Biomedical subjects

Tony Mazzulli

Publications and source records attributed to Tony Mazzulli.

39 records · Page 3Linked to original sources

PubMed2002

Resistance trends in urinary tract pathogens and impact on management.

PURPOSE: The prevalence of antimicrobial resistance among urinary tract pathogens is reviewed and its clinical impact on management is determined. MATERIALS AND METHODS: A Medline search supplemented with references quoted in bibliographies of articles on urinary tract infections, epidemiology of antimicrobial resistance among uropathogens and clinical outcomes in urinary tract infections was conducted. RESULTS: Although some geographic variation is noted in resistance rates among urinary tract Escherichia coli isolates, rates were highest for ampicillin (39% to 45%) and trimethoprim-sulfamethoxazole (14% to 31.4%) and lowest for nitrofurantoin (1.8% to 16%) and fluoroquinolones (0.7% to 10%). Resistance rates also varied based on patient age. A few studies suggested that antimicrobial resistance impacts clinical and bacteriological outcome but the results are limited by the small number of patients. A randomized trial in women with acute uncomplicated pyelonephritis indicated that those treated with trimethoprim-sulfamethoxazole had a clinical and bacteriological success rate that was significantly lower in those patients treated with this drug when the infecting organism was resistant compared to those in whom the organism was susceptible to trimethoprim-sulfamethoxazole. CONCLUSIONS: Resistance rates among common uropathogens continue to evolve and appear to be increasing to many commonly used agents. Continued surveillance of resistance rates among uropathogens is needed to ensure that appropriate recommendations can be made for treatment of infected patients. Further studies addressing the clinical and bacteriological outcomes of patients infected with a resistant pathogen are needed.

Adolescent↗

PubMed2002

Antimicrobial resistance among clinical isolates of Streptococcus pneumoniae in Canada during 2000.

A total of 2,245 clinical isolates of Streptococcus pneumoniae were collected from 63 microbiology laboratories from across Canada during 2000 and characterized at a central laboratory. Of these isolates, 12.4% were not susceptible to penicillin (penicillin MIC, >or=0.12 microg/ml) and 5.8% were resistant (MIC, >or=2 microg/ml). Resistance rates among non-beta-lactam agents were the following: macrolides, 11.1%; clindamycin, 5.7%; chloramphenicol, 2.2%; levofloxacin, 0.9%; gatifloxacin, 0.8%; moxifloxacin, 0.4%; and trimethoprim-sulfamethoxazole, 11.3%. The MICs at which 90% of the isolates were inhibited (MIC90s) of the fluoroquinolones were the following: gemifloxacin, 0.03 microg/ml; BMS-284756, 0.06 microg/ml; moxifloxacin, 0.12 microg/ml; gatifloxacin, 0.25 microg/ml; levofloxacin, 1 microg/ml; and ciprofloxacin, 1 microg/ml. Of 578 isolates from the lower respiratory tract, 21 (3.6%) were inhibited at ciprofloxacin MICs of >or=4 microg/ml. None of the 768 isolates from children were inhibited at ciprofloxacin MICs of >or=4 microg/ml, compared to 3 of 731 (0.6%) from those ages 15 to 64 (all of these >60 years old), and 27 of 707 (3.8%) from those over 65. The MIC90s for ABT-773 and telithromycin were 0.015 microg/ml for macrolide-susceptible isolates and 0.12 and 0.5 microg/ml, respectively, for macrolide-resistant isolates. The MIC of linezolid was <or=2 microg/ml for all isolates. Many of the new antimicrobial agents tested in this study appear to have potential for the treatment of multidrug-resistant strains of pneumococci.

Adolescent↗

PubMedDate not supplied

Long-term follow-up of a cohort of HIV-infected patients who discontinued maintenance therapy for cytomegalovirus retinitis.

PURPOSE: To determine the long-term safety of discontinuation of maintenance therapy for cytomegalovirus retinitis (CMVR) and to identify predictors for relapse. METHOD: This was a prospective cohort study. Patients with treated CMVR who responded to HAART were followed by ophthalmologic assessment, markers for CMV replication (blood and urine cultures, CMV antigenemia, CMV DNA by PCR), and in vitro lymphoproliferative responses to CMV and other antigens after discontinuation of CMVR maintenance therapy. RESULTS: 23 patients were followed a median of 34 (range, 5-61) months. Median CD4 count was 321/mm3 at enrollment and 395/mm3 at last follow-up. HIV RNA was <50 copies/mL in 78% of patients at enrollment and 65% at last follow-up. One CMVR reactivation occurred at 12 months at a CD4 count of 395/mm3 (21%) and HIV RNA <50 copies/mL. Urine cultures were a poor predictive marker for reactivation. Other CMV replication markers had good negative predictive value. 96% of patients had a good lymphoproliferative response to CMV antigen in vitro. CONCLUSION: Maintenance therapy for CMVR can safely be discontinued in patients who have responded to HAART. Combining our results with the published literature, the risk of reactivation is estimated at 0.016 per person year of follow-up. Markers to predict relapse and the need for re-initiation of maintenance therapy are not yet identified.

AIDS-Related Opportunistic Infections↗