Clinical Corner

An inoculum effect in methicillin-susceptible S aureus infective endocarditis is suspected factor in higher all-cause 30-day mortality with cephazolin treatment than with oxacillin.

Levofloxacin was associated with statistically significant reduction in tuberculosis developing in household contacts of persons with multidrug- resistant TB in a meta-analysis, but not in the constituent controlled trials.

Children with invasive candidiasis had successful outcome whether IV antifungal treatment was completed or converted to enteral to reduce risk of infusion site infections and costs.

Intravenous (IV) push is an attractive option to administer antimicrobial therapy to patients in an efficient and effective manner in a variety of clinical settings. While many advantages to IV push administration exist, clinicians should be mindful of available literature regarding safety profiles, pharmacokinetic/pharmacodynamic characteristics, and clinical data for IV push antimicrobial administration prior to utilizing it in specific patient populations.

George Thompson, MD, offers some insights on 2 studies looking at these antifungals in patients with candidemia and invasive candidiasis.

In the second part of our conversation, Abdulwhab Shremo Msdi, PharmD, discusses using this methodology.

Abdulwhab Shremo Msdi, PharmD, offers insights on its complexities, why institutions have been slower to include this dosing technique, and why clinicians need to consider this approach.

Study finds optimal timing of annual COVID-19 booster depends on regional transmission patterns and if/when breakthrough infection has occurred.

This bacteremia can present heterogeneously and be difficult to contain, especially in an older patient population. Daniel B. Chastain, PharmD, BCIDP, AAHIVP, FIDSA, reviews the data of this class of therapies and how it may be clinically beneficial in combination with other antimicrobials.

Reactogenicity of mRNA COVID-19 with inactivated influenza vaccine was similar whether given at same time or separated by 1-2 weeks.

Obesity significantly impacts the pharmacokinetics (PK) of antifungal drugs like echinocandins, including volume of distribution (Vd) and clearance. However, despite these PK differences, current clinical evidence generally does not support the need for universal dose adjustments in obese patients. Clinicians should consider personalized dosing based on patient characteristics, infection severity, and specific drug properties due to echinocandins' favorable safety profiles.

Women were found more likely than men to die following Staphylococcus aureus bacteremia in both a national cohort study and a meta-analysis.

The significance of antiretroviral therapy (ART) has been a game changer for people living with HIV (PLWH). Still, there are some cardiovascular risks associated with different ART classes—particularly protease inhibitors (PIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and integrase strand transfer inhibitors (INSTIs). Authors review a piece in the literature around this area of study.

The ideal parameter for vancomycin monitoring is the area under the curve, which can be calculated using pharmacokinetic equations or Bayesian software.

Forty percent of the dose of the PCV 13 vaccine, but not of the PCV 10 or lower dose, was found noninferior to full doses when immunizing infants in Kenya.

In part 1 of a 2-part story, an investigator discusses the use of procalcitonin and C-reactive protein guided protocols for community-acquired pneumonia (CAP).

Largest randomized trial of povidone iodine vs chlorhexidine gluconate could prompt WHO to recommend either over latter.

Study ranks antibiotic classes by risk for rare, life-threatening cutaneous reactions of Stevens-Johnson syndrome and toxic epidermal necrolysis.

A large Veterans Health Administration (VA) outpatient study showed a large increase in MRSA resistance in one particular area of the United States and varying antimicrobial resistance patterns overall.

Investigators found that 10 days of antibiotics is common for acute otitis media despite that 5 to 7 days is advised by US and international guidelines.

A study finds clinically-relevant sub-phenotypes can be reproducibly, and could lead to patient stratification and treatment.

Clinicians developed an algorithm and screening questionnaire for outpatient penicillin allergy evaluation, designed to stratify patients into high- and low-risk penicillin allergy groups. Here is the sample questionnaire to consider for use in clinics.

Proposed alternative to "unsustainable" wide use of broad spectrum antibiotic prophylaxis in surgeries confronts antimicrobial resistance.

A new study demonstrates that the continuous infusion of β-lactam antibiotics could offer better clinical outcomes in treating sepsis, despite the nuanced statistical results.

Meta-analysis revealing higher 90-day mortality with intermittent than continuous infusion of ß-lactams for sepsis prompts call for latter to be standard of care.

In the latest Bench to Bedside column, clinicians provide information and resources on recommended topics learners should explore.

Piperacillin-tazobactam was associated with higher mortality than cefepime for empiric treatment of sepsis among patients without indication of anaerobic infection.

Spare use of carbapenem-sparing regimens reflects practice lagging behind guidance, among the challenges in implementing antimicrobial stewardship.

A study underscores the microbial etiology of septic arthritis, which can guide clinicians in minimizing the use of overly broad empiric antibiotics.

PEN-FAST is a validated risk stratification tool that promotes efficient, safe, and effective de-labeling of penicillin allergies.