In this post some of the top infectious diseases articles of 2020 are identified.
Article Selection by: Bassam Ghanem, Pharm.D., MS, BCPS
Post Construction by: Timothy P. Gauthier, Pharm.D., BCPS, BCIDP
Posted 22 December 2020
What a year it has been! 2020 has been a stand-out year for infectious diseases – in both a good and bad way. On a positive note we have made tremendous progress fighting a novel pathogen and it has helped raise awareness about the importance of infectious diseases research. On a negative note, COVID sucks on so many levels that words can hardly describe it.
As the year draws to a close we thought it would be good to take a moment and identify some of the top infectious diseases articles from 2020. While some of these are related to COVID, there is a clear effort here to identify a healthy number of non-COVID articles.
RANDOMIZED CONTROLLED TRIALS
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
The CAMERA 2 RCT concluded that addition of an anti-staphylococcal 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. Efficacy and safety of cefiderocol or best available therapy for the treatment of serious infections caused by carbapenem-resistant Gram-negative bacteria (CREDIBLE-CR): a randomised, open-label, multicentre, pathogen-focused, descriptive, phase 3 trial | Lancet ID
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30796-9/fulltext
The CREDIBLE-CR RCT concluded that cefiderocol had similar clinical and microbiological efficacy to best available therapy in a heterogeneous patient population with infections caused by carbapenem-resistant Gram-negative bacteria.
3. Repurposed Antiviral Drugs for Covid-19 – Interim WHO Solidarity Trial Results | NEJM
https://www.nejm.org/doi/full/10.1056/NEJMoa2023184
Remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay.
4. Dexamethasone in Hospitalized Patients with Covid-19 – Preliminary Report, The RECOVERY Collaborative Group | NEJM
https://www.nejm.org/doi/full/10.1056/NEJMoa2021436
Dexamethasone resulted in lower 28-day mortality In patients hospitalized with COVID-19 who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support.
5. 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
The 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.
6. Preoperative oral antibiotics and surgical-site infections in colon surgery (ORALEV): a multicentre, single-blind, pragmatic, randomised controlled trial | Lancet
https://www.thelancet.com/journals/langas/article/PIIS2468-1253(20)30075-3/fulltext
The ORALEV RCT concluded that 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.
7. Three versus six weeks of antibiotic therapy for diabetic foot osteomyelitis: A prospective, randomized, non-inferiority pilot trial | CID
In this randomized, controlled pilot trial, a post-debridement systemic antibiotic therapy course for diabetic foot infection of 3-weeks gave similar (and statistically non-inferior) incidences of remission and adverse events to a course of 6 weeks.
8. Antibiotics versus no therapy in kidney transplant recipients with asymptomatic bacteriuria (BiRT): a pragmatic, multicentre, randomized, controlled trial | CMI
https://www.sciencedirect.com/science/article/pii/S1198743X20305346?via%3Dihub
Applying a screen-and-treat strategy for asymptomatic bacteriuria does not reduce the occurrence of symptomatic UTI in kidney transplant recipients who are more than 2 months post-transplantation.
9. Adjunctive Daptomycin in the Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Randomized Controlled Trial | CID
The DASH RCT concluded that among patients with MSSA bloodstream infections, the administration of adjunctive daptomycin therapy to standard of care treatment did not shorten the duration of bacteremia and should not be routinely considered.
10. Long-Acting Cabotegravir and Rilpivirine for Maintenance of HIV-1 Suppression | NEJM
https://www.nejm.org/doi/full/10.1056/NEJMoa1904398
The ATLA RCT concluded that monthly injections of long-acting cabotegravir and rilpivirine were non-inferior to standard oral therapy for maintaining HIV-1 suppression.
SYSTEMATIC REVIEWS & META-ANALYSIS
1. 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
2. Is Ceftazidime/Avibactam an Option for Serious Infections Due to Extended-Spectrum-Beta-Lactamase- and AmpC-Producing Enterobacterales? A Systematic Review and Meta-analysis | AAC
https://aac.asm.org/content/65/1/e01052-20
This systematic review and meta-analysis concluded that ceftazidime-avibactam may be a carbapenem-sparing option for the treatment of mild to moderate complicated urinary tract and intra-abdominal infections caused by ESBL-producing Enterobacterales species, and the data are too limited to provide any conclusive recommendations for the AmpC producers.
3.Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis | CMI
https://www.sciencedirect.com/science/article/pii/S1198743X20304237
Bacterial co-infection is relatively infrequent in hospitalized patients with COVID-19. The majority of these patients may not require empirical antibacterial treatment.
PROSPECTIVE & RETROSPECTIVE INTERVENTIONAL STUDIES
1. Efficacy of ceftazidime-avibactam plus aztreonam in patients with bloodstream infections caused by MBL-producing Enterobacterales | CID
https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciaa586/5840534
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 length of stay compared with other active antibiotics for patients with bloodstream infection due to MBL-producing Enterobacterales.
2. Association Between Minimum Inhibitory Concentration, Beta-lactamase Genes and Mortality for Patients Treated With Piperacillin/Tazobactam or Meropenem From the MERINO Study | CID
A post hoc analysis found that the 30-day mortality difference from the MERINO trial was less pronounced for piperacillin/tazobactam after excluding non-susceptible strains.
3. 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.
4. Oral Beta-Lactam Antibiotics vs Fluoroquinolones or Trimethoprim-Sulfamethoxazole for Definitive Treatment of Enterobacterales Bacteremia From a Urine Source | JAMA
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771521
This large cohort study concluded that Oral Beta-lactam antibiotics are a reasonable step-down alternative to trimethoprim-sulfamethoxazole or fluoroquinolones after a median 5 days of IV antibiotics in adults with Enterobacterales bacteremia from a suspected urinary source.
5. Utility of Methicillin-Resistant Staphylococcus aureus Nares Screening for Patients with a Diabetic Foot Infection | AAC
https://aac.asm.org/content/64/4/e02213-19
A negative MRSA nares swab, taken within 7 days of culture, is useful to predict the absence of MRSA in a subsequent culture from a diabetic foot infection.
6. Empiric Antibacterial Therapy and Community-onset Bacterial Co-infection in Patients Hospitalized with COVID-19: A Multi-Hospital Cohort Study | CID
https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1239/5895253
This study found high use of early empiric antibacterial therapy in patients hospitalized with COVID-19, despite low prevalence of confirmed community-onset bacterial co-infections.
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