Antibiotic Stewardship
RCT | Comparable efficacy of cefotaxime, ceftriaxone, and ciprofloxacin in treating spontaneous bacterial peritonitis
3 Apr, 2023 | 14:01h | UTCSummary: This multicenter, prospective, open-label, randomized controlled trial compared the efficacy of cefotaxime, ceftriaxone, and ciprofloxacin as initial treatments for spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites. The study included 261 patients aged 16 to 75, with liver cirrhosis, ascites, and a polymorphonuclear cell count of >250/mm3. Researchers performed follow-up paracentesis at 48 hours to evaluate the assigned antibiotics, and assessed resolution rates at 120 and 168 hours of treatment.
The primary endpoint, resolution rates at 120 hours, showed no statistically significant difference between the groups: 67.8% for cefotaxime, 77.0% for ceftriaxone, and 73.6% for ciprofloxacin. One-month mortality rates were also similar. The study concluded that these antibiotics are equally effective as initial treatments for SBP, particularly for community-acquired infections, when administered based on response-guided therapy.
Article: Response-Guided Therapy With Cefotaxime, Ceftriaxone, or Ciprofloxacin for Spontaneous Bacterial Peritonitis: A Randomized Trial: A Validation Study of 2021 AASLD Practice Guidance for SBP – American Journal of Gastroenterology (free for a limited period)
A syndrome-specific antibiotic stewardship intervention reduced antipseudomonal antibiotic use in diabetic foot infections
29 Mar, 2023 | 13:10h | UTC
Plasma D-Dimer may be useful in the diagnosis of periprosthetic joint infection
29 Mar, 2023 | 12:33h | UTCPlasma D-Dimer Is Noninferior to Serum C-Reactive Protein in the Diagnosis of Periprosthetic Joint Infection – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)
News Release: D-dimer blood test shows value in detecting prosthetic joint infections – Wolters Kluwer
CDC report reveals escalating Candida auris transmission and resistance in the US
28 Mar, 2023 | 15:10h | UTCWorsening Spread of Candida auris in the United States, 2019 to 2021 – Annals of Internal Medicine
Commentaries:
CDC reports dramatic increase in US Candida auris cases – CIDRAP
An emerging fungal threat spread at an alarming rate in US health care facilities, study says – CNN
Related:
CDC Report: Transmission of pan-resistant Candida auris in health care facilities.
Case reports: Multidrug-resistant Candida auris infections in critically ill Covid-19 patients
Candida auris: A Review of Recommendations for Detection and Control in Healthcare Settings
Global Epidemiology of Emerging Candida Auris (reviews and commentaries on the subject)
The superbug Candida auris is giving rise to warnings — and big questions – STAT
Candida Auris – “A Mysterious Infection, Spanning the Globe in a Climate of Secrecy” (reviews and commentaries on the subject)
Commentary on Twitter
New Annals of Internal Medicine study finds cases of deadly fungus, Candida auris, rose drastically between 2019 and 2021. Increase included treatment resistant strains: https://t.co/J3SkmfWDr5 @CDCgov pic.twitter.com/ZJBRqMIOy1
— Annals of Int Med (@AnnalsofIM) March 21, 2023
Brief Review | Antifungal stewardship in critically ill patients
28 Mar, 2023 | 14:57h | UTCAntifungal stewardship in critically ill patients – Intensive Care Medicine (if the link is paywalled, try this one)
Commentary on Twitter
Antifungal stewardship in #ICU
🧪 biomarkers
⬇️ de‑escalation
🍄 other methods to improve AFs use
Empirical AFs commonly used (poor prognosis if inappropriate/delayed): AFS can ⬆️ performance measures/⬇️ AFs consumption, no negative impact on outcome
🖇️ https://t.co/eS9EJdjo2a pic.twitter.com/4FMV9NBndb— Intensive Care Medicine (@yourICM) March 24, 2023
M-A | Examining shorter antibiotic treatment durations for community acquired pneumonia in adults
27 Mar, 2023 | 13:29h | UTCSummary: The systematic review and duration-effect meta-analysis included nine randomized trials with a total of 2,399 patients, analyzing antibiotic treatment durations for community-acquired pneumonia (CAP) in adults. The primary outcome was clinical improvement on day 15, with secondary outcomes including all-cause mortality, serious adverse events, and clinical improvement on day 30.
The study found that shorter treatment durations (3–9 days) were likely to be non-inferior to the standard 10-day treatment, and no significant difference in all-cause mortality or serious adverse events was observed. The study suggests that a 3–5 day treatment duration likely offers the optimal balance between efficacy and treatment burden if patients are clinically stable. However, the results are limited by the small number of included studies, the overall moderate-to-high risk of bias, and the varying severity of CAP among patients in the studies. Therefore, further research focusing on the shorter duration range is required.
Related:
Phase 2b RCT | Efficacy and safety of PL-5 (Peceleganan) spray for wound infections
27 Mar, 2023 | 13:08h | UTC
Study reveals high rates of nonadherence to antimicrobial prophylaxis guidelines, often due to unnecessary vancomycin use
23 Mar, 2023 | 13:13h | UTCSummary: The study evaluated adherence to surgical antimicrobial prophylaxis guidelines in 825 US hospitals for elective surgeries from 2019-2020. The study found that 41% of surgical prophylaxis regimens were nonadherent to the American Society of Health-System Pharmacists guidelines.
Unnecessary vancomycin use was the most common reason for nonadherence to surgical antimicrobial prophylaxis guidelines, accounting for 77% of nonadherent regimens and occurring in 31% of all surgeries. It’s noteworthy that when vancomycin was used, it was often unnecessarily combined with cefazolin, and patients who received this combination had a 19% higher risk of acute kidney injury compared to those who received cefazolin alone.
The authors suggest that quality-improvement efforts aimed at reducing unnecessary vancomycin use and potential guideline revisions may offer impactful strategies for improving the risk-benefit profile of antimicrobial prophylaxis.
ATS Position Paper | Immunocompromised host pneumonia: definitions and diagnostic criteria
23 Mar, 2023 | 12:41h | UTC
Consensus Paper | Small intestinal bacterial overgrowth in gastrointestinal disorders
16 Mar, 2023 | 13:23h | UTC
RCT | Intrapartum azithromycin fails to reduce neonatal sepsis and death
14 Mar, 2023 | 14:00h | UTCSummary: This randomized controlled trial aimed to evaluate the effectiveness of administering azithromycin during labor to reduce neonatal sepsis and mortality. The randomized trial involved 11,983 birthing parents and their infants in West Africa.
The study found no significant difference in the incidence of neonatal sepsis or mortality between the azithromycin and placebo groups. On the other hand, the rate of non-invasive infections, including skin infections in newborns, and mastitis and puerperal fever in parents, was lower in the azithromycin group in the following four weeks.
The authors concluded that these results do not support the routine introduction of oral intrapartum azithromycin to reduce neonatal sepsis or mortality. However, it is important to notice that a recent large study published in the New England Journal of Medicine showed conflicting results.
Article: Effect of Intrapartum Azithromycin vs Placebo on Neonatal Sepsis and Death: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries:
Azithromycin during labor doesn’t reduce sepsis, mortality in newborns – CIDRAP
Effect of antibiotics during pregnancy on neonatal sepsis and mortality – MedicalResearch.com
Related study with conflicting results: Azithromycin to Prevent Sepsis or Death in Women Planning a Vaginal Birth – New England Journal of Medicine (link to abstract – $ for full-text)
News Release: Single-dose antibiotic prevents maternal sepsis and death – NIH News
Commentaries:
In large study, a single antibiotic dose slashed rate of sepsis in childbirth – STAT
Dose of azithromycin found to cut risk of maternal death, sepsis in childbirth – CIDRAP
Commentary on Twitter
Study results do not support routine introduction of oral intrapartum azithromycin to reduce neonatal sepsis or mortality. https://t.co/yDpg1CCGa2 pic.twitter.com/5Oc4HqZ4sX
— JAMA (@JAMA_current) March 7, 2023
Risk factors for Carbapenem-Resistant Enterobacterales infections: a matched case-control study
14 Mar, 2023 | 13:43h | UTCSummary: The study aimed to investigate risk factors for infections caused by carbapenem-resistant Enterobacterales (CRE) and identify variables that increase the probability of CRE infection among admitted patients in hospitals with high CRE incidence.
The study was performed in 50 hospitals in Southern Europe from March 2016 to November 2018 and included patients with complicated urinary tract infection, complicated intraabdominal infection, pneumonia, or bacteremia from other sources due to CRE. Control groups were patients with infection caused by carbapenem-susceptible Enterobacterales and non-infected patients, matched according to the same criteria as the CRE group (type of infection, ward, and duration of hospital admission).
The results showed that the main risk factors for CRE infections were previous colonization with CRE, use of urinary catheters, and exposure to broad-spectrum antibiotics.
The study’s findings offer evidence to inform decisions about preventive measures and empirical treatment for patients with suspected CRE infections. Additionally, the study can guide the efficient design of future randomized trials focusing on high-risk patients.
Related:
RCT | Colistin monotherapy vs. combination therapy for carbapenem-resistant organisms
Review | Pathogenesis, epidemiology and control of Group A Streptococcus infection
14 Mar, 2023 | 13:38h | UTC
Commentary on Twitter
NEW📢🎉Pathogenesis, epidemiology and control of Group A Streptococcus infectionhttps://t.co/XFSKQrTe1P
Brouwer & co. summarize the epidemiological and clinical features of Group A Streptococcus infection, and the molecular mechanisms of GAS virulence and drug resistance. pic.twitter.com/qm23YgnKlg
— Nature Reviews Microbiology (@NatureRevMicro) March 10, 2023
M-A | Routine anaerobic coverage for aspiration pneumonia: limited evidence of benefit
13 Mar, 2023 | 15:03h | UTCSummary: Treating aspiration pneumonia with antibiotics that cover anaerobic bacteria has become common practice in many services, but recent studies suggest that this may not necessarily improve prognosis.
Out of 2523 publications, this systematic review and meta-analysis only included one randomized control trial and two observational studies. The study found no clear benefit of anaerobic coverage and concluded that there is not enough data to evaluate the necessity of anaerobic coverage in the antibiotic treatment of aspiration pneumonia.
The authors suggest that covering anaerobic bacteria with antibiotics may not be needed as an initial treatment for aspiration pneumonia if there is no formation of abscess or empyema and the patient has good oral hygiene.
Related: BTS clinical statement on aspiration pneumonia – Thorax
ISCCM Guidelines for the use of procalcitonin for rational use of antibiotics
13 Mar, 2023 | 14:57h | UTC
Review | How to use nebulized antibiotics in severe respiratory infections
10 Mar, 2023 | 14:31h | UTCHow to Use Nebulized Antibiotics in Severe Respiratory Infections – Antibiotics
RCT | Vaginal cleansing before unscheduled cesarean delivery did not reduce postoperative infections
10 Mar, 2023 | 14:23h | UTCVaginal cleansing before unscheduled cesarean delivery to reduce infection: a randomized clinical trial – American Journal of Gynecology & Obstetrics (link to abstract – $ for full-text)
Related studies with conflicting results:
Vaginal Cleansing Before Cesarean Delivery: A Systematic Review and Meta-analysis – Obstetrics & Gynecology (link to abstract – $ for full-text)
Commentary on Twitter
Vaginal Cleansing Before Unscheduled Cesarean Delivery to Reduce Infection: A Randomized Clinical Trial https://t.co/QuNWfCxl3D @acog pic.twitter.com/sauvsRq5C1
— AJOG (@AJOG_thegray) November 30, 2022
M-A | Comparison of a short vs. long-course antibiotic therapy for ventilator-associated pneumonia
7 Mar, 2023 | 13:18h | UTCSummary:
This systematic review and meta-analysis of randomized controlled trials aimed to compare the rates of recurrence and relapse of ventilator-associated pneumonia (VAP) between short-course (≤8 days) and long-course (≥10-15 days) antibiotic therapy strategies. Five relevant studies involving 1069 patients were identified.
Compared to long-course therapy, short-course therapy increased the number of antibiotic-free days without any impact on recurrence and relapses of VAP, 28 days mortality, mechanical ventilation duration, number of extra-pulmonary infections, and length of ICU stay.
However, the study’s limitations, such as the small sample size and the lack of standardized definitions of the assessed outcomes, should be considered when interpreting the results.
Commentary: Study finds benefits in short-course antibiotics for ventilator-associated pneumonia – CIDRAP
Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli
7 Mar, 2023 | 13:00h | UTCRelated:
RCT | Colistin monotherapy vs. combination therapy for carbapenem-resistant organisms
BTS Clinical Guidance | Aspiration pneumonia
6 Mar, 2023 | 14:36h | UTCBTS clinical statement on aspiration pneumonia – Thorax
BTS Clinical Guidance | Prevention and management of community-acquired pneumonia in people with learning disability
6 Mar, 2023 | 14:34h | UTC
Cohort Study | Risk factors for serious infections in ANCA-associated vasculitis
2 Mar, 2023 | 12:52h | UTCRisk factors for serious infections in ANCA-associated vasculitis – Annals of the Rheumatic Diseases
Commentary from the author on Twitter
Just published in @ARD_BMJ (https://t.co/mZVZ7HZaLC) – risk of severe infections in #AAV. The prophylactic use of low-dose TMP/SMX may reduce this risk. A work I am really proud of. Many thanks to all my co-authors, especially to my friend @AKronbichler for his endless support!
— Balazs Odler (@odlerb) January 26, 2023
Review | The golden grapes of wrath – Staphylococcus aureus bacteremia
1 Mar, 2023 | 13:46h | UTC
Choosing Wisely internationally – 213 helpful recommendations for antimicrobial stewardship!
27 Feb, 2023 | 13:19h | UTCSummary: The article discusses the importance of antimicrobial stewardship (AMS) in the face of increasing antimicrobial resistance and the role of the Choosing Wisely campaign in promoting the rational use of antibiotics. The study evaluated 213 Choosing Wisely recommendations related to AMS practices in six countries (Australia/New Zealand, Canada, Italy, Switzerland, the USA, and Germany) and categorized them according to six categories: diagnostics, indication, choice of anti-infective drugs, dosing, application, and duration of therapy. Topics related to indication and diagnostics were most frequently addressed, and avoiding antibiotic treatment of asymptomatic bacteriuria and upper respiratory tract infections were central topics across all countries.
Article: Choosing Wisely internationally – helpful recommendations for antimicrobial stewardship! – Infection
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
Study links proton pump inhibitor use to increased risk of acquiring drug-resistant bacteria in hospitalized patients
27 Feb, 2023 | 13:13h | UTCSummary: This case-control study investigated whether proton pump inhibitors (PPIs) are associated with an increased risk of acquiring extended-spectrum β-lactamase (ESBL) or carbapenemase-producing Enterobacterales among hospitalized patients. The study involved 2239 adult hospitalized patients. After controlling for confounding factors, patients who received PPIs within the previous 30 days had a nearly 50% increased risk (aIRR, 1.48) of acquiring ESBL- or carbapenemase-producing Enterobacterales compared with those who did not receive PPIs. The study has the limitations of an observational study but points to the need for judicious use of PPIs to mitigate the risk of acquiring drug-resistant Enterobacterales among hospitalized patients.
Commentaries:
Study links acid suppressants to colonization with multidrug-resistant bacteria – CIDRAP
Proton Pump Inhibitors Associated With Increased Risk of Drug-Resistant Infections – HCP Live