Vaccines and vaccine resistance: Past, present and future.

Background: Edward Jenner, by any definition would be considered the father of vaccinology. His use of cow pox virus for vaccinating against small pox is the prime example of a live vaccine. Using a virus that has very low virulence for humans and therefore, fits the definition of attenuated.

Successful Treatment of UL97 Mutation Ganciclovir-Resistant Cytomegalovirus Viremia in a Renal Transplant Recipient With Letermovir and Adjunct Hyperimmune Cytomegalovirus Immunoglobulin: A Case Report.

Letermovir is an antiviral agent indicated for primary prophylaxis of cytomegalovirus (CMV) infection and disease in adult allogeneic hematopoietic stem cell transplant recipients. In this case, UL97 mutation that conferred resistance to ganciclovir was seen in a patient 8 months after renal transplant. We report the off-label use of letermovir with adjunct hyperimmune CMV immunoglobulin in the successful treatment of CMV disease.

Correction to: Resistance to Antibacterial Agents: Foregone Conclusion - What's Next?

The article Resistance to Antibacterial Agents: Foregone Conclusion - What's Next?, written by Chand Wattal & Nancy Khardori, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 11 December 2019 with open access.

Controversies in Treating Asymptomatic Bacteriuria and Urinary Tract Infection: A Case Based Review of Antibiotic Use in Renal Transplant Patients and its Impact on the Development of Resistance.

There is excessive use of both broad spectrum and niched antibiotics for urinary tract infections (UTIs) in hospital and ambulatory setting in spite of clear guidelines on appropriate use. Majority of antibiotics prescribed in United States for UTIs are for nonspecific indications such as positive urine cultures in the absence of symptoms, etc. For these conditions especially asymptomatic bacteriuria, a large proportion of the antibiotics prescribed are unlikely to provide clinical benefit to patients.

Diagnostic Microbiology from the Beginning to the Future: Regional Antibiograms as Public Health Tools to Slow Down Antibiotic Resistance.

Infectious diseases is the only area of medicine where we can isolate the cause and study it in the laboratory under conditions similar to human body. Once isolated, we are able to determine the most optimal drug to treat it. Unfortunately, it is also the only specialty where after making truly wondrous strides we find ourselves at the crossroads of a public health crisis in the form of ongoing antibiotic resistance.

Antibiotics: From the Beginning to the Future: Part 2.

We read, write, and discuss the option of adding new agents to the armamentarium of antibiotic therapy very frequently. However, the past and present has taught us that resistance is likely to develop to any and all kinds of antibiotics. Here we start with an overview of potential future antibiotics from novel sources and targets that may circumvent most known resistance mechanisms.

Antibiotics: From the Beginning to the Future: Part 1.

The first written record of intervention against what later came to be known as an infectious disease was in the early seventeenth century by a Buddhist nun. She dried 3 to 4 wk old scabs from patients with mild smallpox and asked well people to inhale the powder. More than a century later in 1796, Edward Jenner described vaccination against smallpox by using cowpox that later was found to be caused by cowpox virus which is non-pathogenic for humans.

A retrospective epidemiologic study to define risk factors, microbiology, and clinical outcomes of infective endocarditis in a large tertiary-care teaching hospital.

Objective: This study aims to define risk factors as well as their association with microbiology and clinical outcomes in a large US infective endocarditis population.

Methods: Hospital records were searched for appropriate infective endocarditis-related ICD codes from 16 July 2007 to 13 August 2015. A total of 363 cases were retrospectively identified that met definite Modified Duke Criteria for infective endocarditis and were analyzed by age group, causative organism, and associated risk factors for use of valvular surgical intervention, 30/90/180-day mortality after admission, and embolic phenomena.

Legionnaire's Disease and Immunosuppressive Drugs.

Immunosuppressive agents predispose patients to legionnaire's disease. Patients receiving tumor necrosis factor antagonists are generally not severely immunocompromised by the underlying disease. In patients with malignancy receiving immunosuppressive therapies, it is difficult to balance the underlying disease versus the therapy used.

Efficacy of ultraviolet C light at sublethal dose in combination with antistaphylococcal antibiotics to disinfect catheter biofilms of methicillin-susceptible and methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis in vitro.

Background: Biofilm formation inside inserted medical devices leads to their failure and acts as a source of refractory infections. The ultraviolet C (UVC) light is a potential therapy that can be used against the biofilm of bacterial pathogens.

Objective: We evaluated the efficacy of sublethal dose of UVC light with anti-staphylococcal antibiotics against biofilms made from 30 isolates of methicillin-susceptible Staphylococcus aureus and methicillin-resistant S.

Nutrition in Wound Care Management: A Comprehensive Overview.

Wound care is a multidisciplinary specialty requiring many physiologic and immunologic processes as well as physical, social, and societal factors to achieve successful wound closure. Most wounds are treated with combinations of antimicrobials, protective barriers, and topical growth agents, including skin and biologic grafts.The role of nutrition in wound healing may be overlooked in the wound care patient.

Evaluation of regional antibiograms to monitor antimicrobial resistance in Hampton Roads, Virginia.

We studied recent antibiograms (2010 to 2011) from 12 hospitals in the Hampton Roads area, Virginia, that refer patients to a tertiary-care facility affiliated with Eastern Virginia Medical School. The data was compiled into a regional antibiogram, and sensitivity rates of common isolates from the tertiary-care facility (central) were compared to those of referring hospitals grouped by locale. Staphylococcus aureus was the most common Gram- positive and E.

Antifungal activity of amphotericin B and voriconazole against the biofilms and biofilm-dispersed cells of Candida albicans employing a newly developed in vitro pharmacokinetic model.

Background: Candida albicans is a common cause of a variety of superficial and invasive disseminated infections the majority of which are associated with biofilm growth on implanted devices. The aim of the study is to evaluate the activity of amphotericin B and voriconazole against the biofilm and the biofilm-dispersed cells of Candida albicans using a newly developed in vitro pharmacokinetic model which simulates the clinical situation when the antifungal agents are administered intermittently.

Methods: RPMI medium containing 1-5 X 10(6) CFU/ml of C.

Comparison of the Immunogenicity of Various Booster Doses of Inactivated Polio Vaccine Delivered Intradermally Versus Intramuscularly to HIV-Infected Adults.

Background: Inactivated polio vaccine (IPV) is necessary for global polio eradication because oral polio vaccine can rarely cause poliomyelitis as it mutates and may fail to provide adequate immunity in immunocompromised populations. However, IPV is unaffordable for many developing countries. Intradermal IPV shows promise as a means to decrease the effective dose and cost of IPV, but prior studies, all using 20% of the standard dose used in intramuscular IPV, resulted in inferior antibody titers.

Overwhelming Capnocytophaga canimorsus infection in a patient with asplenia.

Patients with asplenia are prone to overwhelming infections due to encapsulated organisms. We report a 62-year-old man presenting with fever and weakness. His medical history was significant for splenectomy and owning a dog as pet.

Necrotizing soft-tissue infections.

NSTI is a life-threatening, surgical, and medical emergency. Clinical presentation, at least in the initial phase, can be misleading. Various studies have shown that delay in surgical debridement is associated with increased mortality.

Intra-abdominal and pelvic emergencies.

The diversity in intra-abdominal/pelvic infections is more than any other organ system. Several clinical scenarios can end up in intra-abdominal infections. The common causes include penetrating abdominal trauma, abdominal surgery, diverticulitis, appendicitis, pancreatitis, biliary disease, perforated viscus, and primary peritonitis.

Cardiac emergencies: infective endocarditis, pericarditis, and myocarditis.

Cardiac infections presenting as emergencies include complications of infective endocarditis, including congestive heart failure, chordae tendinae rupture, cardiac arrhythmias, and embolic phenomenon; acute pericarditis, including cardiac tamponade; and acute myocarditis presenting with malignant cardiac arrhythmias or congestive heart failure. Most of these emergent infectious disease manifestations of the cardiovascular system have a good prognosis if diagnosed early and managed appropriately. Newer diagnostic modalities and combined treatment guidelines are available from the European Society of Cardiology and the American Heart Association.

Immunotherapies in infectious diseases.

The development of an infection involves interplay between the host's immune system and the virulence of the infecting microorganism. The traditional treatment of an infection involves antimicrobial chemotherapy to kill the organism. The use of immunotherapies in infections includes treatment options that modulate the immune response and can lead to control of infections.

Immunotherapy in clinical medicine: historical perspective and current status.

In humans, the immune system is a complex organ system involving cells and soluble mediators whose function is, essentially, protection. However, disequilibrium in this intricate system leads to disease in itself. To modulate these responses, immunotherapy is now the primary or adjunct treatment of many diseases.