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Critical ill and resistency

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https://www.readbyqxmd.com/read/28911043/multidrug-resistant-candida-epidemiology-molecular-mechanisms-and-treatment
#1
Maiken Cavling Arendrup, Thomas F Patterson
Invasive Candida infections remain an important cause of morbidity and mortality, especially in hospitalized and immunocompromised or critically ill patients. A limited number of antifungal agents from only a few drug classes are available to treat patients with these serious infections. Resistance can be either intrinsic or acquired. Resistance mechanisms are not exchanged between Candida; thus, acquired resistance either emerges in response to an antifungal selection pressure in the individual patient or, more rarely, occur due to horizontal transmission of resistant strains between patients...
August 15, 2017: Journal of Infectious Diseases
https://www.readbyqxmd.com/read/28906047/a-systematic-review-to-explore-influences-on-parental-attitudes-towards-antibiotic-prescribing-in-children
#2
REVIEW
Helen Bosley, Catherine Henshall, Jane V Appleton, Debra Jackson
AIM: To understand the factors influencing parental attitudes towards antibiotic prescribing. BACKGROUND: Overuse of antibiotics and inappropriate prescribing has resulted in rapid development of antimicrobial resistance (AMR), and is significant global threat to patient safety. In Primary Care settings, substantial numbers of antibiotics are prescribed for young children, despite viral nature of illness for which antibiotics are ineffective. Parents, play a vital role in decision making regarding accessing healthcare services and requesting treatment for their children...
September 14, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28905331/antibiotic-distribution-into-cerebrospinal-fluid-can-dosing-safely-account-for-drug-and-disease-factors-in-the-treatment-of-ventriculostomy-associated-infections
#3
Nilesh Kumta, Jason A Roberts, Jeffrey Lipman, Menino Osbert Cotta
Ventriculostomy-associated infections, or ventriculitis, in critically ill patients are associated with considerable morbidity. Efficacious antibiotic dosing for the treatment of these infections may be complicated by altered antibiotic concentrations in the cerebrospinal fluid due to variable meningeal inflammation and antibiotic properties. Therefore, doses used to treat infections with a higher degree of meningeal inflammation (such as meningitis) may often fail to achieve equivalent exposures in patients with ventriculostomy-associated infections such as ventriculitis...
September 13, 2017: Clinical Pharmacokinetics
https://www.readbyqxmd.com/read/28901793/intravenous-fosfomycin-for-the-treatment-of-hospitalized-patients-with-serious-infections
#4
Andrew F Shorr, Jason M Pogue, John F Mohr
With the worldwide increase in the rates of antimicrobial resistance, antimicrobials with novel mechanisms of action are needed to fill a void in the antimicrobial armamentarium. Areas Covered: Intravenous fosfomycin has been studied extensively in a wide variety of infections including cUTI, lower respiratory tract infection, bone and joint infections, endocarditis, meningitis, and bacteremia outside of the United States. This paper reviews the in vitro activity, pharmacokinetic properties, and clinical experience of intravenous fosfomycin in hospitalized patients with serious infections...
September 13, 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28867537/thermal-injury-of-the-skin-induces-g-csf-dependent-attenuation-of-epo-mediated-stat-signaling-and-erythroid-differentiation-arrest-in-mice
#5
John G Noel, Benjamin J Ramser, Jose A Cancelas, Francis X McCormack, Jason C Gardner
Inflammation mediated impairment of erythropoiesis, plays a central role in the development of the anemia of critical illness (ACI). ACI develops despite elevation of endogenous erythropoietin (EPO), does not respond to exogenous EPO supplementation, and contributes significantly to transfusion requirements in burned patients. We have previously reported that the reduction of red blood cell mass in the bone marrow of a burn-injured ACI mouse model is G-CSF dependent. Given that elevated G-CSF levels have also been associated with lower hemoglobin levels and increased transfusion requirements in trauma victims, we postulated that G-CSF mediates post burn EPO resistance...
August 31, 2017: Experimental Hematology
https://www.readbyqxmd.com/read/28866836/colistin-nephrotoxicity-in-the-icu-is-it-different-in-the-geriatric-patients
#6
Burcu Başarık Aydoğan, Fatma Yıldırım, Avşar Zerman, Kamil Gönderen, Melda Türkoğlu, Gülbin Aygencel
OBJECTIVE: Most significant side effect of colistin therapy which is used for the treatment of multi-drug resistant Gram-negative infections is nephrotoxicity. Our aim was to investigate the differences of colistin nephrotoxicity between the geriatric age group (≥65 years) and the younger age group (<65 years) in critically ill medical intensive care unit (ICU) patients. MATERIAL AND METHOD: The medical records of the 76 patients who were taken colistin therapy due to multi-resistant Gram-negative infections between January 2010 and June 2014 in the our medical ICU were retrospectively investigated...
September 2, 2017: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/28856066/estimation-of-time-period-for-effective-human-inhalational-anthrax-treatment-including-antitoxin-therapy
#7
Lewis Rubinson, Alfred Corey, Dan Hanfling
INTRODUCTION: Infrequent natural human inhalational anthrax cases coupled with high bioterrorism risk have brought about use of animal models to serve as the basis for approval of novel treatments. For inhalational anthrax, protective antigen (PA) drives much of the mortality, and raxibacumab, an anti-PA monoclonal antibody, has been approved for therapeutic use using the Animal Rule. Given the paucity of human inhalational anthrax clinical data including PA kinetics, the post-exposure period for effective treatment of human disease remains unknown...
July 28, 2017: PLoS Currents
https://www.readbyqxmd.com/read/28853230/risk-factors-for-multidrug-resistant-gram-negative-infection-in-burn-patients
#8
Mark L Vickers, Joel M Dulhunty, Emma Ballard, Paul Chapman, Michael Muller, Jason A Roberts, Menino O Cotta
BACKGROUND: Infection with multidrug-resistant (MDR) Gram-negative organisms leads to poorer outcomes in the critically ill burn patient. The aim of this study was to identify the risk factors for MDR Gram-negative pathogen infection in critically ill burn patients admitted to a major tertiary referral intensive care unit (ICU) in Australia. METHODS: A retrospective case-control study of all adult burn patients admitted over a 7-year period was conducted. Twenty-one cases that cultured an MDR Gram-negative organism were matched with 21 controls of similar age, gender, burn size and ICU stay...
August 29, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28845295/apoptotic-resistance-of-human-skin-mast-cells-is-mediated-by-mcl-1
#9
Tarek Hazzan, Jürgen Eberle, Margitta Worm, Magda Babina
Mast cells (MCs) are major effector cells of allergic reactions and contribute to multiple other pathophysiological processes. MCs are long-lived in the tissue microenvironment, in which they matured, but it remains ill-defined how longevity is established by the natural habitat, as research on human MCs chiefly employs cells generated and expanded in culture. In this study, we report that naturally differentiated skin MCs exhibit substantial resilience to cell death with considerable portions surviving up to 3 days in the complete absence of growth factors (GF)...
2017: Cell Death Discovery
https://www.readbyqxmd.com/read/28837364/to-which-extent-can-we-decrease-antibiotic-duration-in-critically-ill-patients
#10
José Garnacho-Montero, Angel Arenzana-Seisdedos, Jan De Waele, Marin H Kollef
Inadequate empirical antibiotic therapy is associated with higher mortality in critically ill patients with severe infections. Nevertheless, prolonged duration of antibiotic treatment is also potentially harmful. Development of new infections with more resistant pathogens is one of the arguments against the administration of prolonged courses of antibiotics. Areas covered: We aim to describe the optimal duration of antimicrobial therapy in the most common infections affecting critically ill patients. A literature search was performed to identify all clinical trials, observational studies, meta-analysis, and reviews about this topic from PubMed...
August 24, 2017: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/28820609/cardio-pulmonary-interactions-physiologic-basis-and-clinical-applications
#11
Michael R Pinsky
The hemodynamic effects of ventilation can be grouped into three concepts: 1) spontaneous ventilation is exercise; 2) changes in lung volume alter autonomic tone, pulmonary vascular resistance, and can compress the heart in the cardiac fossa; 3) spontaneous inspiratory efforts decrease intrathoracic pressure (ITP) increasing venous return and impeding left ventricular (LV) ejection; whereas positive pressure ventilation decreases venous return and unloads LV ejection. Spontaneous inspiratory efforts may induce acute LV failure and cardiogenic pulmonary edema...
August 18, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28810235/obesity-as-a-conditioning-factor-for-high-altitude-diseases
#12
Rocío San Martin, Julio Brito, Patricia Siques, Fabiola León-Velarde
Obesity, a worldwide epidemic, has become a major health burden because it is usually accompanied by an increased risk for insulin resistance, diabetes, hypertension, cardiovascular diseases, and even some kinds of cancer. It also results in associated increases in healthcare expenditures and labor and economic consequences. There are also other fields of medicine and biology where obesity or being overweight play a major role, such as high-altitude illnesses (acute mountain sickness, hypoxic pulmonary hypertension, and chronic mountain sickness), where an increasing relationship among these two morbid statuses has been demonstrated...
2017: Obesity Facts
https://www.readbyqxmd.com/read/28803549/comparative-gut-microbiota-and-resistome-profiling-of-intensive-care-patients-receiving-selective-digestive-tract-decontamination-and-healthy-subjects
#13
Elena Buelow, Teresita D J Bello González, Susana Fuentes, Wouter A A de Steenhuijsen Piters, Leo Lahti, Jumamurat R Bayjanov, Eline A M Majoor, Johanna C Braat, Maaike S M van Mourik, Evelien A N Oostdijk, Rob J L Willems, Marc J M Bonten, Mark W J van Passel, Hauke Smidt, Willem van Schaik
BACKGROUND: The gut microbiota is a reservoir of opportunistic pathogens that can cause life-threatening infections in critically ill patients during their stay in an intensive care unit (ICU). To suppress gut colonization with opportunistic pathogens, a prophylactic antibiotic regimen, termed "selective decontamination of the digestive tract" (SDD), is used in some countries where it improves clinical outcome in ICU patients. Yet, the impact of ICU hospitalization and SDD on the gut microbiota remains largely unknown...
August 14, 2017: Microbiome
https://www.readbyqxmd.com/read/28803496/management-of-multidrug-resistant-pseudomonas-aeruginosa-in-the-intensive-care-unit-state-of-the-art
#14
Alberto Enrico Maraolo, Marco Cascella, Silvia Corcione, Arturo Cuomo, Salvatore Nappa, Guglielmo Borgia, Francesco Giuseppe De Rosa, Ivan Gentile
Pseudomonas aeruginosa (PA) is one of the most important causes of healthcare-related infections among Gram-negative bacteria. The best therapeutic approach is controversial, especially for multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains as well as in the setting of most severe patients, such as in the intensive care unit (ICU). Areas covered: This article addresses several points. First, the main microbiological aspects of PA, focusing on its wide array of resistance mechanisms. Second, risk factors and the worse outcome linked to MDR-PA infection...
August 18, 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28789637/perceptions-practices-and-health-seeking-behaviour-constrain-je-aes-interventions-in-high-endemic-district-of-north-india
#15
Sanjay Chaturvedi, Neha Sharma, Manish Kakkar
BACKGROUND: Acute Encephalitis Syndrome (AES) and Japanese Encephalitis (JE) stay as poorly understood phenomena in India. Multiple linkages to determinants such as poverty, socio-economic status, gender, environment, and population distribution, make it a greater developmental issue than just a zoonotic disease. METHODS: A qualitative study was conducted to map knowledge, perceptions and practices of community and health systems level stakeholders. Seventeen interviews with utilizers of AES care, care givers from human and veterinary sectors, Non-governmental Organizations (NGOs), and pig owners and 4 Focused Group Discussions (FGDs) with farmers, community leaders, and students were conducted in an endemic north Indian district-Kushinagar...
August 8, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28779834/inhaled-antibiotics-for-ventilator-associated-infections
#16
REVIEW
Lucy B Palmer
Multidrug-resistant organisms are creating a challenge for physicians treating the critically ill. As new antibiotics lag behind the emergence of worsening resistance, intensivists in countries with high rates of extensively drug-resistant bacteria are turning to inhaled antibiotics as adjunctive therapy. These drugs can provide high concentrations of drug in the lung that could not be achieved with intravenous antibiotics without significant systemic toxicity. This article summarizes current evidence describing the use of inhaled antibiotics for the treatment of bacterial ventilator-associated pneumonia and ventilator-associated tracheobronchitis...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28774702/candida-and-invasive-mould-diseases-in-non-neutropenic-critically-ill-patients-and-patients-with-haematological-cancer
#17
REVIEW
A L Colombo, J N de Almeida Júnior, Monica A Slavin, Sharon C-A Chen, Tania C Sorrell
Critically ill patients and patients with haematological cancer are HIV-negative populations at high risk of invasive fungal infections. In intensive-care units, candidaemia and intra-abdominal candidiasis predominate, but aspergillosis has emerged as a lethal, under-recognised cause of pneumonia. In patients with haematological malignancies or who have undergone stem-cell transplantations, pulmonary disease due to aspergillus and other mould diseases predominate. In this Series paper, we provide an update on risk assessment, new diagnostic strategies, and therapeutic approaches...
July 31, 2017: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/28758623/risk-factors-and-predictors-of-carbapenem-resistant-pseudomonas-aeruginosa-and-acinetobacter-baumannii-mortality-in-critically-ill-bacteraemic-patients-over-a-6-year-period-2010-15-antibiotics-do-matter
#18
Matthaios Papadimitriou-Olivgeris, Fotini Fligou, Anastasia Spiliopoulou, Kyriaki Koutsileou, Fevronia Kolonitsiou, Aikaterini Spyropoulou, Anastasia Zotou, Markos Marangos, Evangelos D Anastassiou, Myrto Christofidou, Iris Spiliopoulou
PURPOSE: Acinetobacter baumannii and Pseudomonas aeruginosa provoke serious infections, especially in intensive care unit (ICU) patients. METHODOLOGY: The risk factors and predictors of mortality for P. aeruginosa (n=84; 46 carbapenem-resistant) and A. baumannii (n=129; all carbapenem-resistant) bloodstream infections (BSIs) in an ICU were evaluated. Antibiotic susceptibility testing was performed using the agar disk diffusion method according to EUCAST guidelines...
July 31, 2017: Journal of Medical Microbiology
https://www.readbyqxmd.com/read/28754148/nosocomial-bacterial-infections-and-their-antimicrobial-susceptibility-patterns-among-patients-in-ugandan-intensive-care-units-a-cross-sectional-study
#19
Peter Agaba, Janat Tumukunde, J V B Tindimwebwa, Arthur Kwizera
BACKGROUND: The intensive care unit (ICU) admits critically ill patients requiring advanced airway, respiratory, cardiac and renal support. Despite the highly-specialized interventions, the mortality and morbidity is still high due to a number of reasons including nosocomial infections, which are the most likely complications in hospitalized patients with the rates being highest among ICU patients. METHODS: In this cross-sectional study of 111 adult patients admitted to 2 of the ICUs in Uganda, we set out to describe the commonest bacterial infections, their antimicrobial susceptibility patterns and factors associated with development of a nosocomial infection...
July 28, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28748088/modeling-risk-for-developing-drug-resistant-bacterial-infections-in-an-mdr-naive-critically-ill-population
#20
Rajiv Sonti, Megan E Conroy, Elena M Welt, Yi Hu, George Luta, Daniel B Jamieson
PURPOSE: To create a model predictive of an individual's risk of developing a de novo multidrug-resistant (MDR) infection while in the intensive care unit (ICU). METHODS: This is a case-control study in which 189 ICU patients diagnosed with their first infection with an MDR organism were compared on the basis of demographic, past medical and clinical variables to randomly selected ICU patients without such an infection, era-matched in a 2:1 ratio. A prediction tool was derived using multivariate logistic regression...
July 2017: Therapeutic Advances in Infectious Disease
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