Enterobacteriaceae Denton, Miles
International journal of antimicrobial agents,
05/2007, Letnik:
29
Journal Article
Recenzirano
Abstract This review summarises the changing epidemiology of resistance to cephalosporins and fluoroquinolones among the Enterobacteriaceae since the 1980s and its potential impact on prescribing ...choices now and in the immediate future. Whilst multiresistant Enterobacteriaceae are not a novel problem for high-risk hospital units, such as intensive care, the emergence of Escherichia coli co-expressing extended-spectrum β-lactamases, such as CTX-M types, along with fluoroquinolone resistance in the community is starting to impact in situations where cephalosporins and ciprofloxacin were seen as reliable first-line choices. The reduction in effective options to treat these infections, particularly of the urinary tract and bacteraemia, is likely to result in increased prescribing of carbapenems, thus generating further selective pressure for carbapenemases and other mechanisms of carbapenem resistance in the future.
Cystic fibrosis (CF) is an inherited multi-system disorder characterised by chronic airway infection with pathogens such as Pseudomonas aeruginosa. Acquisition of P. aeruginosa by patients with CF is ...usually from the environment, but recent studies have demonstrated patient to patient transmission of certain epidemic strains, possibly via an airborne route. This study was designed to examine the survival of P. aeruginosa within artificially generated aerosols.
Survival was effected by the solution used for aerosol generation. Within the aerosols it was adversely affected by an increase in air temperature. Both epidemic and non-epidemic strains of P. aeruginosa were able to survive within the aerosols, but strains expressing a mucoid phenotype had a survival advantage.
This would suggest that segregating individuals free of P. aeruginosa from those with chronic P. aeruginosa infection who are more likely to be infected with mucoid strains may help reduce the risk of cross-infection. Environmental factors also appear to influence bacterial survival. Warming and drying the air within clinical areas and avoidance of humidification devices may also be beneficial in reducing the risk of cross-infection.
Young people with cystic fibrosis (CF) are asked to avoid a number of environments associated with increased infection risk, but in practice they need to balance this with competing priorities such ...as building and sustaining relationships with friends and family. This study explored the process by which young people make these decisions. Mixed methods were used: a vignette study presenting choices around engaging in activities involving a degree of infection risk and a thematic analysis of participant's accounts of their decision making. The eight participants chose to engage in high risk behaviours in 59% of the choices. All participants chose to engage in at least one risky behavior, though this was less likely when the risk was significant. Thematic analysis revealed large areas of misunderstanding and lack of knowledge, leading to some potentially worrying misconceptions about the nature of infections and risk. Young people with CF are not currently making informed decisions around activities that involve increased risk of infection, and there is an urgent need for CF teams to address this in information provision.
Background: Patients were defined each successive month as either ‘chronic’ when more than 50% of the preceding 12 months were PA culture positive, ‘intermittent’ when ≤50% of the preceding 12 months ...were PA culture positive, ‘free of PA’, with no growth of PA for the previous 12 months, having previously been PA culture positive, or ‘never infected’, when PA had never been cultured. Methods: Cross-sectional analysis of 146 children attending the Leeds Regional Cystic Fibrosis Centre was performed to assess relationship between the new definition and clinical scores and investigations. The response variable was regressed on age and sex and the residuals analysed using the Kruskal–Wallis test. Results: The ‘chronic’ group (18% of patients) had significantly worse Shwachman–Kulczycki (SK) and Northern chest X-ray scores, and % predicted FEV1 values than the ‘free’ (28%) or ‘never’ (20%) categories (P<0.004). The ‘intermittent’ group (34%) had a significantly higher SK score than the ‘chronic’ group (P<0.0001), and a significantly lower % predicted FEV1 value than the ‘free’ or ‘never’ groups (P<0.0003). ‘Chronic’ patients were significantly associated with a positive, and ‘never’ patients with a negative, PA antibody result (P<0.001). Conclusions: The validity and importance of identifying these four subgroups is demonstrated. Previous definitions may over-estimate the prevalence of chronic infection.
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