Clinical Microbiology Newsletter最新文献

The introduction of rapid diagnostic testing has transformed the practice of infectious diseases, facilitating earlier pathogen identification and optimization of antimicrobial therapy. Rapid diagnostic panels have also created new challenges in the interpretation of increasing numbers of results of unclear clinical significance. We highlight the clinical implications of the increasing use of rapid diagnostic panels in pediatric infectious diseases, focusing on commonly adopted testing for the diagnosis of meningitis and encephalitis, bloodstream infections, gastrointestinal infections, and respiratory infections. Rapid diagnostic panels can be useful adjuncts to conventional culture methods, but results must be interpreted with caution and careful attention to the clinical scenario. They are most likely to be successful when implemented in conjunction with clinical guidance in collaboration between microbiology laboratories and antimicrobial stewardship programs.

Coccidiomycosis is an endemic mycosis that is caused by the dimorphic fungal organisms Coccidoides immitis and C. posadasii. Patients with coccidiomycosis often present for care with community-acquired pneumonia-like illness, and unfortunately, this diagnosis is not commonly at the top of a clinician’s differential, even in areas of endemicity. This review examines the various assays that can be used to diagnose infection with Coccidioides spp., including discussion of the performance and interpretation of serological assays, molecular diagnostics, and fungal culture. Additionally, the use of alternative, non-coccidioidal biomarkers to support the diagnosis are discussed.

A scoping review is an approach to evidence synthesis. Its purpose is to provide an overview of the available research evidence without producing a summary answer to a discrete research question. Scoping reviews can be useful for answering expansive questions and identifying information relevant to a given research topic. The utility of scoping reviews is also to inform a systematic review, a knowledge synthesis process that aims to collect, and analyze all evidence that answers a specific research question. Scoping reviews are broadly depicted in the literature; however, the use of scoping review analysis techniques to rigorously prepare a clinical microbiology evidence base for comparison of multicomponent quality improvement interventions has not been explored. Recently, a pilot approach was published, and that approach is summarized here. It combined knowledge synthesis methods to (i) provide a meta-analytic route forward for a systematic review and meta-analysis (SRMA) and (ii) inform the American Society for Microbiology's (ASM's) approach to the production of clinical practice guidelines (CPGs). Further, a generalizable approach for other SRMA investigators who are similarly challenged by an evidence base that involves complex interventions was modeled by an ASM team re-exploring the impact of rapid diagnostics. While the approach is generalized, it is not intended to be prescriptive. The approach may frame or inform further conversation within the clinical microbiology community of practice and anyone reading the ASM CPGs. This article details a fundamental challenge to addressing “intervention complexity” in the clinical microbiology evidence base in the early stages of the CPG process.

Q fever is a disease caused by the bacterial pathogen Coxiella burnetii. This hardy organism can easily spread long distances in the wind, and only a few infectious aerosolized particles are necessary to cause serious illness. Presentations of Q fever disease can be wide ranging, allowing it to masquerade as other illnesses, highlighting the importance of laboratory testing for diagnosis and treatment. This review summarizes Q fever's epidemiology and clinical presentations and presents classical laboratory diagnostic assays and novel approaches to detecting this troubling disease.

Antimicrobial resistance is a growing threat in the treatment of infectious diseases. Multidrug-resistant Gram-negative organisms, in particular, have become progressively difficult to manage, due to the increasing diversity and widespread prevalence of β-lactamase enzymes. Novel β-lactamase inhibitors with expanded activity against such enzymes represent a promising strategy to combat Gram-negative resistance. This review discusses the classification of β-lactamases and the history of β-lactamase inhibitor development with a focus on three novel β-lactamase inhibitors—avibactam, relebactam, and vaborbactam—now FDA approved in combination β-lactam/β-lactamase inhibitor products available for clinical use, including their spectrums of inhibition, mechanisms of action, place in therapy, and evidence for use.