Current opinion in infectious diseases
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Curr. Opin. Infect. Dis. · Aug 2019
ReviewControversy around airborne versus droplet transmission of respiratory viruses: implication for infection prevention.
Health agencies recommend transmission-based precautions, including contact, droplet and airborne precautions, to mitigate transmission of respiratory viruses in healthcare settings. There is particular controversy over the importance of aerosol transmission and whether airborne precautions should be recommended for some respiratory viruses. Here, we review the current recommendations of transmission-based precautions and the latest evidence on the aerosol transmission of respiratory viruses. ⋯ Studies that use transmission events as outcome to demonstrate human-to-human transmission over the aerosol route or quantitative measurement of infectious respiratory viruses in the air are needed to evaluate the infectiousness of respiratory viruses over the aerosol route. When a respiratory virus in concern only leads to disease with low severity, airborne precautions are not likely to be justified.
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Curr. Opin. Infect. Dis. · Aug 2019
New and novel rapid diagnostics that are impacting infection prevention and antimicrobial stewardship.
The current review summarizes advances in rapid diagnostic testing that impacts infection prevention and antimicrobial stewardship programs. ⋯ Tests with broad diagnostic scope and swift turnaround time are rapidly entering the market. Many impact infection prevention and ASP programs. Collaboration with the microbiology laboratory is crucial to ensure that new tests successfully optimize patient care.
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There is convincing evidence linking antibiotic-stewardship efforts which include the infection marker procalcitonin (PCT) to more rational use of antibiotics with improvements in side-effects and clinical outcomes. This is particularly true in the setting of respiratory infection and sepsis. Yet, some recent trials have shown no benefit of PCT-guided care. Our aim was to discuss the benefits and limitations of using PCT for early infection recognition, severity assessment and therapeutic decisions in individual patients based on most the recent study data. ⋯ Inclusion of PCT into antibiotic stewardship algorithms has the potential to improve the diagnostic and therapeutic management of patients presenting with respiratory illnesses and sepsis, and holds great promise to mitigate the global bacterial resistance crisis and move from a default position of standardized care to more personalized treatment decisions.
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We reviewed recent data about epidemiology of Acinetobacter baumannii, resistance mechanisms, and therapeutic options for severe infections caused by multidrug-resistant strains. ⋯ The optimal treatment for multidrug-resistant A. baumannii nosocomial infections has not been established. There are no compelling data to recommend combination therapy for severe A. baumannii infections.
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Curr. Opin. Infect. Dis. · Dec 2018
Review Meta AnalysisTreatment of influenza with neuraminidase inhibitors.
Seasonal and pandemic influenza are major causes of morbidity and mortality globally. Neuraminidase inhibitors (NAIs) are the only class of antiviral agent recommended for the treatment of currently circulating strains of influenza. There has previously been controversy over the level of evidence for patient benefit with NAIs. We review here the current evidence base for the clinical impact of treatment of influenza with NAIs. ⋯ Although there has been controversy over the level of evidence for patient benefit, a growing body of evidence suggests that treatment of influenza with NAIs is associated with improved outcomes for both patients in the community and more severely unwell patients in hospital. Clinical outcomes are optimal with earlier use and strategies to improve early widespread NAI utilization are needed.