Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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Verifying immunization status and updating vaccinations are important steps in the evaluation of patients who are solid-organ transplant candidates because the potential benefits of vaccination outweigh the risk of adverse events. Because patients with end-organ disease, such as end-stage renal disease and cirrhosis, have reduced immune responses to many vaccines, vaccination should be performed as early as possible during the course of these diseases. Furthermore, it is particularly important for live vaccines to be updated during the pretransplant assessment because such vaccines are contraindicated once a patient is maintained on immunosuppression. Current information on vaccination for adult solid-organ transplant candidates is reviewed.
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Various agents have been applied topically to treat infected wounds for millennia, but their proper role remains unclear. Topical therapy affords many potential advantages but also has disadvantages. Opinions differ on which clinical signs define wound infection and on whether quantitative microbiological studies are useful. ⋯ Meta-analyses and systematic reviews suggest there are few proven indications for topical antimicrobials. Use of a newer, relatively nontoxic antiseptic (eg, cadexomer iodine or silver dressings) is preferable to use of topical antibiotics, especially agents that are available for systemic use. We provide clinically relevant information on currently available topical antimicrobial agents.