Stay up-to-date in Infectious Diseases, Clinical Pharmacist, Antibiotics #IDXposts AKA #IDTwitter T🌟P influencer,@Wiki_Guidelines ,#Interstellar,#Dune,🌹❤️Misk
Joined October 2010
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🆕🔥🟢Excellent review article
Carbapenemases: epidemiology, detection and management in a changing global landscape
🔺Carbapenemase classification.
🔺Characteristics of key carbapenemase families
🔺Geographic distribution
🔺Guideline-based treatment recommendations academic.oup.com/jacamr/arti…
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Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 retweeted
Jun 13
Thanks to @highlycritical1 for finding new Shorter Is Better RCT for CAP! This is the 15th RCT showing 3-5 d = 7-14 days.
And thanks to @Zaydovudine for finding 1996 RCT of amox 6 d vs. PCN V 14 d for GAS pharyngitis! Both added to the tables and website.
bradspellberg.com/shorter-is…
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While some may view ARISE-FLUIDS RCT (NEJM) as the final blow to the 30 mL/kg recommendation, a new cohort study just published in JAMA of 25,481 patients found that initial administration of ≥30 mL/kg was associated with lower 30-day mortality among patients with hypoperfusion or intermediate lactate elevation without severe cardiac or kidney comorbidities.
The story of 30 mL/kg is far from over. #idxposts
jamanetwork.com/journals/jam…
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🆕💥🔴Multicenter retrospective study of ICU patients with pneumonia
BIOFIRE® PN Panel implementation was associated with improved early antimicrobial de-escalation and appropriate therapy, with the greatest benefit in hospitals with comprehensive antimicrobial stewardship infrastructure #idxposts academic.oup.com/cid/article…
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I'm curious,what's the range of MICs for cefadroxil for MSSA isolates in your institution please?
Can we apply these dosing recommendations to MSSA BSI? @BradSpellberg @DrToddLee
🆕💥🟢Getting It Right the Second Time: How Can we Optimize First-Generation Cephalosporin (cephalexin and cefadroxil) Dosing for Skin and Soft Tissue Infections in the 21st Century
🔺The authors summarize clinical and PK/PD data that compare dosing strategies for SSTIs.
🔺Conduct population PK target attainment simulations for varying doses of cephalexin and cefadroxil for Staphylococcus aureus and Group A Streptococcus
🔺Given potential risks of underdosing due to obesity, non-adherence with frequently dosed regimens, and inadequate PTA in higher MIC organisms (e.g., MSSA), the authors favor using higher-dosed regimens such as cephalexin 1000 mg three times daily or cefadroxil 1000 mg two times daily for moderate–severe SSTIs #idxposts
accpjournals.onlinelibrary.w…
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🆕💥🟢Getting It Right the Second Time: How Can we Optimize First-Generation Cephalosporin (cephalexin and cefadroxil) Dosing for Skin and Soft Tissue Infections in the 21st Century
🔺The authors summarize clinical and PK/PD data that compare dosing strategies for SSTIs.
🔺Conduct population PK target attainment simulations for varying doses of cephalexin and cefadroxil for Staphylococcus aureus and Group A Streptococcus
🔺Given potential risks of underdosing due to obesity, non-adherence with frequently dosed regimens, and inadequate PTA in higher MIC organisms (e.g., MSSA), the authors favor using higher-dosed regimens such as cephalexin 1000 mg three times daily or cefadroxil 1000 mg two times daily for moderate–severe SSTIs #idxposts
accpjournals.onlinelibrary.w…
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🆕💥🟢Multicenter prospective study shows that quantitative PCR on oral wash has a better positive predictive value than PCR on bronchoalveolar lavage for the diagnosis of Pneumocystis pneumonia in HIV-negative immunocompromised patients #idxposts academic.oup.com/cid/article…
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🆕🔥The ARISE FLUIDS RCT
Among adults with septic shock, the use of restricted fluids and early vasopressors did not result in more days alive and out of the hospital through day 90 than the use of liberal fluids and later vasopressors
Pulmonary edema (0.6% in the vasopressor group vs. 5.0% in the fluids group; P<0.001). #idxposts
Presented at #CCR26:
Among adults with septic shock, the use of restricted fluids and early vasopressors did not result in more days alive and out of the hospital through day 90 than the use of liberal fluids and later vasopressors. Full ARISE FLUIDS trial results: nej.md/3PVdwIp
@CritCareReviews
ALT A graph from an article titled "Vasopressors or Fluids in Early Septic Shock," which was presented at the Critical Care Reviews Meeting. The trial name "ARISE FLUIDS" appears in parentheses with the title. The x-axis shows days 0 to 90, and the y-axis represents the percentage of patients. Two lines indicate the percentage for vasopressors and fluids.
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Culture-negative endocarditis remains a diagnostic challenge, as standard microbiological techniques frequently fail to detect the responsible organisms. Plasma microbial cell-free DNA metagenomic next-generation sequencing (mcfDNA-mNGS) may improve pathogen identification and increase diagnostic yield in these cases. #idxposts
Jun 9
A major milestone—our work is now published in The Lancet Infectious Diseases.
A fatal case of Legionella micdadei prosthetic valve endocarditis diag... sciencedirect.com/science/ar…
Congratulations to Martins and Govindan, our shared first co-authors, for their incredible effort. Privileged to contribute as second author alongside an outstanding multidisciplinary team of senior authors. #LancetID #IDX #mcfDNA #Lancet @BIDMCpath @BIDMChealth @BIDMC_IDFellows @harvardmed
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🆕💥🔴Which trial do we need? Evaluating plasma microbial cell-free DNA in blood culture-negative infective endocarditis #idxposts
clinicalmicrobiologyandinfec…
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Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 retweeted
Jun 10
Well I mean there are exceptions. TB is never going to be treated in 3-5 days. it's replication cycle is just vastly different. But that may be the exception that proves the rule.
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It’s time to shift the focus away from the organism itself and toward the type and source of infection.
Any exceptions ? @BradSpellberg
🆕💥🟢 Narrative review
Treatment duration of community-acquired pneumonia due to Legionella pneumophila: where do we stand? #idxposts
sciencedirect.com/science/ar…
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Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 retweeted
Jun 10
Data is clear there is no advantage of IV therapy to oral for GNB bacteremia, as long as the pt can tolerate po and source is controlled.
🆕💥 🟢 Systematic review and meta-analysis
16 studies (9,819 patients)
Of these, one (6%) was a multi-center, open-label RCT
Efficacy of a transition to oral antimicrobial therapy for gram-negative bacilli bloodstream infection #idxposts
cambridge.org/core/journals/…
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Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 retweeted
Jun 10
Would also like to stop seeing "stepdown" and "de-escalation" terminology being used, really should start using transition or other words suggesting equipose
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Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 retweeted
Jun 10
Good to see data re shorter durations in the immunocompromised population. Typically no reason to use longer courses unless there is an uncontrolled source.
🆕🔥🟢Post hoc subgroup analysis of the BALANCE RCT 7 Vs 14d duration of antibiotic therapy for bacteremia in immune compromised hosts
1037 immune compromised patients
No statistically significant mortality difference between groups with the upper bound of the confidence intervals being below the initial BALANCE trial’s 4% non-inferiority margin
clinicalmicrobiologyandinfec…
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Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 retweeted
Jun 10
Apologies. There’s 5 for GNB Bacteremia with COPAT now published.
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Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 retweeted
Jun 10
The data are (and have been) clear on this. There’s 4 RCTs for GNB listed in our master table. Sounds like they didn’t include all 4.
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Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 retweeted
Jun 10
Thanks @ABsteward this is welcome news that shorter works for IC patients as well.
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🆕💥 🟢 Systematic review and meta-analysis
16 studies (9,819 patients)
Of these, one (6%) was a multi-center, open-label RCT
Efficacy of a transition to oral antimicrobial therapy for gram-negative bacilli bloodstream infection #idxposts
cambridge.org/core/journals/…
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For years, the need for longer durations in immunocompromised patients was treated as the exception to every shorter-duration bacteremia discussion.
BALANCE may have finally put that belief to rest.
Dogma continues to lose ground.
@BradSpellberg
🆕🔥🟢Post hoc subgroup analysis of the BALANCE RCT 7 Vs 14d duration of antibiotic therapy for bacteremia in immune compromised hosts
1037 immune compromised patients
No statistically significant mortality difference between groups with the upper bound of the confidence intervals being below the initial BALANCE trial’s 4% non-inferiority margin
clinicalmicrobiologyandinfec…
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🆕💥🟢 Narrative review
Treatment duration of community-acquired pneumonia due to Legionella pneumophila: where do we stand? #idxposts
sciencedirect.com/science/ar…
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