Guía PRIOAM

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) 👇🏻

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...

The outpatient Global-PPS is a new, simple tool to measure antimicrobial prescribing in global outpatient settings
doi.org/10.1093/jaca...
#JACAMRNews #IDSky

We Are Guardians As Infectious Diseases physicians, when asked about the importance of antimicrobial stewardship, many of us may share the same answers. For one, if we cont

As ID physicians, when asked about the importance of ASP, many of us may share the same answers
How do we know that today's carbapenem use will lead to a superbug tomorrow?
Why worry about resistance decades later, when I have a patient to worry about now. #IDSky
academic.oup.com/cid/article/...

Congratulations for a fantastic work by María Paniagua, Belén Guisado, @josemolinagb.bsky.social, Germán Peñalva, Rocío Álvarez, Mª Eugenia Pachón & @jmcisneros.bsky.social from @hospitaluvrocio.bsky.social & @ibis-investigacion.bsky.social on behalf of @guiaprioam.bsky.social team! 🔝

There’s still a lot to do for stewies in transplant units!

In this table, we propose some future research priorities to optimize antibiotic use in SOT patients.

🔓 www.sciencedirect.com/science/arti...
#IDSky #AMSsky #TxID
🧵(5/6)

Implementing an #ASP in a SOT unit may allow to:
✅ Reduce antibiotic pressure in the unit
🛟 Without compromising infection outcomes
✋🏻 Help control nosocomial infections

🔓 www.sciencedirect.com/science/arti...
#IDSky #AMSsky #TxID
🧵(4/6)

Several studies suggest that uncomplicated graft infections could be treated for 7 days.

Still, transplant patients have been excluded from most duration trials.

Time to bring them into the #ShorterIsBetter movement! 😉

🔓 www.sciencedirect.com/science/arti...
#IDSky #AMSsky #TxID
🧵(3/6)

Metaanalysis of studies assessing single dose vs prolonged antibiotic prophylaxis after transplant surgery.

Prolonging antibiotic prophylaxis in kidney and liver transplant surgery does not reduce the rate of postoperative infections, but may increase side effects associated with antibiotic therapy.

🔓 www.sciencedirect.com/science/arti...
#IDSky #AMSsky #TxID
🧵(2/6)

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) 👇🏻

Today we celebrated our 3rd Annual Researchers’ Meeting at the XXVIII Congress of @seimc.bsky.social!

Only 2️⃣4️⃣ patients left to complete the trial!

An amazing team doing an amazing work! 🤩🔝

#IDSky #AMSsky #TeamPride

Thanks to @josemolinagb.bsky.social from Seville, Spain, for finding a great Shorter Is Better study from 2021 for bronchiectasis exacerbations! Updated tables attached, with link to website with citations. Had to shrink the font to fit so many RCTs in table!
www.bradspellberg.com/shorter-is-b...

Caring for patients with bronchiectasis poses a challenge for both pulmonologists and #AMSky teams.

Standard 14d treatments for exacerbations lack good evidence support.

This small RCT favors shorter durations such as 8d 👉🏻 publications.ersnet.org/content/erj/... #IDsky @bradspellberg.bsky.social

👆🏻 #AMSky

Pediatric Antimicrobial Stewardship Challenges Antimicrobial resistance is a growing health crisis, contributing significantly to morbidity and mortality in adults and children.

Pediatric antimicrobial stewardship is catching up fast. Tailored strategies, rising implementation, and tools like "handshake stewardship" are key to optimizing antibiotic use and tackling #AMR in our tiniest patients. #PedsID #Stewardship

karger.com/neo/article/...

www.idse.net/Review-Artic...

SOT patients have been systematically excluded from most RCTs on treatment duration, leading to prolonged courses still being the standard of care in many centers, even for non-complicated infections.
(🧵1/3) #AMSky #IDsky #TxID

Just 23% of patients received AMS support in transplant units.
A lot to do for stewies in this field yet!
Let’s get to work #AMSky & #TxID! 💪🏼

two men in suits and ties are drinking water from a bottle . ALT: two men in suits and ties are drinking water from a bottle .

Not all aspirations need Abx ☺️

aspiration pneumonitis resolves in 24-48h; if symptoms persist >48h, treat aspiration pneumonia with CTX

CTX covers key oral anaerobes (eg Peptostreptococcus) so extended anaerobe coverage is usually unnecessary

avoid piptaz first-line & reserve for resistant cases

🎙️💊 Sensible y Resistente - Episodio 1
@micromunidad.bsky.social

¿Hasta qué punto importa la duración del tratamiento antibiótico? 🧐

open.spotify.com/episode/4yak31…

Hilo con claves y artículos 📚👇
#AMSsky #IDsky

Systematic review of antibiotic durations in @jac-amr.bsky.social

n=315 RCTs

85% demonstrated equivalence or non-inferiority of shorter therapy

Only 7% in ICU, 14% in LMIC, and 15% low risk of bias

academic.oup.com/jacamr/artic...

Post-discharge prescriptions should be a key focus for #AMSsky!

In her fantastic talk at #ESCMIDglobal, @valerievaughnmd.bsky.social showed how >90% of antibiotic duration excess occurs post-discharge!

The ROADhome framework can be helpful for this task 👉🏻 academic.oup.com/cid/article/... #IDSky

Already listed in Antibiotic Stewards' Starterpack vol.2! 😉
#AMSsky #IDSky
Vol. 1: go.bsky.app/7KcDc2n
Vol. 2: go.bsky.app/2qsEveQ

Shorter vs. standard-duration antibiotic therapy for nocardiosis: a multi-center retrospective cohort study - Infection Purpose The prolonged treatment recommended for nocardiosis does not rely on strong evidence. Consequently, some clinicians opt shorter therapy in certain circumstances. We assessed the effectiveness ...

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

Short-term vs long term abx treatment for nocardia infections

#OncID #idsky

Evaluating Harms Associated With Prolonged Antibiotic Duration of Therapy in Community-Dwelling Older Adults: A Cohort Study Using Instrumental Variable Analysis In this instrumental variable analysis of 117 682 community-dwelling older adults prescribed amoxicillin, cephalexin, or ciprofloxacin, longer antibiotic c

Longer doesn't appear to be better when it comes to antibiotic duration in older adults.
#AMSSky
academic.oup.com/cid/advance-...

References: 2012 Surg Inf, Adnan 2016 J Chemotherapy, Mazzei 2017 WJES, Sartelli 2020 Pharmacotherapy, Thabit

In this table you can find a summary with different antimicrobials’ penetration into the bile (and the peritoneum).
Hope you find it useful! 🙂
#AMSsky #IDOnc #IDSky

One antibiotic PK table to rule them all. This is amazing 🙌 #medsky #pharmsky #AMSky #idsky #MedEd

Thx to
@absteward.bsky.social for finding a new oral vs. IV osteo RCT! Primary endpoint was re surgery. But, 2nd endpoints = treatment failure, recurrence, and non-union. Similar oral vs. IV outcomes for all outcomes. So this is the 10th RCT now, added to table. bradspellberg.com/oral-antibio...

🆕🔥 systematic review and meta-analysis #CMIJournal
6 RCTs,10 adjusted cohorts& 22 unadjusted cohorts
N=11,566
Early transition to oral antibiotics was noninferior to continued IV antibiotic treatment for bacteraemia & sepsis #idsky #medsky
www.clinicalmicrobiologyandinfection.com/article/S119...

#idsky #IDSATLRgroup #antimicrobials #stewardship #antibiotic #failure how to think through when someone calls you for advice regarding antibiotic failure #idchalktalk by Drs Miller & Paras idsame.notion.site/ID-Chalk-Tal...

Only 58 patients to go!
Recruitment is moving along as planned, and fingers crossed, we’ll be done before summer.
Huge shoutout to the @shorten2trial.bsky.social team for keeping up the great work!
#AMSsky #IDSky #ShorterIsBetter