Predictors of survival in sepsis: what is the best inflammatory marker to measure?
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Macrolides for the therapy of nosocomial infections.
Curr Opin Infect Dis. 2012 J…

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Is a ventilator-associated pneumonia rate of zero really possible?
Curr Opin Infe…

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Is healthcare-associated pneumonia a distinct entity needing specific therapy?
Cu…

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Microsporidiosis: not just in AIDS patients.
Curr Opin Infect Dis. 2011 Aug 12;
Authors: Didier ES, Weiss LM
PURPOSE OF REVIEW: Microsporidia have emerged as causes of opportunistic infections associated with diarrhea …

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Invasive nontyphoidal Salmonella disease: epidemiology, pathogenesis and diagnosis.
Curr Opin Infect Dis. 2011 Aug 12;
Authors: Gordon MA
PURPOSE OF REVIEW: This review highlights and discusses important publications o…

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New Gram-positive antibiotics: better than vancomycin?
Curr Opin Infect Dis. 2011 Aug 12;
Authors: van Hal SJ, Paterson DL
PURPOSE OF REVIEW: Despite concerns about vancomycin use in the treatment of multidrug-resistan…

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Defining the causes of diarrhea: novel approaches.
Curr Opin Infect Dis. 2011 Aug 12;
Authors: Operario DJ, Houpt E
PURPOSE OF REVIEW: Diarrheal disease causes substantial morbidity and mortality worldwide; however, de…

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Managing intravascular catheter-related infections in heart transplant patients: how far can we apply IDSA guidelines for immunocompromised patients?
Curr Opin Infect Dis. 2011 Jun 9;
Authors: Bouza E, Burillo A, Guembe M
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Fungal pneumonia in patients with hematologic malignancies: current approach and management.
Curr Opin Infect Dis. 2011 Jun 9;
Authors: Mulanovich VE, Kontoyiannis DP
PURPOSE OF REVIEW: Fungal pneumonia is the most fre…

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Imaging studies for diagnosing invasive fungal pneumonia in immunocompromised patients.
Curr Opin Infect Dis. 2011 Jun 13;
Authors: Marom EM, Kontoyiannis DP
PURPOSE OF REVIEW: The aim is to review imaging advances in …

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Prevention of catheter-related infection: toward zero risk?
Curr Opin Infect Dis. 2011 May 16;
Authors: Zingg W, Walder B, Pittet D
PURPOSE OF REVIEW: This review identifies important findings in the recent literature …

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Why should we measure bacterial load when treating community-acquired pneumonia?

Curr Opin Infect Dis. 2011 Feb 4;

Authors: Waterer G, Rello J

PURPOSE OF REVIEW: We focus on a number of studies in the past 2 years that herald a dramatic shift in how we treat patients with not just community-acquired pneumonia (CAP), but potentially all sepsis. RECENT FINDINGS: Recent studies report that high bacterial load, and specifically pneumococcal load in CAP, appears to be significantly associated with worse outcomes. These findings change the sepsis paradigm. Bacterial load may identify potential candidates for adjunctive therapy, ICU admission and more aggressive management. SUMMARY: Whereas we all acknowledge the importance of the virulence of the pathogen in the outcome of CAP, microbiological tests currently play little role in management of patients. Whereas molecular tests such as polymerase chain reaction have promised to deliver accurate results in a clinically useful period of time, apart from a few niche situations they have yet to enter routine practice. In particular the ability to calculate the bacterial load in blood, and specifically pneumococcal load in CAP, appears to have significant clinical utility. Not only does bacterial load predict clinical outcome, the data so far available challenge some of our fundamental assumptions about optimal antibiotic therapy and the pathogenesis of severe sepsis.

PMID: 21301334 [PubMed - as supplied by publisher]

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The role of viruses in nosocomial pneumonia.

Curr Opin Infect Dis. 2011 Jan 19;

Authors: Chiche L, Forel JM, Papazian L

PURPOSE OF REVIEW: The frequency and impact of viruses among intensive care unit (ICU) nonimmunocompromised patients remains controversial. This review analyzes their place as causal pathogens in ventilator-associated pneumonia, as well as their effects on ICU patients’ outcomes. RECENT FINDINGS: Herpesviruses, namely herpes simplex virus (HSV) and cytomegalovirus (CMV), are the most frequent viruses detected among nonimmunosuppressed ICU patients, as confirmed by recent prospective studies. Patients infected with these viruses show increased morbidity and, especially for CMV, mortality. An increase of bacterial or fungal superinfections was observed in ICU patients with CMV reactivation. A therapeutic trial of acyclovir (HSV antiviral) in ICU patients was negative. Concerning CMV, pathogenicity was suggested by histologic assessment in ICU patients, and recent murine models with a positive effect of prophylaxis with ganciclovir that prevented postseptic CMV reactivation and secondary lung damage. SUMMARY: Using efficient and rapid virologic diagnostic tests (antigenemia or PCR), the identification of viruses in ICU patients is frequent. Their role in the occurrence of ventilator-acquired pneumonia and their impact on patient outcome depend on the virus. There is sufficient evidence suggesting CMV pathogenicity to conduct an interventional randomized trial using anti-CMV drugs.

PMID: 21252660 [PubMed - as supplied by publisher]

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Nursing home acquired pneumonia: approach to management.

Curr Opin Infect Dis. 2011 Jan 19;

Authors: El-Solh AA

PURPOSE OF REVIEW: Pneumonia is among the leading causes of mortality in nursing home residents and a primary reason for transfer to acute care facilities. Compared with community-dwelling individuals, residents of long-term care facilities have extensive underlying medical illnesses and more functional disabilities and are at increased risk of acquiring drug-resistant pathogens. This review focuses on recent recommendations for diagnostic work up, validity of prognostic models, and current approach to treatment of nursing home acquired pneumonia (NHAP). RECENT FINDINGS: The inconsistency in defining NHAP is considered a potential hindrance for a uniform approach to the management of pneumonia. Diagnostic evaluation varies between facilities and depends on severity of illness and access to laboratory facilities. The role of prognostic models in stratifying severity of disease remains largely unknown due to paucity of studies and lack of a specific scoring system for hospitalized patients with NHAP. A controversy still exists concerning the best therapeutic option for NHAP, but it is reasonable to believe that each setting is adapting the existing evidence according to the best local practice. SUMMARY: A unified approach to defining, assessing, and stratifying pneumonia is essential to decrease morbidity and mortality in nursing home residents. High-quality randomized, controlled trials examining empiric antibiotic therapy are needed.

PMID: 21252661 [PubMed - as supplied by publisher]

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