ICYMI: Top ID/Stewardship Journal Articles Trending From April 2019

This article identifies new infectious diseases & antimicrobial stewardship literature released in April of 2019. Hot off the press and put together here in one place!

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

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

[Last updated: 5 May 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 April of 2019…

1. Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events | JAMA Surgery

https://jamanetwork.com/journals/jamasurgery/article-abstract/2731307

This large multicenter, national retrospective cohort found that increasing duration of antimicrobial prophylaxis was associated with higher odds of acute kidney injury and C. difficile infection in a duration-dependent fashion and did not lead to additional SSI reduction.

2. Two weeks versus four weeks of antibiotic therapy after surgical drainage for native joint bacterial arthritis: a prospective, randomised, non-inferiority trial | Ann Rheum Dis

https://ard.bmj.com/content/early/2019/04/15/annrheumdis-2019-215116

This randomized controlled trial found that 2 weeks of targeted antibiotic therapy is not inferior to 4 weeks in adult patients who have undergone drainage of native joint bacterial arthritis in regards to cure rate, adverse events or sequelae and leads to a significantly shorter hospital stay.

3. Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study | Lancet ID

https://www.sciencedirect.com/science/article/pii/S1473309918307928

This multinational prospective cohort study found that carbapenem resistance is associated with increased length of hospital stay and mortality in patients with bloodstream infections in low-income and middle-income countries.

4. Defining the breakpoint duration of Staphylococcus aureus bacteremia predictive of poor outcomes | CID

https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciz257/5428115?redirectedFrom=fulltext

This was a multicenter, prospective, observational study of adult, hospitalized patients with Staph. aureus bacteremia. The study found that the choice of antibiotic therapy did not significantly affect bacteremia duration however every continued day of bacteremia was associated with relative risk of death of 1.16 with significant increase in risk starting at 3 days as determined by ROC analysis.

5. Antimicrobial resistance or delayed appropriate therapy does one influence outcomes more than the other among patients with serious infections due to carbapenem-resistant versus carbapenem-susceptible Enterobacteriaceae? | OFID

https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofz194/5477302

This large US hospital database which identified all admissions over 3 years with evidence of serious Enterobacteriaceae infection found that delayed appropriate therapy is a more important driver of outcomes than carbapenem resistance, although the two factors are somewhat synergistic.

6. Association of Increased Colony-Count Threshold for Urinary Pathogens in Hospitalized Patients With Antimicrobial Treatment | JAMA

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2731706

At a single acute care hospital raising the threshold from 10^4 CFU/mL or greater to 10^5 CFU/mL for working up potential uropathogens in urine cultures led to a reduction in antimicrobial prescribing for asymptomatic bacteriuria and candiduria without significantly changing patient outcomes.