Infectious disease clinics of North America最新文献

Antimicrobial stewardship (AMS) interventions have curbed antibiotic misuse, paradoxically restricting market adoption of new antibiotics in the process. This review critically examines non-traditional approaches to manage bacterial infections, offering solutions to reinforce AMS without compromising the commercial viability of thes new agents. An analysis of the key value propositions, regulatory frameworks, and market access pathways is presented. Actionable strategies to overcome regulatory and commercial challenges towards integrating non-traditional agents into clinical guidelines and AMS policies are highlighted.

Optimal therapeutic strategies for Stenotrophomonas maltophilia infections remain largely undefined. Current evidence tentatively supports combination therapy in immunocompromised hosts and severe infections, as no single agent reliably provides bactericidal activity. However, no specific regimen has been proven superior. Traditional agents such as trimethoprim-sulfamethoxazole, minocycline, and levofloxacin remain essential components of treatment. New antimicrobials, including cefiderocol and aztreonam-avibactam, are promising options, but further clinical data are required to validate their efficacy. To date, no randomized controlled trials have been conducted in S maltophilia infections, and well-designed studies are urgently needed to provide definitive answers.

Prosthetic device infections caused by multidrug-resistant (MDR) gram-positive bacteria pose significant therapeutic challenges. This review examines management strategies for methicillin-resistant staphylococci, ampicillin-resistant enterococci, vancomycin-resistant enterococci, and MDR Corynebacterium infections. Success requires coordinated surgical intervention and antimicrobial therapy, with device removal often necessary. Vancomycin remains the cornerstone for most resistant organisms, while newer agents like dalbavancin enable outpatient therapy. Critical considerations include recognizing linezolid toxicity during prolonged therapy, and understanding that surgical approach determines outcomes more than antimicrobial selection.

Difficult-to-treat resistant (DTR) Pseudomonas aeruginosa is an important cause of severe health care-associated infections and is associated with high morbidity and mortality. Its complex resistance mechanisms compromise the efficacy of traditional therapies and make treatment increasingly difficult. Although new active therapeutic options such as ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-relebactam and cefiderocol are currently available, lack of randomized control trials, drug access limitations, and emerging resistance have a negative impact on the management of these infections. This review discusses the mechanisms of resistance, molecular epidemiology, clinical management, and current and future therapeutic strategies for DTR P aeruginosa infections.

Staphylococcus aureus bacteremia (SAB) continues to challenge clinicians with its' diverse clinical presentations, risk of complications, and high mortality rate. While foundational principles of management, such as adequate source control and appropriate antibiotic treatment, remain unchanged, the landscape is evolving for both diagnostic and treatment strategies. This review explores emerging evidence; outlines current best practice in diagnosis, risk stratification, and treatment; and highlights ongoing controversies and limitations of traditional management paradigms. Given the marked clinical heterogeneity of SAB, advancing toward a personalized medicine approach that tailors management to patient and pathogen characteristics is an important goal for the field.