#97 – Hot Topics: What Did You Miss in Infectious Diseases in 2023-2024 (LIVE from MAD-ID)
May 17, 2024
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In this lively discussion, Dr. Emily Heil, a leading infectious diseases specialist, and Mandee Noval, a presenter of ID literature, unveil the latest advancements in infectious diseases from MAD-ID 2024. They delve into ventilator-associated pneumonia prevention studies and the complexities of antibiotic stewardship. Highlights include findings on MRSA treatment interactions and novel STI prophylaxis with doxycycline. The duo also celebrates new UK regulations on antibiotic usage, urging thoughtful practices in the field.
Infectious Diseases Pharmacists Day on May 22, 2024, aims to underscore the vital role of ID pharmacists in healthcare.
Recent infectious diseases literature highlights significant advances in treatments and guidelines, particularly focusing on bacterial infections and antibiotic stewardship.
Studies discuss ventilator-associated pneumonia prevention with inhaled amikacin and ceftriaxone, emphasizing the need for thorough clinical outcome evaluations.
Current guidelines indicate limited anaerobic coverage is sufficient for aspiration pneumonia, minimizing unnecessary antibiotic use and associated complications.
Deep dives
Infectious Diseases Pharmacists Day and Podcast Milestone
An important date for the infectious diseases pharmacy community is May 22, 2024, marking the fourth annual Infectious Diseases Pharmacists Day. This event aims to highlight the critical role that ID pharmacists play in healthcare, with the theme focused on engaging communities in antibiotic stewardship. Additionally, the podcast is preparing for its 100th episode, encouraging listeners to contribute video messages reflecting their favorite moments from the series. This initiative seeks to celebrate the loyal audience that has supported the podcast's growth over the years.
Key Updates in Infectious Diseases Literature
The session discusses significant literature updates in infectious diseases from May 2023 to April 2024, presented by Dr. Emily Heil and Dr. Mandy Noble. They aim to summarize critical studies while ensuring listeners are informed about advancements in treatment guidelines and clinical practices. A noteworthy focus is on ensuring that pediatric data and COVID-19-related updates are excluded to streamline the discussion toward bacterial infections. This targeted approach allows for a concentrated review of the most relevant literature for practitioners.
Ventilator-Associated Pneumonia Prevention Trials
Two prominent studies on ventilator-associated pneumonia prevention emerged from France, investigating the efficacy of inhaled amikacin and a single dose of ceftriaxone. The first trial, although demonstrating a statistically significant reduction in VAP incidence among patients receiving inhaled amikacin, raised concerns regarding high baseline VAP rates, suggesting potential issues with the trial’s methodology. The second trial showed that ceftriaxone significantly reduced early VAP rates in patients with acute brain injury, leading to improved ventilator-free and antibiotic-free days. Both studies highlight the need for careful evaluation of both clinical outcomes and potential long-term effects on antibiotic resistance.
Combination Therapy vs. Monotherapy for Pseudomonal VAP
A sub-analysis of a previous trial on pseudomonal VAP found no significant benefit of using combination therapy over monotherapy post-culture and susceptibility results. Patients receiving combination therapy had longer durations of treatment and higher rates of persistent cultures, suggesting that these patients present complexities that necessitate further investigation into their underlying resistance mechanisms. The findings indicate that once susceptibility is known, monotherapy may be sufficient for effective treatment success. This insight may influence how clinicians approach initial treatment strategies for patients with suspected drug-resistant infections.
Anaerobic Coverage in Aspiration Pneumonia Treatment
Recent evidence supports the current guidelines, indicating that anaerobic coverage is not necessary for treating aspiration pneumonia without empyema or lung abscess. A large retrospective cohort study demonstrated that patients receiving limited anaerobic coverage did not experience higher in-hospital mortality rates compared to those receiving extended coverage. Notably, the extended coverage group had significantly higher rates of C. difficile colitis, reinforcing the importance of adhering to established guidelines to avoid unnecessary antibiotic use. This reinforces the perspective that targeted antibiotic therapy tailored to clinical evidence is essential for effective patient management.
Prospective Study on Procalcitonin's Role in Antibiotic Duration
A study assessing procalcitonin levels in patients receiving antibiotics for lower respiratory infections indicated no significant differences in clinical outcomes between those monitored with procalcitonin and standard care patients. Interestingly, facilities with higher procalcitonin testing usage saw longer antibiotic durations, suggesting that while the biomarker holds potential, its application in practice remains inconsistent. The findings emphasize the need for established protocols on how to effectively utilize procalcitonin measurements to improve antibiotic stewardship. Consequently, institutions must evaluate their approach to integrating procalcitonin testing into clinical pathways.
Insights on Beta-Lactam Dosing Strategies
Numerous studies discussed highlight ongoing efforts to optimize beta-lactam dosing strategies in critically ill patients, including continuous and extended infusions. One study revealed no significant differences in AKI or mortality rates between continuous and intermittent infusions of meropenem, prompting questions about injection methods and patient populations. Additional research advocated for early dose adjustments within the first 24 hours for patients presenting with acute kidney injury, with findings indicating better outcomes while maintaining appropriate dosing through the critical first day of treatment. Such insights will contribute to shaping future guidelines on optimal antibiotic administration practices.
In this special LIVE podcast episode, Drs. Emily Heil (@emilyheil) and Mandee Noval (@MandeeNoval) present the latest and greatest in ID literature from MAD-ID 2024 (@MAD_ID_ASP) in Orlando, FL. They cover everything from ECCMID late breakers to stewardship to the best things to come out of a good old shortage! You won’t want to miss this one!
