Duration of antibiotic therapy in Gram-negative infections with a particular focus on multidrug-resistant pathogens
Purpose of review Antimicrobial overuse is a major health problem that contributes to antimicrobial resistance (AMR). Infections with Gram-negative bacilli (GNB) and multidrug-resistant organisms (MDRs) are associated with high morbidity and mortality, particularly in patients with underlying medical conditions. Recent findings Although many recent studies have been published about the novel antibiotics in treating infections including those due to MDR-GNB, the optimal duration of treatment (DOT) remains inconclusive. Recent observation has supported that short antibiotic therapy (SAT) decreases AMR and adverse ...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Risk stratification for selecting empiric antibiotherapy during and after COVID-19
Purpose of review SARS-CoV-2 deeply modified the risk of bacterial infection, bacterial resistance, and antibiotic strategies. This review summarized what we have learned. Recent findings During the COVID-19 pandemic, we observed an increase in healthcare-acquired infection and multidrug-resistant organism-related infection, triggered by several factors: structural factors, such as increased workload and ongoing outbreaks, underlying illnesses, invasive procedures, and treatment-induced immunosuppression. The two most frequently healthcare-acquired infections described in patients hospitalized with COVID-19 were...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Epidemiology of Gram-negative bacteria during coronavirus disease 2019. What is the real pandemic?
Purpose of review Bacterial infections play a key role in hospital outcomes during the coronavirus disease 2019 (COVID-19) pandemic. Nonetheless, the global impact on the epidemiology of Gram-negative bacteria (GNB) and antibiotic resistance has not been clearly established. Recent findings Multiple limitations exist in the current literature, in that substantial variability was observed with regard to methodology. Notwithstanding the heterogeneity, the evidence suggests that the COVID-19 pandemic had a substantial negative impact on global epidemiology with an increase in hospital-onset infections, associated w...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Novel agents in development for multidrug-resistant Gram-negative infections: potential new options facing multiple challenges
Purpose of review To review novel antiinfective agents in development for multidrug-resistant (MDR) Gram-negative bacterial infections. Recent findings Four novel agents are in various phases of development (tebipenem, durlobactam-sulbactam, cefepime-taniborbactam, and xeruborbactam). Tebpipenem is an oral carbapenem with a recently completed phase III trial for complicated urinary tract infections while durlobactam-sulbactam represents a potential alternative for drug-resistant Acinetobacter baumannii. Cefepime-taniborbactam possesses in-vitro potency against a range of troubling pathogens and we await further ...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

How to manage central venous catheter-related bloodstream infections due to Gram-negative bacilli?
Purpose of review The aim of this study was to review recent data evaluating the management of central venous catheter-related bloodstream infection due to Gram-negative bacilli (GNB). Recent findings The incidence of GNB catheter-related bloodstream infection (CRBSI) has been increasing considerably in the last years, and this has raised a concern due to the high reported rate of multidrug-resistant in these infections what poses a considerable challenge for effective treatment. However, there are no specific guidelines for the management of GNB-CRBSI and optimal treatment duration has not been clearly defined....
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Controversies over the management of infections caused by Amp-C- and ESBL-producing Enterobacterales: what questions remain for future studies?
Purpose of review The continuous rise in infections caused by third-generation cephalosporin-resistant Enterobacterales (e.g. extended-spectrum beta-lactamase- or AmpC-producing Enterobacterales ) is a major health concern. Carbapenems are regarded as the antibiotics of choice for the treatment of these infections. However, their indiscriminant use is not without consequences, and has contributed to the emergence of carbapenem-resistant Enterobacterales. In this review, we discuss the available evidence supporting the use of other betalactams, nonbetalactams and the new betalactams/beta-lactamase inhibitors (BLA/BLI...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Empirical antibiotic therapy for difficult-to-treat Gram-negative infections: when, how, and how long?
Purpose of review To discuss empirical therapy for severe infections due to Gram-negative bacteria with difficult-to-treat resistance (GNB-DTR) in current clinical practice, focusing in particular on the positioning of novel therapeutic agents and rapid diagnostic tests. Recent findings The current era of novel agents active against GNB-DTR and showing differential activity against specific determinants of resistance is an unprecedented scenario, in which the clinical reasoning leading to the choice of the empirical therapy for treating severe GNB-DTR infections is becoming more complex, but it also allows for e...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

How to use new antibiotics in the therapy of serious multidrug resistant Gram-negative infections?
Purpose of review Multidrug resistant Gram-negative infections are becoming more common and pose a serious threat to both individual patients and the population as a whole. Treatment of these infections can be difficult and result in significant morbidity and mortality. The purpose of this review is to discuss information and strategies for using new antibiotics to combat these infections. Recent findings Eight new antibiotics represent possible means to treat multidrug resistant Gram-negative infections. Although no new mechanisms of action are present amongst these new antibiotics, novel additions to previousl...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Follow-up blood culture in Gram-negative bacilli bacteraemia: for whom is follow-up blood culture useful?
Purpose of review The aim of this narrative review is to examine available evidence about the diagnostic yielding of the follow-up blood cultures (FU-BCs) in patients with Gram-negative bloodstream infection (GN-BSI), the predictors of persistent GN-BSI, and the impact of the performance of FU-BCs on patient management and clinical outcome. Recent findings The rate of persistent GN-BSI varies from 2.6% to 38.5%, with higher percentages in studies where FU-BCs were obtained from selected patients. Risk factors for persistent GN-BSI were analysed and prediction tools were proposed to guide physicians in the select...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Clinical evidence supporting cefiderol for serious Acinetobacter baumannii infections
Purpose of review Nosocomial infections caused by Acinetobacter baumannii currently represent a serious challenge for clinicians because treatment options are limited and frequently associated with significant toxicity. Cefiderocol is a first-in-class siderophore cephalosporin that has a proven efficacy for the treatment of multidrug-resistant Gram-negative infections, including carbapenem-resistant A. baumannii. The aim of this review is to evaluate the current evidence for the role of cefiderocol in the management of A. baumannii infections. Recent findings In this review, we briefly summarize the available da...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Risk factors and outcome of concurrent and sequential multiviral cytomegalovirus, Epstein–Barr virus, BK virus, adenovirus and other viral reactivations in transplantation
Purpose of review Reactivation of viral infections occurs frequently in immunosuppressed populations, particularly in solid organ (SOT) or allogeneic haematopoietic cell (HCT) transplant patients. Concurrent and sequential multivirus infections are common, yet risk factors and outcomes remain unclear. This review aims to identify the patients vulnerable to multivirus infections and characterize the impact of increased viral burden to formulate prevention and treatment strategies. Recent findings Incidences of up to 89% in SOT and 36% in HCT have been reported for two viruses, and 32% in SOT and 28% in HCT for at...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: VIRAL: Edited by Michelle K. Yong Source Type: research

Resistant herpes simplex virus infections – who, when, and what's new?
Purpose of review This review summarizes the literature on acyclovir resistant herpes infections and the most recent data pertinent to diagnosis and treatment in the immunocompromised patient population. Recent findings Although fairly rare, acyclovir resistant herpes infections can be challenging to diagnose. Clinicians should be aware of this entity when facing refractory herpes infections. With updated diagnostics, the diagnosis is usually made through viral culture and sequencing. Therapeutic choices depend on the extent of disease. Topical therapy may be appropriate for mucocutaneous disease. Intravenous an...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: VIRAL: Edited by Michelle K. Yong Source Type: research

Clinical and microbiological characteristics of Staphylococcus lugdunensis
Purpose of review This review provides an update on recent findings about the clinical and microbiological characteristics of Staphylococcus lugdunensis. Recent findings European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Clinical and Laboratory Standards Institute (CLSI) differ in their methodology and breakpoints for the detection of penicillin and oxacillin resistance in S. lugdunensis. The EUCAST method for beta-lactamase detection recommends a 1-unit penicillin disk and has demonstrated superior performance compared to the 10-unit penicillin disk recommended by CLSI. A similar outcome ha...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: BACTERIAL/FUNGAL: Edited by Monica Slavin Source Type: research

Melioidosis and Burkholderia pseudomallei: progress in epidemiology, diagnosis, treatment and vaccination
Purpose of review Melioidosis and its causative bacterium Burkholderia pseudomallei are being found in unexpected locations and bacterial genotyping is providing new insights into global spread and where and how individuals are being infected. This review summarizes recent studies covering the epidemiology, diagnosis, treatment, and prevention of melioidosis. Recent findings Whole-genome sequencing of B. pseudomallei from patients and environmental sampling is informing the phylogeography of B. pseudomallei at regional, continental, and global levels, while also defining the epidemiology for individual cases. Th...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: BACTERIAL/FUNGAL: Edited by Monica Slavin Source Type: research

New approaches to management of fever and neutropenia in high-risk patients
This article details recent progress in this field with particular emphasis on early discontinuation studies in resolved neutropenic fever and improved imaging techniques for the investigation of those with persistent neutropenic fever. Recent randomized controlled trials have shown that early cessation of empiric neutropenic fever therapy is well tolerated in acute leukaemia and autologous HCT patients who are clinically stable and afebrile for 72 h. Delineation of the best approach to cessation (timing and/or use of fluoroquinolone prophylaxis) and whether this approach is well tolerated in the higher risk allogeneic H...
Source: Current Opinion in Infectious Diseases - November 12, 2022 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: BACTERIAL/FUNGAL: Edited by Monica Slavin Source Type: research