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Author Section AUTHOR SECTION patients with new onset of fever, demographic, clinical, and laborato- Mycoplasma spp. Overall, the spectrum of antibacterial activity indi- ry variables were obtained during the 2 days after inclusion, while cates a potential role for this combination in the treatment of diffi- microbiological results for a follow-up period of 7 days were collect- cult-to-treat Gram-positive infections, including those caused by ed. Patients were followed up for survival or death, up to a maximum multidrug-resistant organisms. Since this activity extends to Gram- of 28 days after inclusion. MEASUREMENTS AND RESULTS: Of negative respiratory bacteria, quinupristin/dalfopristin may also find all patients, 95% had SIRS, 44% had sepsis with a microbiologically a role in the treatment of atypical, as well as typical, pneumonia. confirmed infection, and 9% died. A model with a set of variables all significantly (p<0.01) contributing to the prediction of mortality was Boubaker A. et al. [Investigation of the urinary tract in children in nuclear med- derived.The set included the presence of hospital-acquired fever, the icine]. Rev Med Suisse Romande. 2000; 120(3) : 251-7.p Abstract: peak respiratory rate, the nadir score on the Glasgow coma scale, and The early detection of urologic abnormalities by antenatal sonogra- the nadir albumin plasma level within the first 2 days after inclusion. phy has resulted in the investigation of many infants and neonates for This set of variables predicted mortality for febrile patients with suspicion of either obstructive uropathy or reflux nephropathy. microbiologically confirmed infection even better.The predictive val- Nuclear medicine techniques allow to assess renal parenchyma ues for mortality of SIRS and sepsis were less than that of our set of integrity, to detect pyelonephritic scars and to measure absolute and variables. CONCLUSIONS: In comparison to SIRS and sepsis, the relative renal function; these methods are easy to perform and repro- new set of variables predicted mortality better for all patients with ducible, without any sedation, repeated venous punctures or bladder fever and also for those with microbiologically confirmed infection catheterization. Furthermore, the use of dynamic tubular tracers and only.This type of effort may help in refining definitions of SIRS and frusemide test is a very usefull method which can differentiate sepsis, based on prognostically important demographic, clinical, and between upper and/or lower urinary tract obstruction and deter- laboratory variables that are easily obtainable at the bedside. mine the degree of obstruction (severe or incomplete) in order to plan for surgery or conservative treatment. The detection of vesi- Bottger E.C. [Mycobacteria and mycobacterioses]. Pneumologie. 1995; 49 coureteric reflux may be difficult as it is an intermittent phenome- Suppl 3 : 636-42.p Abstract: The genus Mycobacterium harbours non: the use of the indirect radionuclide cystography (IRC), that is a number of significant pathogens. The diagnosis of mycobacterial to say after completion of a dynamic renography, allows to detect infections has traditionally relied on microscopical and cultural tech- reflux with a high sensitivity because images can be recorded con- niques which were compromised by the slow growth of these tinuously until the child voids, without any bladder catheterization microorganisms. More recently, molecular methods suitable for use and at low radiation dosis. In case of discordant results between mic- in diagnostic microbiology have been developed and have been turating cysto-urethrography and IRC or of concomittant obstruc- demonstrated to significantly improve both our diagnostic capabili- tive uropathy, the direct radionuclide cystography (DRC) is indicat- ties as well as our understanding of this complex genus of microor- ed for appropriate treatment. Nuclear medicine techniques do not ganisms. give morphological information about the urinary tract and should be considered as complementary to radiological investigations in first Bouam S. et al. Development of a Web-based clinical information system for evaluation of children with recurrent urinary tract infections or surveillance of multiresistant organisms and nosocomial infections. Proc hydronephrosis. AMIA Symp. 1999; 696-700.p Abstract: To optimize the surveil- lance and control of infections at our hospital, we have developed a Boucher B.A. Role of aztreonam in the treatment of nosocomial pneumonia in clinical information system (CIS) linked to a server providing three the critically ill surgical patient. Am J Surg. 2000; 179(2A Suppl) : 45S- kinds of patient-oriented data reports: 1/an automated alert for mul- 50S.p Abstract: In 1995 the American Thoracic Society issued an tiresistant bacteria from a data-driven mechanism; 2/the relevant official consensus statement on the treatment of hospital-acquired data for surveillance of hospital-acquired infections; 3/some clinical pneumonia (HAP). Classes of antimicrobials included in the list of and educational data for antibiotic prescribing. The new CIS is a antimicrobials deemed to be suitable for the empiric treatment of Web-based one and now integrated to the Hospital Information severe HAP were the aminoglycosides, quinolones, antipseudomon- System (HIS). In a close collaboration with the experts, we have, al penicillins, carbapenems, and beta-lactam/beta-lactamase inhibitor first, specified the relevant information for each report. Then, we combinations. Aztreonam, a monobactam, was also listed and is have linked the system to those HIS DBs containing this informa- unique among these agents based on its spectrum of activity being tion. Finally we have developed a well-secured intranet Web site, on limited to the gram-negative bacillary bacteria combined with an which the concerned practitioners can instantaneously review the excellent safety profile.This review focuses on the role of aztreonam latest alerts and/or the summarized/detailed reports. The prelimi- in the treatment of nosocomial pneumonia in the critically ill nary results shows that the system is reliable in medical practice and patient.A review of the literature was performed using PubMed and the response time is satisfying. secondary literature sources as to the clinical efficacy of aztreonam in the treatment of lower respiratory tract infections as well as its Bouanchaud D.H. In-vitro and in-vivo antibacterial activity of quin- pharmacokinetic and safety profiles. An analysis of aztreonam’s upristin/dalfopristin. J Antimicrob Chemother. 1997; 39 Suppl A : potential pharmacoeconomic advantages compared with other 15-21.p Abstract: Quinupristin/dalfopristin is a new water-solu- agents was also performed.Numerous studies have documented that ble streptogramin antimicrobial agent comprising quinupristin and aztreonam has effectiveness that is equal or superior to that of other dalfopristin in a ratio of 30:70. The in-vitro spectrum of activity suitable antibiotics in the treatment of nosocomial pneumonia. Its includes most multi-resistant Gram-positive aerobes, important excellent safety profile makes it a particularly attractive agent com- Gram-negative aerobes, Gram-positive anaerobes and intracellular pared with the aminoglycosides. Considering the potential costs of bacteria that are causal agents of respiratory, blood and cutaneous bacterial resistance from the use of broader-spectrum alternatives, a infections. Of particular note, quinupristin/dalfopristin is active case can be made that aztreonam is a pharmacoeconomically sound against multidrug-resistant isolates of Staphylococcus aureus, choice as well. Staphylococcus epidermidis and Enterococcus faecium, and against penicillin-resistant and/or erythromycin-resistant Streptococcus Boulesteix J. et al. Acute otitis media in children: a study of nasopharyngeal pneumoniae. The combination is also active against staphylococci carriage of potential pathogens and therapeutic efficacy of cefixime and amox- showing both constitutive and inducible erythromycin resistance. icillin-clavulanate. Infection. 1995; 23 Suppl 2 : S79-82.p Abstract: Bactericidal activity and a prolonged post-antibiotic effect have also We conducted a large, multicenter, randomized, open-label study been noted for quinupristin/dalfopristin against Gram-positive throughout France comparing the efficacy and safety of cefixime cocci. Gram-negative bacteria susceptible to quinupristin/dalfo- suspension (8 mg/kg/day, b.i.d., for 10 days) versus amoxicillin- pristin include Moraxella catarrhalis, Legionella spp. and clavulanate suspension (80 mg/kg/day,t.i.d., for 10 days) in 510 chil- 251 ANTIMICROBIAL RESISTANCE BIBLIOGRAPHY dren (ages 6 to 36 months) with acute otitis media. The most fre- included in this study. quent microorganisms colonizing the nasopharynx at the start of treatment were Streptococcus pneumoniae (51.5%), Haemophilus Bourgault A.M. et al. Update on Pan-American activities in the field of influenzae (45%) and Moraxella catarrhalis (30.2%). Rates of beta- anaerobes: Canada. Clin Infect Dis. 1997; 25 Suppl 2 : S237-40.p lactamase positivity were 32.1% and 95.3% for H. influenzae and M. Abstract: During the past 15 years, important contributions have catarrhalis, respectively.Decreased susceptibility of S. pneumoniae to been made to the field of anaerobes in Canada. Studies on the penicillin was found in 39.7% of isolates. Clinical efficacy was 87.8% importance of the intestinal flora as a source of vitamin K for (223/254) for
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