Section of Infectious Diseases

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Section of Infectious Diseases

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Aboutalebi A.,Baylor College of Medicine | Allen S.E.,Section of Infectious Diseases
Cutis | Year: 2012

Nontuberculous mycobacteria (NTM) are becoming increasingly important cutaneous pathogens as the number of susceptible patients increases. Nevertheless, primary cutaneous infection by one particular species, Mycobacterium avium complex (MAC), remains relatively unusual, particularly in immunocompetent patients. We review the English-language literature on primary cutaneous MAC in patients who were neither immunocompromised nor pharmacologically immunosuppressed. We offer an additional report of a healthy patient who presented to our clinic with primary cutaneous MAC following seemingly innocuous trauma to the leg.

Lautenbach E.,University of Pennsylvania | Han J.,University of Pennsylvania | Santana E.,Section of Infectious Diseases | Tolomeo P.,University of Pennsylvania | And 2 more authors.
Infection Control and Hospital Epidemiology | Year: 2012

We describe the prevalence of and risk factors for colonization with extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBL-EB) in the long-term care facility (LTCF) setting. Colonization prevalence differed significantly across the 3 LTCFs evaluated in the study, with recent use of levofloxacin and fecal incontinence demonstrating borderline significant associations with ESBL-EB colonization. © 2012 by The Society for Healthcare Epidemiology of America. All rights reserved.

Diaz J.H.,Louisiana State University Health Sciences Center | Lopez F.A.,Section of Infectious Diseases
American Journal of the Medical Sciences | Year: 2015

Bacterial infections following aquatic injuries occur commonly in fishermen and vacationers after freshwater and saltwater exposures. Internet search engines were queried with the key words to describe the epidemiology, clinical manifestations, diagnostic and treatment strategies and outcomes of both the superficial and the deeper invasive infections caused by more common, newly emerging and unusual aquatic bacterial pathogens. Main findings included the following: (1) aquatic injuries often result in gram-negative polymicrobial infections with marine bacteria; (2) most marine bacteria are resistant to 1st- and 2nd-generation penicillins and cephalosporins; (3) nontuberculous, mycobacterial infections should be considered in late-onset, culture-negative and antibiotic-resistant marine infections; (4) superficial marine infections and pre-existing wounds exposed to seawater may result in deeply invasive infections and sepsis in immunocompromised patients. With the exception of minor marine wounds demonstrating localized cellulitis, most other marine infections and all gram-negative and mycobacterial marine infections will require therapy with antibiotic combinations. © 2014 by the Southern Society for Clinical Investigation.

Maiyaki M.,Aminu Kano Teaching Hospital | Garbati M.,Section of Infectious Diseases
Annals of African Medicine | Year: 2014

This paper highlights the tenets of globalization and how its elements have spread to sub-Saharan Africa, and Nigeria in particular. It assesses the growing burden of non-communicable diseases (NCDs) in Nigeria and its relationship with globalization. It further describes the conceptual framework on which to view the impact of globalization on NCDs in Nigeria. It assesses the Nigerian dimension of the relationship between the risk factors of NCDs and globalization. Appropriate recommendations on tackling the burden of NCDs in Nigeria based on cost-effective, culturally sensitive, and evidence-based interventions are highlighted.

Trautner B.W.,Section of Infectious Diseases | Trautner B.W.,Houston VA Health Services Research
Current Opinion in Infectious Diseases | Year: 2010

PURPOSE OF REVIEW: The aim of this article is to review recent publications concerning the management of catheter-associated urinary tract infection (CAUTI), including the issues of diagnosis and prevention. Articles reviewed include the various guidelines concerning CAUTI released recently by multiple organizations. RECENT FINDINGS: There has been a recent upsurge of interest in prevention of CAUTI and a proliferation of guidelines in this area. Social changes in US government reimbursement to hospitals and public reporting of hospital-acquired infections may underlie this interest. The awareness that CAUTI and catheter-associated asymptomatic bacteriuria are distinct conditions is increasing, but unnecessary treatment of asymptomatic bacteriuria remains quite prevalent. The focus in recent CAUTI literature is on prevention, often through strategies to minimize urinary catheter use. Very little new evidence is available to guide diagnosis and treatment strategies. SUMMARY: Interpretation of many studies of CAUTI is impeded by the failure to distinguish between symptomatic CAUTI and asymptomatic bacteriuria in the study outcomes. This distinction currently relies on clinical symptoms and is not easily made, even with the help of various guidelines. Many aspects of the management of CAUTI merit further study, and the current interest in CAUTI is likely to lead to exciting advances in this field. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Garbati M.A.,Section of Infectious Diseases | Bin Abdulhak A.,University of Missouri - Kansas City | Baba K.,King Fahad Medical City | Sakkijha H.,King Fahad Medical City
Journal of Infection in Developing Countries | Year: 2013

Introduction: This study was conducted in response to the rising incidence of drug resistance observed in the intensive care unit (ICU) of King Fahad Medical City. Methodology: A retrospective observational study was conducted in the ICU of King Fahad Medical City between October 2003 and April 2012. Data were collected using a structured data sheet. Results: Nine episodes of infection with colistin-resistant Enterobacteriacae were recorded in seven patients. Five were females with an average age of 59.75 years. All patients had multiple co-morbidities; five had diabetes mellitus. In five of the episodes, Klebsiella pneumoniae was responsible, Serratia marcescens was reported in two, while Enterobacter aerogenes and Providencia stuartii were responsible for one episode of infection each. Prior colistin use was documented in all but one patient. Colistin resistance was defined by a minimum inhibitory concentration (MIC) of > 4 μg/mL according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoint for Enterobacteriacae. Various antibiotics were used to treat the patients, with mortality reported in two. Conclusion: Infection due to colistin-resistant Enterobacteriacae is a rising challenge in Saudi Arabia; colistin use is thought to be associated with these infections. This calls for a stricter antimicrobial stewardship program and improved infection control measures to curb the rising trend of antibiotic resistance. © 2013 Garbati et al.

Serpa J.A.,Section of Infectious Diseases | Graviss E.A.,Section of Infectious Diseases | Graviss E.A.,Methodist Hospital Research Institute | Kass J.S.,Baylor College of Medicine | White A.C.,University of Texas Medical Branch
Medicine | Year: 2011

Neurocysticercosis, one of the most common parasitic infections of the human nervous system, has emerged as an important infection in the United States. Neurocysticercosis causes significant morbidity associated with acute seizures, chronic epilepsy, and hydrocephalus.We retrospectively identified patients with definitive or probable neurocysticercosis seen at Ben Taub General Hospital, the largest public teaching hospital in Houston, Texas, from September 1997 through December 2005. We collected demographic, clinical, therapeutic, and outcome variables. Neurocysticercosis was classified according to the location of cysts in imaging studies. We compared cases with parenchymal and extraparenchymal disease.We included 111 patients (48 had definitive and 63 probable neurocysticercosis). The mean age was 28.6 years (standard deviation, 13.6 yr), and the male to female ratio was 2:1. Most patients (93%) were Hispanic immigrants. Sixty (54%) patients had parenchymal disease, 22 (20%) intraventricular, 13 (12%) subarachnoid disease, and 13 (12%) had calcifications only. Additionally, 2 patients had hydrocephalus only, and 1 had ocular cysticercosis. Thirteen (40%) of 32 patients with parenchymal disease and 3 (30%) of 10 patients with calcifications had relapsed seizures at follow-up. Extraparenchymal disease was associated with longer duration of hospitalization compared with parenchymal disease. No deaths were identified in our series during a median follow-up of 1 year.Neurocysticercosis has emerged as an important parasitic infection in developed countries as a result of increased migration. With current management, mortality is limited, but there continues to be significant morbidity. Further studies of the epidemiology and pathophysiology of the infection are urgently needed to develop better preventive and therapeutic strategies. Copyright © 2011 by Lippincott Williams & Wilkins.

Garbati M.A.,Section of Infectious Diseases | Godhair A.I.A.,Pharmacy Administration
African Journal of Infectious Diseases | Year: 2013

Carbapenemases are being increasingly reported in Enterobacteriaceae including Klebsiella pneumoniae causing considerable increases in morbidity and mortality with limited therapeutic options. Issues related to difficulties associated with pathogen identification and infection control have been identified as major obstacles to the control of these multi-drug resistant organisms. Identification of this enzyme in organisms not previously found to harbor them has added to the already existing challenge in the control of this growing problem. The case of a 60 year-old Saudi lady with diabetes, hypertension, pituitary adenoma, hypothyroidism, and obstructive sleep apnea who was admitted in our intensive care unit following a cardiac arrest is hereby presented. During the course of her treatment she acquired various infections that led to her exposure to antimicrobials from almost all classes at various times; including bacteremia due to a pan-drug resistant Klebsiella pneumoniae and multi-drug resistant Acinetobacter baumannii. She was successfully treated with a combination of colistin and amikacin. This case highlights the resurgence of colistin in clinical practice and also calls for the need to expand our antibiogram to include antibiotics not conventionally reported, especially in areas where drug resistance is a growing problem. Improving susceptibility detection methods for Klebsiella pneumoniae and hand hygiene could prove effective in reducing nosocomial infections. Involvement of clinical pharmacists in antimicrobial stewardship could reduce the development of antimicrobial drug resistance.

Shin J.H.,University of Virginia | High K.P.,Section of Infectious Diseases | Warren C.A.,University of Virginia
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2016

Clostridium difficile infection (CDI) is the most common cause of antibiotic-associated diarrhea and a significant burden on the health care system. Aging has been identified in the literature as a risk factor for CDI as well as adverse outcome from CDI. Although this effect of advanced age on CDI could be partially explained by clinical factors associated with aging, biologic factors are important. Innate immune system, responsible for immediate response to acute infections, plays a major role in CDI pathogenesis. Impairment in function of innate immunity with aging, demonstrated in other infection models, may lead to worse outcome with CDI. C. difficile toxin-specific antibody response protects the host against initial and recurrent infections as shown in observational studies and clinical trial. Effect of aging on antibody response to CDI has not been demonstrated, but the results from vaccine studies in other infections suggest a negative effect on humoral immunity from aging. Although intestinal microbiota from healthy people confers resistance to CDI by preventing C. difficile colonization, changes in composition of microbiota with aging may affect that resistance and increase risk for CDI. There are also age-associated changes in physiology, especially of the gastrointestinal tract, that may play a role in CDI risk and outcomes. In this review, we will first discuss the epidemiology of CDI in the elderly people, then the alteration in innate immunity, humoral response, and microbiota that increases susceptibility to CDI and severe disease and lastly, the physiological and functional changes that may modify outcomes of infection. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.

Abad C.L.,Section of Infectious Diseases | Pulia M.S.,University of Wisconsin - Madison | Safdar N.,William ddleton Memorial Veterans Affairs Medical Center
Current Infectious Disease Reports | Year: 2013

Colonization with methicillin-resistant Staphylococcus aureus (MRSA) is an important step in the pathogenesis of active infection and is a key factor in the epidemiology of MRSA infection. Decolonization of patients found to have MRSA carriage may be of value in certain patient populations, especially those undergoing elective surgery. However, the most commonly used agent for decolonization, mupirocin, comes with a considerable risk of resistance if widely employed. Recent studies of other novel agents for decolonization show promise, but further research is necessary. This review focuses on the pathogenesis from MRSA colonization to infection, identifies the risk factors for colonization, and summarizes decolonization strategies, including novel approaches that may have a role in decreasing MRSA disease burden. © 2013 Springer Science+Business Media New York.

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