José Molina

📈 Imported cases are rising:
1,700 in 2015 → 5,100 in 2023

Now we’re also seeing more local transmission.

👩‍⚕️ ECDC is running weekly enhanced surveillance across the EU/EEA - tracking cases and supporting public health action, including for substances of human origin (#SoHO).

#IDsky #EpiSky

Agree!
Also, max dose isn’t always about GI tolerance: absorption matters too.

Hydrophilic drugs like BL need transporters in intestinal epithelium that saturate. So beyond a certain dose (e.g.1g amoxicillin), more drug ≠ more exposure!

A review on the topic 👉🏻 www.sciencedirect.com/science/arti...

Highly versus less bioavailable oral antibiotics in the treatment of gram-negative bloodstream infections: a propensity-matched cohort analysis In this study, we evaluated the clinical outcomes associated with the use of highly bioavailable oral antibiotics (fluoroquinolones and trimethoprim-sulfamethoxazole) compared with the less-bioavailab...

The absolute risk difference of relapse for oral BL is low (<5%) in most studies pointing this problem, and it didn’t seem to be confirmed in works specifically assessing high-dose oral BL (🧵1/4).

www.clinicalmicrobiologyandinfection.com/article/S119... #UTIsky #AMSsky #IDsky

You’re right, maybe the term isn’t ideal here.
I think they mean oral cipro can maintain exposure thanks to higher doses than IV.
But oral BLs usually mean lower total doses than their IV equivalents (cefazolin 2g/8h, amox/clav 1g/200mg/8h…).
I had a slide on this from a previous ESCMID Global! 😉

No, no participamos en la plataforma.
¿El ensayo tiene algún nodo en Europa?
Es una iniciativa estupenda, ¡ánimo con la puesta en marcha! 💪🏼

Hopefully, we will have data from a RCT to solve the question on the efficacy of oral BL for bacteremic infections and cUTI.

BALANCE has evolved to a platform trial (BALANCE+) which have included this in one of its domains! 🤞🏻🇨🇦 (🧵4/4)

www.ccctg.ca/trials-and-s... #IDsky #UTIsky #AMSsky

Defining the Optimal Duration of Therapy for Hospitalized Patients With Complicated Urinary Tract Infections and Associated Bacteremia In a multicenter study of 1099 hospitalized adults with complicated urinary tract infections and associated bacteremia, 7 days of antibiotics was sufficien

I use early oral high-dose BL if no source issues (abscess or prostathitis), independently on the presence of BSI.

If you have no options other than BL and you have source issues, I would consider delaying oral switch and/or prolong therapy (🧵3’/4)

academic.oup.com/cid/article/... #AMSsky #UTIsky

I think that avoiding oral BL for the fear of an unlikely relapse should be balanced with the risks of the alternatives: prolonging hospitalization/iv or using drugs (FQ or TMP/SMX) which may have a worse safety profile.

Could be good to discuss patient’s preferences! (🧵3/4)

#UTIsky #AMSsky #IDsky

Safety of early oral ambulatory treatment of adult patients with bloodstream infections discharged from the emergency department | Antimicrobial Agents and Chemotherapy Randomized trials have unanimously shown the benefits of oral antibiotic treatments for stable patients with bacteremia (1). However, transition to oral therapy has been usually performed after severa...

We recently published a cohort of bacteremic patients treated with a fully-oral course of antibiotics (no IV lead-in).
Over 75% were cUTI treated with high-dose oral BL.

The rate of unplanned reconsultations or readmissions was <5% (🧵2/4)

journals.asm.org/doi/10.1128/... #UTIsky #AMSsky #IDsky

Highly versus less bioavailable oral antibiotics in the treatment of gram-negative bloodstream infections: a propensity-matched cohort analysis In this study, we evaluated the clinical outcomes associated with the use of highly bioavailable oral antibiotics (fluoroquinolones and trimethoprim-sulfamethoxazole) compared with the less-bioavailab...

The absolute risk difference of relapse for oral BL is low (<5%) in most studies pointing this problem, and it didn’t seem to be confirmed in works specifically assessing high-dose oral BL (🧵1/4).

www.clinicalmicrobiologyandinfection.com/article/S119... #UTIsky #AMSsky #IDsky

A relevant update from the SNAP trial on adjunctive clindamycin, and some thoughtful insights in the thread below!
@steventong.bsky.social
@gurujosh.bsky.social
@seanong.bsky.social @drtoddlee.bsky.social
#AMSsky #IDsky

Interesting update for Rx CAP from the USA:

-USS can be used for Dx rather than CXR if ppl are experienced enough
-ABx: 5d or less for nonsevere, 5+ for severe
-Steroids for Severe CAP.

Shorter Is Better continues to spread!

🔥🔥Just published 🔥🔥
ATS CAP guidelines 2025
Diagnosis and Management of Community-acquired Pneumonia. An Official American Thoracic Society Clinical Practice Guideline
Free access pdf #IDsky#EMIMCC
www.atsjournals.org/doi/10.1164/...

This review of tetracycline-resistant Neisseria gonorrhoeae from 51 countries and 80,645 isolates reported high resistance – meaning using doxyPEP is unlikely to be effective in preventing infections
doi.org/10.1093/jaca...
#JACAMRNews

Doxy PEP use among MSM linked to rising NG-tetracycline resistance (27% to 70% by Q2 2024). High-level resistance rose from 2% to 65%. Doxy users had lower S. aureus but higher resistant strains. 📈💊

#idsky

Pivmecillinam for Treatment of Uncomplicated Urinary Tract Infection: New Efficacy Analysis This reanalysis of data from historical randomized, controlled trials, according to criteria published by the US Food and Drug Administration in 2019, conf

Pivmecillinam role in treating uncomplicated UTI is established (esp for many AmpC/ ESBL bacteria).

I wonder if it also has a place in pyelonephritis care. Perhaps as an oral step down once bacillary burden has fallen?
(1/2)

#IDSky #UTISky #MedSky #AMR

67% of 31 patients preferred oral antibiotics for mobility & comfort. 74% wanted more info on prescriptions. 39% believed IVs were more effective. Patient insights can enhance antimicrobial stewardship. 💊🩺

#idsky

📌

It’s encouraging to see new guidelines moving toward shorter and fully-oral treatments for BSIs.

We are honoured to see some of our research cited to help shape these recommendations! 😃

#AMSsky #IDsky #UTIsky @hospitaluvrocio.bsky.social @ibis-investigacion.bsky.social bsky.app/profile/jose...

📌

It’s encouraging to see new guidelines moving toward shorter and fully-oral treatments for BSIs.

We are honoured to see some of our research cited to help shape these recommendations! 😃

#AMSsky #IDsky #UTIsky @hospitaluvrocio.bsky.social @ibis-investigacion.bsky.social bsky.app/profile/jose...

🚨 IDSA has released the first guidelines for the management and treatment of complicated urinary tract infections (cUTIs)!

The new guidelines simplify the prior definitions of uncomplicated UTIs and cUTIs, & address treatment for cUTIs.

View guidelines: bit.ly/4lUjN1a

Is antimicrobial stewardship possible in transplant units?

In our latest systematic review in @eclinicalmed.bsky.social, we discuss which interventions work, evidence gaps and future research priorities for SOT.

🔓 www.sciencedirect.com/science/arti...
#IDSky #AMSsky #TxID

Thread below! 🧵(1/6) 👇🏻

No evidence of benefit for adding fosfomycin to S. aureus bacteremia therapy (and maybe associated harm).
#IDSky #AMSsky

Great review and meta-analysis identifying areas of research on antimicrobial stewardship in SOTr that require the highest priority @ibis-investigacion.bsky.social @isciiisalud.bsky.social

ESGUTI Welcome to the homepage for the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).

Happy to see our ESCMID Study Group for #UTI on Bluesky @esguti-studygroup.bsky.social
We launched in Feb & now have >500 members in 87 countries
If you have an interest in this infection that remains poorly understood & drives #AMR, welcome!
#IDSky #UTISky #MedSky #clinmicro

www.escmid.org/esguti/

This metaanalysis of observational studies in SOT suggests that non-complicated graft infections could be treated 7d, and yet transplant patients have been excluded from most RCT on duration.

Time for a #ShorterIsBetter RCT in #TxID!

kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F... #IDsky #AMSsky

Even more important for sicker patients!!!!

Thank you, Miranda! 🤩

ICYI @absteward.bsky.social @mirandapharmdmph.bsky.social
@bradspellberg.bsky.social @sidpharm.bsky.social @gesitraic-seimc.bsky.social @esgap.bsky.social