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Purpose: Severe and fatal Capnocytophaga canimorsus infection has been described in immunocompromised patients. Data of C. canimorsus infection in immunocompetent and risk factors of severe courses are missing. Our aims were to describe the epidemiology of C. canimorsus infection and to identify potential risk factors of sepsis and fatal outcome. Methods: Observational study and systematic review of all cases reported in immunocompetent subjects between 2002 and 2019. Results: A total of 128 cases of C. canimorsus infection in immunocompetent individuals were reported. Male gender comprised 74.2%, the median age was 58 years and 47.7% were admitted with sepsis. Case-fatality rate was 29.7% and especially high in septic patients (55.7%). Transmission by bite (OR = 2.37, 95% CI: 1.05–6.52) and incubation time ≤3 d (OR = 7.98; 95% CI: 2.33–27.34) were identified as risk factors of sepsis on admission, and early wound cleansing as protective (OR = 0.42; 95% CI: 0.14–0.96). Sepsis (OR = 23.67; 95% CI: 2.85–197.89) and septic shock (OR = 45.50; 95% CI: 3.08–676.55) were risk factors of fatal outcome, whereas early wound cleansing (OR = 0.05; 95% CI: 0.01–0.72), initial penicillin therapy with beta-lactamase inhibitors (OR = 0.48; 95% CI: 0.16–0.92) and surgical removal of infectious focus (OR = 0.38; 95% CI: 0.06–0.95) were protective factors. Conclusions: Immunocompetent patients with C. canimorsus infection frequently develop sepsis. A shorter incubation period in cases of sepsis might be related to higher infectious dose. Fatal outcome may be prevented by early wound cleansing, initial use of penicillins in combination with beta-lactamase inhibitors and surgical removal of an infectious focus. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance is an inescapable consequence of the overuse and abuse of antibiotics. In both the hospital and community environments, resistance problems are evolving through the selection of resistant subpopulations during therapy and through the increased prevalence of pathogens exhibiting resistance through intrinsic or acquired mechanisms. As resistance mechanisms continue to evolve and spread at an alarming rate, clinicians worldwide are faced with the challenge of treating bacteria which have become resistant to virtually all available antibiotics. It is critical that steps be taken to slow the progression of antibiotic resistance among bacteria. Strategies must include both the judicious and optimal use of available drugs, as well as the development of new agents which are active against multiply-resistant bacteria. The fluoroquinolones are one class of antibiotics which are currently being developed to increase potency against multidrugresistant gram-positive pathogens. This review will focus on the advances which have been gained with newer fluoroquinolones against the multiply- resistant enterococci, staphylococci, pneumococci, and viridans streptococci. [ABSTRACT FROM PUBLISHER]

A multinational, multicentre, open, randomised study in hospitalised patients with pneumonia compared levofloxacin 500 mg twice daily with ceftriaxone 4 g i.v. once daily. Levofloxacin patients started on i.v. treatment and switched to oral on d 3-5 of therapy if signs and symptoms had improved. The minimum treatment duration was 5 d, except for treatment failure, and the median 8 d. The primary efficacy analysis was based on the per-protocol assessment of the clinical cure rate determined 2-5 d after the end of treatment in the per-protocol (PP) population (levofloxacin 127, ceftriaxone 139). Of 625 patients enrolled and randomized, 6 received no treatment, giving an intention-to-treat (ITT) population of 619 (levofloxacin 314, ceftriaxone 305). At the clinical endpoint, 2-5 d after the end of treatment, the cure rates for levofloxacin and ceftriaxone were similar in both the ITT (76% and 75%, respectively) and PP (87% and 86%, respectively) populations. Both drugs were well tolerated. Twice-daily levofloxacin 500 mg, either i.v. or as sequential iv/oral therapy, was as effective as i.v. once-daily ceftriaxone 4 g in the treatment of hospitalized patients with pneumonia and offers the advantage of sequential therapy. [ABSTRACT FROM AUTHOR]