Alberto Enrico Maraolo

Proud of the acceptance of a comment on a relevant paper on the combination between colistin and meropenem for invasive #CRAB infections.

It is time to go beyond the association between colistin and meropenem for invasive carbapenem-resistant Acinetobacter baumannii infections Alberto Enrico Maraolo, Giancarlo Ceccarelli; It is time to go beyond the association between colistin and meropenem for invasive carbapenem-resistant Acin

Just published in @cidjournal.bsky.social a letter on the need to definitely move on in the treatment of #CRAB (#acinetobacter) infection, without further investing energies in assessing regimens (colistin plus meropenem) largely suboptimal.

academic.oup.com/cid/article/...

Fantastic #decision_support_system to assess patients coming from abroad for #HCID (high consequences #infectious #diseases). Designed for #UnitedStates #physicians but useful even for specialists of other continents as #Europe.

#IDXposts

www.cambridge.org/core/journal...

COVID-19 in immunocompromised patients: proposed definition of a new entity with prolonged infection

#SARSCoV2 has not disappeared. It has become even more insidious for immunosuppressed #patients, especially the ones with impaired humoral response, ensuing in a #chronic #infection.
A letter in #NewMicrobesAndNewInfections takes sticks of the evidence.

www.sciencedirect.com/science/arti...

Cefixime versus benzathine penicillin G for the treatment of early syphilis—a randomized, controlled open label trial AbstractObjectives. Cefixime is a promising oral treatment alternative for early syphilis but only very limited efficacy data exist. We evaluated the effic

Potentially useful alternative to benzathine penicillin G for early #syphilis: oral cefixime (although with the downside of a 14-day course).
Small but interesting #RCT.

#IDSky

academic.oup.com/jac/advance-...

Good question for the next #UTI #guidelines or meanwhile for dedicated studies... Now the focus is on #ShorterIsBetter but the topic of modifying doses over the #antibiotic course in case of improvement according to primary infection site/source is still neglected.

Indeed even low doses of aminopenicillins can reach very high concentrations in the urinary tract allowing to use them for #VRE cystitis although isolates turn out to be resistant according to the antibiogram.

shea-online.org/shea-journal...

YouTube video by FirstcallID FirstcallID - How to do an Infectious Diseases Consultation - Non-resolving Cellulitis

📺 New from FirstCallID: Non-Resolving Skin & Soft Tissue Infections

When cellulitis isn’t improving, it’s easy to reach for broader antibiotics. But there’s a better way.

Here is a clear, structured approach:
🧩 DDx
🚩 What to rule out
💊 Next steps

🔗 www.firstcallid.ca
#FirstCallID #idsky #MedEd

Novel @idsainfo.bsky.social #guidelines on #urinary_tract_infections for the first time clearly address #complicated forms and revolve around 4 domains:
1) #definitions;
2) #empirical choices (crucial the presence of #sepsis);
3) #switch to oral #antibiotics;
4) #shorter therapies.

#IDSky

Finally out the #guidelines by @idsainfo.bsky.social on #urinary_tract_infections, introducing new definitions and providing important nuanced indications for #treatment.

#IDSky #MedSky

Not statistically significant differences among drugs but a slight preferable trend in favour of Meropenem_Vaborbactam, as already highlighted in previous and smaller studies.

Head-to-head: meropenem/vaborbactam versus ceftazidime/avibactam in ICUs patients with KPC-producing K. pneumoniae infections– results from a retrospective multicentre study - Infection Infection - Meropenem/vaborbactam (M/V) and ceftazidime/avibactam (C/A) are considered key agents in treating KPC-producing Klebsiella pneumoniae (Kp) infections. We compared these two drugs in...

Just published in #Infection (#OpenAccess) likely the largest (retrospective multicenter) cohort so far comparing #Meropenem_Vaborbactam and #Ceftazidime_Avibactam for #KPC infections (#BSI and #pneumonia) in #ICU #patients.

link.springer.com/article/10.1...

#Italy #IDSky #PropensityScore

Revisiting Acyclovir Dosing for Adult Viral Encephalitis Using a Full Bayesian LeiCNS PBPK Modeling Approach - Clinical Pharmacokinetics Background and Objective Acyclovir is a primary treatment for central nervous system (CNS) infections caused by herpes simplex virus (HSV) and varicella-zoster virus (VZV). However, patient outcomes r...

Very informative #Pk_Pd study from @Clinicalpharmacokinetics on #acyclovir dosing for #HSV/#VZV #encephalitis. Standard regimens (10 mg/kg TID) may be inadequate . Alternative strategies: increasing dosing (QID) or extending infusion durations.

#IDSky

link.springer.com/article/10.1...

Measles 2025 | NEJM In this article on measles, the authors review the epidemiology, clinical presentation, and associated illnesses as well as treatment and prevention strategies.

The primary cause of the resurgence in #measles cases is failure to vaccinate, not failure of the #vaccine".
Landmark #review on measles in @nejm.org, facing #pathogenesis, clinical #picture, #management and #prevention in the era of its #resurgence.

#MedSky #IDSky

www.nejm.org/doi/full/10....

Management of methicillin-resistant Staphylococcus aureus bloodstream infections: a comprehensive narrative review of available evidence focusing on current controversies and the challenges ahead Bloodstream infections (BSIs) caused by Staphylococcus aureus are common worldwide, representing one of the most relevant issues in clinical infectious diseases practice. In particular, BSIs by met...

Finally in volume (on Expert Review of Anti-Infective Therapy) the narrative review on the management of methicillin-resistant Staphylococcus aureus bloodstream infections.

Below is the eprint link for free download.

www.tandfonline.com/eprint/IE3MK...

Very precious indications from Canadian Society of Internal Medicine for "high-value, low-carbon care" against the backdrop of climate change.

Emphasis is put on oral antibiotics instead of intravenous whenever possible.

link.springer.com/article/10.1...

#Vitamins are just "a small piece of the puzzle that determines infection susceptibility and severity" so general #supplementation is not a way to treat or prevent #infections. An exception is #Vitamin_A useful against #measles, especially in (malnourished) #children.

#MedSky #IDSky

Vaccination in pregnancy to protect the newborn - Nature Reviews Immunology In this Review, Male and Jones provide an overview of the current vaccines that are offered during pregnancy and to newborns, explaining the rationale behind the different vaccination programmes and t...

Very informative review from @nature.com (Reviews #Microbiology) on how #vaccination in #pregnancy protects newborns, covering immunological aspects and providing practical recommendations.

#IDsky #MedSky

www.nature.com/articles/s41...

Placebo-Controlled Trial of Tecovirimat for Endemic Mpox | NEJM Quick Take Video Summary from The New England Journal of Medicine — Placebo-Controlled Trial of Tecovirimat for Endemic Mpox

Tecovirimat is available to treat mpox in the United States and Europe, but evidence for its efficacy and safety from randomized, controlled trials has been lacking. Findings from the PALM007 trial are summarized in a new Quick Take video. nej.md/4js3uHE

#MedSky #IDSky

Just published a multi-author #review born from a successful multidisciplinary approach (infectious diseases, microbiology, clinical pharmacology, intensive care) on #MRSA #BSI.
Focus on #classification, #diagnosis and #therapy.
Link to the paper:
www.tandfonline.com/eprint/IE3MK...
#IDsky #MedSky

Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Tria... OVP appears to be an efficacious option for prevention of CDI in high-risk subjects undergoing SAT. Nevertheless, additional data from RCTs are needed to establish OVP as good clinical practice and de...

Exactly. The key is the proper selection of the patient, focusing on the ones undergoing systemic antibiotics at higher risk. Unfortunately evidence is mainly driven by observational findings but several RCTs are underway.

pubmed.ncbi.nlm.nih.gov/35203786/

FUTURE-AI: international consensus guideline for trustworthy and deployable artificial intelligence in healthcare Despite major advances in artificial intelligence (AI) research for healthcare, the deployment and adoption of AI technologies remain limited in clinical practice. This paper describes the FUTURE-AI f...

#FUTURE_AI: an international consensus guideline for trustworthy and deployable #AI in #healthcare from
@bmj.com in its "Research Methods & Reporting" section. A set of 30 best practices to cover the entire lifecycle of healthcare #AI.

#MedSky #IDSky

www.bmj.com/content/388/...

In vitro susceptibilities of Stenotrophomonas maltophilia isolates to antimicrobial agents commonly used for related infections: Results from the Antimicrobial Testing Leadership and Surveillance (ATL... Stenotrophomonas maltophilia is an emerging opportunistic pathogen for which there are limited therapeutic options because of intrinsic multidrug resi…

Minocycline usually shows the highest susceptibility rate but Pk/Pd features make it a suboptimal choice for BSI or pneumonia... Combination therapy and/or doubling the dose might be potential solutions. Lastly, IV administration is available in few countries.

www.sciencedirect.com/science/arti...

Drug-Drug Interaction Between Rifampin And Linezolid: Is It A Big Deal? Is the drug-drug interaction between rifampin and linezolid worth worrying about? In this article two infectious diseases pharmacists discuss existing data on the topic.  Authored By: Ryan Stevens, Ph...

Interesting combinations from #POET but some are quite controversial, e.g. linezolid plus rifampicin for #MRSE

www.idstewardship.com/drug-drug-in...

Fever of unknown origin ### What you need to know Fever of unknown origin (also known as fever of undetermined origin or pyrexia of unknown origin) is often a debilitating clinical syndrome. Patients with this syndrome pres...

#IDSky #MedSky #PharmSky @idsainfo.bsky.social @cidjournal.bsky.social @ofidjournal.bsky.social @sidpharm.bsky.social

🚨 In this #BMJ article we update the clinical practice approach to adult fever of unknown origin #FUO!

bmj.com/cgi/content/...

The elusive concept of appropriate antibiotic for septic patients when a pathogen is not detected by standard culture methods - Critical Care

Just published commentary in Critical_Care
about the pitfalls underlying the "culture-negative" #sepsis definition, especially when dealing with #antibiotic appropriateness. Novel and fast #microbiology techniques are essential.

#IDSky #IDsky

ccforum.biomedcentral.com/articles/10....

Penetration of Antibacterial Agents into Pulmonary Epithelial Lining Fluid: An Update - Clinical Pharmacokinetics A comprehensive review of drug penetration into pulmonary epithelial lining fluid (ELF) was previously published in 2011. Since then, an extensive number of studies comparing plasma and ELF concentrat...

Under a theoretical point of view, new #BLBLI based on #carbapenems would perform better due to higher ELF/plasma ratio, compared with Cef/Avi.

link.springer.com/article/10.1...

Predicting sepsis mortality into an era of pandrug-resistant E. coli through modeling - Communications Medicine Koch et al. model scenarios of emergence of a single pan-resistant Escherichia coli strain in the United States. Findings suggest dire mortality outcomes and highlight the importance of measures to pr...

Worrying prediction according to mathematical modeling of the advent of a pandrug-resistant E. coli: #sepsis death in the #UnitedStates could increase 18- to 46-fold within 5 years.

www.nature.com/articles/s43...

#IDSky; #idsky

Expert clinical pharmacological advice may make an antimicrobial TDM program for emerging candidates more clinically useful in tailoring therapy of critically ill patients - PubMed Multidisciplinary approach and timely expert interpretation of TDM results by MD Clinical Pharmacologists could represent cornerstones in improving the cost-effectiveness of an antimicrobial TDM progr...

Yes. Arguably scant data to inform evidence, so there is this interval from 10 to 15 mg/Kg overall. Ideally a service like that would help, but it is privilege of happy few: pubmed.ncbi.nlm.nih.gov/35701812/.
I would go for max dosage (15) in case of shock or other organ dysfunction beyond AKI.

According to the @sanfordguide.bsky.social, 5 mg/Kg ter in die (related to TMP component). According to the Mensa (Spanish textbook also available as useful app) bis in die.