Abstract:
:Although antibiotic therapy is the mainstay of therapy for gram-negative bacillary bacteremia, the amelioration of the underlying conditions, the correction of predisposing factors, the drainage of abscesses, the removal of infected foreign bodies, and adequate supportive care are also of paramount importance for curing the infection and should not be neglected. Beginning in the late 1960s, most of the clinical work on gram-negative infections has focused on the evaluation of new antibiotics. Numerous studies have shown that early, appropriate antibiotic treatment of gram-negative bacteremia significantly improved patients' outcomes and prevented the development of septic shock. Prescribing standard doses of antibiotics does not necessarily mean that therapeutic levels will be reached in all patients, and relapses of infections or breakthrough bacteremias can occur in patients with subinhibitory serum levels of antibiotics. The monitoring of serum concentrations of antibiotic is therefore recommended in critically ill septic patients. Whereas initial studies on the antibiotic treatment of gram-negative bacteremia were carried out in nonneutropenic patients, more recent clinical investigations have been performed almost exclusively in cancer patients with neutropenia. Studies conducted in the 1970s and 1980s among these patients have shown the following: (1) early empirical therapy reduced the mortality of gram-negative bacteremia; (2) therapy with a combination of two antibiotics, be it an extended spectrum penicillin plus an aminoglycoside or a third-generation cephalosporin, has significantly improved patients' outcomes; and (3) triple-drug combinations (i.e., a penicillin plus a cephalosporin plus an aminoglycoside) are not superior to combinations of beta-lactams and aminoglycosides. For the treatment of gram-negative bacteremia, clinicians today have a choice between well-established antibiotic combinations and broad-spectrum single-agent therapy with third-generation cephalosporins or carbapenem antibiotics. Although recent studies suggested that monotherapy could be as effective as combination therapy for the empirical treatment of fever in the neutropenic host, no definitive study has so far unquestionably demonstrated the equivalence of these treatments in patients with gram-negative bacteremias, especially those caused by P. aeruginosa, or in patients with adverse prognostic conditions, such as persistent and profound granulocytopenia. This literature should however be reviewed with great caution. Indeed, only a minority of studies have included a sufficient number of patients to confidently assess the impact of therapy on patients' outcomes. Obviously, small studies can have a significant risk of type II errors, that is, making false-negative conclusions.(ABSTRACT TRUNCATED AT 400 WORDS)
journal_name
Infect Dis Clin North Amjournal_title
Infectious disease clinics of North Americaauthors
Calandra T,Cometta Asubject
Has Abstractpub_date
1991-12-01 00:00:00pages
817-34issue
4eissn
0891-5520issn
1557-9824journal_volume
5pub_type
杂志文章,评审abstract::Anti-varicella-zoster virus serum antibody assays and their use in vaccine development are described. Of particular interest are FAMA and neutralization assays and the gpELISA. These and other assays are compared and summarized in terms of characteristics including biologic relevance, sensitivity, specificity, and sui...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(05)70311-1
更新日期:1996-09-01 00:00:00
abstract::The unknowns persisting in the understanding of the mode of action of anti-core lipopolysaccharide antibodies are discussed, and a study of two anti-lipid A monoclonal antibodies is reviewed. This article also critically analyzes the results of the recent clinical trials with monoclonal antibodies. ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1991-12-01 00:00:00
abstract::In Latin America, acute gastroenteritis remains to be an important cause of morbidity in adults and a major cause of morbidity and mortality in children. A child under 5 years of age belonging to a low income segment of the Latin American population will develop 5 to 10 bouts of diarrhea every year. The bacterial and ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1994-03-01 00:00:00
abstract::Occupational transmission of hepatitis B virus (HBV), hepatitis C virus, and HIV has been documented. The risk for occupationally transmitted infection varies for these three viruses. Despite effective pre- and postexposure prophylaxis for HBV and recent recommendations for postexposure chemoprophylaxis after an HIV e...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(05)70359-7
更新日期:1997-06-01 00:00:00
abstract::Lyme disease affects the nervous system in about 10% to 15% of infected individuals, most commonly causing lymphocytic meningitis. Cranial neuropathies, particularly facial nerve palsy, also occur frequently. Figuring prominently in the European literature, but less emphasized in the United States, is painful radiculi...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2007.12.009
更新日期:2008-06-01 00:00:00
abstract::No practitioner can hide from HIV. Patients infected with HIV are treated in every type of practice setting as the number of cases increases at an alarming rate. This article provides 10 basic guidelines for the care of HIV-infected patients. ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章
doi:
更新日期:1994-06-01 00:00:00
abstract::Antiviral agents aimed at treating HSV-2 chronically infected individuals have proven to be effective in the prevention of symptomatic genital herpes and the reduction of viral shedding. These agents play a key role in current HIV prevention trials that will assess the role of suppression of HSV-2 infection on the ris...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2005.04.005
更新日期:2005-06-01 00:00:00
abstract::Water serves as a major reservoir for the environmental mycobacteria. Many cases of cutaneous mycobacterial disease result from water exposure. The current theory of the pathogenesis of M. avium complex lung disease involves inhalation of organisms aerosolized from surface water. Disseminated M. avium disease in AIDS ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1987-09-01 00:00:00
abstract::Septic shock is a common life-threatening problem, usually presenting with fever, tachycardia, tachypnea, and often a source of infection. The cardiac index is increased, with a decreased systemic vascular resistance, and a reversibly decreased ejection fraction with an increased end diastolic volume. The myocardial d...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(05)70298-1
更新日期:1996-06-01 00:00:00
abstract::Bioterrorism preparedness is clearly a goal for the health care community, working in concert with city, county, state, and federal public health and emergency authorities and in collaboration with law enforcement at the local and federal levels. Opening the channels of communication between all groups involved, obtai...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(05)70189-6
更新日期:2001-12-01 00:00:00
abstract::The treatment of severe sepsis and septic shock remains a challenge as we approach the next millennium. Although more attention is being given to guidelines and care pathways for sepsis, these are unfortunately based primarily on consensus opinion. Additional research into supportive interventions in this potentially ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(05)70088-x
更新日期:1999-06-01 00:00:00
abstract::The central nervous system and systemic complications of bacterial meningitis cause significant morbidity and mortality. This article offers insight into the clinical features, pathogenesis, and management of these complications. In many instances, the improved outcome of intervention is based on clinical suspicion an...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(05)70099-4
更新日期:1999-09-01 00:00:00
abstract::Infections accompanying severe pancreatitis are secondary and of three types: infected pancreatic necrosis, infected pseudocyst (including peripancreatic fluid collection), and pancreatic abscess. The first is an earlier, more morbid process, with antibiotics supportive and surgical debridement necessary. The latter t...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1992-09-01 00:00:00
abstract::The nature of infections after solid-organ transplantation has changed with increasingly potent immunosuppressive regimens, routine use of antimicrobial prophylaxis, and improved microbiologic diagnostic tools. New pathogens have been identified in this population including many with significant antimicrobial resistan...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2010.01.005
更新日期:2010-06-01 00:00:00
abstract::Vaccination usually means the immunization of persons or animals against foreign infectious organisms for disease prevention. However, it has now been demonstrated that immunization against certain self substances to which tolerance normally exists can elicit beneficial effects to humans and other animals without indu...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章
doi:
更新日期:1990-06-01 00:00:00
abstract::Infection with the human immunodeficiency virus type 1 (HIV-1) results in progressive loss of immune function marked by depletion of the CD4+ T-lymphocytes, leading to opportunistic infections and malignancies characteristic of AIDS. Although both host and viral determinants influence the rate of disease progression, ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(05)70135-5
更新日期:2000-12-01 00:00:00
abstract::It appears incontestable that there is a link between genital ulcer disease and HIV infection. On the one hand the natural history and response to therapy of syphilis, HSV-2, and chancroid are all modified by the immunosuppressive effects of HIV infection. On the other hand, HIV transmission is probably facilitated by...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1994-06-01 00:00:00
abstract::Cytomegalovirus (CMV) continues to be responsible for a substantial fraction of the morbidity and mortality that follows organ transplantation. The three major consequences of CMV infection are CMV disease (encompassing a range of clinical illness), superinfection with opportunistic pathogens, and injury to the transp...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1995-12-01 00:00:00
abstract::An overview of the mechanism of action, dosing, clinical indications, and toxicities of the glycopeptide vancomycin is provided. Emerging gram-positive bacterial resistance to antimicrobials and its mechanisms are reviewed. Strategies to control emergence of resistance are proposed. Newer antimicrobial agents with act...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2004.04.014
更新日期:2004-09-01 00:00:00
abstract::Catheter-related bloodstream infections (CRBSI) are responsible for significant morbidity, mortality, and excess health care costs. It is increasingly evident that many CRBSI can be prevented with current knowledge and techniques. Preventive measures can be broadly grouped into clinical practice-based interventions an...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2016.07.001
更新日期:2016-12-01 00:00:00
abstract::Mass gatherings have attracted the attention of the medical community because of the increased demand made on existing services and the potential for public health problems resulting from changes in population dynamics and behaviors. Crowding, lack of hygiene, and rapid population movement at mass gatherings can lead ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2012.05.005
更新日期:2012-09-01 00:00:00
abstract::The problem of prophylaxis in orthopedic implant surgery will become increasingly important and complex as the population ages and requires more arthroplasty procedures, and the prevalence of antimicrobial-resistant bacteria meanwhile also continues to rise. Energy spent preventing prosthetic joint infection is more e...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2005.07.002
更新日期:2005-12-01 00:00:00
abstract::Successful antimicrobial stewardship programs rely on engagement with hospital administrators. Antimicrobial stewards should understand the unique pressures and demands of hospital and health system administration and be familiar with key terminology and regulatory requirements. This article provides guidance on strat...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2019.10.003
更新日期:2020-03-01 00:00:00
abstract::Urinary tract infections are common during infancy and childhood but are easily overlooked because of the unspecific symptoms. Prevention of renal scarring and its potential long-term consequences is possible but requires an increased awareness of the diagnosis, the imaging revealing anomalies within the urinary tract...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(05)70370-6
更新日期:1997-09-01 00:00:00
abstract::The approach to neurologic diagnosis and management of HIV-infected and AIDS patients follows that used in general neurologic practice but takes into account the altered probabilities of differential diagnosis in this group of patients. Clinical and neurodiagnostic evaluations, when pursued with a background understan...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1988-06-01 00:00:00
abstract::Vancomycin and daptomycin are options for the initial treatment of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Treatment options for persistent MRSA bacteremia or bacteremia due to vancomycin-intermediate or vancomycin-resistant strains include daptomycin, ceftaroline, and combination ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2020.04.003
更新日期:2020-12-01 00:00:00
abstract::In the ICU, fever can be expected to accompany an extensive number of conditions of both infectious and noninfectious etiologies. It is crucial to identify the precise cause of fever, because certain conditions in either category may be life-threatening, whereas others require no treatment at all. It is important to r...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(05)70294-4
更新日期:1996-03-01 00:00:00
abstract::Various nontuberculous mycobacteria can cause infection of skin and soft tissues. These organisms are also known as atypical mycobacteria, anonymous mycobacteria, and mycobacteria other than tuberculosis. These organisms are much more common causes of cutaneous infection than Mycobacterium tuberculosis. Infections cau...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1994-09-01 00:00:00
abstract::Mold infections carry a substantial clinical and economic burden in solid organ transplant (SOT) recipients with a high overall mortality of near 30%. The most important pathogens include Aspergillus, the Zygomycetes, Fusarium, Scedosporium/Pseudallescheria, and the dematiaceous (dark) molds. Risk factors for the infe...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2018.04.006
更新日期:2018-09-01 00:00:00
abstract::Tegumentary leishmaniases are caused by approximately 15 species of protozoa of the genus Leishmania. They prevail in tropical and subtropical areas of the Old and New World but human mobility also makes them a medical problem in nonendemic areas. Clinical manifestations may comprise cutaneous and mucocutaneous forms ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章
doi:10.1016/j.idc.2012.03.001
更新日期:2012-06-01 00:00:00