What’s New in ID? January 2020 / Siječanj 2020.

The Effect of Infectious Diseases Consultation on Mortality in Hospitalized Patients With MRSA, Candida, and Pseudomonas Bloodstream Infections

 

Abstract

We evaluated the association between infectious disease consultation and clinical outcome of bloodstream infections, including methicillin-resistant S. aureus, Candida, and Pseudomonas. No infectious diseases consultation was associated with over a 4-fold increased hazard of death at 3 months, and 6-fold increased hazard of death in hospital.

 

Supavit Chesdachai, Susan Kline, Derrek Helmin, Radha Rajasingham, The Effect of Infectious Diseases Consultation on Mortality in Hospitalized Patients With MRSA, Candida, and Pseudomonas Bloodstream Infections, Open Forum Infectious Diseases, , ofaa010, https://doi.org/10.1093/ofid/ofaa010

 

Timing of antiviral therapy for seasonal influenza

When indicated, antiviral therapy for seasonal influenza should be administered as soon as possible since it confers the greatest benefit within the first 48 hours of illness. However, treatment after this interval can still be beneficial. In a randomized, open-label European trial, adding oseltamivir to usual care reduced symptom duration among outpatients with influenza-like illness compared with placebo, even among those with symptom duration >48 hours; for adults ≥65 years old with comorbidities and moderate to severe symptoms, oseltamivir was estimated to reduce symptoms by 2.3 to 3.2 days if started 48 to 72 hours after symptom onset. These data support our approach to treat patients with severe infection or risk factors for complications, regardless of illness duration.

 

Butler CC, van der Velden AW, Bongard E, Saville BR, Holmes J, Coenen S, et al. Oseltamivir plus usual care versus usual care for influenza-like illness in primary care: an open-label, pragmatic, randomised controlled trial. Lancet. 2020 Jan 4;395(10217):42-52.

 

 

Inappropriate antimicrobial use in the outpatient setting

Inappropriate antimicrobial use is common and contributes to antimicrobial resistance. Based upon the annual National Ambulatory Medical Care Survey, antibiotics were prescribed in approximately 13 percent of all ambulatory care visits in the United States. Of those prescriptions, approximately 25 percent were determined to be inappropriate and 18 percent lacked an indication for prescription. This study highlights that antimicrobial stewardship remains a public health priority.

Butler CC, van der Velden AW, Bongard E, Saville BR, Holmes J, Coenen S, et al. Oseltamivir plus usual care versus usual care for influenza-like illness in primary care: an open-label, pragmatic, randomised controlled trial. Lancet. 2020 Jan 4;395(10217):42-52.

 

 

Cefiderocol for multidrug-resistant gram-negative bacteria

Cefiderocol is a novel parenteral cephalosporin that has activity against multidrug-resistant gram-negative bacteria, including carbapenemase-producing organisms and Pseudomonas aeruginosa resistant to other beta-lactams. It was recently approved by the US Food and Drug Administration for use in adults with complicated urinary tract infections (UTIs) and/or pyelonephritis due to highly resistant gram-negative organisms. In approximately 120 patients with pneumonia, complicated UTI, or bloodstream infections due to carbapenem-resistant gram-negative organisms, preliminary results suggested largely similar clinical cure rates (52 versus 50 percent) with cefiderocol versus best-available therapy (colistin-based regimens in two-thirds of cases). Cefiderocol should be reserved for infections for which there are no alternative treatment options.

 

US Food and Drug Administration. New Release: FDA approves new antibacterial drug to treat complicated urinary tract infections as part of ongoing efforts to address antimicrobial resistance

https://www.fda.gov/news-events/press-announcements/fda-approves-new-antibacterial-drug-treat-complicated-urinary-tract-infections-part-ongoing-efforts

FDA Briefing Document. Meeting of the Antimicrobial Drugs Advisory Committee. Cefiderocol Injection. October 16, 2019. https://www.fda.gov/media/131703/download

 

Bedside ultrasonography for detection of skin abscess in adults

Bedside ultrasonography (US) has demonstrated high diagnostic accuracy for patients presenting to the emergency department (ED) with skin and soft tissue infections in prior studies, but whether it leads to change in management, compared to clinical evaluation alone, is unclear. In a multicenter observational study of over 1200 adults presenting to an ED with skin and soft tissue infections, bedside US changed management in approximately 1 percent of over 750 individuals when clinicians were certain about the presence (or absence) of an abscess and in 24 percent of 105 individuals when clinicians were uncertain. Changes made based upon US findings were appropriate in 77 percent of patients when clinical diagnostic certainty was present and in 84 percent of patients when it was not. These findings suggest that US is primarily useful when the clinical diagnosis is uncertain and we recommend its use for these patients whenever equipment and personnel are available. We also suggest that US be used for all patients undergoing incision and drainage of an abscess, whenever possible.

Mower WR, Crisp JG, Krishnadasan A, Moran GJ, Abrahamian FM, Lovecchio F, et al. Effect of Initial Bedside Ultrasonography on Emergency Department Skin and Soft Tissue Infection Management. Ann Emerg Med. 2019 Sep;74(3):372-380.

 

 

Bloodstream infection in Clostridioides difficile infection and fecal microbiota transplantation

Clostridioides difficile infection (CDI) has been associated with bloodstream infection (BSI), although the underlying mechanism is unknown. In a study of approximately 300 patients with recurrent CDI, treatment with fecal microbiota transplantation (FMT) was associated with a lower risk of subsequent BSI compared with antibiotic therapy for CDI. The FMT group also had fewer days of hospitalization and increased overall survival. The use of FMT may have advantageous effects on the risk for BSI in CDI. However, patients who are eligible for FMT have substantial differences in baseline characteristics compared with patients who receive antibiotic therapy, and further study is needed to validate these results.

Ianiro G, Murri R, Sciumè GD, Impagnatiello M, Masucci L, Ford AC, et al. Incidence of Bloodstream Infections, Length of Hospital Stay, and Survival in Patients With Recurrent Clostridioides difficile Infection Treated With Fecal Microbiota Transplantation or Antibiotics: A Prospective Cohort Study. Ann Intern Med. 2019 Nov 5.

 

Kidney transplantation from HIV-positive donor to HIV-positive recipient

Kidney transplantation is considered standard of care for patients with HIV and end-stage kidney disease. While kidney transplants from HIV-positive donors to HIV-positive recipients have been performed, long-term outcomes are unclear. A study from South Africa evaluated outcomes among 51 patients with HIV and an undetectable viral load who received kidney transplants from HIV-positive deceased donors. Five-year patient and graft survival were approximately 83 and 79 percent, respectively. Low levels of donor HIV were transiently detected in one recipient, but the clinical significance of this finding was unclear. As the transplant waitlist continues to grow, there may be an increasing role for HIV-positive to HIV-positive transplants.

Selhorst P, Combrinck CE, Manning K, Botha FCJ, Labuschagne JPL, Anthony C, et al. Longer-Term Outcomes of HIV-Positive-to-HIV-Positive Renal Transplantation. N Engl J Med. 2019 Oct 3;381(14):1387-1389.

 

Mass drug administration for schistosomiasis

Mass drug administration for schistosomiasis can reduce morbidity and reinfection rates in endemic areas, but whether it is sufficient for disease control is uncertain. In a systematic review of data from countries across sub-Saharan Africa and Yemen, control programs implementing mass praziquantel administration reduced the prevalence of heavy-intensity S. mansoni and S. haematobium infection among school-age children to <5 percent in all countries except Niger. However, elimination (reduction in prevalence to <1 percent) was achieved in half of the countries and for S. mansoni infection only. These findings suggest that in the long term, a multifaceted approach of mass drug administration in conjunction with additional interventions (such as improving water sanitation) is needed for elimination of schistosomiasis.

 

Deol AK, Fleming FM, Calvo-Urbano B, Walker M, Bucumi V, Gnandou I, Tukahebwa EM, Jemu S, Mwingira UJ, Alkohlani A, Traoré M, Ruberanziza E, Touré S, Basáñez MG, French MD, Webster JP. Schistosomiasis – Assessing Progress toward the 2020 and 2025 Global Goals. N Engl J Med. 2019 Dec 26;381(26):2519-2528.

Source: Uptodate, Jan. 2020.