a third of children have evidence of viral-bacterial co-infection. In adults, viruses are the putative causative agents in a third of cases of community-acquired pneumonia, in particular influenza viruses, rhinoviruses, and coronaviruses. Bacteria continue to have a predominant role in adults with pneumonia. Presence of viral epidemics in the community, patient’s age, speed of onset of illness, symptoms, biomarkers, radiographic changes, and response to treatment can help differentiate viral from bacterial pneumonia. However, no clinical algorithm exists that will distinguish clearly the cause of pneumonia. No clear consensus has been reached about whether patients with obvious viral community-acquired pneumonia need to be treated with antibiotics. Apart from neuraminidase inhibitors for pneumonia caused by influenza viruses, there is no clear role for use of specific antivirals to treat viral community-acquired pneumonia. Influenza vaccines are the only available specific preventive measures. Further studies are needed to better understand the cause and pathogenesis of community-acquired pneumonia. Furthermore, regional differences in cause of pneumonia should be investigated, in particular to obtain more data from developing countries.


April 11, 2011 at 1:00 pm Leave a comment

Colistin-Tobramycin Combinations Are Superior to Monotherapy Concerning the Killing of Biofilm Pseudomonas aeruginosa

Journal of Infectious Diseases 15 Nov  2010  V.202  N.10 P.1585-1592

Gloria Herrmann1, Liang Yang3, Hong Wu4, Zhijun Song4, Hengzhuang Wang4, Niels Høiby4, Martina Ulrich1, Søren Molin3, Joachim Riethmüller2 and Gerd Döring1

1Institute of Medical Microbiology and Hygiene, Tübingen, Germany

2Childrens Hospital, Universitätsklinikum, University of Tübingen, Tübingen, Germany

3Department of Systems Biology, Technical University of Denmark, Lyngby

4Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark



Antibiotic combination therapy might be more efficient than single antibiotics to combat Pseudomonas aeruginosa biofilms in the airways of patients with cystic fibrosis. We tested the ability of colistin sulphate-tobramycin combinations and single antibiotics to kill P. aeruginosa biofilms.


P. aeruginosa biofilms were generated in vitro and in rat lungs. In a pilot study, 5 patients with cystic fibrosis inhaled colistin and then tobramycin for 4 weeks. The changes in P. aeruginosa counts and lung function were assessed before and after therapy.


Antibiotic combination therapy significantly reduced the number of P. aeruginosa cells in P. aeruginosa biofilm models in vitro. When rats were challenged with 1 × 107 cfu of P. aeruginosa, which was embedded in alginate beads, mortality rates, lung pathologic findings, and bacterial colony-forming unit counts were significantly lower after 7 days in animals receiving antibiotic combination than in animals receiving single antibiotics. In patients with cystic fibrosis, inhaled colistin-tobramycin was well tolerated and resulted in a mean decrease of 2.52 ± 2.5 log10 cfu of P. aeruginosa per milliliter of sputum (P = .027). Measurements of forced expiratory volume in 1 s, obtained both before and after the study, did not differ significantly.


Colistin-tobramycin combinations are more efficient than respective single antibiotics for killing P. aeruginosa in biofilms in vitro, and they significantly reduced P. aeruginosa cell counts in a rat lung infection model and in patients with cystic fibrosis.


April 11, 2011 at 12:57 pm Leave a comment


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