Julian Ventres, PharmD BCPS

Treatment options for recurrent NDM-Pseudomonas bacteremia 2/2 UTI? Resistant to all the normal things. Previously treated with cefiderocol with MIC of 4, colistin MIC of 2. Aztreonam/avibactam an option here? Any luck getting FEP + taniborbactam or nacubactam?
#IDSky

Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial Among patients admitted to hospital with community-acquired pneumonia who met clinical stability criteria, discontinuing β-lactam treatment after 3 days was non-inferior to 8 days of treatment. These ...

*3-5 days for inpatient 😉

www.thelancet.com/article/S014...

Haven't been to Delaware but I can attest to the heat/humidity of the DC/Maryland area 🥵. Definitely feels like a breeding ground for Pseudomonas if every there was one

I do personally use ceftriaxone for that reason, I do know some people hate 3rd gen cephs due to the CDI rates though so included Unasyn as an alternative. But agree ceftriaxone is the better empiric option

Anti-Pseudomonal coverage for DFI is way overdone anyway. Ceftriaxone or Unasyn is sufficient for the majority of patients imo, +/- vanc.

Two weeks late with this point, but was reading through 2011 IDSA MRSA guidelines which give the same level of recommendation (B-II) for both linezolid and vanc for the treatment of MRSA CNS infections

www.idsociety.org/practice-gui...

🆕🔥🔥CloCeBa RCT
Cloxacillin versus cefazolin for MSSA Bacteraemia
Cefazolin has a non-inferior efficacy regarding mortality, microbiological or clinical endpoints and was associated with a lower rate of serious adverse events #IDSky
www.thelancet.com/journals/lan...

Vancomycin may be more studied but not sure about more reliable, especially in the CNS. LZD has great CNS penetration (>70-90%) whereas vanc's is somewhat limited by its large size. This is alleviated by inflammation in the acute phase but LZD still has better serum:csf concentrations overall

Nothing drives me crazy like amox/clav or amp/sulbactam for strep or enterococcus

Caveat: some meds are designed with certain pharmacokinetic goals in mind. Aminoglycosides, for example generally work better with higher peak concentrations, so splitting the dose up is counterproductive despite achieving a smoother concentration

No, this isn't doing anything for the patient. I'm also not sure what they mean by "chronic" MRSA. If they have an active infection with those resistances, you would still have linezolid and tetracycline among other less common options. Oral vanc is just wiping out their GI flora

Would love to see this be a regular thing, I wasn't active during what people have called the golden days of ID Twitter so would thrilled to have a regular journal club in #IDSky

Agree, gentamicin is almost certainly still fine for Pseudomonas limited to the lower urinary tract. Systemic infections maybe not as much. Several other examples of situations where urinary concentrations overcome resistances, my favorite being using amox/amp for amp-resistant Enterococcus cystitis

we're under-utilizing aminoglycosides for urosepsis in patients with good renal function

rising % ESBL is pushing us to use carbapenems for empiric therapy... leading to more resistance (CDiff, CRE)

aminoglycosides have minimal gut penetration = low CDiff risk & protect microbiome 🧵 #1/4 #EMIMCC

I do as well, assuming no uncontrolled source of infection (ie retained stone). Haven't noticed any issues. I try to use TMP/SMX or FQ if able but our E. coli is only ~70% susceptible to those, so using a lot of Amox/clav, less frequently cephalexin or cefpodoxime, and sometimes even just plain amox

Wouldn't be my first choice certainly but I don't have a reason not to think it would work 🤷‍♂️

Is just delaying it enough? Would you like severe, potentially life threatening diarrhea in 2 weeks or 6? We really need better treatment and prevention for CDI #IDSky #Medsky

Bactrim will still be our first line for most things, but unfortunately our MRSA tetracycline susceptibilities are ~70% and dropping (clindas even worse). Will definitely have to keep in mind the toxicity aspect and awareness among our non-ID docs, thanks!

Looking for people that have unrestricted linezolid at their institutions. Any increases in resistance? Better to just ease up on use criteria? Currently reviewing our own usage and seeing what we can do with rising tetracycline resistance in S. aureus #IDSky #AMSky

Linezolid for odontogenic infections? Anyone doing this empirically? It feels like the data is there that LZD covers the relevant bugs, but there's no clinical data that I could find. Have to think LZD would be preferable to clinda #IDSky #AMSky

Oral penem's make me real nervous 😬 not just from a therapeutic standpoint, but from a resistance perspective, being available outpatient for anyone to prescribe. Really think we need to do a better job of leveraging PK/PD to use existing agents when possible #IDSky #AMSSky

Ceftobiprole Launches Commercially in US Innoviva Specialty Therapeutics’ antibiotic is the first and only FDA-approved cephalosporin indicated to treat Staphylococcus aureus bacteremia (SAB), including right-sided endocarditis, caused by th...

Innoviva Specialty Therapeutics’ antibiotic is the first and only FDA-approved cephalosporin indicated to treat Staphylococcus aureus bacteremia, including right-sided endocarditis, caused by the methicillin-resistant Staphylococcus aureus. #IDsky #Medsky

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Would love to see what others use 👀 I have a personal one I use for unnecessary anaerobic coverage in aspiration pneumonia since it comes up frequently, although less and less

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Development and Validation of a Cephalosporin Allergy Clinical Decision Rule Utilising the previously published and internationally validated tool PEN-FAST, we validated the same criteria with minor modifications for low-risk cephalosporin allergies. The results suggest that a...

Derived from the PEN-FAST allergy decision tool, the CEPH-FAST version was developed and validated in this study. www.journalofinfection.com/article/S016...
  #IDsky #pharmsky

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I also hate the term "broad". What is "broad" antibiotics? TMP/SMX is exceptionally broad imo, but I don't see people using that when they're saying broad coverage. Same goes for doxy and mino. More often than not it just means they're throwing stewardship to the wayside during empiric coverage

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