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John Bartlett, MD Professor of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Clostridium difficile has recently received increasing attention due to significant recent changes in the epidemiology of infection. Antimicrobial resistance to the antibiotics used to treat C difficile (metronidazole and vancomycin) is rarely a significant issue. However, a growing number of C difficile infections are related to fluoroquinolone use, which was not previously a significant problem.
Risk Factors for Infection: Community-Acquired Resistant Pathogens
George H. Karam, MD Paula Garvey Manship Professor of Medicine, Division of Infectious Diseases, Louisiana State University School of Medicine, Baton Rouge, Louisiana
It was not long ago when the suspicion of antimicrobial-resistant microorganisms was largely restricted to hospitalized patients. In recent months, however, there has been an increase in resistance in the community setting due to the growing dissemination of organisms such as community-associated methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, quinolone-resistant E coli, and strains of Clostridium difficile that are now resistant to quinolones.
Marin Kollef, MD Professor of Medicine, Washington University School of Medicine, St. Louis, Missouri
In recent years, healthcare-associated pneumonia (HCAP) has increasingly been recognized as distinct from several related conditions, including community-acquired pneumonia (CAP), nursing home-acquired pneumonia, hospital-acquired pneumonia (HAP), and ventilator-acquired pneumonia (VAP).
Peter Linden, MD Professor, Department of Critical Care Medicine, Associate Professor, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
Healthcare-associated infections occur in patients who have experienced recent or even distant exposures to the healthcare environment. These patients may have undergone antibiotic treatment or the placement of intravascular devices, or they may have transferred from other healthcare settings, such as dialysis clinics or long-term care facilities.
Lena Napolitano, MD, FACS, FCCP, FCCM Professor of Surgery, Division Chief, Acute Care Surgery, Associate Chair of Surgery, Department of Surgery, Director, Surgical Critical Care, University of Michigan Health System, Ann Arbor, Michigan
The microbiology of skin and skin structure infections has changed considerably in recent years. Gram-positive organisms have long been recognized as the most common isolates in these serious infections. However, a marked increase in community-associated methicillin-resistant Staphylococcus aureus (MRSA) and healthcare-associated MRSA as a leading cause of complicated skin and skin structure infections has been noted over the last decade.
Rob Owens, PharmD Clinical Specialist, Infectious Diseases, Co-Director, Antimicrobial Stewardship Program, Maine Medical Center, Portland, Maine
Antimicrobial stewardship programs have become more popular as a growing number of studies have demonstrated the overuse of antimicrobials in many clinical settings. Stewardship programs provide an option to improve antimicrobial prescribing for both community-based and hospital-based healthcare professionals. The primary goal of an antimicrobial stewardship program is to optimize clinical outcomes while minimizing the unintended consequences of antimicrobial therapy (eg, toxicity, selection of pathogenic organisms such as Clostridium difficile and antimicrobial resistance). Antimicrobial stewardship programs can also decrease total antimicrobial use and overall treatment cost.
