Letter – Polymyxin B Resistance in Carbapenem-Resistant Klebsiella pneumoniae, São Paulo, Brazil

Emerging Infectious Diseases October 2016 V.22 N.10 P.1849-1851

To the Editor: Infections caused by carbapenem-resistant Enterobacteriaceae have been associated with higher death rates than infections caused by carbapenem-susceptible strains, and resistant infections are mostly treated with polymyxins (1). Several outbreaks caused by carbapenem- and polymyxin-resistant Klebsiella pneumoniae (CPRKp) have been reported, mainly from Europe, and represent an emerging threat……

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http://wwwnc.cdc.gov/eid/article/22/10/pdfs/16-0695.pdf

September 22, 2016 at 8:30 am

IDSA GUIDELINE – Official American Thoracic Society – Centers for Disease Control and Prevention – Infectious Diseases Society of America Clinical Practice Guidelines – Treatment of Drug-Susceptible Tuberculosis

Clinical Infectious Diseases October 1, 2016 V.63 N.7 e147-e195

Payam Nahid1, Susan E. Dorman2, Narges Alipanah1, Pennan M. Barry3, Jan L. Brozek4, Adithya Cattamanchi1, Lelia H. Chaisson1, Richard E. Chaisson2, Charles L. Daley5, Malgosia Grzemska6, Julie M. Higashi7, Christine S. Ho8, Philip C. Hopewell1, Salmaan A. Keshavjee9, Christian Lienhardt6, Richard Menzies10, Cynthia Merrifield1, Masahiro Narita12, Rick O’Brien13, Charles A. Peloquin14, Ann Raftery1, Jussi Saukkonen15, H. Simon Schaaf16, Giovanni Sotgiu17, Jeffrey R. Starke18, Giovanni Battista Migliori11, and Andrew Vernon8

1University of California, San Francisco

2Johns Hopkins University, Baltimore, Maryland

3California Department of Public Health, Richmond

4McMaster University, Hamilton, Ontario, Canada

5National Jewish Health, Denver, Colorado

6World Health Organization, Geneva, Switzerland

7Tuberculosis Control Section, San Francisco Department of Public Health, California

8Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

9Harvard Medical School, Boston, Massachusetts

10McGill University, Montreal, Quebec, Canada

11WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri Care and Research Institute, Tradate, Italy

12Tuberculosis Control Program, Seattle and King County Public Health, and University of Washington, Seattle

13Ethics Advisory Group, International Union Against TB and Lung Disease, Paris, France

14University of Florida, Gainesville

15Boston University, Massachusetts

16Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa

17University of Sassari, Italy

18Baylor College of Medicine, Houston, Texas

The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.

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http://cid.oxfordjournals.org/content/63/7/e147.full.pdf+html

September 21, 2016 at 4:52 pm

IDSA GUIDELINE – 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis

Clinical Infectious Diseases September 15, 2016 V.63 N.6 e112-e146

John N. Galgiani, Neil M. Ampel, Janis E. Blair, Antonino Catanzaro, Francesca Geertsma, Susan E. Hoover, Royce H. Johnson, Shimon Kusne, Jeffrey Lisse, Joel D. MacDonald, Shari L. Meyerson, Patricia B. Raksin, John Siever, David A. Stevens, Rebecca Sunenshine, and Nicholas Theodore

1Valley Fever Center for Excellence

2Division of Infectious Diseases, University of Arizona, Tucson

3Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona

4Division of Pulmonary and Critical Care, University of California, San Diego

5Department of Pediatrics, Infectious Diseases, Stanford University School of Medicine, California

6Division of Sanford Health, Sioux Falls, South Dakota

7David Geffen School of Medicine at UCLA, Department of Medicine, Kern Medical Center, Bakersfield, California

8Department of Rheumatology, University of Arizona, Tucson

9Department of Neurosurgery School of Medicine, University of Utah, Salt Lake City

10Division of Thoracic Surgery, Northwestern University, Feinberg School of Medicine

11Division of Neurosurgery, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois

12Arizona Pulmonary Specialists, Ltd, Phoenix

13Division of Infectious Diseases, Stanford University School of Medicine, California

14Career Epidemiology Field Officer Program, Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention

15Maricopa County Department of Public Health

16Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.

 

Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.

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http://cid.oxfordjournals.org/content/63/6/e112.full.pdf+html

September 21, 2016 at 4:50 pm

Ceftazidime-avibactam Versus Doripenem for the Treatment of Complicated Urinary Tract Infections, Including Acute Pyelonephritis: RECAPTURE, a Phase 3 Randomized Trial Program

Clinical Infectious Diseases September 15, 2016 V.63 N.6 P. 754-762

Florian M. Wagenlehner, Jack D. Sobel, Paul Newell, Jon Armstrong, Xiangning Huang, Gregory G. Stone, Katrina Yates, and Leanne B. Gasink

1Justus-Liebig-University, Giessen, Germany

2Detroit Medical Center, Michigan

3AstraZeneca, Alderley Park, Cheshire

4AstraZeneca, Cambridge, United Kingdom

5AstraZeneca, Waltham, Massachusetts

6AstraZeneca, Wilmington, Delaware

Background

The global emergence of carbapenem-resistant Enterobacteriaceae highlights the urgent need to reduce carbapenem dependence. The phase 3 RECAPTURE program compared the efficacy and safety of ceftazidime-avibactam and doripenem in patients with complicated urinary tract infection (cUTI), including acute pyelonephritis.

Methods

Hospitalized adults with suspected or microbiologically confirmed cUTI/acute pyelonephritis were randomized 1:1 to ceftazidime-avibactam 2000 mg/500 mg every 8 hours or doripenem 500 mg every 8 hours (doses adjusted for renal function), with possible oral antibiotic switch after ≥5 days (total treatment duration up to 10 days or 14 days for patients with bacteremia).

Results

Of 1033 randomized patients, 393 and 417 treated with ceftazidime-avibactam and doripenem, respectively, were eligible for the primary efficacy analyses; 19.6% had ceftazidime-nonsusceptible baseline pathogens. Noninferiority of ceftazidime-avibactam vs doripenem was demonstrated for the US Food and Drug Administration co-primary endpoints of (1) patient-reported symptomatic resolution at day 5: 276 of 393 (70.2%) vs 276 of 417 (66.2%) patients (difference, 4.0% [95% confidence interval {CI}, −2.39% to 10.42%]); and (2) combined symptomatic resolution/microbiological eradication at test of cure (TOC): 280 of 393 (71.2%) vs 269 of 417 (64.5%) patients (difference, 6.7% [95% CI, .30% to 13.12%]). Microbiological eradication at TOC (European Medicines Agency primary endpoint) occurred in 304 of 393 (77.4%) ceftazidime-avibactam vs 296 of 417 (71.0%) doripenem patients (difference, 6.4% [95% CI, .33% to 12.36%]), demonstrating superiority at the 5% significance level. Both treatments showed similar efficacy against ceftazidime-nonsusceptible pathogens. Ceftazidime-avibactam had a safety profile consistent with that of ceftazidime alone.

Conclusions

Ceftazidime-avibactam was highly effective for the empiric treatment of cUTI (including acute pyelonephritis), and may offer an alternative to carbapenems in this setting.

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http://cid.oxfordjournals.org/content/63/6/754.full.pdf+html

September 21, 2016 at 4:49 pm

HIV infection results in metabolic alterations in the gut microbiota different from those induced by other diseases.

Sci Rep. 2016 May 18;6:26192.

Serrano-Villar S1, Rojo D2, Martínez-Martínez M3, Deusch S4, Vázquez-Castellanos JF5,6, Sainz T7, Vera M8, Moreno S1, Estrada V9, Gosalbes MJ5,6, Latorre A5,6,10, Margolles A11, Seifert J4, Barbas C2, Moya A5,6,10, Ferrer M3.

Author information

1Department of Infectious Diseases, University Hospital Ramón y Cajal and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain.

2Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad CEU San Pablo, Campus Montepríncipe, Madrid, Spain.

3Institute of Catalysis, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain.

4Institute of Animal Science, Universität Hohenheim, Stuttgart, Germany.

5Foundation for the Promotion of Health and Biomedical Research in the Valencian Community (FISABIO) – Public Health, Valencia, Spain.

6Network Research Center for Epidemiology and Public Health (CIBER-ESP), Madrid, Spain.

7Department of Pediatric Infectious Diseases, University Hospital La Paz, and La Paz Research Institute (IdiPAZ), Madrid, Spain.

8Centro Sanitario Sandoval, Madrid, Spain.

9HIV Unit, Department of Internal Medicine, University Hospital Clínico San Carlos, Madrid, Spain.

10Instituto Cavanilles de Biodiversidad y Biología Evolutiva (Universidad de Valencia), Valencia, Spain.

11Department of Microbiology and Biochemistry of Dairy Products, Dairy Research Institute (IPLA), CSIC, Villaviciosa, Asturias, Spain.

Abstract

Imbalances in gut bacteria have been associated with multiple diseases. However, whether there are disease-specific changes in gut microbial metabolism remains unknown. Here, we demonstrate that human immunodeficiency virus (HIV) infection (n = 33) changes, at quantifiable levels, the metabolism of gut bacteria. These changes are different than those observed in patients with the auto-immune disease systemic lupus erythaematosus (n = 18), and Clostridium difficile-associated diarrhoea (n = 6). Using healthy controls as a baseline (n = 16), we demonstrate that a trend in the nature and directionality of the metabolic changes exists according to the type of the disease. The impact on the gut microbial activity, and thus the metabolite composition and metabolic flux of gut microbes, is therefore disease-dependent. Our data further provide experimental evidence that HIV infection drastically changed the microbial community, and the species responsible for the metabolism of 4 amino acids, in contrast to patients with the other two diseases and healthy controls. The identification in this present work of specific metabolic deficits in HIV-infected patients may define nutritional supplements to improve the health of these patients

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870624/pdf/srep26192.pdf

September 19, 2016 at 7:43 pm

What happens to cardiovascular system behind the undetectable level of HIV viremia?

AIDS Res Ther. 2016 Apr 27;13:21.

d’Ettorre G1, Ceccarelli G1, Pavone P1, Vittozzi P1, De Girolamo G1, Schietroma I1, Serafino S1, Giustini N1, Vullo V1.

Author information

1Department of Public Health and Infectious Diseases, University of Rome “Sapienza”, Viale del Policlinico 155, Rome, Italy.

Abstract

Despite the combined antiretroviral therapy has improved the length and quality of life of HIV infected patients, the survival of these patients is always decreased compared with the general population. This is the consequence of non-infectious illnesses including cardio vascular diseases. In fact large studies have indicated an increased risk of coronary atherosclerotic disease, myocardial infarction even in HIV patients on cART. In HIV infected patients several factors may contribute to the pathogenesis of cardiovascular problems: life-style, metabolic parameters, genetic predisposition, viral factors, immune activation, chronic inflammation and side effects of antiretroviral therapy. The same factors may also contribute to complicate the clinical management of these patients. Therefore, treatment of these non-infectious illnesses in HIV infected population is an emerging challenge for physicians. The purpose of this review is to focus on the new insights in non AIDS-related cardiovascular diseases in patients with suppressed HIV viremia.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848790/pdf/12981_2016_Article_105.pdf

September 19, 2016 at 7:42 pm

Likely sexual transmission of Zika virus from a man with no symptoms of infection — Maryland, 2016

MMWR Morb Mortal Wkly Rep September 2, 2016  V.65 N.34 P.915–916

Brooks RB et al

In June 2016, the Maryland Department of Health and Mental Hygiene (DHMH) was notified of a nonpregnant woman who sought treatment for a subjective fever and an itchy rash, which was described as maculopapular by her provider. Laboratory testing at the Maryland DHMH Laboratories Administration confirmed Zika virus infection. Case investigation revealed that the woman had not traveled to a region with ongoing transmission of Zika virus, but did have sexual contact with a male partner who had recently traveled to the Dominican Republic. The male partner reported exposure to mosquitoes while traveling, but no symptoms consistent with Zika virus infection either before or after returning to the United States. The woman reported no other sex partners during the 14 days before onset of her symptoms and no receipt of blood products or organ transplants….

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http://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6534e2.pdf

September 19, 2016 at 8:08 am

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