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Infection in the Hematopoeitic Stem Cell Transplant Recipient with Autoimmune Disease
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
Valentina Stosor, Teresa R. Zembower
Polymyositis and dermatomyositis are idiopathic inflammatory myopathies characterized by proximal limb and neck weakness, sometimes associated with muscle pain.52 Malignancy, cardiac and pulmonary dysfunction, and infections are the most common causes of death.53,54 The most common infectious complication is aspiration pneumonia due to respiratory muscle weakness. A case series of four patients with fulminant PCP is described in patients receiving corticosteroids. Three of the patients died in the first month of steroid therapy of overwhelming PCP.55 Herpes zoster is reported to occur with high frequency in these patients. Interestingly, it occurs more commonly in the inactive stages of disease and is not associated with steroid therapy.56 Two cases of nosocomial pneumonia with Stenotrophomonas maltophilia and one case of disseminated N. brasiliensis infection have been described.57,58
Trimethoprim and Trimethoprim–Sulfamethoxazole (Cotrimoxazole)
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Jason A. Trubiano, M. Lindsay Grayson
Stenotrophomonas maltophilia is being found with increasing frequency as a cause of serious infection, especially in cancer patients (Safdar and Rolston, 2007). CoT has been considered the drug of choice of S. maltophilia infections for many years (Marshall et al., 1989). Dosing regimens of CoT similar to those used for Pneumocystis pneumonia are generally recommended (Safdar and Rolston, 2007; Abbott and Peleg, 2015).
Short- versus prolonged-course antibiotic therapy for sepsis or infectious diseases in critically ill adults: a systematic review and meta-analysis
Published in Infectious Diseases, 2022
Kenji Kubo, Yutaka Kondo, Jumpei Yoshimura, Kazuya Kikutani, Nobuaki Shime
We identified two OSs of severe infections in a systematic review that did not meet the criteria for inclusion in the meta-analysis (Supplementary Table 3) [24,25]. Pereira et al. prospectively evaluated the association between antibiotic therapy and prognosis in 502 patients with severe community-acquired pneumonia in 14 ICUs in Portugal. All patients had sepsis (sepsis, 278; septic shock, 224) [24]. Adjusted multivariate logistic regression analysis showed that prolonged antibiotics (>7 days) were associated with a longer ICU stay (14 vs. 7 days; p< .001) and length of hospital stay (25 vs. 17 days; p< .001). Guerci et al. retrospectively evaluated the association between antibiotic therapy and prognosis in 282 patients with hospital-acquired Stenotrophomonas maltophilia VAP in 25 ICUs in France [25]. The distribution of severity scores was very similar to that of the study by Pereira et al., and pneumonia-related septic shock occurred in 123 patients (43.6%). A survival analysis did not show any benefit from prolonged antibiotic therapy for >7 days (hazard ratio = 1.06, 95% CI: 0.6–1.86, p= .84).
Investigational drugs for the treatment of infections caused by multidrug-resistant Gram-negative bacteria
Published in Expert Opinion on Investigational Drugs, 2018
Lindsay M. Avery, David P. Nicolau
In addition to activity against Gram-positive pathogens including MRSA and vancomycin resistant enterococci (VRE), eravacycline displays potent in vitro activity against CRE and ESBL-producing Enterobacteriaceae [50]. Among 230 Enterobacteriaceae isolates with various carbapenem resistance mechanisms, eravacycline MIC90s were 1 μg/mL for all types except IMP-type, for which the MIC90 was 2 μg/mL. In contrast, the MIC90s of minocycline and tetracycline were 8–16-fold higher. Among A. baumannii isolates (n = 55), eravacycline MIC90 was 1 μg/mL, demonstrating increased potency over tigecycline (MIC90 4 μg/mL) [48]. In vitro efficacy against Stenotrophomonas maltophilia was demonstrated in another study (MIC90/50 2/0.5 μg/mL). Notably, potent in vitro activity against P. aeruginosa or Burkholderia cenocepacia was not demonstrated (MIC90/50 32/8 μg/mL for both) [51].
Therapies for multidrug resistant and extensively drug-resistant non-fermenting gram-negative bacteria causing nosocomial infections: a perilous journey toward ‘molecularly targeted’ therapy
Published in Expert Review of Anti-infective Therapy, 2018
Nadim G. El Chakhtoura, Elie Saade, Alina Iovleva, Mohamad Yasmin, Brigid Wilson, Federico Perez, Robert A. Bonomo
Stenotrophomonas maltophilia is an emerging pathogenic non-fermenting gram-negative rod most commonly encountered among immunocompromised hosts in the hospital setting. Risk factors for infection in non-cystic fibrosis patients include malignancy (especially hematologic), treatment with corticosteroids or immunosuppressant medications, exposure to broad-spectrum antibiotics, prolonged hospitalization, intensive care unit admission, mechanical ventilation, presence of an indwelling central catheter, and hemodialysis [45]. Recent surveillance studies estimate its prevalence among isolates from all sources at 1.3–1.7% [46]. S. maltophilia is an environmental pathogen found in water and soil, and has also been isolated in multiple medical devices and products. Most common infectious syndromes are pneumonia, including hemorrhagic pneumonia, bloodstream infection, including catheter-associated bloodstream infections, and urinary tract and wound infections. Other less common syndromes include post-neurosurgical meningitis, endocarditis, sinusitis, eye infections, and septic arthritis [47]. Although difficult to ascertain, in a systematic review, Falagas et al. estimated attributable mortality of S. maltophilia infections at up to 38% [48]. Mortality is even higher in patients with malignancy, in whom it can reach more than 50% [49,50].