The Role of Diagnostic Stewardship in Clostridioides difficile Testing: Challenges and Opportunities
AbstractPurpose of ReviewAccurate and timely diagnosis ofClostridioides difficile infection (CDI) is imperative to preventC. difficile transmission and reduce morbidity and mortality due to CDI, but CDI laboratory diagnostics are complex. The purpose of this article is to review the role of laboratory tests in the diagnosis of CDI and the role of diagnostic stewardship in optimization ofC. difficile testing.Recent FindingsResults fromC. difficile diagnostic tests should be interpreted with an understanding of the strengths and limitations inherent in each testing approach. Use of highly sensitive molecular diagnostic tests...
Source: Current Infectious Disease Reports - February 16, 2020 Category: Infectious Diseases Source Type: research
Carbapenem-Resistant Enterobacterales: Considerations for Treatment in the Era of New Antimicrobials and Evolving Enzymology
AbstractPurpose of ReviewGram-negative resistance is a growing concern globally. Enterobacterales, formerlyEnterobacteriaceae, have developed resistance mechanisms to carbapenems that leave very few antimicrobial options in the clinician ’s armamentarium.Recent FindingsNew antimicrobials like ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, cefiderocol, and plazomicin have the potential to overcome resistance mechanisms in Enterobacterales including different classes of carbapenemases.SummaryNovel β-lactam/β-lactamase inhibitors, plazomicin, and cefiderocol give the clinician options that were once no...
Source: Current Infectious Disease Reports - February 6, 2020 Category: Infectious Diseases Source Type: research
Appropriate Use and Future Directions of Molecular Diagnostic Testing
AbstractPurpose of ReviewMajor technologic advances in two main areas of molecular infectious disease diagnostics have resulted in accelerated adoption or ordering, outpacing implementation, and clinical utility studies. Physicians must understand the limitations to and appropriate utilization of these technologies in order to provide cost-effective and well-informed care for their patients.Recent FindingsRapid molecular testing and, to a lesser degree, clinical metagenomics are now being routinely used in clinical practice. While these tests allow for a breadth of interrogation not possible with conventional microbiology,...
Source: Current Infectious Disease Reports - February 5, 2020 Category: Infectious Diseases Source Type: research
Acute Infectious Diarrhea and Gastroenteritis in Children
AbstractPurpose of ReviewWe aimed to summarize the most current evidence on the main aspects of the diarrheal diseases in children. The following key elements were addressed: definitions, etiology, pathogenesis, diagnosis, dietary management, pharmacological treatments, and prevention. We covered the following questions: What are the most important clinical and laboratory features of the disease? What are the best approaches for the dietary management? What is the best way to classify the hydration status, and to prevent and treat the dehydration? What are the most effective and safe interventions for reducing the diarrhea...
Source: Current Infectious Disease Reports - January 27, 2020 Category: Infectious Diseases Source Type: research
Respiratory Virus Co-infection in Acute Respiratory Infections in Children
AbstractPurpose of ReviewThis investigation aims to understand the role and burden of viral co-infections for acute respiratory illnesses in children. Co-infection can be either viral-viral or viral-bacterial and with new technology there is more information on the role they play on the health of children.Recent FindingsWith the proliferation of multiplex PCR for rapid diagnosis of multiple viruses as well as innovations on identification of bacterial infections, research has been attempting to discover how these co-infections affect each other and the host. Studies are aiming to discern if the epidemiology of viruses seen...
Source: Current Infectious Disease Reports - January 23, 2020 Category: Infectious Diseases Source Type: research
Fluconazole Prophylaxis in Prevention of Symptomatic Candida Vaginitis
AbstractDue to broad spectrum susceptibility ofCandida species to fluconazole, its convenience as an oral agent, and predictable patient tolerance and safety, current practice guidelines recommend the use of long-term suppression regimens of fluconazole as prophylaxis for recurrent vulvovaginal candidiasis (RVVC), as well as in abbreviated doses when known trigger factors emerge and inevitable symptomatic episodes are predictable. However, recent concerns of fluconazole-resistantCandida albicans strains may impact fluconazole use, particularly, concerns of overuse. This literature review discusses current recommendations f...
Source: Current Infectious Disease Reports - January 20, 2020 Category: Infectious Diseases Source Type: research
The Battle Is on: New Beta-Lactams for the Treatment of Multidrug-Resistant Gram-Negative Organisms
AbstractPurpose of ReviewResistant gram-negative infections are becoming increasingly difficult to treat, prompting increased focus on drug development. This review will focus primarily on the new beta-lactam agents developed in the past 5 years that target multidrug-resistant (MDR) gram-negative organisms, including those producing carbapenemases.Recent FindingsFour new agents including ceftazidime-avibactam (CAZ-AVI), meropenem-vaborbactam (MER-VAB), imipenem-relebactam (IMI-REL), and cefiderocol have recently been approved for the treatment of resistant gram-negative infections. CAZ-AVI remains an option forblaOXA-48 ...
Source: Current Infectious Disease Reports - January 12, 2020 Category: Infectious Diseases Source Type: research
Molecular Diagnostic Advances in Transplant Infectious Diseases
AbstractPurpose of ReviewThe infectious complications of transplantation can have devastating consequences for patients. Early and accurate diagnosis is essential to good outcomes. This review describes recent advances in pathogen-directed diagnostic testing and discusses the role of new methods for transplant infectious diseases.Recent FindingsSeveral molecular assays have been introduced into clinical practice in recent years. When the results of rapid testing are linked to patient-specific interventions, improved outcomes can be realized. Syndromic testing along with metagenomic next-generation sequencing (mNGS) represe...
Source: Current Infectious Disease Reports - November 25, 2019 Category: Infectious Diseases Source Type: research
Diagnosis and Treatment of Acute Invasive Fungal Sinusitis in Cancer and Transplant Patients
AbstractPurpose of ReviewModern advances in oncologic and end-organ therapies have led to an increase in immunocompromised patients and a corresponding rise in acute invasive fungal sinusitis (AIFS). Here, we present a comprehensive medical and surgical approach to the diagnosis and management of immunocompromised cancer and transplant patients with AIFS.Recent FindingsAspergillus andMucorales are the most common fungi to cause AIFS, though atypical fungal pathogens have been implicated particularly among patients on azole prophylaxis. Symptoms present in the majority of AIFS cases include fever, nasal congestion, and faci...
Source: Current Infectious Disease Reports - November 25, 2019 Category: Infectious Diseases Source Type: research
The Role of Emerging and Neglected Viruses in the Etiology of Hepatitis
AbstractPurpose of ReviewIn this review, we present the overview of emerging and neglected viruses associated with liver involvement.Recent FindingsHepatitis E virus (HEV) emerged in the last two decades, causing hepatitis in many parts of the world. Moreover, liver involvement was also described in some emerging arboviral infections. Many reports showed dengue-associated liver injury; however, chikungunya, West Nile, tick-borne encephalitis, and Zika virus are rarely associated with clinically manifest liver disease. In addition, some neglected highly prevalent viruses such as adenoviruses and parvovirus B19 are capable o...
Source: Current Infectious Disease Reports - November 20, 2019 Category: Infectious Diseases Source Type: research
Ventilator-Associated Pneumonia: Diagnostic Test Stewardship and Relevance of Culturing Practices
AbstractPurpose of ReviewVentilator-associated pneumonia (VAP) is one of the most common infections in the ICU. Prompt diagnosis is vital as mortality increases with delayed antibiotic therapy. However, accurate diagnosis is challenging due to non-specific clinical features in a complicated patient cohort. Microbiological culture data remains a crucial aspect in confirming diagnosis.Recent FindingsLiterature data comparing the benefit of invasive respiratory sampling to non-invasive is inconclusive. Differences in culturing practices translate in overidentification of organisms of unclear significance. Positive culture dat...
Source: Current Infectious Disease Reports - November 20, 2019 Category: Infectious Diseases Source Type: research
Multidrug Resistant Acinetobacter baumannii : Resistance by Any Other Name Would Still be Hard to Treat
AbstractPurpose of ReviewAcinetobacter baumannii (AB) is an infamous nosocomial pathogen with a seemingly limitless capacity for antimicrobial resistance, leading to few treatment options and poor clinical outcomes. The debatably low pathogenicity and virulence of AB are juxtaposed by its exceptionally high rate of infection-related mortality, likely due to delays in time to effective antimicrobial therapy secondary to its predilection for resistance to first-line agents. Recent studies of AB and its infections have led to a burgeoning understanding of this critical microbial threat and provided clinicians with new ammunit...
Source: Current Infectious Disease Reports - November 15, 2019 Category: Infectious Diseases Source Type: research
Tissue Parasites in HIV Infection
AbstractPurpose of ReviewThe purpose of this review is to discuss the current knowledge of HIV and tissue parasite co-infection in the context of transmission enhancement, clinical characteristics, treatment, relapse, and clinical outcomes.Recent FindingsThe pathophysiology and clinical sequelae of tissue parasites in people living with HIV (PLWH) have been well described for only a handful of organisms, primarily protozoa such as malaria and leishmaniasis. Available published data indicate that the interactions between HIV and tissue parasites are highly variable depending on the infecting organism and the degree of host ...
Source: Current Infectious Disease Reports - November 15, 2019 Category: Infectious Diseases Source Type: research
Migration Health: Highlights from Inaugural International Society of Travel Medicine (ISTM) Conference on Migration Health
AbstractPurpose of ReviewInternational migration is a global phenomenon that is growing in scope, complexity and impact. The inaugural International Society of Travel Medicine (ISTM) International Conference on Migration Health provided a forum to discuss scientific evidence on the broad issues relevant to migration health. This review summarises the key health issues, with a focus on infectious diseases, current effective strategies and future considerations presented at this forum and in the recent literature.Recent FindingsMigrants face health disparities for both communicable and non-communicable diseases. Their height...
Source: Current Infectious Disease Reports - November 15, 2019 Category: Infectious Diseases Source Type: research
Antifungal Resistance: a Concerning Trend for the Present and Future
AbstractPurpose of ReviewThe global emergence of antifungal resistance amongCandida spp. andAspergillus spp. is a growing threat to public health, driven largely by the expanding use of antifungals in both the clinical and agricultural settings. As treatment options remain limited, understanding mechanisms and risk factors for antifungal resistance is essential to retaining their clinical utility.Recent FindingsInvasive candidiasis is increasingly caused by non-albicans Candida species with reduced susceptibility to first-line antifungals, making empiric treatment decisions difficult. Echinocandin resistance inC. glabrata ...
Source: Current Infectious Disease Reports - November 15, 2019 Category: Infectious Diseases Source Type: research
