The epidemiology of Mycobacterium bovis and its treatment regimen are considered. Speciation is important in the choice of an effective chemotherapeutic regimen; the standard short-course (6-month) ...chemotherapeutic regimen for treating tuberculosis caused by drug-susceptible M. tuberculosis includes isoniazid (INH), rifampin, ethambutol, and PZA for the rst 2 months and INH and rifampin for the subsequent 4 months.
Although the production of extended-spectrum β-lactamases (ESBLs) by Klebsiella pneumoniae and Escherichia coli is an emerging problem, limited data are available regarding the frequency of ESBL ...production in other organisms. We provide the only description of regional occurrence of SHV-7 in Enterobacteriaceae other than E. coli or K. pneumoniae in the United States, and we emphasize that, among Enterobacter cloacae strains, not all resistance to extended-spectrum cephalosporins is the result of hyperproduction of AmpC β-lactamase.
Objective—To update recommendations issued by the American Heart Association last published in 1990 for the prevention of bacterial endocarditis in individuals at risk for this disease. ...Participants—An ad hoc writing group appointed by the American Heart Association for their expertise in endocarditis and treatment with liaison members representing the American Dental Association, the Infectious Diseases Society of America, the American Academy of Pediatrics, and the American Society for Gastrointestinal Endoscopy. Evidence—The recommendations in this article reflect analyses of relevant literature regarding procedure-related endocarditis, in vitro susceptibility data of pathogens causing endocarditis, results of prophylactic studies in animal models of endocarditis, and retrospective analyses of human endocarditis cases in terms of antibiotic prophylaxis usage patterns and apparent prophylaxis failures. MEDLINE database searches from 1936 through 1996 were done using the root words endocarditis, bacteremia, and antibiotic prophylaxis. Recommendations in this document fall into evidence level III of the US Preventive Services Task Force categories of evidence. Consensus Process—The recommendations were formulated by the writing group after specific therapeutic regimens were discussed. The consensus statement was subsequently reviewed by outside experts not affiliated with the writing group and by the Science Advisory and Coordinating Committee of the American Heart Association. These guidelines are meant to aid practitioners but are not intended as the standard of care or as a substitute for clinical judgment. Conclusions—Major changes in the updated recommendations include the following: (1) emphasis that most cases of endocarditis are not attributable to an invasive procedure; (2) cardiac conditions are stratified into high-, moderate-, and negligible-risk categories based on potential outcome if endocarditis develops; (3) procedures that may cause bacteremia and for which prophylaxis is recommended are more clearly specified; (4) an algorithm was developed to more clearly define when prophylaxis is recommended for patients with mitral valve prolapse; (5) for oral or dental procedures the initial amoxicillin dose is reduced to 2 g, a follow-up antibiotic dose is no longer recommended, erythromycin is no longer recommended for penicillin-allergic individuals, but clindamycin and other alternatives are offered; and (6) for gastrointestinal or genitourinary procedures, the prophylactic regimens have been simplified. These changes were instituted to more clearly define when prophylaxis is or is not recommended, improve practitioner and patient compliance, reduce cost and potential gastrointestinal adverse effects, and approach more uniform worldwide recommendations.
Although antibiotic prophylaxis against infective endocarditis is recommended, the true risk factors for infective endocarditis are unclear.
To quantitate the risk for endocarditis from dental ...treatment and cardiac abnormalities.
Population-based, case-control study.
54 hospitals in the Philadelphia area.
Persons with community-acquired infective endocarditis not associated with intravenous drug use were compared with community residents, matched by age, sex, and neighborhood of residence.
Information on demographic characteristics, host risk factors, and dental treatment was obtained from structured telephone interviews, dental records, and medical records.
During the preceding 3 months, dental treatment was no more frequent among case-patients than controls (adjusted odds ratio, 0.8 95% CI, 0.4 to 1.5). Of 273 case-patients, 104 (38%) knew of previous cardiac lesions compared with 17 controls (6%) (adjusted odds ratio, 16.7 CI, 7.4 to 37.4). Case-patients more often had a history of mitral valve prolapse (adjusted odds ratio, 19.4 CI, 6.4 to 58.4), congenital heart disease (adjusted odds ratio, 6.7 CI, 2.3 to 19.4), cardiac valvular surgery (adjusted odds ratio, 74.6 CI, 12.5 to 447), rheumatic fever (adjusted odds ratio, 13.4 CI, 4.5 to 39.5), and heart murmur without other known cardiac abnormalities (adjusted odds ratio, 4.2 CI, 2.0 to 8.9). Among case-patients with known cardiac lesions--the target of prophylaxis--dental therapy was significantly (P = 0.03) less common than among controls (adjusted odds ratio, 0.2 CI, 0.04 to 0.7 over 3 months). Few participants received prophylactic antibiotics.
Dental treatment does not seem to be a risk factor for infective endocarditis, even in patients with valvular abnormalities, but cardiac valvular abnormalities are strong risk factors. Few cases of infective endocarditis would be preventable with antibiotic prophylaxis, even with 100% effectiveness assumed. Current policies for prophylaxis should be reconsidered.
Anaerobic pleuropulmonary infection Levison, Matthew E
Current opinion in infectious diseases,
2001-April, Letnik:
14, Številka:
2
Journal Article
Recenzirano
Obligate anaerobes are the predominant constituents of normal oropharyngeal flora and produce pleuropulmonary infection in patients who are prone to aspirate. Obtaining material from these patients ...for culture from the site of infection that is uncontaminated by normal flora is problematic. In-vitro cultivation of obligate anaerobes requires rigorous anaerobic techniques and susceptibility testing of obligate anaerobes is not standardized in many clinical microbiology laboratories. Few clinical trials of drugs have been done in patients with laboratory documented or putative anaerobic pulmonary infection. For these reasons the diagnosis and therapy of anaerobic pulmonary infection are frequently empirical and guided by published studies of in-vitro activity against collected clinical isolates. Several new drugs that have in-vitro activity against obligate anaerobes have recently become available for empirical treatment of pneumonia.
Methicillin resistance, long recognized as characteristic of nosocomial Staphylococcus aureus, has increasingly been identified in community-acquired strains in the past 15 years. The genotypes of ...community-associated methicillin-resistant S. aureus (MRSA) are different from nosocomial strains, and unlike nosocomial strains, they have a distinctive methicillin-resistance chromosomal cassette (designated type IV), are usually susceptible to multiple classes of antimicrobials other than beta-lactams, carry a distinctive virulence factor (the Panton-Valentine leukocidin), cause mainly skin and soft tissue infection and less frequently, necrotizing pneumonia, and involve predominantly children and young adults. Outbreaks have been reported in certain segments of the population (eg, football players, wrestlers, prison inmates, and native people) that often do not have the established risk factors for MRSA. However, these strains have also caused infections likely acquired in an institutional health care setting. Delay in starting appropriate antibiotic therapy for severe infections caused by MRSA can be life-threatening. This requires a reconsideration of the empiric choice of an anti-staphylococcal beta-lactam for seriously ill patients with suspected community-associated S. aureus infections.
Clinical manifestations Respiratory tract diphtheria Following a usual incubation period of 2 to 5 days (range, 1-10 days), inflammation develops at the site of involvement with a blue-white ...pseudomembrane that turns dirty gray. Immunization The recommended immunization schedule by the CDC is five doses before the age of 7 years of diphtheria toxoid combined with tetanus toxoid and acellular pertussis (DTaP) vaccine at 2, 4, 6 and 15 to 18 months of age, followed by a booster at ages 4 to 6 years with DTaP. Donald Kaye, MD, MACP, is a professor of medicine at Drexel University College of Medicine, associate editor of the International Society for Infectious Diseases' ProMED-mail, section editor of news for Clinical Infectious Diseases and an Infectious Disease News Editorial Board member. Matthew E. Levison, MD, FACP, is a ProMEDmail associate editor and bacterial disease moderator, formerly professor of public health, Drexel University School of Public Health, and adjunct professor of medicine and former chief of the division of infectious diseases, Drexel University College of Medicine.
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