DOCSLIB.ORG

Series Fungal Infections 5 the Global Problem of Antifungal Resistance

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Series Fungal Infections 5 the Global Problem of Antifungal Resistance Series Fungal infections 5 The global problem of antifungal resistance: prevalence, mechanisms, and management David S Perlin, Riina Rautemaa-Richardson, Ana Alastruey-Izquierdo All serious fungal infections need appropriate antifungal therapy for successful patient outcome. Only a few classes Lancet Infect Dis 2017 of antifungal drugs are available, so the emergence of resistance to single drug classes and now multidrug resistance This is the fifth in a Series of greatly hampers patient management. Azole resistance among Candida and Aspergillus species is one of the greatest eight papers about fungal challenges to clinical success, followed by echinocandin and multidrug resistance among some Candida species, infections especially Candida glabrata. The spread of agriculturally derived azole-resistant Aspergillus fumigatus and emerging Published Online July 31, 2017 threats such as multidrug resistant Candida auris are also alarming. The molecular mechanisms that cause drug http://dx.doi.org/10.1016/ resistance are naturally occurring in less susceptible species and are acquired in strains of susceptible organisms. S1473-3099(17)30316-X Drug resistance mechanisms include altered drug-target interactions, reduced cellular drug concentrations mediated See Online/Series by drug efflux transporters, and permeability barriers associated with biofilms. Although C auris is inherently http://dx.doi.org/10.1016/ multidrug resistant, other strains typically develop resistance through stepwise selection of multiple drug-resistance S1473-3099(17)30303-1, http://dx.doi.org/10.1016/ mechanisms. Cellular stress induced by drug treatment promotes adaptation, which contributes to breakthrough S1473-3099(17)30304-3, resistance. Drug exposure also drives the emergence of resistance. An effective antifungal stewardship programme is http://dx.doi.org/10.1016/ essential to control drug resistance, and should incorporate rapid fungal diagnostics, therapeutic drug monitoring, S1473-3099(17)30309-2, and clinical intervention teams. The development of better diagnostic tools and strategies that allow targeted use of http://dx.doi.org/10.1016/ S1473-3099(17)30306-7, antifungals is essential to preserve drug effectiveness. http://dx.doi.org/10.1016/ S1473-3099(17)30442-5, Introduction Factors driving emergence of antifungal http://dx.doi.org/10.1016/ Fungal pathogens cause life-threatening invasive resistance S1473-3099(17)30443-7, and http://dx.doi.org/10.1016 diseases (eg, fungaemia, meningitis, pneumonia), severe Therapeutic failure occurs when a patient either fails to S1473-3099(17)30308-0 chronic conditions (eg, chronic pulmonary aspergillosis, respond or no longer responds to a drug administered at See Online/Comment allergic bronchopulmonary aspergillosis), and complex a standard dose. Various host, drug, and microbial http://dx.doi.org/10.1016/ chronic respiratory conditions (eg, asthma, chronic factors contribute to such failures—eg, patients with a S1473-3099(17)30319-5 obstructive pulmonary disease). These pathogens also compromised immune system are more likely to fail to cause recurrent infections, such as oral and vaginal respond to therapy because the antifungal drug is candidiasis. Many invasive fungal infections (IFIs) are a consequence of underlying health conditions associated with immunosuppression.1 Generally, these infections Key messages are associated with high mortality, and successful clinical • Antifungal drug resistance can occur with all drug classes, and involves acquired outcome requires early diagnosis and effective antifungal resistance in susceptible strains and selection of inherently less susceptible species therapy. Yet, antifungal options are few, with chemical • Azole resistance is primarily caused by target modification in Aspergillus species, classes for invasive disease treatment limited to azoles, and by overexpression of drug efflux pumps and modification of the drug target in 2 echinocandins, polyenes, and flucytosine. Candida species Over the past decade, the development of less toxic • Agricultural fungicides drive acquired drug resistance in Aspergillus species, and these drugs, which can be applied safely in a range of patients resistant strains are spreading globally with various conditions, has contributed to the expansion • Candida glabrata can acquire resistance to azoles and echinocandins as single drug of antifungal use for prophylaxis, and empirical and classes, as well as multidrug resistance involving all major drug classes directed therapy, which has in turn led to increased drug • Echinocandin resistance is uncommon, but is conferred by hot spot aminoacid resistance. The use of medically related antifungal drugs substitutions in glucan synthase in agriculture has resulted in environmental reservoirs • Biofilms confer all or partial resistance to most drug classes 3,4 for some drug-resistant pathogens. The emergence of • Genetic factors, such as global transcription factors, DNA repair, and chromosomal drug resistance to any one drug class severely limits abnormalities help to induce drug-resistant phenotypes therapy because so few treatment options are available. • The occurrence of cryptic species, which are often drug resistant, is increasing. Multidrug resistance can eliminate treatment options • Emerging species that are resistant to all antifungal classes (eg, Candida auris) entirely, which has a devastating effect on patient are increasingly reported outcome. In this Series paper, the effect of antifungal • Robust antifungal stewardship programmes that integrate rapid diagnostics, resistance on patient care and the role of antimicrobial therapeutic drug monitoring, and clinical intervention teams are required to stewardship programmes in the prevention of antifungal overcome drug resistance in the clinic resistance are discussed. www.thelancet.com/infection Published online July 31, 2017 http://dx.doi.org/10.1016/S1473-3099(17)30316-X 1 Series Public Health Research without the assistance of a robust immune response in success, uncertain effect of treatment, or high probability Institute, New Jersey Medical the fight against the infection.5 Indwelling catheters, of treatment failure. Antifungal susceptibility testing School, Rutgers Biomedical and artificial heart valves, and other implanted devices identifies fungal strains that probably cause treatment Health Sciences, Newark, NJ, USA (Prof D S Perlin PhD); contribute to refractory infections because these surfaces failure, and provides an index for trends in changing Manchester Academic Health are often colonised with drug-impermeable biofilms. susceptibility or new drug resistance mechanisms. Drug Science Centre, University of Although drug penetration at sites of infection is poorly susceptibility testing is routinely used to assess yeasts, Manchester and University understood, drug delivery within the host is known to but is not formally recommended for the assessment of Hospital of South Manchester, Wythenshawe Hospital, contribute to therapeutic failure—eg, an intra-abdominal Aspergillus species by the Infectious Diseases Society of Manchester, UK abscess can seed drug resistance because fungi are America. (R Rautemaa-Richardson MD); exposed to suboptimal concentrations of drug.6 Among Of course, the application of antifungal susceptibility and Medical Mycology Reference Laboratory, patients with chronic infections, poor compliance with testing varies with clinical setting (eg, those with a high National Center for drug regimens might contribute to suboptimal drug probability of resistance), individual patient risk factors, Microbiology, Instituto de exposure. Drug exposure in the form of prophylaxis, and response to therapy. In specialist laboratories, the Salud Carlos III, Madrid, Spain repeated, or long-term therapy is associated with EUCAST and CLSI reference methods are mostly used for (A Alastruey-Izquierdo PhD) the emergence of resistance. Similarly, exposure to yeast susceptibility testing, whereas routine microbiology Correspondence to: agricultural fungicides with identical molecular targets laboratories rely on commercial techniques, such as Prof David S Perlin, Public Health 15 13 Research Institute, New Jersey to those of systemic antifungals has seeded environmental Etest and Sensititre YeastOne, or automated systems, Medical School-Rutgers reservoirs of resistant organisms. Microbiological drug like Vitek.16 For Candida spp, the results of these tests are University, Newark, NJ 07103, resistance can be either primary (intrinsic) or secondary generally in agreement with those obtained by reference USA [email protected] (acquired). Primary drug resistance is found naturally methods. among some fungi without previous exposure, and often involves the same mechanism as that which causes Azole resistance acquired resistance, although unknown mechanisms can Azole compounds (eg, fluconazole, voriconazole, also be implicated. The molecular mechanisms that posaconazole) target the cytochrome P450 enzyme sterol confer antifungal resistance are known for all major drug 14α-demethylase, which converts lanosterol to ergosterol, classes, and are addressed in this Series paper, but and is encoded by ERG11 in yeast and Cyp51 in moulds. the complex biological factors that promote these Inhibition of 14α-demethylase is fungistatic in yeasts mechanisms are only starting to be elucidated.7 and fungicidal in moulds. Triazoles are recommended for the treatment of aspergillosis, and are widely used Assessment of antifungal
Load more

Recommended publications
  • Council of State and Territorial Epidemiologists
    Appendix 1 Identification of Candida auris (as of August 20, 2018). This appendix will be updated as new information about C. auris identification becomes available. Some yeast identification methods are unable to differentiate C. auris from other yeast species. C. auris can be misidentified as a number of different organisms when using traditional biochemical methods for yeast identification such as VITEK 2 YST, API 20C, BD Phoenix yeast identification system, and MicroScan. The most common misidentification of C. auris is Candida haemulonii. C. haemulonii have been less commonly observed to cause invasive infections. Therefore, C. auris should be suspected when C. haemulonii is identified on culture of blood or other normally sterile site unless the method used can reliably detect C. auris. Candida isolates from the urine and respiratory tract ultimately confirmed as C. auris have been initially identified as C. haemulonii; less data are available about the ability of C. haemulonii to grow in urine or the respiratory tract, although true C. haemulonii infections in general appear to be rare in the United States. The table below summarizes common misidentifications based on the yeast identification method used. If any of the species listed below are identified using the specified identification method, or if species identity cannot be determined by any method, further characterization using appropriate methodology should be sought. Common misidentifications for C. auris by yeast identification method Identification Method Organism C. auris can be misidentified as No misidentifications of Candida auris. Bruker Bruker MALDI Biotyper (FDA database) MALDI-TOF is able to accurately identify C. auris bioMérieux VITEK MS (IVD/RUO database) Candida haemulonii Candida haemulonii VITEK 2 YST (Ver.
    [Show full text]
  • Pdf 839.18 K
    Current Medical Mycology 2019, 5(4): 26-34 Species distribution and susceptibility profiles of Candida species isolated from vulvovaginal candidiasis, emergence of C. lusitaniae Seyed Ebrahim Hashemi1, Tahereh Shokohi2, 3*, Mahdi Abastabar2, 3, Narges Aslani4, Mahbobeh Ghadamzadeh5, Iman Haghani3 1 Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 2 Invasive Fungi Research Centre (IFRC), Mazandaran University of Medical Sciences, Sari, Iran 3 Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 4 Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 5 Gynecology and Obstetrics Department of Hazrat-e- Zainab Hospital, Babolsar, Iran Article Info A B S T R A C T Article type: Background and Purpose: The aim of the current study was to investigate the Original article epidemiology of vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC), as well as the antifungal susceptibility patterns of Candida species isolates. Materials and Methods: A cross-sectional study was carried out on 260 women suspected of VVC from February 2017 to January 2018. In order to identify Candida Article History: species isolated from the genital tracts, the isolates were subjected to polymerase chain Received: 02 August 2019 reaction restriction fragment length polymorphism (PCR-RFLP) using enzymes Msp I Revised: 20 October 2019 and sequencing. Moreover, antifungal susceptibility testing was performed according to Accepted: 10 November 2019 the Clinical and Laboratory Standards Institute guidelines (M27-A3). Results: Out of 250 subjects, 75 (28.8%) patients were affected by VVC, out of whom 15 (20%) cases had RVVC. Among the Candida species, C.
    [Show full text]
  • Prophylactic Antibiotics and Prevention of Surgical Site Infections
    Prophylactic Antibiotics and Prevention of Surgical Site Infections Peter A. Najjar, MD, Douglas S. Smink, MD, MPH* KEYWORDS Surgical site infection Prophylactic antibiotics Perioperative infection control KEY POINTS Surgical site infections (SSIs) are the most common type of healthcare-associated infection in the United States, affecting more than 500,000 patients annually. Studies suggest that 40% to 60% of these infections may be preventable. Patients diagnosed with SSI face a 2 to 11 times increase in mortality along with prolonged hospital stays, treatment-associated risks, and potential long-term sequelae. Nationwide efforts to improve SSI rates include monitoring compliance with preventive guidelines via the Surgical Care Improvement Program (SCIP) along with reporting of risk-adjusted infection rates via the National Healthcare Safety Network (NHSN) and the American College of Surgeons National Surgical Quality Improvement Program (ACS- NSQIP). Preoperative prophylaxis with appropriately selected procedure-specific antibiotics administered 1 hour before skin incision is a mainstay of SSI prevention; excess prophy- lactic antibiotic use either through poor selection or continuation postoperatively is a major driver of increased multidrug-resistant organism isolates. Adjunctive measures, such as surgical safety checklists, minimally invasive surgical techniques, and maintenance of perioperative homeostasis, can help further reduce the burden of SSI. INTRODUCTION Healthcare-associated infections (HAIs) present a significant source of preventable morbidity and mortality. More than 30% of all HAIs are represented by surgical site infections (SSIs), making them the most common subtype.1,2 Between 1.9% and Conflict of Interest: None. Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA * Corresponding author.
    [Show full text]
  • Current Issues and Perspectives in Patients with Possible Sepsis at Emergency Departments
    antibiotics Review Current Issues and Perspectives in Patients with Possible Sepsis at Emergency Departments Ioannis Alexandros Charitos 1, Skender Topi 2, Francesca Castellaneta 3 and Donato D’Agostino 4,* 1 Department of Emergency/Urgency, National Poisoning Center, Riuniti University Hospital (OO.RR.) of Foggia, 71122 Foggia, Italy; [email protected] 2 School of Technical Medical Sciences, University A. Xhuvani, Elbasan 3001, Albania; [email protected] 3 School of Medicine, University of Foggia, 71122 Foggia, Italy; [email protected] 4 Department of Emergency and Organ Transplantation (DETO), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy * Correspondence: donato.d’[email protected] or [email protected]; Tel./Fax: +39-0805595076 Received: 8 April 2019; Accepted: 25 April 2019; Published: 7 May 2019 Abstract: In the area of Emergency Room (ER), many patients present criteria compatible with a SIRS, but only some of them have an associated infection. The new definition of sepsis by the European Society of Intensive Care Medicine and the Society of Critical Care Medicine (2016), revolutionizes precedent criteria, overcoming the concept of SIRS and clearly distinguishing the infection with the patient’s physiological response from the symptoms of sepsis. Another fundamental change concerns the recognition method: The use of SOFA (Sequential-Sepsis Related-Organ Failure Assessment Score) as reference score for organ damage assessment. Also, the use of the qSOFA is based on the use of three objective parameters: Altered level of consciousness (GCS <15 or AVPU), systolic blood pressure 100 mmHg, and respiratory rate 22/min. If patients have at least two of these ≤ ≥ altered parameters in association with an infection, then there is the suspicion of sepsis.
    [Show full text]
  • Antimicrobial Treatment Guidelines for Common Infections
    Antimicrobial Treatment Guidelines for Common Infections June 2016 Published by: The NB Provincial Health Authorities Anti-infective Stewardship Committee under the direction of the Drugs and Therapeutics Committee Introduction: These clinical guidelines have been developed or endorsed by the NB Provincial Health Authorities Anti-infective Stewardship Committee and its Working Group, a sub- committee of the New Brunswick Drugs and Therapeutics Committee. Local antibiotic resistance patterns and input from local infectious disease specialists, medical microbiologists, pharmacists and other physician specialists were considered in their development. These guidelines provide general recommendations for appropriate antibiotic use in specific infectious diseases and are not a substitute for clinical judgment. Website Links For Horizon Physicians and Staff: http://skyline/patientcare/antimicrobial For Vitalité Physicians and Staff: http://boulevard/FR/patientcare/antimicrobial To contact us: [email protected] When prescribing antimicrobials: Carefully consider if an antimicrobial is truly warranted in the given clinical situation Consult local antibiograms when selecting empiric therapy Include a documented indication, appropriate dose, route and the planned duration of therapy in all antimicrobial drug orders Obtain microbiological cultures before the administration of antibiotics (when possible) Reassess therapy after 24-72 hours to determine if antibiotic therapy is still warranted or effective for the given organism or
    [Show full text]
  • Antimicrobial Stewardship
    Antimicrobial Stewardship: Arizona Partnerships Working to Improve the Use of Antimicrobials in the Hospital and Community Part 1 “Antibacterials – indeed, anti-infectives as a whole – are unique in that misuse of these agents can have a negative effect on society at large. Misuse of antibacterials has led to the development of bacterial resistance, whereas misuse of a cardiovascular drug harms only the one patient, not causing a societal consequence.” - Glenn Tillotson; Clin Infect Dis. 2010;51:752 “…we hold closely the principles that antibiotics are a gift to us from prior generations and that we have a moral obligation to ensure that this global treasure is available for our children and future generations.” - David Gilbert, et al (and the Infectious Diseases Society of America). Clin Infect Dis. 2010;51:754-5 A Note To Our Readers and Slide Presenters The objectives of the Subcommittee on Antimicrobial Stewardship Programs are directed at education, presentation, and identification of resources for clinicians to create toolkits of strategies that will assist clinicians with understanding, implementing, measuring, and maintaining antimicrobial stewardship programs. The slide compendium was developed by the Subcommittee on Antimicrobial Stewardship Programs (ASP) of the Arizona Healthcare-Associated Infection (HAI) Advisory Committee in 2012-2013. ASP is a multidisciplinary committee representing various healthcare disciplines working to define and provide guidance for establishing and maintaining an antimicrobial stewardship programs within acute care and long-term care institutions and in the community. Their work was guided by the best available evidence at the time although the subject matter encompassed thousands of references. Accordingly, the Subcommittee selectively used examples from the published literature to provide guidance and evidenced-based criteria regarding antimicrobial stewardship.
    [Show full text]
  • C. Auris Reporting Guidance
    To: Healthcare Providers and Laboratorians From: Iowa Department of Public Health, Center for Acute Disease Epidemiology Re: Candida auris infection or Colonization in Iowa Residents as temporarily Reportable Date: December 4, 2020 Background: Candida auris is an emerging fungus that presents a serious global health threat. The CDC recommends that all Candida isolates obtained from normal sterile sites (e.g., bloodstream, cerebrospinal fluid) be identified to the species level as initial treatment can be administered based on the typical, species-specific susceptibility patterns. C. auris in a non-sterile body site is also very important to identify because the identification can represent wider colonization, which poses a risk for transmission and infection control precautions. If a laboratory identifies any Candida species from any site, submission of the isolate is warranted. Surveillance: All laboratories are to submit isolates from any site that include the following species: 1. Candida auris 2. Candida famata 3. Candida haemulonii 4. Candida sake 5. Rhodotorula glutinis 6. Saccharomyces cerevisiae 7. Candida spp. (isolates where the species is attempted and results are inconclusive). Algorithm to identify C. auris: The Centers for Disease Control and Prevention (CDC) provides an algorithm to identify C. auris based on phenotypic laboratory and initial species identification. The algorithm can be accessed at the following hyperlink: https://www.cdc.gov/fungal/diseases/candidiasis/pdf/Testing-algorithm-by-Method-temp.pdf. Specimen Submission: C. auris can be misidentified as a number of different organisms when using traditional phenotypic methods for yeast identification such as VITEK 2 YST, API 20C, BD Phoenix yeast identification system, and MicroScan.
    [Show full text]
  • Hospital Laboratory Survey for Identification of Candida Auris In
    Journal of Fungi Article Hospital Laboratory Survey for Identification of Candida auris in Belgium Klaas Dewaele 1 , Katrien Lagrou 2,3, Johan Frans 1, Marie-Pierre Hayette 4 and Kris Vernelen 5,* 1 Department of Clinical Microbiology, Imelda General Hospital, 2820 Bonheiden, Belgium 2 Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals of Leuven, 3000 Leuven, Belgium 3 Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium 4 Department of Clinical Microbiology and National Reference Center for Mycosis, University Hospital of Liège, 4000 Liège, Belgium 5 Quality of Laboratories, Sciensano, 1050 Brussels, Belgium * Correspondence: [email protected] Received: 4 August 2019; Accepted: 27 August 2019; Published: 5 September 2019 Abstract: Candida auris is a difficult-to-identify, emerging yeast and a cause of sustained nosocomial outbreaks. Presently, not much data exist on laboratory preparedness in Europe. To assess the ability of laboratories in Belgium and Luxembourg to detect this species, a blinded C. auris strain was included in the regular proficiency testing rounds organized by the Belgian public health institute, Sciensano. Laboratories were asked to identify and report the isolate as they would in routine clinical practice, as if grown from a blood culture. Of 142 respondents, 82 (57.7%) obtained a correct identification of C. auris. Of 142 respondents, 27 (19.0%) identified the strain as Candida haemulonii. The remaining labs that did not obtain a correct identification (33/142, 23.2%), reported other yeast species (4/33) or failed to obtain a species identification (29/33). To assess awareness about the infection-control implications of the identification, participants were requested to indicate whether referral of this isolate to a reference laboratory was desirable in a clinical context.
    [Show full text]
  • Vaginal Colonization and Vulvovaginitis by Candida Species in Pregnant Women from Northern of Colombia
    Archivos de Medicina (Col) ISSN: 1657-320X [email protected] Universidad de Manizales Colombia Vaginal colonization and vulvovaginitis by Candida species in pregnant women from Northern of Colombia Suárez, Paola; Belloz, Ana; Puelloz, Martha; Youngz, Gregorio; Duranz, Marlene; Arechavala, Alicia Vaginal colonization and vulvovaginitis by Candida species in pregnant women from Northern of Colombia Archivos de Medicina (Col), vol. 18, no. 1, 2018 Universidad de Manizales, Colombia Available in: https://www.redalyc.org/articulo.oa?id=273856494005 DOI: https://doi.org/10.30554/archmed.18.1.2010.2018 PDF generated from XML JATS4R by Redalyc Project academic non-profit, developed under the open access initiative Artículos de Investigación Vaginal colonization and vulvovaginitis by Candida species in pregnant women from Northern of Colombia Vulvovaginitis y colonización vaginal por especies de Candida en gestantes del norte de Colombia Resumen Paola Suárez [email protected] Cartagena University, Colombia Ana Belloz [email protected] Cartagena University., Colombia Martha Puelloz [email protected] Cartagena University., Colombia Gregorio Youngz [email protected] Cartagena University., Colombia Marlene Duranz [email protected] Cartagena University., Colombia Archivos de Medicina (Col), vol. 18, no. 1, 2018 Alicia Arechavala [email protected] Universidad de Manizales, Colombia Hospital de Infecciosas Muñiz, Buenos Aires, Argentina., Argentina Received: 10 June 2018 Corrected: 12 March 2018 Accepted: 12 April 2018 DOI: https://doi.org/10.30554/ Abstract: Objective: identify the vaginal colonizing Candida species and VVC species, archmed.18.1.2010.2018 predisposing factors and susceptibility against fluconazole in pregnant women attending Redalyc: https://www.redalyc.org/ gynecological outpatient of a maternal clinic in Cartagena (Colombia).
    [Show full text]
  • Antimicrobials and Resistance | Microbiology and Risk Factors for Transmission | Table of Contents | APIC
    11/2/2017 26. Antimicrobials and Resistance | Microbiology and Risk Factors for Transmission | Table of Contents | APIC Antimicrobials and Resistance Author(s): Forest W. Arnold, DO, MSc, FIDSA Assistant Professor, Division of Infectious Diseases University of Louisville Hospital Epidemiologist University of Louisville Hospital Louisville, KY Published: November 1, 2017 Abstract Although infection prevention traditionally has approached the problem of resistance primarily from the aspect of preventing transmission from an infected patient to a noninfected patient, more needs to be done to improve how antimicrobials are commonly used. Antimicrobial use is the main selective pressure responsible for the increasing resistance seen in hospitals. Patients come to possess a resistant pathogen either by transmitting bacteria that already have the resistance gene in place or by having their bacteria acquire a gene that codes for resistance. The former is more common because it merely requires a handshake while the latter takes days to weeks to develop. To have an impact on antimicrobial use so as to reduce resistance, infection preventionists (IPs) need a working knowledge of available antimicrobials, principles for their appropriate use, the mechanisms by which these drugs inhibit microbial growth, and the mechanisms by which microorganisms develop resistance. In addition, IPs need to understand promising new strategies to improve antimicrobial use and how members of the infection prevention community can become more involved. Key Concepts Although infection prevention traditionally has approached the problem of resistance primarily from the aspect of preventing transmission, more needs to be done to control how antimicrobials are commonly used. Antimicrobial stewardship is the best investment for preventing the proliferation of multidrug-resistant pathogens and the adverse events associated with the drugs used to treat such pathogens.
    [Show full text]
  • IDSA/ATS Consensus Guidelines on The
    SUPPLEMENT ARTICLE Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults Lionel A. Mandell,1,a Richard G. Wunderink,2,a Antonio Anzueto,3,4 John G. Bartlett,7 G. Douglas Campbell,8 Nathan C. Dean,9,10 Scott F. Dowell,11 Thomas M. File, Jr.12,13 Daniel M. Musher,5,6 Michael S. Niederman,14,15 Antonio Torres,16 and Cynthia G. Whitney11 1McMaster University Medical School, Hamilton, Ontario, Canada; 2Northwestern University Feinberg School of Medicine, Chicago, Illinois; 3University of Texas Health Science Center and 4South Texas Veterans Health Care System, San Antonio, and 5Michael E. DeBakey Veterans Affairs Medical Center and 6Baylor College of Medicine, Houston, Texas; 7Johns Hopkins University School of Medicine, Baltimore, Maryland; 8Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi School of Medicine, Jackson; 9Division of Pulmonary and Critical Care Medicine, LDS Hospital, and 10University of Utah, Salt Lake City, Utah; 11Centers for Disease Control and Prevention, Atlanta, Georgia; 12Northeastern Ohio Universities College of Medicine, Rootstown, and 13Summa Health System, Akron, Ohio; 14State University of New York at Stony Brook, Stony Brook, and 15Department of Medicine, Winthrop University Hospital, Mineola, New York; and 16Cap de Servei de Pneumologia i Alle`rgia Respirato`ria, Institut Clı´nic del To`rax, Hospital Clı´nic de Barcelona, Facultat de Medicina, Universitat de Barcelona, Institut d’Investigacions Biome`diques August Pi i Sunyer, CIBER CB06/06/0028, Barcelona, Spain. EXECUTIVE SUMMARY priate starting point for consultation by specialists. Substantial overlap exists among the patients whom Improving the care of adult patients with community- these guidelines address and those discussed in the re- acquired pneumonia (CAP) has been the focus of many cently published guidelines for health care–associated different organizations, and several have developed pneumonia (HCAP).
    [Show full text]
  • Setting a Protocol for Identification and Detecting the Prevalence of Candida Auris in Tertiary Egyptian Hospitals Using the CDC Steps
    Scientific Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2021 Jun 14; 9(A):397-402. https://doi.org/10.3889/oamjms.2021.6095 eISSN: 1857-9655 Category: A - Basic Sciences Section: Microbiology Setting a Protocol for Identification and Detecting the Prevalence of Candida auris in Tertiary Egyptian Hospitals Using the CDC Steps Sahar Mohammed Khairat, Mervat Gaber Anany, Maryam Mostafa Ashmawy , Amira Farouk Ahmed Hussein* Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt Abstract Edited by: Slavica Hristomanova-Mitkovska BACKGROUND: Candida is considered the most common cause of opportunistic infections in the world. Increased Citation: Khairat SM, Ashmawy MM, Hussein A. Setting a Protocol for Identification and Detecting the Prevalence use of antifungal agents may have led to increasing resistance of Candida for antifungals and may be related of Candida auris in Tertiary Egyptian Hospitals Using to therapeutic failures. Recently, a multidrug-resistant Candida auris has immerged causing outbreaks in several the CDC Steps. Access Maced J Med Sci. 2021 Jun 14; countries all over the world. This discovered superbug is widely spread causing a broad range of health care- 9(A):397-402. https://doi.org/10.3889/oamjms.2021.6095 associated infections. Keywords: Candida auris; Multidrug resistance; Thermotolerance; Matrix-assisted laser desorption/ AIM: This study aims to set a protocol for the identification and detection of the prevalence of C. auris in tertiary ionization-time of flight Egyptian hospitals following the center of disease and control (CDC) methodology. *Correspondence: Amira Farouk Ahmed Hussein, Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt.
    [Show full text]