Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients.The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance.The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria.An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.

The correlations between calprotectin and MPO indicate that PMNs are a major contributor to the calprotectin content in gingival crevicular fluid of severely affected sites. Calprotectin levels in gingival crevicular fluid and their changes reflect periodontal inflammation as well as the clinical treatment outcome. A prognostic potential of this marker substance remains to be determined.

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Uri nary tract in fec tion in men Ab stract. Ob jec tive: To ex plore the prev alence and mi cro bi ol ogy of uri nary tract in fection (UTI) in symp tom atic men in a pri mary care set ting and to de ter mine the ap pro pri ateness of pa tient man age ment of these con ditions by the gen eral prac ti tio ners. Meth ods: A cross-sec tional sur vey was car ried out matching doc u men ta tion of symp toms and man agement with urine cul ture and re sults of sus cep tibil ity tests. All pa tients pre sent ing with symptoms typ i cal for a UTI in 36 teach ing gen eral prac tices in the area of Göttingen, Ger many, were el i gi ble for en rol ment in the study. 15% (n = 90) of all pa tients were adult men. Gen eral prac ti tio ners (GPs) were in structed to man age pa tients as usual. Pa tient char ac ter is tics, dipstick tests and treat ment were matched with results of urine cul tures and sus cep ti bil ity testing. Re sults: Men pre sent ing with symp toms in dic a tive of UTI were pre dom i nantly el derly (me dian age 61 years) and 41% had ad di tional risk fac tors. An ti bi ot ics were pre scribed for 36%, but these were not well-tar geted. Urine cul ture re vealed UTI in 60%, of which half had low col ony counts (23% of all pa tients) or multi ple bac te rial growth (7%); 40% had ster ile urine. Dip stick tests proved un help ful: leu kocytes and ni trite had sen si tiv i ties of 54% and 38%, specificities of 55% and 84%, pos i tive pre dic tive val ues of 65% and 78% and neg ative pre dic tive val ues of 44% and 46%, re spectively. Re sis tance lev els were 53% for amoxicillin and cefaclor, 28% for cefixim, 22% for ciprofloxacin, 34% for both trimethoprim as in di vid ual sub stance and the com bi na tion with sulfamethoxazole (cotrimoxazole) and 25% for ni tro fu ran toin. Con clusion: Men with symp toms in dic a tive of a UTI should not be treated em pir i cally. A urine culture and antibiogram should be ob tained before a treat ment de ci sion is made. A low-count UTI was com mon and should not be con sidered nor mal. Methods In the con text of a larger cross-sec tional sur vey on UTI in Ger man gen eral prac tices, all 118 teach ing gen eral prac tices of the Depart ment of Gen eral Prac tice and Fam ily Key words uri nary tract in fec tions/ di ag no sis-uri nary tract in fec tions/ther apyanti-in fec tive agents/ urinary-male-gen eral prac tice Re ceived No vem ber 11, 2003; ac cepted

In these real-life studies, tigecycline, alone and in combination, achieved favourable clinical response rates in patients with cIAI with a high severity of illness.

We describe the first case of prosthetic joint associated infection due to Granulicatella adiacens (formerly Abiotrophia adiacens). Diagnosis was made by broad spectrum PCR, and later by culture. Diagnosis and treatment of this microorganism is difficult. Two y after revision and antibiotic treatment, infection was under control but not cured.

IntroductionTigecycline is an established treatment option for infections with multiresistant bacteria (MRB). It retains activity against many strains with limited susceptibility to other antibiotics. Efficacy and safety of tigecycline as monotherapy or in combination regimens were investigated in a prospective noninterventional study involving 1,025 severely ill patients in clinical routine at 137 German hospitals.Materials and methodsData on the full population have been published; our present analysis focuses on infections caused by MRB. The study population included patients with complicated infections, high disease severity (APACHE II > 15: 65 %) and high MRB prevalence. Most patients had comorbidities, including cardiovascular disease, renal insufficiency, and/or diabetes mellitus. Treatment success was defined as cure/improvement without requirement of further antibiotic therapy.ResultsPathogens isolated from 215 evaluable patients with documented MRB infections included 132 methicillin-resistant Staphylococcus aureus (MRSA), 42 vancomycin-resistant Enterococci (VRE) and 67 Gram-negative extended beta-lactamase (ESBL) producers. Of the MRB subpopulation, 140 patients received tigecycline monotherapy, 75 were treated with combination regimens. High overall clinical success rates were recorded for MRB infections treated with tigecycline alone (94 %) or in combinations (88 %); in detail intraabdominal infections (monotherapy: 90 %; combinations: 93 %), skin/soft tissue infections (93; 100 %), community-acquired pneumonia (100; 100 %), hospital-acquired pneumonia (94,7; 72,7 %), diabetic foot infections (89; 33 %), blood stream infections (100; 100 %) and multiple-site infections (92; 71 %).ConclusionsTigecycline achieved high clinical success rates in patients with documented infections involving MRB strains despite high disease severity. These results add to the evidence indicating that tigecycline is a valuable therapeutic option for complicated infections in severely ill patients with a high likelihood of multidrug-resistant pathogen involvement.

This large prospective non-interventional study investigated the effects of tigecycline either as single agent or in combination with other antimicrobial agents in 1,025 patients treated in clinical routine at German hospitals. Sixty-five percent of the patients had APACHE II scores >15, indicating high overall disease severity. Complicated intra-abdominal infections (cIAI) or complicated skin and skin tissue infections (cSSTI) were the most common indications, with Staphylococcus aureus, Enterococcus faecium and Escherichia coli being the most frequently isolated pathogens. Clinical success was reported at the end of tigecycline therapy in 74.2% of the total population, in 75.4% of the cIAI and in 82.2% of the cSSTI patients. The subpopulation (28.0% of the patients) infected with multidrug-resistant pathogens (methicillin-resistant S. aureus, extended-spectrum β-lactamase producers and vancomycin-resistant enterococci) were treated with similar success rates as the overall population. Tigecycline was generally well tolerated. Drug-related adverse events (AEs) were reported in 7.7% of the total population; 2.5% had serious AEs mostly attributable to inefficacy of therapy or deterioration of the disease. Mortality rates were consistent with the types of infection and severity of illness. There was no indication of excessive mortality associated with tigecycline as had been suggested in previously performed meta-analyses. In this large non-interventional study performed in the clinical routine setting, tigecycline achieved favorable clinical success rates in a patient population with high severity of illness and a high prevalence of multidrug-resistant pathogens and showed a good safety and tolerability profile.