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1.  Community-acquired necrotizing pneumonia due to methicillin-sensitive Staphylococcus aureus secreting Panton-Valentine leukocidin: a review of case reports 
Background
Community-acquired necrotizing pneumonia caused by Panton-Valentine leukocidin (PVL)-secreting Staphylococcus aureus is a highly lethal infection that mainly affects healthy children and young adults. Both methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) may carry the PVL-phage, but the majority of publications relate to community-associated methicillin-resistant S. aureus (CA-MRSA) or mixed patient groups. This study focuses on necrotizing pneumonia due to methicillin-sensitive S. aureus strains, with the purpose to determine factors associated with outcome.
Methods
We report a patient with PVL secreting MSSA necrotizing pneumonia and performed a systematic review of similar case in the literature. We analyzed factors associated with outcome.
Results
A total of 32 patient descriptions were retained for analysis. Septic shock (p = 0.007), influenza-like prodrome (p = 0.02), and the absence of a previous skin and soft-tissue infection (p = 0.024) were associated with fatal outcome. In multivariate analysis, influenza-like prodrome (odds ratio (OR), 7.44; 95% confidence interval (CI), 1.24-44.76; p = 0.028) and absence of previous skin and soft-tissue infection (OR, 0.09; 95% CI, 0.01-0.86; p = 0.036) remained significant predictors of death.
Conclusions
Influenza-like prodrome may be predictive of adverse outcome in PVL-secreting MSSA necrotizing pneumonia. In contrast, previous skin and soft-tissue infection may be associated with improved prognosis.
doi:10.1186/2110-5820-1-52
PMCID: PMC3259061  PMID: 22192614
2.  Diagnosis of invasive candidiasis in the ICU 
Invasive candidiasis ranges from 5 to 10 cases per 1,000 ICU admissions and represents 5% to 10% of all ICU-acquired infections, with an overall mortality comparable to that of severe sepsis/septic shock. A large majority of them are due to Candida albicans, but the proportion of strains with decreased sensitivity or resistance to fluconazole is increasingly reported. A high proportion of ICU patients become colonized, but only 5% to 30% of them develop an invasive infection. Progressive colonization and major abdominal surgery are common risk factors, but invasive candidiasis is difficult to predict and early diagnosis remains a major challenge. Indeed, blood cultures are positive in a minority of cases and often late in the course of infection. New nonculture-based laboratory techniques may contribute to early diagnosis and management of invasive candidiasis. Both serologic (mannan, antimannan, and betaglucan) and molecular (Candida-specific PCR in blood and serum) have been applied as serial screening procedures in high-risk patients. However, although reasonably sensitive and specific, these techniques are largely investigational and their clinical usefulness remains to be established. Identification of patients susceptible to benefit from empirical antifungal treatment remains challenging, but it is mandatory to avoid antifungal overuse in critically ill patients. Growing evidence suggests that monitoring the dynamic of Candida colonization in surgical patients and prediction rules based on combined risk factors may be used to identify ICU patients at high risk of invasive candidiasis susceptible to benefit from prophylaxis or preemptive antifungal treatment.
doi:10.1186/2110-5820-1-37
PMCID: PMC3224461  PMID: 21906271

Results 1-2 (2)