Diagnosing Viral Infections
Firza Alexander Gronthoud in Practical Clinical Microbiology and Infectious Diseases, 2020
Empirical treatment of bacterial infections consists of empirical antibiotic therapy with the highest likelihood of treating the infection before any pathogens are identified, whereas empirical treatment of viral infections is more challenging because: Antiviral agents have specific antiviral activity, are potentially toxic and are therefore only started upon strong clinical suspicion (i.e. in the case of herpes simplex) or a positive result.Different viruses may cause the same clinical syndrome but require different antiviral agents.There are no effective antiviral drugs for many viral infections including arboviruses, parainfluenza, polyoma viruses, parvovirus and measles.
Non-Respiratory Tuberculosis
Peter D O Davies, Stephen B Gordon, Geraint Davies in Clinical Tuberculosis, 2014
Extrapulmonary disease is harder to diagnose. In developed countries where (until the last decade) numbers of cases were falling and there is a very uneven distribution of disease, reduced clinician experience coupled with atypical or gradual presentations has contributed to delays in diagnosis and treatment, leading to further morbidity or even death. In the less developed world, the problems of diagnosis are compounded by a lack of diagnostic resources, with few forms of extrapulmonary TB showing acid-fast bacilli on microscopy. Studies on HIV-associated deaths in sub-Saharan Africa show significant levels of extrapulmonary tuberculosis [11,12]. Empirical treatment or trials of treatment are more often given on clinical and/or radiological grounds without bacteriological and/or histological support or confirmation in such settings.
Infection of the bones and joints
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Blood tests are frequently unhelpful, as inflammatory markers may be normal or only mildly raised. Plain radiographs may show evidence of osteomyelitis, but can be normal (particularly early in infection). MRI is the most sensitive imaging modality for diagnosis of bone involvement. Limited disease has a good prognosis, and in the absence of risk factors for resistant organisms (including prior treatment), empirical treatment can be justified. In extensive or complicated infections, antibiotic therapy should be guided by the results of culture of deep bone or tissue samples obtained surgically or radiologically. Superficial swabs or cultures from ulcers or sinus tracts are not reliable in determining the organisms responsible for underlying deep-seated infection.
What´s new in intraabdominal candidiasis in critically ill patients, a review
Published in Hospital Practice, 2019
Many definitions have been used in the past to try to define these strategies, with the consequences that, recent reports described patients receiving preemptive strategies when they are receiving empirical and vice versa [49]. Both terms refer to the suspicion of IAC without having microbiological confirmation yet. Empirical treatment refers to which is started in patients with risk factors for IAC + clinical signs of infection non-explicable by any other known cause and absence of another responsible pathogen. The preemptive treatment represents a step further of suspicion, patients with risk factors for IAC + clinical signs plus a positive biomarker and again no explicable by other pathogens could receive this treatment approach, in Europe between 18.2% and 28% strategies correlate with preemptive regimen [48]. Some reports have described that empirical strategies achieved better clinical stability [49], and better prognosis in candidemia combined with catheter removal [50]; however, this benefit has not been reported in IAC [51]. In two recently published randomized trials comparing echinocandins versus placebo in the ICU population, the preemptive strategy failed to show effectiveness in preventing invasive candidiasis [52,53]. Table 1 shows prophylaxis, preemptive and empirical treatment strategies clinical trials regarding invasive candidiasis.
Community-acquired pneumonia in hospitalised patients: changes in aetiology, clinical presentation, and severity outcomes in a 10-year period
Published in Annals of Medicine, 2022
Júlia Sellarès-Nadal, Joaquín Burgos, María Teresa Martín-Gómez, Andrés Antón, Roger Sordé, Daniel Romero-Herrero, Pau Bosch-Nicolau, Anna Falcó-Roget, Cristina Kirkegaard, Dolors Rodríguez-Pardo, Oscar Len, Vicenç Falcó
We collected epidemiologic information (age, sex, residency in nursing home, smoking, alcohol consumption and vaccination status), comorbidities (hypertension, chronic obstructive pulmonary disease (COPD), diabetes mellitus, chronic renal failure, neurological disorders, and neoplasms) and immunosuppressive factors (solid organ transplantation, haematopoietic transplantation, chemotherapy, long-term use of corticosteroids, and HIV infection). We also registered clinical information, laboratory results, radiological findings, microbiological information, and severity data (septic shock and respiratory failure). Empirical treatment was recorded. Evolutive variables, such as admission at the Intensive Care Unit (ICU) and in-hospital mortality were collected. CURB-65 score and Pneumonia Severity Index (PSI) were calculated.
Rectal colonization with multidrug-resistant gram-negative bacteria in patients with hematological malignancies: a prospective study
Published in Expert Review of Hematology, 2020
Burak Kömürcü, Elif Tükenmez Tigen, Tayfur Toptaş, Tülin Fıratlı Tuğlular, Volkan Korten
Patients with hematological malignancies (HM) are predisposed to many infections due to both the primary disease and neutropenia caused by chemotherapeutic agents. Infections are also a major cause of mortality in this patient population [1]; multidrug-resistant (MDR) gram-negative infections constitute a growing threat for this vulnerable population [2–4]. Empirical antibiotherapy regimens are not always effective in patients with febrile neutropenia (FN) [5]. The aims of this study were to investigate (i) the risk factors for rectal colonization with carbapenem-resistant Enterobacteriaceae (CRE) and extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E) in hematological malignant patients with FN, (ii) the rate of rectal colonization and infection/colonization with CRE and ESBL-E, (iii) whether empirical treatment can be revised in this patient group.
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