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https://www.readbyqxmd.com/read/28687213/prevention-of-central-line-associated-bloodstream-infections
#1
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/28687214/severe-respiratory-viral-infections-new-evidence-and-changing-paradigms
#2
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/28687215/invasive-fungal-infections-in-the-intensive-care-unit
#3
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/28779830/role-of-procalcitonin-in-the-management-of-infected-patients-in-the-intensive-care-unit
#4
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/28779831/clostridium-difficile-infection
#5
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/28779832/evaluation-and-management-of-necrotizing-soft-tissue-infections
#6
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/28779834/inhaled-antibiotics-for-ventilator-associated-infections
#7
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/28911830/norovirus-infection-in-older-adults-epidemiology-risk-factors-and-opportunities-for-prevention-and-control
#8
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...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28571493/optimizing-%C3%AE-lactams-treatment-in-critically-ill-patients-using-pharmacokinetics-pharmacodynamics-targets-are-first-conventional-doses-effective
#9
Isabelle K Delattre, Fabio S Taccone, Frédérique Jacobs, Maya Hites, Thierry Dugernier, Herbert Spapen, Pierre-François Laterre, Pierre E Wallemacq, Françoise Van Bambeke, Paul M Tulkens
The pharmacokinetic/pharmacodynamic index determining β-lactam activity is the percentage of the dosing interval (%T) during which their free serum concentration remains above a critical threshold over the minimum inhibitory concentration (MIC). Regrettably, neither the value of %T nor that of the threshold are clearly defined for critically-ill patients. Areas covered: We review and assess the targets proposed for β-lactams in critical illness by screening the literature since 1997. Depending on the study intention (clinical cure vs...
July 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28657373/extended-infusion-of-beta-lactam-antibiotics-optimizing-therapy-in-critically-ill-patients-in-the-era-of-antimicrobial-resistance
#10
Nesrine A Rizk, Zeina A Kanafani, Hussam Z Tabaja, Souha S Kanj
Beta-lactams are at the cornerstone of therapy in critical care settings, but their clinical efficacy is challenged by the rise in bacterial resistance. Infections with multi-drug resistant organisms are frequent in intensive care units, posing significant therapeutic challenges. The problem is compounded by a dearth in the development of new antibiotics. In addition, critically-ill patients have unique physiologic characteristics that alter the drugs pharmacokinetics and pharmacodynamics. Areas covered: The prolonged infusion of antibiotics (extended infusion [EI] and continuous infusion [CI]) has been the focus of research in the last decade...
July 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28782390/treatment-of-pneumocystis-jirovecii-pneumonia-in-hiv-infected-patients-a-review
#11
Yu-Shan Huang, Jen-Jia Yang, Nan-Yao Lee, Guan-Jhou Chen, Wen-Chien Ko, Hsin-Yun Sun, Chien-Ching Hung
Pneumocystis pneumonia is a potentially life-threatening pulmonary infection that occurs in immunocompromised individuals and HIV-infected patients with a low CD4 cell count. Trimethoprim-sulfamethoxazole has been used as the first-line agent for treatment, but mutations within dihydropteroate synthase gene render potential resistance to sulfamide. Despite advances of combination antiretroviral therapy (cART), Pneumocystis pneumonia continues to occur in HIV-infected patients with late presentation for cART or virological and immunological failure after receiving cART...
September 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28803496/management-of-multidrug-resistant-pseudomonas-aeruginosa-in-the-intensive-care-unit-state-of-the-art
#12
Alberto Enrico Maraolo, Marco Cascella, Silvia Corcione, Arturo Cuomo, Salvatore Nappa, Guglielmo Borgia, Francesco Giuseppe De Rosa, Ivan Gentile
Pseudomonas aeruginosa (PA) is one of the most important causes of healthcare-related infections among Gram-negative bacteria. The best therapeutic approach is controversial, especially for multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains as well as in the setting of most severe patients, such as in the intensive care unit (ICU). Areas covered: This article addresses several points. First, the main microbiological aspects of PA, focusing on its wide array of resistance mechanisms. Second, risk factors and the worse outcome linked to MDR-PA infection...
September 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28829207/invasive-candidiasis-future-directions-in-non-culture-based-diagnosis
#13
Wilfried Posch, David Heimdörfer, Doris Wilflingseder, Cornelia Lass-Flörl
Delayed initial antifungal therapy is associated with high mortality rates caused by invasive candida infections, since accurate detection of the opportunistic pathogenic yeast and its identification display a diagnostic challenge. diagnosis of candida infections relies on time-consuming methods such as blood cultures, serologic and histopathologic examination. to allow for fast detection and characterization of invasive candidiasis, there is a need to improve diagnostic tools. trends in diagnostics switch to non-culture-based methods, which allow specified diagnosis within significantly shorter periods of time in order to provide early and appropriate antifungal treatment...
September 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28901793/intravenous-fosfomycin-for-the-treatment-of-hospitalized-patients-with-serious-infections
#14
Andrew F Shorr, Jason M Pogue, John F Mohr
With the worldwide increase in the rates of antimicrobial resistance, antimicrobials with novel mechanisms of action are needed to fill a void in the antimicrobial armamentarium. Areas covered: Intravenous fosfomycin has been studied extensively in a wide variety of infections including cUTI, lower respiratory tract infection, bone and joint infections, endocarditis, meningitis, and bacteremia outside of the United States. This paper reviews the in vitro activity, pharmacokinetic properties, and clinical experience of intravenous fosfomycin in hospitalized patients with serious infections...
October 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28922286/nocardia-infections-in-solid-organ-and-hematopoietic-stem-cell-transplant-recipients
#15
Julien Coussement, David Lebeaux, Claire Rouzaud, Olivier Lortholary
PURPOSE OF REVIEW: Nocardia spp. is a gram-positive bacteria that may cause infections in humans. Nocardiosis has been described since the early years of transplantation. This review aims to provide an overview of present knowledge regarding posttransplant nocardiosis, with a focus on recent findings. RECENT FINDINGS: Nocardiosis is not rare among transplant recipients, especially after thoracic transplantation and/or in case of intense immunosuppressive regimen or use of tacrolimus...
September 15, 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/28938246/the-evolving-landscape-of-new-diagnostic-tests-for-invasive-aspergillosis-in-hematology-patients-strengths-and-weaknesses
#16
Dieter Buchheidt, Mark Reinwald, Martin Hoenigl, Wolf-Karsten Hofmann, Birgit Spiess, Tobias Boch
PURPOSE OF REVIEW: The diagnosis of invasive aspergillosis in hematologic patients is a complex composite of clinical preconditions and features, imaging findings, biomarker combinations from appropriate clinical samples and microbiological and/or histological findings. RECENT FINDINGS: Recent developments in the evolving landscape of diagnostic tests for invasive aspergillosis in adult hematology patients are highlighted. SUMMARY: Novel approaches and tools are currently under development...
September 21, 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/28895051/polymyxin-resistance-in-gram-negative-pathogens
#17
REVIEW
Pavithra Srinivas, Kaitlyn Rivard
PURPOSE OF REVIEW: The polymyxins are one of the last line antimicrobial classes to retain activity against multidrug-resistant Gram-negative bacilli. However, with the increased use of polymyxins in recent years, reports of resistance have also been increasing. We aimed to describe the mechanisms and occurrence of polymyxin resistance in Gram-negative organisms and propose strategies to overcome resistance. RECENT FINDINGS: The most common mechanism of acquired resistance to the polymyxins is via modification of the bacterial outer membrane lipopolysaccharide...
September 11, 2017: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/28863048/causes-and-management-of-postrenal-transplant-diarrhea-an-underappreciated-cause-of-transplant-associated-morbidity
#18
Ho Sik Shin, Anil Chandraker
PURPOSE OF REVIEW: This review highlights the current literature on both infectious and noninfectious diarrhea in renal transplant recipients and provides a diagnostic algorithm for the evaluation of posttransplant diarrhea. RECENT FINDINGS: Renal transplant recipients share certain predisposing characteristics for the development of posttransplant diarrhea, including a generalized immunosuppressed state and exposure to polypharmacy, most notably broad-spectrum antimicrobial therapy...
November 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28505028/cytomegalovirus-disease-in-hematopoietic-stem-cell-transplant-patients-current-and-future-therapeutic-options
#19
Shigeo Fuji, Hermann Einsele, Markus Kapp
PURPOSE OF REVIEW: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has become one of the standard treatment for hematological diseases. Although the clinical outcome has improved significantly during the last decades, the morbidity and mortality after allo-HSCT are still obstacles to cure. Out of major morbidities, opportunistic virus infections such as cytomegalovirus (CMV) infection are important complications, in particular in patients who received human leukocyte antigen-mismatched HSCT...
August 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/28520621/outbreaks-in-the-adult-icus
#20
Hasan M Al-Dorzi, Yaseen M Arabi
PURPOSE OF REVIEW: Infectious disease outbreaks in the critical care setting are common and serious consequence. This article reviews and summarizes recent outbreaks in the adult ICUs. RECENT FINDINGS: Outbreaks of multidrug-resistant bacteria, fungi, and emerging viruses in ICUs from different countries are common. Outbreak investigation relies on epidemiologic methods, microbiologic studies, and molecular typing methods. Overuse of antibiotics, gaps in implementing infection prevention measures, and contaminated environment are common causes of ICU outbreaks...
August 2017: Current Opinion in Infectious Diseases
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