Archive for August 15, 2015

Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management.

Infect Drug Resist. 2015 Jul 24;8:217-30.

O’Driscoll T1, Crank CW2.

Author information

1Department of Pharmacy Practice, Chicago College of Pharmacy, Downers Grove, IL, USA.

2Pharmacy Services, Rush-Copley Medical Center, Aurora, IL, USA.

Abstract

Since its discovery in England and France in 1986, vancomycin-resistant Enterococcus has increasingly become a major nosocomial pathogen worldwide.

Enterococci are prolific colonizers, with tremendous genome plasticity and a propensity for persistence in hospital environments, allowing for increased transmission and the dissemination of resistance elements.

Infections typically present in immunosuppressed patients who have received multiple courses of antibiotics in the past.

Virulence is variable, and typical clinical manifestations include bacteremia, endocarditis, intra-abdominal and pelvic infections, urinary tract infections, skin and skin structure infections, and, rarely, central nervous system infections.

As enterococci are common colonizers, careful consideration is needed before initiating targeted therapy, and source control is first priority.

Current treatment options including linezolid, daptomycin, quinupristin/dalfopristin, and tigecycline have shown favorable activity against various vancomycin-resistant Enterococcus infections, but there is a lack of randomized controlled trials assessing their efficacy.

Clearer distinctions in preferred therapies can be made based on adverse effects, drug interactions, and pharmacokinetic profiles.

Although combination therapies and newer agents such as tedizolid, telavancin, dalbavancin, and oritavancin hold promise for the future treatment of vancomycin-resistant Enterococcus infections, further studies are needed to assess their possible clinical impact, especially in the treatment of serious infections.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521680/pdf/idr-8-217.pdf

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August 15, 2015 at 8:40 pm

A series of enterococcal brain abscesses.

J Neurosci Rural Pract. 2015 Jul-Sep;6(3):434-7.

Maiti TK1, Nagarathna S2, Kumari HB2, Shukla DP1.

Author information

1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

2Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

Abstract

BACKGROUND:

Neurosurgeons in developing countries come across brain abscess frequently, but Enterococcus as a cause of abscess is rare.

AIMS:

To describe clinical profile and treatment of a series of patients with enterococcal brain abscess.

MATERIALS AND METHODS:

We retrospectively reviewed microbiological records of patients with brain abscess to identify Enterococcus as a causative organism.

RESULTS:

12 patients (nine males) were diagnosed to have enterococcal brain abscess. All were due to E. species.

CONCLUSIONS:

The clinical feature and management are not different from other etiological agents. The prognosis of enterococcal brain abscess is more favourable than bacteremia.

FULL TEXT

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4481809/

August 15, 2015 at 8:38 pm

Daptomycin vs linezolid for treatment of VRE  bacteremia – Systematic review and meta-analysis.

BMC Infect Dis. 2014 Dec 13;14:687.

Chuang YC, Wang JT1, Lin HY, Chang SC.

Author information

1Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan. 14bcr@yahoo.com.tw

Abstract

BACKGROUND:

Linezolid, which has bacteriostatic activity, is approved for the treatment of vancomycin-resistant enterococci (VRE) infections. Meanwhile, daptomycin exerts bactericidal activity against VRE, but is not approved for the treatment of VRE bacteremia. Only a few studies with small sample sizes have compared the effectiveness of these drugs for treatment of VRE bacteremia.

METHODS:

PubMed, EMBASE, and the Cochrane Library were searched for studies of VRE bacteremia treatment published before January 1, 2014. All studies reporting daptomycin and linezolid treatment outcomes simultaneously were included. The endpoints were mortality and microbiological cure. The adjusted odds ratios (aORs) of mortality in daptomycin- and linezolid-treated patients were extracted if available. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for all outcomes using a random-effects model.

RESULTS:

Thirteen studies (532 patients receiving daptomycin, 656 patients receiving linezolid) met the selection criteria. All studies had retrospective cohort designs and relatively small sample sizes. Eight studies compared the aORs of mortality in daptomycin- and linezolid-treated patients. Four studies were published as conference papers and there was significant heterogeneity among these studies (I2=63%, p=0.04). Daptomycin use was not associated with better microbiological cure (daptomycin vs. linezolid, OR: 0.67, 95% CI: 0.42-1.06, p=0.09). However, mortality was higher in patients receiving daptomycin (OR: 1.43, 95% CI: 1.09-1.86, p=0.009). Subgroup analysis of studies that reported aORs indicated that daptomycin was associated with higher mortality (OR: 1.59, 95% CI: 1.02-2.50, p=0.04). There was no evidence of publication bias, but all enrolled studies were retrospective, had small sample sizes, and had substantial limitations.

CONCLUSIONS:

Although limited data is available, the current meta-analysis shows that linezolid treatment for VRE bacteremia was associated with a lower mortality than daptomycin treatment. However, the results should be interpreted cautiously because of limitations inherent to retrospective studies and the high heterogeneity among studies. A large randomized trial is needed to confirm the present results.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269951/pdf/12879_2014_Article_687.pdf

August 15, 2015 at 8:36 pm

Extrapulmonary pneumocystosis: a case report.

Rev Chilena Infectol. 2015 Jun;32(3):344-9.

Article in Spanish

Valdebenito C, Bonacic M, Matamala J, Wolff M.

Abstract

We report a case of a middle-age male patient, with newly HIV infection in AIDS stage diagnosis, no comorbitidies, who was hospitalized for subacute malaise, fever, self-limited unproductive cough and no bloody chronic diarrea.

The diagnosis of Pneumocystis jiroveci pneumonia was performed by imagenological suspicion and stains of cysts of this pathogen with bronchoalveolar lavage samples.

Treatment was initiated with oral cotrimoxazole and starting HAART with good clinical outcome. Concomitantly, an etiologic study was conducted for chronic diarrhea and through histopathological examination of colonic mucosa, numerous extracellular cystic structures Pneumocystis characteristics were observed, performing the diagnosis of extrapulmonary pneumocystosis.

Extrapulmonary pneumocystosis is a rare cause of P. jiroveci infection, requires a high index of suspicion and should be approached in HIV patients with severe AIDS which is common in co-infection of various infections and is peremptory to make an etiologic diagnosis and early treatment.

PDF

http://www.scielo.cl/pdf/rci/v32n3/art15.pdf

August 15, 2015 at 5:33 pm

Extra-pulmonary Pneumocystis jiroveci infection: a case report.

Braz J Infect Dis. 2014 Nov-Dec;18(6):681-5.

Karam MB1, Mosadegh L2.

Author information

1Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: bestlala@yahoo.com

Abstract

In physical examination abdominal tenderness, gate disturbance and penile herpetic lesions were detected. Decreased disc height at T11-T12 level was detected in chest X-ray.

Abdominal sonography and CT scan revealed hypo dense lesions in Lt left Lobe of liver and multiple hypo dense splenic and pancreatic lesions, ascitis, Lt left sided pleural effusion, thickening of jejuneal mucosa and edema of bowel wall.

Vertebral body lesion and paravertebral abscess, bony calvarial involvement and adjacent extra axial brain lesion were observed in imaging were other findings.

RNA analysis for HIV was positive. Vertebral lesion biopsy and aspiration of splenic lesion were performed and pathology revealed Pneumocystis jirovecii suggestive of extra pulmonary Pneumocystis carinii infection.

PDF

http://ac.els-cdn.com/S1413867014001366/1-s2.0-S1413867014001366-main.pdf?_tid=a7c3f32a-4388-11e5-8d59-00000aacb362&acdnat=1439669171_5f7a9b7846106c600fbf2b6f0953e22e

August 15, 2015 at 5:32 pm

Pregnancy and susceptibility to infectious diseases.

Infect Dis Obstet Gynecol. 2013;2013:752852.

Sappenfield E1, Jamieson DJ, Kourtis AP.

Author information

1Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.

Abstract

To summarize the literature regarding susceptibility of pregnant women to infectious diseases and severity of resulting disease, we conducted a review using a PubMed search and other strategies. Studies were included if they reported information on infection risk or disease outcome in pregnant women.

In all, 1454 abstracts were reviewed, and a total of 85 studies were included. Data were extracted regarding number of cases in pregnant women, rates of infection, risk factors for disease severity or complications, and maternal outcomes.

The evidence indicates that pregnancy is associated with increased severity of some infectious diseases, such as influenza, malaria, hepatitis E, and herpes simplex virus (HSV) infection (risk for dissemination/hepatitis); there is also some evidence for increased severity of measles and smallpox.

Disease severity seems higher with advanced pregnancy. Pregnant women may be more susceptible to acquisition of malaria, HIV infection, and listeriosis, although the evidence is limited. These results reinforce the importance of infection prevention as well as of early identification and treatment of suspected influenza, malaria, hepatitis E, and HSV disease during pregnancy.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3723080/pdf/IDOG2013-752852.pdf

August 15, 2015 at 5:29 pm

Editorial commentary: Measles in pregnancy is not child’s play.

Clin Infect Dis. 2014 Apr;58(8):1093-4.

Brunell PA1.

Author information

1Formerly of the Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.

PDF

http://cid.oxfordjournals.org/content/58/8/1093.full.pdf+html

August 15, 2015 at 5:27 pm


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