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1.
Curr Opin Infect Dis ; 37(2): 87-94, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38037891

RESUMO

PURPOSE OF REVIEW: The early recognition of acute bacterial skin infections (ABSIs) and their swift and adequate care are the major determinants of success. The features that can hamper or delay surgical and medical management can lead to 'difficult-to-treat' ABSIs. RECENT FINDINGS: Delayed diagnosis and belated management are the key obstacles to be overcome. Clinicians should be careful about underestimating the severity of ABSIs and overlooking comorbidities, especially immunosuppression. Many conditions can lead to delayed source control, including a misdiagnosis, interhospital transfers, delayed re-exploration, or extensive injuries. Difficult therapeutic issues can occur, including rapidly destructive infections from highly pathogenic microorganisms (Group-A-streptococci, Vibrio spp., Clostridium spp. and Staphylococcus aureus ) or inadequate antibiotic therapy resulting from multidrug-resistant bacteria. Impaired pharmacokinetic capacities of antibiotic agents should also be considered as a source of clinical failure due to insufficient antimicrobial activity at the site of infection. SUMMARY: Microbiological samples should be used for guiding antimicrobial therapy. Risk factors for multidrug-resistant bacteria should be considered, including local epidemiology and comorbidities. The optimization of antibiotic therapy should be achieved. Optimized care should be achieved through multidisciplinary management involving professionals with sufficient and appropriate training.


Assuntos
Anti-Infecciosos , Infecções Bacterianas , Dermatopatias Bacterianas , Infecções Estafilocócicas , Humanos , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/tratamento farmacológico , Antibacterianos/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Anti-Infecciosos/uso terapêutico , Staphylococcus aureus , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia
2.
J Crit Care ; 50: 155-161, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30551046

RESUMO

Ventilator-associated pneumonia remain frequent and serious diseases since they are associated with considerable crude mortality. Pathophysiology is centered on modifications of regional bacterial flora, especially tracheobronchial tree and oropharyngeal sphere. Bacterial migration from an anatomical area to another seems to be the main explanation of these alterations which are called "transcolonization". The association of transcolonization and lack of tightness of the endotracheal tube cuff provides a direct pathway for bacteria from the upper to the subglottic airways, eventually leading to ventilator-associated pneumonia. Although modification of bacterial flora has been largely studied, the mechanism which underlays the ability of the implantation, growing and interactions with the local microbiome that leads to the observed transcolonization remains to be more clearly deciphered. The aim of our review is to emphasize the cornerstone importance of the "transcolonization" as a nosological entity playing a central role in ventilator-associated pneumonia.


Assuntos
Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Pneumonia Associada à Ventilação Mecânica/microbiologia , Respiração Artificial/métodos , Brônquios/microbiologia , Cuidados Críticos/métodos , Infecção Hospitalar , Humanos , Unidades de Terapia Intensiva , Microbiota , Respiração Artificial/efeitos adversos , Sistema Respiratório , Traqueia/microbiologia
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