Breakpoints
The SIDP Podcast

#56 – Empiric Escalation: Gazing into the Crystal Ball for Multidrug-Resistant Gram-Negatives

Drs. Kate DeSear (@IDPharmD_Kate) and Frank Tverdek (@FTverdek) join Dr. Julie Ann Justo (@julie_justo) to discuss the practice of empiric escalation in this episode of our gram-negative resistance series. Listen in for encouragement on following your intuition and tips on how, when, and why to practice this other side of antimicrobial stewardship.

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

#55 – One World: Global Perspectives in Antimicrobial Stewardship

Drs. Debbie Goff (@idpharmd), Khalid Eljaaly (@khalideljaaly), and Angeliki Messina (@AngPharmID) join Dr. David Ha (@DHpharmd) as part of a global panel discussion on international antimicrobial stewardship practices. Listen in to learn about pharmacy practice in South Africa and Saudi Arabia, antimicrobial stewardship practices in these and other countries, and how you too can get involved in global stewardship.

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

  • 2022 ACCP Global Conference on Clinical Pharmacy. https://www.accp.com/meetings/abstracts.aspx
  • Alhazzani W, Alshahrani M, Alshamsi F, Aljuhani O, Eljaaly K, Hashim S, et al. The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section. J Infect Public Health. 2022;15(1):142-151. doi:10.1016/j.jiph.2021.10.005.
  • Brink AJ, Messina AP, Feldman C, et al. Antimicrobial stewardship across 47 South African hospitals: an implementation study. Lancet Infect Dis. 2016;16(9):1017-1025. doi:10.1016/S1473-3099(16)30012-3
  • Goff DA, Ashiru‐Oredope D, Cairns KA, et al. Global contributions of pharmacists during the COVID‐19 pandemic. J Am Coll Clin Pharm. Published online October 2, 2020:10.1002/jac5.1329. doi:10.1002/jac5.1329
  • Eljaaly K, Elarabi S, Alshehri S, Nix DE. Impact of requiring re-authorization of restricted antibiotics on day three of therapy. J Antimicrob Chemother 2018;73(2):527-530. doi:10.1093/jac/dkx384.
  • Korayem GB, Badreldin HA, Eljaaly K, et al. Clinical pharmacy definition, required education, training and practice in Saudi Arabia: A position statement by the Saudi society of clinical pharmacy. Saudi Pharm J. 2021;29(11):1343-1347. doi:10.1016/j.jsps.2021.09.008.
  • International Pharmaceutical Federation Development Goals: Antimicrobial Stewardship. https://developmentgoals.fip.org/dg17/
  • Messina AP, van den Bergh D, Goff DA. Antimicrobial Stewardship with Pharmacist Intervention Improves Timeliness of Antimicrobials Across Thirty-three Hospitals in South Africa. Infect Dis Ther. 2015;4(Suppl 1):5-14. doi:10.1007/s40121-015-0082-x
  • Open Access BSAC eBook "Antimicrobial Stewardship: From Principles to Practice". https://www.bsac.org.uk/antimicrobialstewardshipebook/BSAC-AntimicrobialStewardship-FromPrinciplestoPractice-eBook.pdf
  • Open Access BSAC course "Antimicrobial Stewardship for the Gulf, Middle East and North Africa". https://www.futurelearn.com/courses/antimicrobial-stewardship-for-the-middle-east
  • Saudi Society of Clinical Pharmacy Infectious Disease Pharmacy Specialty Network. https://sscp.org.sa/infectious-disease/
  • World Health Organization. Antimicrobial Stewardship Programmes in Health-Care Facilities in Low- and Middle-Income Countries: A WHO Practical Toolkit. World Health Organization; 2019. Accessed March 9, 2022. http://apps.who.int/iris/handle/10665/329404

#54 – Connecting with our Colleagues: COVID-19 Treatments in Community Pharmacies

Dr. Jennifer Morrow joins Dr. Rachel Britt (@RachelBPharmD) on this bonus episode of the Breakpoints podcast to discuss how the introduction of COVID-19 therapeutics and vaccines has affected community pharmacy teams and workflows. Also mentioned are the recent Test to Treat initiative, impacts on future community pharmacy practice, and ways inpatient providers can help our community colleagues.

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:

#53 – Abscessus and fortuitum and avium, Oh My!: Updates and Controversies in NTM Management

Drs. Wendi Drummond and Jeff Pearson (@jeffpears0n) join Dr. Rachel Britt (@RachelBPharmD) on the Breakpoints podcast this week to discuss all things on non-tuberculosis mycobacteria pulmonary infections. Listen for answers to all your burning questions like “Are we still using IV amikacin?” and “How do I get omadacycline for my patient?” as well as learning why clofazimine is the coolest drug out there. For more NTM content, check out Dr. Drummond’s podcast, NTMTalk!

This podcast was sponsored by an unrestricted medical education grant from Paratek.

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. www.doi.org/10.1093/cid/ciaa241
  2. www.doi.org/10.1164/rccm.200604-571ST
  3. www.doi.org/10.1136/thoraxjnl-2015-207360
  4. www.doi.org/10.1136/thoraxjnl-2017-210927
  5. www.doi.org/10.1093/ofid/ofaa415
  6. www.doi.org/10.1093/ofid/ofab002
  7. https://clinicaltrials.gov/ct2/show/NCT04922554

#52 – A Conversation with the Authors of IDSA Guidance on Treatment of AmpC, CRAB, and Stenotrophomonas

Drs. Pranita Tamma (@pranita_tamma) and Sam Aitken (@OncIDPharmd) are BACK on the podcast this week with Dr. Erin McCreary (@ErinMcCreary) to discuss IDSA guidance on AmpC producers, carbapenem-resistant Acinetobacter baumanii, and Stenotrophomonas as part of our series on gram-negative bacteria. Listen as the panelists navigate the hot mess that is the CRAB treatment landscape, have a minocycline appreciation moment (we stan for Steno Sam!), and throw down some bar trivia in an "I Feel Nerdy" segment that you don't want to miss.

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. Infectious Diseases Society of America Guidance on the Treatment of Extended-Spectrum β-lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa) - PubMed (nih.gov)
  2. Infectious Diseases Society of America Guidance on the Treatment of AmpC β-lactamase-Producing Enterobacterales, Carbapenem-Resistant Acinetobacter baumannii, and Stenotrophomonas maltophilia Infections - PubMed (nih.gov)
  3. An Overview of the Treatment of Less Common Non-Lactose-Fermenting Gram-Negative Bacteria
  4. Alterations of the Oral Microbiome and Cumulative Carbapenem Exposure Are Associated With Stenotrophomonas maltophilia Infection in Patients With Acute Myeloid Leukemia Receiving Chemotherapy

#51 – A Conversation with the Authors of IDSA Guidance on Treatment of ESBL, CRE, and DTR Pseudomonas

Drs. Pranita Tamma (@pranita_tamma) and Sam Aitken (@OncIDPharmd), authors of the IDSA Guidance on gram-negative resistance, join Dr. Erin McCreary (@ErinMcCreary) for this exquisitely good episode to discuss the soon-to-be-updated guidance on treatment of ESBL producers, CRE producers, and difficult to treat (DTR) Pseudomonas.

Learn more about the Society of Infectious Diseases Pharmacists:

References:

  1. PRO: Testing for ESBL production is necessary for ceftriaxone-non-susceptible Enterobacterales: perfect should not be the enemy of progress - PubMed (nih.gov)
  2. CON: Testing for ESBL production is unnecessary for ceftriaxone-resistant Enterobacterales - PubMed (nih.gov)
  3. Infectious Diseases Society of America Guidance on the Treatment of Extended-Spectrum β-lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa) - PubMed (nih.gov)
  4. Infectious Diseases Society of America Guidance on the Treatment of AmpC β-lactamase-Producing Enterobacterales, Carbapenem-Resistant Acinetobacter baumannii, and Stenotrophomonas maltophilia Infections - PubMed (nih.gov)

#50 – Moving to the Algo-rhythm of IDWeek 2021: Highlights in SoMe and ASP

Episode Notes

Drs. Timothy Gauthier (@IDstewardship) and Jillian Hayes (@thejillianhayes) join Dr. Zahra Kassamali Escobar (@zkePharmD) to recap some IDWeek 2021 highlights on social media and antimicrobial stewardship.

The views and opinions expressed in this podcast are that of the speakers and do not necessarily reflect those of any past, current, or potential future employer.

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. Vosoughi S et al. The spread of true and false news online. Science 2018;359:1146-1151. doi: 10.1126/science.aap9559.
  2. Solis Arce JS et al. COVID-19 vaccine acceptance and hesitancy in low-and middle-income countries. Nature Medicine 2021;27:1385-1394. doi: 10.1038/s41591-021-01454-y.
  3. Metlay JP et al. Tensions in antibiotic prescribing: pitting social concerns against the interests of individual patients. J Gen Intern Med 2002;17(2):87-94. doi: 10.1046/j.1525-1497.2002.10711.x.
  4. Wang et al. Development of Multifaceted Antimicrobial Stewardship Curriculum for Undergraduate Medical Education: The Antibiotic Stewardship, Safety, utilization, Resistance, and Evaluation (ASSURE) Elective. _Open Forum Infect Dis _2021;8(6): ofab231. https://doi.org/10.1093/ofid/ofab231.
  5. Charani E et al. Understanding the Determinants of Antimicrobial Prescribing Within Hospitals: The Role of “Prescribing Etiquette.” Clin Infect Dis 2013;57(2):188-196. doi: 10.1093/cid/cit212.
  6. Lines TH et al. Driving antimicrobial use improvement: attitudes of providers of adult hospital care on optimal attribution and feedback. Infect Control Hosp Epidemiol 2018;39(8):983-985. doi: 10.1017/ice.2018.113.
  7. Teshome BF et al. Duration of Exposure to Antipseudomonal B-Lactam Antibiotics in the Critically Ill and Development of New Resistance. Pharmacotherapy 2019;39(3):261-270. doi: 10.1002/phar.2201.
  8. Teshome BF et al. Evaluation of a ceiling effect on the association of new resistance development to antipseudomonal beta-lactam exposure in the critically ill. Infect Control Hosp Epidemiol 2020;41(4):484-485.
  9. Leone M et al. De-escalation versus continuation of empirical antimicrobial treatment in severe sepsis: a multicenter non-blinded randomized noninferiority trial. Intensive Care Med 2014;40: 1399-1408. doi: 10.1007/s00134-014-3411-8.
  10. Stevens V et al. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis 2011;53(1):42-48. doi: 10.1093/cid/cir301.
  11. Bhalodi A et al. Impact of antimicrobial therapy on the gut microbiome. J Antimicrob Chemother 2019;74(Suppl 1):i6-i15. doi: 10.1093/jac/dky530.

#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.