Archive for October 24, 2016

Advances in the prevention, management, and treatment of community-acquired pneumonia.

F1000Res. 2016 Mar 8;5.

Pletz MW1, Rohde GG2, Welte T3, Kolditz M4, Ott S5.

Author information

1Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.

2Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.

3Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands.

4Division of Pulmonology, University Hospital Carl Gustav Carus, Dresden, Germany.

5Department of Pulmonary Medicine, Inselspital, University Hospital, Bern, Switzerland.


Community-acquired pneumonia (CAP) is the infectious disease with the highest number of deaths worldwide. Nevertheless, its importance is often underestimated.

Large cohorts of patients with CAP have been established worldwide and improved our knowledge about CAP by far.

Therefore, current guidelines are much more evidence-based than ever before.

This article discusses recent major studies and concepts on CAP such as the role of biomarkers, appropriate risk stratification to identify patients in need of hospitalisation or intensive care, appropriate empiric antibiotic therapy (including the impact of macrolide combination therapy and antibiotic stewardship), and CAP prevention with novel influenza and pneumococcal vaccines.


October 24, 2016 at 8:48 am

Methicillin-resistant S. aureus (MRSA), extended-spectrum (ESBL)- and plasmid-mediated AmpC ß-lactamase -producing Gram-negative bacteria associated with skin and soft tissue infections in hospital and community settings.

Med Glas (Zenica). 2015 Aug;12(2):157-68.

Uzunović S1, Bedenić B2, Budimir A3, Ibrahimagić A1, Kamberović F4, Fiolić Z5, Rijnders MI6, Stobberingh EE6.

Author information

1Department of Laboratory Diagnostics, Cantonal Public Health Institute of Zenica-Doboj Canton; Bosnia and Herzegovina.

2School of Medicine, University of Zagreb, Department of Molecular Microbiology, Clinical Hospital Center Zagreb; Croatia.

3Department of Molecular Microbiology, Clinical Hospital Center Zagreb; Croatia.

4Microbiology Department, Biotechnical Faculty, University of Ljubljana, Slovenia.

5Department of Surgery, Clinical Hospital Center Zagreb, Croatia.

6Department of Medical Microbiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Mastricht, The Netherlands.



To investigate the characteristics of meticillin-resistant S. aureus (MRSA), extended-spectrum (ESBL), and plasmid-mediated AmpC beta-lactamase producing Gram-negative bacteria causing skin and soft tissue infections (SSTIs) in hospital and outpatient settings of Zenica-Doboj Canton, Bosnia and Herzegovina.


Antibiotic susceptibility was determined by disc-diffusion and broth microdillution methods according to CLSI guidelines. MecA gene was detected by PCR, and genetic characterization of MRSA was performed using spa-typing and the algorithm based upon repeat patterns (BURP). Double-disk-synergy test was used to screen for ESBLs. PCR was used to detect blaESBL alleles. Genetic relatedness of the strains was tested by PFGE.


Seventeen in-patients with MRSA, 13 with ESBL-producing Gram-negative bacteria and three patients co-infected with both, were detected. Five MRSA and 16 ESBL-producing Gram-negative bacteria were found in outpatient samples. Klebsiella spp. was isolated in 11 in- and seven outpatients. MLST CC152 was the most prevalent MRSA. Seven (38.9%) Klebsiella spp. yielded amplicons with primers specific for SHV, TEM-1 and CTX-M group 1 β-lactamases. Eight K. pneumonia (44.4%) and 16 (64%) MRSA (including the in- and outpatient) strains were clonally related.


The presence of MRSA and ESBL-producing organisms causing SSTIs in the community poses a substantial concern, due to the high morbidity and mortality associated with possible consequent hospital infections.


October 24, 2016 at 8:46 am

Healthcare-Associated Methicillin-Resistant Staphylococcus aureus: Clinical characteristics and antibiotic resistance profile with emphasis on macrolide-lincosamide-streptogramin B resistance.

Sultan Qaboos Univ Med J. 2016 May;16(2):e175-81.

Kumari J1, Shenoy SM1, Baliga S1, Chakrapani M2, Bhat GK1.

Author information

1Departments of Microbiology, Kasturba Medical College, Mangalore, India.

2Medicine, Kasturba Medical College, Mangalore, India.



Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen worldwide and its multidrug resistance is a major concern. This study aimed to determine the clinical characteristics and antibiotic susceptibility profile of healthcare-associated MRSA with emphasis on resistance to macrolide-lincosamide-streptogramin B (MLSB) phenotypes and vancomycin.


This cross-sectional study was carried out between February 2014 and February 2015 across four tertiary care hospitals in Mangalore, South India. Healthcare-associated infections among 291 inpatients at these hospitals were identified according to the Centers for Disease Control and Prevention guidelines. Clinical specimens were collected based on infection type. S. aureus and MRSA isolates were identified and antibiotic susceptibility tests performed using the Kirby-Bauer disk diffusion method. The minimum inhibitory concentration of vancomycin was determined using the Agar dilution method and inducible clindamycin resistance was detected with a double-disk diffusion test (D-test).


Out of 291 healthcare-associated S. aureus cases, 88 were MRSA (30.2%). Of these, 54.6% were skin and soft tissue infections. All of the isolates were susceptible to teicoplanin and linezolid. Four MRSA isolates exhibited intermediate resistance to vancomycin (4.6%). Of the MRSA strains, 10 (11.4%) were constitutive MLSB phenotypes, 31 (35.2%) were inducible MLSB phenotypes and 14 (15.9%) were macrolide-streptogramin B phenotypes.


Healthcare-associated MRSA multidrug resistance was alarmingly high. In routine antibiotic susceptibility testing, a D-test should always be performed if an isolate is resistant to erythromycin but susceptible to clindamycin. Determination of the minimum inhibitory concentration of vancomycin is necessary when treating patients with MRSA infections.


October 24, 2016 at 8:44 am


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