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“Introduction Neisseria meningitidis (Nm) and Haemophilus influenzae type b (Hib) are polysaccharide-encapsulated bacteria capable of rapid invasion and fulminant disease. Even with readily available and affordable therapy, meningococcal disease has a mortality rate of 8–12% and up to 20% of survivors develop permanent sequelae such as amputations, hearing loss, and neurodevelopmental disabilities [1, 2]. Even in the absence of epidemics, more than 500,000 cases of invasive meningococcal disease (IMD) occur annually worldwide

of which approximately 50,000 (10%) result in death [3]. Nm is classified based on the chemical composition of the polysaccharide capsule. There are 13 antigenically distinct serogroups; A, B, C, D, E-29, H, I, K, L, W-135, X, Y, and Z, of which six; A, B, C, W-135, X, and Y, cause virtually all invasive diseases [4]. The incidence of IMD KPT-330 may be up to 100 per 100,000 in an epidemic season in the African meningitis belt but endemic disease incidence tends to lie between 1 to 2 per 100,000 in UK, Europe, and Fedratinib molecular weight Australia and 0.5 to 1.5 per 100,000 in the US [5]. The relative contribution of each serogroup to all IMD is dynamic and varies both geographically and temporally

[5, 6]. The majority of invasive diseases in Africa are caused by serogroup A, and in most developed countries, serogroups B and C. Over the past decade, serogroup Y has become a major contributor to IMD in the US and is steadily increasing in importance in some Nordic countries [5, 7]. Recently, there also has been a significant increase in the incidence of serogroup W-135 in both South Africa and South America, demonstrating the propensity for strain dominance to change in unpredictable ways [8, 9]. C-X-C chemokine receptor type 7 (CXCR-7) The frequency of IMD also varies by age. The highest burden of Nm is in young children, especially infants, and a second smaller peak occurs in adolescence. The routine use of polysaccharide-protein conjugate vaccines in infant schedules has resulted in dramatic country-specific declines in disease burden and mortality caused by these encapsulated bacteria [10–12]. Hib, once the major causative organism of bacterial meningitis in children under 5 years of age, has been practically eliminated by routine use in many countries [13]. The control of IMD, however, has been more challenging.