What is new with hand hygiene?
Purpose of review Healthcare-associated infections (HAIs) challenge healthcare systems worldwide. As healthcare workers’ hands are considered the main vector for transmission of pathogens, effective hand hygiene is the single most important action to prevent HAIs. We sought to highlight new developments and advances in hand hygiene. Recent findings Hand hygiene compliance averages at 38%. A sustained increase of compliance with a subsequent decrease of HAIs may be achieved by national, systematic and rigorous education, and auditing programs. Periodically deployed self-operating hand hygiene surveillance systems...
Source: Current Opinion in Infectious Diseases - July 30, 2020 Category: Infectious Diseases Tags: NOSOCOMIAL AND HEALTHCARE RELATED INFECTIONS: Edited by Trish M. Perl Source Type: research

Healthcare associated diarrhea, not Clostridioides difficile
Purpose of review The aim of this article is to review the epidemiology, cause, diagnostic evaluation, and management of healthcare-associated diarrhea (HCAD) with particular attention to current epidemiology and recent developments in diagnostics. Recent findings Multiplex polymerase chain reaction gastrointestinal panels allow rapid detection of a wide array of potential enteropathogens but the role, yield, and utility of these tests have not been systematically assessed in patients with HCAD. Recent epidemiologic studies reaffirm that HCAD is predominantly a noninfectious condition most often caused by medications ...
Source: Current Opinion in Infectious Diseases - July 30, 2020 Category: Infectious Diseases Tags: NOSOCOMIAL AND HEALTHCARE RELATED INFECTIONS: Edited by Trish M. Perl Source Type: research

Beyond personal protective equipment: adjunctive methods for control of healthcare-associated respiratory viral infections
Purpose of review Prevention of nosocomial transmission of respiratory viruses is a priority in all healthcare settings and often achieved with the use of personal protective equipment. Several adjunctive infection prevention methods are in common use but their effectiveness in reducing healthcare-associated respiratory viral infections is unclear. In this review, recent advances regarding the effectiveness of several adjunctive infection prevention methods to reduce healthcare-associated respiratory viral infections are discussed. Recent findings Training and education on hand hygiene guidelines, mandatory influenza ...
Source: Current Opinion in Infectious Diseases - July 30, 2020 Category: Infectious Diseases Tags: NOSOCOMIAL AND HEALTHCARE RELATED INFECTIONS: Edited by Trish M. Perl Source Type: research

Laboratory-developed test regulation and the immunocompromised patient: uncertainty ahead
Purpose of the review Laboratory-developed tests (LDTs) are essential for the clinical care of immunocompromised individuals. These patients often require specialized testing not available from commercial manufacturers and are therefore dependent on the laboratory to create, validate, and perform these assays. Recent paradigm-shifting legislation could alter the way that LDTs are operationalized and regulated. Recent findings On March 5th, 2020 the Verifying Accurate and Leading-Edge In-Vitro Clinical Tests Development Act (VALID) was introduced in the US Congress. This statute would overhaul existing regulatory frame...
Source: Current Opinion in Infectious Diseases - July 30, 2020 Category: Infectious Diseases Tags: INFECTIONS OF THE IMMUNOCOMPROMISED HOST: Edited by Barbara D. Alexander and Rachel A. Miller Source Type: research

Bacteriophage therapy as a treatment option for transplant infections
Purpose of review Since initial description of the successful use of intravenous bacteriophage therapy in the United States in 2017, there is widespread interest in using bacteriophage therapy for multidrug-resistant (MDR) infections. Recent findings Recent published cases of bacteriophage therapy in transplant candidates and recipients are reviewed highlighting its safety and potential efficacy when used as an adjunct to systemic antibiotics for a variety of clinical indications. An overview of access to bacteriophage therapy in the United States is also provided. Summary The reviewed cases form the basis for ongo...
Source: Current Opinion in Infectious Diseases - July 30, 2020 Category: Infectious Diseases Tags: INFECTIONS OF THE IMMUNOCOMPROMISED HOST: Edited by Barbara D. Alexander and Rachel A. Miller Source Type: research

Aspergillus fumigatus and pan-azole resistance: who should be concerned?
Purpose of review Although clinical outcomes in the treatment of aspergillosis have markedly improved with the availability of newer triazoles, the development of resistance to these antifungals, especially in Aspergillus fumigatus, is a growing concern. The purpose of this review is to provide an update on azole resistance mechanisms and their epidemiology in A. fumigatus, the clinical implications of azole resistance, and to discuss future treatment options against azole-resistant aspergillosis. Recent findings Resistance may develop through either patient or environmental azole exposure. Environmental exposure is t...
Source: Current Opinion in Infectious Diseases - July 30, 2020 Category: Infectious Diseases Tags: INFECTIONS OF THE IMMUNOCOMPROMISED HOST: Edited by Barbara D. Alexander and Rachel A. Miller Source Type: research

Infections associated with the new ‘nibs and mabs’ and cellular therapies
Purpose of review In recent years, we have witnessed a remarkable surge in the clinical development of effective biological and cellular therapies for the treatment of neoplastic and autoimmune disorders. The present review summarizes our understanding of the pathogen-specific infection risk associated with the use of such therapies. Recent findings A variety of biologics, in the form of either monoclonal antibodies (Mabs) or small molecule kinase inhibitors (Nibs), are continuously introduced in the clinic for the management of autoimmune and malignant diseases. In addition, cellular therapies such as the infusion of...
Source: Current Opinion in Infectious Diseases - July 30, 2020 Category: Infectious Diseases Tags: INFECTIONS OF THE IMMUNOCOMPROMISED HOST: Edited by Barbara D. Alexander and Rachel A. Miller Source Type: research

Editorial: Infections of the immunocompromised host: a musing on the changing times
No abstract available (Source: Current Opinion in Infectious Diseases)
Source: Current Opinion in Infectious Diseases - July 30, 2020 Category: Infectious Diseases Tags: INFECTIONS OF THE IMMUNOCOMPROMISED HOST: Edited by Barbara D. Alexander and Rachel A. Miller Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Infectious Diseases)
Source: Current Opinion in Infectious Diseases - July 30, 2020 Category: Infectious Diseases Tags: EDITORIAL INTRODUCTIONS Source Type: research

Central nervous system infections produced by varicella zoster virus
Purpose of review Varicella zoster virus (VZV) causes varicella, establishes latency, then reactivates to produce herpes zoster. VZV reactivation can also cause central nervous system (CNS) disease with or without rash. Herein, we review these CNS diseases, pathogenesis, diagnosis, and treatment. Recent findings The most common CNS manifestation of VZV infection is vasculopathy that presents as headache, cognitive decline, and/or focal neurological deficits. VZV vasculopathy has also been associated with cerebral amyloid angiopathy and moyamoya syndrome. Rarely, VZV will produce a meningitis, encephalitis, cerebelliti...
Source: Current Opinion in Infectious Diseases - May 1, 2020 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

CNS infections in HIV
Purpose of review Central nervous system (CNS) infections associated with HIV remain significant contributors to morbidity and mortality, particularly among people living with HIV (PLWH) in resource-limited settings worldwide. In this review, we discuss several recent important scientific discoveries in the prevention, diagnosis, and management around two of the major causes of CNS opportunistic infections-tuberculous meningitis (TBM) and cryptococcal meningitis including immune reconstitution syndrome (IRIS) associated with cryptococcal meningitis. We also discuss the CNS as a possible viral reservoir, highlighting Cere...
Source: Current Opinion in Infectious Diseases - May 1, 2020 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Tuberculous meningitis: where to from here?
Purpose of review Tuberculous meningitis (TBM) is associated with significant mortality and morbidity yet is difficult to diagnose and treat. We reviewed original research published in the last 2 years, since 1 January 2018, which we considered to have a major impact in advancing diagnosis, treatment and understanding of the pathophysiology of TBM meningitis in children and adults. Recent findings Studies have sought to identify a high sensitivity diagnostic test for TBM, with new data on modified Ziehl--Neelsen staining, urinary and cerebrospinal fluid (CSF) lipoarabinomannan and GeneXpert Ultra. Recent studies on CS...
Source: Current Opinion in Infectious Diseases - May 1, 2020 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Acute infectious myelopathies
We present a syndromic approach to infectious myelopathies, focusing on clinical patterns that help narrow the diagnostic possibilities. (Source: Current Opinion in Infectious Diseases)
Source: Current Opinion in Infectious Diseases - May 1, 2020 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Update on group A streptococcal vaccine development
Purpose of review There is a global need for well tolerated, effective, and affordable vaccines to prevent group A streptococcal infections and their most serious complications. The aim of this review is to highlight the recent progress in the identification of promising vaccine antigens and new approaches to vaccine design that address the complexities of group A streptococcal pathogenesis and epidemiology. Recent findings Combination vaccines containing multiple shared, cross-protective antigens have proven efficacious in mouse and nonhuman primate models of infection. The development of complex multivalent M protei...
Source: Current Opinion in Infectious Diseases - May 1, 2020 Category: Infectious Diseases Tags: PATHOGENESIS AND IMMUNE RESPONSE: Edited by Dennis L. Stevens and Dimitri A. Diavatopoulos Source Type: research

Anatomical site-specific immunomodulation by bacterial biofilms
Purpose of review The human body plays host to bacterial biofilms across diverse anatomical sites. The treatment of pathogenic biofilm infection is confounded by their high rate of antibiotic resistance. Therefore, it is critical to understand the interplay between these biofilms and the host immune system to develop new tactics to combat these infections. Recent findings Bacterial biofilms and the components they produce affect and are affected by the host immune system. Host anatomical sites represent distinct niches in which defined bacterial biofilms are able to form and interact with the host immune system. For p...
Source: Current Opinion in Infectious Diseases - May 1, 2020 Category: Infectious Diseases Tags: PATHOGENESIS AND IMMUNE RESPONSE: Edited by Dennis L. Stevens and Dimitri A. Diavatopoulos Source Type: research

Unraveling Haemophilus influenzae virulence mechanisms enable discovery of new targets for antimicrobials and vaccines
Purpose of review The human upper respiratory tract is colonized with a variety of bacterial microorganisms including Haemophilus influenzae. The species H. influenzae consists of typeable and nontypeable H. influenzae (NTHi) variants. Typeable H. influenzae are subdivided into types a through f, based on the polysaccharide capsule, whereas the NTHi strains do not express a polysaccharide capsule. In this review, we highlight the current advances in the field of H. influenzae, with the focus on bacterial virulence mechanisms that facilitate bacterial colonization and disease, particularly for NTHi. Recent findings In ...
Source: Current Opinion in Infectious Diseases - May 1, 2020 Category: Infectious Diseases Tags: PATHOGENESIS AND IMMUNE RESPONSE: Edited by Dennis L. Stevens and Dimitri A. Diavatopoulos Source Type: research

Antibody glycosylation in pregnancy and in newborns: biological roles and implications
Purpose of review Glycosylation patterns have the potential to affect the function of antibody, antibody half-life and transplacental transfer from mother to foetus. Here, we review recent advances in our understanding of how glycosylation patterns of antibodies may be altered during pregnancy, vaccination and infection. Recent findings During pregnancy, there is preferential transplacental transfer of natural killer (NK) cell-activating antibodies that are galactosylated and sialylated, against both bacterial and viral antigens. Markers of NK cell function are also associated with a higher abundance of galactosylatio...
Source: Current Opinion in Infectious Diseases - May 1, 2020 Category: Infectious Diseases Tags: PATHOGENESIS AND IMMUNE RESPONSE: Edited by Dennis L. Stevens and Dimitri A. Diavatopoulos Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Infectious Diseases)
Source: Current Opinion in Infectious Diseases - May 1, 2020 Category: Infectious Diseases Tags: EDITORIAL INTRODUCTIONS Source Type: research

New treatment options for multiresistant gram negatives
Purpose of review Multidrug-resistant (MDR) Gram-negative bacteria infections are listed among the top public health threats of the current era. As a result, there has been an increase in efforts to develop new therapeutic agents against MDR Gram-negatives. The purpose of this review is to summarize the clinical and preclinical findings associated with recently approved drugs and the drugs in clinical development against ESBL and carbapenemase-producing Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii infections. Recent findings There are a number of ESBL a...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: SPECIAL COMMENTARY Source Type: research

Pulmonary infections in the hematopoietic cell transplant patient
Purpose of review Despite progress in the management of pulmonary infections in the hematopoietic cell transplant (HCT) population, substantial diagnostic, and therapeutic uncertainty remains. Recent findings A growing HCT population reflects more transplants and improved long-term survival. We continue to learn about the epidemiologic and prognostic significance of posttransplant pulmonary infections. Mold-active triazoles have removed invasive fungal pneumonia as a barrier to transplant eligibility. Ibrutinib and respiratory viruses are newly recognized risk factors for invasive fungal disease. Prophylaxis has eleva...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: RESPIRATORY INFECTIONS: Edited by Michael S. Niederman Source Type: research

Optimizing aerosol delivery of antibiotics in ventilated patients
Purpose of review The aim of the article is to review the evidence to select ventilated patients most likely to benefit from inhaled antibiotic therapy and summarize the optimal implementation setup to favor clinical success. Recent findings Although a large body of literature describes the optimal ventilator circuit and settings to implement to favor a high amount of inhaled antibiotic delivery to ventilated patients, recent clinical trials failed to show a significant benefit on patient-centered outcomes. Currently, inhaled antibiotic therapy can only be recommended as a therapeutic modality of last resort after cas...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: RESPIRATORY INFECTIONS: Edited by Michael S. Niederman Source Type: research

Managing and preventing exacerbation of bronchiectasis
Purpose of review Pulmonary exacerbations are key events in the natural history of bronchiectasis given their impact on quality of life, prognosis, and their contribution to healthcare costs. Preventing and managing exacerbations is a priority for clinicians and in this review, we discuss measures that should be utilized to achieve this aim. Recent findings Experts have proposed a focus on phenotyping and endotyping the bronchiectasis population to overcome the heterogeneity of this condition. Recent large studies of inhaled antibiotics and smaller studies of macrolides, which included exacerbation measures as their p...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: RESPIRATORY INFECTIONS: Edited by Michael S. Niederman Source Type: research

Ventilator-associated pneumonia: new principles guiding empiric antibiotic therapy
Purpose of review Ventilator-associated pneumonia (VAP) is a serious event in critically ill patients. We aim to review the most recent evidences about VAP, including its cause, the main differences between the American and European guidelines in the definition of risk factors for multidrug-resistant pathogens, the main principles guiding empirical antibiotic treatment, and the potential role of molecular diagnostic tests. Recent findings The 2016 ATS/IDSA and the 2017 ERS/ESICM/ESCMID/ALAT guidelines provide different approaches for the management of VAP. Both guidelines highlight the need to use local epidemiolo...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: RESPIRATORY INFECTIONS: Edited by Michael S. Niederman Source Type: research

Community-acquired pneumonia in chronic obstructive pulmonary disease
Purpose of review The aim of this study was to discuss the literature on community-acquired pneumonia (CAP) in patients with chronic obstructive pulmonary disease (COPD). Recent findings Well designed studies show that COPD is the strongest risk factor for development of CAP. Lung microbiome, abnormal lung immunity and pathogen virulence are important components of the pathogenesis of CAP in COPD. The cause of CAP in patients with COPD is similar to that of non-COPD patients. However, patients with COPD are at an increased risk of infection by Gram-negative bacilli, including Pseudomonas aeruginosa. Empiric treatment ...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: RESPIRATORY INFECTIONS: Edited by Michael S. Niederman Source Type: research

Advances in the diagnosis and treatment of latent tuberculosis infection
Purpose of review This review describes the major developments in the rationale for treating latent tuberculosis infection; new approaches to identifying persons with latent infection who are most likely to progress to active disease; and the development of novel short-course regimens for treatment of latent tuberculosis. Recent findings As many as one-third of the world's population has latent infection with Mycobacterium tuberculosis. Models demonstrate that tuberculosis will not be eliminated without large-scale treatment of persons with latent TB. Current tools for identifying persons at risk for active tuberculos...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: RESPIRATORY INFECTIONS: Edited by Michael S. Niederman Source Type: research

The interplay between acute bacterial skin and skin structure infections and depression: a vicious circle of major clinical importance
Purpose of review Previous studies suggest an association between depression and increased risk of various type of infections, including acute bacterial skin and skin structure infections (ABSSSI). Here, we review the latest advancement in our understanding of immunity in patients with depression and its relevance to disease management and diagnosis, with a special focus on patients suffering from ABSSSI. Recent findings Recent studies have highlighted the role of hypothalamic–pituitary–adrenal axis, neuro-endocrine stress signaling pathways and behavioral attitudes (substance abuse and homelessness) in th...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: SKIN AND SOFT TISSUE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Treatment of multidrug-resistant Gram-negative skin and soft tissue infections
Purpose of review The increase in skin and soft tissue infections (SSTI) because of multidrug-resistant (MDR) pathogens is a global concern. Although MDR Gram-negative bacteria (GNB) are often overlooked as a cause of SSTIs, their burden on the morbidity of many subgroups of patients is high. There is a paucity in the available treatment options and guidelines on how to treat these pathogens. This manuscript reviews the management of SSTIs caused by carbapenem-resistant Enterobacteriaceae (CRE), Pseudomonas aeruginosa (CRPA), Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia. We also highlight a few novel ...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: SKIN AND SOFT TISSUE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Risk stratification for multidrug-resistant bacteria in patients with skin and soft tissue infection
This article summarizes the available evidence enabling a stratification of risk for multidrug-resistant bacteria (MDRB) in patients with skin and soft tissue infection (SSTI). Recent findings MDRB are increasingly reported in both healthcare-associated (HCA) and community-acquired (CA)-SSTI, including in patients with life-threatening presentations for whom early initiation of adequate antimicrobial therapy is pivotal to improve outcomes. Community-associated methicillin-resistant Staphylococcus aureus (MRSA) is now endemic in several geographical areas and may cause outbreaks in frail populations or other at-risk clus...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: SKIN AND SOFT TISSUE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Fungal infections of the skin and soft tissue
Purpose of review This review aims to update on recent findings about epidemiology, risk factors and therapeutic options for fungi causing skin and soft tissue infections. The latest data on emerging antifungal resistance are also discussed. Recent findings In parallel with increased use of immunosuppression, the incidence of fungal infections is also on rise. This increase involves not only systemic infections but also infections with primary and secondary skin involvement. Antifungal resistance has become a major issue and covers several fungal pathogens including dermatophytes, Candida spp. and, Aspergillus fumigat...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: SKIN AND SOFT TISSUE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Parasitic skin infections: neglected diseases or just challenging for diagnosis?
Purpose of review The aim of the article is to review the most recent evidence concerning parasitic skin infections. Recent findings Parasitic skin infections are increasingly reported worldwide. Special at-risk categories are migrants, returning travelers, and immunocompromised individuals, who are at higher risk to present disseminated disease. The number of reported cases is growing even outside the endemic areas as a consequence of international travels, migration flows, increasing immunocompromised population, climate change, and natural disasters. Summary Skin parasitoses are neglected infections. Funding ass...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: SKIN AND SOFT TISSUE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Role of new antibiotics in the treatment of acute bacterial skin and skin-structure infections
Purpose of review To summarize the available efficacy and safety data of novel agents for treating acute bacterial skin and skin-structure infections (ABSSSI), focusing on those active against methicillin-resistant Staphylococcus aureus (MRSA). Recent findings There are now several agents active against MRSA that are approved for the treatment of ABSSSI, including tedizolid, ceftaroline, dalbavancin, telavancin, oritavancin, delafloxacin, and omadacycline. In addition, iclaprim has completed phase-3 randomized clinical trials (RCTs). Summary Considering the similar efficacy that arose from direct comparisons in pha...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: SKIN AND SOFT TISSUE INFECTIONS: Edited by Matteo Bassetti Source Type: research

The skin and soft tissue infections in hematological patients
Purpose of review Skin and soft tissue infections (SSTIs) in patients with hematological malignancies are frequent, but dedicated epidemiological studies are limited. The aim of this review is to provide updated description of the main etiological agents, differential diagnosis, and treatment. Recent findings In addition to common causes of bacterial skin infections in any kind of patients, such as streptococci and staphylococci (the letter frequently resistant to methicillin), Pseudomonas aeruginosa is a frequent agent in patients with hematological malignancies, with high virulence and typical infection presenting a...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: SKIN AND SOFT TISSUE INFECTIONS: Edited by Matteo Bassetti Source Type: research

The role of multidrug and extensive-drug resistant Gam-negative bacteria in skin and soft tissue infections
Purpose of review Whereas Staphylococcus aureus remains the leading cause of skin and soft tissue infections (SSTI), Gram-negative bacilli (GNB) are increasingly reported as a cause of monomicrobial or polymicrobial infections. This review examines the expanding role of GNB in SSTI and discusses the risks for and the frequency of multidrug-resistance (MDR) and extensive drug-resistance (XDR) and the implications with regard to outcome and therapy. Recent findings Although the global epidemiology and role of GNB in SSTIs have not been studied systematically, complicated SSTIs caused by resistant GNB are increasing part...
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: SKIN AND SOFT TISSUE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Infectious Diseases)
Source: Current Opinion in Infectious Diseases - March 6, 2020 Category: Infectious Diseases Tags: EDITORIAL INTRODUCTIONS Source Type: research

Carbapenem use in critically ill patients
Purpose of review To review available data on carbapenem use in ICU. Carbapenem is a broad spectrum well tolerated antibiotic family that keep an excellent activity to extended spectrum β-lactamases and AmpC hyperproducer and in susceptible Pseudomonas aeruginosa and Acinetobacter baumannii. It becomes a drug of choice for empirical therapy of suspected sepsis in known or presumably known ESBLE carriers. Recent findings Carbapenems remained the drug of choice for severe ESBLE infections. In severe critically ill patients, high off-label dose is necessary especially in patients with sepsis and glomerular hyperfilt...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: SPECIAL COMMENTARIES Source Type: research

Current evidence for therapy of ceftriaxone-resistant Gram-negative bacteremia
This article aims to give a state-of-the-art assessment of treatment options for bloodstream infection because of ceftriaxone-resistant Gram-negative bacilli, especially those caused by extended-spectrum beta-lactamase (ESBL) or AmpC-producing Enterobacteriaceae. In particular, this review assesses whether current data support ‘carbapenem-sparing options’ for treatment of these serious infections. Recent findings The MERINO trial refuted earlier observational studies some of which showed equivalence in outcomes between beta-lactam/beta-lactamase inhibitor combinations and carbapenems for treatment of bloodst...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: SPECIAL COMMENTARIES Source Type: research

Updates in trichomonas treatment including persistent infection and 5-nitroimidazole hypersensitivity
Purpose of review The purpose of this review is to update information on treatment of Trichomonas vaginalis. T. vaginalis is estimated to be the most common treatable sexually transmitted infection. In the world and is associated with poor birth outcomes, cervical cancer, sperm motility and morphology issues, and HIV acquisition and transmission. Recent findings The efficacy of the recommended 2-g oral single-dose metronidazole (MTZ) for the treatment of T. vaginalis in women has recently been challenged. Two recent multicentered randomized trials and a meta-analysis have demonstrated that the 7-day dose of MTZ 500 ...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: STD: Edited by Joseph A. Duncan Source Type: research

Ocular and neurosyphilis: epidemiology and approach to management
This article reviews the current epidemiology, manifestations, and approach to management and treatment. Recent findings Although studies continue investigating alternate approaches and new diagnostic tests for ocular and neurosyphilis, few data exist to change current diagnostic algorithms and approaches to diagnosis, management, or follow up. Summary The diagnosis of neurologic and eye/ear involvement with syphilis may be delayed because of a lack of specificity of findings, low suspicion for syphilis, fluctuation in symptoms, and/or similarities in presentation to other diseases. A high index of suspicion for syph...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: STD: Edited by Joseph A. Duncan Source Type: research

Host–vaginal microbiota interactions in the pathogenesis of bacterial vaginosis
Purpose of review The cause of bacterial vaginosis, the most common cause of vaginal discharge in women, remains controversial. We recently published an updated conceptual model on bacterial vaginosis pathogenesis, focusing on the roles of Gardnerella vaginalis and Prevotella bivia as early colonizers and Atopobium vaginae and other bacterial vaginosis-associated bacteria (BVAB) as secondary colonizers in this infection. In this article, we extend the description of our model to include a discussion on the role of host–vaginal microbiota interactions in bacterial vaginosis pathogenesis. Recent findings Although ...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: STD: Edited by Joseph A. Duncan Source Type: research

Facing increased sexually transmitted infection incidence in HIV preexposure prophylaxis cohorts: what are the underlying determinants and what can be done?
Purpose of review The combined incidence of chlamydia, gonorrhoea and syphilis in MSM PrEP (preexposure prophylaxis) cohorts now frequently exceeds 100 per 100 person years. The efficacy of antiretroviral PrEP in reducing HIV transmission has led to efforts to find similar biomedical ways reduce sexually transmitted infection (STI) incidence. We review the recent evidence for these and other strategies. Recent findings Doxycycline PrEP/postexposure prophylaxis has been shown to reduce the incidence of syphilis and chlamydia but not gonorrhoea. A meningococcal vaccine has been found to result in a lower incidence of go...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: STD: Edited by Joseph A. Duncan Source Type: research

Digital health for sexually transmitted infection and HIV services: a global scoping review
Purpose of review The current study aimed to review how digital health has been used for sexually transmitted infection (STI)/HIV prevention, testing, and treatment. Recent findings A scoping review was conducted by searching five databases for peer-reviewed literature published between March 2018 to August 2019. 23 out of 258 studies met the inclusion criteria and were assessed. Six studies used digital platform to enhance STI/HIV prevention messaging; four studies found that digital health can provide vivid promotional information and has been instrumental in increasing the accessibility and acceptability of STI/HIV...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: STD: Edited by Joseph A. Duncan Source Type: research

Probiotics to manage inflammation in HIV infection
Purpose of review To evaluate the current scientific basis for administering probiotics to people living with HIV (PLHIV) to alleviate chronic inflammation and subsequently improve their prognosis. Recent findings The gut microbiome is a potential contributing factor to low-grade inflammation in HIV infection, and there is a scientific rationale for attempting to attenuate inflammation by administering probiotics. Sixteen reports from clinical studies in antiretroviral therapy (ART)-treated PLHIV assessing inflammation after probiotic intervention have been identified; half of them randomized control trials (RCT). Som...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: HIV INFECTIONS AND AIDS: Edited by David Dockrell Source Type: research

Two drugs regimens for HIV
Purpose of review As the evidence for two-drug regimens (2DR) for HIV treatment accumulates and 2DR start to enter consensus guidelines, this review covers the history, rationale and current evidence for 2DR in first-line and switch settings. Recent findings Until recently, most evidence for 2DR was for boosted protease inhibitor-based therapies but now we have large, randomized trials to support the use of dolutegravir (DTG)-based 2DR, both for initial therapy and suppressed switch, with high efficacy and no emergent resistance at failure. Summary 2DR will increasingly form part of the choice we are able to offer ...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: HIV INFECTIONS AND AIDS: Edited by David Dockrell Source Type: research

Undetectable viral load and HIV transmission dynamics on an individual and population level: where next in the global HIV response?
Purpose of review To examine recent literature on the efficacy and effectiveness of HIV treatment in preventing HIV transmission through sexual exposure, at both an individual and at a population level. Recent findings Two recent studies on the individual-level efficacy of treatment as prevention (TasP) have added to the now conclusive evidence that HIV cannot be transmitted sexually when the virus is suppressed. However, four large cluster-randomized population-level trials on universal HIV testing and treatment in Africa have not delivered the expected impact in reducing HIV incidence at a population level. Two of t...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: HIV INFECTIONS AND AIDS: Edited by David Dockrell Source Type: research

Weight gain and integrase inhibitors
This article comprehensively reviews available data and summarizes our current understanding of the topic. Recent findings Recent studies support the concept that weight gain and treatment emergent obesity are worse with INSTI-based regimens, particularly dolutegravir. Women and nonwhites appear to be the most at risk, and the accompanying nucleoside reverse transcriptase inhibitor may play a role. Lipohypertrophy, an abnormal accumulation of visceral fat and/or ectopic fat depots, continues to be a problem among PLWH, but the role of INSTIs is inconsistent. The pathogenesis of weight gain and changes in body compositio...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: HIV INFECTIONS AND AIDS: Edited by David Dockrell Source Type: research

Interventions to reduce acute hepatitis C virus in HIV-positive MSM
Purpose of review The WHO has set ambitious targets for hepatitis C virus (HCV) elimination by 2030. In this review, we explore the possibility of HCV micro-elimination in HIV-positive (+) MSM, discussing strategies for reducing acute HCV incidence and the likely interventions required to meet these targets. Recent findings With wider availability of directly acting antivirals (DAAs) in recent years, reductions in acute HCV incidence have been reported in some cohorts of HIV+ MSM. Recent evidence demonstrates that treatment in early infection is well tolerated, cost effective and may reduce the risk of onward transmis...
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: HIV INFECTIONS AND AIDS: Edited by David Dockrell Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Infectious Diseases)
Source: Current Opinion in Infectious Diseases - January 3, 2020 Category: Infectious Diseases Tags: EDITORIAL INTRODUCTIONS Source Type: research

Carbapenem-sparing strategy: carbapenemase, treatment, and stewardship
Purpose of review describing the current role of carbapenems and carbapenem-sparing strategies in the setting of antimicrobial stewardship programs. Recent findings sparing carbapenems with other drugs appears to be an interesting perspective for a variety of reasons in the current context of the multidrug-resistant (MDR) pandemic. Specific algorithms should also be precisely investigated to define better how to spare carbapenems within empiric and targeted regimens, with combination treatment or monotherapies, aiming at the best use of the new drugs and improving de-escalation as soon as possible for most of the pati...
Source: Current Opinion in Infectious Diseases - November 4, 2019 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

An overview of guidelines for the management of hospital-acquired and ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria
Purpose of review Multidrug-resistant (MDR) Gram-negative pathogens in hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are associated with poor clinical outcomes. These pathogens represent a global threat with few therapeutic options. In this review, we discuss current guidelines for the empiric management of HAP/VAP caused by MDR Gram-negative pathogens. Recent findings The incidence of MDR Gram-negative bacteria is rising among cases of nosocomial pneumonia, such that it is now becoming a significant challenge for clinicians. Adherence to international guidelines may ensure early and adeq...
Source: Current Opinion in Infectious Diseases - November 4, 2019 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Pharmacologic optimization of antibiotics for Gram-negative infections
Purpose of review Antimicrobial resistance among Gram-negative organisms is a rapidly escalating global challenge. Pharmacologic dose optimization based on pharmacokinetic/pharmacodynamic principles is essential for managing Gram-negative infections. High-risk patient populations may receive nonoptimized antimicrobial dosing because pf physiologic changes in acute illness and/or medical interventions. The purpose of this review is to discuss opportunities for pharmacologic optimization of new agents and highlight patient populations that are often associated with poor drug exposure profiles. Recent findings Dose optim...
Source: Current Opinion in Infectious Diseases - November 4, 2019 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research