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Infectious Disease Clinics of North America

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https://www.readbyqxmd.com/read/28916385/bacterial-pneumonia-in-older-adults
#1
REVIEW
Oryan Henig, Keith S Kaye
The incidence of pneumonia increases with age, and is particularly high in patients who reside in long-term care facilities (LTCFs). Mortality rates for pneumonia in older adults are high and have not decreased in the last decade. Atypical symptoms and exacerbation of underlying illnesses should trigger clinical suspicion of pneumonia. Risk factors for multidrug-resistant organisms are more common in older adults, particularly among LTCF residents, and should be considered when making empiric treatment decisions...
September 12, 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28916384/human-immunodeficiency-virus-and-aging-in-the-era-of-effective-antiretroviral-therapy
#2
REVIEW
Puja Van Epps, Robert C Kalayjian
Persons living with HIV (PLWH) have accentuated risks for age-associated comorbidities. Compared to the general population, PLWH have a 2-fold higher risk of cardiovascular disease, a 3-fold increased risk of fracture, and a risk of kidney disease that is comparable to that in diabetes. Some comorbidities may present at younger ages than among the general population, suggesting the possibility of accelerated aging with HIV infection.
September 12, 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28911830/norovirus-infection-in-older-adults-epidemiology-risk-factors-and-opportunities-for-prevention-and-control
#3
REVIEW
Cristina V Cardemil, Umesh D Parashar, Aron J Hall
Norovirus is the leading cause of acute gastroenteritis. In older adults, it is responsible for an estimated 3.7 million illnesses; 320,000 outpatient visits; 69,000 emergency department visits; 39,000 hospitalizations; and 960 deaths annually in the United States. Older adults are particularly at risk for severe outcomes, including prolonged symptoms and death. Long-term care facilities and hospitals are the most common settings for norovirus outbreaks in developed countries. Diagnostic platforms are expanding...
September 12, 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28911829/influenza-in-older-adults
#4
REVIEW
H Keipp Talbot
Annually, influenza viruses cause significant disease in older adults, varying with the virulence of the circulating strain, prior exposure to circulating strain, and influenza vaccine effectiveness. Older adults often present atypically (eg, without fever) and with complications of influenza infection such as chronic obstructive pulmonary disease and congestive heart failure exacerbations. Prevention methods include antiviral medications and vaccines. Current influenza vaccines have moderate effectiveness for the prevention of hospitalization, but newer more immunogenic vaccines designed for adults 65 years of age and older have been licensed...
September 12, 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28779835/on-the-interface-of-infectious-diseases-and-critical-care-medicine
#5
EDITORIAL
Naomi P O'Grady, Sameer S Kadri
No abstract text is available yet for this article.
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28779834/inhaled-antibiotics-for-ventilator-associated-infections
#6
REVIEW
Lucy B Palmer
Multidrug-resistant organisms are creating a challenge for physicians treating the critically ill. As new antibiotics lag behind the emergence of worsening resistance, intensivists in countries with high rates of extensively drug-resistant bacteria are turning to inhaled antibiotics as adjunctive therapy. These drugs can provide high concentrations of drug in the lung that could not be achieved with intravenous antibiotics without significant systemic toxicity. This article summarizes current evidence describing the use of inhaled antibiotics for the treatment of bacterial ventilator-associated pneumonia and ventilator-associated tracheobronchitis...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28779833/high-containment-pathogen-preparation-in-the-intensive-care-unit
#7
REVIEW
Brian T Garibaldi, Daniel S Chertow
The recent Ebola virus disease outbreak highlighted the need to build national and worldwide capacity to provide care for patients with highly infectious diseases. Specialized biocontainment units were successful in treating several critically ill patients with Ebola virus disease both in the United States and Europe. Several key principles underlie the care of critically ill patients in a high-containment environment. Environmental factors, staffing, equipment, training, laboratory testing, procedures, and waste management each present unique challenges...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28779832/evaluation-and-management-of-necrotizing-soft-tissue-infections
#8
REVIEW
Stephanie L Bonne, Sameer S Kadri
Despite advances in antibiotic and surgical management and supportive care for necrotizing soft tissue infections, morbidity and mortality remain substantial. Although there are clinical practice guidelines in place, there still remains much variability in choice and duration of antibiotic therapy, time to initial surgical debridement, and use of adjuvant medical therapies. This article offers an overview of necrotizing soft tissue infections with a focus on current diagnostic and treatment modalities.
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28779831/clostridium-difficile-infection
#9
REVIEW
John G Bartlett
Clostridium difficile infection is a major health care challenge in terms of patient and economic consequences. For the patient, it is a morbid and sometimes a life-threatening iatrogenic complication of antibiotic treatment. In the United States, the provider's institution may face financial penalties, because the Centers for Disease Control and Prevention views this as an iatrogenic health care-associated complication that may not be reimbursable by the Centers for Medicare and Medicaid Services; this has resulted in substantial incentives for new approaches to prevention and treatment...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28779830/role-of-procalcitonin-in-the-management-of-infected-patients-in-the-intensive-care-unit
#10
REVIEW
David N Gilbert
The combination of molecular pathogen diagnostics and the biomarker procalcitonin (PCT) are changing the use of antimicrobials in patients admitted to critical care units with severe community-acquired pneumonia, possible septic shock, or other clinical syndromes. An elevated serum PCT level is good supportive evidence of a bacterial pneumonia, whereas a low serum PCT level virtually eliminates an etiologic role for bacteria even if the culture for a potential bacterial pathogen is positive. Serum PCT levels can be increased in any shocklike state; a low PCT level eliminates invasive bacterial infection as an etiology in more than 90% of patients...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28687215/invasive-fungal-infections-in-the-intensive-care-unit
#11
REVIEW
Luis Ostrosky-Zeichner, Mohanad Al-Obaidi
Patients in the intensive care unit are exposed to multiple stressors that predispose them to invasive fungal infections (IFIs), which carry high morbidity and mortality. Getting acquainted with the diagnostic methods and therapies is imperative for patient safety and for providing high-quality health care. This article focuses on the most frequent IFIs: invasive candidiasis and invasive aspergillosis.
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28687214/severe-respiratory-viral-infections-new-evidence-and-changing-paradigms
#12
REVIEW
James M Walter, Richard G Wunderink
Lower respiratory tract infection is a leading cause of death in the United States. Advances in diagnostic testing have improved our ability to detect pathogens. Viral pathogens are important causal pathogens in immunocompetent patients. As the number of elderly adults and those with chronic medical conditions increases, the burden of viral respiratory infections will increase. Clinicians must be familiar with the characteristics of rhinovirus, human adenoviruses, respiratory syncytial virus, and human metapneumovirus...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28687213/prevention-of-central-line-associated-bloodstream-infections
#13
REVIEW
Taison Bell, Naomi P O'Grady
Central venous catheters (CVCs) are commonly used in critically ill patients and offer several advantages to peripheral intravenous access. However, indwelling CVCs have the potential to lead to bloodstream infections, with the risk increasing with an array of characteristics, such as catheter choice, catheter location, insertion technique, and catheter maintenance. Evidence-based guidelines have led to a significant reduction in the incidence of bloodstream infections associated with CVCs. The combination of guideline implementation and newer technologies has the potential to further reduce morbidity and mortality from infections related to CVCs...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28687212/sepsis-and-challenging-infections-in-the-immunosuppressed-patient-in-the-intensive-care-unit
#14
REVIEW
Diana F Florescu, Uriel Sandkovsky, Andre C Kalil
In 2017, most intensive care units (ICUs) worldwide are admitting a growing population of immunosuppressed patients. The most common causes of pre-ICU immunosuppression are solid organ transplantation, hematopoietic stem cell transplantation, and infection due to human immunodeficiency virus. In this article, the authors review the most frequent infections that cause critical care illness in each of these 3 immunosuppressed patient populations.
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28687211/preventing-transmission-of-multidrug-resistant-pathogens-in-the-intensive-care-unit
#15
REVIEW
Jeffrey R Strich, Tara N Palmore
Infection control in the intensive care unit (ICU) has seen many advances, including rapid molecular screening tests for resistant organisms and chlorhexidine use in daily baths. Although these developments advance the cause of infection prevention, compliance with some of the basic measures remains elusive. Hand hygiene, antimicrobial stewardship, and reduction in device use remain the low-technology interventions that could have a major impact on nosocomial transmission of antimicrobial-resistant organisms...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28687210/antimicrobial-stewardship-approaches-in-the-intensive-care-unit
#16
REVIEW
Sarah B Doernberg, Henry F Chambers
Antimicrobial stewardship programs aim to monitor, improve, and measure responsible antibiotic use. The intensive care unit (ICU), with its critically ill patients and prevalence of multiple drug-resistant pathogens, presents unique challenges. This article reviews approaches to stewardship with application to the ICU, including the value of diagnostics, principles of empirical and definitive therapy, and measures of effectiveness. There is good evidence that antimicrobial stewardship results in more appropriate antimicrobial use, shorter therapy durations, and lower resistance rates...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28687209/new-sepsis-and-septic-shock-definitions-clinical-implications-and-controversies
#17
REVIEW
Chanu Rhee, Michael Klompas
New sepsis definitions shift emphasis from the systemic inflammatory response syndrome to organ dysfunction, quantified using the Sequential Organ Failure Assessment (SOFA) score. The new definitions also propose Quick SOFA criteria to rapidly identify potentially infected patients at risk for poor outcomes. The diagnosis of septic shock requires vasopressor dependence and increased lactate levels. Strengths of these definitions include their simplicity and clear association with adverse outcomes. However, their utility in identifying patients with serious infections before frank sepsis ensues remains to be seen...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28483046/musculoskeletal-infections-meeting-the-challenge
#18
EDITORIAL
Steven K Schmitt
No abstract text is available yet for this article.
June 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28483045/fungal-musculoskeletal-infections
#19
REVIEW
Michael W Henry, Andy O Miller, Thomas J Walsh, Barry D Brause
Fungi are rare but important causes of osteoarticular infections, and can be caused by a wide array of yeasts and molds. Symptoms are often subacute and mimic those of other more common causes of osteoarticular infection, which can lead to substantial delays in treatment. A high index of suspicion is required to establish the diagnosis. The severity of infection depends on the inherent pathogenicity of the fungi, the immune status of the host, the anatomic location of the infection, and whether the infection involves a foreign body...
June 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28483044/osteomyelitis
#20
REVIEW
Steven K Schmitt
Osteomyelitis is an ancient disease with varied pathophysiology. The several clinical syndromes associated with bone infection have specific clinical presentations and microbiology. Successful recognition and management of the disease requires a knowledge of these mechanisms and the organisms most common in each. Diagnosis is made by a combination of clinical examination, supportive blood testing, and appropriate radiography. With these elements in place, patient presentation can be placed in the framework of a staging system, which often helps to suggest the appropriate mix of antimicrobial and surgical therapies...
June 2017: Infectious Disease Clinics of North America
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