Abstract:
:Antimicrobial stewardship programs aim to monitor, improve, and measure responsible antibiotic use. The intensive care unit (ICU), with its critically ill patients and prevalence of multiple drug-resistant pathogens, presents unique challenges. This article reviews approaches to stewardship with application to the ICU, including the value of diagnostics, principles of empirical and definitive therapy, and measures of effectiveness. There is good evidence that antimicrobial stewardship results in more appropriate antimicrobial use, shorter therapy durations, and lower resistance rates. Data demonstrating hard clinical outcomes, such as adverse events and mortality, are more limited but encouraging; further studies are needed.
journal_name
Infect Dis Clin North Amjournal_title
Infectious disease clinics of North Americaauthors
Doernberg SB,Chambers HFdoi
10.1016/j.idc.2017.05.002subject
Has Abstractpub_date
2017-09-01 00:00:00pages
513-534issue
3eissn
0891-5520issn
1557-9824pii
S0891-5520(17)30032-6journal_volume
31pub_type
杂志文章,评审abstract::Amebiasis is a widespread parasitic disease caused by Entamoeba histolytica. This protozoan organism is the third leading parasitic cause of death in the developing world and is an important health risk to travelers in endemic areas. Amebiasis most commonly results in asymptomatic colonization of the gastrointestinal ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(05)70121-5
更新日期:2000-09-01 00:00:00
abstract::Antigens located in the midgut of the tick are hidden from the host's immune system. Egg production of ticks can be reduced when ticks are fed on animals vaccinated with midgut antigens of the tick, and a subunit vaccine formulated with the recombinant antigen Bm86 is now available that can reduce the number of ticks ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(05)70051-9
更新日期:1999-03-01 00:00:00
abstract::The unknowns persisting in the understanding of the mode of action of anti-core lipopolysaccharide antibodies are discussed, and a study of two anti-lipid A monoclonal antibodies is reviewed. This article also critically analyzes the results of the recent clinical trials with monoclonal antibodies. ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1991-12-01 00:00:00
abstract::Improvements in donor selection, testing of donors for markers of infection, and viral inactivation of plasma-derived products have helped reduce the risk of transfusion-associated infections, including hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency viruses (HIV). The potential for transmission of em...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(05)70419-0
更新日期:1998-03-01 00:00:00
abstract::Injection drug use is the most common transmission route for hepatitis C. High rates of infection are observed among individuals on opioid agonist therapy. Although people who inject drugs carry the highest burden, few have initiated treatment. We present a comprehensive review of the evidence on the efficacy of HCV m...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2018.02.001
更新日期:2018-06-01 00:00:00
abstract::The incidence of meningococcal disease is at an historic low in the United States, but prevention remains a priority because of the devastating outcomes and risk for outbreaks. Available vaccines are recommended routinely for persons at increased risk for disease to protect against all major serogroups of Neisseria me...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2015.08.002
更新日期:2015-12-01 00:00:00
abstract::Cellulitis is a common clinical diagnosis in the outpatient and inpatient setting; studies have demonstrated a surprisingly high misdiagnosis rate: nearly one-third of cases are other conditions (ie, pseudocellulitis). This high rate of misdiagnosis is thought to contribute to nearly $515 million in avoidable health c...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2020.10.001
更新日期:2021-03-01 00:00:00
abstract::Renal transplant recipients continue to have progressive kidney dysfunction and renal graft loss has been attributed to emerging opportunistic infections, specifically BK virus (BKV). BKV is postulated to be selected by the new potent immunosuppressive medications and to be an important factor in graft failure. The pr...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2013.02.002
更新日期:2013-06-01 00:00:00
abstract::This article familiarizes the clinician with the principles of bacterial susceptibility testing and reporting to facilitate communication with the clinical microbiology laboratory. The emergence of resistance in nearly all commonly isolated bacterial organisms has highlighted the need for ongoing dialogue between the ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2004.04.001
更新日期:2004-09-01 00:00:00
abstract::Preventing traveler's diarrhea is usually a matter of common sense, good luck, and the host's ability to defend against enteric pathogens, particularly enterotoxigenic Escherichia coli. Untreated tap water, ice cubes, unpasteurized milk products, salads, food from street vendors, and dining in unhygienic-appearing res...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1992-06-01 00:00:00
abstract::Tegumentary leishmaniases are caused by approximately 15 species of protozoa of the genus Leishmania. They prevail in tropical and subtropical areas of the Old and New World but human mobility also makes them a medical problem in nonendemic areas. Clinical manifestations may comprise cutaneous and mucocutaneous forms ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章
doi:10.1016/j.idc.2012.03.001
更新日期:2012-06-01 00:00:00
abstract::Lyme disease affects the nervous system in about 10% to 15% of infected individuals, most commonly causing lymphocytic meningitis. Cranial neuropathies, particularly facial nerve palsy, also occur frequently. Figuring prominently in the European literature, but less emphasized in the United States, is painful radiculi...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2007.12.009
更新日期:2008-06-01 00:00:00
abstract::Ebola virus disease (EVD) is a deadly zoonotic disease caused by the Ebola virus. There is no specific treatment approved for EVD. Supportive care and management of complications are mainstays of treatment. Effective outbreak control requires a multidisciplinary team effort applying case management, infection preventi...
journal_title:Infectious disease clinics of North America
pub_type: 历史文章,杂志文章,评审
doi:10.1016/j.idc.2019.08.005
更新日期:2019-12-01 00:00:00
abstract::Legionella is a common cause of community- and hospital-acquired pneumonia. New information on the pathogenesis of infection and the host immune response is reviewed. Specialized laboratory tests, especially culture, are necessary for diagnosis since the clinical presentation is nonspecific. New antimicrobial agents a...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1991-09-01 00:00:00
abstract::Pulmonary or extrapulmonary tuberculosis occurs in 5 to 35 per cent of AIDS patients, frequently precedes the diagnosis of AIDS, and is increasing in incidence. Clinically, AIDS-associated tuberculosis is similar in presentation to progressive, primary tuberculosis and can be treated effectively with standard antitube...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1988-06-01 00:00:00
abstract::Traditionally, imaging of renal infections was largely through a multimodality approach. Excretory urography, ultrasonography, nuclear scintigraphy, and CT all played major roles; however, in recent years, CT has increased in prominence in the imaging and evaluation of renal infection. Part of the reason for this tren...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(05)70380-9
更新日期:1997-09-01 00:00:00
abstract::Cytomegalovirus (CMV) may no longer be the menace that plagues stem cell transplant outcomes, owing to marked improvements in transplantation techniques and methods of prophylaxis. However, it still remains a common and morbid problem for recipients of stem cell transplant and patients with certain hematologic maligna...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2019.02.008
更新日期:2019-06-01 00:00:00
abstract::Nosocomial diarrhea due to infection with C. difficile is a major health care problem, causing 20% to 30% of institutionally acquired diarrhea and affecting up to 8% of hospitalized patients. The clinical microbiology laboratory should be able to provide both diagnostic and epidemiologic services for institutions wher...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1993-06-01 00:00:00
abstract::This article reviews the changing epidemiology of infections associated with injection drug use, perceived barriers to care, features of successful programs for outpatient antimicrobial treatment, models of shared decision making at the time of discharge, and linkage to preventative care after antimicrobial completion...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2020.06.009
更新日期:2020-09-01 00:00:00
abstract::The viral hemorrhagic fever (VHF) syndrome is a potentially life-threatening infection typified by a combination of a capillary leak syndrome and bleeding diathesis. Most but not all agents causing VHF are arboviruses, with transmission to humans resulting from an arthropod bite. Agents of VHF affect humans on all con...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2012.02.003
更新日期:2012-06-01 00:00:00
abstract::An increasing number of HIV-infected patients will require surgical therapy. The methods of diagnosis and therapeutic planning for HIV-infected patients are the same as for all other patients. Surgery should be advised if an operation is likely to have a positive effect on the patient's life. Most patients with AIDS w...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1992-09-01 00:00:00
abstract::HIV and tropical infections affect each other mutually. HIV infection may alter the natural history of tropical infectious diseases, impede rapid diagnosis, or reduce the efficacy of antiparasitic treatment. Tropical infections may facilitate the transmission of HIV and accelerate progression from asymptomatic HIV inf...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2004.10.002
更新日期:2005-03-01 00:00:00
abstract::Antiretroviral management of treatment-naive patients begins with the decision of when to start treatment. Current treatment guidelines suggest starting therapy in anyone with AIDS, HIV-related symptoms, or a CD4 cell count less than 200/mm3 regardless of symptoms. Starting treatment in asymptomatic patients with CD4 ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章
doi:10.1016/j.idc.2007.01.002
更新日期:2007-03-01 00:00:00
abstract::The approach to neurologic diagnosis and management of HIV-infected and AIDS patients follows that used in general neurologic practice but takes into account the altered probabilities of differential diagnosis in this group of patients. Clinical and neurodiagnostic evaluations, when pursued with a background understan...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1988-06-01 00:00:00
abstract::This article discusses two tick-borne illnesses: Powassan encephalitis, a rare cause of central nervous system infection caused by the Powassan virus, and Colorado tick fever, an acute febrile illness caused by the Colorado tick fever virus common to the Rocky Mountain region of North America. ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.idc.2008.03.001
更新日期:2008-09-01 00:00:00
abstract::The most frequent and best-studied agent of urinary tract infection (UTI) is Escherichia coli, which serves as a useful model pathogen for understanding microbial virulence in relation to UTI pathogenesis. The E. coli strains that cause most UTIs and other extraintestinal E. coli infections represent a highly speciali...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0891-5520(03)00027-8
更新日期:2003-06-01 00:00:00
abstract::Global eradication of smallpox, elimination of poliomyelitis in the Western Hemisphere, and a 90% decrease in Haemophilus influenzae meningitis in the Western Hemisphere mark some of the achievements of immunization programs around the world. Yet many serious problems continue to exist, particularly in the developing ...
journal_title:Infectious disease clinics of North America
pub_type: 历史文章,杂志文章
doi:
更新日期:1995-06-01 00:00:00
abstract::AIDS is characteristically associated with several intracellular enteric protozoan infections that often cause chronic and sometimes fatal intractable large-volume diarrhea. Until the AIDS epidemic, several of these parasitic infections were almost unknown as causes of human disease. This article reviews the diseases ...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1993-09-01 00:00:00
abstract::Fulminant meningitis requires aggressive management in an intensive care unit setting. The pathophysiology of the various factors that damage the central nervous system in this disease have been reviewed, as well as the management of the many complications of this serious, often devastating, infection. The etiologic a...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1989-03-01 00:00:00
abstract::This article reviews in brief the basic principles of echocardiography and their application in infective endocarditis. The role of echocardiography in relation to surgical decision making is emphasized. The special problems of vegetations, valve ring abscess, leaflet perforation, prosthetic valve endocarditis, and in...
journal_title:Infectious disease clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1993-03-01 00:00:00