Posts filed under ‘GUIDELINES’

Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline: Executive Summary

Clinical Infectious Diseases July 6, 2020

Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline: Executive Summary

Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites.

This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus infection) caused by the most common NTM pathogens such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among the slowly growing NTM and Mycobacterium abscessus among the rapidly growing NTM.

A panel of experts was carefully selected by leading international respiratory medicine and infectious diseases societies (ATS, ERS, ESCMID, IDSA) and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy.

Systematic reviews were conducted around each of 22 PICO (Population, Intervention, Comparator, Outcome) questions and the recommendations were formulated, written, and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

Thirty-one evidence-based recommendations about treatment of NTM pulmonary disease are provided.

This guideline is intended for use by healthcare professionals who care for patients with NTM pulmonary disease, including specialists in infectious diseases and pulmonary diseases.



July 15, 2020 at 9:48 am

IDSA GUIDELINES Therapeutic Monitoring of Vancomycin for Serious Methicillin-resistant Staphylococcus aureus Infections

Clinical Infectious Diseases July 13, 2020

Therapeutic Monitoring of Vancomycin for Serious Methicillin-resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review by the American Society of Health-system Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists

Recent clinical data on vancomycin pharmacokinetics and pharmacodynamics suggest a reevaluation of current dosing and monitoring recommendations. The previous 2009 vancomycin consensus guidelines recommend trough monitoring as a surrogate marker for the target area under the curve over 24 hours to minimum inhibitory concentration (AUC/MIC). However, recent data suggest that trough monitoring is associated with higher nephrotoxicity. This document is an executive summary of the new vancomycin consensus guidelines for vancomycin dosing and monitoring. It was developed by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists vancomycin consensus guidelines committee. These consensus guidelines recommend an AUC/MIC ratio of 400–600 mg*hour/L (assuming a broth microdilution MIC of 1 mg/L) to achieve clinical efficacy and ensure safety for patients being treated for serious methicillin-resistant Staphylococcus aureus infections.



July 15, 2020 at 9:40 am

REVIEW – Empiric therapy for hospital-acquired, Gram-negative complicated intra-abdominal infection and complicated urinary tract infections: a systematic literature review of current and emerging treatment options

BMC Infect Dis. August 2015 V.15 P.313. 



Empiric therapy for healthcare-associated infections remains challenging, especially with the continued development of Gram-negative organisms producing extended-spectrum β-lactamases (ESBLs) and the threat of multi-drug-resistant organisms. Current treatment options for resistant Gram-negative infections include carbapenems, tigecycline, piperacillin-tazobactam, cefepime, ceftazidime, and two recently approved therapies, ceftolozane-tazobactam and ceftazidime-avibactam.


This systematic literature review surveys the published clinical trial evidence available since 2000 in support of both current and emerging treatment options in the settings of complicated intra-abdominal infection (cIAI) and complicated urinary tract infection (cUTI). When available, clinical cure rates for patients with infections from ESBL-producing strains are provided, as is information about efficacy against Pseudomonas aeruginosa.


Clinical trial evidence to guide selection of empiric antibiotic therapy in patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs is limited. Though most of the clinical trials explored in this overview enrolled patients with complicated infections, often patients with severe infections and multiple comorbidities were excluded.


Practitioners in the clinical setting who are treating patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs need to consider the possibility of polymicrobial infections, antibiotic-resistant organisms, and/or severely ill patients with multiple comorbidities. There is a severe shortage of evidence-based research to guide the selection of empiric antibiotic therapy for many patients in this setting. New therapies recently approved or in late-stage development promise to expand the number of options available for empiric therapy of these hospital-acquired, Gram-negative infections.



July 14, 2020 at 5:34 pm

Summary of the international clinical guidelines for the management of hospital-acquired and ventilator-acquired pneumonia

ERJ Open Res. Jube 26, 2018 V.4 N.2 



July 13, 2020 at 3:49 pm

International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia

Eur Respir J. September 10, 2017 V.50 N.3 

Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT)

The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population-intervention-comparison-outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention.



July 13, 2020 at 3:45 pm

Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19.

Clin Infect Dis. April 27, 2020.

Bhimraj A1, Morgan RL2, Shumaker AH3, Lavergne V4, Baden L5, Cheng VC6, Edwards KM7, Gandhi R8, Muller WJ9, O’Horo JC10, Shoham S11, Murad MH12, Mustafa RA13, Sultan S14, Falck-Ytter Y3.



There are many pharmacologic therapies that are being used or considered for treatment of COVID-19. There is a need for frequently updated practice guidelines on their use, based on critical evaluation of rapidly emerging literature.


Develop evidence-based rapid guidelines intended to support patients, clinicians and other health-care professionals in their decisions about treatment and management of patients with COVID-19.


IDSA formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise. Process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations.


The IDSA guideline panel agreed on 7 treatment recommendations and provided narrative summaries of other treatments undergoing evaluations.


The panel expressed the overarching goal that patients be recruited into ongoing trials, which would provide much needed evidence on the efficacy and safety of various therapies for COVID-19, given that we could not make a determination whether the benefits outweigh harms for most treatments.


May 18, 2020 at 8:09 pm

Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19).

Critical Care Medicine March 27, 2020 

Alhazzani W1,2, Møller MH3,4, Arabi YM5, Loeb M1,2, Gong MN6, Fan E7, Oczkowski S1,2, Levy MM8,9, Derde L10,11, Dzierba A12, Du B13, Aboodi M6, Wunsch H14,15, Cecconi M16,17, Koh Y18, Chertow DS19, Maitland K20, Alshamsi F21, Belley-Cote E1,22, Greco M16,17, Laundy M23, Morgan JS24, Kesecioglu J10, McGeer A25, Mermel L8, Mammen MJ26, Alexander PE2,27, Arrington A28, Centofanti JE29, Citerio G30,31, Baw B1,32, Memish ZA33, Hammond N34,35, Hayden FG36, Evans L37, Rhodes A38.



El SARS-CoV-2 es la causa de una enfermedad que se propaga rápidamente, COVID-19, que afecta a miles de personas en todo el mundo. Se necesita orientación urgente para los médicos que atienden a los más enfermos de estos pacientes.


Formaron un panel de 36 expertos de 12 países. Todos los miembros del panel completaron el formulario de divulgación de conflictos de intereses de la OMS.

El panel propuso 53 preguntas que son relevantes para la gestión de COVID-19 en la UCI.

Se realizaron búsquedas bibliográficas para obtener evidencia directa e indirecta sobre el manejo de COVID-19 en pacientes críticos en la UCI.

Identificaron revisiones sistemáticas relevantes y recientes sobre la mayoría de las preguntas relacionadas con la atención de apoyo.

Evaluaron la certeza en la evidencia utilizando el enfoque de Calificación de recomendaciones, evaluación, desarrollo y evaluación (GRADE), luego generaron recomendaciones basadas en el equilibrio entre beneficio y perjuicio, implicaciones de recursos y costos, equidad y factibilidad.

Las recomendaciones fueron fuertes o débiles, o en forma de recomendaciones de mejores prácticas.


El panel COVID-19 de Surviving Sepsis Campaign emitió 54 declaraciones, de las cuales:

cuatro son declaraciones de mejores prácticas,

nueve son recomendaciones sólidas y

35 son recomendaciones débiles.

No se proporcionó ninguna recomendación para seis preguntas.

Los temas fueron:

1) control de infecciones,

2) diagnóstico de laboratorio y muestras,

3) soporte hemodinámico,

4) soporte ventilatorio y

5) terapia COVID-19.


El panel COVID-19 de Surviving Sepsis Campaign emitió varias recomendaciones para ayudar a los trabajadores de la salud que atienden a pacientes críticos de UCI con COVID-19. Cuando esté disponible, proporcionarán nueva evidencia en futuras versiones de estas pautas,


May 18, 2020 at 8:04 pm

Guide to Understanding the 2019 Novel Coronavirus 

Mayo Clinic Proceedings  April 2020
Aditya Shah, MBBSa, Aditya Shah, Rahul Kashyap, MBBS, Pritish Tosh, Priya Sampathkumar, John C. O’Horo
A cluster of cases of pneumonia caused by a novel coronavirus, COVID-19, was first reported in Wuhan in the Hubei province in China in late December 2019. Since then, several thousand cases have been reported in mainland China, with spread to over two dozen countries. Although many comparisons to other coronavirus epidemics have been made, the potential impact of this coronavirus is uncertain. We seek to summarize what is known about COVID-19, compare this epidemic to prior coronavirus outbreaks, and provide a primer on novel coronaviruses for practicing clinicians.
Coronaviruses are widespread among mammals and birds. The widest varieties of genotypes infect bats, but 2 subtypes infect humans: alpha and beta coronaviruses.1 Beta coronaviruses include severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and the coronavirus variant COVID-19 virus first described in Wuhan. In humans, these coronaviruses have short incubation periods, ranging from days for SARS-CoV and weeks for MERS-CoV, with the COVID-19 appearing to fall in between the two.2,3 Although information about the COVID-19 is emerging, SARS-CoV and MERS-CoV provide some context for understanding the public health significance of coronaviruses….

April 13, 2020 at 5:52 pm

REVIEW – Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents.

J Hospital Infect. March 2020 V.104 N.3 P.246–251.

Kampf G,Todt D, Pfaender S, Steinmann E.

Actualmente, la aparición de un nuevo coronavirus humano, SARS-CoV-2, se ha convertido en un problema de salud global que causa infecciones graves del tracto respiratorio en humanos.

Las transmisiones de persona a persona se han descrito con tiempos de incubación de entre 2 y 10 días, lo que facilita su propagación a través de gotas, manos o superficies contaminadas.

Por lo tanto, revisaron la literatura sobre toda la información disponible sobre la persistencia de coronavirus humanos y veterinarios en superficies inanimadas, así como las estrategias de inactivación con agentes biocidas utilizados para la desinfección química, p. ej. en instalaciones sanitarias.

El análisis de 22 estudios revela que los coronavirus humanos como el coronavirus del Síndrome Respiratorio Agudo Severo (SARS), el coronavirus del Síndrome Respiratorio del Medio Oriente (MERS) o los coronavirus humanos endémicos (HCoV) pueden persistir en superficies inanimadas como metal, vidrio o plástico por hasta 9 días, pero se puede inactivar eficientemente mediante procedimientos de desinfección de superficie con:

etanol al 62–71%,

peróxido de hidrógeno al 0.5% o

hipoclorito de sodio al 0.1% en 1 minuto.

Otros agentes biocidas como el cloruro de benzalconio al 0.05–0.2% o el digluconato de clorhexidina al 0.02% son menos efectivos.

Como no hay terapias específicas disponibles para el SARS-CoV-2, la contención temprana y la prevención de una mayor propagación serán cruciales para detener el brote en curso y controlar este nueva infección.




April 4, 2020 at 10:34 am

CDC – Coronavirus Disease 2019 (COVID-19)

CDC – Coronavirus Disease 2019 (COVID-19)

El 11/02/2020, la Organización Mundial de la Salud anunció un nombre oficial para la enfermedad que está causando el brote actual de la enfermedad por coronavirus, COVID-19.







About Coronavirus Disease 2019 (COVID-19)

-How COVID-19 Spreads


-CDC Tests for COVID-19

-Laboratory Work

-Prevention & Treatment

-What to Do If You Are Sick With Coronavirus Disease 2019 (COVID-19)

-Frequently Asked Questions and Answers

– What you need to know (Fact Sheet)

-What to do if you are sick (Fact Sheet)

Information for Healthcare Professionals from CDC

Current Interim Guidance (Orientación provisional actual):

-Evaluating and Reporting Persons Under Investigation (PUI)

-Healthcare Infection Control Guidance

-Clinical Care Guidance

-Home Care Guidance

-Guidance for EMS (Emergency Medical Services)

-Healthcare Personnel with Potential Exposure Guidance

Other Resources:

-COVID-19 Publications

-Healthcare Preparedness Tools

-Health Alert Network (HAN): Update and Interim Guidance on Outbreak of Coronavirus Disease 2019

Resources for Healthcare Professionals Caring for COVID-19 Patients:

-What Healthcare Providers Should Know

-Frequently Asked Questions for Healthcare Providers

Clinical Care:

-Clinical Care Guidance

-Disposition of Hospitalized Patients with COVID-2019

Infection Control:

-Infection Control

-Frequently Asked Questions: Healthcare Infection Prevention and Control

Supply of Personal Protective Equipment (Suministro de equipo de protección personal):

-Healthcare Supply of Personal Protective Equipment

-Strategies for Optimizing Supply of N95 Respirators

-FAQ about Respirators

February 19, 2020 at 8:02 am

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