Breakpoints
The SIDP Podcast

#113 – Ask ChatGPT: The Role of AI in Healthcare

Dr. Brent Richards joins Dr. Erin McCreary to discuss the growing capability for artificial intelligence (AI) and big data in the healthcare industry. What is AI and machine learning, how can these tools enhance patient care, and what can we expect in the future from this space? Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/. Visit our website! https://breakpoints-sidp.org/

#112 – Say It Ain't Steno: Stenotrophomonas maltophilia Review

Drs. Amy Mathers and Julie Ann Justo join Dr. Erin McCreary to talk all things Stenotrophomonas maltophilia, a water-loving organism and frequent colonizer. Hear from the experts on why this organism is so difficult to treat, which agents have in vitro activity, and how to optimize antimicrobial regimens, including the use of combination therapy, in the setting of true infections. This medical education was provided by an unrestricted grant from Shionogi.

References:

  1. Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections. Clin Infect Dis. 2024 Aug 7:ciae403. doi: 10.1093/cid/ciae403. PMID: 39108079.
  2. Clinical challenges treating Stenotrophomonas maltophilia infections: an update. JAC Antimicrob Resist. 2022 May 5;4(3):dlac040. doi: 10.1093/jacamr/dlac040. PMID: 35529051.
  3. Alterations of the Oral Microbiome and Cumulative Carbapenem Exposure Are Associated With Stenotrophomonas maltophilia Infection in Patients With Acute Myeloid Leukemia Receiving Chemotherapy. Clin Infect Dis. 2021 May 4;72(9):1507-1513. doi: 10.1093/cid/ciaa778. PMID: 32544947.
  4. An Overview of the Treatment of Less Common Non–Lactose-Fermenting Gram-Negative Bacteria. Pharmacotherapy. 2020 Sep;40(9):936-951. doi: 10.1002/phar.2447. PMID: 32687670.

#111 – Dosing Consult: Rifampin Part 2

Drs. Henry “Chip” Chambers and Warren Rose join Dr. Megan Klatt to tackle rifampin dosing for gram-positive infections. In this episode, they break down rifampin synergy studies and discuss what is the optimal dosing of rifampin for challenging gram-positive bacterial cases, in particular Staphylococcus aureus infections with or without retained hardware/devices. Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/

References:

  1. Deconstructing the Dogma: Systematic Literature Review and Meta-analysis of Adjunctive Gentamicin and Rifampin in Staphylococcal Prosthetic Valve Endocarditis. Open Forum Infect Dis. 2022 Oct 31;9(11):ofac583. doi: 10.1093/ofid/ofac583. PMID: 36408468.
  2. Effectiveness of adjunctive rifampicin for treatment of Staphylococcus aureus bacteraemia: a systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother. 2023 Oct 3;78(10):2419-2427. doi: 10.1093/jac/dkad214. PMID: 37583062.
  3. Adjunctive Rifampin Following Debridement and Implant Retention for Staphylococcal Prosthetic Joint Infection: Is it Effective if not Combined With a Fluoroquinolone? Open Forum Infect Dis. 2022 Oct 31;9(12):ofac582. doi: 10.1093/ofid/ofac582. PMID: 36504699.

#110 – A Bone to Pick: Biofilm Busters for Prosthetic Joint Infections

Drs. Nico Cortes-Penfield (@Cortes-Penfield), Kerry LaPlante (@Kerry_LaPlante), Jessica Seidelman (@JessieLSeidel) join Dr. Julie Ann Justo (@julie_justo) to discuss the pesky slime that is biofilm in periprosthetic joint infections. They review biofilm composition & development, have an honest discussion about whether antibiotics can ever really eradicate it, and provide updates on the promising non-pharmacologic strategies on the horizon (bacteriophages, electromagnetism, & more).

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @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. Nixing the Nidus: Managing Retained Sources in Prosthetic Joint Infections. Breakpoints Podcast Episode #67. Society of Infectious Diseases Pharmacists.
  2. Dosing Consult: Rifampin Part 1. Breakpoints Podcast Episode #104. Society of Infectious Diseases Pharmacists.
  3. Review on Staphylococcal biofilm development: Schilcher K, Horswill AR. 2020 Aug 12;84(3):e00026-19. doi: 10.1128/MMBR.00026-19. PMID: 32792334.
  4. Antibiotics can fail to kill biofilm cells even if they penetrate the biofilm: Singh R, et al. Pathog Dis. 2016 Aug;74(6):ftw056. doi: 10.1093/femspd/ftw056. Epub 2016 Jul 7. PMID: 27402781.
  5. Subinhibitory antibiotic concentrations can promote biofilm formation: Schilcher K, et al. Antimicrob Agents Chemother. 2016 Sep 23;60(10):5957-67. doi: 10.1128/AAC.00463-16. PMID: 27458233.
  6. Clinical and genetic risk factors for biofilm-forming Staphylococcus aureus: Luther MK, et al. Antimicrob Agents Chemother. 2018 Apr 26;62(5):e02252-17. doi: 10.1128/AAC.02252-17. PMID: 29530854.
  7. Meta-analysis showing poor clinical outcomes with debridement, antibiotics, and implant retention (DAIR): Kunutsor SK, et al. J Infect. 2018 Dec;77(6):479-488. doi: 10.1016/j.jinf.2018.08.017. PMID: 30205122.
  8. Thieme L, et al. MBEC versus MBIC: the lack of differentiation between biofilm reducing and inhibitory effects as a current problem in biofilm methodology. Biol Proced Online 21, 18 (2019). https://doi.org/10.1186/s12575-019-0106-0.
  9. Ongoing trial investigating use of MBEC in the treatment of PJIs: Tillander JAN, et al. BMJ Open. 2022 Sep 15;12(9):e058168. doi: 10.1136/bmjopen-2021-058168. PMID: 36109038.
  10. Maale, G. Complete eradication of biofilm using low frequency electromagnetic force (EMF) and antibiotics at MIC. 34th Annual Meeting Musculoskeletal Infection Society. 2024 Aug. Abstract 1232 (see full program).
  11. Meta-analysis on bacteriophages for biofilm: Kovacs CJ, et al. Mil Med. 2024 May 18;189(5-6):e1294-e1302. doi: 10.1093/milmed/usad385. PMID: 37847552.
  12. Berking BB, et al. Biofilm disruption from within: light-activated molecular drill-functionalized polymersomes bridge the gap between membrane damage and quorum sensing-mediated cell death. ACS Biomater Sci Eng. 2024 Sep 9;10(9):5881-5891. doi: 10.1021/acsbiomaterials.4c01177. PMID: 39176452.
  13. Aboelnaga N, et al. Deciphering the dynamics of methicillin-resistant Staphylococcus aureus biofilm formation: from molecular signaling to nanotherapeutic advances. Cell Commun Signal. 2024 Mar 22;22(1):188. doi: 10.1186/s12964-024-01511-2. PMID: 38519959.
  14. Conway J, et al. Phase 1 study of the pharmacokinetics and clinical proof-of-concept activity of a biofilm-disrupting human monoclonal antibody in patients with chronic prosthetic joint infection of the knee or hip. Antimicrob Agents Chemother. 2024 Aug 7;68(8):e0065524. doi: 10.1128/aac.00655-24. PMID: 39012102.
  15. Mulpur P, et al. Efficacy of intrawound vancomycin in prevention of periprosthetic joint infection after primary total knee arthroplasty: a prospective double-blinded randomized control trial. J Arthroplasty. 2024 Jun;39(6):1569-1576. doi: 10.1016/j.arth.2024.01.003. PMID: 38749600.
  16. Dong Y, et al. Synergy of ultrasound microbubbles and vancomycin against Staphylococcus epidermidis biofilm. J Antimicrob Chemother. 2013 Apr;68(4):816-26. doi: 10.1093/jac/dks490. PMID: 23248238.
  17. Miltenberg B, et al. Intraosseous Regional Administration of Antibiotic Prophylaxis for Total Knee Arthroplasty: A Systematic Review. J Arthroplasty. 2023 Apr;38(4):769-774. doi: 10.1016/j.arth.2022.10.023. PMID: 36280158.
  18. Viswanathan VK, et al. Intraosseous regional antibiotic prophylaxis in total joint arthroplasty (TJA): Systematic review and meta-analysis. J Clin Orthop Trauma. 2024 Oct 3;57:102553. doi: 10.1016/j.jcot.2024.102553. PMID: 39435324.
  19. SOLARIO trial: Dudareva M, et al. The European Bone and Joint Infection Society Meeting, 2024 Sept.
  20. SOLARIO trial press release from BoneSupportTM. 2024 Oct 3.
  21. Fehring TK, et al. Does treatment at a specialized prosthetic joint infection center improve the rate of reimplantation. J Arthroplasty. 2023 Jun;38(6S):S314-7. PMID 37004968.
  22. ROADMAP trial website. 2024.

#109 – IDWeek 2024 Recap: Practice Changing Papers and ID Potpourri

We are back with more exciting IDWeek 2024 content. In this episode, Breakpoints hostesses Drs. Erin McCreary, Julie Ann Justo, Jeannette Bouchard, and Megan Klatt highlight more of our favorite sessions and posters at IDWeek, this episode is a must listen if you are an IDWeek nerd like us!

References:

  1. Perret et al. Application of OpenAI GPT-4 for the retrospective detection of catheter-associated urinary tract infections in a fictitious and curated patient data set. 10.1017/ice.2023.189
  2. Wiemken et al. Assisting the infection preventionist: Use of artificial intelligence for health care–associated infection surveillance. 10.1016/j.ajic.2024.02.007
  3. Leekha et al. Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study. 10.1136/bmjqs-2023-016831
  4. Diekema et al. Are Contact Precautions "Essential" for the Prevention of Healthcare-associated Methicillin-Resistant Staphylococcus aureus? 10.1093/cid/ciad571
  5. Martin et al. Contact precautions for MRSA and VRE: where are we now? A survey of the Society for Healthcare Epidemiology of America Research Network. 10.1017/ash.2024.350
  6. Browne et al. Investigating the effect of enhanced cleaning and disinfection of shared medical equipment on health-care-associated infections in Australia (CLEEN): a stepped-wedge, cluster randomised, controlled trial. 10.1016/S1473-3099(24)00399-2
  7. Protect trial: Decolonization in Nursing Homes to Prevent Infection and Hospitalization. 10.1056/NEJMoa2215254
  8. Aldardeer et al. Early Versus Late Antipseudomonal β-Lactam Antibiotic Dose Adjustment in Critically Ill Sepsis Patients With Acute Kidney Injury: A Prospective Observational Cohort Study. 10.1093/ofid/ofae059
  9. Schmiemann et al. Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial. 10.1136/bmj-2023-076305
  10. Vernacchio et al. Improving Short Course Treatment of Pediatric Infections: A Randomized Quality Improvement Trial. 10.1542/peds.2023-063691
  11. Advani et al. Bacteremia From a Presumed Urinary Source in Hospitalized Adults With Asymptomatic Bacteriuria. 10.1001/jamanetworkopen.2024.2283
  12. Saif et al. Clinical decision support for gastrointestinal panel testing. 10.1017/ash.2024.15
  13. Bekker et al. Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention in Cisgender Women. 10.1056/NEJMoa2407001
  14. Montini et al. Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial. 10.1542/peds.2023-062598
  15. Nielsen et al. Oral versus intravenous empirical antibiotics in children and adolescents with uncomplicated bone and joint infections: a nationwide, randomised, controlled, non-inferiority trial in Denmark. 10.1016/S2352-4642(24)00133-0
  16. Kaasch et al. Efficacy and safety of an early oral switch in low-risk Staphylococcus aureus bloodstream infection (SABATO): an international, open-label, parallel-group, randomised, controlled, non-inferiority trial. 10.1016/S1473-3099(23)00756-9
  17. AMIKINHAL: Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia. 10.1056/NEJMoa2310307
  18. PROPHY-VAP: Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial. 10.1016/S2213-2600(23)00471-X
  19. AVENIR: Azithromycin to Reduce Mortality — An Adaptive Cluster-Randomized Trial. 10.1056/NEJMoa2312093
  20. Thomas et al. Comparison of Two High-Dose Versus Two Standard-Dose Influenza Vaccines in Adult Allogeneic Hematopoietic Cell Transplant Recipients. 10.1093/cid/ciad458
  21. Schuster et al. The Durability of Antibody Responses of Two Doses of High-Dose Relative to Two Doses of Standard-Dose Inactivated Influenza Vaccine in Pediatric Hematopoietic Cell Transplant Recipients: A Multi-Center Randomized Controlled Trial. 10.1093/cid/ciad534
  22. Mahadeo et al. Tabelecleucel for allogeneic haematopoietic stem-cell or solid organ transplant recipients with Epstein-Barr virus-positive post-transplant lymphoproliferative disease after failure of rituximab or rituximab and chemotherapy (ALLELE): a phase 3, multicentre, open-label trial. 10.1016/S1470-2045(23)00649-6
  23. Khoury et al. Third-party virus-specific T cells for the treatment of double-stranded DNA viral reactivation and posttransplant lymphoproliferative disease after solid organ transplant. 10.1016/j.ajt.2024.04.009
  24. Spec et al. MSG-15: Super-Bioavailability Itraconazole Versus Conventional Itraconazole in the Treatment of Endemic Mycoses—A Multicenter, Open-Label, Randomized Comparative Trial. 10.1093/ofid/ofae010

#108 – IDWeek 2024 Recap: Late Breaker Abstracts and Stewardship Talks

Did you miss IDWeek this year and trying to catch up on the hot topics? Or was there just too many good sessions and you want to catch up on the ones you missed? Let the Breakpoints Hostesses help you out! In the first of two IDWeek 2024 recap episodes, join Drs. Erin McCreary, Julie Ann Justo, Jeannette Bouchard, and Megan Klatt as they cover top late breaking abstracts and stewardship data that you won’t want to miss!

References:

  1. BALANCE Trial: Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. 10.1056/NEJMoa2404991
  2. White et al. Antibiotic stewardship targets in the outpatient setting. 10.1016/j.ajic.2019.01.027
  3. Wattengel et al. Outpatient antimicrobial stewardship: Optimizing patient care via pharmacist led microbiology review. 10.1016/j.ajic.2019.07.018
  4. Augostini et al. An evaluation of antimicrobial prophylaxis for transrectal prostate biopsies: A potential stewardship target. 10.1016/j.ajic.2024.05.012
  5. Cotter et al. Antibiotic use and outcomes among children hospitalized with suspected pneumonia. 10.1002/jhm.13002

#107 – Dosing Consult: Valganciclovir

Drs. Anne-Grete Märtson, Megan Wimmer, and Evan Clemens join Dr. Erin McCreary to tackle the one of the hottest debates among providers taking care of immunocompromised patients, valganciclovir dosing! Learn all about the history of valganciclovir dosing, what is valganciclovir’s PK/PD target, and even valganciclovir therapeutic drug monitoring.

References:

  1. Märtson AG, Edwina AE, Kim HY, Knoester M, Touw DJ, Sturkenboom MGG, Alffenaar JC. Therapeutic Drug Monitoring of Ganciclovir: Where Are We? Ther Drug Monit. 2022 Feb 1;44(1):138-147. doi: 10.1097/FTD.0000000000000925. PMID: 34610621; PMCID: PMC8746890.
  2. Wiltshire H, Paya CV, Pescovitz MD, Humar A, Dominguez E, Washburn K, Blumberg E, Alexander B, Freeman R, Heaton N, Zuideveld KP; Valganciclovir Solid Organ Transplant Study Group. Pharmacodynamics of oral ganciclovir and valganciclovir in solid organ transplant recipients. Transplantation. 2005 Jun 15;79(11):1477-83. doi: 10.1097/01.tp.0000164512.99703.ad. PMID: 15940035.

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#106 – Stewie Struggles: EHR Edition

Drs. Ed Septimus and Whitney Buckel join Dr. Jeannette Bouchard for our second episode in the series “Stewie Struggles.” In this episode, we focus on interventions within the EHR and what we can do on the end-user side of antimicrobials. We discuss how to use unique tools within the EHR and get a VIP look at the efforts to pull off the amazing INSPIRE trials! You don’t want to miss this!

Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/ 

References:

  1. INSPIRE PNA: doi:10.1001/jama.2024.6248
  2. INSPIRE UTI: doi:10.1001/jama.2024.6259
  3. Order set study by Kufel et al: doi:10/1017/ice.2023.293

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#105 – Bringing Positive Vibes Only: Breaking News & Emerging Hypotheses for Gram-Positive Bacterial Infections

Drs. Cesar Arias (@SuperBugDoc) and Katie Barber join Dr. Julie Ann Justo (@julie_justo) to discuss what is hot-off-the-presses for gram-positive bacterial infections and it’s a total party vibe! They review the latest news for recent and ongoing clinical trials (DOTS, DISRUPT, and SNAP trials), discuss hope for novel clinical tests of the cefazolin inoculum effect in staphylococci, and explore the fascinating changes in virulence and potential therapeutic options for the most challenging enterococci.

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @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. Climate Change and Antimicrobial Resistance. Editors in Conversation Podcast. American Society for Microbiology. Oct 2023.
  2. Is More Better? The Role of Combination Therapy for MRSA. Breakpoints Podcast Episode #30. Society of Infectious Diseases Pharmacists.
  3. Turner NA, et al. DOTS: Dalbavancin as an Option for Treatment of Staphylococcus aureus Bacteremia. ESCMID Global 2024. April 2024. NCT04775953.
  4. Real-world dalbavancin observational cohort: Rebold N, et al. Infect Dis Ther. 2024 Mar;13(3):565-579. doi: 10.1007/s40121-024-00933-2. PMID: 38427289.
  5. Exebacase DISRUPT trial : Fowler VG Jr, et al. Clin Infect Dis. 2024 Jun 14;78(6):1473-1481. doi: 10.1093/cid/ciae043. PMID: 38297916.
  6. @snap_trial tweet of Breaking News. Aug 2024.
  7. Investigator Resources for the SNAP trial. Sept 2024: https://www.snaptrial.com.au/for-investigators#interim
  8. Cefazolin inoculum effect on mortality in MSSA bacteremia : Miller WR, et al. Open Forum Infect Dis. 2018 May 23;5(6):ofy123. doi: 10.1093/ofid/ofy123. PMID: 29977970.
  9. Prevalence of cefazolin inoculum effect in MSSA and modified rapid nitrocefin test for detection: Carvajal LP, et al. Antimicrob Agents Chemother. 2024 Sep 30:e0089824. doi: 10.1128/aac.00898-24. PMID: 39345182.
  10. LiaX as surrogate for cell envelope stress in Enterococus faecium: Axell-House DB, et al. Antimicrob Agents Chemother. 2024 Mar 6;68(3):e0106923. doi: 10.1128/aac.01069-23. PMID: 38289081.
  11. Shorter is better for uncomplicated streptococcal bacteremia: Clutter DS, et al. Antimicrob Agents Chemother. 2024 Aug 7;68(8):e0022024. doi: 10.1128/aac.00220-24. PMID: 38975753.
  12. Short vs. long antibiotic duration in Streptococcus pneumoniae bacteremia: Crotty M, et al. Open Forum Infect Dis. 2024 Aug 30;11(9):ofae478. doi: 10.1093/ofid/ofae478. PMID: 39257675.

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#104 – Dosing Consult: Rifampin Part 1

In this episode of Breakpoints’ Dosing Consult series, Drs. Chuck Peloquin and Gerry Davies join Dr. Megan Klatt to discuss rifampin dosing for mycobacterial infections. Hear from the experts on if higher doses are really better, toxicity thresholds, and the role of alternative rifamycins for patients with MTB and NTMs.

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @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. Efficacy and Safety of High-Dose Rifampin in Pulmonary Tuberculosis. A Randomized Controlled Trial. Am J Respir Crit Care Med. 2018 Sep 1;198(5):657-666. doi: 10.1164/rccm.201712-2524OC.
  2. Rifampin vs. rifapentine: what is the preferred rifamycin for tuberculosis? Expert Rev Clin Pharmacol. 2017 Oct;10(10):1027-1036. doi: 10.1080/17512433.2017.1366311.
  3. Rifabutin for treating pulmonary tuberculosis. Cochrane Database Syst Rev. 2007 Oct; 2007(4): CD005159. doi: 10.1002/14651858.CD005159.pub2.
  4. Implementation of Bedaquiline, Pretomanid, and Linezolid in the United States: Experience Using a Novel All-Oral Treatment Regimen for Treatment of Rifampin-Resistant or Rifampin-Intolerant Tuberculosis Disease. Clin Infect Dis. 2023 Oct 5;77(7):1053-1062. doi: 10.1093/cid/ciad312.

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