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Find video protocols related to scientific articles indexed in Pubmed.
Hepatitis B vaccine alone or with hepatitis B immunoglobulin in neonates of HBsAg+/HBeAg- mothers: a systematic review and meta-analysis.
J. Antimicrob. Chemother.
PUBLISHED: 11-03-2014
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The cost-effectiveness of augmenting immunization against hepatitis B infection with hepatitis B immunoglobulin (HBIG) remains controversial, particularly for the subpopulation of babies of HBsAg+/HBeAg- mothers that are considered as low-infective. We aimed to evaluate the effectiveness of vaccine alone compared with vaccine plus HBIG for the immunization of babies of HBsAg+/HBeAg- mothers.
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Antistaphylococcal penicillins versus cephalosporins for definitive treatment of meticillin-susceptible Staphylococcus aureus bacteraemia: A systematic review and meta-analysis.
Int. J. Antimicrob. Agents
PUBLISHED: 07-07-2014
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The objective of this study was to assess the comparative effectiveness and safety of antistaphylococcal penicillins (ASPs) and cephalosporins for the definitive treatment of patients with meticillin-susceptible Staphylococcus aureus (MSSA) bacteraemia. PubMed and Scopus electronic databases were searched up to December 2013. All-cause mortality was the primary outcome of interest. A meta-analysis of unadjusted and adjusted data was performed. Seven articles (1643 patients) were included; all but one were retrospective studies, and three of them employed propensity score matching. The studies enrolled primarily adults hospitalised in medical wards for primary or secondary community-acquired, healthcare-associated or nosocomial MSSA bacteraemia. Several ASPs and cephalosporins were compared. Unadjusted 30-day mortality was lower in patients treated with ASPs than in those treated with cephalosporins [risk ratio (RR)=0.62, 95% confidence interval (CI) 0.40-0.98]. Propensity score-adjusted 30-day mortality was not different in patients receiving ASPs or cephalosporins (RR=0.75, 95% CI 0.41-1.39). Substantial heterogeneity and publication bias were found in these analyses. Both unadjusted (RR=0.85, 95% CI 0.54-1.32) and adjusted (RR=1.42, 95% CI 0.22-9.06) 90-day mortality did not differ between patients receiving ASPs or cephalosporins. Limited data regarding adverse events, development of resistance and recurrence were available. In conclusion, the limited available published data derive from retrospective studies and show that there appears to be no statistically significant difference in mortality between ASPs and cephalosporins for the treatment of MSSA bacteraemia.
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Deaths attributable to carbapenem-resistant Enterobacteriaceae infections.
Emerging Infect. Dis.
PUBLISHED: 06-25-2014
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We evaluated the number of deaths attributable to carbapenem-resistant Enterobacteriaceae by using studies from around the world published before April 9, 2012. Attributable death was defined as the difference in all-cause deaths between patients with carbapenem-resistant infections and those with carbapenem-susceptible infections. Online databases were searched, and data were qualitatively synthesized and pooled in a metaanalysis. Nine studies met inclusion criteria: 6 retrospective case-control studies, 2 retrospective cohort studies, and 1 prospective cohort study. Klebsiella pneumoniae was the causative pathogen in 8 studies; bacteremia was the only infection in 5 studies. We calculated that 26%-44% of deaths in 7 studies were attributable to carbapenem resistance, and in 2 studies, which included bacteremia and other infections, -3% and -4% of deaths were attributable to carbapenem resistance. Pooled outcomes showed that the number of deaths was significantly higher in patients with carbapenem-resistant infections and that the number of deaths attributable to carbapenem resistance is considerable.
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Use of Negative-Pressure Wound Therapy in Breast Tissues: Evaluation of the Literature.
Surg Infect (Larchmt)
PUBLISHED: 05-30-2014
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Abstract Background: Negative-pressure wound therapy (NPWT) has been suggetsed to have a positive impact on the healing of sternal or extremity wounds. However, few data deriving from breast surgery have been published. We evaluated the available literature regarding the effectiveness of NPWT systems in the healing of breast tissues. Methods: The PubMed and Scopus databases were searched systematically, and all studies that provided relevant data were considered eligible for inclusion in the review. Twenty studies (154 female patients) met the inclusion criteria (four cohort studies, one case series, and 15 case reports). Results: The NPWT system was used alone in 17 patients and in combination with other techniques in the remaining 137. The lesion was secondary to plastic surgery in 107 women, other operations in 40 women (38 of them for breast cancer), and primary breast infection in seven women. Infections (including necrotizing fasciitis), pyoderma gangrenosum, and necrosis were among the most common complications for which NPWT was used. In total, 150 of 154 patients receiving NPWT healed completely. Two patients died before complete closure for reasons unrelated to the wound, and NPWT failed in two patients who healed later with muscle flap coverage. Conclusion: The scant published evidence suggests that NPWT systems might be useful in the healing of complicated breast wounds. However, larger studies are needed to investigate the effectiveness of this system further before it is established in breast surgery.
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Vacuum-assisted closure versus closure without vacuum assistance for preventing surgical site infections and infections of chronic wounds: a meta-analysis of randomized controlled trials.
Surg Infect (Larchmt)
PUBLISHED: 05-08-2014
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We sought to examine whether vacuum-assisted closure (VAC) is associated with fewer surgical site infections (SSIs) or infections of chronic wounds than other management procedures for surgical wounds.
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Effectiveness and safety of high-dose tigecycline-containing regimens for the treatment of severe bacterial infections.
Int. J. Antimicrob. Agents
PUBLISHED: 01-14-2014
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Here we review the effectiveness and safety of high-dose tigecycline (200mg daily). A systematic search was performed in PubMed and Scopus databases as well as of abstracts presented at scientific conferences. Eight studies (263 patients; 58% critically ill) were included, comprising one randomised controlled trial (RCT), four non-randomised cohorts and three case reports. Klebsiella pneumoniae was the most commonly isolated pathogen (reported in seven studies). In the RCT, response in the clinically evaluable patients was 85.0% (17/20) in the 100mg every 12h (q12h) group and 69.6% (16/23) in the 75mg q12h group (P=0.4). More episodes of diarrhoea, treatment-related nausea and vomiting developed in the high-dose group (14.3% vs. 2.8%, 8.6% vs. 2.8% and 5.7% vs. 2.8%, respectively; P>0.05 for all comparisons). Three (8.6%) and 7 (19.6%) patients died in the 200mg and 150mg daily dose groups, respectively. The cohort studies enrolled patients with severe infections, including ventilator-associated pneumonia and complicated intra-abdominal infections. Mortality with high-dose tigecycline (100mg q12h) in the cohort studies ranged from 8.3% to 26%; mortality in the low-dose groups (50mg q12h) ranged from 8% to 61% and depended on the severity of the underlying infection. There are limited available data regarding the effectiveness and safety of high-dose tigecycline. Most of the data come from critically ill patients with difficult-to-treat infections. Pharmacokinetic/pharmacodynamic properties of tigecycline suggest that high-dose regimens may be more effective than low-dose regimens. Candidates for administration of high-dose tigecycline should be also defined.
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In vitro activity of fosfomycin in combination with linezolid against clinical isolates of methicillin-resistant Staphylococcus aureus.
J. Antibiot.
PUBLISHED: 01-14-2014
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The objective of this paper was to investigate the in vitro effects of fosfomycin combined with linezolid against methicillin-resistant Staphylococcus aureus (MRSA). A total of 102 MRSA isolates isolated from clinical specimens of human infections from three hospitals in China were studied. The microdilution checkerboard method was used to determine whether combinations act synergistically against these isolates. The susceptibility results for fosfomycin and linezolid were interpreted according to the guidelines of the Clinical and Laboratory Standards Institute. Synergy and indifference were defined as a fractional inhibitory concentration index of ?0.5 and >0.5 but ?4, respectively. The combination of fosfomycin and linezolid demonstrated the following interactions: 98.04% (100/102) synergism; 1.96% (2/102) indifference; no antagonism was seen. Thus, the combination between fosfomycin and linezolid shows synergism for most of the MRSA isolates tested in this study. If these findings are confirmed in further in vitro or in vivo studies, the above combination could be tested clinically for difficulty to treat MRSA infections, particularly those warranting prolonged oral therapy.
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Proportion of extended-spectrum ?-lactamase (ESBL)-producing isolates among Enterobacteriaceae in Africa: evaluation of the evidence--systematic review.
J. Antimicrob. Chemother.
PUBLISHED: 01-06-2014
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Extended-spectrum ?-lactamases (ESBLs) have become widespread around the world. We sought to evaluate the proportion of ESBL-producing isolates among Enterobacteriaceae in Africa.
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Determination of MIC distribution of arbekacin, cefminox, fosfomycin, biapenem and other antibiotics against gram-negative clinical isolates in South India: a prospective study.
PLoS ONE
PUBLISHED: 01-01-2014
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To determine the in vitro activity of antibiotics, including arbekacin, cefminox, fosfomycin and biapenem which are all still unavailable in India, against Gram-negative clinical isolates.
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Morbidity and outcomes of foreign travelers in Zakynthos island, Greece: a retrospective study.
PLoS ONE
PUBLISHED: 01-01-2014
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Although there is satisfactory recording of diseases affecting travelers visiting developing countries, little is known regarding morbidity of travelers when visiting developed countries. We sought to evaluate the morbidity of foreign travelers in Zakynthos, a popular Greek island attracting large number of foreign tourists every summer.
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Frequency of the off-label use of monoclonal antibodies in clinical practice: a systematic review of the literature.
Curr Med Res Opin
PUBLISHED: 11-12-2013
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Abstract Background: The monoclonal antibodies represent novel therapeutic options for many clinical entities. This study aimed to study the frequency of the off-label use to total use of different monoclonal antibodies in clinical practice. Methods: This study systematically searched the PubMed and Scopus databases for relevant studies. Results: Fifteen studies were considered eligible for inclusion in this review. Eight of the included studies referred to the off-label use of anti-neoplastic monoclonal antibodies, three referred to immunosuppressive ones, and four to other types of monoclonal antibodies. The most studied anti-neoplastic monoclonal antibody was rituximab; which was prescribed off-label at a frequency varying between 16-75%, mostly for an unapproved diagnosis. Bevacizumab was prescribed off-label for age-related macular degeneration more often than ranibizumab, the approved monoclonal antibody for this condition. Of the immunosuppressive monoclonal antibodies, infliximab was used off-label in an average of 15.4% (range?=?2.8-25%) and adalimumab in 10.5% (range?=?0-15.4% in different years). Conclusion: The frequency of off-label use of different types of monoclonal antibodies varies, but appears to be considerably high for specific monoclonal antibodies or indications. In certain examples, this might reflect implementation into clinical practice of relevant scientific data, albeit not of the strength or quality that suffices for receipt of regulatory approval. In others, it might relate to the sub-optimal effectiveness and considerable toxicity of the conventional therapies. Still, the clinician should bear in mind the potential costs and toxicity that can be associated with off-label use of monoclonal antibodies.
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Antibiotic treatment of infections due to carbapenem-resistant Enterobacteriaceae: systematic evaluation of the available evidence.
Antimicrob. Agents Chemother.
PUBLISHED: 09-30-2013
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Objectives: We sought to evaluate the effectiveness of the antibiotic treatment administered for infections caused by carbapenemase-producing Enterobacteriaceae.Methods: PubMed and Scopus databases were systematically searched. Articles reporting the clinical outcomes of patients infected with carbapenemase-producing Enterobacteriaceae according to the antibiotic treatment administered were eligible.Results: Twenty non-randomized studies comprising 692 patients who received definitive treatment were included. Almost all studies reported on Klebsiella spp. In 8 studies, the majority of infections were bacteremia, while pneumonia and urinary tract infections were the most common infections in 12 studies. In 10 studies, the majority of patients were critically ill. There are methodological issues, including clinical heterogeneity, that preclude the synthesis of the available evidence using statistical analyses including meta-analysis. From the descriptive point of view, among patients who received combination treatment, mortality was up to 50% for tigecycline-gentamicin combination, up to 64% for tigecycline-colistin, and up to 67% for carbapenem-colistin. Among the monotherapy-treated patients, mortality was up to 57% for colistin and up to 80% for tigecycline. Certain regimens were administered to a small number of patients in certain studies. Three studies reporting on 194 critically ill patients with bacteremia showed individually significantly lower mortality in the combination arm compared to the monotherapy arm. In the other studies, no significant difference in mortality was recorded between the compared groups.Conclusion: Combination antibiotic treatment may be considered the optimal option for severely ill patients with severe infections. However, well-designed randomized studies in specific patient populations are needed to further clarify this issue.
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Extended or continuous versus short-term intravenous infusion of cephalosporins: a meta-analysis.
Expert Rev Anti Infect Ther
PUBLISHED: 06-12-2013
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The authors sought to study whether extended or continuous infusion of cephalosporins is associated with better clinical outcomes than short-term infusion. PubMed and Scopus databases were systematically searched. Studies reporting the clinical outcomes of patients receiving extended or continuous infusion (?3 or 24 h, respectively) versus short-term infusion (?1 h) of cephalosporins were considered eligible. Eleven studies (1250 clinically evaluable patients) were included. Clinical cure and mortality were not statistically different between the compared groups (risk ratio: 1.14; 95% CI: 0.94-1.37 and risk ratio: 0.96; 95% CI: 0.80-1.15, respectively). This meta-analysis did not show a difference in clinical cure or mortality regarding extended or continuous versus short-term intravenous infusion of cephalosporins. However, in most of the included studies, patients in the extended/continuous infusion group received a substantially lower total dosage of antibiotic than those in the short-term group for the total duration of treatment.
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Aminoglycoside therapy in infectious diseases.
Expert Opin Pharmacother
PUBLISHED: 06-08-2013
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Aminoglycosides are of the oldest antibiotics. Even though representatives of the class are used in various applications, the use that has established aminoglycosides in medicine is their antimicrobial activity.
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Evaluation of antimicrobial susceptibility of Enterobacteriaceae causing urinary tract infections in Africa.
Antimicrob. Agents Chemother.
PUBLISHED: 05-20-2013
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Our objective was to evaluate the antimicrobial susceptibility of Enterobacteriaceae causing urinary tract infections (UTIs) in adults in Africa. The PubMed database was systematically searched to identify relevant studies published after 2000. Google, World Health Organization, and African Field Epidemiology networks were also searched. Twenty-eight studies, accounting for 381,899 urine isolates from 14 African countries, met the inclusion criteria. Escherichia coli, Klebsiella spp., and Proteus spp. were the most commonly encountered uropathogens. Cefotaxime, imipenem, fosfomycin, and ciprofloxacin were the antibiotics with the highest activity against E. coli isolates from outpatients, with susceptibility being 92 to 99, 100, 100, and 68 to 91%, respectively. The susceptibility among Klebsiella spp. isolates from outpatients varied from 80 to 100% for amikacin and from 53 to 100% for ciprofloxacin, while susceptibility was 74 to 78, 97, and 77% for ciprofloxacin, amikacin, and fosfomycin, respectively, among Klebsiella species isolates from inpatients or patients with hospital-acquired UTIs. With regard to Proteus spp., the highest activity was observed among fluoroquinolones; 71 to 100% of the P. mirabilis isolates were susceptible to ciprofloxacin in four studies, and 74 to 100% of the P. vulgaris isolates were susceptible to ofloxacin in two studies. The currently available evidence suggests that the antimicrobial susceptibility patterns of Enterobacteriaceae uropathogens in African countries were similar to those in countries of southeast Europe. Further original studies are warranted from African countries for which there is limited published data.
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Use of real-time polymerase chain reaction for the diagnosis of Pneumocystis pneumonia in immunocompromised patients: a meta-analysis.
Chin. Med. J.
PUBLISHED: 05-16-2013
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The diagnosis of Pneumocystis pneumonia (PCP) in immunocompromised patients is still challenging today due to the absence of an in vitro culture system and the low diagnostic accuracy of microscopic examinations. Herein, we performed a meta-analysis to evaluate the accuracy of real-time polymerase chain reaction (PCR) in the diagnosis of PCP.
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Evaluation of fosfomycin activity against uropathogens in a fosfomycin-naive population in South India: a prospective study.
Future Microbiol
PUBLISHED: 05-07-2013
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The aim was to evaluate the in vitro activity of fosfomycin against common uropathogens in a fosfomycin-naive population in India.
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A prospective study of characteristics and outcomes of bacteremia in patients with solid organ or hematologic malignancies.
Support Care Cancer
PUBLISHED: 04-11-2013
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To study the epidemiology and outcomes of bacteremia in patients with hematologic or solid organ malignancies cared for at the University Hospital of Heraklion, Greece.
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Antimicrobial activity and clinical effectiveness of sisomicin: an evaluation of the literature (1995-2011).
Expert Rev Anti Infect Ther
PUBLISHED: 04-10-2013
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The authors sought to evaluate whether sisomicin has a place in the current therapeutic armamentarium. PubMed and Scopus databases were systematically searched. Ten cohort studies and 11 case reports and case series were included evaluating, in total, 383 Gram-positive and 83 Gram-negative isolates. Sisomicin was active in vitro against 41% of Enterococcus spp., 97% of Staphylococcus spp. and was the most active in vitro (74%) aminoglycoside against Stenotrophomonas maltophilia isolates in one study. Regarding clinical effectiveness, sisomicin topical cream was effective in all 290 patients with pyoderma in one study, while the intravenous formulation of sisomicin was effective as prophylaxis for the development of postoperative pneumonia in 91% of lung surgery patients in another. In conclusion, sisomicin may be useful against certain pathogens; however, clinical data are scarce. Further studies are needed and may shed additional light in this area.
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Impact of antimicrobial multidrug resistance on inpatient care cost: an evaluation of the evidence.
Expert Rev Anti Infect Ther
PUBLISHED: 03-06-2013
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This article evaluates the in-hospital costs attributable to antimicrobial multidrug resistance, defined as the difference in averaged costs of the patients infected with a multidrug-resistant (MDR) versus a non-MDR organism. PubMed and Scopus databases were searched to identify relevant studies. Twenty four studies were included: four on carbapenem-resistant or MDR Gram negative nonfermenters, eight on extended-spectrum b-lactamase-producing Enterobacteriaceae and 12 on methicillin-resistant Staphylococcus aureus. In two studies on carbapenem-resistant nonfermenters, the attributable mean hospital charges were US$58,457 and 85,299, respectively. The attributable mean total costs were US$4484 in a study referring to MDR Acinetobacter baumannii, while that varied from US$1584 to 30,093 among studies on extended-spectrum b-lactamase-producing Enterobacteriaceae. With respect to methicillin-resistant S. aureus, the attributable mean total costs varied from US$1014 to 40,090. The in-hospital costs attributable to multidrug resistance are alarmingly high, justifying the application of strict infection control measures in medical institutions with increased rate of MDR infections.
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Ertapenem use and antimicrobial resistance to group 2 carbapenems in Gram-negative infections: a systematic review.
Expert Rev Anti Infect Ther
PUBLISHED: 02-23-2013
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The authors sought to evaluate the impact of ertapenem use on the resistance of Gram-negative bacteria (in general and in specific species) to group 2 carbapenems. PubMed and Scopus databases were systematically searched. Eight studies were included; all reported on Pseudomonas aeruginosa and four reported on Enterobacteriaceae. Five studies did not show any difference in group 2 carbapenem resistance for P. aeruginosa, while three reported a significant decline after ertapenem introduction. Three studies did not show any difference in group 2 carbapenem resistance between the compared periods for Enterobacteriaceae and one study did not present a statistical analysis. In conclusion, the currently available data suggest that ertapenem use does not affect the resistance of Gram-negative bacteria to group 2 carbapenems.
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?-Lactam plus aminoglycoside or fluoroquinolone combination versus ?-lactam monotherapy for Pseudomonas aeruginosa infections: a meta-analysis.
Int. J. Antimicrob. Agents
PUBLISHED: 02-12-2013
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The objective of this review was to compare the effectiveness and safety of ?-lactam combined with aminoglycoside or fluoroquinolone with that of ?-lactam monotherapy for the treatment of Pseudomonas aeruginosa infections. We searched Scopus and PubMed databases and synthesised the outcomes of the individual studies in a meta-analysis. Both non-randomised studies and randomised controlled trials (RCTs) that evaluated outcomes of patients with P. aeruginosa infections receiving treatment with ?-lactams alone or in combination with an aminoglycoside or a fluoroquinolone were included. Studies including patients with cystic fibrosis were excluded. Nineteen articles (eight RCTs) were included (1721 patients with P. aeruginosa infections). Patients receiving combination therapy had no difference in mortality compared with patients receiving ?-lactam monotherapy either as definitive (risk ratio=0.97, 95% confidence interval 0.77-1.22) or as empirical treatment (1.02, 0.78-1.34). In the definitive treatment group, no difference in mortality was found between combination therapy and monotherapy for patients with bacteraemia (0.95, 0.67-1.34) or severe infections (0.96, 0.75-1.24). Patients receiving definitive combination therapy had non-significantly higher clinical cure compared with patients receiving ?-lactam monotherapy (1.36, 0.99-1.86). A higher clinical cure rate was observed for patients receiving empirical treatment with combination therapy (1.23, 1.05-1.43). There was no difference in clinical cure either for RCTs (1.29, 0.91-1.83) or for non-randomised studies (1.18, 0.97-1.45). In conclusion, no benefit in mortality was observed in patients receiving combination therapy for P. aeruginosa infections. A well-designed multicentre RCT is warranted to address this important issue.
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The impact of article length on the number of future citations: a bibliometric analysis of general medicine journals.
PLoS ONE
PUBLISHED: 02-06-2013
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The number of citations received is considered an index of study quality and impact. We aimed to examine the factors associated with the number of citations of published articles, focusing on the article length.
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Weight-adjusted versus fixed dose of linezolid for Chinese healthy volunteers of higher and lower body weight: a Phase I pharmacokinetic and pharmacodynamic study.
Expert Opin Investig Drugs
PUBLISHED: 01-30-2013
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The objective was to evaluate the pharmacokinetic and pharmacodynamic properties of a single intravenous fixed dose compared with a weight-adjusted dose of linezolid.
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Understanding of statistical terms routinely used in meta-analyses: an international survey among researchers.
PLoS ONE
PUBLISHED: 01-11-2013
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Biomedical literature is increasingly enriched with literature reviews and meta-analyses. We sought to assess the understanding of statistical terms routinely used in such studies, among researchers.
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Continuous versus Conventional Infusion of Amphotericin B Deoxycholate: A Meta-Analysis.
PLoS ONE
PUBLISHED: 01-01-2013
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Treatment with Amphotericin B (AmB) deoxycholate, which is still used widely, particularly in low-resource countries, has been challenged due to nephrotoxicity. We sought to study whether continuous infusion of AmB deoxycholate reduces nephrotoxicity retaining, however, the effectiveness of the drug.
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Incidence, clinical, microbiological features and outcome of bloodstream infections in patients undergoing hemodialysis.
Int J Med Sci
PUBLISHED: 01-01-2013
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Infection is a common cause of death among hemodialysis patients. The study investigated incidence, risk factors, clinical features and outcome of bloodstream infections (BSIs) in haemodialysis patients.
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MRSA in Africa: filling the global map of antimicrobial resistance.
PLoS ONE
PUBLISHED: 01-01-2013
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We sought to assess the prevalence of methicillin-resistance among Staphylococcus aureus isolates in Africa. We included articles published in 2005 or later reporting for the prevalence of MRSA among S. aureus clinical isolates. Thirty-two studies were included. In Tunisia, the prevalence of MRSA increased from 16% to 41% between 2002-2007, while in Libya it was 31% in 2007. In South Africa, the prevalence decreased from 36% in 2006 to 24% during 2007-2011. In Botswana, the prevalence varied from 23-44% between 2000-2007. In Algeria and Egypt, the prevalence was 45% and 52% between 2003-2005, respectively. In Nigeria, the prevalence was greater in the northern than the southern part. In Ethiopia and the Ivory Coast, the prevalence was 55% and 39%, respectively. The prevalence of MRSA was lower than 50% in most of the African countries, although it appears to have risen since 2000 in many African countries, except for South Africa.
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Trends of mortality due to septicemia in Greece: an 8-year analysis.
PLoS ONE
PUBLISHED: 01-01-2013
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Infectious diseases are among the major causes of death worldwide. We evaluated the trends of mortality due to septicemia in Greece and compared it with mortality due to other infections.
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Impact of vacuum-assisted closure (VAC) therapy on clinical outcomes of patients with sternal wound infections: a meta-analysis of non-randomized studies.
PLoS ONE
PUBLISHED: 01-01-2013
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To examine the impact of VAC therapy on mortality of patients with sternal wound infections after cardiothoracic surgery.
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Pharmacological considerations for the proper clinical use of aminoglycosides.
Drugs
PUBLISHED: 11-17-2011
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Aminoglycosides constitute one of the oldest classes of antimicrobials. Despite their toxicity, mainly nephrotoxicity and ototoxicity, aminoglycosides are valuable in current clinical practice, since they retain good activity against multidrug-resistant Gram-negative pathogens, such as Pseudomonas aeruginosa and Acinetobacter spp. Time-kill studies have shown a concentration-dependent and partially concentration-dependent bacterial killing against Gram-negative and Gram-positive bacteria, respectively. Pharmacodynamic data gathered over recent decades show that the administration of aminoglycosides by an extended-interval dosing scheme takes advantage of the maximum potential of these agents, with the goal of achieving an area under the concentration-time curve (AUC) of 100?mg?·?h/L over 24 hours and a peak plasma drug concentration (C(max)) to minimum inhibitory concentration (MIC) ratio of 8-10. Several clinical conditions that are common in seriously ill patients result in expansion of the extracellular space and can lead to a lower than desirable C(max) with the usual loading dose. Extended-interval dosing schemes allow adequate time to decrease bacterial adaptive resistance, a phenomenon characterized by slow concentration-independent killing. Adaptive resistance is minimized by the complete clearance of the drug before the subsequent dose, thus favouring the extended-interval dosing schemes. The efficacy of these schemes is also safeguarded by the observed post-antibiotic sub-MIC effect and post-antibiotic leukocyte enhancement, which inhibit bacterial regrowth when the serum aminoglycoside levels fall below the MIC of the pathogen. In everyday clinical practice, aminoglycosides are usually used empirically to treat severe sepsis and septic shock while awaiting the results of antimicrobial susceptibility testing. The European Committee on Antimicrobial Susceptibility Testing acknowledges the regimen-dependent nature of clinical breakpoints for aminoglycosides, i.e. of MIC values that classify bacterial isolates into sensitive or resistant, and bases its recommendations on extended-interval dosing. To a large extent, the lack of correlation between in vitro antimicrobial susceptibility testing and clinical outcome is derived from the fact that the available clinical breakpoints for aminoglycosides are set based on mean pharmacokinetic parameters obtained in healthy volunteers and not sick patients. The nephrotoxicity associated with once- versus multiple-daily administration of aminoglycosides has been assessed in numerous prospective randomized trials and by several meta-analyses. The once-daily dosing schedule provides a longer time of administration until the threshold for nephrotoxicity is met. Regarding ototoxicity, no dosing regimen appears to be less ototoxic than another. Inactivation of aminoglycosides inside the bacterial pathogens occurs by diverse modifying enzymes and by operation of multidrug efflux systems, making both of these potential targets for inhibition. In summary, despite their use for several decades, the ideal method of administration and the preferred dosing schemes of aminoglycosides for most of their therapeutic indications need further refinement. Individualized pharmacodynamic monitoring has the potential of minimizing the toxicity and the clinical failures of these agents in critically ill patients.
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Fosfomycin: evaluation of the published evidence on the emergence of antimicrobial resistance in Gram-negative pathogens.
J. Antimicrob. Chemother.
PUBLISHED: 11-16-2011
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Fosfomycin has attracted renewed interest for the treatment of lower urinary tract and even systemic infections caused by Gram-negative pathogens with resistance to traditionally used agents. The main concern regarding the clinical utility of fosfomycin refers to the potential for the emergence of resistance during therapy. In this review, we evaluate the available published evidence regarding the mechanisms and the frequency of in vitro mutational resistance to fosfomycin in Gram-negative pathogens. We also review data regarding the emergence of resistance in clinical studies of fosfomycin therapy in various infectious syndromes and data from studies that evaluate the evolution of fosfomycin resistance over time. There appears to be discordance between the high frequency of mutational resistance to fosfomycin in vitro and the lower extent of this phenomenon in clinical studies. This discordance could at least partly be attributed to a biological cost associated with common mutations that confer resistance to fosfomycin, including decreased growth rate and low adherence to epithelial cells for the resistant mutants. The development of resistance appears to be more frequent both in vitro and in clinical studies for Pseudomonas aeruginosa in comparison with Escherichia coli, whereas relevant data for other Enterobacteriaceae are relatively scarce. The urinary tract seems to provide a favourable environment for the use of fosfomycin with a low associated likelihood for the emergence of resistance, owing to high drug concentrations and acidic pH. Additional data are needed to further clarify the optimal use of fosfomycin for different infectious syndromes caused by contemporary multidrug-resistant pathogens.
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Sutures versus staples for the management of surgical wounds: a meta-analysis of randomized controlled trials.
Am Surg
PUBLISHED: 09-28-2011
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Surgical sutures are conventionally used in skin closure of surgical wounds. Alternative wound closure techniques include staples and adhesive strips. We aimed to evaluate sutures versus staples as methods of surgical wound closure by performing a meta-analysis. We searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials for randomized controlled trials that compared sutures with staples for surgical wound closure. Trials referring to orthopedic operations were excluded. Twenty studies (involving a total of 2111 patients) were included. Five studies referred to obstetrics/gynecological operations, seven to general surgery, four to emergency care treatment, three to head/neck operations, and one to vascular surgery. Regarding the time needed for wound closure, staples were superior to sutures; the mean difference observed between the sutures and staples groups was 5.56 minutes per wound (95% confidence intervals [CI], 0.05 to 11.07). Wound infections were significantly fewer in the staples group compared with the sutures group(s) (12 studies, 1529 patients; odds ratio, 2.06; 95% CI, 1.20 to 3.51). In five studies, the use of staples was associated with significantly more pain compared with sutures. The majority of studies with available relevant data reported nonsignificant differences regarding the cosmetic result and patients satisfaction. Our findings suggest that staples are associated with fewer wound infections compared with sutures in the evaluated types of surgery. However, in a rather limited number of studies, the use of staples was associated with more pain. Further studies incorporating more objective methods for assessment cosmetic and patient satisfaction are required to clarify this issue.
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Adhesive strips for the closure of surgical incisional sites: a systematic review and meta-analysis.
Surg Innov
PUBLISHED: 09-16-2011
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The authors evaluated the available evidence regarding the use of adhesive strips for the management of surgical incisions and compared them with sutures and other closure materials. Study design. Systematic review and meta-analysis of randomized controlled trials (RCTs).
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Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies.
World J Surg
PUBLISHED: 09-14-2011
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Mesh infection, although infrequent, is a devastating complication of mesh hernioplasties. The aim of this study was to systematically review and synthesize the available evidence on risk factors for synthetic mesh infection after hernioplasty. A systematic search was performed in PubMed and Scopus databases. The extracted data were synthesized with the methodology of meta-analysis. We identified six eligible studies that reported on 2,418 mesh hernioplasties. The crude mesh infection rate was 5%. Statistically significant risk factors were smoking (risk ratio [RR] = 1.36 [95% confidence interval (CI): 1.07, 1.73]; 1,171 hernioplasties), American Society of Anesthesiologists (ASA) score ?3 (RR = 1.40 [1.15, 1.70]; 1,682 hernioplasties), and emergency operation (RR = 2.46 [1.56, 3.91]; 1,561 hernioplasties). Also, mesh infections were significantly correlated with patient age (weighted mean difference [WMD] = 2.63 [0.22, 5.04]; 2,364 hernioplasties), ASA score (WMD = 0.23 [0.08, 0.38]; 1,682 hernioplasties), and the duration of the hernioplasty (WMD = 44.92 [25.66, 64.18]; 833 hernioplasties). A trend toward higher mesh infection rates was observed in obese patients (RR = 1.41 [0.94, 2.11]; 2,243 hernioplasties) and in patients operated on by a resident (in contrast to a consultant; RR = 1.18 [0.99, 1.40]; 982 hernioplasties). Mesh infections usually resulted in mesh removal, and common pathogens included Staphylococcus spp., Enterococcus spp., and gram-negative bacteria. Patient age, ASA score, smoking, and the duration and emergency setting of the operation were found to be associated with the development of synthetic mesh infection. The heterogeneity of the available evidence should be taken under consideration. Prospective studies with a meticulous follow-up are warranted to further investigate mesh-related infections.
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In vitro activity of minocycline combined with fosfomycin against clinical isolates of methicillin-resistant Staphylococcus aureus.
J. Antibiot.
PUBLISHED: 07-20-2011
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This study aimed to evaluate the in vitro activity of minocycline combined with fosfomycin against isolates of methicillin-resistant Staphylococcus aureus (MRSA). A total of 87 clinical isolates of MRSA collected from three Chinese hospitals were included in the study. The checkerboard method with determination of the fractional IC index (FICI) was used to determine whether antibiotic combinations act synergistically against these isolates. The susceptibility results for minocycline and fosfomycin were interpreted according to the most relevant criteria. The results demonstrated the following interactions: 76 isolates (87.4%) showed synergistic interactions (FICI?0.5) and 11 isolates (12.6%) showed indifferent interactions (0.5
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Therapeutic options for infections with Enterobacteriaceae producing carbapenem-hydrolyzing enzymes.
Future Microbiol
PUBLISHED: 06-29-2011
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Enterobacteriaceae that produce serine carbapenemases or metallo-?-lactamases, such as KPC, OXA-48, VIM or NDM, respectively, are spreading mostly as nosocomial pathogens worldwide. Such strains are typically resistant to most if not all available antimicrobials. Specific relevant clinical data are scarce to guide the determination of the most appropriate treatment options. Data on antimicrobial susceptibility, resistance development, synergy, pharmacokinetic and pharmacodynamic parameters of the candidate regimens, as well as the experience from the treatment of infections with nonfermenting Gram-negative pathogens, can aid in this regard. Colistin and tigecycline are most likely to be active in vitro against Enterobacteriaceae producing carbapenem-hydrolyzing ?-lactamases, but resistance development is of concern. Individual members of the aminoglycoside class can also be active in vitro, while carbapenems or aztreonam (specifically for metallo-?-lactamase producers) can have low minimum inhibitory concentrations. Current data do not reliably support the use of these agents as monotherapy for systemic infections. Several expanded-spectrum cephalosporins, such as ceftazidime, may be active against OXA-48 type producers. Fosfomycin might be useful as a last-resort option as part of combination regimens. Combination antimicrobial therapy with agents exhibiting synergy might also be of benefit, until novel effective agents could become clinically available.
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Modern technology-assisted vs conventional tonsillectomy: a meta-analysis of randomized controlled trials.
Arch. Otolaryngol. Head Neck Surg.
PUBLISHED: 06-22-2011
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To systematically review evidence regarding modern technology-assisted tonsillectomy pertaining to operative time, intraoperative and postoperative bleeding, postoperative pain, and other outcomes.
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Impact of definitive therapy with beta-lactam monotherapy or combination with an aminoglycoside or a quinolone for Pseudomonas aeruginosa bacteremia.
PLoS ONE
PUBLISHED: 06-17-2011
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Bacteremia by Pseudomonas aeruginosa represents one severe infection. It is not clear whether beta-lactam monotherapy leads to similar rates of treatment success compared to combinations of beta-lactams with aminoglycosides or quinolones.
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Predictors of impaired glucose regulation in patients with non-alcoholic fatty liver disease.
Exp Diabetes Res
PUBLISHED: 06-15-2011
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INTRODUCTION. Many patients with non-alcoholic fatty liver disease (NAFLD) have impaired glucose regulation or type 2 diabetes mellitus (DM). We investigated characteristics of NAFLD patients associated with hyperglycemia. METHODS. During a 2-hour oral glucose tolerance test (OGTT), serum glucose and insulin were measured in 152 NAFLD patients. RESULTS. 48.7% of NAFLD patients had hyperglycemia. Age (odds ratio (OR) = 1.08, 95% confidence interval (CI): 1.03-1.13), body mass index (BMI) (OR = 1.12, 95% CI: 1.01-1.25), and lower high-density lipoprotein cholesterol (HDL-C) (OR = 0.95, 95% CI: 0.92-0.98) proved to be independent predictors of hyperglycemia. After OGTT, 30?min insulin was lower in hyperglycemic patients (74.2 ± 49.7 versus 94.5 ± 53.9??IU/mL, P = 0.02), while 90?min insulin (170.1 ± 84.6 versus 122.9 ± 97.7??U/mL, P = 0.01) and 120?min insulin (164.0 ± 101.2 versus 85.3 ± 61.9??IU/mL, P < 0.01) were higher. CONCLUSIONS. NAFLD patients with higher BMI, lower HDL-C, or older age were more likely to have impaired glucose metabolism. An OGTT could be of value for early diagnosis of DM among this population.
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Acute Tc-99m DMSA scan for identifying dilating vesicoureteral reflux in children: a meta-analysis.
Pediatrics
PUBLISHED: 06-13-2011
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Controversy exists regarding the type and/or sequence of imaging studies needed during the first febrile urinary tract infection (UTI) in young children. Several investigators have claimed that because acute-phase Tc-99m dimercaptosuccinic acid (DMSA) renal-scan results are abnormal in the presence of dilating vesicoureteral reflux, a normal DMSA-scan result makes voiding cystourethrography (VCUG) unnecessary in the primary examination of infants with UTI. To evaluate the accuracy of acute-phase DMSA scanning in identifying dilating (grades III through V) vesicoureteral reflux documented by VCUG in children with a first febrile UTI, we performed a meta-analysis of the accuracy of diagnostic tests as reported from relevant studies identified through the PubMed and Scopus databases. Patient-based and renal unit-based analyses were performed. Overall, 13 cohort studies were identified. Nine studies involved patients younger than 2 years, 3 involved children aged 16 years or younger, and 1 involved exclusively neonates. Girls constituted 22% to 85% of the involved children. Pooled (95% confidence intervals) sensitivity and specificity rates of DMSA scanning were 79% and 53%, respectively, for the patient-based analysis (8 studies) and 60% and 65% for the renal unit-based analysis (5 studies). The respective areas under the hierarchical summary receiver operating curves were 0.71 and 0.67. Marked statistical heterogeneity was observed in both analyses, as indicated by I(2) test values of 91% and 87%, respectively. Acute-phase DMSA renal scanning cannot be recommended as replacement for VCUG in the evaluation of young children with a first febrile UTI.
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Age distribution of cases of 2009 (H1N1) pandemic influenza in comparison with seasonal influenza.
PLoS ONE
PUBLISHED: 06-08-2011
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Several aspects of the epidemiology of 2009 (H1N1) pandemic influenza have not been accurately determined. We sought to study whether the age distribution of cases differs in comparison with seasonal influenza.
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Biological mesh for abdominal wall hernia synthetic mesh multidrug-resistant Pseudomonas aeruginosa infection: report of a case.
Surg. Today
PUBLISHED: 05-01-2011
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The use of biological mesh for the treatment of synthetic mesh-related infections in patients who undergo ventral hernia repair has been considered over the past few years. Removal of the infected synthetic mesh, which may be required in such cases, can result in recurring herniation. Biological implants have thus been recently used for the reconstruction of the existing defect. We herein present the case of a patient who developed multidrug-resistant Pseudomonas aeruginosa synthetic mesh infection following hernia repair, which was managed by the removal of the material and the application of a biological mesh in the contaminated area.
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Atelectasis as a cause of postoperative fever: where is the clinical evidence?
Chest
PUBLISHED: 04-28-2011
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Atelectasis is considered to be the most common cause of early postoperative fever (EPF) but the existing evidence is contradictory. We sought to determine if atelectasis is associated with EPF by analyzing the relevant published evidence.
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Colistin: recent data on pharmacodynamics properties and clinical efficacy in critically ill patients.
Ann Intensive Care
PUBLISHED: 04-19-2011
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Recent clinical studies performed in a large number of patients showed that colistin "forgotten" for several decades revived for the management of infections due to multidrug-resistant (MDR) Gram-negative bacteria (GNB) and had acceptable effectiveness and considerably less toxicity than that reported in older publications. Colistin is a rapidly bactericidal antimicrobial agent that possesses a significant postantibiotic effect against MDR Gram-negative pathogens, such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. The optimal colistin dosing regimen against MDR GNB is still unknown in the intensive care unit (ICU) setting. A better understanding of the pharmacokinetic-pharmacodynamic relationship of colistin is urgently needed to determine the optimal dosing regimen. Although pharmacokinetic and pharmacodynamic data in ICU patients are scarce, recent evidence shows that the pharmacokinetics/pharmacodynamics of colistimethate sodium and colistin in critically ill patients differ from those previously found in other groups, such as cystic fibrosis patients. The AUC:MIC ratio has been found to be the parameter best associated with colistin efficacy. To maximize the AUC:MIC ratio, higher doses of colistimethate sodium and alterations in the dosing intervals may be warranted in the ICU setting. In addition, the development of colistin resistance has been linked to inadequate colistin dosing. This enforces the importance of colistin dose optimization in critically ill patients. Although higher colistin doses seem to be beneficial, the lack of colistin pharmacokinetic-pharmacodynamic data results in difficulty for the optimization of daily colistin dose. In conclusion, although colistin seems to be a very reliable alternative for the management of life-threatening nosocomial infections due to MDR GNB, it should be emphasized that there is a lack of guidelines regarding the ideal management of these infections and the appropriate colistin doses in critically ill patients with and without multiple organ failure.
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Trimethoprim/sulfametrole: evaluation of the available clinical and pharmacokinetic/pharmacodynamic evidence.
Int. J. Antimicrob. Agents
PUBLISHED: 04-19-2011
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Emergence of resistance to widely used trimethoprim/sulfamethoxazole (TMP/SMX) as well as common adverse events in human immunodeficiency virus (HIV)-infected patients casts interest on combinations of TMP with other sulfonamides. Sulfametrole (SMT) combined with TMP could provide a choice for difficult-to-treat infections, particularly when administered intravenously. The objective of this review was to evaluate the available clinical and pharmacokinetic/pharmacodynamic (PK/PD) evidence regarding TMP/SMT, particularly in comparison with TMP/SMX. We reviewed the available evidence retrieved from searches in PubMed/Scopus/Google Scholar and by bibliography hand-searching. In total, 46 eligible studies (most published before 1997) were identified, 7 regarding intravenous (i.v.) TMP/SMT, 24 regarding oral TMP/SMT and 15 providing comparative data for TMP/SMT versus TMP/SMX. The antimicrobial activity of TMP/SMT was similar to TMP/SMX for Gram-positive isolates. A greater percentage of Escherichia coli and Proteus spp. isolates were susceptible to TMP/SMT compared with TMP/SMX. PK/PD data suggest a dosage adjustment of i.v. TMP/SMT in patients with seriously impaired renal function. Four randomised controlled trials and 16 non-comparative studies reported good effectiveness/safety outcomes for oral TMP/SMT in genital ulcers (mainly chancroid), respiratory tract infections and urinary tract infections (UTIs). Moreover, i.v. TMP/SMT was effective against Pneumocystis jiroveci infection in HIV-infected patients, severe pneumonia and UTIs. In one study, hypersensitivity reactions occurred in 18/52 (34.6%) of HIV-infected patients; 2/52 (3.8%) developed psychosis. Gastrointestinal adverse events were mild and rare. Excipients in i.v. TMP/SMT formulations might be less toxic compared with i.v. TMP/SMX formulations, particularly for children. In conclusion, despite the scarcity of contemporary evidence, available data suggest that TMP/SMT could be an alternative treatment option to TMP/SMX, even in serious infections, when administered intravenously.
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Knowledge and practices regarding prevention of infections associated with central venous catheters: a survey of intensive care unit medical and nursing staff.
Am J Infect Control
PUBLISHED: 04-15-2011
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Infections associated with central venous catheters (CVCs) are associated with considerable morbidity and mortality.
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Serum procalcitonin as a diagnostic marker for neonatal sepsis: a systematic review and meta-analysis.
Intensive Care Med
PUBLISHED: 03-05-2011
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To assess the value of serum procalcitonin (PCT) for the differentiation between patients with and without neonatal sepsis.
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?-D-glucan assay for the diagnosis of invasive fungal infections: a meta-analysis.
Clin. Infect. Dis.
PUBLISHED: 03-04-2011
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We aimed to assess the accuracy of measuring serum or plasma (1?3)-?-D-glucan (BDG) for the diagnosis of invasive fungal infections (IFIs) by means of a meta-analysis of relevant studies. We searched in bibliographic databases for relevant cohort or case-control studies. We primarily compared BDG between patients with proven or probable IFIs (excluding Pneumocystis jirovecii infections), according to the criteria of the European Organization for Research and Treatment of Cancer/Mycoses Study Group or similar criteria, and patients without IFIs (excluding healthy individuals as controls). A total of 2979 patients (594 with proven or probable IFIs), included in 16 studies, were analyzed. The pooled sensitivity of BDG was 76.8% (95% confidence interval [CI], 67.1%-84.3%), and the specificity was 85.3% (95% CI, 79.6%-89.7%). The area under the summary receiver operating characteristic curve was 0.89. Marked statistical heterogeneity was noted. BDG has good diagnostic accuracy for distinguishing proven or probable IFIs from no IFIs. It can be useful in clinical practice, if implemented in the proper setting and interpreted after consideration of its limitations.
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Temporal trends in the impact factor of European versus USA biomedical journals.
PLoS ONE
PUBLISHED: 02-09-2011
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The impact factors of biomedical journals tend to rise over time. We sought to assess the trend in the impact factor, during the past decade, of journals published on behalf of United States (US) and European scientific societies, in four select biomedical subject categories (Biology, Cell Biology, Critical Care Medicine, and Infectious Diseases).
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Prulifloxacin: a review focusing on its use beyond respiratory and urinary tract infections.
Int. J. Antimicrob. Agents
PUBLISHED: 02-09-2011
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Prulifloxacin is a fluoroquinolone antibiotic that has been approved in several European countries for the treatment of lower urinary tract infections and exacerbations of chronic bronchitis. In this review, PubMed and Scopus databases were searched for potential uses of prulifloxacin beyond respiratory and urinary tract infections. Nine individual articles (eight randomised controlled trials and one cohort study) were regarded as eligible for inclusion in the review. Three of the studies were double-blinded, whilst six were open-label trials. Three studies referred to the treatment of patients with chronic bacterial prostatitis (CBP), one to prophylaxis of patients undergoing transrectal prostate biopsy, one to prophylaxis of women undergoing surgical abortion, two to patients with travellers diarrhoea, one to diabetic patients with soft tissue infections or osteomyelitis, and one to improving tolerance of Bacillus Calmette-Guérin (BCG) instillations in patients with bladder cancer. Regarding CBP, prulifloxacin was non-inferior to its comparators, with a trend towards better microbiological outcomes at follow-up. Regarding travellers diarrhoea, prulifloxacin resulted in better clinical and microbiological outcomes compared with placebo. Finally, prulifloxacin decreased the adverse events associated with BCG instillations in patients with bladder cancer, without affecting cancer recurrence rates. In summary, prulifloxacin appears to be a promising agent for the treatment of bacterial prostatitis and travellers diarrhoea.
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Aerosol delivery of antimicrobial agents during mechanical ventilation: current practice and perspectives.
Curr Drug Deliv
PUBLISHED: 01-18-2011
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Critically ill patients, who develop ventilator-associated pneumonia during prolonged mechanical ventilation, often require antimicrobial agents administered through the endotracheal or the tracheotomy tube. The delivery of antibiotics via the respiratory tract has been established over the past years as an alternative route in order to deliver high concentrations of antimicrobial agents directly to the lungs and avoid systemic toxicity. Since the only formal indications for inhaled/aerosolized antimicrobial agents is for patients suffering from cystic fibrosis, consequently the majority of research and published studies concerns this group of patients. Newer devices and new antibiotic formulations are currently off-label used in ambulatory cystic fibrosis patients whereas similar data for the mechanically ventilated patients do not yet exist.
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Do psychological variables affect early surgical recovery?
PLoS ONE
PUBLISHED: 01-13-2011
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Numerous studies have examined the effect of psychological variables on surgical recovery, but no definite conclusion has been reached yet. We sought to examine whether psychological factors influence early surgical recovery.
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Biological mesh in hernia repair, abdominal wall defects, and reconstruction and treatment of pelvic organ prolapse: a review of the clinical evidence.
Am Surg
PUBLISHED: 12-15-2010
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The use of biological meshes seems to be an innovation that influences all surgical fields. The existing evidence indicates that biological meshes cannot only be applied on the area of hernia repair, but also on cases of abdominal reconstruction and pelvic organ prolapse treatment, especially in the presence of contaminated or potentially contaminated surgical fields. Low risks of graft rejection, complications, and infection seem to be the main advantages of biological meshes in comparison with the synthetic nonabsorbable ones. Nevertheless, the elevated costs suggest that biological mesh implantation should be evaluated in correlation to the needs of each clinical case.
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Once versus multiple daily dosing of aminoglycosides for patients with febrile neutropenia: a systematic review and meta-analysis.
J. Antimicrob. Chemother.
PUBLISHED: 12-03-2010
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Once daily dosing (ODD) of aminoglycosides has become a standard of care for most patient populations. However, the use of ODD of aminoglycosides has not been clarified in febrile neutropenia.
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Association between thyroid function tests at baseline and the outcome of patients with sepsis or septic shock: a systematic review.
Eur. J. Endocrinol.
PUBLISHED: 11-15-2010
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The severity of critical illness is associated with various patterns of thyroid hormone abnormalities. We sought to evaluate whether the outcome of patients with, specifically, sepsis or septic shock is associated with the thyroid function tests evaluated at diagnosis or admission in the intensive care unit (ICU).
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H1N1v influenza vaccine in Greek medical students.
Eur J Public Health
PUBLISHED: 09-10-2010
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We sought to investigate the penetration of the H1N1v vaccine in Greek medical students, as well as their approach to the vaccination.
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Antimicrobial prophylaxis in surgery: an international survey.
Surg Infect (Larchmt)
PUBLISHED: 08-11-2010
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We investigated current clinical practice of antimicrobial prophylaxis (AMP) in surgery.
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Inhaled colistin for the treatment of tracheobronchitis and pneumonia in critically ill children without cystic fibrosis.
Pediatr. Pulmonol.
PUBLISHED: 07-27-2010
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Data regarding the role of inhaled colistin in critically ill pediatric patients without cystic fibrosis are scarce. Three children (one female), admitted to the intensive care unit (ICU) of a tertiary-care pediatric hospital in Athens, Greece, during 2004-2009 received inhaled colistin as monotherapy for tracheobronchitis (two children), and as adjunctive therapy for necrotizing pneumonia (one child). Colistin susceptible Acinetobacter baumannii and Pseudomonas aeruginosa were isolated from the cases bronchial secretions specimens. All three children received inhaled colistin at a dosage of 75 mg diluted in 3 ml of normal saline twice daily (1,875,000 IU of colistin daily), for a duration of 25, 32, and 15 days, respectively. All three children recovered from the infections. Also, a gradual reduction, and finally total elimination of the microbial load in bronchial secretions was observed during inhaled colistin treatment in the reported cases. All three cases were discharged from the ICU. No bronchoconstriction or any other type of toxicity of colistin was observed. In conclusion, inhaled colistin was effective and safe for the treatment of two children with tracheobronchitis, and one child with necrotizing pneumonia. Further studies are needed to clarify further the role of inhaled colistin in pediatric critically ill patients without cystic fibrosis.
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Fosfomycin versus other antibiotics for the treatment of cystitis: a meta-analysis of randomized controlled trials.
J. Antimicrob. Chemother.
PUBLISHED: 06-29-2010
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Cystitis is a common infection. The alarmingly high resistance rates exhibited by contemporary uropathogens necessitate the re-evaluation of old antibiotics.
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Antiviral treatment for severe EBV infections in apparently immunocompetent patients.
J. Clin. Virol.
PUBLISHED: 06-16-2010
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Infectious mononucleosis usually runs a mild self-limiting course. Complications arise rarely and when so, corticosteroids are the mainstay of their treatment. The role of antivirals in the management of severe EBV infections is debatable.
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Case-control studies reporting on risk factors for emergence of antimicrobial resistance: bias associated with the selection of the control group.
Microb. Drug Resist.
PUBLISHED: 06-07-2010
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The optimal control group for case-control studies examining antibiotics as risk factors for the emergence of antimicrobial resistance is patients selected randomly from the total hospital population, while the selection of patients with a susceptible bacterium is deemed suboptimal. We sought to theoretically elaborate on potential parameters that introduce bias associated with the use of randomly selected control subjects, based on personal experience and data from the literature. In addition, we considered parameters that introduce potential bias associated with the definition of case patients. Parameters that may introduce potential bias associated with the randomly selected control subjects are use of antibiotics in the community (background exposure), availability of an antibiotic in a country, ability to purchase specific antibiotics or health care, the bacterial resistance pattern in the country, in vitro evaluation issues, source of admitting patients (nursing home or community), type of hospital to which patients are admitted (general or disease specific), and ward of hospital to which patients are admitted. Parameters that may introduce potential bias associated with the case definition are multidrug resistance versus resistance to only one antibiotic, resistance phenotype of the microbe, multistep versus one-step development of resistance, appropriateness versus adequacy of antibiotic treatment, antibiotic synergy, details regarding the daily dose and duration of administration of the specific antibiotic, and use of other antibiotics. In conclusion, selection of control subjects from the hospital population is also associated with bias. The most acceptable solutions to evaluate the risk factors for antimicrobial resistance are probably the case-control-control study design and the case-case-control study design.
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Antimicrobial susceptibility of Gram-negative nonurinary bacteria to fosfomycin and other antimicrobials.
Future Microbiol
PUBLISHED: 06-05-2010
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Fosfomycin is an antimicrobial commonly used in uncomplicated urinary tract infections. The microbiological effectiveness of fosfomycin against nonurinary Gram-negative isolates has not been widely investigated. The aim of this study was to evaluate the in vitro activity of fosfomycin against Gram-negative nonurinary isolates in a region of Greece where considerable antimicrobial resistance has been detected.
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Clinical features, risk factors, and complications among pediatric patients with pandemic influenza A (H1N1).
Clin Pediatr (Phila)
PUBLISHED: 06-03-2010
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The authors aimed to describe the epidemiological characteristics, clinical features, risk factors for severe disease, and complications in children with laboratory-confirmed pandemic influenza A (H1N1).
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Tuberculosis of the oral cavity: a systematic review.
Eur. J. Oral Sci.
PUBLISHED: 05-22-2010
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The recent increase in the incidence of tuberculosis, combined with an emerging global resistance to antituberculous drugs, warrants an increased awareness of the involvement of Mycobacterium tuberculosis in persistent or atypical lesions in the oral cavity. We sought to review the published reports of mycobacterial infection of the oral cavity found in the literature in otherwise uncompromised patients, from 1950 to the present day, and analyzed the documented manifestations. M. tuberculosis infects all parts of the mouth (soft and hard palate, uvula, buccal mucosa, gingivae, lips, tongue, maxilla, and mandible) more often in men than in women, appearing predominantly in the form of ulcerative lesions. It was found as a secondary infection in 58% (54% pulmonary, 4% extrapulmonary) of patients and as a primary infection in 42% of patients. Carcinomas are found to co-exist in the same lesion site in 3% of patients. In approximately 50% of patients, an oral manifestation of TB has led to the diagnosis of a previously unknown systemic infection, which resulted in a timely and effective treatment. The investigation for tuberculosis should therefore be actively pursued in the dental surgery. Diagnostic work-up for systemic involvement and control of healthcare-associated spread is important, while therapeutic options are still considered adequate.
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Effectiveness and safety of neuraminidase inhibitors in reducing influenza complications: a meta-analysis of randomized controlled trials.
J. Antimicrob. Chemother.
PUBLISHED: 05-20-2010
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Several studies suggest that neuraminidase inhibitors (NIs) can reduce the duration of influenza symptoms. However, data regarding their effectiveness in reducing influenza complications are scarce.
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The pleiotropic effects of statins and omega-3 fatty acids against sepsis: a new perspective.
Expert Opin Investig Drugs
PUBLISHED: 05-18-2010
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The available therapeutic options for sepsis are restricted by their effectiveness and high cost. Emerging preliminary data suggest that statins and omega-3 fatty acids (OM3FA) may be associated with improved outcomes in terms of prevention and treatment of sepsis. We sought to review the current evidence on the effectiveness of their combined administration against sepsis, by carrying out a review of PubMed and Scopus databases for relevant studies, without imposing language or time restrictions. No clinical studies were identified regarding the effect of the combination treatment with statins and OM3FA on sepsis in terms of prevention or treatment. However, there is experimental evidence that both statins and OM3FA inhibit the inflammatory process at different levels, but also enhance inhibition at those levels that are common. There are also preliminary data supporting the beneficial effect of this combination on platelet function and other haemostatic mechanisms. Appropriately designed and powered clinical trials are warranted to investigate the effectiveness and safety of the combined administration of statins and OM3FA for the prevention and treatment of sepsis.
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Unusual climatic conditions and infectious diseases: observations made by Hippocrates.
Enferm. Infecc. Microbiol. Clin.
PUBLISHED: 05-13-2010
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About 2500 years ago, Hippocrates made noteworthy observations about the influence of climate on public health. He believed that people living in cities with different climate may suffer from different diseases. Hippocrates also observed that abrupt climatic changes or unusual weather conditions affect public health, especially the incidence and severity of various infectious diseases, including gastrointestinal infections, tuberculosis, and central nervous system infections. We believe that Hippocrates scientific observations are great early historic examples that stress to modern infectious diseases researchers and clinicians the need to study intensively the effect of the occurring global climate changes to infectious diseases in order to help in the prevention of possible epidemics of infections.
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Resistance to polymyxins: Mechanisms, frequency and treatment options.
Drug Resist. Updat.
PUBLISHED: 04-27-2010
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Polymyxins act by binding to lipid A moiety of the bacterial lipopolysaccharide and subsequently disintegrating the bacterial membranes. The most important mechanism of resistance includes modifications of the bacterial outer membrane structure, including lipopolysaccharide. Lipopolysaccharide modification is mostly mediated by PmrA/PmrB and PhoP/PhoQ two-component regulatory systems. These mechanisms exist with some differences in many gram-negative bacterial species. Resistance to polymyxins is generally less than 10%. In specific regions, such as the Mediterranean basin, Korea and Singapore, they tend to be higher. Heteroresistance to polymyxins is associated with exposure to polymyxins and especially suboptimal therapeutic dosage. Polymyxin combination regimens, tigecycline and fosfomycin may be useful options for the treatment of polymyxin-resistant gram-negative infections.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.