Carbapenem-resistant Acinetobacter baumannii: in pursuit of an effective treatment.

BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) has gained global notoriety as a critically important nosocomial pathogen. It mostly affects debilitated patients, causing pneumonia and bloodstream infections with high mortality rates. Difficulties in treating CRAB infections stem from a formidable resistance profile that leaves available only a few antibiotics of uncertain efficacy such as colistin and tigecycline. Despite the relentless attempts to improve therapeutic approaches (as depicted in colistin-oriented randomized clinical trials and the numerous observational studies), progress is still limited. AIMS: We aim (a) to assist physicians to adapt therapeutic approaches in CRAB infections by considering all potentially available antimicrobials, and (b) to present directions for future investigations that emerge through treatment efforts in endemic settings. SOURCES: Articles and reviews from PubMed and Scopus databases; studies from ClinicalTrials.gov; presentations from ECCMID congresses and IDWeek meetings. CONTENT: The review provides a succinct overview of the important pharmacokinetic/pharmocodynamic parameters of relevant antimicrobial agents, a critical appraisal of randomized control trials and observational studies, suggestions for increasing the strength of observational studies and directions facilitating the choice of therapeutic regimens by severity of infection and status of the host. IMPLICATIONS: The lack of an optimal therapeutic regimen for CRAB thus far, as shown in this review, suggests the need to thoroughly investigate alternative approaches through carefully designed trials that should include all relevant drugs. Some of these alternative directions are indicated in the present review.

Malaria in Europe: emerging threat or minor nuisance?

Malaria was eradicated from Europe in the 1970s through a combination of insecticide spraying, drug therapy and environmental engineering. Since then, it has been mostly imported into the continent by international travellers and immigrants from endemic regions. Despite the substantial number of imported malaria cases and the documented presence of suitable anopheline vectors, autochthonous transmission has not been widely observed in Europe, probably as a result of early diagnosis and treatment, afforded by efficient healthcare systems. Current climatic conditions are conducive to malaria transmission in several areas of Southern Europe, and climate change might favour mosquito proliferation and parasite development, further facilitating malaria transmission. Moreover, the continuing massive influx of refugee and migrant populations from endemic areas could contribute to building up of an infectious parasite reservoir. Although the malariogenic potential of Europe is currently low, particularly in the northern and western parts of the continent, strengthening of disease awareness and maintaining robust public health infrastructures for surveillance and vector control are of the utmost importance and should be technically and financially supported to avert the possibility of malaria transmission in Europe's most vulnerable areas.

Immune responses in children infected with the pinworm Enterobius vermicularis in central Greece.

Previous studies have suggested an immunomodulatory and even protective role for Enterobius vermicularis, the least pathogenic human intestinal helminth. Here, in a study using haematological and serological parameters, we tested a total of 215 children from central Greece, with a mean age of 8.39, of whom 105 (48.84%) were infected with E. vermicularis and 110 (51.16%) were matched healthy controls. In particular, we analysed eosinophil counts (EO), serum eosinophil cationic protein (ECP), total and specific serum immunoglobulin E (IgE) and the ECP/EO ratio. The atopic status and the potential occurrence of clinically expressed allergic diseases were both taken into account. Eosinophils, ECP and IgE were found to be higher in infected than in uninfected children, indicating a type-2 immune response activation during infection. Atopic infected children exhibited higher IgE levels compared to non-atopic ones. EO and ECP were found to be lower in atopic children who had a history of allergic disease than in those with no such history. The type-2 oriented immune response elicited against E. vermicularis could contribute to a balanced activation of the immune system in the examined children. Interestingly, although the atopic children showed a stronger activation, they did not exhibit any symptoms and, moreover, there seemed to be some indication of immunosuppression in those children with a positive history of allergic disease.

Methicillin-resistant Staphylococcus aureus nasal carriage among healthy employees of the Hellenic Air Force.

The prevalence of methicillin-resistant Staphylococcus aureus nasal carriage among 959 healthy employees of the Hellenic Air Force was investigated from November 2004 to October 2005. Nine participants were found to be colonised by methicillin-resistant Staphylococcus aureus (MRSA) (SCCmec type IV). Eight of the MRSA isolates were PVL-negative and belonged to ST30 by MLST, while the remaining one isolate was PVL-positive and classified as ST-80.