Current opinion in infectious diseases
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Curr. Opin. Infect. Dis. · Jun 2011
ReviewThe effect of inflammation on coagulation and vice versa.
In infection, inflammation is frequently accompanied by a disturbance of the normal hemostatic balance provided by procoagulant and anticoagulant mechanisms. This review summarizes recently acquired knowledge on the bimodal interactions between coagulation and inflammation in infection. ⋯ Recent data provide new insights into how inflammation impacts on coagulation and vice versa, identifying crucial roles for PARs. This knowledge may assist in designing novel interventions targeted at the perpetuation of inflammation by mediators traditionally implicated in coagulation.
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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. ⋯ 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.
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Due to their different virulence and infectivity, both severe acute respiratory syndrome (SARS) and H1N1 09 revealed different strengths and weaknesses in our ability to contain new viral threats over the past decade. This review focuses on recent literature around attempts to contain the impact of these two viral epidemics that have refined our approach for the future. ⋯ The experience with H1N1 09 and SARS has been very useful in informing us of the strengths and weaknesses of our current approach to emerging epidemics. Key messages are a need for improved surveillance, more flexible planning, improved diagnostic testing and retaining a focus on basic hygiene measures.
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Curr. Opin. Infect. Dis. · Apr 2011
ReviewModifying endotracheal tubes to prevent ventilator-associated pneumonia.
The endotracheal tube (ETT) is the main avenue leading to airway contamination and subsequent ventilator-associated pneumonia (VAP) during mechanical ventilation. A number of modifications to the ETT are available, aimed at reducing the incidence of VAP. We review here available systems and devices, and clinical data regarding their efficacy. ⋯ Modifications of ETTs aimed at decreasing the onset of VAP show promising results. However, the lack of a significant effect on outcomes prompts us to use caution before recommending their widespread use.
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Curr. Opin. Infect. Dis. · Feb 2011
ReviewAntimicrobial stewardship: bridging the gap between quality care and cost.
Antibiotic resistance continues to rise, whereas development of new agents to counter it has slowed. A heightened need exists to maintain the effectiveness of currently available agents. This review focuses on the need for better antimicrobial stewardship, expected benefits of well designed antimicrobial stewardship programs (ASPs), and provides suggestions for development of an effective ASP. ⋯ Better antimicrobial stewardship is needed to limit the emergence of antibiotic resistance, prolong the effectiveness of currently available agents, improve patient outcomes, and reduce healthcare and societal costs associated with HAIs. Guidelines from the IDSA/SHEA and experiences at OSUMC provide examples of how best to develop an institutional ASP to accomplish these goals.