ICYMI: Top ID/Stewardship Journal Articles Just Released In July 2019

Here we identify infectious diseases & antimicrobial stewardship literature just released in July of 2019. We hope if you find this helpful, you will share it with others!

Written By: Bassam Ghanem, Pharm.D., MS, BCPS

Edited By: Timothy P. Gauthier, Pharm.D., BCPS-AQ ID

Last updated: 1 August 2019

In this monthly column two pharmacists who utilize Twitter to stay current with antimicrobial stewardship literature (@ABsteward [B.G.] & @IDstewardship [T.G.]) identify some of the top hot off the press articles recently published.

The following are some of the new publications we found most interesting or noteworthy that were released in July of 2019. We get to learn each month from all of these amazing publications and hope you enjoy this list as much as we enjoy putting it together!

1. Cefepime neurotoxicity: thresholds and risk factors. A Retrospective Cohort study | CMI

https://www.sciencedirect.com/science/article/pii/S1198743X19303799

This was the largest retrospective study to date for patients on cefepime who underwent therapeutic drug monitoring (TDM). It found that the overall incidence of neurotoxicity was 23.2% . The study concluded that TDM should be systematically performed especially for patients with lower renal function aiming at trough concentrations below 7.5 mg/L.

2. Excess Antibiotic Treatment Duration and Adverse Events in Patients Hospitalized With Pneumonia: A Multihospital Cohort Study | Annals of Internal Medicine

https://annals.org/aim/article-abstract/2737823/excess-antibiotic-treatment-duration-adverse-events-patients-hospitalized-pneumonia-multihospital

This large retrospective cohort study for patients with pneumonia found two thirds of patients received excess antibiotic therapy, with most antibiotics prescribed at discharge. Excess treatment was not associated with lower rates of any adverse outcomes, however each excess day associated with a 5% increase in the odds of antibiotic-associated adverse events.

3. When not to start antibiotics: avoiding antibiotic overuse in the intensive care unit | CMI

https://www.sciencedirect.com/science/article/abs/pii/S1198743X19303969

This narrative review addressed the safety and utility of a watchful waiting approach to antibiotic initiation with selected patients in the ICU. The review concluded that prospective trials that identify clinical situations wherein it is safe to delay or withhold antibiotic initiation in the ICU until the presence of an infection is proven are warranted.

4. Effect of oral oseltamivir on virological outcomes in low-risk adults with influenza: a randomized clinical trial | CID

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz634/5539729

This randomized controlled trial found that oseltamivir decreased viral shedding in this low-risk adult population but did not significantly decrease the time to resolution of clinical symptoms.

5. Ceftazidime, carbapenems, or piperacillin-tazobactam as single definitive therapy for Pseudomonas aeruginosa bloodstream infection – a multi-site retrospective study | CID

https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciz668/5533273?redirectedFrom=fulltext

This multi-national retrospective study found no significant difference in mortality, clinical, and microbiological outcomes or adverse events between ceftazidime, carbapenems and piperacillin-tazobactam as definitive treatment of P. aeruginosa bacteremia.

6. Effectiveness of a Bundled Intervention Including Adjunctive Corticosteroids on Outcomes of Hospitalized Patients With Community-Acquired Pneumonia: A Stepped-Wedge Randomized Clinical Trial | JAMA Internal Medicine

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2737749

This stepped-wedge, cluster-randomized effectiveness trial found that a bundle of evidence-supported treatments (including adjunctive corticosteroids) failed to improve outcomes of patients with CAP and resulted in higher incidence of GI bleeding.