Archive for May 5, 2019

Liposomal Amphotericin B: Two Decades of Preclinical and Clinical Advances for Treatment of Invasive Fungal Infections

Clinical Infectious Diseases May 15, 2019 V.68 SUPPL. 4

Pharmacology of Liposomal Amphotericin B: An Introduction to Preclinical and Clinical Advances for

Treatment of Life-threatening Invasive Fungal Infections

Preclinical Safety, Tolerability, Pharmacokinetics, Pharmacodynamics, and Antifungal Activity of Liposomal Amphotericin B

Clinical Pharmacokinetics, Pharmacodynamics, Safety and Efficacy of Liposomal Amphotericin B

https://academic.oup.com/cid/issue/68/Supplement_4

 

May 5, 2019 at 12:31 pm

Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America

Clinical Infectious Diseases May 15, 2019 V.68 N.10 P.1611-1615

IDSA GUIDELINES

Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.

FULL TEXT

https://academic.oup.com/cid/article/68/10/1611/5481760

PDF (CLIC en PDF)

May 5, 2019 at 12:04 pm

Clinical Infectious Diseases May 1, 2019 V.68 N.9 P.1456-1462

EDITOR’S CHOICE

Incidence of Acute Kidney Injury Among Critically Ill Patients With Brief Empiric Use of Antipseudomonal ß-Lactams With Vancomycin

Findings suggest that nephrotoxicity occurs after 3–5 days of piperacillin-tazobactam/vancomycin therapy. We found in a large observational study of intensive care unit patients that brief (<72-hour) empiric use of this combination was no more nephrotoxic than other such combinations.

Background

Nephrotoxins contribute to 20%–40% of acute kidney injury (AKI) cases in the intensive care unit (ICU). The combination of piperacillin-tazobactam (PTZ) and vancomycin (VAN) has been identified as nephrotoxic, but existing studies focus on extended durations of therapy rather than the brief empiric courses often used in the ICU. The current study was performed to compare the risk of AKI with a short course of PTZ/VAN to with the risk associated with other antipseudomonal ß-lactam/VAN combinations.

Methods

The study included a retrospective cohort of 3299 ICU patients who received =24 but =72 hours of an antipseudomonal ß-lactam/VAN combination: PTZ/VAN, cefepime (CEF)/VAN, or meropenem (MER)/VAN. The risk of developing stage 2 or 3 AKI was compared between antibiotic groups with multivariable logistic regression adjusted for relevant confounders. We also compared the risk of persistent kidney dysfunction, dialysis dependence, or death at 60 days between groups.

Results

The overall incidence of stage 2 or 3 AKI was 9%. Brief exposure to PTZ/VAN did not confer a greater risk of stage 2 or 3 AKI after adjustment for relevant confounders (adjusted odds ratio [95% confidence interval] for PTZ/VAN vs CEF/VAN, 1.11 [.85–1.45]; PTZ/VAN vs MER/VAN, 1.04 [.71–1.42]). No significant differences were noted between groups at 60-day follow-up in the outcomes of persistent kidney dysfunction (P = .08), new dialysis dependence (P = .15), or death (P = .09).

Conclusion

Short courses of PTZ/VAN were not associated with a greater risk of short- or 60-day adverse renal outcomes than other empiric broad-spectrum combinations.

FULL TEXT

https://academic.oup.com/cid/article/68/9/1456/5079140

PDF (CLIC en PDF)

May 5, 2019 at 11:56 am

Infectious Diseases Society of America Position Statement on Telehealth and Telemedicine as Applied to the Practice of Infectious Diseases

Clinical Infectious Diseases May 1, 2019 V.68 N.9 P.1437-1443

IDSA FEATURES

Infectious Diseases Society of America Position Statement on Telehealth and Telemedicine as Applied to the Practice of Infectious Diseases

The Infectious Diseases Society of America supports telehealth, antimicrobial stewardship, and infection prevention and control programs, education, and research. Programs should be appropriately designed and implemented, with consideration of quality of care, licensure, credentialing, reimbursement, liability, confidentiality, and patient engagement.

Over the last 2 decades, telemedicine has effectively demonstrated its ability to increase access to care. This access has the ability to deliver quality clinical care and offer potential savings to the healthcare system. With increasing frequency, physicians, clinics, and medical centers are harnessing modern telecommunications technologies to manage a multitude of acute and chronic conditions, as well as incorporating telehealth into teaching and research. The technologies spanning telehealth, telemedicine, and mobile health (mHealth) are rapidly evolving, and the Infectious Diseases Society of America (IDSA) has prepared this updated position statement to educate its membership on the use of telemedicine and telehealth technologies. IDSA supports the appropriate and evidence-based use of telehealth technologies to provide up-to-date, timely, cost-effective subspecialty care to resource-limited populations.

FULL TEXT

https://academic.oup.com/cid/article/68/9/1437/5372646

PDF (CLIC en PDF)

May 5, 2019 at 11:54 am


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