Breakpoints
The SIDP Podcast

#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:

#39 – A Little More on the Littles: What Adults Should Know about ID Pediatrics

In this rapidfire episode Dr. Erin Weslander (@littlebugdrug), Dr. Laura Bio (@StanfordPedsASP), and Dr. Diana Yu (@dyupharmd) reveal their super-secret ID toolkit to figure out dosing and approaches to treatment in pediatric patients.

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/

#38 – You're KID-ding! Myths in ID Pediatrics

Dr. Erin Weslander (@littlebugdrug), Dr. Laura Bio (@StanfordPedsASP), and Dr. Diana Yu (@dyupharmd) breakdown common myths about antimicrobials in pediatric patients.

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/

#37 – A Gab about Cab: The Short on Long-Acting Antiretrovirals for HIV

Dr. Fidelia Bernice, Dr. Rodrigo Burgos, and Dr. Neha Pandit, join Breakpoints to discuss the first available long-acting antiretroviral agent, cabotegravir/rilpivirine.

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/

#36 – Monoclonal Antibodies: Gateway Drugs for Future Care Delivery Models

Dr. Susan Davis (@IDPharmProf), Dr. Emily Spivak (@EmilySpivak), and Dr. Minkey Wungwattana (@minkeyw) join Dr. Erin McCreary (@ErinMcCreary) to discuss individual and shared experiences operationalizing COVID-19 monoclonal antibody therapy across their institutions and states. They tackle big and small hurdles from finding ways to ensure equitable distribution to pronouncing the drug names!

This episode was sponsored by an unrestricted grant from Regeneron Pharmaceuticals.

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/

#35 – Oral Beta-Lactams, Are We Serious?

Dr. Jill Cowper (@jillcowper), and Dr. Jesse Sutton, join host Dr. Zahra Kassamali Escobar (@zkePharmD) to discuss the data behind use of oral beta-lactams as step-down therapy for bacteremia and other serious infections. 

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. Sutton J, Stevens V, Chang NN et al. Oral β-Lactam Antibiotics vs Fluoroquinolones or Trimethoprim-Sulfamethoxazole for Definitive Treatment of Enterobacterales Bacteremia From a Urine Source. JAMA Netw Open. 2020 Oct 1;3(10):e2020166.
  2. Punjabi C, Tien V, Meng C, et al. Oral Fluoroquinolone or Trimethoprim-Sulfamethoxazole vs ß-Lactams as Step-Down Therapy for Enterobacteriaceae Bacteremia: Systematic Review and Meta-analysis, Open Forum Infect Dis 2019; 6(10):ofz364.
  3. Tamma PD, Conley AT, Cosgrove SE, et al. Association of 30-Day Mortality With Oral Step-Down vs Continued Intravenous Therapy in Patients Hospitalized With Enterobacteriaceae Bacteremia. JAMA Intern Med 2019; 179(3):316-323.
  4. Mercuro NJ, Stogsdill P, Wungwattana M. Retrospective analysis comparing oral stepdown therapy for enterobacteriaceae bloodstream infections: fluoroquinolones versus beta-lactams. Int J Antimicrob Agents 2018;51(5)687-692.
  5. Kutob LF, Justo JA, Bookstaver BA et al. Effectiveness of oral antibiotics for definitive therapy of Gram-negative bloodstream infections. Int J Antimicrob Agents 2016 Nov;48(5):498-503.
  6. Mogle BT, Beccari MV, Steele JM, et al. Clinical considerations for oral beta-lactams as step-down therapy for Enterobacteriaceae bloodstream infections. Expert Opin Pharmacother. 2019 Jun;20(8):903-907.
  7. Migils C, Rhodes NJ, Kuti JL, et al. Defining the impact of severity of illness on time above the MIC threshold for cefepime in Gram-negative bacteraemia: a 'Goldilocks' window. Int J Antimicrob Agents 2017;50(3):487-490.
  8. Sandberg T, Englund G, Lincoln K, Nilsson LG. Randomised double-blind study of norfloxacin and cefadroxil in the treatment of acute pyelonephritis. Eur J Clin Microbiol Infect Dis. 1990;9(5):317-323.
  9. Mahoney MV, Swords KE. Fluoroquinolones: Friends or Foe? Clin Infect Dis. Clin Infect Dis. 2021 Feb 19:ciab150.
  10. Arensman K, Shields M, Beganovic M, et al. Fluoroquinolone versus beta-lactam oral step-down therapy for uncomplicated streptococcal bloodstream infections. Antimicrob Agents Chemother 2020;64(11):e01515-20. 
  11. Seaton RA, Ritchie ND, Robb F, et al. From 'OPAT' to 'COpAT': implications of the OVIVA study for ambulatory management of bone and joint infection. J Antimicrob Chemother. 2019 Aug 1;74(8):2119-2121.

#34 – The New Scoop on Poop: Updates in the Management of C. difficile infections

Dr. Kevin Garey (@GareyKgarey), Dr. Kelly Reveles (@KellyReveles), Dr. Mandelin Cooper, and host Dr. Rachel Britt (@RachelBPharmD) discuss proposed updates of the IDSA-SHEA C. difficile guidelines, including: fidaxomicin over oral vancomycin as first-line therapy, the roles and logistical hurdles of fecal microbiota transplant, bezlotoxumab, and the pros and cons of prophylaxis.

Timestamps

1:16 - Panel introductions 3:19 - Fidaxomicin vs PO vancomycin for first occurrence 7:21 - Fidaxomicin cost effectiveness 11:26 - Factors to consider for health systems when considering switch to fidaxomicin 14:23 - Fidaxomicin vs PO vancomycin for recurrences 17:52 - Role of pulsed and tapered PO vancomycin 19:57 - Role of fecal microbiota transplant (FMT) 22:24 - Challenges of FMT and where pharmacy fits in 27:27 - Bezlotoxumab 31:54 - Feasibility issues with bezlotoxumab and strategies to address them 35:25 - CDI prophylaxis 40:28 - Stewardship's role in reducing C. difficile infections

References

Fidaxomicin Cost-effectiveness

  • Reveles KR, et al. Pharmacotherapy. 2017;37(12):1489-97.
  • Watt M, et al. Infection. 2016;44(5):599-606.
  • Cornely OA, et al. J Antimicrob Chemother. 2018;73(9):2529-39.
  • Rubio-Terres C, et al. Eur J Clin Microbiol Infect Dis. 2019;38(6):1105-11.

Bezlotoxumab

  • Wilcox MH, et al. N Engl J Med. 2017;376:305-17.
  • Oksi J, et al. Eur J Clin Microbiol Infect Dis. 2019;38(10):1947-52.
  • Hengel RL, et al. Open Forum Infect Dis. 2020;7(4):ofaa097.

Bezlotoxumab Cost-effectiveness

  • Salavert M, et al. Adv Ther. 2018;35(11):1920-34.
  • Prabhu VS, et al. Clin Infect Dis. 2018;66(3):355-62.

Primary prophylaxis 

  • Pereiras MA, et al. Biol Blood Marrow Transplant. 2017; 23:S395. 
  • Ganetsky A, et al. Clin Infect Dis. 2019;68(12):2003-2009.
  • Mullane KM, et al. Clin Infect Dis. 2019; 68(2):196–203.

Secondary prophylaxis  

  • Carignan A, et al. Am J Gastroenterol. 2016;111:1834-1840.
  • Van Hise NW, et al. Clin Infect Dis. 2016;63:651-653.
  • Splinter et al. Ann Pharmacother. 2018;52:113-119.
  • Knight EM, et al. J Pharm Pract. 2019;:897190019825994.
  • Morrisette T, et al. Biol Blood Marrow Transplant. 2019;25(10):2091-2097.

#33 – A Lung Time Coming: Controversies in Community Acquired Pneumonia

Join Dr. Elizabeth Covington (@ewood_1875), Dr. Brandon Dionne (@BWDionne), Dr. Jason Pogue (@jpogue1), and Dr. David Ha (@DHpharmd) as they discuss new and old antibiotic therapies for community acquired pneumonia, just how typical are atypicals, what happened to HCAP, and much more! This episode was sponsored by an unrestricted educational grant from Paratek Pharmaceuticals

Time stamps: 00:00 Intro, guest bios 03:54 Procalcitonin 10:06 Pneumococcal and legionella antigen testing 16:30 Outpatient CAP therapy 23:40 Newer agents 31:18 Inpatient CAP therapy 39:09 Atypical coverage for admitted patients 44:27 Beta-lactam combination therapy 46:58 Ceftaroline vs ceftriaxone for pneumococcal pneumonia 55:23 Steroid use in CAP

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/

#32 – Unsolicited Advice: An Honest Discussion of Burnout in Stewardship

Join Dr. Julie Szymczak @julieszymczak, Dr. Emily Heil @emilylheil, Dr. Zahra Kassamali Escobar @zkepharmd, and Dr. Erin McCreary @erinmccreary, for a discussion on stewardship burnout—what is it, who is at risk for it, and what can we do about it?

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/