Archive for July 3, 2014

Why is mucormycosis more difficult to cure than more common mycoses?

Clinical Microbiology and Infection June 2014 V.20 Suppl S6

Review

A. Katragkou1,2, T. J. Walsh2,3,4 andE. Roilides1,*

1Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration Hospital, Thessaloniki, Greece

2Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medical Center, New York, NY, USA

3Department of Pediatrics, Weill Cornell Medical Center, New York, NY, USA

4Department of Microbiology & Immunology, Weill Cornell Medical Center, New York, NY, USA

* Corresponding author: E. Roilides, 3rd Department of Pediatrics, Hippokration Hospital, Konstantinoupoleos 49, GR-546 42 Thessaloniki, Greece   E-mail: roilides@med.auth.gr

Although considered to be a rare infection, mucormycosis (zygomycosis) has emerged as the second most common invasive mould infection. Despite the advent of newer antifungal agents, mortality rate of mucormycosis remains exceedingly high.

Successful management of mucormycosis requires early diagnosis, reversal of underlying predisposing risk factors, surgical debridement and prompt administration of active antifungal agents.

However, mucormycosis is not always amenable to cure. There are challenging obstacles that lead to difficulties in management of amphotericin B.

These include unique host-based risk factors for mucormycosis, the fungus’ resistance to innate host defences and distinctive features of its immunopathogenesis, such as extensive angioinvasion, increased virulence and use of chelators by the fungus as siderophores.

In addition to these obstacles, the difficulties in early diagnosis, including nonspecific clinical manifestations, lack of serological methods, as well limitations of culture and molecular methods, lead to delay in initiation of antifungal therapy.

Finally, the variability of susceptibility to amphotericin B and resistance to most other conventional antifungal agents leads to major limitations in successful treatment of this devastating infection.

PDF

http://onlinelibrary.wiley.com/doi/10.1111/1469-0691.12466/pdf

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July 3, 2014 at 3:17 pm

Mucormycosis – from the pathogens to the disease

Clinical Microbiology and Infection June 2014 V.20 Suppl S6

Review

U. Binder*, E. Maurer andC. Lass-Flörl

Division of Hygiene and Medical Microbiology, Medical University Innsbruck, Innsbruck, Austria

* Corresponding author: U. Binder, Department of Hygiene, Microbiology and Social Medicine, Division of Hygiene and Medical Microbiology, Medical University Innsbruck, Fritz Pregl Str. 3/3, A-6020 Innsbruck, Tirol, Austria

E-mail: ulrike.binder@i-med.ac.at

Mucormycosis is an emerging fungal infection worldwide, with devastating disease symptoms and diverse clinical manifestations.

The most important underlying risk factors are:

immunosuppression,

poorly controlled diabetes,

iron overload and

major trauma.

The aetiological agents involved in the disease have been re-classified due to changes in taxonomy and nomenclature, which also led to appropriately naming the disease ‘mucormycosis’.

This article shortly explains the new nomenclature, clinical manifestations and risk factors and focuses on putative virulence traits associated with mucormycosis, mainly in the group of diabetic ketoacidotic patients.

PDF

http://onlinelibrary.wiley.com/doi/10.1111/1469-0691.12566/pdf

July 3, 2014 at 3:15 pm

Aerosolized antibiotics – Do they add to the treatment of pneumonia?

Current Opinion in Infectious Diseases Dec 2013 V.26 N.6 P.538–544

Kollef, Marin H.a; Hamilton, Cindy W.b,c; Montgomery, A. Bruced

aVirginia E. and Sam J. Golman Chair in Respiratory Intensive Care Medicine, Washington University School of Medicine, St. Louis, Missouri

bVirginia Commonwealth University School of Pharmacy, Richmond

cPrincipal, Hamilton House, Virginia Beach, Virginia

dCardeas Pharma Corp., Seattle, Washington, USA

Correspondence to Dr Marin Kollef, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052, St. Louis, Missouri 63110, USA. Tel: +1 314 454 8764; e-mail: mkollef@DOM.wustl.edu

Purpose of review

The increasing rate of ventilator-associated pneumonia (VAP) caused by multidrug-resistant pathogens warrants the development of new treatment strategies. Carefully engineered delivery systems are undergoing evaluation to test the hypothesis that aerosolized administration of antibiotics will provide high local concentrations and fast clearance, which in turn may improve efficacy and decrease the risk of microbial resistance.

Recent findings

Recent studies indicate that aerosolized delivery systems for specially formulated antibiotics yield high local concentrations with rapid clearance and low systemic exposure. Preliminary clinical studies reveal that aerosolized delivery of antibiotics is well tolerated and active, when combined with intravenous antibiotics. No single aerosolized antibiotic is likely to provide broad-spectrum activity against both Gram-negative and Gram-positive bacteria.

Summary

Large multicenter trials are needed to determine whether preliminary findings will translate to improved clinical activity and decreased microbial resistance in VAP patients, and to optimize the use of aerosolized antibiotics.

FULL TEXT

http://journals.lww.com/co-infectiousdiseases/Fulltext/2013/12000/Aerosolized_antibiotics___do_they_add_to_the.7.aspx

PDF (CLIC on PDF)

 

July 3, 2014 at 3:10 pm

Back to basics – Hand hygiene and isolation

Current Opinion in Infect Diseases Aug 2014 V.27 N.4 P.379-389

Lin Huang, G. Khaia; Stewardson, Andrew J.a,b,d; Lindsay Grayson, M.a,b,c,d

aDepartment of Infectious Diseases, Austin Hospital

bHand Hygiene Australia

cDepartment of Epidemiology and Preventive Medicine, Monash University, Melbourne

dDepartment of Medicine, University of Melbourne, Victoria, Australia

Correspondence to Prof. M. Lindsay Grayson, MD, FRACP, FAFPHM, FRCP, FIDSA, Infectious Diseases Department, Austin Health, Studley Rd., Heidelberg, VIC 3084, Australia. Tel: +61 3 94966676; fax: +61 3 9496 6677; e-mail: lindsay.grayson@austin.org.au

Purpose of review

Hand hygiene and isolation are basic, but very effective, means of preventing the spread of pathogens in healthcare. Although the principle may be straightforward, this review highlights some of the controversies regarding the implementation and efficacy of these interventions.

Recent findings

Hand hygiene compliance is an accepted measure of quality and safety in many countries. The evidence for the efficacy of hand hygiene in directly reducing rates of hospital-acquired infections has strengthened in recent years, particularly in terms of reduced rates of staphylococcal sepsis. Defining the key components of effective implementation strategies and the ideal method(s) of assessing hand hygiene compliance are dependent on a range of factors associated with the healthcare system. Although patient isolation continues to be an important strategy, particularly in outbreaks, it also has some limitations and can be associated with negative effects. Recent detailed molecular epidemiology studies of key healthcare-acquired pathogens have questioned the true efficacy of isolation, alone as an effective method for the routine prevention of disease transmission.

Summary

Hand hygiene and isolation are key components of basic infection control. Recent insights into the benefits, limitations and even adverse effects of these interventions are important for their optimal implementation.

FULL TEXT

http://journals.lww.com/co-infectiousdiseases/Fulltext/2014/08000/Back_to_basics__hand_hygiene_and_isolation.13.aspx

PDF (CLIC on PDF)

 

July 3, 2014 at 3:07 pm


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