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Rita Wilson Dib, Ray Y Hachem, Anne-Marie Chaftari, Fady Ghaly, Ying Jiang, Issam Raad
BACKGROUND: Early antifungal therapy for invasive aspergillosis (IA) has been associated with improved outcome. Traditionally, of empiric antifungal therapy has been used for clinically suspected IA. We compared outcomes of patients with hematologic malignancy and IA who were treated with voriconazole using the diagnostic driven DDA (DDA-Vori) that includes galactomannan testing vs. empiric therapy with a non-voriconazole-containing regimen (EMP-non-Vori) or empiric therapy with voriconazole (EMP-Vori)...
December 13, 2018: BMC Infectious Diseases
Davide Facchinelli, Gessica Marchesini, Gianpaolo Nadali, Livio Pagano
This review summarizes the more recent evidence about epidemiology and risk factors for invasive fungal infections (IFI) in patients affected by Chronic Lymphocytic Leukemia (CLL), indolent Non Hodgkin Lymphoma (iNHL) and Multiple Myeloma (MM). Despite advances in the prognosis and treatment of hematological malignancies in recent years, susceptibility to infection remains a significant challenge to patient care. A large amount of data regarding patients with acute leukemia has been published while little information is available on the incidence of IFI in chronic lymphoproliferative disorders (CLD)...
2018: Mediterranean Journal of Hematology and Infectious Diseases
Zaira R Palacios-Baena, Mercedes Delgado-Valverde, Adoración Valiente Méndez, Benito Almirante, Silvia Gómez-Zorrilla, Núria Borrell, Juan E Corzo, Mercedes Gurguí, Cristina de la Calle, Lara García-Álvarez, Lucía Ramos, Mónica Gozalo, María Isabel Morosini, José Molina, Manuel Causse, Álvaro Pascual, Jesús Rodríguez-Baño
Background: More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate predictors of de-escalation and its impact on the outcome of patients with bloodstream infection due to Enterobacteriaceae (BSI-E). Methods: A post-hoc analysis was performed of a prospective, multicenter cohort of patients with BSI-E initially treated with ertapenem or antipseudomonal β-lactams...
December 8, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Dafna Yahav, Erica Franceschini, Fidi Koppel, Adi Turjeman, Tanya Babich, Roni Bitterman, Ami Neuberger, Nesrin Ghanem-Zoubi, Antonella Santoro, Noa Eliakim-Raz, Barak Pertzov, Tali Steinmetz, Anat Stern, Yaakov Dickstein, Elias Maroun, Hiba Zayyad, Jihad Bishara, Danny Alon, Yonatan Edel, Elad Goldberg, Claudia Venturelli, Cristina Mussini, Leonard Leibovici, Mical Paul
Background: Gram-negative bacteremia is a major cause of morbidity and mortality in hospitalized patients. Data to guide the duration of antibiotic therapy are limited. Methods: Randomized, multicenter, open-label, non-inferiority trial. Inpatients with Gram-negative bacteremia, afebrile and hemodynamically stable for at least 48 hours, were randomized to receive 7 (intervention) or 14 days (control) of covering antibiotic therapy. Patients with uncontrolled focus of infection were excluded...
December 11, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Giorgio Berlot, Claudio Michele Vassallo, Nicola Busetto, Margarita Nieto Yabar, Tatiana Istrati, Silvia Baronio, Giada Quarantotto, Mattia Bixio, Giulia Barbati, Roberto Dattola, Irene Longo, Antonino Chillemi, Alice Scamperle, Fulvio Iscra, Ariella Tomasini
BACKGROUND: The administration of endovenous immunoglobulins in patients with septic shock could be beneficial and preparations enriched with IgA and IgM (ivIgGAM) seem to be more effective than those containing only IgG. In a previous study Berlot et al. demonstrated that early administration of ivIgGAM was associated with lower mortality rate. We studied a larger population of similar patients aiming either to confirm or not this finding considering also the subgroup of patients with septic shock by multidrug-resistant (MDR) pathogens...
December 10, 2018: Annals of Intensive Care
John M Benson
Antimicrobial use in older adults requires working knowledge of the pharmacokinetics and pharmacodynamics of these drugs, and the alterations known to occur with these models as patients age. A summary of pharmacokinetic principles relevant to antimicrobials and an overview of published medical literature describing pharmacokinetic changes known to correlate with age are presented. Pharmacodynamic models that apply to antibacterial agents are reviewed, as are likely effects of aging on these models. The understanding of how older adults respond in terms of efficacy and toxicity is increasing but limited...
December 2017: Infectious Disease Clinics of North America
Theresa A Rowe, June M McKoy
Sepsis disproportionally affects older adults with more than 60% of sepsis diagnoses attributed to adults aged 65 years and older. Identifying, diagnosing, and treating sepsis in older individuals remain a challenge for clinicians, and few studies focus specifically on older adults with multiple medical comorbidities. Principles guiding management of sepsis for older adults are generally the same as in younger adults; however, unique considerations particularly pertinent to the care older adults include antimicrobial selection and dosing, delirium management, and goals of care discussions...
December 2017: Infectious Disease Clinics of North America
Staci A Fischer
Infection is an inevitable complication of solid organ transplantation. Unrecognized infection may be transmitted from a donor and result in disseminated disease in the immunosuppressed host. Recent outbreaks of deceased donor-derived infections resulting in high rates of mortality and severe morbidity have emphasized the need to be cautious in using donors with possible meningoencephalitis. Screening of organ donors for potential transmissible infections is paramount to improving transplantation outcomes.
September 2018: Infectious Disease Clinics of North America
Michele Bartoletti, Maddalena Giannella, Sara Tedeschi, Pierluigi Viale
The current era is ruled by an alarming evolution of antimicrobial resistance. Solid organ transplant recipients are prone to develop infections caused by multidrug-resistant pathogens. The current challenges in this setting include screening of donors and recipients, and prevention/treatment of donor-derived and posttransplant infections. The epidemiology of these infections varies between centers, type of transplanted organ, and pathogen. Treatment options are limited. Efforts to reduce carbapenem antibiotic pressure and infection control measures are necessary to reverse the spread of multidrug-resistant pathogens...
September 2018: Infectious Disease Clinics of North America
Christine E Koval
Despite advances in prevention and treatment, cytomegalovirus (CMV) infection and disease remain an expected problem in solid organ transplant recipients. Because of the effect of immunosuppressing medications, CMV primary, secondary, and reactivated infection requires antiviral medications to prevent serious direct and indirect effects of the virus. Side effects and drug resistance, however, often limit the capacity of traditional antiviral therapies. This article updates the clinician on current and promising approaches to the management and control of CMV in the solid organ transplant recipient...
September 2018: Infectious Disease Clinics of North America
Nissreen Elfadawy, Masaaki Yamada, Nagaraju Sarabu
BK virus (BKV) can cause graft dysfunction or failure in kidney transplant recipients and hemorrhagic cystitis in allogeneic hematopoietic stem cell transplant patients. BKV-associated nephropathy (BKVAN) emerged as a common complication in the late 1990s, probably due to the introduction of potent immunosuppressive agents. BKVAN occurred in up to 5% of kidney transplant recipients, with graft failure in up to 70%. Since universal implementation of effective screening and treatment strategies, BKV is no longer a common cause of graft failure; reported graft loss is only 0% to 5%...
September 2018: Infectious Disease Clinics of North America
Alan J Taege
Human immunodeficiency virus (HIV) has become a chronic disease with a near normal life span resulting in increased risk of organ failure. HIV organ transplantation is a proven and accepted intervention in appropriately selected cases. HIV-positive organ transplantation into HIV-positive recipients is in its nascent stages. Hepatitis C virus, high rates of organ rejection, and immune dysregulation are significant remaining barriers to overcome. This article provides an overview of the transplantation needs in the HIV population focusing on kidney and liver transplants...
September 2018: Infectious Disease Clinics of North America
Elizabeth Buganza-Torio, Karen Elizabeth Doucette
With potent nucleos(t)ide analogue (NA) therapy, hepatitis B virus (HBV) is now an uncommon indication for liver transplant (LT) in North America. NA therapy, with or without hepatitis B immunoglobulin, results in low recurrence rates and excellent outcomes after LT. Direct-acting antiviral therapy for hepatitis C virus (HCV), results in cure in most patients, either before or after transplant. There are now descriptions of good clinical outcomes of transplant from HBV and HCV infected donors, as treatments are so effective and well tolerated...
September 2018: Infectious Disease Clinics of North America
Sarah Taimur
Invasive candidiasis (IC) remains the most common invasive fungal infection following solid-organ transplant (SOT), but risk factors are evolving. Current challenges include infection due to drug resistant non-albicans and emerging novel species such as Candida auris. Preventive antifungal use in SOT needs to be re-examined in light of these current challenges. Cryptococcosis is the second most common IFI following SOT. Cryptococcus gattii is an emerging pathogen that can have reduced in-vitro susceptibility to antifungal agents...
September 2018: Infectious Disease Clinics of North America
Jeremy S Nel, Luther A Bartelt, David van Duin, Anne M Lachiewicz
The endemic mycoses are a group of thermally dimorphic fungal pathogens occupying a specific geographic range. In North America, the chief endemic mycoses are histoplasmosis, coccidioidomycosis, and blastomycosis. Endemic fungi can cause serious infections in solid organ transplant recipients from primary infection, reactivation of latent disease, or donor-derived infection.
September 2018: Infectious Disease Clinics of North America
Tracy L Lemonovich
Mold infections carry a substantial clinical and economic burden in solid organ transplant (SOT) recipients with a high overall mortality of near 30%. The most important pathogens include Aspergillus, the Zygomycetes, Fusarium, Scedosporium/Pseudallescheria, and the dematiaceous (dark) molds. Risk factors for the infections vary by transplant type but include degree of immune suppression and loss of skin or mucosal integrity. Correct diagnosis usually requires histopathology and/or culture. Management often requires a multidisciplinary team approach with combined antifungal and surgical therapies...
September 2018: Infectious Disease Clinics of North America
David J Epstein, Aruna K Subramanian
Solid organ transplant recipients are at an increased risk of tuberculosis and transplant candidates should be screened early in their evaluation with a detailed history, tuberculin skin test or tuberculosis interferon-gamma release assay, and chest radiograph. For latent tuberculosis treatment, isoniazid and rifamycin-based regimens have advantages and disadvantages; treatment decisions should be customized. Tuberculosis after solid organ transplantation generally occurs after months or years; early infections should raise the possibility of donor-derived infections...
September 2018: Infectious Disease Clinics of North America
Maricar F Malinis
Mycobacteria other than tuberculosis are important pathogens to consider in solid organ transplant recipients. Delay in recognition and treatment may incur significant morbidity and mortality. Management of mycobacteria other than tuberculosis requires a knowledge of treatment specific for each species and drug-drug interactions between antimicrobial and immunosuppressive drugs. Therapy in solid organ transplant can be prolonged and may require a reduction in immunosuppression to improve outcomes.
September 2018: Infectious Disease Clinics of North America
Stephanie M Pouch, Rachel J Friedman-Moraco
Clostridium difficile infection is a significant cause of morbidity and mortality in solid organ transplant recipients. Risk factors in this population include frequent hospitalizations, receipt of immunosuppressive agents, and intestinal dysbiosis triggered by several factors, including exposure to broad-spectrum antimicrobials. The incidence and potential for significant adverse outcomes among solid organ transplant recipients with C difficile infection highlight the evolving need for strategic C difficile infection risk factor modification and novel approaches to disease management in this patient population...
September 2018: Infectious Disease Clinics of North America
Justin Hayes, Anoma Nellore
Strongyloides stercoralis is a threadworm parasite with the unique capacity to complete its entire life cycle in a human host. Although asymptomatic in normal hosts, S stercoralis infection in solid organ transplant recipients is often severe, disseminated, and fatal. Risk factors for disease acquisition include travel to endemic regions. Antihelminth therapy should be instituted before transplantation for optimal clinical outcomes. Herein we review the epidemiology, biology, immune response, and diagnostic and screening strategies, as well as treatment modalities for S stercoralis in the solid organ transplant population...
September 2018: Infectious Disease Clinics of North America
2018-12-11 16:27:58
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