Our data are supportive of the use of combination therapy with oral vancomycin and IV metronidazole in critically ill patients with CDI. However, prospective, randomized studies are required to define optimal treatment regimens in this limited population of CDI patients.

Pharmacists' knowledge of diverse combinations of antimicrobial agents and additives in lock solutions, including several shown to be stable and compatible for extended periods, can help expand and optimize the use of ALT in both treatment and prophylactic modalities.

BackgroundThe addiction crisis is widespread, and unsafe injection practices among people who inject drugs (PWID) can lead to infective endocarditis.MethodsA retrospective analysis of adult patients with definite or possible infective endocarditis admitted to a tertiary care center in Portland, Maine was performed over three-year period. Our primary objective was to examine differences in demographics, health characteristics, and health service utilization between injection drug use (IDU)-associated infective endocarditis and non-IDU infective endocarditis. The association between IDU and mortality, morbidity (defined as emergency department visits within 3 months of discharge), and cardiac surgery was examined. Bivariate and multivariate analyses were performed. A subgroup descriptive analysis of PWID was also performed to better examine substance use disorder (SUD) characteristics, treatment with medication for opioid use disorder (MOUD) and health service utilization.ResultsOne-hundred and seven patients were included in the study, of which 39.2% (n = 42) had IDU-associated infective endocarditis. PWID were more likely to be homeless, uninsured, and lack a primary care provider. PWID were notably younger and had less documented comorbidities, however had similar in-hospital mortality rates (10% vs. 14%, p = 0.30), ED visits (50% vs. 54%, p = 0.70) and cardiac surgery (33% vs. 26%, p = 0.42) compared to those with non-IDU infective endocarditis. Ninety-day mortality was less among PWID (19.0% vs. 36.9%, p = 0.05). IDU was not associated with morbidity (adjusted odds ratio (AOR) 0.73, 95% CI 0.18–3.36), 90-day mortality (AOR 0.72, 95% CI 0.17–3.01), or cardiac surgery (AOR 0.15, 95% CI 0.03–0.69). Ninety-day mortality among PWID who received MOUD was lower (3% vs 15%, p = 0.45), as were ED visits (10% vs. 41%, p = 0.42) compared to those who did not receive MOUD.ConclusionsOur results highlight existing differences in health characteristics and social determinants of health in people with IDU-associated versus non-IDU infective endocarditis. PWID had less comorbidities and were significantly younger than those with non-IDU infective endocarditis and yet still had similar rates of cardiac surgery, ED visits, and in-hospital mortality. These findings emphasize the need to deliver comprehensive health services, particularly MOUD and other harm reduction services, to this marginalized population.

I n the era of potentantiretrovira1 (ARV) therapy(ART), Hlv-I infection has become a chronicdiseaserather than a terminal illness, allowing those whoaretreated with ART to have normal life ex-pectancies} Complications, mortality, and viral transmission of Hlv-I have significantly decreased with the adventof new ARVs.2.7 Long-term adverse effects of olderARVs include dysglycemia, dyslipidemia, lipodystrophy, and gastrointestinal discomfort'If nonadherence occurs in patients on ART, Hlv-l drugresistance may develop,limiting the effectiveness of future therapy. Hence, it is crucial to choose regimens that are not only effective against Hl'V-l , but alsominimize adverse events andmaximize adherence. Raltegravir,formerly known as MK-0518, is the first integrase strandtransfer inhibitor (INSTI) to be approved by the Food and Drug Administration (FDA). It works by preventing the formation of a functional integrated proviral DNA.s First approved in October 2007 for salvage therapy in ARV-experienced patients, raltegravir is active against multiclass-resistant HIV-I and both CCR5tropic and CXCR4-tropic HIV_I.s-lo In December 2011, the FDA extended the Author information providedat end of text. OBJECTIVE: To review the literature concerning the role of raltegravir in the treatment of HIV•1 in antiretroviral (ARV)-experienced and ARV-na"ive patients. DATA SOURCES: A PubMed search was conducted for published data through March 2012 using the search terms raltegravir, MK-0518, and integrase strand transfer inhibitor. An additional search of International Pharmaceutical Abstracts for unpublished data, including data from the Infectious Diseases Society of America, the Conference on Retroviruses and Opportunistic Infections, the International AIDS Society. and the Interscience Conference on Antimicrobial Agents and Chemotherapy, was conducted using similar search terms. STUDY SELECT10N AM) DATA EXmACTlON: In vitroand in vivo Phase2, Phase 3 , and postmarketing studies availableIn English, evaluating antiretroviral regimens that containrattegravir for the treatment of HIV•1 infection in both ARV•naive andARV• experienced patients, were evaluated. Studies assessing raltegravirpharrnacokineticsand pharmacodynamics were included for review. DATA SYNTliESlS: The nucleoside-based regimen of raltegravir with tenofovir/emtri• citabine provides an effective first•line treatment option. However, nucleoside• sparing regimens appear unfavorable in ARV•naive subjects and should be reserved for patients with limited treatment options. Raltegravir used with optimized background therapy provides an a1temative regimen for ARV-experienced patients. This review describesthe available in vitro and in vivo data on raltegravir potency, defined as the abilityto achieve undetectable viral load, and safety profile, as well as comparison to standardHIV•1 therapies. CONCLUSIONS: Raltegravir has demonstrated potent antiretroviral activity against HIV•1 in both ARV•naive and ARV-experienced subjects, with the benefits of a favorable adverse effect profile ...

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