RESUMEN
The incidence of aztreonam and cephalosporin susceptibility, determined using the revised CLSI breakpoints, for extended-spectrum-ß-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae isolates was evaluated. Our analysis showed that results for aztreonam and/or ≥1 cephalosporin were reported as susceptible or intermediate for 89.2% of ESBL-producing E coli isolates (569/638 isolates) and 67.7% of ESBL-producing K. pneumoniae isolates (155/229 isolates).
Asunto(s)
Antibacterianos/farmacología , Aztreonam/farmacología , Cefalosporinas/farmacología , Escherichia coli/efectos de los fármacos , Escherichia coli/enzimología , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/enzimología , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Humanos , Incidencia , Infecciones por Klebsiella/epidemiología , Infecciones por Klebsiella/microbiología , Pruebas de Sensibilidad Microbiana , beta-Lactamasas/metabolismoRESUMEN
We evaluated the BD GeneOhm MRSA achromopeptidase (ACP) assay, which incorporates a new specimen preparation approach. A total of 1,216 leftover nasal samples were tested; using culture as the gold standard, the sensitivity and specificity were 92% and 94.6%, respectively. The new lysis method provides good sensitivity and simplifies specimen preparation.
Asunto(s)
Técnicas Bacteriológicas/métodos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Técnicas de Diagnóstico Molecular/métodos , Mucosa Nasal/microbiología , Reacción en Cadena de la Polimerasa/métodos , Serina Endopeptidasas/genética , Infecciones Estafilocócicas/diagnóstico , Proteínas Bacterianas/genética , Humanos , Staphylococcus aureus Resistente a Meticilina/enzimología , Staphylococcus aureus Resistente a Meticilina/genética , Juego de Reactivos para Diagnóstico , Sensibilidad y Especificidad , Manejo de Especímenes/métodos , Infecciones Estafilocócicas/microbiologíaRESUMEN
We cared for a patient with methicillin-resistant Staphylococcus aureus bacteremia who experienced clinical failure with daptomycin. The failure was accompanied by progressive elevation of the daptomycin minimum inhibitory concentration during treatment. DNA fingerprinting confirmed that the minimum inhibitory concentration elevation occurred within the same strain of methicillin-resistant Staphylococcus aureus. This observation provides important new information to clinicians who adopt this promising drug for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus.
Asunto(s)
Daptomicina/uso terapéutico , Resistencia a la Meticilina , Infecciones Estafilocócicas/tratamiento farmacológico , Anciano de 80 o más Años , Dermatoglifia del ADN , Farmacorresistencia Bacteriana , Resultado Fatal , Femenino , Humanos , Pruebas de Sensibilidad Microbiana , Infecciones Estafilocócicas/fisiopatología , Staphylococcus aureus/efectos de los fármacosRESUMEN
The optimal strategy for ventilator-associated pneumonia remains controversial. To clarify the tradeoffs involved, we performed a decision analysis. Strategies evaluated included antibiotic therapy with and without diagnostic testing. Tests that were explored included endotracheal aspirates, bronchoscopy with protected brush or bronchoalveolar lavage, and nonbronchoscopic mini-bronchoalveolar lavage (mini-BAL). Outcomes included dollar cost, antibiotic use, survival, cost-effectiveness, antibiotic use per survivor, and the outcome perspective of financial cost-antibiotic use per survivor. Initial coverage with three antibiotics was better than expectant management or one or two antibiotic approaches, leading to both improved survival (54% vs. 66%) and decreased cost (US dollars 55447 vs. US dollars 41483 per survivor). Testing with mini-BAL did not improve survival but did decrease costs (US dollars 41483 vs. US dollars 39967) and antibiotic use (63 vs. 39 antibiotic days per survivor). From the perspective of minimizing cost, minimizing antibiotic use, and maximizing survival, the best strategy was three antibiotics with mini-BAL.