Archive for November 26, 2015

Bloodstream infections in intensive care unit patients: distribution and antibiotic resistance of bacteria.

Infect Drug Resist. 2015 Aug 10;8:287-96.

Russotto V1, Cortegiani A1, Graziano G2, Saporito L2, Raineri SM1, Mammina C2, Giarratano A1.

Author information

1Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy.

2Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo, Palermo, Italy.

Abstract

Bloodstream infections (BSIs) are among the leading infections in critically ill patients. The case-fatality rate associated with BSIs in patients admitted to intensive care units (ICUs) reaches 35%-50%.

The emergence and diffusion of bacteria with resistance to antibiotics is a global health problem. Multidrug-resistant bacteria were detected in 50.7% of patients with BSIs in a recently published international observational study, with methicillin resistance detected in 48% of Staphylococcus aureus strains, carbapenem resistance detected in 69% of Acinetobacter spp., in 38% of Klebsiella pneumoniae, and in 37% of Pseudomonas spp.

Prior hospitalization and antibiotic exposure have been identified as risk factors for infections caused by resistant bacteria in different studies.

Patients with BSIs caused by resistant strains showed an increased risk of mortality, which may be explained by a higher incidence of inappropriate empirical therapy in different studies.

The molecular genetic characterization of resistant bacteria allows the understanding of the most common mechanisms underlying their resistance and the adoption of surveillance measures.

Knowledge of epidemiology, risk factors, mechanisms of resistance, and outcomes of BSIs caused by resistant bacteria may have a major influence on global management of ICU patients.

The aim of this review is to provide the clinician an update on BSIs caused by resistant bacteria in ICU patients.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536838/pdf/idr-8-287.pdf

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November 26, 2015 at 7:43 pm

Ceftobiprole for the treatment of pneumonia: a European perspective.

Drug Des Devel Ther. 2015 Aug 18;9:4565-72.

Liapikou A1, Cillóniz C2, Torres A2.

Author information

16th Respiratory Department, Sotiria Chest Diseases Hospital, Athens, Greece.

2Pulmonology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Spain Insitut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

Abstract

Ceftobiprole, a new broad spectrum, parenteral cephalosporin, exhibits potent in vitro activity against a number of Gram-positive pathogens, including methicillin-resistant Staphylococcus aureus and penicillin-resistant Streptococcus pneumoniae, and Gram-negative pathogens associated with hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP). Ceftobiprole has demonstrated noninferiority in two large-scale pivotal studies comparing it to ceftriaxone with or without linezolid in CAP, with clinical cure rates 86.6% versus 87.4%, or ceftazidime in HAP, with clinical cure rates of 77% versus 76%, respectively. However, ceftobiprole was inferior in the subgroup of patients undergoing mechanical ventilation. Ceftobiprole has so far demonstrated a good safety profile in preliminary studies, with similar tolerability to comparators. The most commonly observed adverse events of ceftobiprole included headache and gastrointestinal upset. It is the first cephalosporin monotherapy approved in the EU for the treatment of both CAP and HAP (excluding ventilator-associated pneumonia).

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547641/pdf/dddt-9-4565.pdf

November 26, 2015 at 7:40 pm

Dalbavancin: A Novel Lipoglycopeptide Antibiotic with Extended Activity Against Gram-Positive Infections.

Infect Dis Ther. 2015 Sep;4(3):245-58.

Smith JR1, Roberts KD2, Rybak MJ3.

Author information

1High Point University School of Pharmacy, 833 Montlieu Avenue, High Point, NC, 27265, USA.

2St. Vincent Indianapolis, 2001 W. 86th Street, Indianapolis, IN, 46260, USA.

3Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, 259 Mack Avenue, Detroit, MI, 48201, USA. m.rybak@wayne.edu

Abstract

Dalbavancin is a lipoglycopeptide antibiotic recently approved by the United States Food and Drug Administration (FDA) for acute bacterial skin and skin structure infections (ABSSSIs). It is active against gram-positive pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), and minimum inhibitory concentrations (MICs) are consistently <0.125 µg/ml, much lower than most other anti-MRSA agents. Dalbavancin possesses an extended half-life of over 1 week, allowing an initial dose of 1000 mg followed by 500 mg 1 week later to complete a course of therapy for ABSSSI. It is approximately 95% protein bound and is widely distributed throughout the body, achieving concentrations similar to plasma levels in numerous tissues. Against MRSA, dalbavancin is 4-8 times more potent than vancomycin in vitro, and limited data suggest it possesses activity against MRSA with reduced susceptibility to vancomycin such as hVISA and VISA. Dalbavancin also possesses in vitro activity against streptococci and enterococci, although activity against vancomycin-resistant enterococci is lacking. In phase 3 ABSSSI studies, dalbavancin demonstrated similar activity to vancomycin and provides a more convenient dosing regimen. Limited phase 2 data suggest dalbavancin also possesses activity in catheter-related bloodstream infections. Potential further therapeutic uses include conditions that require long-term treatment such as osteomyelitis and infective endocarditis, although data are currently lacking. The extended half-life of dalbavancin, along with its in vitro activity against gram-positive organisms with reduced susceptibility to other anti-MRSA antibiotics, suggest it could have an exciting clinical role going forward.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575294/pdf/40121_2015_Article_77.pdf

November 26, 2015 at 7:38 pm


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