Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review.

BACKGROUND: Candidemia is among the leading causes of nosocomial bloodstream infections and is associated with significant mortality. Several centers have published data regarding the incidence and relative frequency of Candida spp. OBJECTIVE: We performed a systematic review to summarize and evaluate the available evidence regarding the distribution of the relative frequency of Candida spp isolated from blood, according to geographic region and study design, during the period 1996 to 2009. METHODS: We searched PubMed and Scopus and retrieved 81 relevant articles reporting data on the relative frequency of Candida spp. RESULTS: C. albicans was the predominant species in almost all studies. The highest proportion of C. albicans was found in North and Central Europe and the USA. Non-albicans species were more common in South America, Asia, and South Europe. C. glabrata was commonly isolated in the USA and North and Central Europe; C. parapsilosis in South America, South Europe, and several parts of Asia; and C. tropicalis in South America and Asia. The relative frequency of C. krusei was low in all regions. Significant differences were noted depending on study design (surveillance study, multicenter or single centre, prospective or retrospective) and setting (hospital or intensive care unit). CONCLUSIONS: Significant geographic variation is evident among cases of candidemia in different parts of the world. Local epidemiological data continue to be of major significance.

Clinical significance of the pharmacokinetic and pharmacodynamic characteristics of fosfomycin for the treatment of patients with systemic infections.

The advancing antimicrobial drug resistance in common bacterial pathogens, along with the relative shortage of new antibacterial agents, call for the re-evaluation of available therapeutic options. Fosfomycin is an established treatment option for uncomplicated urinary tract infections. Here we review and evaluate the main pharmacokinetic and pharmacodynamic parameters of intravenously administered fosfomycin with regard to its use for systemic infections. Fosfomycin is a relatively small, hydrophilic agent with almost negligible serum protein binding. It is excreted unchanged in urine, achieving high concentrations for a prolonged period. Fosfomycin has good distribution into tissues, achieving clinically relevant concentrations in sites such as serum, soft tissue, lungs, bone, cerebrospinal fluid and heart valves. Fosfomycin has shown antimicrobial activity against biofilms, particularly in combination with fluoroquinolones. It also exerts immunomodulatory effects, mainly on lymphocyte and neutrophil function. Potentially useful properties of fosfomycin regarding its use in combination regimens include reduction in the expression of certain penicillin-binding proteins and attenuation of nephrotoxicity caused by several antimicrobial agents. In conclusion, the pharmacokinetic and pharmacodynamic properties of fosfomycin do not preclude its use for various types of systemic infections and suggest further research on relevant clinical applications of this agent.

Seasonality of mortality: the September phenomenon in Mediterranean countries.

BACKGROUND: Seasonal increases in the mortality rate have been associated with excessively cold or hot weather. We evaluated monthly patterns of mortality in selected countries. METHODS: We analyzed all-cause mortality statistics from 5 European Mediterranean countries (Cyprus, France, Greece, Italy, Spain), Sweden, North America (United States and Canada), Australia, New Zealand and Japan. We extracted and tabulated data on monthly all-cause mortality in the general population from the earliest to the latest year that records were available. RESULTS: We identified relevant data for a period of 2-57 years in each country. In the Mediterranean countries, the lowest average daily mortality was observed in September (all countries, 125/168 [74%] years). The fewest deaths were in August in Sweden (14/20 [70%] years) and North America (32/50 [64%] years). The fewest deaths in Japan occurred in July (2/2 [100%] years). In the southern hemisphere, the lowest mortality in Australia occurred in March (7/10 [70%] years) and in February for New Zealand (cumulative over 24 years). INTERPRETATION: Mortality in the general population declines in the late summer to early fall months in the countries evaluated. Environmental parameters may partly account for these associations, and further research is needed on the contribution of additional factors such as summer vacations.

Fosfomycin for the treatment of infections caused by Gram-positive cocci with advanced antimicrobial drug resistance: a review of microbiological, animal and clinical studies.

BACKGROUND: The advancing antimicrobial drug resistance in Gram-positive cocci complicates the selection of appropriate therapy. The re-evaluation of older antibiotics may prove useful in expanding relevant therapeutic options. OBJECTIVE: We sought to evaluate fosfomycin for the treatment of infections caused by methicillin-resistant staphylococci, vancomycin-resistant enterococci, and penicillin-non-susceptible pneumococci. METHODS: We searched in PubMed, Scopus, and the Cochrane Library for studies evaluating the antimicrobial activity of fosfomycin against the above-mentioned pathogens, or the in vivo or clinical effectiveness of fosfomycin for the treatment of infections caused by these pathogens. RESULTS/CONCLUSIONS: As reported in the identified studies, the susceptibility rate of methicillin-resistant Staphylococcus aureus to fosfomycin was > or = 90% in 12/22, and 50-90% in 7/22 studies; the cumulative susceptibility rate was 87.9% (4240/4892 isolates). The cumulative susceptibility rate of vancomycin-resistant enterococci to fosfomycin was 30.3% (183/604 isolates), and that of penicillin-non-susceptible pneumococci was 87.2% (191/219 isolates). Clinical data show that fosfomycin, primarily in combination regimens, has been associated with clinical success in 28/29 (96.6%) cases of infection (mainly pneumonia, bacteremia, and meningitis) by fosfomycin-susceptible isolates of methicillin-resistant S. aureus. The above data support further research on the role of fosfomycin against infections caused by Gram-positive cocci with advanced antimicrobial drug resistance.

Toxoplasmosis snapshots: global status of Toxoplasma gondii seroprevalence and implications for pregnancy and congenital toxoplasmosis.

Toxoplasma gondii's importance for humans refers mainly to primary infection during pregnancy, resulting in abortion/stillbirth or congenital toxoplasmosis. The authors sought to evaluate the current global status of T. gondii seroprevalence and its correlations with risk factors, environmental and socioeconomic parameters. Literature published during the last decade on toxoplasmosis seroprevalence, in women who were pregnant or of childbearing age, was retrieved. A total of 99 studies were eligible; a further 36 studies offered seroprevalence data from regions/countries for which no data on pregnancy/childbearing age were available. Foci of high prevalence exist in Latin America, parts of Eastern/Central Europe, the Middle East, parts of south-east Asia and Africa. Regional seroprevalence variations relate to individual subpopulations' religious and socioeconomic practices. A trend towards lower seroprevalence is observed in many European countries and the United States of America (USA). There is no obvious climate-related gradient, excluding North and Latin America. Immigration has affected local prevalence in certain countries. We further sought to recognise specific risk factors related to seropositivity; however, such risk factors are not reported systematically. Population awareness may affect recognition of said risks. Global toxoplasmosis seroprevalence is continuingly evolving, subject to regional socioeconomic parameters and population habits. Awareness of these seroprevalence trends, particularly in the case of women of childbearing age, may allow proper public health policies to be enforced, targeting in particular seronegative women of childbearing age in high seroprevalence areas.

Trends of tuberculin skin test positivity rate among schoolchildren in Attica, Greece.

We sought to estimate the prevalence and temporal trends of tuberculin skin test (TST) positivity rate among schoolchildren, in a suburban area of Attica, Greece. We retrospectively analysed the prevalence of the TST positivity (forearm volar surface induration >10 mm) of schoolchildren, in the catchment area of the public primary healthcare centre of Vari, over a 16-y period (1990-2005). TSTs were performed in the context of a national, government-directed TB screening programme. We retrieved 11,105 records of TSTs performed on children aged 6 and 14 y. These tests referred to 7920 and 2969 BCG unvaccinated and vaccinated children, respectively, as well as 120 children who had close contact with a TB confirmed case, and 6 children with known active or latent TB. The prevalence of TST positivity among BCG unvaccinated children was 2.0% over the whole study period; this figure declined in the second compared to the first half of the study period (2.4% vs 1.4%, p<0.001). The gradual decline in TST positivity among BCG unvaccinated schoolchildren, despite the substantial rise in the number of immigrants in Greece, over our study period, may, at least in part, be attributed to relevant national screening and prevention measures.