Antimicrobials News

It was my first week of intern year, in the medical ICU. He presented in extremis and died within 90 minutes. He was reportedly bitten by his dog 3 days prior. I remember leaving the MICU in tears, overcome with emotion, feelings of guilt and helplessness, wishing I could have changed his outcome. When his admission blood cultures later grew Capnocytophaga canimorsus, I was intrigued. I was unfamiliar with the organism at the time and yearned to learn more. Henceforth, I was “hooked on ID,” forever.

Clostridioides difficile infection, or CDI, continues to be a significant pathogen in both hospitals and community-based settings. The associated morbidity, mortality and health care costs have prompted many to strengthen infection prevention and antimicrobial stewardship strategies to minimize transmission and recurrence. Optimizing these efforts is a tough task because of the broad array of CDI risk factors. Recent antibiotic exposure — especially to fluoroquinolones, clindamycin, carbapenems and third- and fourth-generation cephalosporins — along with chemotherapy, proton-pump inhibitors, immunosuppression, advanced age, comorbidities such as renal dysfunction and hospitalization duration are known CDI risk factors. The frequent exposure to antimicrobials and health care settings, along with higher rates of C. difficile colonization in the immunosuppressed population, poses an appreciable conundrum to clinicians who are trying to reduce CDI risk.

Today we have access to a multitude of new and novel medications, biologic agents, medical devices, imaging modalities, and surgical and nonsurgical invasive procedures, which have transformed the practice of internal medicine from what was essentially a diagnostic profession to one that is now heavily focused on treatment. Although the subspecialty of ID has been treatment oriented for many years, the advent of many new and sophisticated tests means we should turn our attention to potential improper use of the clinical laboratory — a major cost center in any health care system. This brings up the less often addressed but surely relevant concept of laboratory stewardship.

Researchers have developed a population-based pharmacokinetic model to identify target levels for vancomycin treatment so that infants infected with Staphylococcus aureus receive effective therapy.

Updated clinical practice guidelines prepared by the European Conference on Infections in Leukemia recommend the use of letermovir for the prevention of cytomegalovirus in adults undergoing allogeneic hematopoietic stem cell transplant, or HSCT. The guidance was published in The Lancet Infectious Diseases.

One course of antibiotics could expand the gut resistome in children, according to the results of a randomized clinical trial published in Clinical Infectious Diseases. Researchers suggested that azithromycin may cause more drastic changes to the gut microbiota compared with antibiotics in other classes.

In patients with hematologic malignancies, receipt of prophylactic levofloxacin was associated with less disruption of the gut microbiome than treatment with broad-spectrum beta-lactams, or BSBLs, according to findings from a retrospective cohort study.

A mass drug administration, or MDA, of azithromycin remained effective at reducing child mortality in the 3rd year of its implementation in Niger, according to a cluster-randomized trial published in The New England Journal of Medicine.

The prevalence of antibiotic-susceptible Acinetobacter calcoaceticus-baumannii complex isolates changes seasonally, with increased rates of multidrug resistance observed during the winter months, possibly due to increases in antibiotic prescriptions in the outpatient setting, researchers reported.

Around 80% of antibiotics prescribed for infection prophylaxis before dental visits are unnecessary, findings from a large retrospective cohort study published today in JAMA Network Open suggest.