Want help keeping up with ID/stewardship publications? We have got your back! Here are our picks for the top new ID/stewardship journal articles trending on Twitter from September 2018.
[Last updated: 3 October 2018]
Keeping up with literature within a niche area of a given field can be challenging. Staying current with literature in an entire specialty is arguably impossible. This is one of the big reasons some professionals are drawn to Twitter and other social media networks: to stay in the loop!
Both of the accounts @ABsteward (B.G.) & @IDstewardship (T.P.G.) are here to help and in this monthly publication series we provide summaries to help you keep an eye on the leading edge of science in the fields of antimicrobial stewardship & infectious diseases.
The following are new publications we found most interesting or noteworthy in September of 2018.
MERINO: Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance, A Randomized Clinical Trial | JAMA.
Carbapenems have been generally regarded as the treatment of choice for serious infections caused by ESBL producers. Previous observational studies have suggested piperacillin-tazobactam may be a clinically effective carbapenem-sparing option for treating some infections caused by ESBL producers, but conflicting results have been reported. MERINO was an international, multicenter, open-label, parallel group, randomized clinical trial that found definitive treatment with piperacillin-tazobactam compared with meropenem in patients with bloodstream infection caused by ceftriaxone-nonsusceptible E coli or Klebsiella spp, did not result in a non-inferior 30-day mortality. These findings do not support use of piperacillin-tazobactam in this setting.
You can read a free exclusive IDstewardship interview with the lead MERINO investigator here.
Effect of Levofloxacin Prophylaxis on Bacteremia in Children With Acute Leukemia or Undergoing Hematopoietic Stem Cell Transplantation: A Randomized Clinical Trial | JAMA
There are limited data on the effect of antibiotic prophylaxis on bacteremia among children with acute leukemia and those undergoing hematopoietic stem cell transplantation (HSCT). This randomized clinical trial concluded that levofloxacin prophylaxis significantly reduced the risk of bacteremia in children with acute leukemia receiving intensive chemotherapy but not in those undergoing HSCT. Fever and neutropenia were less common in the levofloxacin group. There were no significant differences in severe infection, invasive fungal disease, C. difficile–associated diarrhea or musculoskeletal toxic effects at 2 months or at 12 months between the levofloxacin and control groups.
Effect of Algorithm-Based Therapy vs Usual Care on Clinical Success and Serious Adverse Events in Patients with Staphylococcal Bacteremia.A Randomized Clinical Trial | JAMA
Optimal duration of therapy for staphylococcal bacteremia has not been established with prospective clinical trial. A standardized strategy to classify patients with complicated and uncomplicated staphylococcal bacteremia and treat them with the appropriate duration of antibiotics would thus improve patient care. This international, multicenter, randomized clinical trial found that among patients with staphylococcal bacteremia, the use of an algorithm to guide testing and treatment compared with usual care resulted in a non-inferior rate of clinical success. Rates of serious adverse events were not significantly different, but interpretation is limited by wide confidence intervals. Among per-protocol patients with uncomplicated bacteremia, duration of therapy was significantly shorter in the algorithm-based therapy group than in the usual practice group (difference, −1.8 days). The difference was most notable among patients with coagulase-negative staphylococcal bacteremia, for whom antibiotic duration was reduced by 3.1 days.
Incidence of Acute Kidney Injury Among Patients Receiving the Combination of Vancomycin with Piperacillin-tazobactam or Meropenem | Pharmacotherapy.
Vancomycin (VAN) is routinely given in combination with an anti-pseudomonal beta-lactam for empiric treatment of severe infections. There are conflicting data regarding the risk of acute kidney injury (AKI) when VAN is combined with either Piperacillin-tazobactam (PTZ) or meropenem (MER) in hospitalized, non-critically ill patients. This retrospective cohort study of 576 acutely ill patients compares the risk of AKI for patients who received the combination of VAN and either PTZ or MER for at least 48 hours found that VAN/PTZ was associated with 6.8-fold increased risk of developing AKI compared to VAN/MER. VAN doses >4 g/day and trough levels >20 mcg/mL were independent risk factors for developing AKI.
Outpatient Antibiotic Prescribing for Older Adults in the United States: 2011 to 2014 | J Am Geriatr Soc
Antibiotics are some of the most commonly prescribed medications for older adults (≥65) in the United States. Researchers from the CDC extracted the outpatient systemic oral antibiotic prescriptions dispensed in the United States for older adults from the IQVIA Xponent database from 2011 to 2014. Prescribing rates for outpatient antibiotics remained stable overall between 2011 and 2014. Internists and family physicians prescribed 43% of all antibiotics for older adults; quinolones were the most commonly prescribed outpatient antibiotic class accounting for 22% of all antibiotics prescribed followed by penicillins and macrolides.
Carriage of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae and the Risk of Surgical Site Infection after Colorectal Surgery: a Prospective Cohort Study | CID
Current antibiotics prophylaxis regimens for colorectal surgery do not cover extended-spectrum beta lactamase-producing Enterobacteriaceae (ESBL-PE). Little is known about the effect of ESBL carriage on the rate of surgical site infections (SSI) following colorectal surgery. This international, multicenter prospective cohort study of 3600 patients undergoing elective colorectal surgery who received standard regimen (cephalosporin plus metronidazole) found that the rate of SSI among ESBL-PE carriers was more than doubled compared to non-carriers after colorectal surgery.
Implementation of a Two-Point Pharmacokinetic AUC-Based Vancomycin Therapeutic Drug Monitoring Approach in Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia. | JAAI
Limited evidence exists evaluating pharmacokinetic thresholds for vancomycin efficacy and nephrotoxicity using non-Bayesian methods. This was a retrospective cohort study to evaluate vancomycin AUC24 thresholds for efficacy and nephrotoxicity in adult patients with MRSA-bacteremia treated with vancomycin for ≥72 hours after implementation of an individualized, AUC-based, two-point pharmacokinetic vancomycin TDM approach. Patients with an AUC24 ≥297 mg*h/L had a >2.5-fold increase in clinical success compared to those who did not and patients with an AUC24 ≥710 mg*h/L had a >7-fold increase in nephrotoxicity compared to those with an AUC24 <710 mg*h/L. The study supports current recommendations to target vancomycin AUC24 values of 400 – 600 mg*h/L when calculated using two-point pharmacokinetics.
Implementation of a Two-Point Pharmacokinetic AUC-Based Vancomycin Therapeutic Drug Monitoring Approach in Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia
The latest IDSA vancomycin guideline is highly anticipated and people are currently wonder how they might mitigate the risk for nephrotoxicity while maximizing the chance for efficacy when employing vancomycin therapy. AUC-based therapeutic drug monitoring offers one potential avenue for attempting to address this. In a single-center, retrospective cohort study of 46 adult patients with MRSA treated with vancomycin for over 72 hours, investigators found patients with an AUC24 ≥297 mg*h/L had a >2.5-fold increase in clinical success versus patients who did not (89.5% versus 33.3%, respectively; P = 0.01). In addition, patients with an AUC24 ≥710 mg*h/L had a >7-fold increase in nephrotoxicity compared to those with an AUC24 <710 mg*h/L (66.7% versus 9.5%, respectively; P = 0.04). The authors conclude that their data support the currently recommended AUC24 values of 400 – 600 mg*h/L calculated via two-point pharmacokinetics and suggest that a wider range may exist.
ADDITIONAL NEW & NOTABLE PUBLICATIONS
- The effect of antibiotic stewardship interventions with stakeholder involvement in hospital settings: a multicentre, cluster randomized controlled intervention study | ARIC
- Successful six-week antibiotic treatment for early surgical-site infections in spinal surgery | CID
- Oral vancomycin prophylaxis is highly effective in preventing Clostridium difficile infection in allogeneic hematopoietic cell transplant recipients | CID
- Dosing vancomycin in the super obese: less is more | JAC
- Pharmacodynamic Analysis of Daptomycin-Treated Enterococcal Bacteremia: It Is Time to Change the Breakpoint | CID
- Oral Fluoroquinolone and the Risk of Aortic Dissection | JAAC
- Moving Past the Routine Use of Macrolides—Reviewing the Role of Combination Therapy in Community-Acquired Pneumonia. Current infectious disease reports | CIDR
- Considerations for Clinical Trials of Staphylococcus aureus Bloodstream Infection in Adults | CID
- Prioritising research areas for antibiotic stewardship programmes in hospitals:a behavioural perspective consensus paper | CMI
- Renal Dosing of Antibiotics: Are We Jumping the Gun? | CID
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