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Current Challenges in Antibiotic Stewardship in Low- and Middle-Income Countries
AbstractPurpose of reviewASPs are key tools in the time where an increase in the rates of bacterial resistance and cases ofClostridium difficile disease is observed worldwide, forcing a more efficient use of antibiotic therapy. We review some examples of the actual state of bacterial resistance in low- and middle-income countries (LMIC), as well as some of the proposed strategies for the establishment of ASPs in resource-constrained environments.Recent findingsIn LMIC, there are important challenges in antimicrobial prescription; although not all inhabitants have access to adequate antibiotic therapy, the consumption of th...
Source: Current Treatment Options in Infectious Diseases - July 17, 2018 Category: Infectious Diseases Source Type: research

Cutaneous Botryomycosis and Staphylococcus aureus : Diagnosis, Management, and a Systemic Literature Review
We present a case and provide a review of the literature of all confirmed cases of cutaneous botryomycosis due toStaphylococcus aureus between January 1, 1990 and January 31, 2018.Recent findingsCutaneous botryomycosis occurs in diverse age groups and more frequently in men. Immunodeficiency increases risk for botryomycosis. Preceding trauma commonly occurs, and after bacterial inoculation, patients develop a variety of chronic skin lesions. Culture and biopsy of lesions aid in diagnosis. Pathology usually displays the Splendore-Hoeppli reaction. Culture confirms the identity of the bacterium and provides antimicrobial sen...
Source: Current Treatment Options in Infectious Diseases - July 16, 2018 Category: Infectious Diseases Source Type: research

An Overview of the Treatment of Mycobacterium ulcerans Infection (Buruli Ulcer)
AbstractPurpose of reviewBuruli ulcer is a major cause of morbidity in the regions where it is endemic across 33 countries. The treatment of the disease has changed drastically over the last 15  years with a move away from reliance on wide surgical excision, increased confidence in the efficacy of antibiotics and a better understanding of the pathogenesis ofMycobacterium ulcerans infections.Recent findingsAntibiotic regimens based on rifampicin for 8  weeks combined with either streptomycin, clarithromycin or a quinolone companion drug are highly effective againstM. ulcerans. Excisional surgery and thermotherapy are othe...
Source: Current Treatment Options in Infectious Diseases - July 3, 2018 Category: Infectious Diseases Source Type: research

Treatment of Chagas Disease in the United States
AbstractPurpose of ReviewChagas disease (CD) is endemic to much of Latin America, but also present in the United States (U.S.). Following a lengthy asymptomatic period, CD produces serious cardiac or gastrointestinal complications in 30 –40% of people. Less than 1% of the estimated six million cases in the Americas, including 326,000–347,000 in the U.S., are diagnosed. Infected persons are typically unaware and the bulk of clinicians are unfamiliar with current treatment guidelines. This review provides U.S. and other clinician s with the latest knowledge of CD treatment.Recent FindingsChagas cardiomyopathy (CCM) cause...
Source: Current Treatment Options in Infectious Diseases - June 26, 2018 Category: Infectious Diseases Source Type: research

Current Treatment Options for HIV Elite Controllers: a Review
AbstractOpinion statementInitiating antiretroviral therapy (ART) in human immunodeficiency virus (HIV) elite controllers remains controversial, because current evidence does not definitively demonstrate that the benefits of ART outweigh risk in this patient population. However, it is the opinion of the authors that in developed countries, where first-line ART regimens have minimal toxicities, treatment of elite controllers should be strongly considered. Treatment of elite controllers has the potential to minimize the size of the HIV reservoir, which benefits elite controllers who choose to pursue future cure, dampen immune...
Source: Current Treatment Options in Infectious Diseases - June 1, 2018 Category: Infectious Diseases Source Type: research

Mucosal Barrier Injury Laboratory Confirmed Bloodstream Infections
AbstractPurpose of ReviewTo increase the awareness of the new CDC survey definition of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection (MBI-LCBI). We included a comparison of the definition of Central Line-Associated Bloodstream Infection (CLABSI), with a high sensitivity but low specificity and Catheter-Related Bloodstream Infection (CRBSI). There are other parameters like the difference between the size of the inoculum (catheter lumen vs peripheral), that increased specificity and is useful for research and clinical decisions. Also, MBI-LCBI secondary to bacterial translocation in patients who had recei...
Source: Current Treatment Options in Infectious Diseases - June 1, 2018 Category: Infectious Diseases Source Type: research

Tele-antimicrobial Stewardship in Action
AbstractPurpose of reviewSummarize the latest literature and our own clinical experience in the emerging technique of tele-antimicrobial stewardship, and provide practical advice for those considering providing or consuming this service.Recent findingsThe need for tele-antimicrobial stewardship is high and rising. Although the benefits of antimicrobial stewardship are well documented, tele-antimicrobial stewardship is a recent advance, and there is a relative lack of peer-reviewed clinical trials substantiating the impact of telehealth techniques in antimicrobial stewardship.SummaryAntimicrobial stewardship is more importa...
Source: Current Treatment Options in Infectious Diseases - June 1, 2018 Category: Infectious Diseases Source Type: research

Antimicrobial Stewardship in the Treatment of Infections Among Patients With Cystic Fibrosis
AbstractPurpose of ReviewTo describe potential antimicrobial stewardship program strategies to enhance the optimization of antimicrobial therapy for patients with cystic fibrosis (CF).Recent FindingsCystic fibrosis is a complex medical condition known for its frequent pulmonary exacerbations attributed to microorganisms which are treated with antimicrobials administered by various routes. Due to exposure to antimicrobials from an early age, both as eradication regimens and for chronic colonization, this patient population often has drug-resistant organisms colonizing their respiratory tract. With CF patients surviving well...
Source: Current Treatment Options in Infectious Diseases - June 1, 2018 Category: Infectious Diseases Source Type: research

Role of Antimicrobial Stewardship Programs in Decreasing Hospital-Associated Clostridium difficile Infections
Opinion statementPurpose of reviewTo provide a review of literature that discusses some of the most successful antimicrobial stewardship interventions reported across institutions worldwide in response to increasedClostridium difficile infection (CDI) rates.Recent findingsAlthough many different types of antimicrobial reduction practices have been proven effective, differences in resources across varying sizes of institutions may make some interventions more attainable than other. Regardless of available resources, an initial assessment of the correlation of positive laboratory tests to clinical disease is necessary to qua...
Source: Current Treatment Options in Infectious Diseases - June 1, 2018 Category: Infectious Diseases Source Type: research

Hepatocellular Carcinoma Risk After Hepatitis C Cure
Opinion statementWith the recent introduction of direct acting antiviral agents for hepatitis C treatment, many patients are receiving these highly effective therapies. Patients with advanced fibrosis or cirrhosis prior to antiviral treatment will have decreased but persistent risk of hepatocellular carcinoma following cure of hepatitis C. This review will discuss this risk and review current surveillance recommendations. (Source: Current Treatment Options in Infectious Diseases)
Source: Current Treatment Options in Infectious Diseases - June 1, 2018 Category: Infectious Diseases Source Type: research

A Timeout on the Antimicrobial Timeout: Where Does It Stand and What Is Its Future?
Opinion statementPurpose of reviewTo summarize literature describing the antimicrobial timeout, its rationale for use as an antimicrobial stewardship program (ASP) strategy, and its potential role in overall ASP strategy.Recent findingsStudies have correlated a formal antimicrobial timeout process with increased rates of therapy modification and reductions in use of select broad-spectrum antibiotics. There remains a need for further guidance on how to best implement a system-wide antimicrobial timeout.SummaryThe antimicrobial timeout is a stewardship tool that protocolizes review of objective clinical data and encourages s...
Source: Current Treatment Options in Infectious Diseases - June 1, 2018 Category: Infectious Diseases Source Type: research

Challenger Treats Zika Virus
AbstractPurpose of reviewArthropod-borne viruses (arboviruses) are zoonotic, and the common vectors are ticks and hematophagous mosquitoes. Currently, dengue, chikungunya, yellow fever, West Nile, and Japanese encephalitis virus infections have been causing worldwide concerns. In 2015, a large outbreak was documented with another mosquito-borne flavivirus, the Zika virus (ZIKV), and ravaging South and Central Americas and the Caribbean. ZIKV was declaring a public health emergency, because of the clinical evidence neurological complications.Recent findingsThe flavivirus infection is difficult to differentiate only with cli...
Source: Current Treatment Options in Infectious Diseases - June 1, 2018 Category: Infectious Diseases Source Type: research

Hospitalists as Integral Stakeholders in Antimicrobial Stewardship
AbstractPurpose of reviewThe purpose of this review is to discuss the role of the hospitalist in antimicrobial stewardship programs (ASPs), to offer antimicrobial stewardship strategies that hospitalists can implement, to discuss opportunities for hospitalists to serve as educators on stewardship practices, and to offer resources for hospitalists to gain further training in antimicrobial stewardship.Recent findingsAntimicrobial stewardship is vital to combat antibiotic resistance, and effective stewardship requires a multidisciplinary approach. Antimicrobial stewardship programs have typically included infectious disease s...
Source: Current Treatment Options in Infectious Diseases - June 1, 2018 Category: Infectious Diseases Source Type: research

Antimicrobial Stewardship Efforts to Improve Management of Uncomplicated Urinary Tract Infections in the Ambulatory Care Setting: a Review
AbstractPurpose of the ReviewOutpatient practice sites prescribe more antibiotics than any other healthcare setting contributing to the increasing rate of drug-resistant infections in the USA. Until the release of the Centers for Disease Control and Prevention ’s Core Elements in 2016, outpatient antimicrobial stewardship (AMS) was largely overlooked. The current review seeks to discuss recent AMS interventions for uncomplicated urinary tract infection (UTI) in the outpatient setting and how they relate to the core elements.Recent FindingsEvidence-based methods for UTI in the outpatient setting include pharmacist-review ...
Source: Current Treatment Options in Infectious Diseases - June 1, 2018 Category: Infectious Diseases Source Type: research

Candida auris : What We Need to Know in Healthcare Settings
AbstractPurpose of reviewCandida auris is an emerging pathogen characterized for its difficult identification, rapid nosocomial spread, and limited treatment options. Data is currently limited; however, this will change as the pathogen ’s prevalence increases. The goal of this review is to provide a concise summary of the available data to manage a possibleC. auris infection.Recent findingsCandida auris has been rapidly spreading globally and has been evading popular identification methods with MALDI-TOF being the only successful modality as long as the “research use only” database is used. Echinocandins are the trea...
Source: Current Treatment Options in Infectious Diseases - June 1, 2018 Category: Infectious Diseases Source Type: research