Klebsiella pneumoniae carbapenemases in Enterobacteriaceae: history, evolution, and microbiology concerns.

Since the discovery of penicillin 80 years ago, gram-negative bacteria have become proficient at evading the lethal activity of β-lactam antibiotics, principally through the production of β-lactamases. The rapid emergence of penicillinases in both gram-positive and gram-negative bacteria led to the development of cephalosporin β-lactam antibiotics, but production of plasmid-mediated extended-spectrum cephalosporinases (or extended-spectrum β-lactamases) and AmpC enzymes resulted in resistance to this drug class. Because carbapenems were the only β-lactam agents active against such extended-spectrum β-lactamase-producing strains, appropriate and inappropriate use soon resulted in Enterobacteriaceae resistance.

Candidemia incidence in recipients of parenteral nutrition.

Background: The purpose of this study was to assess the incidence of candidemia in recipients of parenteral nutrition (PN) in a tertiary medical center with disease-specific guidelines for appropriate PN use.

Methods: A retrospective, medical record/database review was conducted for adult patients who received PN in a 473-bed medical center from January 2006 to October 2008. Patients receiving PN >72 hours with no recent history of fungemia or concomitant antifungal therapy were evaluated for candidemia incidence with special interest in intensive care unit (ICU) patients.

Trimethoprim-sulfamethoxazole exposure alters ex vivo function of B lymphocytes isolated from human immunodeficiency virus-infected patients receiving Zidovudine.

Study Objective: To determine if exposure to trimethoprim-sulfamethoxazole (TMP-SMX) causes a defect in peripheral B-cell function among patients with the human immunodeficiency virus (HIV) who are receiving zidovudine antiretroviral therapy.

Design: Prospective, single-center, single-group, case-crossover design with a 4-week exposure period.

Setting: University-affiliated infectious diseases outpatient clinic.

Bugs versus drugs: addressing the pharmacist's challenge.

Purpose: To address how the high endemic levels of antimicrobial resistance and multidrug resistance in hospitals have challenged clinicians to select appropriate therapy for effectively treating bacterial infections among seriously ill patients.

Summary: Among gram-positive bacterial infections, differentiating between healthcare-associated and community-associated methicillin-resistant Staphylococcus aureus infections is becoming more difficult and can seriously impact therapeutic strategies and hence outcomes. Furthermore, the rising prevalence of multidrug-resistant gram-negative bacterial infections is increasing the pressure on proper antimicrobial selection given the dearth of new antimicrobial agents under development.

Characterization of community-acquired Staphylococcus aureus infections in children.

Background: Limited data exist concerning characteristics of community-acquired Staphylococcus aureus infections (CA-SAI) in central and eastern Kentucky.

Objective: To describe the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections from January 1, 2004 through December 31, 2005, compare the number of CA-MRSA infections between years, and contrast treatment interventions and antibiotic susceptibility patterns of CA-SAI.

Methods: A concurrent and retrospective study was conducted in 125 patients less than 18 years of age with CA-SAI admitted to the hospital/clinic based on criteria from the Centers for Disease Control and Prevention.

Blunted humoral response to influenza vaccination in patients exposed to zidovudine plus trimethoprim-sulfamethoxazole.

Study Objectives: To determine as proof of principle the effect of combination exposure to zidovudine plus trimethoprim-sulfamethoxazole (TMP-SMX) on humoral immune responses to influenza vaccination in patients with human immunodeficiency virus (HIV).

Design: Prospective, open-label trial.

Setting: University-affiliated infectious diseases outpatient clinic.

Utilizing Pharmacy Records to Assess Antibiotic Prescribing Patterns on the Incidence of Community-Acquired Methicillin-Resistant Staphylococcus aureus Infections in Children.

Objective: To assess the effect of prior antibiotic therapy on the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children.

Methods: This was a concurrent and retrospective review of antibiotic records for children < 18 years of age with documented CA-MRSA infection identified between January 1, 2004, and December 31, 2005. Antibiotic records were compared against a control group.

Why is the microbiology lab calling about an extended-spectrum beta-lactamase bacterium from a wound culture?

As more and more gram-negative bacteria produce extended-spectrum beta-lactamases, it is important that physicians know what to do when these bacteria cause postoperative infections in patients.

Trimethoprim-sulfamethoxazole as a viable treatment option for infections caused by methicillin-resistant Staphylococcus aureus.

Objective: To review available data regarding the efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA).

Data Sources: A MEDLINE search was performed (January 1966-December 2003) using the search terms Staphylococcus aureus , sulfamethoxazole, trimethoprim, co-trimoxazole, and methicillin resistance. Abstracts from infectious diseases meetings also were reviewed.

Use of macrolides and tetracyclines for chronic inflammatory diseases.

Objective: To review the efficacy of macrolides and tetracyclines in several chronic inflammatory conditions.

Data Sources: Searches of MEDLINE (1966-March 2004) and an extensive bibliography search were undertaken. Key terms included acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis.

Methicillin-resistant staphylococcal infections: an important consideration for orthopedic surgeons.

Postoperative infections in joint prostheses and fracture-fixation devices commonly involve both MRSA and methicillin resistant coagulase-negative staphylococcus. In addition, community-acquired MRSA has also become an important consideration when infected patients are admitted to the hospital from the community. Preoperative colonization with MRSA and methicillin resistant coagulase-negative staphylococcus increases the risk of postoperative surgical site infections in orthopedic patients.

Drug costs and bacterial susceptibility after implementing a single-fluoroquinolone use policy at a university hospital.

The University of Kentucky Hospital investigated the feasibility of choosing a sole fluoroquinolone for its formulary in an effort to reduce costs without affecting clinical outcomes. A three-step process was used to plan, implement, and monitor the selection program. Based on the range of clinical indications, safety profile, local susceptibility, cost, and dosing convenience, levofloxacin was chosen over ciprofloxacin and gatifloxacin as the sole fluoroquinolone.

Changing strategies for the management of invasive fungal infections.

The frequency of invasive fungal infections (IFIs) has increased with the increase in number of high-risk patients. United States trends in mortality due to invasive mycoses showed a striking increase in the past 2 decades. Human immunodeficiency virus-associated opportunistic mycoses accounted for part of the increase, as did mycoses in other immunocompromised populations.