Echinocandin use in hospitalized patients: a multi-institutional study.

Background: The echinocandin antifungals are recommended as initial therapy in hospitalized patients with candidemia. Contemporary usage rates and indication for use of echinocandins have not been studied in the United States. The purpose of this study was to evaluate echinocandin usage patterns in community and academic teaching hospitals over time and to evaluate dose, duration of therapy and indications for use.

Real-world performance of a microarray-based rapid diagnostic for Gram-positive bloodstream infections and potential utility for antimicrobial stewardship.

The Verigene Gram-positive blood culture assay (BC-GP) is a microarray-based rapid diagnostic test, which includes targets for 12 bacterial species and 3 resistance determinants. We prospectively compared the diagnostic accuracy of the BC-GP to routine microbiologic methods and evaluated the potential of the BC-GP for antimicrobial stewardship programs. A total of 143 consecutive patients with Gram-positive bacteremia were included in the analysis.

A hospital-based study of the clinical characteristics of Clostridium difficile infection in children.

Background: Clostridium difficile infection (CDI) is an increasingly important cause of morbidity in hospitalized children. We describe the recent epidemiology of pediatric CDI at a children's hospital, compare community-associated (CA) and hospital-associated (HA) infections and identify risk factors for severe disease.

Methods: Children with CDI at Texas Children's Hospital were identified from February 1, 2011, to October 31, 2011.

Real-time polymerase chain reaction detection of asymptomatic Clostridium difficile colonization and rising C. difficile-associated disease rates.

Objective: To evaluate the accuracy of real-time polymerase chain reaction (PCR) for Clostridium difficile-associated disease (CDAD) detection, after hospital CDAD rates significantly increased following real-time PCR initiation for CDAD diagnosis.

Design: Hospital-wide surveillance study following examination of CDAD incidence density rates by interrupted time series design.

Setting: Large university-based hospital.

Clinical practice patterns in hospitalized patients at risk for invasive candidiasis: role of antifungal stewardship programs in an era of rapid diagnostics.

Background: Rapid diagnostic tests for Candida are becoming available that may supplement traditional microbiological identification.

Objective: Assess clinical practice patterns in patients with or at risk of candidiasis who may benefit from the use of rapid diagnostic tests.

Methods: This was a prospective cohort study of patients with candidemia or receiving systemic antifungals conducted at a university-affiliated tertiary care hospital.

Colonic immunopathogenesis of Clostridium difficile infections.

There are major gaps in our understanding of the immunopathogenesis of Clostridium difficile infections (CDIs). In this study, 36 different biomarkers were examined in the stools of CDI and non-CDI patients using the Proteome Profiler human cytokine array assay and quantitative enzyme-linked immunosorbent assay. Diarrheal stools from patients with CDI (CDI-positive diarrheal stools) showed higher relative amounts of the following inflammatory markers than the diarrheal stools from CDI-negative patients (CDI-negative diarrheal stools): C5a, CD40L, granulocyte colony-stimulating factor, I-309, interleukin-13 (IL-13), IL-16, IL-27, monocyte chemoattractant protein 1, tumor necrosis factor alpha, and IL-8.

Paradoxical immune reconstitution inflammatory syndrome due to toxoplasmic encephalitis: two cases and review of initiation of antiretroviral timing in toxoplasmic encephalitis IRIS.

Toxoplasma encephalitis immune reconstitution inflammatory syndrome (TE-IRIS) is rare and usually occurs in an unmasking, rather than paradoxical form. To the best of our knowledge, only two cases of paradoxical TE-IRIS and nine cases of unmasking TE-IRIS have been previously described. We present two additional cases of histopathology-consistent paradoxical TE-IRIS, after early initiation of antiretroviral therapy (ART), and review the literature on TE-IRIS.

Noroviruses: The Most Common Pediatric Viral Enteric Pathogen at a Large University Hospital After Introduction of Rotavirus Vaccination.

We conducted an 8.5-year study examining enteric viruses at Texas Children's Hospital (TCH) before and after rotavirus vaccine introduction. Norovirus prevalence was 10.

Clostridium difficile: an emerging pathogen in children.

Clostridium difficile is emerging as an important enteric pathogen in children. Historically considered as an asymptomatic colonizer of the gastrointestinal tract, C. difficile infection (CDI) has not been well-studied in pediatric populations.

Rifaximin therapy of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by abdominal pain and altered bowel habits in the absence of specific organic pathology. Although the underlying pathogenesis of IBS is not well-understood, small intestinal bacterial overgrowth (SIBO) or other abnormalities in the gut flora is believed to contribute to the development of a subset of IBS cases. Rifaximin is a poorly absorbed antimicrobial with activity against enteric pathogens.

Norovirus gastroenteritis successfully treated with nitazoxanide.

Infectious diarrhea is a common occurrence in the immunosuppressed population. We present a 43-year-old individual with large-volume stool output Norovirus acute gastroenteritis in the setting of relapsed refractory acute myelogenous leukemia, hematopoietic stem cell transplantation, and biopsy-proven cutaneous and pulmonary graft-versus-host disease. Therapeutic options such as intravenous immunoglobulin or reduction of immunosuppressants were not a feasible choice.

Noroviruses: The leading cause of gastroenteritis worldwide.

Noroviruses are the leading cause of foodborne disease outbreaks worldwide, and may soon eclipse rotaviruses as the most common cause of severe pediatric gastroenteritis, as the use of rotavirus vaccines becomes more widespread. Genetic mutations and recombinations contribute to the broad heterogeneity of noroviruses and the emergence of new epidemic strains. Although typically a self-limited disease, norovirus gastroenteritis can cause significant morbidity and mortality among children, the elderly, and the immunocompromised.

Future novel therapeutic agents for Clostridium difficile infection.

Importance Of The Field: Clostridium difficile is the most important definable cause of healthcare acquired diarrhea. The increasing incidence and mortality associated with this enteric pathogen and the significant rate of treatment failures and recurrences with current antibiotics emphasize the need for the discovery of new and improved therapeutic and preventative agents.

What The Reader Will Gain: We review upcoming novel therapeutic agents and the clinical evidence to support their efficacy in treating C.

Clostridium difficile infection: update on emerging antibiotic treatment options and antibiotic resistance.

Clostridium difficile infection (CDI) is the most common cause of identifiable diarrhea in hospitalized patients. The incidence and severity of CDIs are increasing. The increased incidence and severity of the disease has sparked interest in the optimal treatment of CDI as well as the use of new therapies and drug discovery.

Noroviruses as a cause of diarrhea in travelers to Guatemala, India, and Mexico.

Noroviruses (NoVs) are increasingly being recognized as an important enteric pathogen of gastroenteritis worldwide. The prevalence of NoVs as a cause of diarrhea acquired by travelers in developing countries is not well known. We examined the prevalence and importance of NoV infection in three international traveler cohorts with diarrhea acquired in three developing regions of the world, Mexico, Guatemala, and India.

The role of rifaximin in the treatment and chemoprophylaxis of travelers' diarrhea.

Travelers' diarrhea is a common illness among international travelers from developed to developing countries. Travelers' diarrhea is caused by ingestion of contaminated food and water. Bacteria are the primary cause of travelers' diarrhea.

Rifaximin: a unique gastrointestinal-selective antibiotic for enteric diseases.

Purpose Of Review: Rifaximin is gaining attention for its potential activity in a multitude of gastrointestinal diseases. We review the unique pharmaceutical properties of this antibiotic and the published evidence in the literature regarding the use of rifaximin for different gastrointestinal disorders.

Recent Findings: Rifaximin is a gastrointestinal-selective antibiotic with a broad spectrum of antimicrobial activity, an excellent safety profile, minimal drug interactions, and negligible impact on the intestinal microbiome.

Coliform and Escherichia coli contamination of desserts served in public restaurants from Guadalajara, Mexico, and Houston, Texas.

Bacterial enteropathogens acquired from contaminated food are the principal causes of travelers' diarrhea (TD). We evaluated desserts obtained from popular restaurants in the tourist city of Guadalajara, Mexico, and Houston, Texas, to determine coliform and Escherichia coli contamination levels and presence of diarrheagenic E. coli known to be important in TD.

A nosocomial outbreak of norovirus infection masquerading as clostridium difficile infection.

Noroviruses (NoVs) are increasingly being recognized as important enteric pathogens. At a university-based hospital, we investigated a nosocomial outbreak of NoV infection that was originally attributed to Clostridium difficile. We describe here the unique challenges of the identification of NoVs as the true etiologic pathogen in an outbreak occurring in a health care setting, where C.

Antimotility agents for the treatment of Clostridium difficile diarrhea and colitis.

Antimotility agent use for the treatment of Clostridium difficile infection (CDI) is discouraged. We reviewed the literature and unpublished postmarketing surveillance reports regarding antimotility treatment of CDI. Twenty reports met inclusion criteria, describing 55 patients with CDI who were exposed to antimotility agents.

Coliform contamination of vegetables obtained from popular restaurants in Guadalajara, Mexico, and Houston, Texas.

Food is the primary vehicle of transmission for traveler's diarrhea. We evaluated coliform contamination of vegetables from popular restaurants in Guadalajara, Mexico, and Houston, Texas. Contamination of vegetables in Guadalajara restaurants was widespread.

Drug-drug interaction between itraconazole and efavirenz in a patient with AIDS and disseminated histoplasmosis.

Although there is a presumed drug-drug interaction between itraconazole and nonnucleoside reverse-transcriptase inhibitors, the medical literature lacks such documentation. We describe a drug-drug interaction between itraconazole and efavirenz in a patient with disseminated histoplasmosis and acquired immunodeficiency syndrome (AIDS). The drug combination resulted in persistently elevated urinary Histoplasma antigen levels and subtherapeutic plasma itraconazole concentrations.