Top Infectious Disease News of the Week—October 20, 2019

#5: Pathogen-Negative Sepsis Is a Strong Candidate for Stewardship

As physicians and health care organizations search for better ways to curb the use of antibiotics and the growth of antimicrobial resistance, a new study suggests sepsis is one area that might be ripe for better antimicrobial stewardship.

Specifically, the study argues pathogen-negative cases of sepsis, where the current antibiotic treatment time ranges from 4 to 9 days, are a good opportunity that warrants attention. The study was published in Open Forum Infectious Diseases.

Marin H. Kollef, MD, of the Washington University School of Medicine, in St. Louis, writes with colleagues that sepsis represents the most common reason for empiric antibiotic use among patients in American hospitals. Indeed, new guidelines recommend the quick and aggressive use of broad-spectrum antibiotics in patients suspected of having sepsis. Yet, Kollef and colleagues note nearly 9 in 10 cases of sepsis are pathogen-negative cases.

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#4: How the EU is Combatting Drug-Resistant Gonorrhea

Antibiotic resistance is a term that invokes fear and worry across multiple sectors. When many people think of antimicrobial resistance (AMR) they commonly think of super infections in the lungs or bloodstream. Unfortunately, there is an all too real threat of AMR when it comes to sexually transmitted diseases (STD) like gonorrhea.

In the United States, there is a national surveillance program, which was established in 1986, and tracks antimicrobial susceptibility of Neisseria gonorrhoeae strains throughout STD clinics. A new report in 2017 found considerable trends in gonorrhea incidence, noting that it is the second most reported STD with roughly 820,000 cases each year.

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#3: Promising Steps Toward a Universal Influenza Vaccine

The influenza virus is among the most daunting global health challenges, with current seasonal vaccines requiring close calibration to strains circulating in the population. But now, new progress has been made in the development of a universal influenza vaccine candidate, using a novel approach called chimeric hemagglutinin.

A phase 1 study, led by investigators from the Icahn School of Medicine at Mount Sinai, deployed the unique approach and according to interim results, published in The Lancet Infectious Diseases, the method shows promise.

Interim results indicate that this is the first human trial able to generate antibodies which will target a different area of the hemagglutinin protein, which binds the influenza virus to target cells, than traditional influenza vaccines.

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#2: Are Certain Factors Associated With Weight Gain Upon ART Initiation?

People with HIV are living longer thanks to modern antiretroviral therapy (ART); however, studies have noted that initiating these treatment regimens can lead to weight gain.

In some cases, weight gain can be a positive prognostic indicator among individuals who are underweight at the point of initiation. But among those in normal or overweight categories, weight gain may increase the risk of cardiovascular and metabolic diseases.

Two previous studies and several retrospective cohort studies have reported that integrase strand transfer inhibitors (INSTIs) may be implicated in weight gain upon initiation. As a result, a team of investigators set out to explore clinical factors associated with weight gain from multiple randomized comparative clinical trials of ART initiation. Their findings were published in an article in Clinical Infectious Diseases.

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#1: Eravacycline: The Next Frontier in C diff Treatment?

More research into eravacycline as a treatment options for patients with a history of Clostridioides difficile (C diff) is warranted after the agent offered a protective effect, according to a poster presented during IDWeek 2019. It may also be useful for patients who acquire other infections and are at a higher risk for developing C diff infection.

Investigators from the University of Houston College of Pharmacy conducted a prospective study in order to analyze the occurrence of C diff infection in patients with community-acquired pneumonia, if their treatment included doxycycline. The study team wanted to assess the in vitro susceptibility of eravacycline compared to other commonly-used antibiotics against C diff isolates, including those isolates with decreased susceptibility to metronidazole and vancomycin.

In general, tetracycline antibiotics are considered an antibiotic with low risk for causing C diff, the study authors noted. For example, tigecycline is known to decrease toxin production, inhibit spore formation, and have clinical efficacy in patients with severe and severely complicated C diff infection, they continued. However, the use of tigecycline in clinical practice is limited due to its multiple known toxicities. Conversely, eravacycline has a more favorable safety profile.

The investigators collected 234 isolates from their biobank and divided the samples into groups of 37-42 isolates per C diff ribotype. The 6 most common ribotypes were F001, F002, F014-020, F027, F106 and F255, they said. The investigators measured the minimum inhibitory concentration (MIC) for eravacycline, vancomycin, metronidazole and fidaxomicin against all of the ribotypes.

Overall, eravacycline was more efficient against more common isolated ribotypes from the biobank compared to vancomycin and metronidazole, the study authors found. The MICs values of eravacycline were consistent across all of the ribotypes in the investigators tested, they said.

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