Current Opinion in Infectious Diseases最新文献

Purpose of review: To evaluate the current evidence on the use of omadacycline for the treatment of skin and soft tissue infections (SSTIs).

Recent findings: This narrative review examines the available data on the pharmacology, clinical efficacy, safety profile, and comparative effectiveness of omadacycline in treating SSTIs, with a focus on its potential role in everyday clinical practice.

Summary: Omadacycline is a viable option for outpatient therapy and early discharge in patients with SSTIs, particularly in frail populations and those undergoing chronic polypharmacotherapy. Emerging real-world evidence highlights its potential utility beyond approved indications, particularly for infections caused by multidrug-resistant microorganisms where treatment options are limited. However, further studies are needed to confirm its role in contexts beyond its current approvals.

Purpose of review: Optimal duration of therapy in SSTIs - a heterogeneous group of infections - remains unknown. The advances in knowledge of antibiotic duration of treatment in selected SSTIs that can impact clinical practice and published in the last 18 months are reviewed.

Recent findings: Recent evidence indicates that few patients receive guideline concordant empiric antibiotics and appropriate duration in the United States, although this likely can be extrapolated to other countries. One of the most commonly identified opportunities to improve antibiotic stewardship is duration of therapy more than 10 days. The long-standing debate regarding the significance of abscess size and its impact on clinical response to antibiotics, following proper drainage, is increasingly shifting towards the conclusion that abscess size is not directly associated with cure.In obese patients with SSTI, there is no benefit to longer antibiotic durations for SSTIs in patients with obesity, and it appears that longer antibiotic duration of therapy was associated with increased treatment failure. In diabetic foot infections (DFO), two randomized studies suggest that in the presence of osteomyelitis, the total duration of antibiotic therapy for patients treated nonsurgically does not need to be more than 6 weeks. In a prospective, randomized, noninferiority, pilot trial, patients with DFO who underwent surgical debridement and received either a 3-week or 6-week course of antibiotic therapy had similar outcomes and antibiotic-related adverse events. In patients with necrotizing soft tissue infections, successive observational studies clearly suggest that short duration of antibiotic treatment after NSTI source control is as well tolerated and effective as a longer course. It appears that 48 h would be enough. The possibility of fixed versus individualized approaches to therapy for common bacterial infections, including SSTIs merits to be considered seriously. Fully individualized therapy may be an ideal approach to maximize the benefits and minimize the harms of antimicrobials. Much more work is needed before this strategy becomes feasible.

Summary: There is increasing evidence that shorter duration of treatment is better in different types of SSTIs. Paradoxically, evaluation of real-life clinical practice indicates that long treatments continue to be commonly given to this population.

Purpose of review: Recurrent skin and soft tissue infections (RSSTIs) are challenging for the clinicians due to morbidity and healthcare-related costs. Here, we review updates on risk factors and management.

Recent findings: RSSTIs rates range between 7 and 45%. Local and systemic conditions can favour RSSTIs, with comorbidities such as obesity, diabetes, cancer and immunosuppressive disease becoming increasingly relevant. Streptococcus spp . and Staphylococcus aures (including methicillin resistant, MRSA) are the leading causative pathogens of RSSTIs, but also Gram-negative bacteria and polymicrobial infection should be considered. To prevent recurrences, treatment of underlying predisposing factor, complete source control and appropriate antibiotic therapy are crucial. Antibiotic prophylaxis for recurrent erysipelas and decolonization for MRSA carriers demonstrated some advantages, but also long-term loss of efficacy and possible adverse effects. Clinical score and patients risk stratification could be useful tools to target prophylaxis and decolonization strategies. To reduce hospitalization rates and costs, outpatient oral and parenteral antibiotic therapy (OPAT) and long-acting antibiotics are being implemented.

Summary: Management of RSSTIs requires both preventive interventions on modifiable risk factors and pharmacological strategies, with a patient tailored approach.

Purpose of review: The aim is to discuss the evidence and recent literature on the role of older antibiotics in the treatment of skin and soft tissue infections (SSTIs).

Recent findings: The choice of therapy for SSTIs is complicated in view of the rising antimicrobial resistance (AMR) and the availability of new antibiotics. SSTIs are predominantly caused by Staphylococcus aureus and beta-hemolytic streptococci, but other organisms can be involved in patients with comorbidities or post trauma. Treatment options are dictated by the accessibility and cost of newer antibiotics in resource-constrained settings. 'Old antibiotics' including β-lactams, doxycycline, trimethoprim-sulfamethoxazole (TMP/SMX), clindamycin, azithromycin, and ciprofloxacin remain good choices in treating SSTIs. They offer affordable options for outpatient settings. Only few randomized trials have addressed the role of the old agents in SSTIs treatment. Studies suggest that these agents remain effective for empirical and targeted therapy based on the epidemiological context. Ongoing surveillance and clinical trials are needed to assess the role of these agents and to integrate them into modern SSTIs management, supporting sustainable treatment models in both high-income and low-income settings.

Summary: Older antibiotics can be effectively used in treating SSTIs, provided their use is guided by current epidemiological data or culture and susceptibility results.

Purpose of review: Define the utility of adjunctive macrolide therapy in patients with more severe forms of community-acquired pneumonia (CAP).

Recent findings: Guidelines recommend adjunctive macrolide therapy as an option for patients with CAP, admitted to the hospital. A large data set collected both retrospectively and prospectively, including several recent randomized controlled trials (RCTs) have shown that adjunctive macrolide therapy can reduce mortality and improve outcomes in patients with severe CAP, more effectively than other alternative therapies. This effect appears to be most evident in those with severe illness and appears to be independent of direct antimicrobial effects and may be a result of the immunomodulatory properties of macrolides. A recent RCT, the ACCESS study, showed a clinical benefit of macrolides in severe CAP patients, but this may have been the result of a reversal of infection-related immunoparalysis. Macrolides appear to be valuable for patients with more severe CAP, but their therapeutic value is being challenged by the recent emergence of macrolide-resistant Mycoplasma pneumoniae; however, the optimal therapy for this pathogen still needs to be defined.

Summary: New evidence has further advanced the role of macrolides as preferred adjunctive therapy for patients with severe CAP.

Purpose of review: To discuss the new available options for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) and how to implement in the clinical practice innovative approaches for their management.

Recent findings: The availability of long-acting antibiotics, including dalbavancin and oritavancin, changed the approach to patients with ABSSSI. Direct discharge from the emergency department and early discharge from the hospital should be considered in patients with ABSSSI. Despite limited data about different bactericidal properties, the choice between dalbavancin and oritavacin is usually based on patients' characteristics and comorbidities. Delafloxacin and omadacycline are other options and have the advantage to be available for both intravenous and oral formulations, allowing a sequential therapy and switch from intravenous to oral treatment in clinically stable patients. Further studies should elucidate the profile of patients who may beneficiate from these drugs.

Summary: Early discharge from the hospital should be considered in patients with ABSSSI at a high risk of methicillin-resistant Staphylococcus aureus and in vulnerable patients for which hospitalization may have detrimental consequences. In elderly individuals, patients with diabetes mellitus, oncological people who need for continuing their healthcare pathway, this approach may reduce complications and costs related to hospitalization.

Purpose of review: The 2024 mpox outbreak, primarily driven by the possibly more virulent clade Ib strain, prompted the WHO declaring it a public health emergency of international concern (PHEIC) on August 14, 2024. This review provides essential guidance for clinicians managing mpox cases, as it contrasts the features of the 2024 outbreak with those of the 2022 epidemic to support better clinical decision-making.

Recent findings: The review highlights significant differences between the 2024 and 2022 outbreaks, including total case numbers, demographic distribution, and fatality rates. It also examines the increased severity associated with clade Ib. The article reviews the differential diagnosis of mpox, diagnostic tools, updates on Tecovirimat treatment, and infection control practices, particularly among healthcare workers. Vaccination strategies, including the role of smallpox vaccines and at-risk groups, are also discussed, along with recommendations for countries outside Africa.

Summary: The findings underscore the importance of early diagnosis and appropriate treatment for mpox in light of the 2024 outbreak's unique characteristics. Clinicians are advised to stay informed about updated diagnostic and therapeutic strategies, including vaccine recommendations, to mitigate the spread of the disease.

Purpose of review: Morbidity and mortality rates after lung transplantation still remain higher than after other forms of solid organ transplantation, primarily due to a higher risk of infections and the development of chronic lung allograft dysfunction. Thus, a tiered approach highlighting the most significant respiratory pathogens including common opportunistic infections along with diagnostic, treatment and prevention strategies, including vaccination and prophylaxis is needed.

Recent findings: The need for intense immunosuppressive therapy to prevent rejection, coupled with the transplanted lung's constant exposure to environment and impaired local defence mechanisms leads to frequent infections. Viral and bacterial infections are most frequent while fungal infections mainly involve the tracheobronchial tract but may be fatal in case of disseminated disease. Some infectious agents are known to trigger acute rejection or contribute to chronic allograft dysfunction. Invasive testing in the form of bronchoscopy with bronchoalveolar lavage is standard and increasing experience in point of care testing is gained to allow early preemptive therapy.

Summary: Timely diagnosis, treatment, and ongoing monitoring are essential, but this can be difficult due to the wide variety of potential pathogens.

Purpose of review: To discuss skin and soft tissue infections (SSTIs) caused by group A Streptococcus (GAS) by focusing on their pathogenesis, clinical manifestations, and management strategies.

Recent findings: GAS is responsible for a wide range of infections from mild disease to severe fatal invasive infections with high mortality rates. Invasive GAS (iGAS) infections affect both young and old individuals and account for 1.8 million cases worldwide, with a mortality rate of up to 20%. In addition, conditions resulting by immune responses triggered by GAS also contribute to GAS-associated morbidity, and should not be overlooked. GAS has the ability to produce a wide set of virulence factors which contribute to its pathogenicity and its ability to colonize different body site and subsequently cause invasive infections. Management of SSTIs caused by GAS is challenging due to the risk of rapid progression and the risk of developing complications.

Summary: During the COVID-19 pandemic, a relevant increase in iGAS infections has been registered. A constantly updated knowledge of the clinical presentation of iGAS infections is thus necessary to reduce their high mortality rates. Proper recognition and treatment of iGAS infections remain crucial.