Jeff Brock, PharmD, MBA, BCIDP

As an infectious diseases pharmacist who works in a hospital setting, I do not often encounter patients with Mycoplasma genitalium.

Antimicrobial stewardship has been defined as coordinated interventions designed to improve and measure appropriate use of antimicrobial agents by promoting the selection of optimal drug regimens.

Corticosteroids are an important treatment modality for a multitude of indications. Currently, dexamethasone is one of the only proven treatment options for patients suffering from COVID-19.

Although antimicrobial stewardship programs are well established in hospitals, they are not common in the outpatient setting, despite the fact that this is where the majority of antimicrobials are prescribed.

Summer is upon us, and it is the time of year when we start to see an increasing incidence of gastroenteritis from increased exposure to various water and foodborne pathogens.

Aspiration pneumonia is a common diagnosis among patients seen in and out of the hospital. Aspiration pneumonia is estimated to occur in 5% to 15% of patients with community-acquired pneumonia (CAP); however, standard diagnostic criteria for aspiration pneumonia are lacking. Aspiration is the result of impaired swallowing, allowing oral or gastric contents — or both — to enter the lungs. Following an aspiration event, the pathology varies from pneumonitis to pneumonia, lung abscesses or empyema.

When to begin ART once HIV diagnosis is confirmed has been an area of research and debate for many years. The standard of care in the United States is to start ART when patients are agreeable to begin therapy, regardless of CD4 count. Often, though, there are barriers that may delay the start of HIV treatment. Lack of insurance coverage, active injection drug use, patient and provider attitudes toward treatment and opportunistic infection testing are all obstacles to beginning treatment, as well as numerous other factors. In many cases, HIV testing is done in settings other than where treatment is offered. This can delay ART by weeks or even months, depending on when the patient can be linked to HIV care. There are now clinics offering rapid ART initiation on the same day of HIV diagnosis to circumvent a delay in starting therapy due to a failure of patients to engage in care after their initial HIV diagnosis. Unfortunately, current HIV treatment guidelines are inconsistent when it comes to rapid initiation of ART. Both WHO and the International Antiviral Society (IAS)-USA treatment recommendations support immediate ART once HIV is diagnosed, including same-day ART initiation. However, HHS states that despite the potential benefits, ART initiation on the day of diagnosis remains investigational regarding its efficacy.

Staphylococcus aureus nasal carriage is a proven risk factor for the development of staphylococcal surgical site infections, or SSIs. S. aureus infections are associated with increased length of hospital stays, increased mortality and higher costs of medical care. Nasal colonization rates with S. aureus have been reported to reach up to 30%, with 1% to 3% having methicillin-resistant organisms.

One of the most disappointing situations you can encounter while traveling is the dreaded travelers’ diarrhea. Travelers’ diarrhea is the most common travel-related illness that can disrupt vacations and business plans when visiting low-income countries. The rate of travelers’ diarrhea has been reported to be as high as 70%, depending on the time of year and destination, but most recent data suggest that rates have decreased overall and are in the range of 10% to 40%. The highest risk for infection is within the first few weeks while abroad, and it somewhat decreases thereafter. The definition of classic travelers’ diarrhea is three or more diarrheal stools per day, along with at least one other clinical sign, such as abdominal cramps, fever, nausea or vomiting. Approximately 10% of those suffering from this illness will require medical care, and up to 3% may require hospitalization. On average, the duration of illness in those that go untreated is approximately 4 to 5 days.

Treatment of gram-positive bloodstream infections often is a clinical challenge, especially those caused by staphylococci. Staphylococci are one of the most commonly identified pathogens associated with both community- and hospital-acquired bloodstream infections. The incidence of Staphylococcus aureus bacteremia (SAB) ranges from 10 to 30 per 100,000 person-years, with case fatality rates of 15% to 50%, which has not really improved over the past few decades. Much of the current data for management of SAB are based on low-quality evidence, and the optimal duration of therapy has not yet been established with prospective clinical trials. In general, uncomplicated SAB is treated for 14 days following negative blood cultures whereas complicated infections require 4 to 6 weeks of treatment. With the exception of S. lugdunensis, coagulase-negative staphylococci (CoNS) are of lower virulence compared with S. aureus. However, CoNS infections pose therapeutic dilemmas because they are common contaminants, therefore if isolated from cultures, providers must determine whether it is a true infection. When treatment is necessary, CoNS also have a high rate of methicillin resistance; moreover, increasing numbers are becoming less susceptible to glycopeptides. In addition, the duration of therapy for CoNS is also based on limited evidence, ranging from no treatment for contamination, up to 5 to 7 days for uncomplicated infections, and several weeks for complicated bacteremia such as those with retained foreign bodies or endocarditis.