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Antimicrobial Synergy Testing by the Inkjet Printer-assisted Automated Checkerboard Array and the Manual Time-kill Method
12:03

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Published on: April 18, 2019

[Treatment of severe Gram-positive infections: current situation and new opportunities]

Michel Wolff1

  • 1Service de réanimation médicale et des maladies infectueuses, Hôpital Bichat-Claude Bernard, Paris (75).

Presse Medicale (Paris, France : 1983)
|May 20, 2003
PubMed

Insights

To combat rising Methicillin-resistant Staphylococcus aureus (MRSA) infections, especially vancomycin-intermediate strains, optimizing antibiotic strategies is crucial. This includes rational glycopeptide use and exploring alternative agents like linezolid.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pharmacology

Context:

  • Increasing prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) strains.
  • Emergence of vancomycin-intermediate (VISA) and glycopeptide-intermediate (GISA) strains poses treatment challenges.
  • Acute pneumonia in mechanically ventilated patients requires optimized antibiotic dosing.

Purpose:

  • To review current challenges and potential solutions for treating MRSA infections, particularly those with reduced vancomycin susceptibility.
  • To explore alternative antibiotic agents and combination therapies to preserve glycopeptide efficacy.
  • To guide vancomycin dosing strategies in specific patient populations.

Summary:

  • Achieving vancomycin concentrations 2-4 times the minimum inhibitory concentration (MIC) is recommended for MRSA pneumonia in ventilated patients, balancing efficacy and toxicity.
  • Strategies to combat resistant MRSA include infection prevention, rational glycopeptide use, and antibiotic cycling.
  • Alternative agents like linezolid and cotrimoxazole, and combinations with vancomycin (e.g., with gentamicin, rifampicin) are discussed for managing resistant strains.

Impact:

  • Highlights the need for strategic antibiotic use to preserve the effectiveness of existing treatments.
  • Provides insights into managing challenging MRSA infections with reduced susceptibility.
  • Informs clinical practice regarding antibiotic selection and dosing for MRSA pneumonia.

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