In 1995, the U.S. Public Health Service (USPHS) and the Infectious Diseases Society of America (IDSA) developed guidelines for preventing opportunistic infections (OIs) among persons infected with human immunodeficiency virus (HIV); these guidelines were updated in 1997 and 1999. This fourth edition of the guidelines, made available on the Internet in 2001, is intended for clinicians and other health-care providers who care for HIV-infected persons. The goal of these guidelines is to provide evidence-based guidelines for preventing OIs among HIV-infected adults and adolescents, including pregnant women, and HIV-exposed or infected children. Nineteen OIs, or groups of OIs, are addressed, and recommendations are included for preventing exposure to opportunistic pathogens, preventing first episodes of disease by chemoprophylaxis or vaccination (primary prophylaxis), and preventing disease recurrence (secondary prophylaxis). Major changes since the last edition of the guidelines include 1) updated recommendations for discontinuing primary and secondary OI prophylaxis among persons whose CD4+ T lymphocyte counts have increased in response to antiretroviral therapy; 2) emphasis on screening all HIV-infected persons for infection with hepatitis C virus; 3) new information regarding transmission of human herpesvirus 8 infection; 4) new information regarding drug interactions, chiefly related to rifamycins and antiretroviral drugs; and 5) revised recommendations for immunizing HIV-infected adults and adolescents and HIV-exposed or infected children.

Resistance rates are increasing among several problematic Gramnegative pathogens that are often responsible for serious nosocomial infections, including Acinetobacter spp., Pseudomonas aeruginosa, and (because of their production of extendedspectrum β-lactamase) Enterobacteriaceae. The presence of multiresistant strains of these organisms has been associated with prolonged hospital stays, higher health care costs, and increased mortality, particularly when initial antibiotic therapy does not provide coverage of the causative pathogen. Conversely, with high rates of appropriate initial antibiotic therapy, infections caused by multiresistant Gram-negative pathogens do not negatively influence patient outcomes or costs. Taken together, these observations underscore the importance of a 'hit hard and hit fast' approach to treating serious nosocomial infections, particularly when it is suspected that multiresistant pathogens are responsible. They also point to the need for a multidisciplinary effort to combat resistance, which should include improved antimicrobial stewardship, increased resources for infection control, and development of new antimicrobial agents with activity against multiresistant Gramnegative pathogens. IntroductionThe treatment of serious bacterial infections in clinical practice is often complicated by antibiotic resistance. Based on their clinical experience, most clinicians -but not all [1,2] -believe that antibiotic resistance is increasing, is associated with increased morbidity and mortality, and is expensive. The importance of each of these points depends on the person's perspective: the first is most important to clinicians, the subsequent two to patients, and finally the last point to hospital administrators and health care payors. Recognizing the growing problem of antibiotic resistance, as well as the decreasing investment being made in antimicrobial research and development, the Infectious Diseases Society of America created the Antimicrobial Availability Task Force in March 2003 [3]. This group of national experts was charged with reviewing trends in antibiotic research and development in concert with the rise in antibiotic resistance and then proposing various solutions to ensure the availability of effective antibiotics in the future. Their policy report, issued in July 2004, was entitled 'Bad bugs, no drugs: as antibiotic R&D stagnates, a public health crisis brews'. Although the report has had a favorable impact on government legislation, much more remains to be done.The Antimicrobial Availability Task Force identified six particularly problematic pathogens, including three Gramnegative organisms: Acinetobacter baumannii, extendedspectrum β-lactamase (ESBL)-producing Enterobacteriaceae, and Pseudomonas aeruginosa. The other problematic organisms were the Gram-positive pathogens methicillinresistant Staphylococcus aureus (MRSA) and vancomycinresistant Enterococcus faecium, and the filamentuous fungi Aspergillus spp. [3]. Without a doubt, MRSA is the organism that has receiv...

ID interventions are associated with improved patient outcomes. Early ID interventions are also associated with reduced costs for Medicare beneficiaries with select infections.

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