PubMed Health⌕ Search

Biomedical subjects

M E Falagas

Publications and source records attributed to M E Falagas.

At least 19 recordsLinked to original sources
PubMed2007

Systematic review: fluoroquinolones for the treatment of intra-abdominal surgical infections.

BACKGROUND: Intra-abdominal infections result in substantial morbidity and mortality. Fluoroquinolones are among the various regimens that are used for the treatment of these infections. AIM: To evaluate the available data from laboratory and clinical studies regarding the use of fluoroquinolones for the treatment of patients with intra-abdominal infections. METHODS: We searched for relevant laboratory and clinical studies in the PubMed and the Cochrane Library databases. RESULTS: Good pharmacokinetic and pharmacodynamic properties of fluoroquinolones in inflamed abdominal tissue are reported in several laboratory studies. In six prospective non-randomized clinical studies of patients with intra-abdominal infections, the clinical success achieved with the use of fluoroquinolones ranged from 77% to 94%. In 10 randomized-controlled trials fluoroquinolone-based regimens were compared with other commonly used (mainly beta-lactam-based) regimens. Clinical success, bacterial eradication, withdrawal because of toxicity and mortality were similar between the compared treatment arms except from two randomized-controlled trials, in which clinical success was statistically higher in the fluoroquinolone treatment arm. CONCLUSIONS: Fluoroquinolones seem to be an effective and relatively safe option for the treatment of patients with intra-abdominal infections.

Abdominal Abscess↗
PubMed2006

Doxycycline-rifampicin: physicians' inferior choice in brucellosis or how convenience reigns over science.

OBJECTIVES: Brucellosis treatment is based on sub-optimal, not universally implemented regimens (doxycycline-rifampicin and doxycycline-streptomycin). The authors sought to evaluate specialists' and physicians' attitude towards regimens used, non-medical aspects, and future trends in human brucellosis treatment. METHODS: A questionnaire-based survey of multi-national specialists, physicians, and trainees, was conducted, questionnaire answered following lectures outlining major scientific facts about existing regimens. Responders indicated preference between the two regimens, their opinion on protracted monotherapy or triple regimens of shorter duration, awareness of disease notification and hospitalization practices. Results were evaluated in relation with professional status and experience with the disease. RESULTS: Although scientifically inferior to doxycycline-streptomycin, doxycycline-rifampicin is the choice regimen for 64.6% of the participants. A shorter triple regimen, but not protracted monotherapy, would be desirable (60.2% and 10.4%, respectively). Low awareness of disease-notifying status and related procedures were recorded in 53.9%. CONCLUSION: When choosing between currently acceptable brucellosis regimens, medical personnel prefer convenience, even at the cost of a slightly higher relapse percentage. Future trials should evaluate shorter triple regimens. Enhancement of awareness on the disease and its principles may increase therapeutic cost effectiveness.

Anti-Bacterial Agents↗
PubMed2006

Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection?

BACKGROUND: Escherichia coli O157:H7 is a foodborne pathogen causing haemorrhagic colitis, which is sometimes complicated by haemolytic uraemic syndrome or thrombotic thrombocytopenic purpura. AIM: To review the available evidence regarding the question of whether antibiotics are effective or harmful for the treatment of patients infected with E. coli O157:H7 infection. METHODS: We searched in the PubMed for relevant laboratory and clinical studies published between 1982 and 2005. RESULTS: In vitro studies have shown that most E. coli O157:H7 isolates are susceptible to various antibiotics, although certain antibiotics, especially at sublethal concentrations, have been found to increase the release of Shiga-like toxins, which have been associated with the development of haemolytic uraemic syndrome/thrombotic thrombocytopenic purpura in humans. No clinical studies have indicated that antibiotics are effective in reducing the duration of E. coli O157:H7 infection or the duration of diarrhoea or bloody diarrhoea specifically, while a few studies have supported that some antibiotics, especially quinolones and fosfomycin, may prevent the development of haemolytic uraemic syndrome or thrombotic thrombocytopenic purpura. On the other hand, there are some clinical studies that associate antibiotics with a higher risk for haemolytic uraemic syndrome and/or longer duration of diarrhoea, even with high mortality. CONCLUSIONS: More randomized controlled trials are necessary in order to elucidate whether antibiotics are effective in reducing the morbidity and mortality of E. coli O157:H7 infection, rather than having a detrimental effect.

Animals↗
PubMed2006

Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature.

An understanding of the epidemiology of multi-drug-resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa infections is necessary in order to develop strategies to curtail their spread. For this purpose, the evidence linking the isolation of MDR A. baumannii and P. aeruginosa with specific risk factors was evaluated. PubMed was searched for the 20-year period from September 1985 to September 2005, and eligible studies were considered to be those that: (1) linked the isolation of A. baumannii and P. aeruginosa with specific risk factors; (2) described the characteristics of the affected patients in detail; and (3) provided data on the antibiotic resistance profile of the isolated micro-organisms. Fifty-five studies were found referring to A. baumannii (28 with case-control methodology and 27 outbreak investigations without case-control methodology), and 42 studies were found referring to P. aeruginosa (25 with case-control methodology and 17 outbreak investigations without case-control methodology). Although heterogeneous study designs and investigated risk factors limited this analysis, it was concluded that acquisition and spread of these micro-organisms appear to be related to a large number of variables. Among the most important were deficiencies in the implementation of infection control guidelines and the use of broad-spectrum antibiotics. Use of carbapenems and third-generation cephalosporins appear to be related to the development of an MDR phenotype by A. baumannii, while carbapenems and fluoroquinolones are implicated in MDR P. aeruginosa. The diversity of risk factors associated with the development of MDR A. baumannii and P. aeruginosa suggests that a separate outbreak investigation should be performed in each hospital setting. The development of innovative control strategies is needed in order to limit the spread of these pathogens.

Acinetobacter Infections↗
PubMed2006

Attributable mortality of candidemia: a systematic review of matched cohort and case-control studies.

A systematic review of matched cohort and case-control studies was performed to examine the mortality attributable to candidemia. The review included studies that compared mortality of patients with candidemia (cases) to that of matched patients without candidemia (controls). Secondary variables examined were the length and cost of hospital stay. Relevant studies were identified using the PubMed database and by examining the references of the initially selected studies. Two independent reviewers performed the literature search, study selection and data extraction from the identified studies. A total of seven studies were included in the review. The patients included those hospitalized in intensive care units (ICU) and hospital wards and those undergoing transplantation. The mortality attributed to candidemia in the reviewed studies ranged from 5 to 71%. For six of the reviewed studies the difference in mortality between cases and controls was statistically significant. Among those who survived, the length of stay and the cost of hospitalization of patients with candidemia were significantly higher than those of controls. Despite the methodological heterogeneity of the reviewed studies, the data from the available matched cohort and case-control studies suggest that candidemia is associated with considerable mortality that is attributed, at least to some degree, to the infection itself and not only to the presence of another comorbidity.

Adult↗
PubMed2006

Effectiveness and nephrotoxicity of intravenous colistin for treatment of patients with infections due to polymyxin-only-susceptible (POS) gram-negative bacteria.

The prospective case series study presented here was conducted to assess the outcome of patients with infections caused by polymyxin-only-susceptible (POS) gram-negative bacteria managed with intravenous colistin. Between July 2003 and April 2005 a total of 27 patients were infected with a POS gram-negative bacterium and received intravenous colistin at a dose of 2 million international units (MIU) (160 mg or 66.7 mg colistin base) every 8 h for a mean (+/-SD) duration of 13.9 (+/-7.5) days. Nine patients had ventilator-associated pneumonia and received, in addition to the intravenous colistin therapy, 1 MIU (80 mg or 33.3 mg colistin base) aerosolized colistin every 12 h for a mean (+/-SD) duration of 13 (+/-6.5) days. The predominant pathogens were Pseudomonas aeruginosa (n = 17) and Acinetobacter baumannii (n = 12); in two patients both pathogens were isolated from one clinical specimen. In-hospital mortality and clinical response were 15% and 85%, respectively. Colistin-associated nephrotoxicity was observed in two of the 27 patients. POS gram-negative pathogens represent a major threat for hospitalized patients. Colistin appears to be an effective and safe treatment, even in patients with severe underlying diseases.

Acinetobacter Infections↗
PubMed2006

Mesh-related infection after hernia repair: case report of an emerging type of foreign-body related infection.

The use of a mesh has been an advance in hernia repair and subsequently has become prevalent worldwide. However, the use of mesh may be associated with both non-infectious and infectious complications. We present here a representative case of a mesh-related infection due to Staphylococcus aureus and review the available data about the incidence, etiology, clinical manifestations, diagnosis, management, and prevention of this emerging type of foreign body infections.

Female↗
PubMed2006

Morganella morganii infections in a general tertiary hospital.

BACKGROUND: Morganella morganii is a commensal Gram-negative bacillus of the intestinal tract of humans and other mammals and reptiles. Few reports exist in the literature regarding infections caused by this organism. METHODS: A retrospective study at the 650-bed University Hospital of Heraklion, Crete, Greece was performed during a 4-year period (2001-2004) to identify and analyze infections caused by M. morganii. RESULTS: Twenty-four patients had M. morganii isolated from clinical specimens during the study period. Thirteen patients (54%) suffered from skin and soft tissue infections, five from pyelonephritis, three from female genital tract infections, one from pneumonia, one from gangrenous appendicitis, and one from tonsillitis. M. morganii was a constituent of polymicrobial infections in 14 patients (58%). The patients received various antibiotics, i.e., six patients received ciprofloxacin, four piperacillin/tazobactam, two amoxicillin/clavulanic acid, one ticarcillin/clavulanic acid, one ceftriaxone, one imipenem, and one cefuroxime monotherapy, whereas the remaining eight received antibiotic combinations. Two (both debilitated) of 24 patients (8%) died, despite antibiotic treatment. CONCLUSION: Skin and soft tissue infection was the commonest type of infection due to M. morganii in our series. M. morganii is commonly a part of polymicrobial infections and can rarely cause fatalities in debilitated patients.

Adolescent↗
PubMed2006

Comparative effects of ertapenem, imipenem, and meropenem on the colonization of the gastrointestinal tract of mice by Candida albicans.

We evaluated the effect of three carbapenems on gut colonization of mice by Candida albicans. A total of 150 Crl:CD1 (ICR) BR mice were fed chow containing C. albicans or regular chow. Both groups were subsequently treated either with one carbapenem or with normal saline for 10 days. Stool cultures to determine colonization by C. albicans were performed immediately before, at the end, and one week after the end of treatment. Candida-colonized mice that received carbapenems had substantially higher C. albicans concentrations than control animals fed C. albicans, especially if they received ertapenem. Mice fed regular chow and treated with the study antibiotics or saline did not have Candida in their stools. Candida was not detected in the internal organs of any group of mice.

Animals↗
PubMed2006

Anti-cytomegalovirus prophylaxis in solid-organ transplant recipients.

Ganciclovir and its prodrug, valganciclovir, are more effective than acyclovir in preventing cytomegalovirus (CMV) infection and disease in solid-organ transplant recipients. However, the indirect effects of prophylactic use of ganciclovir and acyclovir are comparable, and the greater effectiveness of ganciclovir may be compensated for by less drug-related toxicity with acyclovir or valacyclovir. No conclusive data exist concerning the best technique and duration of surveillance for CMV infection in patients for whom active surveillance for late-onset CMV should be performed, i.e., those reaching the end of prophylaxis. Only large randomised controlled trials, with long follow-up periods, will provide definitive conclusions regarding the comparative prophylactic roles of the major antiviral agents in this population, and how their use fits with a strategy of active surveillance and pre-emptive therapy.

Acyclovir↗
PubMed2006

Effectiveness and nephrotoxicity of colistin monotherapy vs. colistin-meropenem combination therapy for multidrug-resistant Gram-negative bacterial infections.

A retrospective cohort study evaluated the effectiveness and nephrotoxicity of intravenous colistin monotherapy vs. colistin-meropenem combination therapy for patients with multidrug-resistant Gram-negative bacterial infections. Fourteen patients received intravenous colistin monotherapy and 57 received colistin-meropenem. No significant differences were found concerning clinical response of the infection (12/14 (85.7%) vs. 39/57 (68.4%), p 0.32) and development of nephrotoxicity (0/14 (0%) vs. 4/57 (7%), p 0.58). A favourable association was revealed between survival and treatment with colistin monotherapy compared to colistin-meropenem (0/14 (0%) vs. 21/57 (36.8%) deaths, p 0.007), even after adjusting for the variables for which significant differences were found.

Acute Kidney Injury↗
PubMed2006

Resistance of Mycobacterium tuberculosis isolates in different populations in Greece during 1993-2002.

OBJECTIVE: To document the prevalence of resistance of Mycobacterium tuberculosis to isoniazid (INH), rifampicin (RMP) and both combined (multidrug resistance [MDR]) in Greece from 1993 to 2002. DESIGN: We studied a single sputum sample per patient from 4108 patients referred to the Greek National Referral Centre for Mycobacteria. Patients were divided into native Greeks, immigrants and repatriated Greeks originating from the former Soviet Union. Prior treatment status was not recorded. RESULTS: A statistically significant increase in resistance to INH and RMP and MDR was noted comparing the years 1993-1997 to 1998-2002 (P < 0.0001). Resistance to INH and RMP and MDR rose from 5.6% to 7.71%, from 1.57% to 4.49% and from 1.23% to 3.98%, respectively, among native Greeks and from 23.63% to 32.91%, from 6.36% to 15.19% and from 6.36% to 13.92% among repatriated Greeks. Smaller changes were seen among immigrants (from 15.43% to 9.57% for INH, from 5.51% to 6.12% for RMP and from 5.71% to 5.32% for MDR). CONCLUSION: We documented an increase in M. tuberculosis resistance to INH and RMP, and MDR. This was mainly limited to native and repatriated Greeks. Although this is likely the result of immigration and of mismanagement of index cases in Greece, molecular methods are needed to better describe the situation.

Antitubercular Agents↗
PubMed2005

Bibliometric analysis of global trends for research productivity in microbiology.

In order to expand upon the limited literature estimating the quantity and quality of worldwide research production in the field of microbiology, a bibliometric analysis was conducted for the period 1995-2003 using the PubMed and Journal Citation Reports databases. By searching the "microbiology" category of the Journal Citation Reports database, a total of 74 journals were identified that were also included in PubMed. From these journals, a total of 89,527 articles were identified for analysis, and data on the country in which the research originated was available for 88,456 (98.8%) of them. The individual countries were separated into nine world regions. In terms of research production for the period studied, Western Europe exceeded all other world regions, with the USA ranking second. The mean impact factor was highest for the USA at 3.4, while it was 2.8 for Western Europe and 2.4 for the rest of the world combined. The research productivity per unit of expenditure for research and development was higher for Canada and Western Europe than for the USA. The three regions in which research productivity increased the most were Asia, Latin America, and Eastern Europe.

Africa↗
PubMed2005

Regression of subcorneal pustular dermatosis type of IgA pemphigus lesions with azithromycin.

We present our experience with a 56-year-old man who complained for generalized dermatopathy, manifested by skin lesions with diameter from 0.5 to 5 cm. The lesions did not respond to a 20-day systemic steroid regimen. The results of biopsies of three excised lesions, in combination with the clinical manifestations, led to the diagnosis of subcorneal pustular dermatosis type of IgA pemphigus. An unexpected improvement was noted after treatment with azithromycin (which was provided for management of concurrent non-specific urethritis) and local non-potent steroid plus keratolytic agent ointment.

Anti-Bacterial Agents↗
PubMed2005

Mesh-related infections after hernia repair surgery.

Clinicians have been challenged in the past few years by an increasing variety of novel non-infectious and infectious complications following the widespread use of meshes after open or laparoscopic repair of hernias. The possibility of a mesh-related infection occurring weeks or even years after hernia repair, should be considered in any patient with fever of unknown origin, or symptoms and/or signs of inflammation of the abdominal wall following hernia repair. The reported incidence of mesh-related infection following hernia repair has been 1%-8% in different series, and this incidence is influenced by underlying co-morbidities, the type of mesh, the surgical technique and the strategy used to prevent infections. An approach that combines medical and surgical management is necessary for cases of mesh infection. The antimicrobial treatment regimen chosen initially should include coverage of Staphylococcus spp. and, particularly, Staphylococcus aureus.

Herniorrhaphy↗
PubMed2005

Colistin treatment in patients with ICU-acquired infections caused by multiresistant Gram-negative bacteria: the renaissance of an old antibiotic.

A retrospective case series study was performed in a 30-bed general intensive care unit (ICU) of a tertiary care hospital to assess the effectiveness and safety of colistin in 43 critically ill patients with ICU-acquired infections caused by multiresistant Gram-negative bacteria. Various ICU-acquired infections, mainly pneumonia and bacteraemia caused by multiresistant strains of Pseudomonas aeruginosa and/or Acinetobacter baumannii, were treated with colistin. Good clinical response (cure or improvement) was noted in 74.4% of patients. Deterioration of renal function occurred in 18.6% of patients during colistin therapy. Nephrotoxicity was elevated significantly in those patients with a history of renal failure (62.5%). All-cause mortality amounted to 27.9%. In this group of critically ill patients, an age of >50 years (OR, 5.4; 95% CI 1.3-24.9) and acute renal failure (OR, 8.2; 95% CI 2.9-23.8) were independent predictors of mortality. Colistin should be considered as a treatment option in critically ill patients with infection caused by multiresistant Gram-negative bacilli.

Adult↗