Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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Clostridium difficile infection (CDI) is a major cause of hospital-acquired diarrhea and is most commonly associated with changes in normal intestinal flora caused by administration of antibiotics. Few studies have examined the risk of CDI associated with total dose, duration, or number of antibiotics while taking into account the complex changes in exposures over time. ⋯ Cumulative antibiotic exposures appear to be associated with the risk of CDI. Antimicrobial stewardship programs that focus on the overall reduction of total dose as well as number and days of antibiotic exposure and the substitution of high-risk antibiotic classes for lower-risk alternatives may reduce the incidence of hospital-acquired CDI.
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The clinical importance of low-level mupirocin resistance and genotypic chlorhexidine resistance remains unclear. We aimed to determine whether resistance to these agents increases the risk of persistent methicillin-resistant Staphylococcus aureus (MRSA) carriage after their use for topical decolonization therapy. ⋯ Combined low-level mupirocin and genotypic chlorhexidine resistance significantly increases the risk of persistent MRSA carriage after decolonization therapy. Institutions with widespread use of these agents should monitor for resistance and loss of clinical effectiveness.
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The accepted approach to surveillance for hospital-acquired bloodstream infection (HABSI) due to central venous catheters requires use of the National Health and Safety Network (NHSN) definition for catheter-associated bloodstream infection (CLABSI). In this commentary, we discuss our experience with the application of current NHSN surveillance definitions for CLABSI and the impact that public reporting of CLABSI rates in settings with a high prevalence of special populations has on infection prevention (IP) programs. ⋯ Current NHSN CLABSI definitions lack specificity for complex and heterogeneous patient populations and require modification. Beyond definitions, IP programs must critically assess the value of their current approach to surveillance to assure that patient-centered outcomes are the focus of prevention efforts.
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Over the past decade, the United States has witnessed an epidemic of acute bacterial skin and skin-structure infections (ABSSSIs) caused primarily by community-acquired methicillin-resistant Staphylococcus aureus. To address this medical need as well as the ongoing threat of increasing resistance, new antibiotics are being developed. Clinical trials involving patients with complicated ABSSSI are being implemented to understand the efficacy and safety of these new antibiotic agents. ⋯ Next, we address the ongoing discussion of the new 2010 guidance as we understand it, along with its perceived strengths and weaknesses. Throughout this process, we wish to emphasize that the continued development of antibiotics is essential. Thus, we hope that as the FDA and FNIH move forward they will strike a balance between "The Perfect" statistical solution and "The Good" practical clinical realities.