In this post an infectious diseases pharmacist identifies several important infectious diseases/ antimicrobial stewardship articles that may have been due to all eyes being on the coronavirus these past few months.
Written By: Bassam Ghanem, Pharm.D., MS, BCPS
Edited By: Timothy P. Gauthier, Pharm.D., BCPS
[Last updated 7 June 2020]
Coronavirus has been at the forefront of our minds for many months now. It has changed our habits and impacted the way we live our lives. As coronavirus has disrupted life, you may not have been focusing on the non-coronavirus publications that have come out.
In an effort to identify some of the important non-coronavirus publications that have come out in the last few months, the following is provided. These are some of the very top publications we identified and exclusion from this list is not an indication that works are not important too.
1. Effect of Vancomycin or Daptomycin With vs Without an Antistaphylococcal Beta-Lactam on Mortality, Bacteremia, Relapse, or Treatment Failure in Patients With MRSA Bacteremia: A Randomized Clinical Trial | JAMA
https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2020.0103
CAMERA 2 RCT concluded that addition of an antistaphylococcal beta-lactam to standard antibiotic therapy with vancomycin or daptomycin for patients with MRSA bacteremia did not result in significant improvement in the primary composite end point of mortality, persistent bacteremia, relapse, or treatment failure.
2. Effect of C-Reactive Protein-Guided Antibiotic Treatment Duration, 7-Day Treatment, or 14-Day Treatment on 30-Day Clinical Failure Rate in Patients With Uncomplicated Gram-Negative Bacteremia A Randomized Clinical Trial | JAMA
https://jamanetwork.com/journals/jama/fullarticle/2766635
PIRATE RCT found that 30-day rates of clinical failure for CRP-guided antibiotic treatment duration (discontinuation once CRP declined by 75%), fixed 7-day treatment were non-inferior to fixed 14-day treatment in patients with uncomplicated Gram-negative bacteremia.
3. Preoperative oral antibiotics and surgical-site infections in colon surgery (ORALEV): a multicentre, single-blind, pragmatic, randomised controlled trial | The Lancet
https://www.thelancet.com/journals/langas/article/PIIS2468-1253(20)30075-3/fulltext
ORALEV RCT concluded the administration of oral antibiotics as prophylaxis the day before colon surgery significantly reduces the incidence of surgical-site infections without mechanical bowel preparation and should be routinely adopted before elective colon surgery.
4. Effect of postoperative continuation of antibiotic prophylaxis on the incidence of surgical site infection: a systematic review and meta-analysis | Lancet
https://www.sciencedirect.com/science/article/pii/S1473309920300840
This systematic review and meta-analysis concluded that postoperative continuation of antibiotic prophylaxis did not provide any additional benefit in preventing surgical site infection when best practices for surgical antibiotic prophylaxis were followed.
5. Efficacy of ceftazidime-avibactam plus aztreonam in patients with bloodstream infections caused by MBL- producing Enterobacterales | CID
Prospective observational study including patients admitted to three hospitals in Italy and Greece found that CAZ-AVI/ATM combination was associated with significant reduction in 30-day mortality rate, lower clinical failure at day 14 and shorter LOS compared with other active antibiotics for patients with bloodstream infection due to MBL-producing Enterobacterales.
6. Is Piperacillin-Tazobactam Effective for the Treatment of Pyelonephritis Caused by Extended-Spectrum Beta-Lactamase-Producing Organisms |CID
This multicenter observational study found no significant difference in clinical outcomes of adults hospitalized with ESBL-producing pyelonephritis who were treated with piperacillin-tazobactam as compared to carbapenems.
7. Effectiveness and safety of an institutional aminoglycoside-based regimen as empirical treatment of patients with pyelonephritis | JAC
This large cohort study aimed to determine clinical outcomes associated with aminoglycosides versus other antimicrobial agents as empirical treatment of hospitalized patients with pyelonephritis. Aminoglycosides was associated with higher rates of in vitro activity and lower overall mortality compared with non-aminoglycoside drugs, without excess nephrotoxicity.
8. Evaluation of a Paradigm Shift From Intravenous Antibiotics to Oral Step-Down Therapy for the Treatment of Infective Endocarditis: A Narrative Review | JAMA
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2020.0555
This review describes ample data demonstrating the therapeutic effectiveness of oral step-down vs intravenous-only antibiotic therapy for IE, and no contrary data were identified.
9. Antimicrobial therapeutic drug monitoring in critically ill adult patients: a Position Paper | Intensive Care Med
https://link.springer.com/article/10.1007%2Fs00134-020-06050-1
This Position Paper aims to review and discuss the available data on TDM of antibacterials, antifungals and antivirals , also provides a practical guide on how TDM can be applied in routine clinical practice to improve therapeutic outcomes in critically ill adult patients.
10. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. |AJHP
https://academic.oup.com/ajhp/article/77/11/835/5810200
The guidelines recommend targeting an AUC/MIC ratio of 400 to 600 (assuming an MIC of 1 mg/L) for empiric dosing of vancomycin in both adult and pediatric patients to maximize clinical efficacy and minimize AKI risk for treatment of serious MRSA infections. Trough-only monitoring, with a target of 15 to 20 mg/L, is no longer recommended based on efficacy and nephrotoxicity data in patients with serious MRSA infections.
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