Breakpoints
The SIDP Podcast

#49 – A PGY-What Now? A Primer on ID Pharmacy Fellowships

Episode Notes

Drs. Keith Rodvold and Taylor Morrisette (@TayMorrisette) join Dr. Julie Ann Justo (@julie_justo) to discuss ID pharmacy fellowships, their pros and cons compared to other post-graduate training opportunities, the ID "pharmily tree," and Mai Tais.

Find more information on ID pharmacy fellowships available in the United States here: -SIDP Fellowship Listings -ACCP Directory of Residencies, Fellowships, and Graduate Training Programs

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/

#48 – Aligning Goals: Antibiotics in End of Life Care

Drs. Molly Sinert and Jon Furuno join Dr. David Ha (@DHpharmd) to discuss the prevalence of antibiotic use and its harms and benefits in reducing suffering and providing comfort during end-of-life care.

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/

References:

  1. Sinert et al. Guidance for Safe and Appropriate Use of Antibiotics in Hospice Using a Collaborative Decision Support Tool. Accessed October 6, 2021. https://oce-ovid-com.laneproxy.stanford.edu/article/00129191-202008000-00005/HTMLA
  2. Albrecht JS, McGregor JC, Fromme EK, Bearden DT, Furuno JP. A Nationwide Analysis of Antibiotic Use in Hospice Care in the Final Week of Life. Journal of Pain and Symptom Management. 2013;46(4):483-490. doi:10.1016/j.jpainsymman.2012.09.010
  3. Furuno JP, Noble BN, Fromme EK. Should we refrain from antibiotic use in hospice patients? Expert Review of Anti-infective Therapy. 2016;14(3):277-280. doi:10.1586/14787210.2016.1128823
  4. Servid SA, Noble BN, Fromme EK, Furuno JP. Clinical Intentions of Antibiotics Prescribed Upon Discharge to Hospice Care. Journal of the American Geriatrics Society. 2018;66(3):565-569. doi:10.1111/jgs.15246
  5. Gaw CE, Hamilton KW, Gerber JS, Szymczak JE. Physician Perceptions Regarding Antimicrobial Use in End-of-Life Care. Infection Control & Hospital Epidemiology. 2018;39(4):383-390. doi:10.1017/ice.2018.6
  6. Broom J, Broom A, Good P, Lwin Z. Why is optimisation of antimicrobial use difficult at the end of life? Internal Medicine Journal. 2019;49(2):269-271. doi:10.1111/imj.14200
  7. Kwon KT. Implementation of Antimicrobial Stewardship Programs in End-of-Life Care. Infect Chemother. 2019;51(2):89-97. doi:10.3947/ic.2019.51.2.89
  8. Datta R, Topal J, McManus D, et al. Perspectives on antimicrobial use at the end of life among antibiotic stewardship programs: A survey of the Society for Healthcare Epidemiology of America Research Network. Infection Control & Hospital Epidemiology. 2019;40(9):1074-1076. doi:10.1017/ice.2019.194
  9. Lopez S, Vyas P, Malhotra P, et al. A Retrospective Study Analyzing the Lack of Symptom Benefit With Antimicrobials at the End of Life. Am J Hosp Palliat Care. 2021;38(4):391-395. doi:10.1177/1049909120951748
  10. Ito H. Antibiotics in end-of-life care: What is the driving factor? Infectious Diseases Now. Published online July 7, 2021. doi:10.1016/j.idnow.2021.07.003
  11. Kates OS, Krantz EM, Lee J, et al. Association of Physician Orders for Life-Sustaining Treatment With Inpatient Antimicrobial Use at End of Life in Patients With Cancer. Open Forum Infectious Diseases. 2021;8(8). doi:10.1093/ofid/ofab361
  12. Hickman SE, Nelson CA, Moss AH, Tolle SW, Perrin NA, Hammes BJ. The consistency between treatments provided to nursing facility residents and orders on the physician orders for life-sustaining treatment form. J Am Geriatr Soc. 2011; 59(11): 2091–2099. doi:10.1111/j.1532-5415.2011.03656.x.
  13. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical Infectious Diseases, Volume 62, Issue 10, 15 May 2016, Pages e51–e77, https://doi.org/10.1093/cid/ciw118

#47 – A Nefarious Orchestra: Gram-Negative Resistance Mechanisms Part 2

From generating 150 liters-worth of E. coli to the first X-ray crystallography of an ESBL, Drs. Robert Bonomo, Ryan Shields (@ryankshields), and Erin McCreary (@ErinMcCreary) take a deep dive into beta-lactamases like AmpCs, KPCs, and more.

#46 – A Nefarious Orchestra: Gram-Negative Resistance Mechanisms Part 1

Mechanisms of antibiotic resistance help us understand and recognize antibiotic susceptibility patterns that don't make sense. Robert Bonomo and Ryan Shields (@ryankshields) join Erin McCreary (@ErinMcCreary) to discuss efflux and porin mechanisms of resistance in Gram negative bacteria and their impact on antibacterial treatment.

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/

#45 – Expectation vs. Reality: An Insider look at the OVERCOME and MERINO-2 trials

Pathogen-directed trials are among the most important trials that clinicians need to guide therapy but are also incredibly difficult to design and enroll. Rachel Britt (@RachelBPharmD) gets a behind-the-scenes interview with Adam Stewart (@adm_stewart), lead investigator of MERINO-2, and Jason Pogue (@jpogue1), lead investigator of OVERCOME. They discuss original intentions and evolving expectations to investigate optimal antibiotic therapy for multidrug resistant bacteria. Listen in for the insider analysis!

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/

#44 – The VaxScene, a review of the COVID-19 vaccine landscape in the US with a focus on equitable distribution and vaccine hesitancy

Jacinda Abdul-Mutakabbir (@jayCdoesID) and Jeannette Bouchard (@jlbouchard001) join Erin McCreary (@ErinMcCreary) to discuss COVID vaccines, including access to, confidence in, and hesitancy around them. This episode was sponsored by an unrestricted educational grant from Janssen Therapeutics, Division of Janssen Products, LP

References:

  1. Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med 2020;383:2603-2615.
  2. Baden LR, El Sahly HM, Essink B, et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med 2021;384:403-416.
  3. Sadoff J, Gray G, Vandebosch A, et al. Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19. N Engl J Med 2021
  4. Rosenblum HG, Hadler SC, Moulia D, et al. Use of COVID-19 Vaccines After Reports of Adverse Events Among Adult Recipients of Janssen (Johnson & Johnson) and mRNA COVID-19 Vaccines (Pfizer-BioNTech and Moderna): Update from the Advisory Committee on Immunization Practices — United States, July 2021. MMWR Morb Mortal Wkly Rep 2021;70:1094-1099. DOI: http://dx.doi.org/10.15585/mmwr.mm7032e4external icon.
  5. Rapaka RR, Hammershaimb EA, Neuzil KM. Are some COVID vaccines better than others? Interpreting and comparing estimates of efficacy in trials of COVID-19 vaccines [published online ahead of print, 2021 Mar 6]. Clin Infect Dis. 2021;ciab213. doi:10.1093/cid/ciab213
  6. ACIP Website: https://www.cdc.gov/vaccines/acip/index.html
  7. Marcelin JR, Swartz TH, Bernice F, et al. Addressing and Inspiring Vaccine Confidence in Black, Indigenous, and People of Color (BIPOC) during the COVID-19 Pandemic. [published online ahead of print, 2021 Aug 9]. Open Forum Infect Dis. 2021. Doi: 10.1093/ofid/ofab417
  8. Abdul-Mutakabbir JC, Casey S, Jews V, et al. A three-tiered approach to address barriers to COVID-19 vaccine delivery in the Black community. Lancet Glob Health. 2021 Jun;9(6):e749-e750. doi: 10.1016/S2214-109X(21)00099-1. Epub 2021 Mar 10.

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/

#43 – Level Up: Implementation of Beta-lactam Therapeutic Drug Monitoring

Erin McCreary (@erinmccreary) reviews clinical data and implementation strategies for therapeutic drug monitoring of beta-lactam antibiotics with Veena Venugopalan (@Veena_PharmD), Joseph Kuti, Jason Roberts (@jasonroberts_pk), and Marc Scheetz (@IDPharmacometrx).

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/

#42 – The Level is in the Details: Beta-lactam Therapeutic Drug Monitoring

Erin McCreary (@erinmccreary) discusses clinical rationale behind therapeutic drug monitoring of beta-lactam antibiotics with Veena Venugopalan (@Veena_PharmD), Joseph Kuti, Jason Roberts (@jasonroberts_pk), and Marc Scheetz (IDPharmacometrx).

For BCIDP credit, visit https://sidp.org/BCIDP

References:

  1. https://pubmed.ncbi.nlm.nih.gov/32383061/ 2.    https://clicktime.symantec.com/3BcGw6g11AZY2rSUu7KpT1D7Vc?u=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F34136822%2F3. https://pubmed.ncbi.nlm.nih.gov/33480024/

  2. https://pubmed.ncbi.nlm.nih.gov/32910809/

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/

#41 – The Gray Zone: Antimicrobial Stewardship in Immunocompromised Hosts

Promoting evidence-based antimicrobial stewardship for patients with immunocompromising conditions can be tricky when they’re often excluded from clinical studies. Dr. Zahra Kassamali Escobar (@ZKEPharmD) explores this gray zone with Dr. Catherine Liu and Dr. Justine Ross (@abella_ross)

References:

Fluoroquinolone Prophylaxis 

  • Bucaneve et al. Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med 2005; 353:977-87. DOI: 10.1056/NEJMoa044097 
  • Cullen et al. Antibacterial prophylaxis after chemotherapy for solid tumors and lymphomas. N Engl J Med 2005; 353:988-98. DOI: 10.1056/NEJMoa050078 
  • Drayson et al. Levofloxacin prophylaxis in patients with newly diagnosed myeloma (TEAMM): a multicenter, double-blind, placebo-controlled, randomized, phase 3 trial. Lancet Oncology  2019; 20(12):1760-72. DOI: 10.1016/S1470-2045(19)30506-6
  • Satlin et al. Colonization with fluoroquinolone-resistant enterobacterales decreases the effectiveness of fluoroquinolone prophylaxis in hematopoietic cell transplant recipients. Clin Infect Dis 2021 May 6. doi: 10.1093/cid/ciab404. 

Antibiotic Treatment and Microbiome Implications

  • Aguilar-Guisado M, et al. Optimisation of empirical antimicrobial therapy in patients with haemotological malignancies and febrile neutropenia (How Long study): an open-label, randomized, controlled, phase 4 trial. Lancet Haematol. 2017 Dec;4(12):e573-83. doi: 10.1016/S2352-3026(17)30211-9.
  • Shono et al. Gut microbiome injury in allogeneic haematopoietic stem cell transplantation. Nat Rev Cancer. 2018;18(5):283-95. doi: 10.1038/nrc.2018.10. 
  • Weber et al. Microbiome disruption induced by early use of broad-spectrum antibiotics is an independent risk factor of outcome after allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2017;23(5):845-52. doi: 10.1016/j.bbmt.2017.02.006 
  • Pinato et al. Association of prior antibiotic treatment with survival and response to immune checkpoint inhibitor therapy in patients with cancer. JAMA Oncol. 2019;5(12):1774-78. doi:10.1001/jamaoncol.2019.2785  

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/

#40 – Breakpoints Talks Breakpoints: Microbiology Labs and Stewardship

In this episode, host Dr. Erin McCreary (@erinmccreary) talks all things micro labs and stewardship with Dr. Romney Humphries (@romneyinla), Dr. Mary Hutton (@m3rkat), and Dr. Joseph Lutgring. From cascading results and breakpoint changes, to making connections within and outside of the lab, we hope you listen, laugh, and learn! 

> Show notes: