This article provides a year in review by featuring top non-COVID infectious diseases articles of 2021.
Article Selection by: Bassam Ghanem, Pharm.D., MS, BCPS
Post Construction by: Timothy P. Gauthier, Pharm.D., BCPS, BCIDP
Article Last Updated: 28 December 2021
For the field of infectious diseases 2021 has been a year for the record books. The COVID-19 pandemic raged on as the Alpha variant gave way to the Delta variant and now the Omicron variant looks to be gaining ground. New monoclonal antibodies became available in the United States (e.g., sotrovimab), an oral therapy (molnupiravir) became available in the United Kingdom, and COVID vaccine boosters were given around the world. We have all watched the data closely day-to-day, sometimes even hour to hour, just trying to keep up with it all.
Many folks in the infectious diseases community are now using Twitter to monitor emerging scholarly work and other data within our specialty. In doing so, it’s not just COVID and SARS-CoV-2 that is being discussed. In fact, many of us are quite tired of COVID hogging all the spotlight. With that in mind, the following top non-COVID infectious diseases articles of 2021 are provided here. This list was developed by BG who you can follow on Twitter @ABsteward. There is no particular order.
We hope you find this list helpful, maybe it will even inspire a journal club or two! Click on the journal name to access the article.
1. Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial | The Lancet
PTC RCT: Among patients admitted to hospital with community-acquired pneumonia who met clinical stability criteria, discontinuing β-lactam treatment after 3 days was non-inferior to 8 days of treatment.
2. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection | NEJM
DATIPO RCT: Among patients with microbiologically confirmed prosthetic joint infections that were managed with standard surgical procedures, antibiotic therapy for 6 weeks was not shown to be noninferior to antibiotic therapy for 12 weeks and resulted in a higher percentage of patients with unfavorable outcomes.
3. Four-Month Rifapentine Regimens with or without Moxifloxacin for Tuberculosis | NEJM
TBTC Study 31 RCT: The efficacy of a 4-month rifapentine-based regimen containing moxifloxacin was noninferior to the standard 6-month regimen in the treatment of tuberculosis.
4. Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia, The SAFER Randomized Clinical Trial | JAMA pediatrics
The SAFER RCT: In a population of previously healthy children diagnosed with CAP in ED, outcomes associated with the use of 5 days of high-dose amoxicillin were comparable to those associated with the use of 10 days of high-dose amoxicillin.
5. Effect of 7 vs 14 Days of Antibiotic Therapy on Resolution of Symptoms Among Afebrile Men With Urinary Tract Infection, A Randomized Clinical Trial | JAMA
Among afebrile men with suspected UTI, treatment with ciprofloxacin or trimethoprim/sulfamethoxazole for 7 days was noninferior to 14 days of treatment with regard to resolution of UTI symptoms by 14 days after antibiotic therapy.
6. Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia, The CAP-IT Randomized Clinical Trial | JAMA
The CAP-IT RCT: Among children with CAP discharged from an emergency department or hospital ward (within 48 hours), lower-dose outpatient oral amoxicillin was noninferior to higher dose, and 3-day duration was noninferior to 7 days, with regard to need for antibiotic re-treatment.
7. Posaconazole versus voriconazole for primary treatment of invasive aspergillosis: a phase 3, randomised, controlled, non-inferiority trial | The Lancet
This double-blind, double-dummy, randomised controlled trial, showed that posaconazole was non-inferior to voriconazole for the treatment of invasive aspergillosis, and participants who received posaconazole had significantly fewer treatment-related adverse events.
8. Meropenem Versus Piperacillin-Tazobactam for Definitive Treatment of Bloodstream Infections Caused by AmpC β-Lactamase–Producing Enterobacter spp, Citrobacter freundii, Morganella morganii, Providencia spp, or Serratia marcescens: A Pilot Multicenter Randomized Controlled Trial (MERINO-2) | OFID
MERINO-2 RCT: Among patients with BSI due to AmpC producers, this pilot randomized trial was unable to show a difference in primary outcome between the piperacillin-tazobactam and meropenem treatment groups; piperacillin-tazobactam may lead to more microbiological failures, albeit fewer microbiological relapses.
9. Posaconazole for prevention of invasive pulmonary aspergillosis in critically ill influenza patients (POSA-FLU): a randomised, open-label, proof-of-concept trial | Intensive Care Med
POSA-FLU: Posaconazole didn’t prevent pulmonary aspergillosis in critically ill influenza patients. The higher than expected incidence of early Influenza-associated pulmonary aspergillosis precludes any definite conclusion on POS prophylaxis. High mortality of early IAPA, despite timely antifungal therapy, indicates that alternative management strategies are required.
10. Efficacy of Wolbachia-Infected Mosquito Deployments for the Control of Dengue | NEJM
AWED RCT: Introgression of wMel of Wolbachia pipientis into A. aegypti populations was effective in reducing the incidence of symptomatic dengue and resulted in fewer hospitalizations for dengue among the participants.
11. Maribavir for Refractory Cytomegalovirus Infections With or Without Resistance Post-Transplant: Results from a Phase 3 Randomized Clinical Trial | CID
SOLSTICE RCT: Maribavir was superior to investigator-assigned therapy for cytomegalovirus viremia clearance, and viremia clearance plus symptom control maintained post-therapy in transplant recipients with or without resistance cytomegalovirus.
12. Secondary Antibiotic Prophylaxis for Latent Rheumatic Heart Disease | NEJM
GOAL RCT: Among children and adolescents 5 to 17 years of age with latent rheumatic heart disease, secondary antibiotic prophylaxis reduced the risk of disease progression at 2 years.
13. Dolutegravir or Darunavir in Combination with Zidovudine or Tenofovir to Treat HIV | NEJM
NADIA RCT: Dolutegravir in combination with NRTIs was effective in treating patients with HIV-1 infection, including those with extensive NRTI resistance in whom no NRTIs were predicted to have activity. Tenofovir was noninferior to zidovudine as second-line therapy.
14. Effect of Probiotics on Incident Ventilator-Associated Pneumonia in Critically Ill Patients, A Randomized Clinical Trial | JAMA
PROSPECT RCT: Among critically ill patients requiring mechanical ventilation, administration of the probiotic L rhamnosus GG compared with placebo, resulted in no significant difference in the development of ventilator-associated pneumonia. These findings do not support the use of L rhamnosus GG in critically ill patients.
15. Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO-study): A Multicentre, Randomised, Open-label, Noninferiority Trial | Ann Surg
DINAMO RCT: Antibiotic-free outpatient treatment of mild acute diverticulitis is not inferior to standard antibiotic treatment in terms of hospital admission, revisit rates, or subsequent recovery.
16. A Phase 3, Randomized, Double-Blind Study Comparing Tedizolid Phosphate and Linezolid for Treatment of Ventilated Gram-Positive Hospital-Acquired or Ventilator-Associated Bacterial Pneumonia | CID
This randomized, controlled trial demonstrated that tedizolid was noninferior to linezolid for day 28 all-cause mortality in the treatment of gram-positive ventilated HABP/VABP. Noninferiority of tedizolid for investigator-assessed clinical response at TOC was not demonstrated.
17. Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis | NEJM
POINTER RCT: This trial did not show the superiority of immediate drainage over postponed drainage with regard to complications in patients with infected necrotizing pancreatitis. Patients randomly assigned to the postponed-drainage strategy received fewer invasive interventions.
18. Fosfomycin versus ciprofloxacin as oral stepdown treatment for Escherichia coli febrile urinary tract infection in women: a randomised, placebo-controlled, double blind, multicenter trial | CID
FORECAST RCT: Fosfomycin is non-inferior to ciprofloxacin as oral stepdown treatment for febrile UTI caused by E. coli in women. Fosfomycin use is associated with more gastro-intestinal events.
19. Seven-versus 14-day course of antibiotics for the treatment of bloodstream infections by Enterobacterales: a randomized, controlled trial | CMI
SHORTEN RCT: 7-day courses of antibiotics for bloodstream infections caused by members of the Enterobacterales allow a reduction in patients’ exposure to antibiotics while achieving clinical outcomes similar to those of 14-day schemes
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