Early Appropriate Parenteral Antimicrobial Treatment of Complicated Skin and Soft Tissue Infections Caused by Methicillin-Resistant Staphylococcus aureus

Abstract Background: Complicated skin and soft tissue infections (cSSTIs) are a major clinical problem, in part because of the increasing resistance of infecting bacteria to our current antibiotic therapies. Prompt appropriate treatment of infections in hospitalized patients reduces the mortality rate. Furthermore, appropriate and timely antibiotic therapy improves outcomes for cSSTIs caused by methicillin-resistant Staphylococcus aureus (MRSA). This review delineates factors to consider in the choice of initial antibiotic treatment for cSSTIs and describes the antimicrobial agents available or under clinical development for the treatment of cSSTIs caused by MRSA. Methods: Review of the pertinent literature and recommendations. Results: The choice of antimicrobial agent for empiric treatment of cSSTIs should be guided by the site and type of infection, the presence of an immunocompromised state or neutropenia, and risk factors for hospital-acquired MRSA (HA-MRSA) or community-associated MRSA (CA-MRSA) infection. Most CA-MRSA strains remain susceptible to ciprofloxacin, clindamycin, gentamicin, and trimethoprim/sulfamethoxazole, although resistance to clindamycin can emerge during treatment. Of the agents available for the treatment of HA-MRSA cSSTIs, vancomycin has been the reference standard, but clinical failures have been reported increasingly. Alternative agents for HA-MRSA include linezolid, which has been well-studied for treatment of cSSTIs, as well as daptomycin and tigecycline. A number of antibiotic agents are undergoing clinical trials or are under development for the treatment of cSSTIs caused by MRSA. Conclusions: Severe and progressive cSSTIs should be treated promptly with appropriate antibiotic agents. The choice of agent should be guided by a number of factors, including suspected CA-MRSA or HA-MRSA infection. Available agents should be evaluated carefully for efficacy in the treatment of MRSA cSSTIs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63135/1/sur.2008.063.supp.pd

Species Discrimination, Population Structure and Linkage Disequilibrium in Eucalyptus camaldulensis and Eucalyptus tereticornis Using SSR Markers

Eucalyptus camaldulensis and E. tereticornis are closely related species commonly cultivated for pulp wood in many tropical countries including India. Understanding the genetic structure and linkage disequilibrium (LD) existing in these species is essential for the improvement of industrially important traits. Our goal was to evaluate the use of simple sequence repeat (SSR) loci for species discrimination, population structure and LD analysis in these species. Investigations were carried out with the most common alleles in 93 accessions belonging to these two species using 62 SSR markers through cross amplification. The polymorphic information content (PIC) ranged from 0.44 to 0.93 and 0.36 to 0.93 in E. camaldulensis and E. tereticornis respectively. A clear delineation between the two species was evident based on the analysis of population structure and species-specific alleles. Significant genotypic LD was found in E. camaldulensis, wherein out of 135 significant pairs, 17 pairs showed r2≥0.1. Similarly, in E. tereticornis, out of 136 significant pairs, 18 pairs showed r2≥0.1. The extent of LD decayed rapidly showing the significance of association analyses in eucalypts with higher resolution markers. The availability of whole genome sequence for E. grandis and the synteny and co-linearity in the genome of eucalypts, will allow genome-wide genotyping using microsatellites or single nucleotide polymorphims