Archive for October 20, 2016

Mycoplasma pneumoniae: Current Knowledge on Macrolide Resistance and Treatment.

Front Microbiol. 2016 Jun 22;7:974.

Pereyre S1, Goret J1, Bébéar C1.

Author information

1USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, Univ. BordeauxBordeaux, France; USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, INRABordeaux, France; Laboratoire de Bactériologie, Centre Hospitalier Universitaire de BordeauxBordeaux, France.

Abstract

Mycoplasma pneumoniae causes community-acquired respiratory tract infections, particularly in school-aged children and young adults.

These infections occur both endemically and epidemically worldwide. M. pneumoniae lacks cell wall and is subsequently resistant to beta-lactams and to all antimicrobials targeting the cell wall.

This mycoplasma is intrinsically susceptible to macrolides and related antibiotics, to tetracyclines and to fluoroquinolones.

Macrolides and related antibiotics are the first-line treatment of M. pneumoniae respiratory tract infections mainly because of their low MIC against the bacteria, their low toxicity and the absence of contraindication in young children.

The newer macrolides are now the preferred agents with a 7-to-14 day course of oral clarithromycin or a 5-day course of oral azithromycin for treatment of community-acquired pneumonia due to M. pneumoniae, according to the different guidelines worldwide.

However, macrolide resistance has been spreading for 15 years worldwide, with prevalence now ranging between 0 and 15% in Europe and the USA, approximately 30% in Israel and up to 90-100% in Asia.

This resistance is associated with point mutations in the peptidyl-transferase loop of the 23S rRNA and leads to high-level resistance to macrolides.

Macrolide resistance-associated mutations can be detected using several molecular methods applicable directly from respiratory specimens.

Because this resistance has clinical outcomes such as longer duration of fever, cough and hospital stay, alternative antibiotic treatment can be required, including tetracyclines such as doxycycline and minocycline or fluoroquinolones, primarily levofloxacin, during 7-14 days, even though fluoroquinolones and tetracyclines are contraindicated in all children and in children < 8 year-old, respectively.

Acquired resistance to tetracyclines and fluoroquinolones has never been reported in M. pneumoniae clinical isolates but reduced susceptibility was reported in in vitro selected mutants.

This article focuses on M. pneumoniae antibiotic susceptibility and on the development and the evolution of acquired resistance. Molecular detection of resistant mutants and therapeutic options in case of macrolide resistance will also be assessed.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916212/pdf/fmicb-07-00974.pdf

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October 20, 2016 at 3:28 pm

Staphylococcus aureus Toxins and Diabetic Foot Ulcers: Role in Pathogenesis and Interest in Diagnosis.

Toxins (Basel). 2016 Jul 7;8(7).

Dunyach-Remy C1,2, Ngba Essebe C3, Sotto A4,5, Lavigne JP6,7.

Author information

1Institut National de la Santé Et de la Recherche Médicale U1047, Université de Montpellier, UFR de Médecine, Nîmes 30908, France. catherine.remy@chu-nimes.fr

2Service de Microbiologie, Centre Hospitalo-Universitaire Carémeau, Nîmes 30029, France. catherine.remy@chu-nimes.fr

3Institut National de la Santé Et de la Recherche Médicale U1047, Université de Montpellier, UFR de Médecine, Nîmes 30908, France. ngbachristelle@hotmail.fr

4Institut National de la Santé Et de la Recherche Médicale U1047, Université de Montpellier, UFR de Médecine, Nîmes 30908, France. albert.sotto@chu-nimes.fr

5Service des Maladies Infectieuses et Tropicales, Centre Hospitalo-Universitaire Carémeau, Nîmes 30029, France. albert.sotto@chu-nimes.fr

6Institut National de la Santé Et de la Recherche Médicale U1047, Université de Montpellier, UFR de Médecine, Nîmes 30908, France. jean.philippe.lavigne@chu-nimes.fr

7Service de Microbiologie, Centre Hospitalo-Universitaire Carémeau, Nîmes 30029, France. jean.philippe.lavigne@chu-nimes.fr

Abstract

Infection of foot ulcers is a common, often severe and costly complication in diabetes.

Diabetic foot infections (DFI) are mainly polymicrobial, and Staphylococcus aureus is the most frequent pathogen isolated.

The numerous virulence factors and toxins produced by S. aureus during an infection are well characterized. However, some particular features could be observed in DFI.

The aim of this review is to describe the role of S. aureus in DFI and the implication of its toxins in the establishment of the infection.

Studies on this issue have helped to distinguish two S. aureus populations in DFI: toxinogenic S. aureus strains (harboring exfoliatin-, EDIN-, PVL- or TSST-encoding genes) and non-toxinogenic strains.

Toxinogenic strains are often present in infections with a more severe grade and systemic impact, whereas non-toxinogenic strains seem to remain localized in deep structures and bone involving diabetic foot osteomyelitis.

Testing the virulence profile of bacteria seems to be a promising way to predict the behavior of S. aureus in the chronic wounds.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4963842/pdf/toxins-08-00209.pdf

October 20, 2016 at 3:25 pm

Clinical practice of respiratory virus diagnostics in critically ill patients with a suspected pneumonia: A prospective observational study.

J Clin Virol. 2016 Oct;83:37-42.

van Someren Gréve F1, Ong DS2, Cremer OL3, Bonten MJ4, Bos LD5, de Jong MD6, Schultz MJ5, Juffermans NP5; MARS consortium.

Author information

1Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: frankvsg@gmail.com.

2Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: davidsyong@gmail.com.

3Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.

4Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

5Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

6Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Abstract

BACKGROUND:

Clinical guidelines suggest testing for respiratory viruses during the influenza season, but are unclear which categories of patients on the intensive care unit (ICU) should be tested.

OBJECTIVE:

We described the clinical practice of diagnostic testing for respiratory virus infections in patients presenting to ICU with suspected community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP).

STUDY DESIGN:

Prospective observational study in consecutive CAP and HAP patients with an ICU stay of more than 24h in two tertiary care hospitals in The Netherlands, from 2011 to December 2013. The proportion of patients receiving diagnostic testing with PCR for the presence of respiratory viruses in respiratory tract specimens was determined.

RESULTS:

In total, 1452 patients were included, of which 712 patients presented with CAP and 740 with HAP. In CAP, 282 of 712 (40%) were tested for respiratory viruses (190 of 417 (46%) during the influenza season). In HAP, 95 of 740 (13%) were tested (50 of 372 (13%) during the influenza season). Regardless of the season, virus diagnostic tests were ordered significantly more often in patients with comorbidities, and in those presenting with elevated CRP and leucopenia. In patients who were tested during the influenza season, the prevalence of influenza was 14% in patients with CAP and 10% in those with HAP. Influenza was absent during the summer in both groups.

CONCLUSIONS:

Less than half of patients admitted to the ICU with suspected pneumonia were tested for the presence of viral pathogens, either in or outside the influenza season.

PDF

http://www.journalofclinicalvirology.com/article/S1386-6532(16)30498-X/pdf

October 20, 2016 at 8:23 am

Consensus on surgical aspects of managing osteomyelitis in the diabetic foot.

Diabet Foot Ankle. 2016 Jul 12;7:30079.

Allahabadi S1, Haroun KB1, Musher DM2, Lipsky BA3,4,5, Barshes NR6.

Author information

1Baylor College of Medicine, Houston, Texas.

2Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas.

3Department of Medicine, University of Washington, Seattle.

4Department of Medicine (Infectious Diseases), University of Geneva, Geneva, Switzerland.

5Department of Medicine, Green Templeton College, University of Oxford, Oxford, United Kingdom.

6Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine / Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; nbarshes@bcm.tmc.edu

Abstract

BACKGROUND:

The aim of this study was to develop consensus statements that may help share or even establish ‘best practices’ in the surgical aspects of managing diabetic foot osteomyelitis (DFO) that can be applied in appropriate clinical situations pending the publication of more high-quality data.

METHODS:

We asked 14 panelists with expertise in DFO management to participate. Delphi methodology was used to develop consensus statements. First, a questionnaire elicited practices and beliefs concerning various aspects of the surgical management of DFO. Thereafter, we constructed 63 statements for analysis and, using a nine-point Likert scale, asked the panelists to indicate the extent to which they agreed or disagreed with the statements. We defined consensus as a mean score of greater than 7.0.

RESULTS:

The panelists reached consensus on 38 items after three rounds. Among these, seven provide guidance on initial diagnosis of DFO and selection of patients for surgical management. Another 15 statements provide guidance on specific aspects of operative management, including the timing of operations and the type of specimens to be obtained. Ten statements provide guidance on postoperative management, including wound closure and offloading, and six statements summarize the panelists’ agreement on general principles for surgical management of DFO.

CONCLUSIONS:

Consensus statement on the perioperative management of DFO were formed with an expert panel comprised of a variety of surgical specialties. We believe these statements may serve as ‘best practice’ guidelines until properly performed studies provide more robust evidence to support or refute specific surgical management steps in DFO.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944594/pdf/DFA-7-30079.pdf

October 20, 2016 at 8:20 am


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