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Managing Candidiasis: Updated Guidelines

Managing Candidiasis: Updated Guidelines

The Infectious Diseases Society of America (IDSA) last updated their guideline on the management of candidiasis in 2009. Since that time, new data have emerged on the diagnosis, prevention, and treatment of this major cause of morbidity and mortality, leading to an update to IDSA’s recommendations that was recently released. “Among the most important studies during this time were those that assessed first-line therapy with echinocandins versus azoles,” says Peter G. Pappas, MD, lead author of the guideline update. This new research shows that echinocandins—which kill the fungus—are more effective than azoles—which prevent the fungus from growing—in treating invasive infections. “The data support our key recommendation to start most patients with candidiasis on echinocandins and then step down to an azole.” Judicious Prophylaxis The updated guideline also addresses the importance of judiciously using prophylaxis. It is important to understand which patient populations are mostly likely to benefit from prophylaxis, including ICU patients and transplant recipients. ICU patients who stand to benefit most from prophylaxis include patients: Who have been on antibiotics. Have central venous catheters. Are on a ventilator. Have pancreatitis or recent abdominal surgery. Are immunosuppressed. Have skin burns. “Transplant patients who would benefit most from prophylaxis include high-risk liver transplant recipients, those with modified renal function, and those with prolonged operations who require blood products,” adds Dr. Pappas. Clinicians are also advised to suspect candidiasis in patients who are deteriorating without an obvious reason, have unexplained fever, and have elevated white blood cell counts.   The Importance of Early Care A key theme throughout the guideline update is the importance of early recognition and initiation of therapy...
Progress Elusive for New Antibiotics

Progress Elusive for New Antibiotics

There has been a desperate need for new antibiotics to treat infections caused by multidrug-resistant gram-negative bacilli (GNB) bacteria. In 2010, the Infectious Diseases Society of America (IDSA) launched its 10 x ’20 Initiative, which established a goal to develop 10 new systemic drugs to treat infections caused by resistant GNB bacteria by 2020. Unfortunately, there are still many barriers to the approval of these needed additional antibiotics, and it’s highly unlikely that these new drugs will be developed by 2020. Accelerated Efforts on Antibiotic Development Needed According to recent data, only seven new drugs are currently in development for the treatment of infections caused by GNB bacteria. Since the IDSA’s 10 x ’20 Initiative, only one new systemic antibiotic has been approved. There is also no guarantee that the drugs currently in development will actually gain FDA approval or will work against the most resistant bugs. While some progress has been made, ground is still being lost because new drugs aren’t being developed quickly enough to keep pace with antibiotic resistance.   At this time of greatest need, the number of pharmaceutical companies investing in antibiotic research and development (R&D) has decreased substantially. Only four multinational pharmaceutical companies have engaged in antibacterial discovery. R&D resources are typically strongest for developing drugs for chronic disease like high cholesterol, diabetes, and cancer. These drugs can provide significant financial rewards, partly because they’re intended for use for long periods of time. Antibiotics are a different story because they’re intended to be taken for shorter courses. This has made it less appealing for the pharmaceutical industry to use R&D resources for such...
Guideline Recommendations for Prosthetic Joint Infections

Guideline Recommendations for Prosthetic Joint Infections

Research shows that as many as 20,000 of the nearly 1 million total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures performed in the United States result in a prosthetic joint infection (PJI) over the lifetime of the device. PJIs remain one of the most serious complications of prosthetic joint implantation. According to recent estimates, roughly 4 million THAs and TKAs will be performed each year in the U.S. by 2030, due largely to the rapidly increasing elderly population. Diagnosing PJIs is often challenging for physicians and frequently necessitates multiple modalities. Management of these infections typically requires surgical interventions and lengthy courses of intravenous (IV) and oral antibiotics. Although much research has been conducted in this area, questions about optimal diagnosis and management strategies for PJIs remain. The Infectious Diseases Society of America (IDSA) recently released updated guidelines that are intended to help clinicians by offering optimal strategies to improve the diagnosis and management of these infections. Using a Team Approach A key point that the IDSA guidelines emphasize is that using a multidisciplinary team approach is essential for managing PJIs. “A strong collaboration is required from all medical specialists who are involved in the care of patients with PJIs,” explains Douglas R. Osmon, MD, who served as lead author of the IDSA guidelines. “This team most often includes an orthopedist and an infectious diseases specialist. Other specialists should be involved on a case-by-case basis, such as plastic surgeons, general internists, nurses, mid-level providers, and microbiologists.”   Patients requiring THA or TKA procedures tend to be elderly, meaning they are more likely than others to have multiple comorbidities,...
Guidelines for Diagnosing & Treating Diabetic Foot Infections

Guidelines for Diagnosing & Treating Diabetic Foot Infections

As the incidence of diabetes has steadily increased over the last several decades throughout the United States, diabetic foot infections have also become increasingly common. As many as one in four people with diabetes will have a foot ulcer in their lifetime, and these wounds can easily become infected. If left unchecked, they can spread and may ultimately require amputation of the toe, foot, or part of the leg. Nearly 80% of all nontraumatic amputations occur in people with diabetes, 85% of which begin with a foot ulcer. “Lower extremity amputation severely affects quality of life in people with diabetes because it reduces independence and mobility,” says Warren S. Joseph, DPM, FIDSA. “Furthermore, about 50% of patients who have foot amputations die within 5 years, which ranks as a worse mortality rate than for most cancers.” However, about half of lower extremity amputations that are not caused by trauma can be prevented through proper care of foot infections. Preventing amputations is vital. In most cases, these infections can be prevented or cured when properly managed. Recommendations for Diabetic Foot Infections In a 2012 issue of Clinical Infectious Diseases, the Infectious Diseases Society of America (IDSA) published a clinical practice guideline for diagnosing and treating diabetic foot infections. The guideline addresses 10 common questions with evidencebased answers that experts have determined are most likely to help healthcare providers treating these infections. The guideline is a revision and update of IDSA’s 2004 recommendations for managing diabetic foot infections. With regard to diagnosis, the guideline recommends that infections in foot wounds be defined clinically by the presence of inflammation or purulence, and...

Welcome Guidelines for Managing Rhinosinusitis

Recent estimates suggest that the direct annual costs of sinusitis are approximately $5.8 billion in the United States, and nearly one in seven Americans is diagnosed with a sinus infection every year. Rhinosinusitis is one of the most common reasons patients seek medical help. It ranks among the top five reasons for antibiotic prescriptions for adults. However, 90% to 98% of patients presenting with symptoms of sinusitis have viral causes and will not benefit from antibiotics. The overuse of antibiotics among this population has contributed largely to the emergence of antimicrobial resistance. The Need for Guidance “Clinicians need clear guidance on how to treat patients with rhinosinusitis and on how to differentiate viral from bacterial infections,” says Thomas M. File, Jr., MD. In the April 15, 2012 issue of Clinical Infectious Diseases, Dr. File coauthored guidelines from the Infectious Disease Society of America (IDSA) on acute bacterial rhinosinusitis in children and adults. “Reasonable criteria are needed for making decisions on when it’s appropriate to prescribe antibiotics in rhinosinusitis,” he says. “We also wanted to provide an update on the information available on the bacteria that are causing bacterial sinusitis as a result of emerging resistance [Table 1].” With no simple test to quickly determine whether an infection is viral or bacterial, many physicians prescribe antibiotics to play it safe. According to Dr. File, this practice has led patients to expect to receive antibiotics when they have an infection. “If they aren’t prescribed one, they may be dissatisfied with the patient–physician interaction,” he adds. “Patients and physicians both need to be educated that using antibiotics when they’re unwarranted will provide...
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