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Background Looking only at the index infection, studies have described risk factors for infections caused by resistant bacteria. We hypothesized that septic patients with bloodstream infections may transition across states characterized by different microbiology and that their trajectory is not uniform. We also hypothesized that baseline risk factors may influence subsequent blood culture results. Methods All adult septic patients with positive blood cultures over a 7-year period were included in the study. Baseline risk factors were recorded. We followed all survivors longitudinally and recorded subsequent blood culture results. We separated states into bacteremia caused by gram-positive cocci, susceptible gram-negative bacilli (sGNB), resistant GNB (rGNB), and Candida spp. Detrimental transitions were considered when transitioning to a culture with a higher mortality risk (rGNB and Candida spp.). A multistate Markov-like model was used to determine risk factors associated with detrimental transitions. Results A total of 990 patients survived and experienced at least 1 transition, with a total of 4282 transitions. Inappropriate antibiotics, previous antibiotic exposure, and index bloodstream infection caused by either rGNB or Candida spp. were associated with detrimental transitions. Double antibiotic therapy (beta-lactam plus either an aminoglycoside or a fluoroquinolone) protected against detrimental transitions. Conclusion Baseline characteristics that include prescribed antibiotics can identify patients at risk for subsequent bloodstream infections caused by resistant bacteria. By altering the initial treatment, we could potentially influence future bacteremic states. [ABSTRACT FROM AUTHOR]

The article offers information on trials for treatment of hospital-acquired bacterial pneumonia (HABP) or ventilator-associated bacterial pneumonia (VABP). It mentions need to identify both the safety and efficacy of the new antimicrobial agent within clinically important patient groupings related to disease severity, causative pathogens, and study drug clearance.

The author reflects on a clinical approach to antibiotic treatment presented in a study that is antimicrobial de-escalation (ADE) to limit unnecessary antimicrobial exposure for reducing antibiotic resistance. He states that there is no evidence of lower emergence of resistance resulted by ADE. The author suggests that the impact of matrix-assisted laser desorption-ionization (MALDI-TOF) mass spectrometry (MS) can be analyzed in patients with bloodstream infections.

Information on several papers discussed during the "Health Care-Associated Pneumonia Summit" that was conducted in 2007 is presented. Topics include the risk factors used to identify health care-associated infections (HAI) and the appropriate initial empirical antibiotic treatment strategies for patients at risk for health care-associated pneumonia.

Increasingly, patients are receiving treatment at facilities other than hospitals, including long-term-health care facilities, assisted-living environments, rehabilitation facilities, and dialysis centers. As with hospital environments, nonhospital settings present their own unique risks of pneumonia. Traditionally, pneumonia in these facilities has been categorized as community-acquired pneumonia (CAP). However, the new designation for pneumonias acquired in these settings is health care-associated pneumonia (HCAP), which covers pneumonias acquired in health care environments outside of the traditional hospital setting and excludes hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and CAP. Although HCAP is currently treated with the same protocols as CAP, recent evidence indicates that HCAP differs from CAP with respect to pathogens and prognosis and, in fact, more closely resembles HAP and VAP. The HCAP Summit convened national infectious disease opinion leaders for the purpose of analyzing current literature, clinical trial data, diagnostic considerations, therapeutic options, and treatment guidelines related to HCAP. After an in-depth analysis of these areas, the infectious disease investigators participating in the summit were surveyed with regard to 10 clinical practice statements. The results were then compared with results of the same survey as completed by 744 Infectious Diseases Society of America members. The similarities and differences between those survey results are the basis of this publication. [ABSTRACT FROM AUTHOR]