State-of-the-Art Reviews
Explore the latest State-of-the-Art reviews from Clinical Infectious Diseases on the contemporary diagnosis and management of infectious diseases. Learn more about how to submit your own State-of-the-Art review article here.
Over 50% of adult women experience at least 1 urinary tract infection (UTI) in their lifetime, and almost one-quarter of them will experience a recurrent UTI (rUTI). Recurrent UTI is defined as ≥2 UTIs in a 6-month period or ≥3 UTIs in 12 months (at least 1 of these episodes should be ...
On urinalysis, absence of pyuria can help rule out a UTI but the presence of pyuria or nitrites is not diagnostic of UTI in otherwise asymptomatic patients. Urine culture results in symptomatic patients can help target antimicrobial therapy but also rule out other genitourinary conditions such as ...
As active medical and surgical providers of gender-affirming care, we aim to share lived experiences of our patients and outline best practices in gender-affirming medicine in this review.
As active medical and surgical providers of gender-affirming care, we aim to share lived experiences of our patients and outline best practices in gender-affirming medicine in this review.
Cardiac implantable electronic device infections (CIEDIs) present substantial challenges for infectious diseases specialists, encompassing diagnosis, management, and complex decision-making involving patients, families, and multidisciplinary teams. This review, guided by a common clinical case ...
Diagnosis and management of cardiac implantable electronic device infections (CIEDIs) are challenging and require a multidisciplinary team effort. This review uses a common clinical case presentation encountered in daily practice to demonstrate the complex approach to CIEDIs from various aspects.
This review on spinal implant infections (SIIs) is based on best-available evidence. Early infections are often managed with debridement, implant retention and 12-week antibiotic therapy. Chronic infections may need implant removal or revision.
Collaborations between ophthalmologists and infectious disease specialists are critical for optimizing care of many patients with eye infections. We review challenges in common and uncommon eye infections to promote better understanding of these infections and prioritize areas for further research.
Ocular infections are common and range from mild to vision-threatening. They can occur independently or as a manifestation or complication of a systemic infection that can cause extraocular morbidity and even mortality. Diagnosing and managing ocular infections can be inherently challenging. ...
This article explores the management of pelvic osteomyelitis in patients with stage IV pressure injuries, emphasizing the need for multidisciplinary care and highlighting the challenges faced by healthcare providers due to the lack of high-quality evidence to guide best practices.
Managing pelvic osteomyelitis (POM) in the setting of stage IV pressure injuries requires multidisciplinary evaluation as well as patient and caregiver engagement and is complicated by the lack of high-evidence data to guide best practices. In this review, we describe our approach to pressure ...
Management of nontuberculous mycobacterial pulmonary disease requires a multidisciplinary approach that addresses comorbidities, nutrition, and airway clearance. Antimicrobial therapy typically includes a multidrug macrolide-oriented regimen, ethambutol for slowly growing mycobacteria, and possibly an aminoglycoside for severe or treatment-limited diseases.
Delusional infestation is a condition in which patients have a fixed, false belief that they are infested with living creatures or nonliving objects. It can be categorized as a primary disorder, which is a diagnosis of exclusion or can be secondary to another medical or psychiatric illness. The ...
Delusional infestation is a condition in which patients have a fixed, false belief that they are infested with living creatures or nonliving objects. This paper provides evidence-based guidance for infectious diseases clinicians in the evaluation and management of these patients.
We review key concepts in the diagnosis, treatment, and follow-up of individuals with neurosyphilis. While we did not focus on ocular and otic syphilis, which are entities distinct from neurosyphilis, we have included some information about these diagnoses to highlight relevant distinctions with ...
Vascular graft infection (VGI) is one of the most serious complications following arterial reconstructive surgery. VGI has received increasing attention over the past decade, but many questions remain regarding its diagnosis and management. In this review, we describe our approach to VGI through ...
Vascular graft infection (VGI) is one of the most serious complications following arterial reconstructive surgery. VGI has received increasing attention over the past decade, but many questions remain regarding its diagnosis and management. In this review, we describe our approach to VGI through ...
Glucocorticoid-induced immunosuppression is linked to the dose, duration, and intensity, but the dose-dependent model may inaccurately predict the risk of opportunistic infections. We discuss details of glucocorticoid treatments to determine their effect on immune function and risk of opportunistic infections.
Hospitalizations from recurrent infections often result in progressive asthenia and functional decline. Our discussion centers around a patient with unresectable cholangiocarcinoma whose recurrent infections pose various challenges as her clinical condition evolves. We emphasize the importance of ...
Navigating antibiotics at the end of life is a challenge for infectious disease (ID) physicians who remain deeply committed to providing patient-centered care and engaging in shared decision making. ID physicians, who often see patients in both inpatient and outpatient settings and maintain ...
Acknowledgments. All authors contributed to the manuscript. AAs report no conflicts of interest. DJM reports payment from Antimicrobial Resistance Leadership Group for participation in a systematic review; and travel support from UCSF ID division to attend IDWeek. HFC reports an institutional ...
Persistent enterococcal bacteremia is a commonly encountered and morbid syndrome without a strong evidence base for optimal management practices. Here we highlight reports on the epidemiology of enterococcal bacteremia to better describe and define persistent enterococcal bacteremia, discuss factors specific to Enterococcus species that may contribute to persistent infections, and describe a measured approach to diagnostic and therapeutic strategies for patients with these frequently complicated infections. The diagnosis of persistent enterococcal bacteremia is typically clinically evident in the setting of repeatedly positive blood culture results; instead, the challenge is to determine in an accurate, cost-effective, and minimally invasive manner whether any underlying nidus of infection (eg, endocarditis or undrained abscess) is present and contributing to the persistent bacteremia. Clinical outcomes for patients with persistent enterococcal bacteremia remain suboptimal. Beyond addressing host immune status if relevant and pursuing source control for all patients, management decisions primarily involve the selection of the proper antimicrobial agent(s). Options for antimicrobial therapy are often limited in the setting of intrinsic and acquired antimicrobial resistance among enterococcal clinical isolates. The synergistic benefit of combination antimicrobial therapy has been demonstrated for enterococcal endocarditis, but it is not clear at present whether a similar approach will provide any clinical benefit to some or all patients with persistent enterococcal bacteremia.
In parallel with rising mortality from drug overdoses, hospitalizations for infectious complications from substance use are increasing [ 1 ]. One in 9 hospitalized adults in the United States has a substance use disorder (SUD) [ 2 ]. Traditionally, patients with injection drug use (IDU)–associated ...
As the overdose crisis continues to worsen, infectious complications from substance use also continue to rise [ 1 ]. It is important to understand that people with substance use disorder (SUD) may delay seeking care due to several barriers, thus impacting clinical presentation. Barriers to ...
Persistent enterococcal bacteremia is a commonly encountered and morbid syndrome without a strong evidence base for optimal management practices. Here we highlight reports on the epidemiology of enterococcal bacteremia to better describe and define persistent enterococcal bacteremia, discuss ...
In this review, we will present a clinical case of a critically ill patient representative of those often encountered in the hospital setting. We will discuss proposed approaches and a general treatment framework for such cases, with a focus on identifying risk factors for MDR-GN infections, ...
In this review, we seek to provide a comprehensive overview of the evaluation and management of Staphylococcus aureus bacteremia, with special focus on areas where the highest level of evidence is lacking to inform best practices.
This review describes the current state of care for periprosthetic joint infection, focusing on multidisciplinary collaboration, common diagnostic and management conundrums, and patient-focused decision making.
In the past decade, the prevalence of multidrug-resistant gram-negative (MDR-GN) bacterial infections has increased significantly, leading to higher rates of morbidity and mortality. Treating these infections poses numerous challenges, particularly when selecting appropriate empiric therapy for ...
Encephalitis is a potentially devastating neurologic disease associated with significant morbidity during the acute illness and often complicated by prolonged neurologic deficits. Historically, only about half of all cases of encephalitis had a cause identified. Recent advances in molecular testing ...
Glucocorticoid-induced immunosuppression is linked to the dose, duration, and intensity, but the dose-dependent model may inaccurately predict the risk of opportunistic infections. We discuss glucocorticoid treatment details to determine the effect on immune function and risk of opportunistic infections.
We review key concepts in the diagnosis, treatment, and follow-up of individuals with neurosyphilis. We describe the epidemiology of syphilis in the United States, highlight populations that are markedly affected by this infection, and attempt to estimate the burden of neurosyphilis. We describe ...
The causes and management of encephalitis have evolved significantly over the last decade. This update highlights a pragmatic approach to the evaluation of acute encephalitis, emphasizing core pathogens, autoimmune causes, and the role of emerging molecular diagnostics.
This review describes the current state of care for periprosthetic joint infection, focusing on multidisciplinary collaboration, common diagnostic and management conundrums, and patient-focused decision-making.
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