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01-02-2019 | What's New in Intensive Care

Infectious diseases: the 10 common truths I never believed

Authors: Jordi Rello, Emine Alp, Kalwaje Eshwara Vandana

Published in: Intensive Care Medicine | Issue 2/2019

Excerpt

The field of infectious diseases has caught us with many surprises. Even in the time of modern medicine, evolutionary perspectives on disease biology and management have continued to challenge us from time to time (Fig. 1). Integration of knowledge from various fields of science has opened an exciting arena, ruffling our beliefs learned in medical schools or during practice of clinical medicine. Ten selected topics that developed under the influence of certain evolutionary factors in medicine are presented in Table 1.

Table 1

Ten surprises in infectious diseases

	Topics
1	Respiratory viruses are common causes of community-acquired pneumonia requiring hospitalization
2	MALDI-TOF significantly reduces the time to organism identification in blood
3	Carbapenenem-resistant Klebisella pneumoniae can be treated with carbapenems
4	Identification of drug response phenotypes helps to understand different responses in patients with sepsis
5	Weak evidence to support aerosolization of antimicrobials in respiratory infections
6	Oral cleansing with chlorhexidine may be harmful in intubated patients
7	Colistin is not the solution to treating MDR Gram-negative organisms
8	Therapeutic drug monitoring is required to optimize dosage in bacterial and fungal infections in mechanically ventilated patients
9	Invasive aspergillosis is a life-threating complication after viral pneumonia
10	Pulmonary manifestations are more common complications than bleeding when managing Ebola virus disease (EVD) outside of low- and middle income countries

…

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De Pascale G, Martucci G, Montini L et al (2017) Double carbapenem as a rescue strategy for the treatment of severe carbapenemase-producing Klebsiella pneumoniae infections: a two-center, matched case-control study. Crit Care. https://doi.org/10.1186/s13054-017-1769-z CrossRefPubMedPubMedCentral

Rello J, van Engelen TSR, Alp E et al (2018) Towards precision medicine in sepsis: a position paper from the European Society of Clinical Microbiology and Infectious Diseases. Clin Microbiol Infect. https://doi.org/10.1016/j.cmi.2018.03.011 CrossRefPubMed

Klompas M, Speck K, Howell MD et al (2014) Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA Intern Med 174:751–761. https://doi.org/10.1001/jamainternmed.2014.359 CrossRefPubMed

Deschepper M, Waegeman W, Eeckloo K et al (2018) Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study. Intensive Care Med. https://doi.org/10.1007/s00134-018-5171-3 CrossRefPubMedPubMedCentral

Solé-Lleonart C, Rouby JJ, Blot S et al (2017) Nebulization of antiinfective agents in invasively mechanically ventilated adults: a systematic review and meta-analysis. Anesthesiology 126:890–908. https://doi.org/10.1097/ALN.0000000000001570 CrossRefPubMed

Rello J, Solé-Lleonart C, Rouby JJ et al (2017) Use of nebulized antimicrobials for the treatment of respiratory infections in invasively mechanically ventilated adults: a position paper from the European Society of Clinical Microbiology and Infectious Diseases. Clin Microbiol Infect 23:629–639. https://doi.org/10.1016/j.cmi.2017.04.011 CrossRefPubMed

10.

Alp E, Eren E, Elay G et al (2017) Efficacy of loading dose of colistin in Acinetobacter baumannii ventilator-associated pneumonia. Infez Med 25:311–319PubMed

11.

Pogue JM, Ortwine JK, Kaye KS (2015) Editorial commentary: optimal usage of colistin: are we any closer? Clin Infect Dis 61:1778–1780. https://doi.org/10.1093/cid/civ723 CrossRefPubMed

12.

Borgatta B, Gattarello S, Mazo CA et al (2017) The clinical significance of pneumonia in patients with respiratory specimens harbouring multidrug-resistant Pseudomonas aeruginosa: a 5-year retrospective study following 5667 patients in four general ICUs. Eur J Clin Microbiol Infect Dis 36:2155–2163. https://doi.org/10.1007/s10096-017-3039-z CrossRefPubMed

13.

Roberts JA, Paul SK, Akova M et al (2014) DALI: defining antibiotic levels in intensive care unit patients: are current ß-lactam antibiotic doses sufficient for critically ill patients? Clin Infect Dis 58:1072–1083. https://doi.org/10.1093/cid/ciu027 CrossRefPubMed

14.

Garcia-Vidal C, Barba P, Arnan M et al (2011) Invasive aspergillosis complicating pandemic influenza A (H1N1) infection in severely immunocompromised patients. Clin Infect Dis 53:e16–e19. https://doi.org/10.1093/cid/cir485 CrossRefPubMed

15.

Uyeki TM, Mehta AK, Davey RT et al (2016) Clinical management of ebola virus disease in the United States and Europe. N Engl J Med 374:636–646. https://doi.org/10.1056/NEJMoa1504874 CrossRefPubMedPubMedCentral

Title: Infectious diseases: the 10 common truths I never believed
Authors: Jordi Rello
Emine Alp
Kalwaje Eshwara Vandana
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 2/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5272-z

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