Expert review of anti-infective therapy
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Expert Rev Anti Infect Ther · Jul 2019
Emerging strategies for the noninvasive diagnosis of nosocomial pneumonia.
Introduction: Hospital-acquired pneumonia is a common and therapeutically challenging diagnosis that can lead to severe sepsis, critical illness, and respiratory failure. In this review, we focus on efforts to enhance microbiological diagnosis of hospital-acquired pneumonia, including ventilator-associated pneumonia. Areas covered: A systematic literature review was conducted by searching Medline from inception to December 2018, including hand-searching of the reference lists for additional studies. ⋯ Expert opinion: In recent years, the microbiological diagnosis of respiratory pathogens has improved significantly by the development and implementation of molecular diagnostic tests for pneumonia. Real-time polymerase chain reaction, hybridization, and mass spectrometry-based platforms dominate the scene, with microarray-based assays, multiplex polymerase chain reaction, and MALDI-TOF mass spectrometry capable of detecting the determinants of antimicrobial resistance (mainly β-lactamase genes). Introducing these assays into routine clinical practice for rapid identification of the causative microbes and their resistance patterns could transform the care of pneumonia, improving antimicrobial selection, de-escalation, and stewardship.
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Expert Rev Anti Infect Ther · Apr 2019
Detection and treatment of Candida auris in an outbreak situation: risk factors for developing colonization and candidemia by this new species in critically ill patients.
Candida auris is an emerging, multidrug-resistant yeast causing hospital outbreaks. This study describes the first 24 months of the ongoing C. auris outbreak in our hospital and analyzes predisposing factors to C. auris candidemia/colonization. ⋯ Predictor conditions to C. auris colonization/candidemia are similar to other Candida species. C. auris colonizes multiple patient's environment surfaces. All isolates are resistant to fluconazole and had significant reduced susceptibility to voriconazole.
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Sepsis, defined as infection plus some degree of organ dysfunction, is still associated with high mortality and morbidity rates. Management focuses on three key areas: infection control, hemodynamic stabilization and organ support, and modulation of the sepsis response. Areas covered: This review will not cover infection control. ⋯ Some of the immunomodulatory agents currently in development are briefly discussed. Expert opinion: Management of the patient with sepsis remains a challenge and needs to be personalized. The search for new immunomodulatory drugs continues and will be facilitated by better characterization of patients using modern 'omics' technology and complex analysis of the large quantities of clinical data increasingly available.
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Expert Rev Anti Infect Ther · Feb 2019
ReviewAntibiotic stewardship in sepsis management: toward a balanced use of antibiotics for the severely ill patient.
Severe infections in critically ill patients carry a high morbidity and mortality rate. Given the impact of early and broad-spectrum empirical therapy in several studies and the emphasis on this in international guidelines, there is a low threshold for initiating antibiotics in many patients with suspected infection. This has led to the widespread use of antibiotics in critically ill patients, which is often unnecessary or inappropriate. ⋯ Watchful waiting, or withholding antibiotics until infection is confirmed, is justified in non-severely ill patients in whom the clinical picture is not clear. Expert opinion: Integrating AMS strategies in clinical practice can help upholding the best antibiotic empirical therapy while reducing antibiotic consumption. AMS is a multidisciplinary policy and should be embraced by critical care physicians as a solution for balanced antibiotic use.