Winter is coming…
#AMSsky

The OPTIMISE trial aimed to test 7 vs 14 days for treating MDR infections in ICU patients.

Although underpowered due to early stop, no signal of inefficacy was observed for short treatments

Pseudomonas were underrepresented in this trial 🙁

link.springer.com/article/10.1... #AMSsky #IDsky #PsWatch

#AMSsky

Bad news for patients with MDR infections…

Merck has announced that imipenem/relebactam supply will be discontinued in US by the end of September.

Guess this will extend to Europe soon?

We definitely need new payment models for antibiotics 🙁

www.cidrap.umn.edu/antimicrobia... #IDsky #AMSsky #AMR

So, I think there still is a safe way for cefepime in clinical practice:

✅ Limited to patients with normal renal function.
✅ As empirical treatment for non-severe cases.
✅ As targeted therapy for low-MIC isolates.

Extended-infusion and TDM would probably help in many cases!

🧵(5/5) #IDsky #AMSsky

We also have the efficacy question.

In my center we use EUCAST for susceptibility testing, whose MIC breakpoints are more restrictive than CLSI’s.

So, we use cefepime just for strains with lower MICs than our american colleagues, probably favoring PK/PD target achievement

🧵 (3/5) #IDsky #AMSsky

Neurotoxicity is definitely an issue for cefepime.

But I find it to be very rare among patients with normal renal function and no prior seizure-predisposing conditions.

This association was already established in previous metaanalyses 🧵(2/5)

academic.oup.com/jac/article/... #IDsky #AMSsky

I find cefepime very useful to diversify empiric antipseudomonal treatments among immunocompromised hosts, and as a carbapenem-sparing agent against ampC producers.

This recent metaanalysis made me wonder if I should stop using it… 🧵(1/5)

jamanetwork.com/journals/jam... #IDSky #AMSsky #IDOnc

I recently heard from a geriatrician that all the urinary pathogens at a long-term care facility he covers are resistant to nitrofurantoin. Having worked at one, it doesn't surprise me since nurses and families often request antibiotics for assumed UTIs.
#AMSSky
kffhealthnews.org/aging/3-comm...

When will medical schools and residency programs stop teaching trainees that not all hospitalized DFI cases require anti-MRSA and anti-pseudomonal coverage?
#AMSSky

I've experienced the same challenges outlined in this study at my institution. The hardest factor to overcome is the emotions driving the need to order urine testing, such as a clinician's fear of missing a diagnosis or facing potential legal consequences.
#AMSSky

This study should help dispel a common myth that all immunocompromised patients with CAP need empiric broad-spectrum antibiotic therapy over standard therapy because these patients have higher risk of infection with MRSA and Pseudomonas.
#AMSSky

A good guide for stewards who are proposing a business case for a diagnostic stewardship project to their C-suite.
#AMSSky