The “Infectious Diseases Twitter Highlights” column presents recent twitter posts that are of particular interest to the infectious diseases community and provides commentary. This is the summary for the second week of July 2017.
Authored By: Jamie Kisgen, Pharm.D., BCPS-AQ ID
Article link is here.
Commentary: If you are like me, you are always looking for good ID review articles to share with students and residents. I highly recommend you add this one to your reading list. The authors do a nice job highlighting and addressing 10 common myths related to cellulitis. The article flows well and is well referenced.
My favorite Myth would have to be #7: “Because one cannot tell whether cellulitis is caused by Streptococcus spp., MSSA, MRSA, Gram-negative or anaerobic pathogens, each patient needs to be treated with broad-spectrum antibiotic therapy.” Wait, are you saying we should not give “Vosyn” or “Vancopeme” to everyone who gets admitted with cellulitis?
Of note, JEM also published a Top Ten Myths Regarding the Diagnosis and Treatment of Urinary Tract Infections last year, available here.
Article is available here.
Commentary: Therapeutic drug monitoring (TDM) of antimicrobials has been common practice for decades. Most hospitals now have in-house testing and dosing protocols for vancomycin and aminoglycosides. However, the role of TDM for β-lactams continues to be debated in the literature and most institutions are unable to perform testing in real time.
Historically, most articles have focused on the value of TDM in optimizing PK/PD target attainment in order to improve time > MIC and clinical outcomes, but this article from Australia looks at the potential impact of TDM in monitoring for drug-induced toxicity. This was a retrospective cohort of consecutive patients who underwent piperacillin, meropenem and flucloxacillin TDM at a single institution. The aim of the study was to determine if there was a concentration-toxicity relationship for β-lactams and the development of neurotoxicity, nephrotoxicity, hepatotoxicity, and Clostridium difficile infection. They found that incidence of neurotoxicity and nephrotoxicity may be impacted by serum concentration, however hepatotoxicity and CDI were not. Although the authors did a good job controlling for potential bias, the retrospective nature of the study and low number of patients with toxicity in each group limit the applicability of the results.
I feel this study adds to the debate and hope others will continue to explore TDM for β-lactams. If you are interested, there is another article in press now out of France looking at continuous infusion piperacillin/tazobactam and neurotoxicity, available here.
Article is here.
Commentary: The CDC estimates that over 800K new gonococcal infections occur in the United States each year. Antibiotic resistance with Neisseria gonorrhoeae has reached a point where some strains have no active antibiotics. For years, vaccines haves been developed against this challenging organism, however all have failed to make it to the market.
This article published in the Lancet explores the potential impact of a Meningococcal Group B vaccine on gonorrhea incidence in New Zealand. In this retrospective case-control study of patients at sexual health clinics who were 15 to 30 years old, they found a 31% reduction in infection in those who received the vaccine compared to controls. Before you get too excited, the vaccine reviewed in the study was an outer membrane vesicle vaccine, which is not currently used in the U.S. This article does however show a potential target for future vaccine development.
Document is here.
Commentary: Antimicrobial stewardship programs are becoming more common in larger academic and community hospitals, especially after implementation of the new Joint Commission Medication Management Standards in January 2017. However, the literature and best practice recommendations for implementing stewardship programs at smaller institutions are limited, even though the need is very apparent. Thankfully, this new document posted last week by the CDC provides guidance and implementation tools for Small and Critical Access hospitals. It was developed by the CDC, The American Hospital Association, The Federal Office of Rural Health Policy and The Pew Charitable Trusts.
Document is here.
Statement from the G20 Leaders:
“Combatting Antimicrobial Resistance (AMR): AMR represents a growing threat to public health and economic growth. To tackle the spread of AMR in humans, animals and the environment, we aim to have implementation of our National Action Plans, based on a One-Health approach, well under way by the end of 2018. We will promote G20 Leaders´ Declaration the prudent use of antibiotics in all sectors and strive to restrict their use in veterinary medicine to therapeutic uses alone. Responsible and prudent use of antibiotics in food producing animals does not include the use for growth promotion in the absence of risk analysis. We underline that treatments should be available through prescription or the veterinary equivalent only. We will strengthen public awareness, infection prevention and control and improve the understanding of the issue of antimicrobials in the environment. We will promote access to affordable and quality antimicrobials, vaccines and diagnostics, including through efforts to preserve existing therapeutic options. We highlight the importance of fostering R&D, in particular for priority pathogens as identified by the WHO and tuberculosis. We call for a new international R&D Collaboration Hub to maximise the impact of existing and new anti-microbial basic and clinical research initiatives as well as product development. We invite all interested countries and partners to join this new initiative. Concurrently, in collaboration with relevant experts including from the OECD and the WHO, we will further examine practical market incentive options.”
Bonus Tweet! …Conference call bingo!!
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