Infectious Diseases Society of America Guidance on the Treatment of AmpC β-Lactamase-Producing Enterobacterales, Carbapenem-Resistant Acinetobacter baumannii, and Stenotrophomonas maltophilia Infections

The Infectious Diseases Society of America (IDSA) is committed to providing up-to-date guidance on the treatment of antimicrobial-resistant infections. A previous guidance document focused on infections caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa). Here, guidance is provided for treating AmpC β-lactamase-producing Enterobacterales (AmpC-E), carbapenem-resistant Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia infections. A panel of 6 infectious diseases specialists with expertise in managing antimicrobial-resistant infections formulated questions about the treatment of AmpC-E, CRAB, and S. maltophilia infections. Answers are presented as suggested approaches and corresponding rationales. In contrast to guidance in the previous document, published data on the optimal treatment of AmpC-E, CRAB, and S. maltophilia infections are limited. As such, guidance in this document is provided as "suggested approaches"based on clinical experience, expert opinion, and a review of the available literature. Because of differences in the epidemiology of resistance and availability of specific anti-infectives internationally, this document focuses on the treatment of infections in the United States. Preferred and alternative treatment suggestions are provided, assuming the causative organism has been identified and antibiotic susceptibility results are known. Approaches to empiric treatment, duration of therapy, and other management considerations are also discussed briefly. Suggestions apply for both adult and pediatric populations. The field of antimicrobial resistance is highly dynamic. Consultation with an infectious diseases specialist is recommended for the treatment of antimicrobial-resistant infections. This document is current as of 17 September 2021 and will be updated annually. The most current version of this document, including date of publication, is available at www.idsociety.org/practice-guideline/amr-guidance-2.0/

Infectious Diseases Society of America Guidance on the Treatment of Extended-Spectrum β-lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa)

Background: Antimicrobial-resistant infections are commonly encountered in US hospitals and result in significant morbidity and mortality. This guidance document provides recommendations for the treatment of infections caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa). Methods: A panel of 6 infectious diseases specialists with expertise in managing antimicrobial-resistant infections formulated common questions regarding the treatment of ESBL-E, CRE, and DTR-P. aeruginosa infections. Based on review of the published literature and clinical experience, the panel provide recommendations and associated rationale for each recommendation. Because of significant differences in the molecular epidemiology of resistance and the availability of specific anti-infective agents globally, this document focuses on treatment of antimicrobial-resistant infections in the United States. Results: Approaches to empiric treatment selection, duration of therapy, and other management considerations are briefly discussed. The majority of guidance focuses on preferred and alternative treatment recommendations for antimicrobial-resistant infections, assuming that the causative organism has been identified and antibiotic susceptibility testing results are known. Treatment recommendations apply to both adults and children. Conclusions: The field of antimicrobial resistance is dynamic and rapidly evolving, and the treatment of antimicrobial-resistant infections will continue to challenge clinicians. This guidance document is current as of 17 September 2020. Updates to this guidance document will occur periodically as new data emerge. Furthermore, the panel will expand recommendations to include other problematic gram-negative pathogens in future versions. The most current version of the guidance including the date of publication can be found at www.idsociety.org/practice-guideline/amr-guidance/

Infectious Diseases Society of America 2022 Guidance on the Treatment of Extended-Spectrum β-lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa)

Background: The Infectious Diseases Society of America (IDSA) is committed to providing up-to-date guidance on the treatment of antimicrobial-resistant infections. The initial guidance document on infections caused by extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa) was published on 17 September 2020. Over the past year, there have been a number of important publications furthering our understanding of the management of ESBL-E, CRE, and DTR-P. aeruginosa infections, prompting a rereview of the literature and this updated guidance document. Methods: A panel of 6 infectious diseases specialists with expertise in managing antimicrobial-resistant infections reviewed, updated, and expanded previously developed questions and recommendations about the treatment of ESBL-E, CRE, and DTR-P. aeruginosa infections. Because of differences in the epidemiology of resistance and availability of specific anti-infectives internationally, this document focuses on the treatment of infections in the United States. Results: Preferred and alternative treatment recommendations are provided with accompanying rationales, assuming the causative organism has been identified and antibiotic susceptibility results are known. Approaches to empiric treatment, duration of therapy, and other management considerations are also discussed briefly. Recommendations apply for both adult and pediatric populations. Conclusions: The field of antimicrobial resistance is highly dynamic. Consultation with an infectious diseases specialist is recommended for the treatment of antimicrobial-resistant infections. This document is current as of 24 October 2021. The most current versions of IDSA documents, including dates of publication, are available at www.idsociety.org/practice-guideline/amr-guidance/

Performance of the T2Candida Panel for the Diagnosis of Intra-abdominal Candidiasis.

Performance of T2Candida for detecting intra-abdominal candidiasis (IAC) was assessed in 48 high-risk patients. T2Candida sensitivity/specificity and positive/negative predictive values were 33%/93% and 71%/74%, respectively. IAC was present in 100% of cases with concordant positive T2Candida/1,3-beta-d-glucan and absent in 90% of concordant negative results. Combination T2Candida/1,3-beta-d-glucan may help guide treatment decisions

Particle motion and gravitational lensing in the metric of a dilaton black hole in a de Sitter universe

We consider the metric exterior to a charged dilaton black hole in a de Sitter universe. We study the motion of a test particle in this metric. Conserved quantities are identified and the Hamilton-Jacobi method is employed for the solutions of the equations of motion. At large distances from the black hole the Hubble expansion of the universe modifies the effective potential such that bound orbits could exist up to an upper limit of the angular momentum per mass for the orbiting test particle. We then study the phenomenon of strong field gravitational lensing by these black holes by extending the standard formalism of strong lensing to the non-asymptotically flat dilaton-de Sitter metric. Expressions for the various lensing quantities are obtained in terms of the metric coefficients.Comment: 8 pages, RevTex, 1 eps figures; discussion improved; typos corrected; references adde

High time resolution and polarization properties of ASKAP-localized fast radio bursts

Combining high time and frequency resolution full-polarization spectra of fast radio bursts (FRBs) with knowledge of their host galaxy properties provides an opportunity to study both the emission mechanism generating them and the impact of their propagation through their local environment, host galaxy, and the intergalactic medium. The Australian Square Kilometre Array Pathfinder (ASKAP) telescope has provided the first ensemble of bursts with this information. In this paper, we present the high time and spectral resolution, full polarization observations of five localized FRBs to complement the results published for the previously studied ASKAP FRB 181112. We find that every FRB is highly polarized, with polarization fractions ranging from 80 to 100 per cent, and that they are generally dominated by linear polarization. While some FRBs in our sample exhibit properties associated with an emerging archetype (i.e. repeating or apparently non-repeating), others exhibit characteristic features of both, implying the existence of a continuum of FRB properties. When examined at high time resolution, we find that all FRBs in our sample have evidence for multiple subcomponents and for scattering at a level greater than expected from the Milky Way. We find no correlation between the diverse range of FRB properties (e.g. scattering time, intrinsic width, and rotation measure) and any global property of their host galaxy. The most heavily scattered bursts reside in the outskirts of their host galaxies, suggesting that the source-local environment rather than the host interstellar medium is likely the dominant origin of the scattering in our sample

Spectropolarimetric Analysis of FRB 181112 at Microsecond Resolution: Implications for Fast Radio Burst Emission Mechanism

We have developed a new coherent dedispersion mode to study the emission of fast radio bursts (FRBs) that trigger the voltage capture capability of the Australian SKA Pathfinder (ASKAP) interferometer. In principle the mode can probe emission timescales down to 3 ns with full polarimetric information preserved. Enabled by the new capability, here we present a spectropolarimetric analysis of FRB 181112 detected by ASKAP, localized to a galaxy at redshift 0.47. At microsecond time resolution the burst is resolved into four narrow pulses with a rise time of just 15 μs for the brightest. The pulses have a diversity of morphology, but do not show evidence for temporal broadening by turbulent plasma along the line of sight, nor is there any evidence for periodicity in their arrival times. The pulses are highly polarized (up to 95%), with the polarization position angle varying both between and within pulses. The pulses have apparent rotation measures that vary by and apparent dispersion measures that vary by. Conversion between linear and circular polarization is observed across the brightest pulse. We conclude that the FRB 181112 pulses are most consistent with being a direct manifestation of the emission process or the result of propagation through a relativistic plasma close to the source. This demonstrates that our method, which facilitates high-time-resolution polarimetric observations of FRBs, can be used to study not only burst emission processes, but also a diversity of propagation effects present on the gigaparsec paths they traverse