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Transcript
Update on Infectious Disease in the Critically Ill Patient
Heather L. Evans, MD, MS
Assistant Professor of Surgery, University of Washington, Seattle WA
1. Overview of new antibiotics (including some that are several years old but
not yet widely employed)
a. Telavacin
b. Ceftaroline fosamil
c. Tedizolid
d. Other antibiotics with Gram positive activity currently in development
i. Solithromycin
ii. Dalbavancin
iii. Oritavancin
e. IDSA initiative “10 x ‘20” to facilitate antimicrobial drug development
2. New (and increasingly accepted) treatments for C. difficile colitis
a. Fidaxomicin
b. Fecal microbiata transplant (FMT)
3. New problems and evolving solutions for fungal infections
a. Epidemic of fungal meningitis d/t contaminated methylprednisolone
b. Antifungal resistance emerging
c. Role of empiric antifungals, review of SIS/IDSA intra-abdominal
infection guidelines
d. Role of prophylactic antifungals for critically ill patients
i. Risk-benefit of prophylaxis
ii. Review of IDSA guidelines and 3 RCTs in critically ill surgical
patients
4. Latest data on Procalcitonin
a. Largest RCT to date suggests that PCT is not THE answer for
escalation of diagnosis and treatment of sepsis
b. Newer trials suggest uncertainty in differentiation of bacterial
pneumonia from other infections
Bibliography for ID in Critical Care
1. Sader et al. Antimicrobial Activity of Ceftaroline Tested against Staphylococci
with Reduced Susceptibility to Linezolid, Daptomycin, or Vancomycin from
U.S. Hospitals, 2008 to 2011. Antimicrob Agents Chemother. 2013
Jul;57(7):3178-81.
2. Prokocimer et al. Tedizolid Phosphate vs Linezolid for Treatment of Acute
Bacterial Skin and Skin Structure Infections The ESTABLISH-1 Randomized
Trial. JAMA. 2013;309(6):559-569.
3. Rybak et al. Current and prospective treatments for multidrug-resistant
gram-positive infections. Expert Opin. Pharmacother. (2013) 14(14)
4. Boucher et al. 10 × '20 Progress—Development of New Drugs Active Against
Gram-Negative Bacilli: An Update From the Infectious Diseases Society of
America. Clin Infect Dis 2013;56(12):1685-1694
5. Louie TJ et al. Fidaxomicin versus Vancomycin for Clostridium difficile
Infection. N Engl J Med 2011;364:422-431.
6. van Nood E et al. Duodenal Infusion of Donor Feces for Recurrent Clostridium
difficile. N Engl J Med 2013;368:407-415.
7. http://www.cdc.gov/hai/outbreaks/meningitis-map-large.html
8. Swenson et al. Choosing Antibiotics for Intra-Abdominal Infections: What Do
We Mean by “High Risk”? Surg Infect 2009;10(1):29-39
9. Solomkin et al. Diagnosis and management of complicated intra-abdominal
infection in adults and children: guidelines by the Surgical Infection Society
and the Infectious Diseases Society of America. Surg Infect 2010;11(1):79109
10. Shorr A et al. Fluconazole prophylaxis in critically ill surgical patients: a
meta-analysis. Crit Care Med. 33(9):1928-1935.
11. Pappas et al. Clinical practice guidelines for the management of candidiasis:
2009 update by the Infectious Diseases Society of America. Clin Infect Dis
2009;48(5):503-535
12. Eggimann et al. Fluconazole prophylaxis prevents intra-abdominal
candidiasis in high-risk surgical patients. Crit Care Med 1999;27:1066-72
13. Pelz et al. Double-blind placebo-controlled trial of fluconazole to prevent
candidal infections in critically ill surgical patients. Ann Surg 2001;233:542548.
14. Garbino et al. Prevention of severe Candida infections in nonneutropenic,
high-risk, critically ill patients: a randomized, double-blind, placebocontrolled trial in patients treated by selective digestive decontamination. Int
Care Med 2002;28:1708-1717
15. Jensen JU et al. Procalcitonin-guided interventions against infections to
increase early appropriate antibiotics and improve survival in the intensive
care unit: a randomized trial. Crit Care Med 2011 Sep;39:2048-2058.
16. Kruger et al. Inflammatory parameters predict etiologic patterns but do not
allow for individual prediction of etiology in patients with CAP – Results from
the German competence network CAPNETZ. Respir Res 2009;10(1):65
17. Luyt et al. Usefulness of procalcitonin for the diagnosis of ventilatorassociated pneumonia. Intensive Care Med 2008 Aug;34(8):1434-40
18. Layios et al. Procalcitonin usefulness for the initiation of antibiotic treatment
in intensive care unit patients. Crit Care Med 2012 Aug;40(8):2304-9