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Current Opinion in Infectious Diseases

Jan J De Waele, Ignacio Martin-Loeches
PURPOSE OF REVIEW: Whilst many guidelines recommend limiting the use of antibiotics because of the increase in antimicrobial resistance (AMR), this strategy becomes challenging when dealing with severe infections in critically ill patients. Moreover, some Gram-negative bacilli (GNB) can exhibit mechanisms of resistance that make the patient more vulnerable to recurrence of infections. We reviewed recent data on the optimal duration of antibiotic therapy in these patients. RECENT FINDINGS: Apart from having no additional clinical benefit at a certain point after initiation, antibiotics might have negative effects...
December 2018: Current Opinion in Infectious Diseases
Mario Tumbarello, Angela Raffaella Losito, Helen Giamarellou
PURPOSE OF REVIEW: In the absence of randomized clinical trial data, questions remain regarding the optimal treatment of carbapenem-resistant Enterobacteriaceae (CRE) infections. CRE have historically been susceptible to polymyxins, tigecycline or aminoglycosides (mostly gentamicin), and these antibiotics have long been considered the drugs of choice for CRE infections, although varying rates of resistance to all have been reported. This review looks at data from clinical studies assessing the outcomes of CRE infections treated with different antibiotic regimens...
December 2018: Current Opinion in Infectious Diseases
Efthymia I Matthaiou, Gabriele Sass, David A Stevens, Joe L Hsu
PURPOSE OF REVIEW: Aspergillus fumigatus is a ubiquitous saprophytic fungus that can cause life-threatening invasive aspergillosis in immunocompromised patients. Apart from the immune status of the host only a few characterized virulence factors have been identified. In this review, we describe the role of iron in the manifestation of A. fumigatus virulence. RECENT FINDINGS: We gathered recent clinical evidence suggesting that tissue iron overload increases the risk of invasive aspergillosis occurrence...
December 2018: Current Opinion in Infectious Diseases
Roy F Chemaly, Tristan W Clark
No abstract text is available yet for this article.
December 2018: Current Opinion in Infectious Diseases
Marjorie V Batista, Lynn El Haddad, Roy F Chemaly
PURPOSE OF REVIEW: In hematopoietic cell transplant (HCT) recipients, paramyxovirus infections are major viral respiratory tract infections that, if they progress to lower respiratory tract infections, are associated with reduced survival rates in this population. There are important knowledge gaps regarding treatment decisions for HCT recipients with these infections and in the identification of risk factors that predict infection severity. Here, we review recent data on paramyxovirus infections in HCT recipients focusing on risk factors, new diagnostic and prognostic tools, and management including new drugs and vaccines under development...
December 2018: Current Opinion in Infectious Diseases
Kate R Beard, Nathan J Brendish, Tristan W Clark
PURPOSE OF REVIEW: Seasonal and pandemic influenza are major causes of morbidity and mortality globally. Neuraminidase inhibitors (NAIs) are the only class of antiviral agent recommended for the treatment of currently circulating strains of influenza. There has previously been controversy over the level of evidence for patient benefit with NAIs. We review here the current evidence base for the clinical impact of treatment of influenza with NAIs. RECENT FINDINGS: Meta-analysis of pharma-sponsored studies (including previously unpublished data) shows that NAIs reduce the duration of illness in influenza-infected patients, and suggest a possible reduction in the rate of complications and hospitalization...
December 2018: Current Opinion in Infectious Diseases
Lore Vanderbeke, Isabel Spriet, Christine Breynaert, Bart J A Rijnders, Paul E Verweij, Joost Wauters
PURPOSE OF REVIEW: Bacterial super-infection of critically ill influenza patients is well known, but in recent years, more and more reports describe invasive aspergillosis as a frequent complication as well. This review summarizes the available literature on the association of invasive pulmonary aspergillosis (IPA) with severe influenza [influenza-associated aspergillosis (IAA)], including epidemiology, diagnostic approaches and treatment options. RECENT FINDINGS: Though IPA typically develops in immunodeficient patients, non-classically immunocompromised patients such as critically ill influenza patients are at high-risk for IPA as well...
December 2018: Current Opinion in Infectious Diseases
Matteo Bassetti, Andrew F Shorr
No abstract text is available yet for this article.
December 2018: Current Opinion in Infectious Diseases
Matteo Bassetti, Antonio Vena, Alessandro Russo, Antony Croxatto, Thierry Calandra, Benoit Guery
PURPOSE OF REVIEW: This review details the management of Pseudomonas aeruginosa infections covering both current and future treatment options that are and may be available for the clinicians. RECENT FINDINGS: Pseudomonas aeruginosa infections are a great concern in hospital-acquired infections with very limited therapeutic options. The increasing antibiotic resistance has led to a need for different treatment choices that range from the use of new antibiotics to new nonantibiotic alternative agents to kill or disarm the pathogen...
December 2018: Current Opinion in Infectious Diseases
Jean-Christophe Lagier, Didier Raoult
PURPOSE OF REVIEW: The delay between first clinical signs and diagnosis of Whipple's disease and Tropheryma whipplei infections is more than 6 years, and relapses are frequently observed, resulting in a need for clinicians to be aware of this infection. RECENT FINDINGS: 18 FDG-PET is useful in the diagnosis and the follow-up of patients (particularly in case of neurological involvement). Histological involvement remains the goldstandard for classic Whipple's disease diagnosis...
December 2018: Current Opinion in Infectious Diseases
Karen F Urbancic, Karin Thursky, David C M Kong, Paul D R Johnson, Monica A Slavin
PURPOSE OF REVIEW: To outline key drivers and components of antifungal stewardship (AFS) programmes, the evidence for specific interventions, and methods to assess performance of programmes. RECENT FINDINGS: Recent developments in antifungal resistance and breakthrough invasive fungal diseases have increased the urgency for effective AFS. In practice, however, few hospitals have dedicated AFS programmes. To date, AFS programmes have centred around the provision of expert bedside reviews and have reduced costs and consumption of antifungal agents...
December 2018: Current Opinion in Infectious Diseases
Michelle K Yong, Monica A Slavin, Dimitrios P Kontoyiannis
PURPOSE OF REVIEW: Invasive fungal disease (IFD) and cytomegalovirus (CMV) infections occur frequently, either concomitantly or sequentially in immune-compromised hosts. Although there is extensive knowledge of the risk factors for these infections as single entities, the inter-relationship between opportunistic fungii and CMV has not been comprehensively explored. RECENT FINDINGS: Both solid organ and stem cell transplant recipients who develop CMV invasive organ disease are at an increased risk of developing IFD, particularly aspergillosis and Pneumocystis pneumonia (PCP)...
December 2018: Current Opinion in Infectious Diseases
John H Beigel
PURPOSE OF REVIEW: This review summarizes past and ongoing efforts for using polyclonal and monoclonal antibodies for the treatment of influenza, and is focused on products that have entered clinical trials. RECENT FINDINGS: At least three polyclonal and eight monoclonal antibody products have been tested in clinical trials for the treatment of influenza. Considered across the two classes of therapeutics, these products appear to be safe and well tolerated. However, the efficacy results have been mixed and inconclusive...
December 2018: Current Opinion in Infectious Diseases
Philippe Montravers, Matteo Bassetti
PURPOSE OF REVIEW: The worldwide spread of extended-spectrum beta-lactamase (ESBL)-producing bacteria, the overuse of carbapenems, the emergence of carbapenemase-producing organisms and the growing importance of multidrug-resistant and/or extended drug-resistant strains have totally changed prescribers' habits, leading to very few treatment options in many cases. Beta-lactam/beta-lactamase inhibitor (BLBLI) combinations should be considered as an alternative to carbapenems for treating ESBL-producing bacteria and Pseudomonas aeruginosa infections...
December 2018: Current Opinion in Infectious Diseases
Jean-Louis Vincent, Wasineenart Mongkolpun
PURPOSE OF REVIEW: Sepsis is a common condition in critically ill patients and associated with high morbidity and mortality. Sepsis is the result of infection by many potential pathogens, including Gram-negative bacteria. There are no specific antisepsis therapies and management relies largely on infection control and organ support, including hemodynamic stabilization. We discuss these key aspects and briefly mention potential immunomodulatory strategies. RECENT FINDINGS: New aspects of sepsis management include the realization that early treatment is important and that fluids and vasopressor agents should be administered simultaneously to insure rapid restoration of an adequate perfusion pressure to limit development and worsening of organ dysfunction...
December 2018: Current Opinion in Infectious Diseases
Elena Carrara, Damiano Bragantini, Evelina Tacconelli
PURPOSE OF REVIEW: Combination therapy is a common strategy for treatment of multidrug resistant infections. Despite the strong twin rationales of improving efficacy and reducing resistance development, the evidence supporting this strategy remains controversial. The aims of this review are to assess the most recent studies supporting the use of combination therapy for treating infections because of carbapenem-resistant Enterobacteriaceae (CRE) and to highlight relevant areas for further research...
December 2018: Current Opinion in Infectious Diseases
Nelson Lee, Aeron C Hurt
PURPOSE OF REVIEW: Neuraminidase inhibitors (NAIs), including oseltamivir, zanamivir, and peramivir, is the main class of antiviral available for clinical use. As such, development of resistance toward these agents is of great clinical and public health concern. RECENT FINDINGS: At present, NAI resistance remains uncommon among the circulating viruses (oseltamivir <3.5%, zanamivir <1%). Resistance risk is slightly higher in A(H1N1) than A(H3N2) and B viruses...
December 2018: Current Opinion in Infectious Diseases
Jessica P Hwang, Harrys A Torres
PURPOSE OF REVIEW: To provide an update on recent studies of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in cancer patients with an emphasis on viral reactivation after cancer treatment, new antiviral therapies, and safety concerns. RECENT FINDINGS: The diagnostic criteria for HBV reactivation in patients receiving cancer therapy were revised in 2018. HBV reactivation in these patients is preventable, even with the use of new cancer therapies...
December 2018: Current Opinion in Infectious Diseases
Aaron J Heffernan, Fekade B Sime, Fabio S Taccone, Jason A Roberts
PURPOSE OF REVIEW: Optimized antibiotic dosing regimens improve survival rates in critically ill patients. However, dose optimization is challenging because of fluctuating antibiotic pharmacokinetics both between patients and within a single patient. This study reviews the pharmacokinetic changes that occur in critically ill patients, along with the pharmacodynamics and toxicodynamics of antibiotics commonly used for the treatment of Gram-negative bacterial infections to formulate a recommendation for antibiotic dosing at the bedside...
December 2018: Current Opinion in Infectious Diseases
Jose Tiago Silva, Mario Fernández-Ruiz, Jose Maria Aguado
PURPOSE OF REVIEW: Solid organ transplantation (SOT) is the best therapeutic option for both acute and chronic end-stage diseases. The development of more potent and safer immunosuppressants and the improvement of prophylactic practices have significantly diminished the morbidity and mortality associated with rejection and opportunistic infections. However, infections produced by multidrug-resistant (MDR) Gram-negative bacilli (GNB) have recently emerged as a significant threat. RECENT FINDINGS: The Spanish Society of Transplantation (SET), the Group for Study of Infection in Transplantation of the Spanish Society of Infectious Diseases and Clinical Microbiology (GESITRA-SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI) have recently published their recommendations concerning the management of MDR GNB infections in SOT recipients...
December 2018: Current Opinion in Infectious Diseases
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