December 360: Trending Infectious Disease News of the Month

As the year comes to a close, we are looking back on the infectious disease news that made headlines this December.

December’s print issue of Contagion® was released, kicked off by a letter from our editor-in-chief Jason Gallagher, PharmD, FCCP, FIDP, FIDSA, BCPS, on a novel development in legislation related to infectious diseases practice. The issue also included a feature article written by Thomas Lodise, PharmD, PhD, and Monique Bidell, PharmD, BCPS, on cefiderocol and imipenem/cilastatin/relebactam. Additionally, Dimple Patel, PharmD, BCPS-AQ ID, and Esther King, PharmD, compiled an antimicrobial stewardship wish list, ahead of the holiday season.

The Contagion® editorial staff reported on the American Society of Health-System Pharmacists (ASHP) 2019 conference, and covered a presentation on improving penicillin allergy documentation can cut costs. We also talked to Lisa Dumkow, PharmD, BCPS, BCIDP, about the communit- acquired pneumonia treatment landscape, new options in the space, updates to the clinical practice guidelines, and more.

In other news, the US Food and Drug Administration approved the first disposable duodenoscope. Conventional duodenoscopes require cleaning between uses, putting patients at risk of contaminated tissue or fluid transmitting infection if the devices are not properly sanitized.

The FDA also announced a new crowdsourcing app to share information on difficult-to-treat infections.

In outbreak news, the FDA continued their investigation into an outbreak of E coli linked to farms in Salinas, California, locating a likely common grower. In addition, the US Centers for Disease Control and Prevention is investigating an outbreak of multidrug-resistant Campylobacter jejuni cases related to puppies from pet stores in multiple states.

As always, check out the Contagion® Outbreak Monitor to learn more about infectious diseases outbreaks in your area.

Let’s take a look at the top 5 web articles from the month of December:

#5 Alternative Antiretroviral Medication Delivery Systems Emerge to Treat, Prevent HIV Infection

Most chronic disease states are treated with daily oral administration of medi­cations, which are often ideal because of ease of administration. However, real-life adherence to oral medications can be approximately 50%.

Improved adherence has been seen with novel formulations of medications in disease states such as schizophrenia.2 Currently, all recommended initial HIV treatment/prevention regimens include daily oral administration. Novel formulations are necessary to provide options for patients who have difficulty swallowing, a history of medication nonadherence, or concerns about HIV disclosure or even those learning to cope with their HIV diagnosis.

Emerging alternative antiretroviral (ARV) delivery systems for HIV treatment and prevention include injectables, topicals, and implants. These delivery systems may give patients the ability to administer daily medica­tion less frequently and allow in-clinic admin­istration for those who have not disclosed their status and do not want to bring medi­cation bottles home. However, each system has advantages and disadvantages.

Read the full article.

#4 CDC Investigating Campylobacter jejuni Outbreak Linked to Puppies From Pet Stores

The US Centers for Disease Control and Prevention (CDC) is collaborating with public health officials in several states to investigate an outbreak of multidrug-resistant human Campylobacter jejuni infections linked to contact with puppies from pet stores, including Petland.

As of December 17th, the outbreak strain has been identified in 30 people infected with Campylobacter jejuni in 13 states. There have been 4 hospitalizations and no deaths reported.

Read the full article.

#3 Entering the Ring: Oral Vancomycin Versus Metronidazole for C difficile Infection and the Risk of Vancomycin-Resistant Enterococcus

Clostridioides difficile infection (CDI) continues to be a tough arena among health care-associated infections and is classified as a major health threat by the US Centers for Disease Control and Prevention. Traditionally, to combat CDI, oral metronidazole was a top contender, recommended as first-line therapy for mild to moderate cases (now known as nonsevere), reserving oral vancomycin for severe CDI. In 2017, however, a guideline update stripped metronidazole of its first-line therapy designation and crowned oral vancomycin as initial therapy for all CDI cases.

Some providers already regarded oral vancomycin as the champion treatment, but others had concerns about increased indi­vidual and health care costs and emergence of vancomycin-resistant Enterococcus (VRE) from routine use of oral vancomycin. In litera­ture, a link between vancomycin exposure and an increased risk of VRE has been suggested, but these studies have many limitations, such as small populations, heterogeneity, and little to no oral vancomycin representation. Oral metronidazole has also been associated with VRE growth and colonization, further clouding predictions of the effect of a widespread prac­tice change.

Read the full article.

#2 Teaching Old Dogs New Tricks: Make the Most of Twitter to Boost ID Education, Engagement, and Advocacy

“Tell me and I forget. Teach me and I remember. Involve me and I learn.” These time-honored words of wisdom from Benjamin Franklin hold true today in medical and pharmacy education as the field advances into social media. Twitter represents a significant evolution in how information is developed and shared, including between people who otherwise would not have been able to connect. Twitter flattens the existent hierarchy, is immediate, and allows timely dissemination of relevant infectious diseases (ID) information beyond the reach of traditional education methods. Twitter can be an appropriate pedagogical tool to foster collaborative learning, engagement, and advocacy.

The way students and residents learn is rapidly changing. Currently, most medical and pharmacy students, residents, and early career physicians and pharmacists belong to the millennial generation, consisting of individuals born between 1980 and 1999. Millennials prefer a broad spectrum of learning strategies, with fewer lectures and more collaboration with peers.

Read the full article.

#1 Get Off the SOFA! Introducing the Quick Pitt Bacteremia Score

Since its inception in 1989, the Pitt Bacteremia Score (PBS) has been used in numerous pivotal studies of bloodstream infections (BSIs). It has outperformed more complex scores of acute severity of illness in predicting mortality in various clin­ical settings. Among its other advantages, the PBS is solely based on clinical variables and lacks any laboratory criteria. This means it may be applied immediately at the bedside without the need to wait for blood collection or laboratory results.

During the first decade of the PBS usage, point alloca&shy;tion for temperature underwent several revisions. This is conceivable because fever represents a natural response to systemic infections, including BSI, and is not a consistent predictor of mortality. On the other hand, hypothermia (temperature <36° C) constitutes a dysregulated host response to infection and has been associated with high risk of mortality in patients with BSI.

Despite its relative simplicity, the PBS may still require some reference of the score’s criteria and take some thought to calculate. A quick form of the PBS (qPitt) was developed to further simplify the score by using only binary variables and allocating 1 point for each variable. This was achieved by either merging categorical into binary variables or eliminating variables that did not predict mortality. This also provided an opportunity to reexamine fever and allowed earlier detection of respiratory failure prior to mechanical ventilation.

In the derivation study of the qPitt, Battle and colleagues examined clinical risk factors for 14-day mortality in patients with gram-negative BSI.14 This retrospective cohort study included 832 patients hospitalized with gram-negative BSI at Prisma Health—Midlands hospitals in South Carolina over a 4-year period. All variables in the PBS were independently associated with 14-day mortality except fever (temperature >39° C). In addition, respiratory rate (≥25 breaths/minute) was associated with 14-day mortality.

Read the full article.