Amphotericin B Deoxycholate
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 in Kucers’ The Use of Antibiotics, 2017
There has been a dramatic increase in the incidence of candidemia since the 1980s, with Candida spp. becoming one of the most common causes of healthcare-associated bloodstream infections (Magill et al., 2014). The options for management of candidemia have expanded enormously over the past decade (Pappas et al., 2015). AMB (or one of the lipid formulations), echinocandins, fluconazole, and voriconazole are all effective treatment options. Use of AMB for first-line treatment of candidemia and invasive candidiasis has now largely been superseded by initial treatment with the echinocandin antifungals (Chapter 146, Caspofungin; Chapter 147, Micafungin; and Chapter 148, Anidulafungin) for both nonneutropenic and neutropenic patients, de-escalating to azoles pending clinical stability, blood culture sterilization, and microbiologic susceptibility. AMB and its lipid formulation are an alternative when there is intolerance or resistance (including the recently emergent multidrug-resistant C. glabrata), or in the case of CNS, eye and urinary tract infections, due to superior pharmacokinetics (Pappas et al., 2015). No clinical trials in candidiasis have demonstrated superiority of one antifungal agent over another, nor of lipid AMB formulations over AMB, where the choice to use a more expensive lipid formulation is purely one driven by reduced toxicity. In the next paragraph we summarize the evidence from clinical trials pertaining to AMB. Liposomal formulations are discussed elsewhere.
Antibacterial Activity of Seaweeds and their Extracts
Leonel Pereira in Therapeutic and Nutritional Uses of Algae, 2018
E. coli and S. aureus are the main causes of bloodstream infections (BSIs) in humans. A remarkable increase in the number of BSIs caused by E. coli along with an alarming increase of antimicrobial multiresistance were observed in Europe from 2002 to 2009 (Gagliotti et al. 2011). In turn, of all the resistance traits that S. aureus has acquired since the introduction of antimicrobial chemotherapy, methicillin resistance is clinically the most important, since a single genetic element confers resistance to the most commonly prescribed class of antimicrobials, the β-lactam antibiotics (Grundmann et al. 2006). The antimicrobial therapy used to treat infections caused by these microorganisms has therefore become problematic, emphasizing the need of a rational use along with a pharmaceutical investment in antibiotic research and development (Silva 2015).
Quality and safety of healthcare
Liam J. Donaldson, Paul D. Rutter in Donaldsons' Essential Public Health, 2017
A different approach to standardization of practice has emerged with the concept of the care bundle. This is a small set of evidence-based interventions for a particular patient population and healthcare setting. One of the first, and best-documented, applications of a care bundle was to reduce central-line-associated bloodstream infections in intensive care patients. Professor Peter Pronovost, a critical care physician at Johns Hopkins Hospital in Baltimore, has led the work. He is also director of the Armstrong Institute for Quality and Safety and a global patient safety leader. He reduced the incidence of central-line-associated bloodstream infections by two-thirds in intensive care units across the state of Michigan (Figure 7.7), saving 1500 lives and $100 million annually. This involved no new clinical intervention – just a set of tools to help health professionals reliably apply best practice when inserting, and then maintaining, a central line. The initiative has been applied widely in other parts of the United States and elsewhere in the world, with similar impact. What has been learned from the implementation sites is that it is not enough to make staff aware of the bundle and require them to use it. Such an approach will meet with resistance and noncompliance. Cultural change, organizational development, staff engagement and team building must be introduced alongside the technical intervention of the care bundle.
Carbapenem-resistant Gram-negative pathogens associated with septic shock: a review of 120 cases
Published in Journal of Chemotherapy, 2022
Uğur Önal, Deniz Akyol, Merve Mert, Dilşah Başkol, Seichan Chousein Memetali, Gamze Şanlıdağ, Buse Kenanoğlu, Ayşe Uyan-Önal, Günel Quliyeva, Cansu Bulut Avşar, Damla Akdağ, Melike Demir, Hüseyin Aytaç Erdem, Ümit Kahraman, Osman Bozbıyık, Erkin Özgiray, Devrim Bozkurt, Funda Karbek Akarca, Kubilay Demirağ, İlkin Çankayalı, Mehmet Uyar, Feriha Çilli, Bilgin Arda, Tansu Yamazhan, Hüsnü Pullukçu, Meltem Işıkgöz Taşbakan, Hilal Sipahi, Sercan Ulusoy, Oguz Resat Sipahi
The diagnosis of CAP was made based on a history of cough, dyspnea, pleuritic pain, or acute functional or cognitive decline, with abnormal vital signs (e.g. fever and tachycardia), lung examination, and radiological findings [10]. HAP was defined as pneumonia not incubating at the time of hospital admission and occurring 48 h or more after admission, while VAP was defined as pneumonia occurring >48 h after endotracheal intubation [11]. UTI criteria were based on findings as significant bacteriuria in a patient with symptoms or signs attributable to the urinary tract, such as new onset or worsening of fever, rigors, altered mental status, malaise, lethargy with no other identified cause, flank pain, costovertebral angle tenderness, acute hematuria, and pelvic discomfort and dysuria, urgent or frequent urination, or suprapubic pain or tenderness in those whose catheters had been removed [12]. Bloodstream infection was defined as the positivity of a microbial pathogen in blood culture by virtue of infection, not specimen contamination. Finally, CRBI was defined as bloodstream infection attributed to an intravascular catheter by quantitative culture of the catheter tip or by differences in growth between the catheter and peripheral blood culture specimens [13].
High nuc DNA load in whole blood is associated with sepsis, mortality and immune dysregulation in Staphylococcus aureus bacteraemia
Published in Infectious Diseases, 2019
Ingrid Ziegler, Sara Cajander, Gunlög Rasmussen, Theresa Ennefors, Paula Mölling, Kristoffer Strålin
The department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden, serves a population of 300,000 inhabitants and has a ward for 30 adult patients. A prospective study was conducted at the department between February 2011 and June 2014, where patients with bloodstream infection were included [25]. In the study protocol, whole blood EDTA tubes were collected together with blood culture bottles and routine chemistry samples from patients with suspected sepsis at the emergency department (day 0). When blood culture positivity was reported (days 1–2), the patient was enrolled. Blood samples and EDTA tubes were then collected on days 1–2, 3–4, 6–8, 13–15 and 26–30. Exclusion criteria were blood borne diseases (HIV, hepatitis B or hepatitis C), to minimize the risk for transmission by needle-stick injuries, and age under 18 years. The study was approved by the Regional Ethical Review Board of Uppsala, Sweden (approval number 2009/024). All patients (or a next-of-kin) provided written informed consent. The study had several branches with different aims, and the present study represents one minor branch, covering all included patients with S. aureus bacteraemia.
Are we missing the Staphylococcus aureus bacteraemia forest for the MRSA trees?
Published in Infectious Diseases, 2018
Staphylococcus aureus is the most important cause of bloodstream infection in high-income countries. While it consistently is the second most commonly identified etiologic agent of bloodstream infection observed after Escherichia coli, the frequent complications, need for prolonged treatment, and adverse outcomes associated with SAB make its burden paramount [2]. Population based studies, which provide the least biased assessment of burden of disease have reported on SAB epidemiology from many countries and jurisdictions worldwide [3–9]. The epidemiology of SAB is dynamic and varies by region and over time. While there is less variability with community onset MSSA, there are notable differences observed with hospital onset SAB and MRSA bacteraemia among different regions [3].
Related Knowledge Centers
- Asepsis
- Fungal Infection
- Fungemia
- Meningitis
- Pneumonia
- Infection
- Blood
- Pathogenic Bacteria
- Blood Culture
- Sepsis