Current opinion in infectious diseases
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This review summarizes the recent advances in vaccination against Salmonella enterica serovar Typhi and highlights the data supporting the development of next generation vaccines to address paratyphoid fever and invasive nontyphoidal Salmonella (iNTS) disease. ⋯ Current typhoid vaccines, although moderately effective for short periods of time, cannot be used in all age groups and only target one of the clinically relevant Salmonella serovars. Greater effort must be placed on the development and implementation of improved vaccines for the disease burden resulting from Typhi, Paratyphi A or iNTS infections.
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Given that ventilator-associated pneumonia (VAP) causes substantial morbidity, mortality and costs, prevention of this infectious process is a major challenge. ⋯ Several preventive measures have been shown to reduce the rate of VAP but many less have demonstrated an impact on patient outcomes (noninvasive positive pressure ventilation, sedation and weaning protocols, selective digestive and oral decontamination and endotracheal tube with drainage of subglottic secretions). Patients at risk must be approached with a bundle of preventive measures. Beyond the theoretical frame, a great deal of attention must be given to the factors that might improve adherence to those preventive measures. Future clinical trials testing new strategies in preventing VAP should have patient outcomes (i.e. a reduction in the length under mechanical ventilation, in the duration of stay in healthcare settings or in antibiotic consumption) as primary end-points rather than VAP rates.
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Catheter-associated urinary tract infection (CAUTI) is the commonest nosocomial infection worldwide. Here we review the recent advances in the prevention of CAUTI. ⋯ Numerous strategies have been developed to reduce the incidence of CAUTI but few have proven effective. Reducing the inappropriate use of catheters and development of novel technologies targeted against these increasingly multidrug-resistant pathogens may be useful in the prevention of CAUTI in our vulnerable patients.
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Sepsis is an inflammatory condition associated with significant morbidity and mortality. Given the lack of specific therapies for the condition, prevention has garnered significant interest and increased importance. The article reviews the current literature regarding the use of aspirin and statins for the prevention of sepsis. ⋯ Sepsis is a deadly and costly condition with no available, specific treatment options. The statins and aspirin are well tolerated and widely used for prevention of cardiovascular disease. Because of their effects on the immune system and inflammatory pathways, they may present viable medical options for the prevention of sepsis.
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Curr. Opin. Infect. Dis. · Apr 2012
ReviewFor whom should we use selective decontamination of the digestive tract?
This review discusses the relevant studies on selective decontamination of the digestive tract (SDD) published between 2009 and mid-2011. ⋯ Recent studies show that in ICUs with low levels of antibiotic resistance, SDD and SOD improved patient outcome and reduced infections and carriage with antibiotic-resistant pathogens. The effect in settings with higher levels of antibiotic resistance remains to be determined as well as the efficacy of SDD and SOD in specific patient groups.