Posts filed under ‘GUIDELINES’

Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure — United States, July 2016

MMWR Morb Mortal Wkly Rep 2016;65(Early Release)

Titilope Oduyebo, MD; Irogue Igbinosa, MD; Emily E. Petersen, MD; et al.

CDC has updated its interim guidance for health care providers in the United States caring for pregnant women with possible Zika virus exposure, based on emerging data indicating Zika virus RNA can be detected for prolonged periods in some pregnant women. To increase the proportion of pregnant women with Zika virus infection who receive a definitive diagnosis, this guidance includes recommendations to expand real-time reverse transcription–polymerase chain reaction testing.


July 26, 2016 at 8:27 am

Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, July 2016

MMWR Morb Mortal Wkly Rep 2016;65(Early Release)

John T. Brooks, MD; Allison Friedman, MS; Rachel E. Kachur, MPH; et al.

CDC has updated interim guidance for the prevention of sexual transmission of Zika virus. The recommendations apply to all men and women who have traveled to or reside in areas with active Zika virus transmission and their sex partners. The recommendations in this report replace those previously issued and are now updated to reduce the risk for sexual transmission of Zika virus from both men and women to their sex partners. This guidance will be updated as more information becomes available.


July 26, 2016 at 8:26 am

2016-07-14 Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents

Key Updates

What to Start: Initial Combination Regimens for the Antiretroviral-Naive Patient

The approval of 3 fixed-dose combination products containing tenofovir alafenamide (an oral prodrug of tenofovir) and emtricitabine (TAF/FTC) prompted several changes in the What to Start section. The key changes are highlighted below:

– TAF/FTC was added as a 2-NRTI option in several Recommended and Alternative regimens, as noted in Table 6 of the guidelines. The addition of TAF/FTC to these recommendations is based on data from comparative trials demonstrating that TAF-containing regimens are as effective in achieving or maintaining virologic suppression as tenofovir disoproxil fumarate (TDF)-containing regimens and with more favorable effects on markers of bone and renal health.

– In the What to Start section, the evidence quality rating “II” was expanded to include “relative bioavailability/bioequivalence studies or regimen comparisons from randomized switch studies.” This evidence rating was broadened because not all recommended regimens were evaluated in randomized, controlled trials in antiretroviral therapy (ART)-naive patients. The Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel) based their recommendations for some regimens on either data from bioequivalence or relative bioavailability studies, or by extrapolating results from randomized “switch” studies that evaluated a drug’s or regimen’s ability to maintain virologic suppression in patients whose HIV was suppressed on a previous regimen. Guidance for clinicians on choosing between abacavir (ABC)-, TAF-, and TDF-containing regimens was added to What to Start.

– The lopinavir/ritonavir (LPV/r) plus 2-NRTI regimen was removed from the list of Other regimens because regimens containing this protease inhibitor (PI) combination have a larger pill burden and greater toxicity than other currently available options.

Regimen Switching

– Based on the most current data, this section was simplified to focus on switch strategies for virologically suppressed patients. The strategies are categorized as Strategies with Good Supporting Evidence, Strategies Under Evaluation, and Strategies Not Recommended.

HIV-Infected Women

– The Panel emphasizes that ART is recommended for all HIV-infected patients, including all HIV-infected women.

– The Panel also stresses the importance of early treatment for HIV-infected women during pregnancy and continuation of ART after pregnancy.

– This section was updated to include new data on interactions between antiretroviral (ARV) drugs and hormonal contraceptives.

Hepatitis B Virus (HBV)/HIV Coinfection

– This section was updated to include TAF/FTC as a treatment option for patients with HBV/HIV coinfection. Data on the virologic efficacy of TAF for the treatment of HBV in persons without HIV infection and TAF/FTC in persons with HBV/HIV coinfection are discussed.

– The Panel no longer recommends adefovir or telbivudine as options for HBV/HIV coinfected patients, as there is limited safety and efficacy data on their use in this population. In addition, these agents have a higher incidence of toxicities than other recommended treatments.

Hepatitis C Virus (HCV)/HIV Coinfection

– The text and Table 12 in this section were updated with information regarding the potential pharmacokinetic (PK) interactions between different ARV drugs and the recently approved hepatitis C drugs daclatasvir and the fixed-dose combination product of elbasvir and grazoprevir.

– Peginterferon alfa and ribavirin were removed from Table 12, as these agents do not have significant PK interactions with ARV drugs.

Tuberculosis (TB)/HIV Coinfection

– This section was updated to include a discussion on the treatment of latent tuberculosis infection (LTBI) in HIV-infected persons. The added discussion notes that a 12-week course of once-weekly rifapentine and isoniazid is an option for patients receiving either an efavirenz (EFV)- or a raltegravir (RAL)-based regimen.

– This section addresses the data from the TEMPRANO and START studies demonstrating a potential role of ART in reducing TB disease.

The recommendations and discussion regarding when to initiate ART in patients with active TB were simplified.

– As rifamycins are potent inducers of P-glycoprotein (P-gp), and TAF is a P-gp substrate, coadministration of TAF and rifamycins is not recommended.

Additional Updates

Minor revisions were made to the following sections:

– Laboratory Testing for Initial Assessment and Monitoring of HIV-Infected Patients on Antiretroviral Therapy

– Drug Resistance Testing

– Adverse Effects of Antiretroviral Agents and Tables 14 and 15

– Monthly Average Wholesale Price of Commonly Used Antiretroviral Drugs (Table 16)

– Drug Interaction Tables 18, 19a-e, and 20b

– Drug Characteristics Tables (Appendix B, Tables 1–7)



July 25, 2016 at 2:17 pm

Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society

Clin Infect Diseases July 14, 2016

Andre C. Kalil1,a, Mark L. Metersky2,a, Michael Klompas3,4, John Muscedere5, Daniel A. Sweeney6, Lucy B. Palmer7, Lena M. Napolitano8, Naomi P. O’Grady9, John G. Bartlett10, Jordi Carratalà11, Ali A. El Solh12, Santiago Ewig13, Paul D. Fey14, Thomas M. File Jr15, Marcos I. Restrepo16, Jason A. Roberts17,18, Grant W. Waterer19, Peggy Cruse20, Shandra L. Knight20, and Jan L. Brozek21

1Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha

2Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington

3Brigham and Women’s Hospital and Harvard Medical School

4Harvard Pilgrim Health Care Institute, Boston, Massachusetts

5Department of Medicine, Critical Care Program, Queens University, Kingston, Ontario, Canada

6Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego

7Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, State University of New York at Stony Brook

8Department of Surgery, Division of Trauma, Critical Care and Emergency Surgery, University of Michigan, Ann Arbor

9Department of Critical Care Medicine, National Institutes of Health, Bethesda

10Johns Hopkins University School of Medicine, Baltimore, Maryland

11Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Spanish Network for Research in Infectious Diseases, University of Barcelona, Spain

12Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, Veterans Affairs Western New York Healthcare System, New York

13Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Germany

14Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha

15Summa Health System, Akron, Ohio

16Department of Medicine, Division of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System and University of Texas Health Science Center at San Antonio

17Burns, Trauma and Critical Care Research Centre, The University of Queensland

18Royal Brisbane and Women’s Hospital, Queensland

19School of Medicine and Pharmacology, University of Western Australia, Perth, Australia

20Library and Knowledge Services, National Jewish Health, Denver, Colorado

21Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, Ontario, Canada

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. IDSA 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.

These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel’s recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.


July 21, 2016 at 8:50 am


Javier P. Gisbert a,,1, Javier Molina-Infante b,1, Javier Amador c, Fernando Bermejo d, Luis Bujanda e, Xavier Calvetf, Manuel Castro-Fernándezg, Antonio Cuadrado-Lavín h, J. Ignasi Elizaldei, Emili Genej, Fernando Gomollónk, Ángel Lanas k, Carlos Martín de Argilal, Fermín Mearin m, Miguel Montoro n, Ángeles Pérez-Aisa o, Emilio Pérez-Trallero p y Adrián G. McNicholl a

a Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Espana

b Servicio de Aparato Digestivo, Hospital San Pedro de Alcántara, Cáceres, Espana

c Medicina de Familia, Centro de Salud Los Ángeles, Madrid, Espana

d Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Espana

e Servicio de Digestivo, Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco UPV/EHU, CIBEREHD, San Sebastián, Espana

f Servicio de Aparato Digestivo, Hospital Parc Taulí, Universitat Autónoma de Barcelona, CIBEREHD, Sabadell, Barcelona, Espana

g Servicio de Aparato Digestivo, Hospital Universitario de Valme, CIBEREHD, Sevilla, Espana

h Servicio Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander

i Servicio de Aparato Digestivo, Hospital Clínic, CIBEREHD, Barcelona, Espana

j Servicio de Urgencias, Hospital Parc Taulí Sabadell, CIBEREHD, Universitat Internacional de Catalunya, Sabadell, Barcelona, Espana

 k Servicio de Aparato Digestivo, Hospital Clínico Universitario de Zaragoza, IIS Aragón, CIBEREHD, Zaragoza, Espana

 l Servicio de Aparato Digestivo, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Espana

m Servicio de Aparato Digestivo, Centro Médico Teknon, Barcelona, Espana

n Servicio de Aparato Digestivo, Hospital San Jorge, Huesca, Espana

o Servicio de Aparato Digestivo, Agencia Sanitaria Costa del Sol, Marbella, Málaga, Espana

p Servicio de Microbiología, Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco UPV/EHU, CIBEREHD, San Sebastián, Espana

La infección por Helicobacter pylori afecta aproximadamente al 50% de la población espanola ˜ y es causante de la gastritis crónica, la úlcera péptica y el cáncer gástrico. Se han llevado a cabo hasta el momento, en nuestro país, 3 reuniones de Consenso sobre el manejo de la infección por H. pylori (la última de ellas en 2012). Los cambios en los esquemas de tratamiento y la creciente evidencia disponible al respecto han justificado la organización de esta IV Conferencia Espanola ˜ de Consenso en marzo de 2016, centrada en el tratamiento de esta infección. Participaron 19 expertos sobre el tema, que realizaron una búsqueda sistemática de la evidencia científica y elaboraron una serie de recomendaciones que fueron sometidas a un proceso de interacción de votaciones anónimas seriadas mediante metodología Delphi. Para clasificar la evidencia científica y la fuerza de las recomendaciones se utilizó el sistema GRADE. Este consenso establece, como punto de partida, un aumento de la exigencia en la eficacia de los tratamientos recomendados, que deben alcanzar, o preferiblemente superar, el 90% de curación al ser administrados de forma empírica. De este modo, tanto en primera como en segunda línea se recomiendan tratamientos cuádruples con o sin bismuto, generalmente prescritos durante 14 días. El tratamiento cuádruple sin bismuto concomitante, que incluye un inhibidor de la bomba de protones, claritromicina, amoxicilina y metronidazol, se recomienda como primera línea. En el presente consenso se revisan también con detalle otras alternativas de tratamiento tanto de primera línea como de rescate


July 5, 2016 at 2:11 pm

Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review.

Orthop Rev (Pavia). 2015 Mar 9;7(1):5623.

Jakobs O1, Schoof B1, Klatte TO2, Schmidl S1, Fensky F2, Guenther D3, Frommelt L4, Gehrke T1, Gebauer M5.

Author information

1Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg , Hamburg, Germany.

2Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf , Hamburg, Germany.

3Department of Trauma, Hannover Medical School , Hamburg, Germany.

4Institute for Clinical Microbiology, Infectiology and Infection Control, Helios Endo-Klinik Hamburg , Hamburg, Germany.

5Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg , Hamburg, Germany ; Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf , Hamburg, Germany.


Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). A standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. In this systematic review, we collected data from 36 studies with a total of 45 reported cases of a TKA complicated by a fungal PJI. Subsequently, an analysis focusing on diagnostic, medicaments and surgical procedures in the pre-, intra- and postoperative period was performed. Candida spp. accounts for about 80% (36 out of 45 cases) of fungal PJIs and is therefore the most frequently reported pathogen. A systemic antifungal therapy was administered in all but one patient whereas a local antifungal therapy, e.g. the use of an impregnated spacer, is of inferior relevance. Resection arthroplasty with delayed re-implantation (two-stage revision) was the surgical treatment of choice. However, in 50% of all reported cases the surgical therapy was heterogeneous. The outcome under a combined therapy was moderate with recurrent fungal PJI in 11 patients and subsequent bacterial PJI as a main complication in 5 patients. In summary, this systematic review integrates data from up to date 45 reported cases of a fungal PJI of a TKA. On the basis of the current literature strategies for the treatment of this devastating complication after TKA are discussed.


July 4, 2016 at 9:08 am

Fungal periprosthetic joint infection of the hip: a systematic review.

Orthop Rev (Pavia). 2015 Mar 31;7(1):5748.

Schoof B1, Jakobs O1, Schmidl S1, Klatte TO2, Frommelt L3, Gehrke T1, Gebauer M1.

Author information

1Department of Orthopedic Surgery, HELIOS Endo-Clinic Hamburg , Hamburg, Germany.

2Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf , Hamburg, Germany.

3Centre of Infections and Microbiology, HELIOS Endo-Clinic , Hamburg, Germany.


Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty with an incidence of approximately 1%. Due to the high risk of persisting infection, successful treatment of fungal PJI is challenging. The purpose of this study was to gain insight into the current management of fungal PJI of the hip and, by systematically reviewing the cases published so far, to further improve the medical treatment of this serious complication of total hip arthroplasty. Thus, we conducted a systematic review of the available literature concerning fungal PJI in total hip arthroplasty, including 45 cases of fungal PJI. At the moment a two-stage revision procedure is favorable and there is an ongoing discussion on the therapeutic effect of antifungal drug loaded cement spacers on fungal periprosthetic infections of the hip. Due to the fact that there is rare experience with it, there is urgent need to establish guidelines for the treatment of fungal infections of total hip arthroplasty.


July 4, 2016 at 9:04 am

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