Over the past 2 decades, there has been an alarming increase in opportunistic fungal infections w... more Over the past 2 decades, there has been an alarming increase in opportunistic fungal infections with an associated rise in morbidity and mortality. This trend has been attributed to the growing number of patients who are immunocompromised because of bone marrow or solid organ transplant, immunosuppressive drugs, AIDS, and hematological malignancies. Advances in trauma and critical care medicine that lead to longer survival of more patients with immunocompromising conditions also play a role.
Despite advances in resuscitation and surgical management of combat wounds, infection remains a c... more Despite advances in resuscitation and surgical management of combat wounds, infection remains a concerning and potentially preventable complication of combat-related injuries. Interventions currently used to prevent these infections have not been either clearly defined or subjected to rigorous clinical trials. Current infection prevention measures and wound management practices are derived from retrospective review of wartime experiences, from civilian trauma data, and from in vitro and animal data. This update to the guidelines published in 2008 incorporates evidence that has become available since 2007. These guidelines focus on care provided within hours to days of injury, chiefly within the combat zone, to those combat-injured patients with open wounds or burns. New in this update are a consolidation of antimicrobial agent recommendations to a backbone of high-dose cefazolin with or without metronidazole for most postinjury indications, and recommendations for redosing of antimicrobial agents, for use of negative pressure wound therapy, and for oxygen supplementation in flight.
Infection Control and Hospital Epidemiology, Jul 1, 2006
Objective.To evaluate whether skin colonization withAcinetobacter calcoaceticus-baumanniicomplex ... more Objective.To evaluate whether skin colonization withAcinetobacter calcoaceticus-baumanniicomplex exists in a population of healthy, nondeployed US Army soldiers and, if present, how it might relate to the infections seen in current war casualties.Design.We sampled various skin sites of soldiers to test for the presence ofA. calcoaceticus-baumanniicomplex and to establish the prevalence of colonization. We then used ribotyping and antimicrobial susceptibility profiles to compare the isolates we recovered withA. calcoaceticus-baumanniicomplex isolates from injured soldiers.Setting.Fort Sam Houston, Texas.Participants.A population of healthy, nondeployed US Army soldiers in training.Results.A total of 17% of healthy soldiers were found to harborA. calcoaceticus-baumanniicomplex. However, the strains differed from those recovered from injured soldiers.Conclusions.Skin carriage ofA. calcoaceticus-baumanniicomplex exists among soldiers before deployment. However, the difference in the strains isolated from healthy soldiers, compared with the strains from injured soldiers, makes it difficult to identify skin colonization as the source of infection.
Pegylated interferons have recently been approved for treatment of hepatitis C. The safety of the... more Pegylated interferons have recently been approved for treatment of hepatitis C. The safety of these formulations is reported to be similar to that of non-pegylated interferon. We present two patients who experienced exacerbations of their liver disease following administration of pegylated interferon alfa-2b. Vigilant monitoring of patients treated with these new agents is recommended.
Sporotrichosis is a fungal infection that typically results in cutaneous or lymphocutaneous disea... more Sporotrichosis is a fungal infection that typically results in cutaneous or lymphocutaneous disease, although other, more severe, life-threatening manifestations do occur. This article reviews updated treatment guidelines, which state that itraconazole has become the preferred therapy for most forms of infection. Amphotericin B remains the mainstay of treatment for severe cases, but lipid formulations are now preferred because of their more favorable toxicity profile. Also, fluconazole has been shown to be less effective than itraconazole and is no longer recommended except as an alternative for cutaneous and lymphocutaneous disease. [Drug Benefit Trends. 2010;22:49-52]
Posaconazole, indicated for prophylaxis of invasive Aspergillus and Candida infections in immunos... more Posaconazole, indicated for prophylaxis of invasive Aspergillus and Candida infections in immunosuppressed patients aged 13 years or older and for treatment of oropharyngeal candidiasis (Table 1), is like other triazole antifungals in that it blocks ergosterol biosynthesis. 1 Its chemical structure is most similar to that of itraconazole (Figure), which may confer efficacy even against strains resistant to fluconazole and voriconazole.2
... Email me when someone comments on this article. Enoch DA, Ludlam HA, Brown NM. Invasive funga... more ... Email me when someone comments on this article. Enoch DA, Ludlam HA, Brown NM. Invasive fungal infections: a review of epidemiology and management options. J Med Microbiol. ... Philadelphia: Churchill Livingstone; 2005:3068-3079. Koga T, Kitajima T, Tanaka R, et al. ...
... Address for correspondence: Dr. Duane Hospenthal, Infectious Disease Service (MCHK-DMI), Trip... more ... Address for correspondence: Dr. Duane Hospenthal, Infectious Disease Service (MCHK-DMI), Tripler Army Medical Center, Hawaii 96859-5000 (Fax: 808-883-0808; Email: Duane.Hospenthal@ amedd.army.mil). ... 9. Valdez H, Gripshover BM, Stover MD, Salata RA. ...
Background: Combat injury–related wounds are generally acute, and occur in young, otherwise healt... more Background: Combat injury–related wounds are generally acute, and occur in young, otherwise healthy adults. The most significant sequelae of wound bioburden, sepsis, which previously affected 90% of casualties in the preantibiotic era, continues to occur in 5–10%, ...
Over the past 2 decades, there has been an alarming increase in opportunistic fungal infections w... more Over the past 2 decades, there has been an alarming increase in opportunistic fungal infections with an associated rise in morbidity and mortality. This trend has been attributed to the growing number of patients who are immunocompromised because of bone marrow or solid organ transplant, immunosuppressive drugs, AIDS, and hematological malignancies. Advances in trauma and critical care medicine that lead to longer survival of more patients with immunocompromising conditions also play a role.
Despite advances in resuscitation and surgical management of combat wounds, infection remains a c... more Despite advances in resuscitation and surgical management of combat wounds, infection remains a concerning and potentially preventable complication of combat-related injuries. Interventions currently used to prevent these infections have not been either clearly defined or subjected to rigorous clinical trials. Current infection prevention measures and wound management practices are derived from retrospective review of wartime experiences, from civilian trauma data, and from in vitro and animal data. This update to the guidelines published in 2008 incorporates evidence that has become available since 2007. These guidelines focus on care provided within hours to days of injury, chiefly within the combat zone, to those combat-injured patients with open wounds or burns. New in this update are a consolidation of antimicrobial agent recommendations to a backbone of high-dose cefazolin with or without metronidazole for most postinjury indications, and recommendations for redosing of antimicrobial agents, for use of negative pressure wound therapy, and for oxygen supplementation in flight.
Infection Control and Hospital Epidemiology, Jul 1, 2006
Objective.To evaluate whether skin colonization withAcinetobacter calcoaceticus-baumanniicomplex ... more Objective.To evaluate whether skin colonization withAcinetobacter calcoaceticus-baumanniicomplex exists in a population of healthy, nondeployed US Army soldiers and, if present, how it might relate to the infections seen in current war casualties.Design.We sampled various skin sites of soldiers to test for the presence ofA. calcoaceticus-baumanniicomplex and to establish the prevalence of colonization. We then used ribotyping and antimicrobial susceptibility profiles to compare the isolates we recovered withA. calcoaceticus-baumanniicomplex isolates from injured soldiers.Setting.Fort Sam Houston, Texas.Participants.A population of healthy, nondeployed US Army soldiers in training.Results.A total of 17% of healthy soldiers were found to harborA. calcoaceticus-baumanniicomplex. However, the strains differed from those recovered from injured soldiers.Conclusions.Skin carriage ofA. calcoaceticus-baumanniicomplex exists among soldiers before deployment. However, the difference in the strains isolated from healthy soldiers, compared with the strains from injured soldiers, makes it difficult to identify skin colonization as the source of infection.
Pegylated interferons have recently been approved for treatment of hepatitis C. The safety of the... more Pegylated interferons have recently been approved for treatment of hepatitis C. The safety of these formulations is reported to be similar to that of non-pegylated interferon. We present two patients who experienced exacerbations of their liver disease following administration of pegylated interferon alfa-2b. Vigilant monitoring of patients treated with these new agents is recommended.
Sporotrichosis is a fungal infection that typically results in cutaneous or lymphocutaneous disea... more Sporotrichosis is a fungal infection that typically results in cutaneous or lymphocutaneous disease, although other, more severe, life-threatening manifestations do occur. This article reviews updated treatment guidelines, which state that itraconazole has become the preferred therapy for most forms of infection. Amphotericin B remains the mainstay of treatment for severe cases, but lipid formulations are now preferred because of their more favorable toxicity profile. Also, fluconazole has been shown to be less effective than itraconazole and is no longer recommended except as an alternative for cutaneous and lymphocutaneous disease. [Drug Benefit Trends. 2010;22:49-52]
Posaconazole, indicated for prophylaxis of invasive Aspergillus and Candida infections in immunos... more Posaconazole, indicated for prophylaxis of invasive Aspergillus and Candida infections in immunosuppressed patients aged 13 years or older and for treatment of oropharyngeal candidiasis (Table 1), is like other triazole antifungals in that it blocks ergosterol biosynthesis. 1 Its chemical structure is most similar to that of itraconazole (Figure), which may confer efficacy even against strains resistant to fluconazole and voriconazole.2
... Email me when someone comments on this article. Enoch DA, Ludlam HA, Brown NM. Invasive funga... more ... Email me when someone comments on this article. Enoch DA, Ludlam HA, Brown NM. Invasive fungal infections: a review of epidemiology and management options. J Med Microbiol. ... Philadelphia: Churchill Livingstone; 2005:3068-3079. Koga T, Kitajima T, Tanaka R, et al. ...
... Address for correspondence: Dr. Duane Hospenthal, Infectious Disease Service (MCHK-DMI), Trip... more ... Address for correspondence: Dr. Duane Hospenthal, Infectious Disease Service (MCHK-DMI), Tripler Army Medical Center, Hawaii 96859-5000 (Fax: 808-883-0808; Email: Duane.Hospenthal@ amedd.army.mil). ... 9. Valdez H, Gripshover BM, Stover MD, Salata RA. ...
Background: Combat injury–related wounds are generally acute, and occur in young, otherwise healt... more Background: Combat injury–related wounds are generally acute, and occur in young, otherwise healthy adults. The most significant sequelae of wound bioburden, sepsis, which previously affected 90% of casualties in the preantibiotic era, continues to occur in 5–10%, ...
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