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Transplant stewardship

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https://www.readbyqxmd.com/read/27880667/the-current-treatment-landscape-other-fungal-diseases-cryptococcosis-fusariosis-and-mucormycosis
#1
Olivier Lortholary, Mario Fernández-Ruiz, John R Perfect
Compared with major invasive mycoses such as aspergillosis and candidiasis, the antifungal stewardship management strategies of other fungal diseases have different opportunities and considerations. Cryptococcosis, fusariosis and mucormycosis are globally prevalent invasive fungal diseases (IFDs), but are not currently included in antifungal prophylaxis guidelines for immunocompromised hosts. Since the implementation of biomarkers as part of diagnostic screening strategies, the concept of pre-emptive antifungal therapy has emerged for these IFDs...
November 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27862115/pediatric-acute-liver-failure-of-undetermined-cause-a-research-workshop
#2
Estella M Alonso, Simon P Horslen, Edward M Behrens, Edward Doo
: Pediatric Acute liver failure (PALF) is a potentially devastating condition which occurs in previously healthy children of all ages and frequently leads to a rapid clinical deterioration. An identified cause for liver injury is lacking in approximately 30% of cases. Children with undetermined diagnosis have lower spontaneous survival and higher rates of transplantation and death than other diagnostic groups. A single day workshop sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases brought together clinicians and basic scientists to integrate aligned research findings and develop a foundation for new mechanistic studies and future treatment trials...
November 14, 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/27766987/fear-of-failure-engaging-patients-in-antimicrobial-stewardship-after-fecal-transplantation-for-recurrent-clostridium-difficile-infection
#3
Michelle T Hecker, Edith Ho, Curtis J Donskey
No abstract text is available yet for this article.
October 21, 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27758967/intravenous-immune-globulin-stewardship-program-at-a-tertiary-academic-medical-center
#4
Megan A Rocchio, James W Schurr, Aaron P Hussey, Paul M Szumita
BACKGROUND: In October 2010, a pharmacist-driven stewardship program was implemented at the Brigham and Women's Hospital to ensure continued adherence to the prescribing guideline, focusing on indications for intravenous immune globulin (IVIG) use and dosing per ideal body weight. OBJECTIVE: The primary objective was to describe an IVIG stewardship program at a tertiary academic medical center. METHODS: This was a prospective, observational study from January 2013 through December 2014...
October 6, 2016: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/27733304/solid-organ-transplant-antibiograms-an-opportunity-for-antimicrobial-stewardship
#5
Rossana Rosa, Jacques Simkins, Jose F Camargo, Octavio Martinez, Lilian M Abbo
OBJECTIVES: We aimed to compare the antimicrobial susceptibility percentages in blood and urine bacterial isolates recovered from solid organ transplant (SOT) recipients with those reported in the hospital-wide antibiogram. METHODS: Retrospective review of the antimicrobial susceptibilities of bacterial isolates recovered from SOT recipients at a 1550-bed hospital over a 2-year period. Antibiograms were categorized by anatomic site (blood and urine). Percentage of bacterial susceptibilities to specific antibiotics were compared with the hospital-wide antibiogram...
August 26, 2016: Diagnostic Microbiology and Infectious Disease
https://www.readbyqxmd.com/read/27710140/risk-factors-and-prophylaxis-against-invasive-fungal-disease-for-haematology-and-stem-cell-transplant-recipients-an-evolving-field
#6
Abby P Douglas, Monica A Slavin
Due to increasing intensity and complexity of therapies and longer survivorship, many patients with haematologic malignancy (HM) are at risk of invasive fungal disease (IFD). Mortality from IFD is high and treatment of an episode of IFD results in an excess length of hospital stay and costs and delays delivery of curative therapy of the underlying haematologic condition. Therefore, prevention and early recognition and treatment of IFD are crucial. Areas covered: Risk factors particular to certain HMs and haematopoietic stem cell transplantation, as well as those risk factors universal to all HM groups are examined...
October 6, 2016: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/27692005/impact-of-an-infection-control-and-antimicrobial-stewardship-program-on-solid-organ-transplantation-and-hepatobiliary-surgical-site-infections
#7
Charles Frenette, David Sperlea, Yveta Leharova, Daniel J G Thirion
OBJECTIVE The goal of this long-term quasi-experimental retrospective study was to assess the impact of a 5-year serial infection control and antimicrobial stewardship intervention on surgical site infections (SSIs). METHODS This study was conducted in a tertiary-care public teaching institution over a 5-year period from January 2010 to December 2014. All patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas-kidney transplantation were included. Outcomes were compared between a preintervention group (2010-2011) and a postintervention group (2012-2014)...
December 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27457099/current-state-of-antimicrobial-stewardship-at-solid-organ-and-hematopoietic-cell-transplant-centers-in-the-united-states
#8
Susan K Seo, Kaming Lo, Lilian M Abbo
OBJECTIVE To assess the extent of antimicrobial stewardship programs (ASPs) at solid organ transplant (SOT) and hematopoietic cell transplant (HCT) centers in the United States. DESIGN An 18-item voluntary survey was developed to gauge current antimicrobial stewardship practices in transplant patients, examine the availability and perceived usefulness of novel diagnostics and azole levels to guide therapy, and identify challenges for implementation of ASPs at these centers. PARTICIPANTS The survey was distributed electronically to infectious disease physicians and pharmacists at adult and pediatric SOT and HCT centers during May 1-22, 2015...
October 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27194400/fecal-microbiota-transplantation-for-the-intestinal-decolonization-of-extensively-antimicrobial-resistant-opportunistic-pathogens-a-review
#9
Amee R Manges, Theodore S Steiner, Alissa J Wright
Treatment options for multidrug-resistant (MDR) bacterial infections are limited and often less effective. Non-pharmacologic approaches to preventing or treating MDR infections are currently restricted to improved antimicrobial stewardship and infection control practices. Fecal microbiota transplantation (FMT), a highly effective treatment for recurrent Clostridium difficile infection, has emerged as a promising therapy for intestinal MDR bacterial decolonization. A total of eight case reports have been published showing FMT resulted in intestinal decolonization of extended spectrum β-lactamase (ESBL)-producing and carbapenemase-producing Enterobacteriaceae, vancomycin-resistant Enterococci, or methicillin-resistant Staphylococcus aureus...
August 2016: Infectious Diseases
https://www.readbyqxmd.com/read/26992472/solid-organ-transplant-patients-are-there-opportunities-for-antimicrobial-stewardship
#10
Miranda So, Daisy Yu Yang, Chaim Bell, Atul Humar, Andrew Morris, Shahid Husain
OBJECTIVE: Rising incidence of Clostridium difficile and multidrug-resistant organisms' infections and a dwindling development of new antimicrobials are an impetus for antimicrobial stewardship in organ transplant recipients. We sought to understand antimicrobial prescribing practices and identify opportunities for interdisciplinary collaboration among the transplant, antimicrobial stewardship, and infectious diseases teams. METHODS: In 2013, two assessors conducted four real-time audits on all antimicrobial therapy in transplant patients, assessing each regimen against stewardship principles established by the Centers for Disease Prevention and Control, supplemented by applicable transplant-specific infection guidelines...
June 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/26972929/use-of-concomitant-antibiotics-during-treatment-for-clostridium-difficile-infection-cdi-in-pediatric-inpatients-an-observational-cohort-study
#11
Vanessa W Stevens, Cary Thurm, Elyse M Schwab, Matthew P Kronman, Jeffrey S Gerber, Samir S Shah, Jason G Newland, Joshua Courter, Sarah Parker, Thomas V Brogan, Adam L Hersh
Concomitant antibiotic use during treatment for Clostridium difficile infection (CDI) increases the risk of recurrence. Across a network of children's hospitals, 46% of patients treated for CDI received concomitant antibiotics for a median of 7 days. Concomitant antibiotic use was more common among patients with malignancies, and solid organ or bone marrow transplant. Unnecessary concomitant antibiotic use in CDI patients is a potential target for pediatric antimicrobial stewardship.
March 2016: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/26820755/recommendations-for-solid-organ-transplantation-for-transplant-candidates-with-a-pretransplant-diagnosis-of-cutaneous-squamous-cell-carcinoma-merkel-cell-carcinoma-and-melanoma-a-consensus-opinion-from-the-international-transplant-skin-cancer-collaborative
#12
F Zwald, J Leitenberger, N Zeitouni, S Soon, J Brewer, S Arron, J Bordeaux, C Chung, M Abdelmalek, E Billingsley, A Vidimos, T Stasko
Advancements in solid organ transplantation successfully extend the lives of thousands of patients annually. The tenet of organ stewardship aims to prevent the futile expenditure of scarce donor organs in patient populations with high mortality risk, to the detriment of potential recipients with greater predicted life expectancy. The development of skin cancer posttransplantation portends tremendous morbidity, adversely affecting quality of life for many transplant recipients. This special article, provided by of members of the International Transplant Skin Cancer Collaborative (ITSCC), will provide the transplant professional with a consensus opinion and recommendations as to an appropriate wait period pretransplantation for transplant candidates with a history of either cutaneous squamous cell carcinoma, malignant melanoma, or Merkel cell carcinoma...
February 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/26766415/bloodstream-infections-after-solid-organ-transplantation
#13
Antonios Kritikos, Oriol Manuel
Solid-organ transplantation (SOT) has become the preferred strategy to treat a number of end-stage organ disease, because a continuous improvement in survival and quality of life. While preventive strategies has decreased the risk for classical opportunistic infections (such as viral, fungal and parasite infections), bacterial infections, and particularly bloodstream infections (BSIs) remain the most common and life-threatening complications in SOT recipients. The source of BSI after transplant depends on the type of transplantation, being urinary tract infection, pneumonia, and intraabdominal infections the most common infections occurring after kidney, lung and liver transplantation, respectively...
April 2, 2016: Virulence
https://www.readbyqxmd.com/read/26639441/antimicrobial-stewardship-barriers-and-goals-in-pediatric-oncology-and-bone-marrow-transplantation-a-survey-of-antimicrobial-stewardship-practitioners
#14
Joshua Wolf, Yilun Sun, Li Tang, Jason G Newland, Jeffrey S Gerber, Christie J Van Dyke, Saul R Hymes, Diana Yu, Delia C Carias, Penelope A Bryant
We undertook a cross-sectional survey of antimicrobial stewardship clinicians in North America and Australasia regarding practices, goals, and barriers to implementation of stewardship for pediatric oncology patients. Goals and barriers were similar regardless of clinician or institutional characteristics and geographic location. Strategies addressing these factors could help optimize antimicrobial use.
March 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/26627934/controversies-in-candida-management
#15
A El Zakhem, H Saad, R Tayyar, S S Kanj
Invasive candidiasis (IC) is associated with increased morbidity and mortality. Although advances in diagnosis and management of this infection have been reached, there remain several controversies. The aim of this review is to tackle some of these controversies and shed light on studies that support the different sides of the arguments. Regarding central line-associated candidaemia, the current evidence appears to be more in favour of early central line removal whenever possible. Otherwise, antifungal agents such as echinocandins or polyenes should be the preferred agents...
December 2015: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/26562402/-clinical-impact-of-infections-with-carbapenem-resistant-enterobacteriaceae-in-liver-transplant-recipients
#16
REVIEW
C Lübbert, H M Hau, A Rodloff, J Mössner, A Mischnik, S Bercker, M Bartels, U X Kaisers
Infections with carbapenem-resistant Enterobacteriaceae (CRE) are an emerging cause of morbidity and mortality among liver transplant recipients (LTR) worldwide, particularly Klebsiella pneumoniae carbapenemase (KPC)-producing organisms. Approximately 3 - 13 % of solid organ transplant recipients in CRE-endemic areas develop CRE infections, and the infection site correlates with the transplanted organ. The cumulative 30-day mortality rate of LTR infected with carbapenem-resistant K. pneumoniae is 36 %, and the 180-day mortality rate is 58 %...
November 2015: Zeitschrift Für Gastroenterologie
https://www.readbyqxmd.com/read/26455382/the-epidemiology-of-carbapenem-resistant-klebsiella-pneumoniae-colonization-and-infection-among-long-term-acute-care-hospital-residents
#17
John P Mills, Naasha J Talati, Kevin Alby, Jennifer H Han
OBJECTIVE An improved understanding of carbapenem-resistant Klebsiella pneumoniae (CRKP) in long-term acute care hospitals (LTACHs) is needed. The objective of this study was to assess risk factors for colonization or infection with CRKP in LTACH residents. METHODS A case-control study was performed at a university-affiliated LTACH from 2008 to 2013. Cases were defined as all patients with clinical cultures positive for CRKP and controls were those with clinical cultures positive for carbapenem-susceptible K...
January 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/26190379/horizontal-infection-prevention-measures-and-a-risk-managed-approach-to-vancomycin-resistant-enterococci-an-evaluation
#18
Elizabeth Bryce, Jennifer Grant, Sydney Scharf, Linda Dempster, Tim T Y Lau, Felicia Laing, Salomeh Shajari, Leslie Forrester
BACKGROUND: The use of infection control measures in the management of vancomycin-resistant enterococci (VRE) is hotly debated. A risk-managed approach to VRE control after the introduction of 2 horizontal infection prevention measures-an environmental cleaning (EC) and an antimicrobial stewardship (AMS) program-was assessed. METHODS: Routine screening for VRE was discontinued 6 and 4 months after introduction of the EC and AMS programs, respectively. Only 4 units (intensive care, burns-trauma, solid organ transplant, and bone marrow transplant units) where patients were deemed to be at increased risk for VRE infection continued screening and contact precautions...
November 2015: American Journal of Infection Control
https://www.readbyqxmd.com/read/26185610/bacterial-infections-in-hematopoietic-stem-cell-transplant-recipients
#19
REVIEW
Elisa Balletto, Małgorzata Mikulska
Bacterial infections are major complications after Hematopoietic Stem Cell Transplant (HSCT). They consist mainly of bloodstream infections (BSI), followed by pneumonia and gastrointestinal infections, including typhlitis and Clostridium difficile infection. Microbiological data come mostly from BSI. Coagulase negative staphylococci and Enterobacteriaceae are the most frequent pathogens causing approximately 25% of BSI each, followed by enterococci, P. aeruginosa and viridans streptococci. Bacterial pneumonia is frequent after HSCT, and Gram-negatives are predominant...
2015: Mediterranean Journal of Hematology and Infectious Diseases
https://www.readbyqxmd.com/read/26038744/assessing-control-bundles-for-clostridium-difficile-a-review-and-mathematical-model
#20
Laith Yakob, Thomas V Riley, David L Paterson, John Marquess, Archie Ca Clements
Clostridium difficile is the leading cause of infectious diarrhea in hospitalized patients. Integrating several infection control and prevention methods is a burgeoning strategy for reducing disease incidence in healthcare settings. We present an up-to-date review of the literature on 'control bundles' used to mitigate the transmission of this pathogen. All clinical studies of control bundles reported substantial reductions in disease rates, in the order of 33%-61%. Using a biologically realistic mathematical model we then simulated the efficacy of different combinations of the most prominent control methods: stricter antimicrobial stewardship; the administering of probiotics/intestinal microbiota transplantation; and improved hygiene and sanitation...
June 2014: Emerging Microbes & Infections
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