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Antibiotic Stewardship

Cluster RCT | Effect of an antibiotic stewardship intervention to improve antibiotic prescribing for suspected UTI in older adults

24 Feb, 2023 | 13:58h | UTC

Summary: The study evaluated the effectiveness of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections (UTI) in frail older adults. The study was a pragmatic, parallel, cluster-randomized controlled trial conducted in four European countries and included 1041 frail older adults aged 70 or older. The intervention involved a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. The control group provided care as usual. The primary outcome was the number of antibiotic prescriptions for suspected UTI per person year, and secondary outcomes included incidence of complications, hospital referrals, admissions, and mortality. The results showed that the intervention group had a lower rate of receiving an antibiotic prescription for a suspected UTI (0.27 per person year) compared to the control group (0.58 per person year), with no increase in complications or adverse events.

Article: Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries – The BMJ

Commentary: Trial: Stewardship intervention cuts antibiotic prescribing for suspected urinary infections – CIDRAP

Related:

Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women

Bacteriuria in older adults triggers confusion in healthcare providers: A mindful pause to treat the worry – Antimicrobial Stewardship & Healthcare Epidemiology

Antibiotics versus no treatment for asymptomatic bacteriuria in residents of aged care facilities: a systematic review and meta-analysis – British Journal of General Practice

USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults

Most doctors still believe in prescribing unnecessary antibiotics to treat asymptomatic bacteriuria, study suggests.

Randomized trial: Antibiotics vs. no therapy in kidney transplant recipients with asymptomatic bacteriuria

 

Guideline | Diagnosis and treatment of Helicobacter pylori

24 Feb, 2023 | 13:53h | UTC

Helicobacter pylori World Gastroenterology Organization Global Guideline – Journal of Clinical Gastroenterology

Related:

AGA Clinical Practice Update on the Management of Refractory Helicobacter pylori Infection: Expert Review – Gastroenterology

Evidence based guidelines for the treatment of Helicobacter pylori infection in Korea 2020 – The Korean Journal of Internal Medicine

Management of Helicobacter pylori infection: Guidelines of the Italian Society of Gastroenterology (SIGE) and the Italian Society of Digestive Endoscopy (SIED) – Digestive and Liver Disease

 

SR | The impact of Antimicrobial Stewardship Programs in pediatric emergency departments and primary care

24 Feb, 2023 | 13:20h | UTC

The impact of Antimicrobial Stewardship Programmes in paediatric emergency departments and primary care: a systematic review – Therapeutic Advances in Infectious Disease

 

Review | When and how to use MIC in clinical practice?

24 Feb, 2023 | 13:28h | UTC

When and How to Use MIC in Clinical Practice? – Antibiotics

 

Commentary on Twitter

https://twitter.com/ABsteward/status/1616852667124400129

 

Antibiotic allergy de-labeling: a pathway against antibiotic resistance

23 Feb, 2023 | 13:12h | UTC

Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance – Antibiotics

Related:

Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs – JAC-Antimicrobial Resistance

Management of Patients with Suspected or Confirmed Antibiotic Allergy. Executive Summary of Guidance from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC) – Journal of Investigational Allergology and Clinical Immunology (PDF)

The prevalence of penicillin allergy labeling ranged from 0.9% to 10.2% across practices in a large pediatric cohort, raising questions regarding the validity of those labels and the unnecessary use of second-line antibiotics that may follow.

The prevalence of penicillin allergy labeling ranged from 0.9% to 10.2% across practices in a large pediatric cohort, raising questions regarding the validity of those labels and the unnecessary use of second-line antibiotics that may follow.

M-A: Most patients with allergy to Penicillin can be given Cefazolin

Systematic review: Safety and efficacy of de-labelling penicillin allergy in adults using direct oral challenge

Penicillin allergy labels increase second-line broad-spectrum antibiotic prescribing for pediatric respiratory tract infections

Podcast: A Clinical Pharmacologist’s Perspective on Penicillin Allergy

Study: Development and Validation of a Penicillin Allergy Clinical Decision Rule

Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations – British Journal of Anaesthesia

NICE: Double Check Patients with ‘Penicillin Allergy’ to Avoid Increased MRSA Risk

Cohort Study: Risk of Meticillin Resistant Staphylococcus Aureus and Clostridium Difficile in Patients with a Documented Penicillin Allergy

 

Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women

22 Feb, 2023 | 12:43h | UTC

Summary: The presence of pyuria is commonly used as the cornerstone of urinary tract infection (UTI) diagnosis. However, over 90% of asymptomatic bacteriuria (ASB) patients also have pyuria, which can lead to unnecessary treatment. This is especially problematic in older women who may have pre-existing lower urinary tract symptoms, cognitive impairment, and a high prevalence of ASB. This study examined the diagnostic accuracy of different pyuria thresholds for UTI in older women. The study found that current pyuria cut-offs (10 leukocytes/µl) are too low and promote inappropriate UTI diagnosis in older women. A threshold of 300 leukocytes/µl is suggested as a considerable improvement, increasing specificity to avoid overtreatment, while still maintaining a fair sensitivity. This has implications for patient care, antimicrobial stewardship efforts, and research. The impact of higher cut-off values on prescription behavior and UTI related outcomes in older women deserves further study.

Article: Current pyuria cut-offs promote inappropriate UTI diagnosis in older women – Clinical Infectious Diseases

Related:

Bacteriuria in older adults triggers confusion in healthcare providers: A mindful pause to treat the worry – Antimicrobial Stewardship & Healthcare Epidemiology

Antibiotics versus no treatment for asymptomatic bacteriuria in residents of aged care facilities: a systematic review and meta-analysis – British Journal of General Practice

USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults

Most doctors still believe in prescribing unnecessary antibiotics to treat asymptomatic bacteriuria, study suggests.

Randomized trial: Antibiotics vs. no therapy in kidney transplant recipients with asymptomatic bacteriuria

 

Commentary on Twitter

Article under a https://creativecommons.org/licenses/by-nc-nd/4.0/ license

 

Bacteriuria in older adults triggers confusion in healthcare providers: a mindful pause to treat the worry

22 Feb, 2023 | 12:42h | UTC

Bacteriuria in older adults triggers confusion in healthcare providers: A mindful pause to treat the worry – Antimicrobial Stewardship & Healthcare Epidemiology

Related:

Current pyuria cut-offs promote inappropriate UTI diagnosis in older women – Clinical Infectious Diseases

Antibiotics versus no treatment for asymptomatic bacteriuria in residents of aged care facilities: a systematic review and meta-analysis – British Journal of General Practice

USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults

Most doctors still believe in prescribing unnecessary antibiotics to treat asymptomatic bacteriuria, study suggests.

Randomized trial: Antibiotics vs. no therapy in kidney transplant recipients with asymptomatic bacteriuria

 

Commentary on Twitter

Under a http://creativecommons.org/licenses/by/4.0/ license

 

Bacteremia | ED presentations, evaluation, and management

22 Feb, 2023 | 12:25h | UTC

Bacteremia: ED Presentations, Evaluation, and Management – emDocs

 

M-A | Global status of azithromycin and erythromycin resistance rates in Neisseria gonorrhoeae

17 Feb, 2023 | 12:58h | UTC

Global status of Azithromycin and Erythromycin Resistance Rates in Neisseria gonorrhoeae: A Systematic Review and Meta-analysis – Yale Journal of Biology and Medicine

 

Case Reports | Seventeen cases of daptomycin-induced eosinophilic pneumonia in bone and joint infections

17 Feb, 2023 | 12:54h | UTC

Seventeen Cases of Daptomycin-Induced Eosinophilic Pneumonia in a Cohort of Patients Treated for Bone and Joint Infections: Proposal for a New Algorithm – Open Forum Infectious Diseases

 

M-A | Association between antimicrobial stewardship programs and antibiotic use globally

16 Feb, 2023 | 15:21h | UTC

Association Between Antimicrobial Stewardship Programs and Antibiotic Use Globally: A Systematic Review and Meta-Analysis – JAMA Network Open

Commentaries:

Antibiotic stewardship programs linked to reduced antibiotic prescribing, consumption worldwide – CIDRAP

Antimicrobial Stewardship Programs Beneficial for Cutting Antibiotic Use – HealthDay

 

M-A | Worldwide prevalence of antibiotic-associated Stevens-Johnson syndrome and toxic epidermal necrolysis

16 Feb, 2023 | 15:04h | UTC

Summary: The article examined the prevalence Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) associated with antibiotics worldwide. The analysis included 38 studies involving 2,917 patients, which showed that 28% of SJS/TEN cases were associated with antibiotics. Among antibiotic-associated SJS/TEN, the sulfonamide class was associated with 32% of cases, followed by penicillins, cephalosporins, fluoroquinolones, and macrolides.

Article: Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Meta-analysis – JAMA Dermatology (free for a limited period)

 

*Note: This summary was created through the collaboration of a medical editor and ChatGPT.

 

RCT | Antimicrobial therapy for 7 days is inferior to treatment for 14 days in men with febrile urinary tract infection

15 Feb, 2023 | 16:11h | UTC

Summary: This study aimed to compare the effectiveness of 7-day versus 14-day antibiotic treatment for febrile urinary tract infections in men. The multicenter randomized, double-blind, placebo-controlled non-inferiority trial enrolled 282 men from 27 centers in France. The primary endpoint was treatment success, defined as a negative urine culture, the absence of fever, and no subsequent antibiotic treatment between the end of treatment and 6 weeks after day 1. The results showed that the 14-day treatment was superior to the 7-day treatment, with a treatment success rate of 77.6% versus 55.7%, respectively. Adverse events were similar in both groups, and rectal carriage of resistant Enterobacterales did not differ. Therefore, the study concludes that treatment with ofloxacin for 7 days is inferior to 14 days for febrile UTI in men and should not be recommended.*

Article: Antimicrobial for 7 or 14 days for febrile urinary tract infection in men: a multicenter noninferiority double blind placebo-controlled, randomized clinical trial – Clinical Infectious Diseases (link to abstract – $ for full-text)

 

*Note: This summary was created through the collaboration of a medical editor and ChatGPT.

 

Retrospective Study | Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome

15 Feb, 2023 | 15:40h | UTC

Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome – Critical Care

 

Single-arm study | Effects of SER-109 as an investigational microbiome therapeutic in recurrent C. difficile infection

14 Feb, 2023 | 10:47h | UTC

Summary: This was a phase 3, open-label, single-arm trial of 263 adults with recurrent Clostridioides difficile Infection (CDI). The trial aimed to evaluate the safety and rate of CDI recurrence after administration of the investigational microbiome therapeutic SER-109. The trial found that SER-109 was well tolerated and the overall rate of recurrent CDI was low, regardless of the number of prior recurrences, demographics, or diagnostic approach.

(By ChatGPT, reviewed and edited)

 

Article: Safety and Tolerability of SER-109 as an Investigational Microbiome Therapeutic in Adults With Recurrent Clostridioides difficile Infection: A Phase 3, Open-Label, Single-Arm Trial – JAMA Network Open

Commentary: Phase 3 trial provides more positive data for recurrent C diff microbiome drug – CIDRAP

Related:

RCT: Among patients with recurrent Clostridioides difficile infection, the use of SER-109, an oral microbiome therapy, reduced recurrence rate compared to placebo (12% vs. 40%).

Post-trial follow-up | Microbiome therapeutic SER-109 through 24 weeks for recurrent Clostridioides difficile infection.

 

Cohort study | Epidemiology and outcomes of hospital-acquired bloodstream infections in ICU patients

14 Feb, 2023 | 10:44h | UTC

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study – Intensive Care Medicine (if the link is paywalled, try this one)

 

Commentary on Twitter

 

Cohort Study | Global epidemiology of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases

14 Feb, 2023 | 10:43h | UTC

Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study – The Lancet Microbe

 

RCT | Azithromycin reduces the risk of maternal sepsis or death in women planning a vaginal birth

13 Feb, 2023 | 13:02h | UTC

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

Single dose of the antibiotic azithromycin decreases sepsis and death risk during childbirth – News Medical/ University of Virginia Health System

 

Guideline for management of septic arthritis in native joints

10 Feb, 2023 | 14:00h | UTC

Guideline for management of septic arthritis in native joints (SANJO) – Journal of Bone and Joint Infection

 

SR | Mechanical plus oral antibiotic bowel preparation may prevent complications in elective colorectal surgery

10 Feb, 2023 | 13:53h | UTC

Preoperative combined mechanical and oral antibiotic bowel preparation for preventing complications in elective colorectal surgery – Cochrane Library

Summary: Can combined mechanical and oral antibiotic bowel preparation reduce the risk of complications after scheduled colon or rectal resections compared with purely mechanical, purely oral antibiotic or no bowel preparation? – Cochrane Library

Related:

M-A: Strategies for antibiotic administration for bowel preparation among patients undergoing elective colorectal surgery – “the addition of oral antibiotics to intravenous antibiotics was associated with a reduction in the incidence of incisional surgical site infection by more than 50%”.

Meta-Analysis: Effects of Mechanical Bowel Preparation and Oral Antibiotics Before Elective Colorectal Surgery

 

How to use biomarkers of infection or sepsis at the bedside: guide to clinicians

9 Feb, 2023 | 13:26h | UTC

How to use biomarkers of infection or sepsis at the bedside: guide to clinicians – Intensive Care Medicine

 

Commentary on Twitter

 

An analysis of national action plans for antimicrobial resistance—gaps and opportunities in strategies optimizing antibiotic use

7 Feb, 2023 | 13:48h | UTC

An analysis of existing national action plans for antimicrobial resistance—gaps and opportunities in strategies optimising antibiotic use in human populations – The Lancet Global Health

 

Commentary on Twitter

 

Can the future of ID escape the inertial dogma of its past? The exemplars of shorter is better and oral is the new IV

7 Feb, 2023 | 13:34h | UTC

Can the Future of ID Escape the Inertial Dogma of Its Past? The Exemplars of Shorter Is Better and Oral Is the New IV – Open Forum Infectious Diseases

 

Guideline | Diagnosis and management of otitis media with effusion in children

6 Feb, 2023 | 13:23h | UTC

Clinical practice guidelines for the diagnosis and management of otitis media with effusion (OME) in children in Japan – 2022 update – Auris Nasus Larynx

 

Rates of antimicrobial resistance in Helicobacter pylori isolates across the US and Europe

6 Feb, 2023 | 13:12h | UTC

Rates of Antimicrobial Resistance in Helicobacter pylori Isolates From Clinical Trial Patients Across the US and Europe – The American Journal of Gastroenterology

Commentary: Time to ditch clarithromycin for H. pylori? – MDedge

 

Commentary on Twitter

 

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