Noteworthy ID Papers of 2019

Segment Description: Jason Gallagher, PharmD, FCCP, FIDSA, BCPS, clinical professor at Temple University College of Pharmacy and editor-in-chief of Contagion®, discusses noteworthy infectious disease papers published in 2019.

Interview Transcript (modified slightly for readability):

Contagion® Were there any particular papers that were published in 2019 that you're excited about?

Gallagher: In the past year, there were several big papers in infectious diseases on a range of different subjects. One of the ones that I found most exciting was a comparison of 7 versus 14 days of antibiotics for uncomplicated gram-negative bacteremia. That conclusion that the 7 day course of therapy was just as good as 14 days was not surprising to me. But it's always nice to have another piece of evidence to bring along when you're debating someone who is reluctant to give shorter courses of antibiotics.

There are two other significant studies that also kind of shook practice up a little bit. Both have catchy titles, and were in the same edition of the New England Journal of Medicine. And those were OVIVA, which studied oral compared to IV antibiotics for bone infections and POET, which was endocarditis partially treated with oral antibiotics, both of which showed that the oral antibiotics were just as good as IV antibiotics, which makes sense because the bacteria certainly don't know where the antibiotics are coming from.

Now they each have caveats that I think are important for clinicians to look at themselves. But both can help move our practice away from this sort of arbitrary decision to treat people IV who may not actually need it.

There were a few more papers that probably didn't receive quite as much attention. One was looking at the impact of infectious disease consults on outcomes in patients with candidemia, led by Andrej Spec. That one was in Lancet ID [The Lancet Infectious Diseases] this year that showed that consulting ID led to significant decreases and mortality in patients with Candida bloodstream infection.

And besides that, there was one more that I think was completely unsurprising in terms of its conclusion, but still important nonetheless. And it was a paper that looked at whether patients converted from broad spectrum therapy to narrow spectrum therapy had any difference in outcomes for bacteremia, and they were the same.

So that one I think, is kind of notable, if for no other reason, because we shouldn't need that study. And yet we do because people are so reluctant to go from the “big guns” of broad spectrum therapy down to more narrow spectrum ones, even when we know that the organisms are susceptible.