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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


The Changing Epidemiology of Community-Acquired Mixed Bacterial Infections: Methods and Strategies for Effective Treatment


GOAL
To provide physicians with practical information on the changing epidemiology of community-acquired mixed infections that can lead to improved and effective treatment strategies.

TARGET AUDIENCE
This activity is designed for infectious disease specialists, general surgeons, and pharmacy directors.

LEARNING OBJECTIVES
After reading this issue, the participant should be able to:

  • Understand and implement the current recommendations for antimicrobial stewardship.
  • Identify the most relevant bacterial pathogens responsible for community-acquired mixed infections.
  • Discuss the current trends and mechanisms of resistance for community-acquired mixed bacterial infections.
  • Develop and implement the most effective treatment strategies for community-acquired mixed infections based on current trends in resistance.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 hours in Category 1 credit toward the American Medical Association (AMA) Physicians' Recognition Award. Each physician should only claim those hours of credit that he/she actually spends in this educational activity. Credits are available until the expiration date of March 31, 2004.

This continuing education activity was produced under the supervision of John G. Bartlett, MD, Professor and Chief, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.

This program is supported by an unrestricted educational grant from Merck & Co., Inc.

Publisher's Note and Disclaimer: The opinions expressed in this issue are those of the authors, presenters, and/or panelists and are not attributable to the publisher, editor, advisory board of Advanced Studies in Medicine, or The Johns Hopkins University School of Medicine or its Office of Continuing Medical Education. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this issue are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, LLC, an HMG Company. P.O. Box 340, Somerville, NJ 08876. (908) 253-9001. Web site: www.galenpublishing.com. Copyright ©2001 by Galen Publishing, LLC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Bulk postage paid at Somerville, NJ Post Office and at additional mailing offices. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC. Printed on acid-free paper. BPA Membership applied for December 2000.

The contents of this issue of Advanced Studies in Medicine include articles based on presentations given at a satellite symposium, supported by Merck & Co., at the 39th Annual Meeting of the Infectious Diseases Society of America held in San Francisco, California, on October 24, 2001.

CHAIR

    John G. Bartlett, MD
    Professor and Chief
    Division of Infectious Disease
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Bartlett reports serving on the HIV advisory boards for Abbott, GlaxoSmithKline, and Merck.

PARTICIPATING FACULTY

    William A. Craig, MD
    Professor of Medicine
    University of Wisconsin-Madison
    Department of Medicine
    William S. Middleton Memorial Veterans Hospital
    Madison, Wisconsin
    • Dr Craig reports receiving grant/research support from Aventis, GlaxoSmithKline, Merck, Tap, Ortho-McNeil, Abbott, Bayer, Wyeth Ayerst, Bristol-Myers Squibb, Schering Plough, Pharmacia, Cubist, Roche, and Pfizer; serving on the advisory boards for Aventis, GlaxoSmithKline, Merck, Tap, Ortho-McNeil, Abbott, Bayer, Wyeth Ayerst, Bristol-Myers Squibb, Eli Lilly, and Microcide; receiving lecture support from Aventis, GlaxoSmithKline, Roche, and Pfizer; and serving as a consultant to Schering Plough, Pharmacia, Cubist, and Pfizer.

    Neil O. Fishman, MD
    Assistant Professor
    Infectious Disease Division
    Director, Antimicrobial Management Program
    University of Pennsylvania Medical Center
    Philadelphia, Pennsylvania
    • Dr Fishman reports receiving grant/research support from Ortho-McNeil; serving on the advisory boards for Pfizer, Merck, GlaxoSmithKline, Bristol-Myers Squibb, Elan, Pharmacia, and Ortho-McNeil; serving on the advisory board for Merck; and serving as a consultant to TheraDoc.

    Richard P. Wenzel, MD, MSc
    Chairman
    Internal Medicine Department
    Medical College of Virginia Campus
    Virginia Commonwealth University
    Richmond, Virginia
    • Dr Wenzel reports receiving grant support from Intrabiotics, Pfizer, Merck, and Pharmacia; and serving on the advisory boards of Intrabiotics, Pfizer, Merck, and Eli Lilly.

Advanced Studies in Medicine provides disclosure information from contributing authors, participating faculty, and presenters only. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

The Changing Epidemiology of Community-Acquired Mixed Bacterial Infections: Methods and Strategies for Effective Treatment
John G. Bartlett, MD*

Infectious diseases is a rapidly moving field, and it very recently has become a high priority in American health, primarily because of emerging antibiotic resistance (ie, the increasing prevalence of methicillin-resistant Staphylococcus aureus in the community, evolving pneumococcal resistance, fluoroquinolone resistance) and now bioterrorism. For these and many other reasons, there is a desperate need for better diagnostic techniques and better treatment strategies.

Community-acquired mixed bacterial infections are susceptible to the wave of antibiotic resistance sweeping across the United States. Thornsberry and coworkers have reported rates of penicillin-resistant Streptococcus pneumoniae of up to 25% in some parts of the United States.1 Complicating matters is wide regional variation and multidrug resistance, and anaerobes as well as aerobes are vulnerable.

This collection of articles is based on presentations from a satellite symposium (supported by Merck & Co., Inc.) held during the 39th Annual Meeting of the Infectious Diseases Society of America in San Francisco, Calif., October 24, 2001. The focus of the program was the changing epidemiology of community-acquired mixed bacterial infections and the presentations addressed a wide range of issues including the epidemiology and mechanisms of antibiotic resistance, community-acquired pneumonia, antimicrobial stewardship, and pharmacodynamics.

This issue begins with a review of anaerobic microbiology and pathology with a historical review of our experiences with anaerobes over the last 100 to 150 years. Research of anaerobes has undergone substantial changes that affect the way we detect and treat these organisms.

Dr Richard Wenzel focused his presentation on community-acquired pneumonia (CAP), the concerns about resistance seen among pneumonia-causing pathogens, and the challenges in diagnosing CAP. In recent months, anthrax has received nationwide attention, which increases our concern for patients presenting with respiratory infection symptoms. As Dr Wenzel points out, we are currently able to diagnose the microbial etiology of CAP in only about 40% to 60% of cases, so first-line therapy often requires empiric decisions.

Dr Neil Fishman enlightened the group with his expertise of antimicrobial stewardship. His studies at the University of Pennsylvania have offered great insight into the effective strategies for improved antibiotic use. In his article he reviews those strategies, which range in complexity and cost from simple handwashing (by patients and health care staff) to restricted formularies, multidisciplinary infectious disease teams, computer-based interactive textbooks, and point-of-care decision tools. His program has already shown cost savings.

Dr William Craig approached the challenges of treating community-acquired mixed infections from a molecular and pharmacological vantage point. He has conducted extensive studies of the pharmacokinetic and pharmacodynamic parameters of different classes of antibiotics and how they affect efficacy. These studies are changing the way we think about dosing regimens and antibiotic choice for different infections.

This issue provides a useful approach to community-acquired mixed bacterial infections from 4 points of view. Each offers key insights into optimal treatment strategies and the role that antibiotic resistance plays in defining those strategies.

REFERENCE
1. Thornsberry C, Sahm DF, Kelly LJ, et al. Regional trends in antimicrobial resistance among clinical isolates of streptococcus pneumoniae, haemophilus influenzae, and moraxella catarrhalis in the United States: results from the TRUST Surveillance Program, 1999-2000. Clin Infect Dis. 2002; 1(suppl 34):S4-S16.

*Professor and Chief, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.