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Gram-negative bacteria as a cause of mediastinitis after cardiac surgery
Purpose of review Poststernotomy mediastinitis (PSM) remains a serious infection and is significantly associated with high morbidity, short-term and long-term mortality. Gram-negative bacteria (GNB) are an underestimated cause of PSM, and there is little information on the risk factors, prevention, diagnosis and management of GNB PSM. Recent findings The pathogenesis of PSM is the result of a complex and multifactorial interplay between intraoperative wound contamination, host-related and surgical host factors but GNB are probably mostly translocated from other host site infections. GNB are frequent cause of PSM...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

New antibiotics for the treatment of nonfermenting Gram-negative bacteria
Purpose of review To discuss the current literature on novel agents for the treatment of carbapenem-resistant nonfermenting Gram-negative bacteria (NF-GNB) infections. Recent findings Some novel agents have recently become available that are expected to replace classical polymyxins as the first-line options for the treatment of carbapenem-resistant NF-GNB infections. Summary In this narrative review, we provide a brief overview of the differential activity of various recently approved agents against NF-GNB most encountered in the daily clinical practice, as well as the results from phase-3 randomized clin...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Duration of antibiotic therapy for Enterobacterales and Pseudomonas aeruginosa: a review of recent evidence
Purpose of review Emergence of multidrug-resistant organisms, impact on intestinal microbiome, side effects and hospital costs are some of the factors that have encouraged multiple studies over the past two decades to evaluate different duration of antibiotic therapy with the goal of shorter but effective regimens. Here, we reviewed the most recent relevant data on the duration of therapy focused on two of the most common Gram-negative organisms in clinical practice, Pseudomonas aeruginosa and Enterobacterales. Recent findings Recent studies including meta-analysis confirm that short antibiotic courses for both ...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Predictors of multidrug resistant Pseudomonas aeruginosa involvement in bloodstream infections
Purpose of review In the last decades, there has been a worldwide worrisome spread of multidrug resistant (MDR) Pseudomonas aeruginosa. Treatment of these infections is challenging, in part due to the lack of therapeutic options, and the importance of prescribing an adequate empirical treatment. Bacteraemia is one of the most severe infections, with mortality rates ranging between 20 and 40%. Recent findings It is key to understand which patients are at a higher risk of MDR P. aeruginosa bloodstream infection (BSI) to better direct empirical therapies and improve overall survival. Immunocompromised patients are ...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Duration of antibiotic therapy in central venous catheter-related bloodstream infection due to Gram-negative bacilli
Purpose of review The aim of this study was to review recent data evaluating the duration of antibiotic therapy in central venous catheter-related bloodstream infection (CRBSI) due to Gram-negative bacilli (GNB). Recent findings CRBSI is the most common complication associated with the use of intravascular catheters. CRBSI directly contributes to increase additional days of hospitalization, morbidity and therefore economic costs. The incidence of GNB CRBSI has been increasing considerably in the last years; this has raised a concern due to the high reported rate of multi drug resistant bacteria in these infec...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Gram-negative endocarditis: disease presentation, diagnosis and treatment
Purpose of review Gram-negative bacilli (GNB) cause between 1% and 10% of infective endocarditis (IE). Most episodes are caused by microorganisms of the Haemophilus spp., Aggregatibacter spp. Cardiobacterium spp., Eikenella spp., and Kingella spp (HACEK) group. The frequency of IE caused by non-HACEK (GNB-IE) has increased in recent years. Uncertainties persist regarding its best medical treatment and the appropriateness and timing of surgical treatment. In addition, there are new drugs with activity against multiresistant microorganisms, of which there is little experience in this disease. We review this topic by answ...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: GRAM-NEGATIVE INFECTIONS: Edited by Matteo Bassetti Source Type: research

Cytomegalovirus in primary immunodeficiency
Purpose of review Cytomegalovirus (CMV) infection and disease are well described in the setting of secondary immunodeficiency. Less is known about CMV in the context of primary immunodeficiencies (PIDs), where inborn errors in one or more arms of the immune system result in variable degrees of CMV susceptibility. Recent findings PID presents unique challenges in the diagnosis and management of CMV disease. The clinical presentation of CMV in PID is often severe, accelerated by underlying immune dysregulation and iatrogenic immunosuppression. Here we describe the clinical significance of CMV infection in PID, the...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: VIRAL: Edited by Michelle K. Yong Source Type: research

Severe acute respiratory syndrome coronavirus 2 infection in the stem cell transplant recipient − clinical spectrum and outcome
Purpose of review Focusing on large multicenter cohorts reported over the last months, this review aims at summarizing the available evidence by July 2021 on the impact of coronavirus disease 2019 (COVID-19) on hematopoietic stem cell transplant (HSCT) recipients in terms of epidemiology, clinical features, and outcome. Recent findings The incidence of COVID-19 in institutional cohorts varied according to different regions and study periods from 0.4% to 8.3%. Clinical presentation was overall comparable to other immunocompromised hosts and the general population. Microbiologically confirmed superinfection occurr...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: VIRAL: Edited by Michelle K. Yong Source Type: research

Human herpesvirus 8 and Kaposi sarcoma: how should we screen and manage the transplant recipient?
Purpose of review HHV-8-associated diseases are rare but potentially fatal in transplant recipients. Important differences exist in the distribution of HHV-8 seroprevalence, which might contribute to the lack of uniform approach to HHV-8. The aim of this review was to discuss recent updates in screening and management of HHV-8 after transplant. Recent findings Increasing attention has been given to the nonmalignant but potentially fatal inflammatory syndrome caused by HHV-8 in solid organ transplant (SOT) recipients. At-risk groups include HHV-8-IgG D+/R- transplant and HHV-8-positive recipients. Severe cases of...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: VIRAL: Edited by Michelle K. Yong Source Type: research

Epstein–Barr virus posttransplant lymphoproliferative disorder: update on management and outcomes
Purpose of review Management of Epstein–Barr virus posttransplant lymphoproliferative disorder (EBV PTLD) is complex, involving risk stratification, prevention and/or preemptive measures involving monitoring EBV DNAemia and balancing treatment options, using a combination of reduction of immune suppression, anti-B cell therapy, and cytotoxic T lymphocytes (CTLs). Recent findings The highest risk factor for the development of EBV PTLD in hematopoietic cell transplant (HCT) remains T cell depletion, with increasing use of antithymocyte globulin (ATG) or alemtuzumab in conditioning. In solid organ transplantation...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: VIRAL: Edited by Michelle K. Yong Source Type: research

Beyond antivirals: virus-specific T-cell immunotherapy for BK virus haemorrhagic cystitis and JC virus progressive multifocal leukoencephalopathy
Purpose of review The clinical manifestations of the polyomaviruses BK and JC in immunocompromised patients include BK virus (BKV) induced haemorrhagic cystitis and nephropathy, and JC virus (JCV) associated progressive multifocal leukoencephalopathy (PML) and are typically a consequence of impaired adaptive immunity in the host. To date, little clinical success has been achieved with antiviral agents or other drug therapies to treat these conditions. Here we review the methods and outcomes of the most recent clinical studies utilising adoptive immunotherapy with BK and/or JC virus-specific T-cells (VST) as either prop...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: VIRAL: Edited by Michelle K. Yong Source Type: research

How different is invasive fusariosis in pediatric patients than in adults? A systematic review
Purpose of review To investigate the peculiarities of invasive fusariosis (IF) in pediatric patients. Methods We conducted a systematic literature review to identify human cases of locally invasive and systemic fusariosis documented in children (up to 18 years) published between 1973 (first case report) and 2021. Recent findings One hundred and six cases were retrieved, and hematologic malignancy was reported in 64% (68/106) of the cases. The most frequent anatomic sites involved were skin 66% (70/106), blood 47% (50/106), and lungs 35% (37/106), bone and joint (8%, 09/106), and eye/central nervous syst...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: BACTERIAL/FUNGAL: Edited by Monica A. Slavin Source Type: research

Management dilemmas in Nocardia brain infection
Purpose of review Brain nocardiosis is a rare but severe infection mostly occurring among immunocompromised patients. In this review, we present recent data on this infection and address some of the common clinical dilemmas encountered in patients with brain nocardiosis. Recent findings Strategies used to approach a patient with suspected brain nocardiosis include the ’conservative strategy’ (without early neurosurgery) and the ’neurosurgical strategy’ (with early aspiration or excision of brain abscess[es]). The advantages and disadvantages of both strategies are summarised. Our opinion is that the use ...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: BACTERIAL/FUNGAL: Edited by Monica A. Slavin Source Type: research

New evidence for managing Gram-negative bloodstream infections
Purpose of review Gram-negative bloodstream infections (GNBSI) are common and carry considerable mortality. Treatment is complicated by increasing antimicrobial resistance, posing a challenge for timely appropriate antibiotics and limiting the choices of effective definitive therapy. The present review aims to summarize recent studies addressing the management of GNBSI. Recent findings New rapid diagnostic tests (RDT) for pathogen identification and antibiotic susceptibility are associated with improved antimicrobial stewardship and reduced length of stay. No mortality benefit or patient-related outcomes are rep...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: BACTERIAL/FUNGAL: Edited by Monica A. Slavin Source Type: research

Novel strategies for prevention and treatment of antimicrobial resistance in sexually-transmitted infections
Purpose of review Antimicrobial resistance in sexually acquired infection (STI) pathogens is an important global public health threat. There is an urgent need for novel STI treatment and prevention strategies to tackle the rising incidence of STIs in high-income settings and the static progress in low- and middle-income settings over the past decade. The purpose of this review was to describe the research outlining the emergence of resistance in common STI pathogens and new strategies for their treatment and prevention. Recent findings Rates of STIs have dramatically increased over the past decade. Further, anti...
Source: Current Opinion in Infectious Diseases - November 22, 2021 Category: Infectious Diseases Tags: ANTIMICROBIAL AGENTS: BACTERIAL/FUNGAL: Edited by Monica A. Slavin Source Type: research