Antibiotic Steward 🅱️C🆔🅿️🌟

Clinical impact of BioFire Blood Culture Identification 2 implementation in patients with Staphylococcus bacteremia | Microbiology Spectrum PCR-based blood culture testing with concurrent antimicrobial stewardship program review continues to facilitate the initiation of pathogen-targeted antimicrobials in a shorter amount of time compared...

🆕⚡🔥🧬 BCID2 on Fire — Slashing Vancomycin Time in Staph Bacteremia Faster ID , Safer Care, Microbiology Spectrum, 2025 #IDSky #EMIMCC
journals.asm.org/doi/10.1128/...

Activity of aztreonam-avibactam, cefiderocol, and cefepime-taniborbactam against a global collection of genetically characterized metallo-β-lactamase-producing Enterobacterales | Antimicrobial Agents ... Acquired metallo-β-lactamases (MBLs) emerged in the early 1990s with the description of IMP-1 in a Serratia marcescens isolate from Japan (1). The description of this enzyme was followed by the report...

🆕⚡🦠 Aztreonam-Avibactam — The Undisputed Hero 🏆 Tackling MBLs Like a Pro
🐯 Tigecycline strong & reliable not in BSI
🐴 Cefiderocol ,Once a Trojan Horse, not the soldier we hoped for
Cefepime-Taniborbactam🎯MBLs, yet resistance strikes with tricky combos #idsky #EMIMCC
journals.asm.org/doi/10.1128/...

👉 Evidence is limited, but reducing β-lactam doses too early in AKI may underdose critically ill patients at the worst possible time.
🛡️ Delayed dose reduction (after reassessing kidney recovery ~48H) might improve mortality—but better prospective studies are urgently needed #idsky #EMIMCC

Sounds like a temporary rift...but things need to change in the future or it will be likely to happen again due to problems with the methodology and execution

2025 threw some curveballs in infectious diseases… I’ve been nerding out over the data, and a few gems you won’t want to miss. Something that could save you hours catching up with the literature is coming soon, stay tuned 😏👀 #IDSky #EMIMCC

Infectious Diseases Society of America (IDSA) Position Statement: Why IDSA Did Not Endorse the Community-Acquired Pneumonia Guidelines 2025 Update The Infectious Diseases Society of America (IDSA) did not endorse updated community-acquired pneumonia guidelines because they recommend antibiotics for pa

🆕⚡ A Temporary Rift or a Permanent Split? Why Didn’t IDSA Endorse the CAP Guidelines 2025 Update?
In 2025 IDSA disagreed because the new guidelines recommend routine antibiotics for viral-positive outpatients with comorbidities & inpatients with nonsevere CAP #IDSky
academic.oup.com/cid/article-...

In critically ill pts, avoid adjusting initial doses based solely on early bloodwork. When pts present to ED, SCr/eGFR may not accurately reflect kidney fxn. These early labs represent pre-treatment📷(before IV💧, Abxs & resus). W/ these interventions, SCr/eGFR often improves #emimcc #medsky #pharmsky

Breaking down the Desirability of Outcome Ranking (DOOR): unpacking the methodology behind the Dalbavancin as an Option for Treatment of Staphylococcus aureus Bacteremia (DOTS) trial Desirability of Outcome Ranking (DOOR) outcomes such as the primary outcome of the DOTS (Dalbavancin as an Option for Treatment of Staphylococcus aure…

🤔 I’ll admit — I’m still wrapping my head around DOOR in clinical trials. I’m used to P-values and classic non-inferiority, but DOOR feels different.
Breaking down the DOOR in DOTS RCT @cmicomms.bsky.social
#idsky #EMIMCC
www.sciencedirect.com/science/arti...

🆕🎙️🔥Febrile Podcast just dropped!
✅ID Jedi @bradspellberg.bsky.social
✅Mini-cases OM,IE,Bacteremia
✅IV vs PO debates
✅Duration of therapy
✅Shmidelines Vs WikiGuideline
✅A must-listen for every antibiotic steward! #IDsky #EMIMCC
febrilepodcast.com/episodes/
open.spotify.com/episode/6dkJ...

Oral vs Intravenous Antibiotics for Fracture-Related Infections The POvIV randomized clinical trial evaluates the effectiveness of treatment of fracture-related infection with oral vs intravenous antibiotics across 24 trauma centers in the US among patients aged 1...

Dr Spellberg was referring to
The POvIV trial randomized 233 patients with fracture-related infections to receive initial oral antibiotics (no IV lead-in) vs IV-only therapy, showing no difference in surgical interventions, reinfections, or non-unions at 1 year.
jamanetwork.com/journals/jam...

Beta-lactam dose reductions in critically ill patients with acute kidney injury: a scoping review - Critical Care Background Acute kidney injury is a common complication in critically ill patients, often coinciding with the need for antibiotic therapy. The dose of beta-lactam antibiotics is frequently adjusted an...

⚡💉Are We Jumping the Gun? Early Beta-Lactam Dose Cuts Risk Underdosing in AKI, Critical Care, 2025

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

Link to X post:
x.com/ABsteward/st...
#idsky #EMIMCC

Great graphic representation of those darn carbapenemases!

The role of corticosteroids in severe CAP & ARDS is one of the longest-running controversies in critical care.
High-profile studies have variously reported that corticosteroids do or do not lower short-term mortality. Guidelines have also shifted. #idsky #EMIMCC
www.acpjournals.org/doi/10.7326/...

The ‘Big Five’ carbapenemases:
1️⃣VIM
2️⃣IMP
3️⃣NDM
4️⃣KPC
5️⃣OXA-48
🌟Timeline representing the introduction of carbapenems & the appearance of carbapenemases worldwide. 🌟 #IDSky

Wow Excellent talk my friend
Please everyone needs to listen to Dr Spellberg segment esp
IV PO & duration
I love when you said oral is my default
I was completely shocked when others insisted on mentioning 2015 guidelines and old IDSA guidelines ignoring the WikiGuidelines
2015?? #idsky #EMIMCC

Steroids in CAP is a 🔥topic #EMIMCC #idsky

🆕🔥 🫁🧯 Steroids Save Lives — Low-Dose Corticosteroids Cut Short-Term Mortality in Severe Pneumonia & ARDS, Annals of Internal Medicine, 2025 #idsky

www.acpjournals.org/doi/10.7326/...

x.com/ABsteward/st...

🆕⚡🧬🔥 Clash of Titans: Integrase vs Boosted Protease Inhibitors— Biktarvy Outscores Symtuza with Fewer AEs in Advanced HIV (LAPTOP RCT), Lancet ID, 2025 #idsky #hivsky

x.com/ABsteward/st...

www.thelancet.com/journals/lan...

🆕🔥🦴 Our 2025 Update to @wiki-guidelines.bsky.social for the Management of Pyogenic Osteomyelitis in Adults 🌟 @bradspellberg.bsky.social
🔗 [link] #idsky
www.amjmed.com/article/S000...

In high-income countries, up to 11.5% of adults report a penicillin allergy, and in high-risk groups prevalence can reach 35%. However, more than 90% of these labels are inaccurate, resulting in substantial clinical and public health consequences in hospitals and communities #idsky

The misconception that antibiotic allergy assessment is solely the domain of allergists has led to complacency in clinical practice, yet verifying allergy histories should be a core competency for all physicians, particularly infectious diseases. #IDsky #EMIMCC

Cross-reactivity of beta-lactams. A review of the beta-lactam cross-reactivity patterns based on key pharmacological structures and known clinical cross-reactivity #idsky

🆕🔥State-of-the-Art Review with 🌟s @trubianojason.bsky.social : Antibiotic Allergy—A Multidisciplinary Approach to Delabeling #idsky
url: academic.oup.com/cid/article/...

Yeah
Non cUTI indications?
Duration of Rx in cUTI?

IV fosfo finally FDA approved in US for cUTI d/t E. coli or Kleb pneumo.
-How much will it cost?
-Folks willing to use it for Kleb (or other Enterobacterales) in the absence of CLSI BPs?
-Dose: 6G IV q8h…Tolerability in real-world? 🤔
Lots of questions to consider….
#IDSky #AMSsky

www.accessdata.fda.gov/drugsatfda_d...

🔥Meitheal Pharmaceuticals Receives Approval from the US FDA for CONTEPO™ (fosfomycin) for injection in Patients ≥ 18 Years Having Complicated Urinary Tract Infections (cUTI),Including Acute Pyelonephritis🔥#idsky
www.businesswire.com/news/home/20...

Exciting to have more anti-Staph therapeutics, if a real effect. But don't look forward to a time when I have to manage a patient's anti-platelet drugs as ID...

(Rifampin interactions for TB and PJI are already plenty)

#IDSky

Toujours la même histoire :
1) Inventer un theorie.
2) Buter quelques souris sur l'autel de la science pour valider le concept. NDLR : à peine 10% de ces papiers ont des résultats reproductibles
3) Faire des etudes observationnelles bourrées de biais, dont le plus gros est le parti pris

P2Y12 inhibitors in Staphylococcus aureus bacteraemia: current evidence and clinical implications Staphylococcus aureus bacteraemia presents a substantial clinical burden, with high rates of morbidity and mortality. Despite its severity, therapeutic advancements have been small in the past decade,...

🆕🌟Excellent review article
P2Y12 inhibitors(eg clopidogrel,ticagrelor)in Staphylococcus aureus bacteraemia: current evidence and clinical implications
Coming soon: CLOPI-SNAP+ Clopido-SNAP #idsky #EMIMCC
www.thelancet.com/journals/lan...