The Experts below are selected from a list of 213336 Experts worldwide ranked by ideXlab platform
Leonard A Mermel - One of the best experts on this subject based on the ideXlab platform.
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geographical variability in the likelihood of bloodstream infections due to gram Negative Bacteria correlation with proximity to the equator and health care expenditure
PLOS ONE, 2014Co-Authors: David N Fisman, Yehuda Carmeli, Eleni Patrozou, Eli N Perencevich, Ashleigh R Tuite, Leonard A MermelAbstract:Objective Infections due to Gram-Negative Bacteria exhibit seasonal trends, with peak infection rates during warmer months. We hypothesized that the likelihood of a bloodstream infection due to Gram-Negative Bacteria increases with proximity to the equator. We tested this hypothesis and identified geographical, climatic and social factors associated with this variability. Design We established a network of 23 international centers in 22 cities. Setting: De-identified results of positive blood cultures from 2007–2011 and data sources for geographic, climatic and socioeconomic factors were assembled for each center. Participants Patients at the 23 centers with positive blood cultures. Main outcome Due to variability in the availability of total culture volumes across sites, our primary outcome measure was the fraction of positive blood cultures that yielded Gram-Negative Bacteria; sources of variability in this outcome measure were explored using meta-regression techniques. Results The mean fraction of bacteremia associated with Gram-Negative Bacteria was 48.4% (range 26.4% to 61.8%). Although not all sites displayed significant seasonality, the overall P-value for seasonal oscillation was significant (P<0.001). In univariate meta-regression models, temperature, latitude, latitude squared, longitude, per capita gross domestic product and percent of gross domestic product spent on healthcare were all associated with the fraction of bacteremia due to Gram-Negative Bacteria. In multivariable models, only percent of gross domestic product spent on healthcare and distance from the equator (ie. latitude squared) were significantly associated with the fraction of bacteremia due to Gram-Negative Bacteria. Conclusions The likelihood of bacteremia due to Gram-Negative Bacteria varies markedly between cities, in a manner that appears to have both geographic (latitude) and socioeconomic (proportion gross domestic product devoted to health spending) determinants. Thus, the optimal approach to initial management of suspected bacteremia may be geographically specific. The rapid emergence of highly antibiotic-resistant Gram-Negative pathogens may have geographically specific impacts.
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geographical variability in the likelihood of bloodstream infections due to gram Negative Bacteria correlation with proximity to the equator and health care expenditure
PLOS ONE, 2014Co-Authors: David N Fisman, Yehuda Carmeli, Eleni Patrozou, Eli N Perencevich, Ashleigh R Tuite, Leonard A MermelAbstract:Objective Infections due to Gram-Negative Bacteria exhibit seasonal trends, with peak infection rates during warmer months. We hypothesized that the likelihood of a bloodstream infection due to Gram-Negative Bacteria increases with proximity to the equator. We tested this hypothesis and identified geographical, climatic and social factors associated with this variability.
Leonard Leibovici - One of the best experts on this subject based on the ideXlab platform.
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combination therapy for carbapenem resistant gram Negative Bacteria
Journal of Antimicrobial Chemotherapy, 2014Co-Authors: M Paul, Johan W. Mouton, Yehuda Carmeli, Emanuele Durantemangoni, Evelina Tacconelli, Ursula Theuretzbacher, Cristina Mussini, Leonard LeiboviciAbstract:Carbapenem-resistant Gram-Negative Bacteria (CR-GNB) represent an increasing hazard in healthcare settings. A central question concerning the treatment of invasive infections caused by CR-GNB involves the use of combination therapy. Potential advantages of combination therapy include improved efficacy due to synergy, while the disadvantages include adverse events and increased antibiotic use with a potential drive towards resistance. Several observational studies have examined whether combination therapy offers an advantage over colistin/ polymyxin monotherapy. We highlight the inherent limitations of these studies related to their observational design and sample size to show why they do not at present provide an answer to the question of combination versus monotherapy.This distinction is important to guide clinical practice until solid evidence has been obtained and to enable the recruitment of patients into randomized controlled trials. A few randomized controlled trials examining specific combinations have recently been completed or are ongoing. Currently, however, there is no evidence-based support for mostcombination therapies against CR-GNB, including colistin/carbapenem combination therapy.
Matthew E Falagas - One of the best experts on this subject based on the ideXlab platform.
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outcome of infections due to pandrug resistant pdr gram Negative Bacteria
BMC Infectious Diseases, 2005Co-Authors: Matthew E Falagas, Ioannis A Bliziotis, Sofia K Kasiakou, G Samonis, Panayiota Athanassopoulou, Argyris MichalopoulosAbstract:Background The increasing problem of infections due to multidrug-resistant Gram-Negative Bacteria has led to re-use of polymyxins in several countries. However, there are already clinical isolates of Gram-Negative Bacteria that are resistant to all available antibiotics, including polymyxins.
Yehuda Carmeli - One of the best experts on this subject based on the ideXlab platform.
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geographical variability in the likelihood of bloodstream infections due to gram Negative Bacteria correlation with proximity to the equator and health care expenditure
PLOS ONE, 2014Co-Authors: David N Fisman, Yehuda Carmeli, Eleni Patrozou, Eli N Perencevich, Ashleigh R Tuite, Leonard A MermelAbstract:Objective Infections due to Gram-Negative Bacteria exhibit seasonal trends, with peak infection rates during warmer months. We hypothesized that the likelihood of a bloodstream infection due to Gram-Negative Bacteria increases with proximity to the equator. We tested this hypothesis and identified geographical, climatic and social factors associated with this variability.
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geographical variability in the likelihood of bloodstream infections due to gram Negative Bacteria correlation with proximity to the equator and health care expenditure
PLOS ONE, 2014Co-Authors: David N Fisman, Yehuda Carmeli, Eleni Patrozou, Eli N Perencevich, Ashleigh R Tuite, Leonard A MermelAbstract:Objective Infections due to Gram-Negative Bacteria exhibit seasonal trends, with peak infection rates during warmer months. We hypothesized that the likelihood of a bloodstream infection due to Gram-Negative Bacteria increases with proximity to the equator. We tested this hypothesis and identified geographical, climatic and social factors associated with this variability. Design We established a network of 23 international centers in 22 cities. Setting: De-identified results of positive blood cultures from 2007–2011 and data sources for geographic, climatic and socioeconomic factors were assembled for each center. Participants Patients at the 23 centers with positive blood cultures. Main outcome Due to variability in the availability of total culture volumes across sites, our primary outcome measure was the fraction of positive blood cultures that yielded Gram-Negative Bacteria; sources of variability in this outcome measure were explored using meta-regression techniques. Results The mean fraction of bacteremia associated with Gram-Negative Bacteria was 48.4% (range 26.4% to 61.8%). Although not all sites displayed significant seasonality, the overall P-value for seasonal oscillation was significant (P<0.001). In univariate meta-regression models, temperature, latitude, latitude squared, longitude, per capita gross domestic product and percent of gross domestic product spent on healthcare were all associated with the fraction of bacteremia due to Gram-Negative Bacteria. In multivariable models, only percent of gross domestic product spent on healthcare and distance from the equator (ie. latitude squared) were significantly associated with the fraction of bacteremia due to Gram-Negative Bacteria. Conclusions The likelihood of bacteremia due to Gram-Negative Bacteria varies markedly between cities, in a manner that appears to have both geographic (latitude) and socioeconomic (proportion gross domestic product devoted to health spending) determinants. Thus, the optimal approach to initial management of suspected bacteremia may be geographically specific. The rapid emergence of highly antibiotic-resistant Gram-Negative pathogens may have geographically specific impacts.
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combination therapy for carbapenem resistant gram Negative Bacteria
Journal of Antimicrobial Chemotherapy, 2014Co-Authors: M Paul, Johan W. Mouton, Yehuda Carmeli, Emanuele Durantemangoni, Evelina Tacconelli, Ursula Theuretzbacher, Cristina Mussini, Leonard LeiboviciAbstract:Carbapenem-resistant Gram-Negative Bacteria (CR-GNB) represent an increasing hazard in healthcare settings. A central question concerning the treatment of invasive infections caused by CR-GNB involves the use of combination therapy. Potential advantages of combination therapy include improved efficacy due to synergy, while the disadvantages include adverse events and increased antibiotic use with a potential drive towards resistance. Several observational studies have examined whether combination therapy offers an advantage over colistin/ polymyxin monotherapy. We highlight the inherent limitations of these studies related to their observational design and sample size to show why they do not at present provide an answer to the question of combination versus monotherapy.This distinction is important to guide clinical practice until solid evidence has been obtained and to enable the recruitment of patients into randomized controlled trials. A few randomized controlled trials examining specific combinations have recently been completed or are ongoing. Currently, however, there is no evidence-based support for mostcombination therapies against CR-GNB, including colistin/carbapenem combination therapy.
Cornelia B Landersdorfer - One of the best experts on this subject based on the ideXlab platform.
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combination therapy for carbapenem resistant gram Negative Bacteria
Expert Review of Anti-infective Therapy, 2013Co-Authors: Alexandre P Zavascki, Jurgen B Bulitta, Cornelia B LandersdorferAbstract:The emergence of resistant to carbapenems Gram-Negative Bacteria (CR GNB) has severely challenged antimicrobial therapy. Many CR GNB isolates are only susceptible to polymyxins; however, therapy with polymyxins and other potentially active antibiotics presents some drawbacks, which have discouraged their use in monotherapy. In this context, along with strong pre-clinical evidence of benefit in combining antimicrobials against CR GNB, the clinical use of combination therapy has been raised as an interesting strategy to overcome these potential limitations of a single agent. Polymyxins, tigecycline and even carbapenems are usually the cornerstone agents in combination schemes. Optimization of the probability to attain the pharmacokinetic/pharmacodynamic targets by both cornerstone drug and adjuvant drug is of paramount importance to achieve better clinical and microbiological outcomes. Clinical evidence of the major drugs utilized in combination schemes and how they should be prescribed considering pharmaco...
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combination therapy for carbapenem resistant gram Negative Bacteria
Expert Review of Anti-infective Therapy, 2013Co-Authors: Alexandre P Zavascki, Jurgen B Bulitta, Cornelia B LandersdorferAbstract:The emergence of resistant to carbapenems Gram-Negative Bacteria (CR GNB) has severely challenged antimicrobial therapy. Many CR GNB isolates are only susceptible to polymyxins; however, therapy with polymyxins and other potentially active antibiotics presents some drawbacks, which have discouraged their use in monotherapy. In this context, along with strong pre-clinical evidence of benefit in combining antimicrobials against CR GNB, the clinical use of combination therapy has been raised as an interesting strategy to overcome these potential limitations of a single agent. Polymyxins, tigecycline and even carbapenems are usually the cornerstone agents in combination schemes. Optimization of the probability to attain the pharmacokinetic/pharmacodynamic targets by both cornerstone drug and adjuvant drug is of paramount importance to achieve better clinical and microbiological outcomes. Clinical evidence of the major drugs utilized in combination schemes and how they should be prescribed considering pharmacokinetic/pharmacodynamic characteristics against CR GNB will be reviewed in this article.
