Current opinion in infectious diseases
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This review evaluates the potential benefits as well as adverse effects from adjunctive therapy with systemic steroids in patients with pneumonia: either mild-to-moderate or severe, community-acquired or hospital-acquired, of bacterial or of viral origin (in particular H1N1 viral infection). ⋯ According to the current evidence, there are no data to support the well tolerated use of systemic steroids as a standard of care in pneumonia, neither in mild-to-moderate and severe, nor in bacterial and viral infection. Clinical and basic research should work together to improve trial designs to identify reliable surrogate markers of outcome, in particular of mortality. This may improve the patient selection and facilitate the identification of subgroups that can benefit from adjunctive steroid therapy.
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Curr. Opin. Infect. Dis. · Apr 2012
ReviewIs a ventilator-associated pneumonia rate of zero really possible?
The increasing number of hospitals reporting ventilator-associated pneumonia (VAP) rates at or close to zero begs the question of whether zero should become the national benchmark for VAP. This article explores the significance of very low VAP rates, reviews differences in surveillance and clinical rates, proposes reasons for their discrepancies, and suggests possible objective alternatives for surveillance. ⋯ The increasing mismatch between surveillance rates and clinical diagnoses limits the utility of official VAP rates to estimate disease burden and guide quality improvement. Advocates are advised to consider objective alternatives such as average duration of mechanical ventilation, length of stay, mortality, and antibiotic prescribing. Emerging surveillance definitions that use more objective criteria may better reflect and inform future clinical practice.
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Curr. Opin. Infect. Dis. · Aug 2011
ReviewAntimicrobial prophylaxis regimens following transplantation.
Infection remains a major cause of morbidity and mortality following transplantation, and antimicrobial prophylaxis regimens continue to improve. This review summarizes the important studies on prophylaxis following solid organ transplant (SOT) and hematopoietic stem cell transplantation (HSCT) published in the last 18 months. ⋯ In organ transplantation, routine antibacterial, antiviral, and antifungal regimens need to be tailored to address donor-transmitted infections, serological risk status of recipients, and measurable antifungal drug levels. Recent studies indicate that longer duration prophylaxis for CMV may have advantages in high-risk SOT recipients. After HSCT, regimens require adjustment based on immunological risks associated with transplant type and presence of graft vs. host disease.
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Curr. Opin. Infect. Dis. · Aug 2011
ReviewVentilator-associated pneumonia as a model for approaching cost-effectiveness and infection prevention in the ICU.
Nosocomial infection is a major cause of morbidity and mortality. In the ICU, ventilator-associated pneumonia (VAP) represents the most prevalent and visible hospital-acquired infection (HAI). Although some evidence-based strategies reduce the incidence of VAP, despite a recent policy drive toward zero VAP rates, no evidence supports feasibility of VAP eradication. Furthermore, in the era of resource constraints, cost-effectiveness of various strategies is critical to consider. ⋯ Cost-effectiveness of VAP prevention bundles is not known. This is a critical piece of information, particularly as it relates to such important downstream outcomes of VAP prevention as the use of antibiotics and hospital length of stay. Understanding the incremental cost-effectiveness of VAP bundles can help prioritize efforts to minimize the associated morbidity.
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Curr. Opin. Infect. Dis. · Jun 2011
ReviewThe effect of inflammation on coagulation and vice versa.
In infection, inflammation is frequently accompanied by a disturbance of the normal hemostatic balance provided by procoagulant and anticoagulant mechanisms. This review summarizes recently acquired knowledge on the bimodal interactions between coagulation and inflammation in infection. ⋯ Recent data provide new insights into how inflammation impacts on coagulation and vice versa, identifying crucial roles for PARs. This knowledge may assist in designing novel interventions targeted at the perpetuation of inflammation by mediators traditionally implicated in coagulation.