Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia:a Multinational Point Prevalence Study of Hospitalised Patients

Pseudornonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aeruginosa-CAP are limited. We assessed the multinational burden and specific risk factors associated with P. aeruginosa-CAP. We enrolled 3193 patients in 54 countries with confirmed diagnosis of CAP who underwent microbiological testing at admission. Prevalence was calculated according to the identification of P. aeruginosa. Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant P. aeruginosa-CAP. The prevalence of P. aeruginosa and antibiotic-resistant P. aeruginosa-CAP was 4.2% and 2.0%, respectively. The rate of P. aeruginosa CAP in patients with prior infection/colonisation due to P. aeruginosa and at least one of the three independently associated chronic lung diseases (i.e. tracheostomy, bronchiectasis and/or very severe chronic obstructive pulmonary disease) was 67%. In contrast, the rate of P. aeruginosa-CAP was 2% in patients without prior P. aeruginosa infection/colonisation and none of the selected chronic lung diseases. The multinational prevalence of P. aeruginosa-CAP is low. The risk factors identified in this study may guide healthcare professionals in deciding empirical antibiotic coverage for CAP patients

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time, and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space. While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes, vast areas of the tropics remain understudied. In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity, but it remains among the least known forests in America and is often underrepresented in biodiversity databases. To worsen this situation, human-induced modifications may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge, it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Enterobacteriaceae with extended spectrum betalactamases: Their importance as nosocomial pathogen agents [Enterobacterias con betalactamasas de espectro extendido: Su importancia como patogenos nosocomiales]

This article reviews the emergence evolution, epidemiology, laboratory detection and options for therapy and control of bacteria capable of producing extended spectrum betalactamases (ESBL). ESBL producing bacteria is now commonly found in nosocomial isolates like Klebsiella pneumoniae. ESBL mediated resistance first appeared in Europe in 1983, soon after oxymino- cephalosporins were introduced, and then spread to the America in 1988. ESBL bacteria are acquired by hospitalized patients that have risk factors that include duration of stay, invasive procedures and previous antibiotic exposure. Nosocomial infections caused by ESBL producing bacteria increase the morbidity, mortality and costs of the hospitalized patients. The therapeutic options are limited and complicated by the production of other mechanisms of resistance to the antibiotics of choice for the treatment of nosocomialisolates resistant to third-generation cephalosporins

Vancomycin-resistant Staphylococcus aureus. The management of infections due to this bacteria becomes difficult [Resistencia de Staphylococcus aureus a la vancomicina. El manejo de las infecciones producidas por esta bacteria se dificulta]

[No abstract available

Vancomycin-resistant Staphylococcus aureus. The management of infections due to this bacteria becomes difficult [Resistencia de Staphylococcus aureus a la vancomicina. El manejo de las infecciones producidas por esta bacteria se dificulta]

[No abstract available

Antimicrobial resistance in enterococci: Clinical implications [Resistencia de los enterococos a los antimicrobianos: Implicaciones clínicas]

The appearance of multiresistant enterococci represent to therapeutic challenge. During the last decade Enterococcus species have developed high-level gentamicin resistance, beta-lactamase production, vamcomycin and teicoplanin resistance, and high-level ampicillin resistance. The enterococci have become common nosocomial pathogens and problematic community pathogens. Enterococcus like E. faecium and E. faecalis are two of the bacteria that have developed bacterial resistance to almost all available antimicrobial agents. Enterococcus has joined methicillin-resistant Staphylococcus, penicillin-resistant Pneumococcus, vancomycin-resistant coagulase-negative Staphylococcus, and vancomycin-resistant S. aureus to the new gram-positive problem bacteria, similar to the gram-negative preponderance in the 1970s. The emergence of transferable multiresistance in gram-positive cocci like Enterococcus demands better laboratory methods for its detection and a complete adherence to the recommendations for preventing the spread of resistance in bacteria that frequently cause human infections

Infections produced by Gram-positive bacteria. Controversies related to the development of resistance [Infecciones producidas por bacterias grampositivas. Controversias relacionadas al desarrollo de resistencia]

Development of bacterial resistance to antibiotics is a world-wide public health problem. In the United States of America 64% of bacterial nosocomial infections are produced by Gram-positive cocci and the percentage of resistance in high. These are patogens with great ability to disseminate as well as with ability to develop resistance to most of the antibiotics currently in use. Today, S. aureous resistant to glicopeptids is a problem that makes difficult the choice of adequate drugs against these emergent bacteria. In this situation we must select the antibiotic with better activity, pharmacokinetic and pharmacodynamic as well as the lowest risk. Among these drugs are the oxazolidinonas

Antimicrobial resistance in enterococci: Clinical implications [Resistencia de los enterococos a los antimicrobianos: Implicaciones clínicas]

The appearance of multiresistant enterococci represent to therapeutic challenge. During the last decade Enterococcus species have developed high-level gentamicin resistance, beta-lactamase production, vamcomycin and teicoplanin resistance, and high-level ampicillin resistance. The enterococci have become common nosocomial pathogens and problematic community pathogens. Enterococcus like E. faecium and E. faecalis are two of the bacteria that have developed bacterial resistance to almost all available antimicrobial agents. Enterococcus has joined methicillin-resistant Staphylococcus, penicillin-resistant Pneumococcus, vancomycin-resistant coagulase-negative Staphylococcus, and vancomycin-resistant S. aureus to the new gram-positive problem bacteria, similar to the gram-negative preponderance in the 1970s. The emergence of transferable multiresistance in gram-positive cocci like Enterococcus demands better laboratory methods for its detection and a complete adherence to the recommendations for preventing the spread of resistance in bacteria that frequently cause human infections

The clinical applications of pharmacodynamics and pharmacokinetics of linezolid [Las aplicaciones clínicas de la farmacodinámica y farmacocinética de linezolid]

Background. Antimicrobial resistance among Gram-positive organisms is rising. Resistant Staphylococcus aureus, coagulase-negative Staphylococcus, Enterococcus, and Streptococcus pneumoniae, are now common pathogens of a variety of nosocomial and community infections. The treatment of Grampositive infections is complicated due to the frequent resistance of S. aureus to methicillin, S. pneumoniae to penicillin and the vancomycin resistance of Enterococcus. Purpose. To review the pharmacokinetic and pharmacodynamic properties of linezolid. Data sources. Medline search for studies examining the pharmacokinetics and pharmacodynamics of linezolid. Study selection. Fifty studies reviewed. Data synthesis. Linezolid is a new antibiotic that belongs to the Oxazolidinone class of antimicrobial agents. Linezolid inhibits the initiation of protein synthesis in a variety of bacteria. Linezolid is active against methicillin-resistant S. aureus, penicillin-resistant S. pneumoniae and vancomycin-resistant Enterococcus faecium among other Gram-positive pathogens. After the administration of 600 mg of linezolid the half-life at the elimination phase is 5.5 h, the mean maximum concentration of the drug in plasma at steady state ranges from 15 to 21 ?g/mL. The oral bioavailability is 100% after oral administration with a time to maximum concentration after an oral dose of 1.0 to 1.5 h. Linezolid has good tissue penetration including skin and lung. The usual linezolid dosage in adults is 600 mg every 12 h, and in children a dosage of 10 mg/kg every 8 h will be probably approved. A value of > 39% for the percentage of time during which the linezolid concentration exceeds the MIC of susceptible bacteria correlates with therapeutic success. The rapidly and extensively absorption after and oral dose facilitates the early discharge of patients with severe infections. Conclusions. Linezolid pharmacokinetics, pharmacodynamics and pharmacoeconomic properties support the use for the treatment of resistant Gram-positive infections

Infections produced by Gram-positive bacteria. Controversies related to the development of resistance [Infecciones producidas por bacterias grampositivas. Controversias relacionadas al desarrollo de resistencia]

Development of bacterial resistance to antibiotics is a world-wide public health problem. In the United States of America 64% of bacterial nosocomial infections are produced by Gram-positive cocci and the percentage of resistance in high. These are patogens with great ability to disseminate as well as with ability to develop resistance to most of the antibiotics currently in use. Today, S. aureous resistant to glicopeptids is a problem that makes difficult the choice of adequate drugs against these emergent bacteria. In this situation we must select the antibiotic with better activity, pharmacokinetic and pharmacodynamic as well as the lowest risk. Among these drugs are the oxazolidinonas