Infections by Organ System

Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness.

*For information on the timing of future updates of this guideline, please contact the AHA.

Despite improvements in cardiovascular implantable electronic device (CIED) design, application of timely infection control practices, and administration of antibiotic prophylaxis at the time of device placement, CIED infections continue to occur and can be life-threatening.
 
* For information on the timing of future updates of this guideline, please contact the AHA.

Infective endocarditis (IE) is an uncommon but life-threatening infection. Despite advances in diagnosis, antimicrobial therapy, surgical techniques, and management of complications, patients with IE still have high morbidity and mortality rates related to this condition. Since the last American Heart Association (AHA) publication on prevention of IE in 1997, many authorities and societies, as well as the conclusions of published studies, have questioned the efficacy of antimicrobial prophylaxis to prevent IE in patients who undergo a dental, gastrointestinal (GI), or genitourinary (GU) tract procedure and have suggested that the AHA guidelines should be revised.
 
*For information on the timing of future updates of this guideline, please contact the AHA. 

The objective of these practice guidelines is to provide clinicians with recommendations for the diagnosis and treatment of bacterial meningitis. Patients with bacterial meningitis are usually treated by primary care and emergency medicine physicians at the time of initial presentation, often in consultation with infectious diseases specialists, neurologists, and neurosurgeons. In contrast to many other infectious diseases, the antimicrobial therapy for bacterial meningitis is not always based on randomized, prospective, double-blind clinical trials, but rather on data initially obtained from experimental animal models of infections. Link to full text guideline
 
*This guideline has been split into two separate guidelines: (1) community acquired, and (2) nosocomial. The nosocomial guideline is currently being updated and following its publication, community acquired will be developed. 
 
*Estimated publication of Nosocomial guideline, Fall 2014.

Encephalitis is defined by the presence of an inflammatory process of the brain in association with clinical evidence of neurologic dysfunction. Of the pathogens reported to cause encephalitis, the majority are viruses. However, despite extensive testing, the etiology of encephalitis remains unknown in most patients. Another major challenge for patients with encephalitis is to determine the relevance of an infectious agent identified outside of the CNS; these agents may play a role in the neurologic manifestations of illness but not necessarily by directly invading the CNS. Link to full text guideline 

*Every 12 to 18 months following publication, IDSA reviews its guidelines to determine whether an update is required.  This guideline was last reviewed and deemed current as of 07/2011. 

These clinical practice guidelines are a revision of the 2008 SSC guidelines for the Management of Severe Sepsis and Septic Shock. The recommendations in this document are intended to provide guidance for the clinician caring for a patient with severe sepsis or septic shock. Recommendations from these guidelines cannot replace the clinician’s decision-making capability when he or she is presented with a patient’s unique set of clinical variables. Most of these recommendations are appropriate for the severe sepsis patient in the ICU and non-ICU settings.
 
*For information on the timing of future updates to this guideline, please contact the SCCM or the Surviving Sepsis Campaign.

This guideline is designed to improve the diagnosis and management of Clostridium difficile infection (CDI) in adult patients. A case of CDI is defined by the presence of symptoms (usually diarrhea) and either a stool test positive for C. difficile toxins or toxigenic C. difficile, or colonoscopic or histopathologic findings revealing pseudomembranous colitis. In addition to diagnosis and management, recommended methods of infection control and environmental management of the pathogen are presented. The recommendations are based on the best available evidence and practices, as determined by a joint Expert Panel appointed by SHEA and the Infectious Diseases Society of America (IDSA) (the SHEA-IDSA Expert Panel). The use of these guidelines can be impacted by the size of the institution and the resources, both financial and laboratory, available in the particular clinical setting. Link to full text guideline

*Projected publication, Summer 2014

The widening array of recognized enteric pathogens and the increasing demand for cost-containment sharpen the need for careful clinical and public health guidelines based on the best evidence currently available. Adequate fluid and electrolyte replacement and maintenance are key to managing diarrheal illnesses. Thorough clinical and epidemiological evaluation must define the severity and type of illness, exposures, and whether the patient is immunocompromised, in order to direct the performance of selective diagnostic cultures, toxin testing, parasite studies, and the administration of antimicrobial therapy. Link to full text guideline

*Projected Publication, Spring 2014

Intended for use by physicians, these recommendations suggest preferred approaches to the diagnostic, therapeutic, and preventive aspects of care. They are intended to be flexible, in contrast to standards of care, which are inflexible policies to be followed in every case. Specific recommendations are based on relevant published information. To more fully characterize the quality of evidence supporting recommendations, the Practice Guidelines Committee of the AASLD requires a Class (reflecting benefit versus risk) and Level (assessing strength or certainty) of Evidence to be assigned and reported with each recommendation (Table 1, adapted from the American College of Cardiology and the American Heart Association Practice Guidelines). Link to full text guideline

*For information on the timing of future updates of this guideline, contact the AASLD.

The purpose of this guideline is to provide recommendations for diagnosis and treatment of asymptomatic bacteriuria in adult populations >18 years of age. The recommendations were developed on the basis of a review of published evidence, with the strength of the recommendation and quality of the evidence graded using previously described Infectious Diseases Society of America (IDSA) criteria. Link to full text guideline

*Every 12 to 18 months following publication, IDSA reviews its guidelines to determine whether an update is required. This guideline was last reviewed and deemed current as of 03/2011.

Guidelines for the diagnosis, prevention, and management of persons with catheter‐associated urinary tract infection (CA‐UTI), both symptomatic and asymptomatic, were prepared by an Expert Panel of the Infectious Diseases Society of America. The evidence‐based guidelines encompass diagnostic criteria, strategies to reduce the risk of CA‐UTIs, strategies that have not been found to reduce the incidence of urinary infections, and management strategies for patients with catheter‐associated asymptomatic bacteriuria or symptomatic urinary tract infection. Link to full text guideline

*Every 12 to 18 months following publication, IDSA reviews its guidelines to determine whether an update is required. This guideline was last reviewed and deemed current as of 03/2012.

Panel of International Experts was convened by the Infectious Diseases Society of America (IDSA) in collaboration with the European Society for Microbiology and Infectious Diseases (ESCMID) to update the 1999 Uncomplicated Urinary Tract Infection Guidelines by the IDSA. Co-sponsoring organizations include the American Congress of Obstetricians and Gynecologists, American Urological Association, Association of Medical Microbiology and Infectious Diseases–Canada, and the Society for Academic Emergency Medicine. The focus of this work is treatment of women with acute uncomplicated cystitis and pyelonephritis, diagnoses limited in these guidelines to premenopausal, non-pregnant women with no known urological abnormalities or co-morbidities. Link to full text guideline

*Every 12 to 18 months following publication, IDSA reviews its guidelines to determine whether an update is required. This guideline was last reviewed and deemed current as of 02/2012.  

Evidence‐based guidelines for managing patients with intra‐abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America. These updated guidelines replace those previously published in 2002 and 2003. The guidelines are intended for treating patients who either have these infections or may be at risk for them. New information, based on publications from the period 2003–2008, is incorporated into this guideline document. The panel has also added recommendations for managing intra‐abdominal infection in children, particularly where such management differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates. Link to full text guideline

*Every 12 to 18 months following publication, IDSA reviews its guidelines to determine whether an update is required. This guideline was last reviewed and deemed current as of 01/2012.

Improving the care of adult patients with community-acquired pneumonia (CAP) has been the focus of many different organizations, and several have developed guidelines for management of CAP. Two of the most widely referenced are those of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS). In response to confusion regarding differences between their respective guidelines, the IDSA and the ATS convened a joint committee to develop a unified CAP guideline document. Link to full text guideline

*Projected Publication, Spring 2015

Since the initial 1996 American Thoracic Society (ATS) guideline on nosocomial pneumonia, a number of new developments have appeared, mandating a new evidence-based guideline for hospital-acquired pneumonia (HAP), including healthcare-associated pneumonia (HCAP) and ventilator-associated pneumonia (VAP). This document, prepared by a joint committee of the ATS and Infectious Diseases Society of America (IDSA), focuses on the epidemiology and pathogenesis of bacterial pneumonia in adults, and emphasizes modifiable risk factors for infection.

*Projected Publication, Spring 2014

This guideline addresses several issues in the management of acute bacterial rhinosinusitis (ABRS), including (1) inability of existing clinical criteria to accurately differentiate bacterial from viral acute rhinosinusitis, leading to excessive and inappropriate antimicrobial therapy; (2) gaps in knowledge and quality evidence regarding empiric antimicrobial therapy for ABRS due to imprecise patient selection criteria; (3) changing prevalence and antimicrobial susceptibility profiles of bacterial isolates associated with ABRS; and (4) impact of the use of conjugated vaccines for Streptococcus pneumoniae on the emergence of nonvaccine serotypes associated with ABRS. Link to full text guideline 
 
*Every 12 to 18 months following publication, IDSA reviews its guidelines to determine whether an update is required.This guideline was published in March of 2012 and is the most current version.

The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Link to full text guideline
 
*Every 12 to 18 months following publication, IDSA reviews its guidelines to determine whether an update is required.This guideline was published in September of 2012 and is the most current version.

Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Link to full text guideline

*Every 12 to 18 months following publication, IDSA reviews its guidelines to determine whether an update is required. This guideline was published in August of 2011 and is the most current version.

Foot infections are a common and serious problem in persons with diabetes. Diabeticfootinfections (DFIs) typically begin in a wound, most often a neuropathic ulceration. While all wounds are colonized with microorganisms, the presence of infection is defined by ≥2 classic findings of inflammation or purulence. Infections are then classified into mild (superficial and limited in size and depth), moderate (deeper or more extensive), or severe (accompanied by systemic signs or metabolic perturbations). This classification system, along with a vascular assessment, helps determine which patients should be hospitalized, which may require special imaging procedures or surgical interventions, and which will require amputation. Link to full text guideline

*Every 12 to 18 months following publication, IDSA reviews its guidelines to determine whether an update is required. This guideline was published in June of 2012 and is the most current version. 

Soft-tissue infections are common, generally of mild to modest severity, and are easily treated with a variety of agents. Clinical assessment of the severity of infection is crucial, and several classification schemes and algorithms have been proposed to guide the clinician. However, most clinical assessments have been developed from either retrospective studies or from an author's own “clinical experience,” illustrating the need for prospective studies with defined measurements of severity coupled to management issues and outcomes. Link to full text guideline

*Projected Publication, Fall 2013 

Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures. Link to full text guideline

*Every 12 to 18 months following publication, IDSA reviews its guidelines to determine whether an update is required. This guideline was last reviewed and deemed current as of 12/2012.