Infectious Disease Clinics of North America RSS feed: Current Issue. Infectious Disease Clinics of North America updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in infectious diseases and is presented by an experienced Guest Editor under the guidance of Robert Moellering Jr, MD, Harvard Medical School. http://www.id.theclinics.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Infectious Disease Clinics of North America0891-5520261March 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.id.theclinics.com/article/PIIS089155201100105X/abstract?rss=yesContributors10.1016/S0891-5520(11)00105-XInfectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-3iiivhttp://www.id.theclinics.com/article/PIIS0891552011001061/abstract?rss=yesContents10.1016/S0891-5520(11)00106-1Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-3viixhttp://www.id.theclinics.com/article/PIIS0891552011001073/abstract?rss=yesForthcoming Issues10.1016/S0891-5520(11)00107-3Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-3xixihttp://www.id.theclinics.com/article/PIIS0891552011000882/abstract?rss=yesEach year hundreds of thousands of patients undergo implantation of various medical devices, including prosthetic joints, urinary and venous catheters, and left ventricular assist devices. Although these technologies can improve quality and sometimes even quantity of life, infection remains a potentially devastating complication. Besides significant morbidity and functional impairment, device-associated infection presents a considerable economic burden, accounting for hundreds of millions of dollars in excess health care costs. Despite improved diagnostics and an expanding antimicrobial armamentarium, successful treatment of device-associated infection remains a vital clinical challenge.Device-Associated InfectionsPreeti N. Malani10.1016/j.idc.2011.09.013Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-3xiiixivhttp://www.id.theclinics.com/article/PIIS0891552011000778/abstract?rss=yesCentral line-associated bloodstream infections (CLA-BSI) are one of the leading causes of healthcare-associated infections, resulting in significant morbidity and substantial excess cost. There is a growing recognition that most CLA-BSIs are preventable. Elimination of preventable CLA-BSI is the focus of a recently released CDC Guideline. Universal preventative measures include collaborative performance improvement using checklists and bundles, education of persons who insert and maintain catheters, maximal sterile barrier precautions, and chlorhexidine skin preparation. Technologic innovations including coated catheters, antimicrobial impregnated dressings, and antimicrobial lock solutions should be considered if the rate of CLA-BSI is not acceptable after application of universal precautions.New Developments in the Prevention of Intravascular Catheter Associated InfectionsAngela L. Hewlett, Mark E. Rupp10.1016/j.idc.2011.09.002Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-3111http://www.id.theclinics.com/article/PIIS0891552011000845/abstract?rss=yesCatheter-acquired urinary infection is the most common device-associated healthcare-acquired infection. Although most patients are asymptomatic, symptomatic infection may occur and is associated with increased morbidity and costs. Long-term indwelling catheters are associated with more complex microbiology and greater morbidity than short-term catheters. The most effective way to prevent these infections is to restrict indwelling urinary catheter use to limited indications, and to discontinue use of a catheter as soon as feasible. Alternate means of managing bladder emptying, including external condom catheters for men and intermittent catheterization for patients with neurologic impairment of bladder emptying, should be used when possible.Urinary Catheter-Associated InfectionsLindsay E. Nicolle10.1016/j.idc.2011.09.009Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-31327http://www.id.theclinics.com/article/PIIS0891552011000869/abstract?rss=yesProsthetic joint infection (PJI) is a serious complication of total joint arthroplasty (TJA) that can negatively affect functional status and quality of life. This article examines the epidemiology of PJI and reviews current diagnostic, treatment, and management strategies. Diagnosis can be challenging because presenting symptoms are often nonspecific and there is no simple gold standard diagnostic test. Successful treatment of PJI requires a combination of medical and surgical strategies. Given the devastating nature of PJI and the increasing numbers of TJAs performed, prevention efforts remain critical.Management and Prevention of Prosthetic Joint InfectionEmily K. Shuman, Andrew Urquhart, Preeti N. Malani10.1016/j.idc.2011.09.011Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-32939http://www.id.theclinics.com/article/PIIS0891552011000791/abstract?rss=yesProsthetic vascular grafting is a commonly performed procedure that is central to the management of arterial disease and renal failure. Though rare, vascular graft infections (VGI) are potentially devastating, and carry a high rate of mortality and amputation. Despite extensive research and clinical experience, VGI remain a daunting therapeutic challenge for surgeons and infectious disease specialists. This article reviews the pathogenesis of VGI, in particular the role of biofilms, as well as the current state of clinical management including diagnostic modalities, surgical options for treatment, antimicrobial therapy, and preventive measures.Vascular Graft InfectionsMichael H. Young, Gilbert R. Upchurch, Preeti N. Malani10.1016/j.idc.2011.09.004Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-34156http://www.id.theclinics.com/article/PIIS0891552011000766/abstract?rss=yesInfectious complications of cardiovascular implantable electronic devices (CIED) have risen out of proportion to overall increases in use. Although CIED can provide potentially life-saving benefits, device-associated infections can be a devastating complication. This article examines the epidemiology and microbiology of CIED infection and reviews specific host and procedural risk factors. Recent advances in the diagnosis of CIED infections and the multifaceted approach required for successful management in this complex patient population are also considered.Cardiovascular Implantable Electronic Device Associated InfectionsTejal Gandhi, Thomas Crawford, James Riddell10.1016/j.idc.2011.09.001Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-35776http://www.id.theclinics.com/article/PIIS0891552011000833/abstract?rss=yesThe left ventricular assist device (LVAD) is a mechanical pump that supplements or replaces the function of a damaged left ventricle. Although LVAD support is associated with improved survival and quality of life, infectious complications remain a major limitation. The authors examine the epidemiology of LVAD-associated infections and review current diagnostic, treatment, and management strategies. Novel evidence-based approaches to infection prevention remain critical because the number of patients receiving long-term mechanical support continues to burgeon.Left Ventricular Assist Device–Associated InfectionsSophia Califano, Francis D. Pagani, Preeti N. Malani10.1016/j.idc.2011.09.008Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-37787http://www.id.theclinics.com/article/PIIS089155201100081X/abstract?rss=yesInfections of central nervous system (CNS) devices are relatively common and potentially severe. The most common devices associated with infection are ventriculostomy catheters, shunts, and deep brain stimulators. The prevention, diagnosis, and management of these infections require a collaborative approach because of the complexity of surgery, the nuances of antimicrobial delivery in the CNS, and the potential for severe morbidity and mortality. This article focuses on new developments in the management and prevention of intracranial device infections, in particular ventriculostomy-related infections and infections of deep brain stimulators.Central Nervous System Device InfectionsEdward Stenehjem, Wendy S. Armstrong10.1016/j.idc.2011.09.006Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-389110http://www.id.theclinics.com/article/PIIS089155201100078X/abstract?rss=yesInfection after breast implant surgery occurs in 1.1% to 2.5% of procedures performed for augmentation and up to 35% of procedures performed for reconstruction after mastectomy. Most infections result from skin organisms and occur in the immediate postoperative period, although infections can occasionally present after many years. Diagnosis of breast implant infection relies on the clinical presentation of breast pain, swelling, erythema, and drainage in conjunction with ultrasound-guided cultures of periprosthetic fluid. Management commonly involves implant removal, with device salvage attempted in select situations.Breast Implant InfectionsLaraine L. Washer, Karol Gutowski10.1016/j.idc.2011.09.003Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-3111125http://www.id.theclinics.com/article/PIIS0891552011000808/abstract?rss=yesInfectious complications remain a major source of morbidity and mortality for patients with end-stage renal disease on dialysis. The majority of these complications are related to dialysis access devices, and as such represent a potentially modifiable risk factor. This article reviews the important infectious complications associated with dialysis access, including both hemodialysis and peritoneal dialysis. The discussion highlights the epidemiology, management, and prevention of dialysis access infections.Infectious Complications of Dialysis Access DevicesNatasha Bagdasarian, Michael Heung, Preeti N. Malani10.1016/j.idc.2011.09.005Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-3127141http://www.id.theclinics.com/article/PIIS0891552011000821/abstract?rss=yesIndwelling medical devices are increasingly used in long-term care facilities (LTCFs). These devices place residents at a heightened risk for infection and colonization and infection with multidrug-resistant organisms. Understanding the risk and pathogenesis of infection associated with commonly used medical devices can help facilitate appropriate therapy. Programs to minimize unnecessary use of indwelling medical devices in residents and maximize staff adherence to infection control and maintenance procedures are essential features of a LTCF infection prevention program. LTCFs that provide care for large numbers of residents with indwelling medical devices should routinely perform surveillance for device-related infections and develop systems for assessing the safety and efficacy of newly introduced device-related technology.Medical Device–Associated Infections in the Long-Term Care SettingChristopher J. Crnich, Paul Drinka10.1016/j.idc.2011.09.007Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-3143164http://www.id.theclinics.com/article/PIIS0891552011000857/abstract?rss=yesReuse of both single-use and multiuse medical devices is a common practice and can result in transmission of infection when appropriate sterilization or reprocessing does not occur. Reuse of single-use devices can be problematic because there are no clear standards for reprocessing, although data regarding adverse outcomes are limited. Single-use devices are commonly reused, appropriately or inappropriately, in resource-limited settings because of cost constraints. Reuse of medical devices raises important legal and ethical questions.Reuse of Medical Devices: Implications for Infection ControlEmily K. Shuman, Carol E. Chenoweth10.1016/j.idc.2011.09.010Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-3165172http://www.id.theclinics.com/article/PIIS0891552011000870/abstract?rss=yesThe pathogenesis of device-associated infections is related to biofilm bacteria that exhibit distinct characteristics with respect to growth rate, structural features, and protection from host immune mechanisms and antimicrobial agents when compared with planktonic counterparts. Biofilm-associated infections are prevented, diagnosed, and treated differently from infections not associated with biofilms. This article reviews innovative concepts for the prevention of biofilm formation, and novel treatment approaches. Specific approaches for the diagnosis and prevention of catheter-associated urinary tract and bloodstream infections, as well as infections associated with orthopedic implants and cardiovascular implantable electronic devices, are also discussed.Novel Approaches to the Diagnosis, Prevention, and Treatment of Medical Device-Associated InfectionsPaschalis Vergidis, Robin Patel10.1016/j.idc.2011.09.012Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-3173186http://www.id.theclinics.com/article/PIIS0891552011001085/abstract?rss=yesIndex10.1016/S0891-5520(11)00108-5Infectious Disease Clinics of North America 26, 1 (2012)2012-03-01Infectious Disease Clinics of North America2012-03-01261S0891-5520(11)X0005-3187193