Infectious disease clinics of North America
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Infect. Dis. Clin. North Am. · Sep 2017
ReviewInhaled Antibiotics for Ventilator-Associated Infections.
Multidrug-resistant organisms are creating a challenge for physicians treating the critically ill. As new antibiotics lag behind the emergence of worsening resistance, intensivists in countries with high rates of extensively drug-resistant bacteria are turning to inhaled antibiotics as adjunctive therapy. ⋯ This article summarizes current evidence describing the use of inhaled antibiotics for the treatment of bacterial ventilator-associated pneumonia and ventilator-associated tracheobronchitis. Preliminary data suggest aerosolized antimicrobials may effectively treat resistant pathogens with high minimum inhibitory concentrations.
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Infect. Dis. Clin. North Am. · Sep 2017
ReviewNew Sepsis and Septic Shock Definitions: Clinical Implications and Controversies.
New sepsis definitions shift emphasis from the systemic inflammatory response syndrome to organ dysfunction, quantified using the Sequential Organ Failure Assessment (SOFA) score. The new definitions also propose Quick SOFA criteria to rapidly identify potentially infected patients at risk for poor outcomes. ⋯ However, their utility in identifying patients with serious infections before frank sepsis ensues remains to be seen. This article reviews challenges in defining sepsis, strengths and weaknesses of the new definitions, and unresolved issues.
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Infect. Dis. Clin. North Am. · Sep 2017
Review Case ReportsAntimicrobial Stewardship Approaches in the Intensive Care Unit.
Antimicrobial stewardship programs aim to monitor, improve, and measure responsible antibiotic use. The intensive care unit (ICU), with its critically ill patients and prevalence of multiple drug-resistant pathogens, presents unique challenges. ⋯ There is good evidence that antimicrobial stewardship results in more appropriate antimicrobial use, shorter therapy durations, and lower resistance rates. Data demonstrating hard clinical outcomes, such as adverse events and mortality, are more limited but encouraging; further studies are needed.
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Infect. Dis. Clin. North Am. · Sep 2017
ReviewEvaluation and Management of Necrotizing Soft Tissue Infections.
Despite advances in antibiotic and surgical management and supportive care for necrotizing soft tissue infections, morbidity and mortality remain substantial. Although there are clinical practice guidelines in place, there still remains much variability in choice and duration of antibiotic therapy, time to initial surgical debridement, and use of adjuvant medical therapies. This article offers an overview of necrotizing soft tissue infections with a focus on current diagnostic and treatment modalities.