Clinical Infectious Diseases最新文献

Vulvovaginal candidiasis is one of the most prevalent infections in women worldwide. Together with its recurrent form, it affects millions of women annually, causing significant symptoms and severely impacting quality of life. This review examines the pathophysiology, risk factors, microbiome interactions, clinical manifestations, and challenges in diagnosing and managing vulvovaginal candidiasis, with emphasis on recurrent vulvovaginal candidiasis. While Candida albicans is the primary cause, non-albicans species are increasingly common. Multiple factors contribute to both forms, including hormonal changes, diabetes, antibiotic use, immune dysfunction, and genetics. The vaginal microbiome plays a key role in maintaining homeostasis and preventing Candida overgrowth. Symptoms such as itching, discharge, and soreness overlap with other conditions, complicating the diagnosis. Standard treatment involves topical or systemic antifungals, but recurrence and resistance are frequent. Emerging strategies include novel antifungals, immunomodulators, and vaccines. Future approaches should focus on modulating host and environmental factors to prevent recurrence, reduce resistance, and improve outcomes.

Background: Switching to oral therapy has become an option for treating infective endocarditis (IE) in well-selected patients. This study aimed to assess its effectiveness in real-life settings, including patients who would not have been eligible under current guidelines based on the POET trial results.

Methods: All adults treated for IE in two French tertiary centers from January 2016 to December 2023 were included in a retrospective cohort. For each participant, clinical, microbiological, and therapeutic data were collected retrospectively. Patients who received at least 10 days of effective antibiotic therapy were included and categorized based on the route of administration (exclusively intravenous or with a switch to oral therapy). POET-ineligible patients were those who were not eligible in the POET trial. Treatment failure (death, recurrence, or need for suppressive therapy, within 3 months following completion of the initial antibiotic course) was assessed using propensity score (PS) analysis, with oral switch as a time-dependent variable.

Results: Three hundred and thirty-three participants were included (233 in the intravenous group and 100 patients in the oral group). No significant difference in treatment failure was observed between groups after adjustment using a PS (HR = 0.55 in favor of oral switch, 95% CI = .27-1.17). The results were similar in the POET-ineligible subgroup, which accounted for 44.7% of participants. Days alive outside the hospital were significantly higher in the oral group (59 vs 47 days, P = .001).

Conclusions: Oral switch is a suitable option beyond "classical" frontiers in the management of IE, with potential direct and indirect benefits.

This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children, developed by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. In this report, the panel provides recommendations for intrapleural fibrinolysis with tissue plasminogen activator (tPA) alone over tPA and dornase alfa (DNase) in children (3 months to 18 years) with complicated parapneumonic effusion and empyema. The panel's recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.