Successful Use of Cefiderocol to Treat a Multidrug-resistant Stenotrophomonas maltophilia Ventilator-associated Pneumonia in an Extremely Preterm Neonate.

BACKGROUND: Ventilator-associated pneumonia (VAP) caries a morbidity and mortality risk in the preterm neonate, particularly in the context of rising global antimicrobial resistance driving infections due to multidrug-resistant Gram-negative bacteria. Cefiderocol, a siderophilic cephalosporin, has broad Gram-negative antimicrobial activity and central nervous system penetration and is used for the treatment of hospital-acquired pneumonia or VAP in adults. Scarce data exists on its use in neonates. CASE: A female neonate born at 26 + 6 weeks developed VAP at 21 days of life. She was commenced on corticosteroids, vancomycin and ceftazidime but continued to deteriorate. Sputum cultures yielded Stenotrophomonas maltophilia resistant to trimethoprim/sulfamethoxazole, ciprofloxacin and ceftazidime, with potential susceptibility to cefiderocol. Cerebrospinal fluid showed an elevated white cell count. In view of worsening respiratory and hemodynamic status, antibiotic treatment was changed to cefiderocol monotherapy at 30 mg/kg/dose every 8 hours. Within 72 hours of commencing cefiderocol, the neonate was successfully extubated to variable-flow continuous positive airway pressure and showed ongoing clinical improvement. CONCLUSIONS: Cefiderocol was integral for the care of our neonate without any immediate adverse safety consequences. We relied on dosing data from a conference abstract, due to the paucity of evidence on the use of novel antimicrobials. This lack of evidence is particularly concerning given preterm neonates are particularly vulnerable to infections with multidrug-resistant Gram-negative organisms due to their immature immune systems, prolonged hospital stay, repeated interventions and antimicrobial exposure.

The challenge of talking about sex: the importance of patient-physician interaction.

Sexuality is a complex phenomenon, with physical, psychological, and social components. In evaluating and counselling the patient with sexual problems, it is important for the physician to communicate effectively and to be open to the patient's own experience of sexuality. This paper provides an overview of important issues related to evaluation of these patients and presents a stepwise approach to the clinical evaluation suitable to the limited time frame of a medical consultation.

Psychotherapeutic interventions for female sexual dysfunction.

This paper summarizes basic elements of psychotherapeutic interventions in women with female sexual dysfunction. Many women can be helped simply by being allowed to talk about their concerns in a safe and sympathetic environment or by being provided with basic information about female physiology and the sexual response. For other women, biomedical treatment (e.g. sex hormone therapy) may be appropriate. For those women who require more intensive or sustained psychotherapy, a variety of different approaches can be combined in a treatment program.

Attitudes, perceptions and knowledge about the vagina: the International Vagina Dialogue Survey.

BACKGROUND: The International Vagina Dialogue Survey examined women's attitudes, perceptions and knowledge regarding the vagina. METHODS: In total, 9441 women (18-44 years) from 13 countries underwent online interviews during April/May 2004. RESULTS: The majority of the women thought that vaginal health did not receive the attention it deserves (66%) and that society has too many misconceptions about the vagina (65%); indeed, 78% agreed that society's taboos surrounding the vagina contribute to women's ignorance. Only 39% of the women had ever read an informative article on the vagina, although 83% would like to read such an article. Although 79% of the women relied on advice from healthcare professionals (HCPs) when choosing a contraceptive, <50% were comfortable talking to HCPs about vagina-related issues. CONCLUSIONS: A more open and informative approach is needed with regard to the subject of the vagina in order to empower and educate women about their bodies and in matters such as choice of contraception.