Contagion Live News Network: Should Hospitals Shorten Stays For PWID Using Outpatient Oral Antibiotics?

Hello and welcome to Contagion. I’m Assistant Editor Grant Gallagher here with a brief on the latest infectious disease headlines. IV-to-Oral Antibiotic Courses May Reduce Invasive Infection Readmissions During the Opioid Epidemic, according to a recent study published in Clinical Infectious Diseases by investigators from the Washington University School of Medicine, St. Louis.

Findings suggest that drug users who begun IV antibiotics for serious infections in the hospital and then finished their courses of treatment at home with antibiotic pills fared as well as patients who stayed in the hospital for their full treatment course.

Senior author Michael Durkin, MD, co-director of antimicrobial stewardship at Barnes-Jewish Hospital, said in a Washington University press release that, quote, ““There was this idea that people who inject drugs do not care about their health and would not adhere to an oral antibiotic regimen on discharge. So letting patients leave the hospital partway through an IV antibiotic course was akin to abandoning all treatment.” “We didn’t believe that was true.”

Patients in the study who ended hospitalization without antibiotic prescriptions were more than 2 times as likely to be readmitted within 3 months than those who left earlier in treatment course with prescriptions, or those who completed treatment in the hospital.

The investigators found that for every 3 people treated with oral antibiotics, 1 less patient needed to be readmitted to the hospital. Between the 2 full-course groups, there was no significant difference in readmissions between those who stayed in the hospital for full courses of IV antibiotics and those who completed partial courses of IV antibiotics followed by oral antibiotics, the authors wrote.

In other news, we published online an article from our June print edition: an examination of COVID-19 complicating an Already Difficult Presentation of Infective Endocarditis. Dr. TONI CAMPANELLA, PHARMD, the author of the article, outlined the case as follows:

A 49-year-old woman presented to the hospital from her hemo­dialysis appointment with a fever and a cough. Three days prior, she had begun feeling symptoms of myalgias, fatigue, and worsening cough, causing her to miss her initial hemodialysis appointment. Upon presentation to the following hemodialysis appointment, the patient was febrile to 101 °F and complained of a productive cough, prompting admission.

The patient had a medical history of end-stage renal disease on hemodialysis, type 2 diabetes mellitus, posterior uveitis, peripheral artery disease status post below-knee amputation, pulmonary embolism 10 years prior, cerebrovascular accident, and epilepsy. She has been receiving hemodialysis for 6 years.

On the patient’s initial presentation, the physical exam was unremarkable and vital signs were within normal limits. However, the patient was intermittently febrile throughout the first 3 days of her admission, with a maximum tempera­ture of 103.2 °F on day 2. Given the pandemic and the patient’s clinical presentation, the patient was tested for (SARS-CoV-2), and the PCR was positive.

On day 3, the patient received a diagnosis of cytokine storm, most likely the result of her current SARS-CoV-2 infection. At the time of writing, the patient’s clinical condition was improving. More detail can be read at Contagionlive.com

We also feature on the site part 1 of an interview with Dr. Vibeke Strand, Adjunct Clinical Professor in the Division of Immunology/Rheumatology professor at Stanford University School of Medicine, discusses lupus patients who are having a hard time getting their usual supplies of hydroxychloroquine due to the COVID-19 pandemic response.

In part 2 (publication pending) of the interview, Dr. Strand will dive into the potentials of AI-developed novel therapeutics from her speciality’s perspective. TwoXAR Pharmaceuticals recently announced promising preclinical results in 2 leads for potential treatment of systemic lupus. Despite a long period of time since the last novel lupus approval, these drugs have 2 different novel mechanisms of action in lupus or other autoimmune disorders.

And lastly, head to Contagion’s HCV / HEPATITIS specialty page for our coverage a new phase 2b trial with potential good news for HCV therapies.

For Contagion, I’m Grant Gallagher. Thanks for watching.