Current Infectious Disease Reports最新文献

Purpose of Review

Suppurative tenosynovitis is a serious infection mostly affecting the flexor tendons of the hand and is considered a medico-surgical emergency.

Recent Findings

Infectious tenosynovitis is mostly caused by Staphylococci, Streptococci, Gram negatives, and following bite injury, Eikenella and Pasteurella species. Atypical organisms especially in immunocompromised patients are increasingly being reported like fungi and slowly or rapidly growing mycobacteria. Management can be conservative with intravenous antibiotics and close monitoring especially in mild cases. Minimally invasive catheter irrigation of the tendon sheath can be used with improved functional outcomes.

Summary

Suppurative tenosynovitis is an infection of the tendon sheath. Inoculation usually occurs following injury, puncture wounds, bites, recent surgery, or via hematogenous or contiguous spread of infection. Kanavel signs are helpful when evaluating patients. Hand surgeons should be promptly consulted for decision about need for surgical exploration. Uncomplicated cases can be treated with 7 to 14 days of an oral antibiotic. Smoking, diabetes, vascular disease, and advanced Michon stage infection are associated with higher risk of amputation or decreased mobility. Infectious diseases specialists should be consulted in the management of atypical presentations like fungal and mycobacterial tenosynovitis.

Purpose of Review

Bruton tyrosine kinase inhibitors (BTKIs) are immunosuppressive cancer therapies approved for the treatment of various mature B-cell malignancies. Hepatitis B virus reactivation (HBVr) is a known complication in patients with chronic or past HBV infection undergoing immunosuppressive chemotherapy. The present work aims to establish the correlation between HBVr and patients receiving BTKIs.

Recent Findings

This review included 18 studies. The overall incidence of HBVr was found to be 6.6% in patients with past HBV infections who received ibrutinib. Fourteen cases of HBVr were associated with ibrutinib (two occult hepatitis B infections and twelve past HBV infections). One case of HBV past infection was associated with zanubrutinib, and three cases were recorded for acalabrutinib (one chronic HBV and two past HBV). Most incidents occurred in males older than 60 years within the first year after initiating BTKIs. Three reported cases documented HBVr after discontinuing ibrutinib and zanubrutinib. Two deaths caused by HBVr in patients with past HBV infections were recorded (one for each of acalabrutinib and ibrutinib). Remarkably, HBV antiviral treatment normalized liver functions and eliminated serum HBV in most cases. It was reported that false negativity of HBsAg following reactivation occurred in two cases: one case was attributed to HBsAg escape mutations, and the other to the hook effect.

Summary

Our findings show that HBVr risk is intermediate in patients with past HBV infections who receive ibrutinib. Universal anti-HBV prophylaxis before initiating ibrutinib may be an option.

Abstract

Purpose of Review

Inappropriate and unnecessary antibiotic prescriptions are common in the outpatient setting and as patients transition from inpatient to outpatient care. This review is designed to discuss effective strategies aimed to improve appropriate antibiotic use during transitions of care and in the outpatient setting for high-priority syndrome areas including acute respiratory infections (ARI), urinary tract infections (UTI), skin and soft tissue infections (SSTI), and bone and joint infections (BJI).

Recent Findings

Unlike inpatient stewardship programs, outpatient stewardship practices are currently not standardized across many healthcare systems. Since starting an outpatient ASP can be overwhelming, many programs opt to start by focusing on a smaller subset of high-priority locations or syndromes where antibiotics may be inappropriately prescribed. Numerous studies have identified effective antimicrobial stewardship strategies that can be incorporated on transitions of care and in the outpatient setting; however, a multimodal approach combining several stewardship strategies is often cited as the most effective approach. Available syndrome-specific interventions include opportunities at time of diagnosis, order entry, and post-prescription which may be tailored to meet individual program needs.

Summary

Outpatient ASP interventions targeted at diagnostic stewardship, adjustments to duration of therapy, optimization of agent selection, and avoidance of intravenous therapy remain high-priority target areas to prevent inappropriate antibiotic use.