Infectious disease clinics of North America
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Misuse and overuse of antibiotic therapy is a frequent cause of resident harm in nursing facilities. As a result, newly released policy and regulatory initiatives will require antibiotic stewardship programs (ASPs) in nursing facilities. Although implementing ASPs can be challenging, improving the quality of antibiotic prescribing is achievable in this setting. The authors review the determinants of antibiotic prescribing in nursing facilities, strategies to improve antibiotic prescribing in this setting, current status of ASPs in nursing facilities, and steps that facilities can take to enhance existing ASP structure and process.
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Infect. Dis. Clin. North Am. · Dec 2017
ReviewAntimicrobial Pharmacokinetics and Pharmacodynamics in Older Adults.
Antimicrobial use in older adults requires working knowledge of the pharmacokinetics and pharmacodynamics of these drugs, and the alterations known to occur with these models as patients age. A summary of pharmacokinetic principles relevant to antimicrobials and an overview of published medical literature describing pharmacokinetic changes known to correlate with age are presented. ⋯ The understanding of how older adults respond in terms of efficacy and toxicity is increasing but limited. Further research into the effects of aging on the actions of antimicrobials in the elderly is needed.
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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.