Posts filed under ‘Update’

The Role of Trimethoprim/Sulfamethoxazole in the Treatment of Infections Caused by Carbapenem-Resistant Enterobacteriaceae

OPEN FORUM INFECTIOUS DISEASES January 2019 V.6 N.1

Courtney L Luterbach; Ashley Boshe; Heather I Henderson; Eric Cober; Sandra S Richter

In the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE), trimethoprim-sulfamethoxazole (TMP-SMX) had a limited role in the treatment of less severe carbapenem-resistant Enterobacteriaceae (CRE) infections, especially urinary tract infections. Of tested CRE, only 29% were susceptible to TMP-SMX. Development of resistance further limits the use of TMP-SMX in CRE infections.

FULL TEXT

https://academic.oup.com/ofid/article/6/1/ofy351/5250079

PDF (CLIC en PDF)

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January 20, 2019 at 12:18 pm

Toxoplasmosis: The Heart of the Diagnosis

OPEN FORUM INFECTIOUS DISEASES January 2019 V.6 N.1

James H England; Samuel S Bailin; Jeffrey R Gehlhausen; Donald H Rubin

Toxoplasma gondii is a common parasite that infects warm-blooded animals, including humans, and is a foodborne pathogen. We report a case of acute toxoplasmosis in a 76-year-old man after ingestion of the undercooked heart of a white-tailed deer (Odocoileus virginianus) in Tennessee. The patient’s adult grandson, who also consumed part of the heart, became ill with nearly identical symptoms, though he did not seek medical care. This case highlights important public health concerns about deer-to-human transmission of Toxoplasma.

FULL TEXT

https://academic.oup.com/ofid/article/6/1/ofy338/5250666

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January 20, 2019 at 12:17 pm

Human Immunodeficiency Virus Drug Resistance: 2018 Recommendations of the International Antiviral Society–USA Panel

Clinical Infectious Diseases January 15, 2019 V.68 N.2 P.177–187

Huldrych F Günthard; Vincent Calvez; Roger Paredes; Deenan Pillay; Robert W Shafer …

Background

Contemporary antiretroviral therapies (ART) and management strategies have diminished both human immunodeficiency virus (HIV) treatment failure and the acquired resistance to drugs in resource-rich regions, but transmission of drug-resistant viruses has not similarly decreased. In low- and middle-income regions, ART roll-out has improved outcomes, but has resulted in increasing acquired and transmitted resistances. Our objective was to review resistance to ART drugs and methods to detect it, and to provide updated recommendations for testing and monitoring for drug resistance in HIV-infected individuals.

Methods

A volunteer panel of experts appointed by the International Antiviral (formerly AIDS) Society–USA reviewed relevant peer-reviewed data that were published or presented at scientific conferences. Recommendations were rated according to the strength of the recommendation and quality of the evidence, and reached by full panel consensus.

Results

Resistance testing remains a cornerstone of ART. It is recommended in newly-diagnosed individuals and in patients in whom ART has failed. Testing for transmitted integrase strand-transfer inhibitor resistance is currently not recommended, but this may change as more resistance emerges with widespread use. Sanger-based and next-generation sequencing approaches are each suited for genotypic testing. Testing for minority variants harboring drug resistance may only be considered if treatments depend on a first-generation nonnucleoside analogue reverse transcriptase inhibitor. Different HIV-1 subtypes do not need special considerations regarding resistance testing.

Conclusions

Testing for HIV drug resistance in drug-naive individuals and in patients in whom antiretroviral drugs are failing, and the appreciation of the role of testing, are crucial to the prevention and management of failure of ART.

FULL TEXT

https://academic.oup.com/cid/article/68/2/177/5055715

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January 20, 2019 at 11:08 am

The prevention of Prosthetic Joint Infection (PJI)- 12 modifiable risk factors

The Bone & Joint Journal January 2019 V.101-B N.1 Suppl.A P.3-9

K. Alamanda, B. D. Springer

Aims

Prosthetic joint infection (PJI) remains a serious complication that is associated with high morbidity and costs. The aim of this study was to prepare a systematic review to examine patient-related and perioperative risk factors that can be modified in an attempt to reduce the rate of PJI.

Materials and Methods

A search of PubMed and MEDLINE was conducted for articles published between January 1990 and February 2018 with a combination of search terms to identify studies that dealt with modifiable risk factors for reducing the rate of PJI. An evidence-based review was performed on 12 specific risk factors: glycaemic control, obesity, malnutrition, smoking, vitamin D levels, preoperative Staphylococcus aureus screening, the management of anti-rheumatic medication, perioperative antibiotic prophylaxis, presurgical skin preparation, the operating room environment, irrigant options, and anticoagulation.

Results

Poor glycaemic control, obesity, malnutrition, and smoking are all associated with increased rates of PJI. Vitamin D replacement has been shown in preliminary animal studies to decrease rates of PJI. Preoperative Staphylococcus aureus screening and appropriate treatment results in decreased rates of PJI. Perioperative variables, such as timely and appropriate dosage of prophylactic antibiotics, skin preparation with chlorohexidine-based solution, and irrigation with dilute betadine at the conclusion of the operation, have all been associated with reduced rates of PJI. Similarly, aggressive anticoagulation and increased operating room traffic should be avoided to help minimize risk of PJI.

Conclusion

PJI remains a serious complication of arthroplasty. Surgeons should be vigilant of the modifiable risk factors that can be addressed in an attempt to reduce the risk of PJI.

FULL TEXT

https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.101B1.BJJ-2018-0233.R1

PDF

https://online.boneandjoint.org.uk/doi/pdf/10.1302/0301-620X.101B1.BJJ-2018-0233.R1

 

January 20, 2019 at 11:06 am

Osteomyelitis Complicating Sacral Pressure Ulcers: Whether or Not to Treat With Antibiotic Therapy

Clinical Infectious Diseases January 15, 2019 V.68 N.2 P.338–342

EDITOR’S CHOICE

Darren Wong; Paul Holtom; Brad Spellberg

The treatment of osteomyelitis in patients with stage IV sacral pressure ulcers is controversial. We conducted a systematic literature review and did not find evidence of benefit of antibacterial therapy in this setting without concomitant surgical debridement and wound coverage. Furthermore, many patients with chronically exposed bone do not have evidence of osteomyelitis when biopsied, and magnetic resonance imaging may not accurately distinguish osteomyelitis from bone remodeling. The goal of therapy should be local wound care and assessment for the potential of wound closure. If the wound can be closed and osteomyelitis is present on bone biopsy, appropriate antibiotic therapy is reasonable. We find no data to support antibiotic durations of >6 weeks in this setting, and some authors recommend 2 weeks of therapy if the osteomyelitis is limited to cortical bone. If the wound will not be closed, we find no clear evidence supporting a role for antibiotic therapy.

FULL TEXT

https://academic.oup.com/cid/article/68/2/338/5050260

PDF (CLIC en PDF)

January 20, 2019 at 11:03 am

Hantavirus Cardiopulmonary Syndrome Due to Imported Andes Hantavirus Infection in Switzerland: A Multidisciplinary Challenge, Two Cases and a Literature Review.

Clin Infect Dis. November 13, 2018 V.67 N.11 P.1788-1795.

Kuenzli AB1, Marschall J1, Schefold JC1, Schafer M1, Engler OB2, Ackermann-Gäumann R2, Reineke DC1, Suter-Riniker F3, Staehelin C1.

Author information

1 Bern University Hospital and University of Bern, Switzerland.

2 Spiez Laboratory, Federal Office for Civil Protection, Switzerland.

3 Institute for Infectious Diseases, University of Bern, Switzerland.

Abstract

Two travellers returning from South America were diagnosed with Andes hantavirus infection, the only member of the Hantaviridae family known to be transmitted from person to person.

We describe the clinical course and therapeutic and infection control measures.

While both patients showed high viral load (VL) and shedding over several months, 1 patient recovered within 1 week from severe respiratory illness that required noninvasive ventilation, whereas the second patient developed severe hantavirus cardiopulmonary syndrome that required extracorporeal membrane oxygenation for 27 days.

The clinical course in the latter patient was complicated by severe disseminated intravascular coagulopathy with diffuse hemorrhage that necessitated mass transfusions, as well as by multiple organ failure, including the need for renal replacement therapy.

Results of VL in blood, respiratory secretions, and semen for the first 9 months of follow-up are reported. To our knowledge, these are the first cases of Andes hantavirus infection detected in Europe.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233683/pdf/ciy443.pdf

January 19, 2019 at 11:17 am

Incubation period of hantavirus cardiopulmonary syndrome.

Emerg Infect Dis. August 2006 V.12 N.8 P.1271-3.

Vial PA1, Valdivieso F, Mertz G, Castillo C, Belmar E, Delgado I, Tapia M, Ferrés M.

Author information

1 Faculdad se Medicina Clinica Alemana, Universidad del Desarrollo, Las Condes 12438, Lo Barnechea, Santiago 0000, Chile. pvial@udd.cl

Abstract

The potential incubation period from exposure to onset of symptoms was 7-39 days (median 18 days) in 20 patients with a defined period of exposure to Andes virus in a high-risk area.

This period was 14-32 days (median 18 days) in 11 patients with exposure for <48 hours.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291207/pdf/05-1127.pdf

January 19, 2019 at 11:15 am

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