A review of linezolid: the first oxazolidinone antibiotic

Resistance of Gram-positive bacterial pathogens, such as Staphylococcus aureus and Enterococcus faecium, to existing antibiotics continues to increase, and new antibiotics with activity against these pathogens are in demand. Linezolid (Zyvox^®, Pharmacia and Upjohn) is the first agent of a new class of antibiotics called the oxazolidinones. Linezolid possesses excellent microbial activity against a wide variety of Gram-positive pathogens including those resistant to methicillin and vancomycin (Vancocin^®, Eli Lilly). Linezolid is available for intravenous and oral administration and possesses excellent bioavailability. It exhibits good penetration into pulmonary, as well as skin and related structure tissues, and does not require dosage adjustment in hepatic or renal dysfunction. Linezolid is generally well-tolerated, with the predominant adverse effect manifesting as a duration dependent, reversible thrombocytopenia. Linezolid possesses monoamine oxidase inhibitor activity and caution is warranted with coadministration of adrenergic or seritonergic medications. Clinical trials conducted with linezolid in skin and structure infections, lower respiratory tract infections and vancomycin-resistant enterococcal infections demonstrate that linezolid is an effective therapy. Recent data suggest that linezolid may be superior to vancomycin for the treatment of infections caused by methicillin-resistant S. aureus. Linezolid is an excellent and promising new antibiotic for the treatment of resistant Gram-positive pathogens.     

Comparison of the clinical and laboratory features of muscle infections caused by Salmonella and those caused by other pathogens

Muscle infections caused by Salmonella constitute an uncommon complication of extraenteric salmonellosis. The aim of this study was to compare the clinical features of Salmonella muscle infections with those reported in several large series of typical, both tropical and non-tropical, pyomyositis, caused mostly by Staphylococcus aureus. A literature survey of Salmonella muscle infections was carried out by using MEDLINE files 1966 through 2000, and cross-references from the selected articles, as well as major reviews of Salmonella infections and of pyomyositis. The survey yielded 32 cases suitable for analysis. The sex distribution, duration of symptom at presentation, degree of fever, involvement of multiple muscle groups, and leukocyte counts were not significantly different between patients with muscle infections caused by Salmonella and typical pyomyositis patients. In contrast, the median age of the patients with Salmonella muscle infections, and the rate of underlying conditions, were significantly higher than those in typical pyomyositis. Psoas muscle was involved more commonly in Salmonella infections than in typical pyomyositis, and the yield of posi-tive blood cultures and, particularly, the mortality rate, were substantially higher in Salmonella muscle infections than in typical pyomyositis. We conclude that patients with Salmonella muscle infections seem to have some different characteristics with respect to typical pyomyositis, such as older age, and higher rates of associated conditions, psoas muscle involvement, bacteremia, and mortality. Received: February 14, 2001 / Accepted: April 14, 2001     

Community-acquired necrotizing fasciitis caused by Acinetobacter calcoaceticus: A case report and literature review

A 61-year-old man presented with pain in the abdomen and right lower limb. He had a history of hepatitis B virus-induced liver cirrhosis, but had not been visiting the outpatient clinic and did not receive any medication. Cutaneous necrosis and bulla were observed on his abdomen and right lower limb. The necrotic skin was incised, and he was diagnosed with necrotizing fasciitis. A nonfermentative Gram-negative bacillus infection was confirmed from aspirated fluid and blood cultures. Therefore, meropenem and immunoglobulins were administered. Because necrosis was widespread, surgical debridement was performed. Thereafter, Acinetobacter calcoaceticus infection was confirmed by semi-quantitative PCR using the bullous fluid and blood cultures. Meropenem was administered for 3 weeks, followed by levofloxacin alone for 1 week. The patient's condition improved; therefore, skin grafting was performed as planned and yielded a favorable response. After rehabilitation, the patient could walk without support and infection did not recur. However, he had severe liver cirrhosis and large esophageal varices, and he eventually died from sudden varix rupture.Necrotizing fasciitis is an uncommon soft tissue infection, associated with high morbidity and mortality, and early recognition and treatment are crucial for survival. Acinetobacter is rarely associated with necrotizing fasciitis. Although this is a very rare case of the occurrence of necrotizing fasciitis due to A. calcoaceticus infection, we believe that this organism can be pathogenic in immunocompromised patients such as those with liver cirrhosis by reporting this case.     

Management of bacterial skin and skin structure infections with polymicrobial etiology

Introduction: Skin and Soft Tissue Infections (SSTIs) are some of the most commonly occurring bacterial infections, with a wide range of possible etiological pathogens and a considerable variety of clinical presentations and severity; from mild to severe life-threatening infections. Several classifications have been proposed based on a specific variable, such as anatomical localization, skin extension, progression rate, clinical presentation, severity, and etiological agent.

Areas covered: The last criteria allows the differentiation of SSTIs as monomicrobial and polymicrobial. Among them, especially those infections with a long lasting or chronic course can be sustained by multiple microbial etiology. Most polymicrobial SSTIs can be included in the following: diabetes foot infections (DFIs), pressure ulcers infection, burn infection, and infected chronic ulcers.

Expert commentary: The medical management of these infections comprises the administration of wide a spectrum antibiotic, taking into consideration the frequent occurrence of multidrug resistant microorganisms as responsible agents. An appropriate deep tissue specimen for microbiological examination is a very important issue, especially for polymicrobial infections, sometimes permitting the distinction between real pathogens and contaminants avoiding more complex antibiotic treatments. This aspect must be strongly emphasized, as frequently superficial swabs remain the specimen of choice because they are easy to obtain.     

Current management of bloodstream infections

Bloodstream infection (BSI) is a frequent complication of invasive infections. The presence of bacteremia has therapeutic and prognostic implications. Here we review recent changes in the epidemiology, diagnosis and treatment of BSI (excluding candidemia). The evidence of the impact of healthcare-association in many community-onset episodes and the increase in drug-resistant pathogens causing BSI in the community and hospitals is reviewed. The emergence of molecular methods as an alternative tool for the diagnosis of BSI and novel aspects of clinical management, particularly of some multidrug-resistant organisms. Several quality indicators related to the diagnosis and management of bacteremia in hospitals are proposed.     

Inhibition of HIV by chemokine receptor antagonists: exciting new targets,complex development

The prevalence of invasive fungal infections is increasing and the infections are becoming a major problem in immunocompromised children and neonates. Fortunately, there has been a recent surge in the development of new antifungal agents. Caspofungin, the first licensed echinocandin, is a novel class of antifungal and is approved for use in children 3 months of age or older for the treatment of invasive candidiasis, salvage therapy for invasive aspergillosis and as empirical therapy for febrile neutropenia. This article reviews the published data on the use of caspofungin in immunocompromised children and neonates with invasive fungal infections.     

Invasive fungal infections in pediatric patients: a review focusing on antifungal therapy

Invasive fungal infections in children appear to have increased over the past few decades. Substantial differences compared with adult patients in risk factors, pathogen epidemiology, pathophysiology and, most notably, pharmacokinetics of antifungal agents require age-adapted management and treatment approaches. The present article reviews these aspects for invasive aspergillosis and invasive candidiasis, the two most common life-threatening fungal infections.     

77例小儿巨细胞病毒感染的血液学表现

【目的】探讨巨细胞病毒感染的血液学表现。【方法】回顾性分析77例小儿巨细胞病毒感染血液学的临床表现。【结果】77例出现血液学表现,43例出现血液系统并发症(55.8%)。主要有外周血血小板增多34例(44.2%),粒细胞减少症28例(36.3%),贫血12例(15.6%),血小板减少症2例(2.6%),全血细胞减少1例(1.3%)。【结论】巨细胞病毒感染可引起各种各样血液学并发症,临床应高度重视。     

青岛市2010年夏季病毒性腹泻流行病学特点

目的了解2010年青岛市夏季病毒性腹泻的流行病学特点。方法收集2010年5—9月青岛市临床诊断为病毒性腹泻病人的临床资料进行流行病学分析。随机抽取其中260例病人进行大便标本病原学检测,并与260例细菌性腹泻病人进行比较。结果病毒性腹泻病人数占就诊腹泻总人数的60.6%,发病人群以中青年为主,平均年龄38.0岁。主要临床症状有腹痛（48.1%）,发热（46.8%）,水样便（43.8%）。大便病毒检测阳性率40.8%,其中轮状病毒（36.8%）、星状病毒（23.6%）和诺如病毒（22.6%）为主要病原体。与细菌性腹泻相比,受凉诱因、有无发热、是否水样便、腹泻次数以及腹鸣等症状差异有显著性（χ2=4.207～7.964,P〈0.05）。结论2010年夏季腹泻以病毒性腹泻为主,轮状病毒和星状病毒为主要病原体,抗病毒治疗不能显著改善疗效。     

降钙素原和超敏C反应蛋白检测在再生障碍性贫血合并肺部感染患者病原菌诊断中的意义

目的探讨降钙素原（PCT）和超敏C反应蛋白（hs-CRP）在再生障碍性贫血合并肺部感染患者病原菌诊断中的意义。方法将98例再生障碍性贫血合并肺部感染患者分为细菌感染组（n=28）、真菌感染组（n=28）、细菌合并真菌感染组（n=28）、支原体或病毒感染（n=14）,并以健康体检者作为对照组（n=28）。检测各组患者降钙素原（PCT）和超敏C反应蛋白（hsCRP）及WBC。结果与对照组比较,细菌感染组、真菌感染组、细菌合并真菌感染组患者PCT和hs-CRP均有不同程度升高,而支原体或病毒感染组的变化不明显。各感染组患者WBC明显低于对照组（P〈0.01）。与单纯真菌感染相比,革兰阳性菌和革兰阴性菌感染患者的PCT和hs-CRP均有不同程度升高,差异有统计学意义（P〈0.05）。与总体真菌感染患者比较,念珠菌感染患者PCT值高于曲霉菌感染（P〈0.05）。结论 PCT和hs-CRP检测对再生障碍性贫血合并肺部感染患者的病原菌诊断具有重要意义。     

Warned, but not well armed: preventing viral upper respiratory infections in households

The purpose of this state-of-the-science review was to identify strategies and household-level interventions for public health nurses to help prevent the acquisition and spread of viral upper respiratory infections (URI) in the community. Even though viral URI are a major global economic and social problem, surprisingly little research has been conducted to attempt to prevent them or reduce their transmission, probably because URI (with the exception of epidemic influenza) are generally considered to be mild and self-limited. Based on the research to date, public health nurses can use several promising strategies for prevention: (a) provide more tailored educational messages regarding preventive strategies such as vaccination, hand hygiene, spatial separation of infected household members, avoidance of antibiotics to treat viral URI, and environmental cleaning (e.g., for toys or other shared items), which are delivered personally rather than passively (e.g., pamphlets placed in a waiting room); (b) use each patient encounter in any setting to encourage influenza vaccination for relevant risk groups; (c) encourage use of alcohol hand sanitizers by household members during the cold and flu season; and (d) provide opportunities for skill development for adult and child household members (e.g., cover your cough, when to seek care or an antibiotic).     

从临床标本中定量检测泌尿生殖道支原体耐药性的研究

目的比较抗生素对临床标本中泌尿生殖道支原体抗菌作用。方法采用直接肉汤药盘法定量测定了临床标本中２１１株解脲脲原体（Ｕｕ）和５４株人型支原体（Ｍｈ）对８种抗菌药物的耐药性。结果２１１株Ｕｕ对四环素、强力霉素、氧氟沙星、环丙沙星、米诺环素、阿奇霉素、罗红霉素、交沙霉素耐药率分别为３８４％、２３２％、２０７％、６５４％、５１６％、０％、０９％及５７％；５４株Ｍｈ对四环素、强力霉素、氧氟沙星、环丙沙星、米诺环素、阿奇霉素、罗红霉素、交沙霉素耐药率分别为５９２％，４８．１％，３３３％，７５９％，５００％，１００％，１００％及２７８％。耐四环素的Ｕｕ株对强力霉素、环丙沙星、米诺环素都有交叉耐药，但对阿奇霉素、罗红霉素、交沙霉素无交叉耐药，耐四环素的Ｍｈ株对强力霉素、氧氟沙星、环丙沙星、米诺环素和交沙霉素有显著性交叉耐药。结论提示泌尿生殖道脲原体的耐药性监测，对指导临床治疗具有重要意义。     

泌尿生殖道非淋菌性感染及耐药性分析

目的　比较不同性别患者标本中支原体和衣原体分离率及对 6种抗菌素的耐药性。方法　采用IST和VI DAS试剂盒 ,对 4 5 5例疑为NGU患者的泌尿生殖道标本进行了支原体和衣原体检测 ,同时对支原体检测阳性标本进行了菌落计数和抗生素敏感性检测。结果　 4 5 5例标本中支原体和衣原体分离率为 36 8% ,其中男性标本中支原体和衣原体分离率为 19 9% ,女性标本中支原体和衣原体分离率为 5 2 3%。Uu菌落计数结果 ,≥ 10 4 cfu ml比较女性(74 4 % )高于男性 (6 0 0 % ) ;Mh菌落计数结果 ,≥ 10 4 cfu ml比较女性 (35 8% )与男性 (36 4 % )基本相同。支原体对PRI保持敏感 ,对DOX、JOS、OFL、ERY、TET的耐药率女性和男性标本各不相同。结论　NGU患者中支原体和衣原体是主要的病原 ,监测支原体的耐药性对指导临床治疗具有重要意义 ,原始霉素 (PRI)和强力霉素 (DOX)可作为治疗支原体感染NGU的首选药物     

解脲支原体和沙眼衣原体感染与孕囊枯萎的相关研究

目的研究解脲支原体 (UU)和沙眼衣原体 (CT)感染对孕囊枯萎的影响。方法应用支原体培养和衣原体抗原免疫快速法对 10 2例囊枯萎组 (观察组 )和 86例早孕人工流产 (对照组 )宫颈分泌物进行UU和CT的检测。结果观察组宫颈分泌物UU和CT阳性检出率分别为 36 .2 %和 2 0 .6 % ,均明显高于对照组(P <0 .0 1)。观察组UU和CT复合感染率为19 .6 % ,也较对照组明显升高 (P <0 .0 1)。术后随访 2年 ,UU和CT阳性组其输卵管妊娠的发生率升高。结论UU和CT感染与孕囊枯萎密切相关。     

婴幼儿反复呼吸道感染相关多因素的分析

【目的】探讨长沙地区婴幼儿反复呼吸道感染（RRTI）的相关因素,为防治此类疾病提供科学依。据。【方法】收集2009年5月至2010年5月本院126例RRTI患儿作为病例组,以180例健康婴幼儿作为对照组,分析婴幼儿RRTI的相关因素。单因素分析采用x^2分析或t检验,多因素分析采用非条件Logistic回归分析。【结果】单因素分析结果显示年龄、有无早产、哺养方式、锌、血清免疫球蛋白、IgG、IgA水平及Z评分法儿童发育状况不同婴幼儿RRTI发生率不同。多因素分析结果显示年龄、Z评分法儿童发育状况、锌及血清免疫球蛋白IgA、IgG为婴、幼儿RRTI的保护因素（OR〈1,P〈0．05）。【结论】婴幼儿RRTI发生与婴幼儿年龄,Z评分法儿童发育状况、锌,血清免疫球蛋白IgA,IgG密切相关。     

Azithromycin in children: A critical review of the evidence

Background: Azithromycin is a macrolide antibiotic that can be dosed once daily. In the last decade, the body of literature concerning the clinical applications of azithromycin has grown rapidly, leading to improved understanding as well as new questions about the role of this drug in the treatment of adult and pediatric infections.Objective: This review explores the use of azithromycin in the treatment of pediatric infections.Methods: We conducted a MEDLINE literature search to identify pertinent English-language studies of azithromycin published between 1987 and 2001.Results: The use of azithromycin in the treatment of acute Streptococcus pyogenes pharyngotonsillitis, acute otitis media, community-acquired pneumonia, pertussis, skin and soft tissue infections, Mycobacterium avium complex (MAC), trachoma, typhoid fever, cat-scratch disease, cryptosporidiosis, and legionnaires' disease has been studied in clinical trials.Conclusions: Azithromycin is indicated as a first-line treatment for respiratory tract infections caused by Legionella species, Mycoplasma pneumoniae, and Chlamydia pneumoniae, and as empiric therapy for community-acquired pneumonia in older children and adolescents who are deemed appropriate for outpatient oral therapy. Azithromycin in a single dose is an excellent treatment for chlamydia cervicitis/urethritis and for trachoma and has demonstrated efficacy in prophylaxis and treatment of disseminated MAC infections in children who have AIDS. Azithromycin may be considered as an alternative in the treatment of skin and soft tissue infections, although local patterns of resistance of pathogens must be considered in its selection.     

血清降钙素原与超敏C反应蛋白联合检测在真菌性感染诊断中的应用

目的：观察细菌性及真菌性感染患者血清降钙素原（PCT）、超敏C反应蛋白（hs‐CRP）检测水平。方法选取56例感染患者,其中细菌性感染33例（细菌组）、真菌性感染23例（真菌组）,另选择30例体检中心健康体检者作为对照组。采集静脉血检测3组血清PCT及hs‐CRP水平。结果细菌组、真菌组、对照组血清hs‐CRP分别为（38．1±10．5）、（36．5±9．8）、（7．2±3．6）mg／L ,细菌组、真菌组与对照组比较差异有统计学意义（P＜0．05）;细菌组与真菌组比较差异无统计学意义（P＞0．05）。细菌组、真菌组、对照组血清PCT分别为（7．35±2．12）、（3．15±1．03）、（0．42 ± 0．16）ng／mL ,细菌组、真菌组与对照组比较差异有统计学意义（P＜0．05）;细菌组与真菌组比较差异有统计学意义（P＜0．05）。结论真菌性感染患者血清hs‐CRP、PCT水平均升高,但较细菌性感染患者血清PCT水平升高不明显,故联合检测血清PCT、hs‐CRP有助于早期诊断真菌性感染。     

比阿培南和亚胺培南对呼吸道和泌尿道致病菌的体外抗菌活性比较

目的研究比阿培南和亚胺培南对呼吸道和泌尿道致病菌的体外抗菌活性。方法采用琼脂二倍稀释法，测定比阿培南和亚胺培南对294株呼吸道和泌尿道致病菌的MIC。结果比阿培南对所有测试菌的MIC价MIC90和敏感率范围分别为≤0．03～4μg／ml、0．06～〉128μg／ml及90％～100％，亚胺培南为≤0．03—2μg／ml、0．06～〉128μg／ml及86．7％～100％。比阿培南对金黄色葡萄球菌、表皮葡萄球菌的MIC90（4，1μg／ml）是亚胺培南MIC90（2，0．25μg/ml）的2—4倍，对大肠埃希菌、阴沟肠杆菌、奇异变形杆菌、铜绿假单胞菌、鲍曼不动杆菌的MIC90（0．125—4μg／ml）是亚胺培南MIC90（0．5～8μg／ml）的1／4～1／2，对肠球菌属、肺炎链球菌、肺炎克雷伯菌、流感嗜血杆菌的MIC90与亚胺培南相当，分别为〉128、0．06、0．5、2μg／ml。结论比阿培南对革兰阳性菌和革兰阴性菌均具有广谱抗菌活性，其中对革兰阴性菌的作用优于亚胺培南，对革兰阳性菌的作用稍差于亚胺培南。