The “Infectious Diseases Twitter Highlights” column presents recent twitter posts that are of particular interest to the infectious diseases community and provides commentary.
Authored By: Mike Turk, Pharm.D., AAHIVP & Jamie Kisgen, Pharm.D., BCPS-AQ ID
Article link is here
Commentary: An interesting, but short paper reviewing the 13 identified studies that compared serum to cerebral spinal fluid vancomycin concentrations. The ratios ranged from 0.00 to 0.81, and varied depending on the infection that was being treated. Regardless of this reported variability in concentrations, 83% of meningitis and 100% of ventriculitis patients achieved a cure. No factor could predict the penetration rate of vancomycin into the CSF. An interesting data point (and one that tells us that even with variable penetration), is that the current dosing schemes used for CNS infections are working.
Story is available here
Commentary: A new threat that has been percolating up from CDC reports – MDR Candida auris. Reports of 77 cases from New York, New Jersey, Illinois, Indiana, Maryland, Massachusetts, and Oklahoma have been filed with the CDC through May 2017. The article notes that subsequent screening of patients in the same wards found an additional 45 patients with colonization. 86% of isolates were resistant to fluconazole, and 43% to amphotericin B. In past research, the in-hospital mortality rate of a C. auris infection ranges from 30-60%. This is an emerging area of concern, and one to continue watching. Make sure your lab is up-to-date on the latest recommendations for testing and identification, which can be found here:
Article is available here
Commentary: An excellent review of the data we have on cross-reactivity between penicillins and cephalosporins, and most importantly a good table that shows which ones have similar side chains to each other. This is an important resource for management of penicillin allergies, and while the article stresses we do not know the actual rate of cross-reactivity, a safe measure is to avoid agents with similar side chains. For me, the highlight of this article is the chart, and I will be putting it into my personal toolbox.
Post is available here
Commentary: Infectious Diseases physician Dr. Paul Sax provides an excellent overview of the new fluoroquinolone delafloxacin (Baxdela), which was approved in June 2017 by the FDA for acute bacterial skin and skin structure infections (ABSSSI). He does a nice job outlining the key pros and cons of the drug and provides a little history on the class. Key pros include the spectrum of activity (MRSA and Pseudomonas!) and anionic properties, which may allow for increased accumulation in bacteria. Key cons/concerns include development of resistance and class adverse effects/warnings. As he points out, we do not need another skin drug at this time and its role in therapy may evolve over time as new indications are explored by the company or pioneering clinicians (e.g., CAP, SAB?, Osteomyelitis?, UTI?, Tb?).
Article is here
Commentary: This is a systematic review of all human trials assessing the use of AMP+CTX in enterococcal endocarditis. It is relevant, because we see this combination quite often in practice. Four studies were identified, all observational – one was a comparison between ampicillin and gentamicin vs ampicillin and ceftriaxone, and the other three were simply ampicillin and ceftriaxone in combination. The studies were not well-powered, nor were they designed to show equivalence or non-inferiority; however in the comparison study, AMP+CTX was similar to AMP+gentamicin, and in all the studies AMP+CTX was well tolerated. The review concludes that this is a reasonable option for high-risk renal patients or those with aminoglycoside-resistant pathogens. A head to head randomized control study is needed though to truly determine which regimen should be first line. See blog post by Dr. David Paterson for more info and perspective: https://davidantibiotics.blogspot.com.au/2017/07/ampicillin-and-ceftriaxone-as-first.html
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