Episode Notes

The Society of Infectious Diseases Pharmacists is excited to invite you to the first ever meeting (via Breakpoints) of The Tortured Stewards & Surgeons Department. Today’s agenda items: optimal management of perioperative antibiotics and prevention of surgical site infections.

Drs. Trisha Peel (@DrTrishaPeel), Michael Calderwood (@CalderwoodMD) and Patch Dellinger join Dr. Jillian Hayes (@thejillianhayes) to discuss some of the controversies we encounter while managing antibiotics in the perioperative space. Does anyone really need post-op antimicrobial prophylaxis longer than 24 hours? Where should vancomycin be fitting into surgical prophylaxis regimens? Can we truly give pre-operative cefazolin to patients with a penicillin allergy? Tune in for the answers to these questions and 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

If you’d like more information about the CALIPSO trial, please visit this link: https://www.anzca.edu.au/profiles/ctn-trials/underway/calipso

Bibliography

1. SSI Infection Prevention Review: https://jamanetwork.com/journals/jama/article-abstract/2800424#:~:text=Six%20are%20supported%20by%20randomized,use%20a%20chlorhexidine%20gluconate%2Dalcoho
2. Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update: https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/strategies-to-prevent-surgical-site-infections-in-acutecare-hospitals-2022-update/2F824B9ADD6066B29F89C8A2A127A9D
3. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update: https://journals.lww.com/journalacs/citation/2017/01000/american_college_of_surgeons_and_surgical.8.aspx 
4. 2017 CDC Guidelines: https://jamanetwork.com/journals/jamasurgery/fullarticle/2623725 
5. 2018 WHO Guidelines: https://arthroplasty.biomedcentral.com/articles/10.1186/s42836-022-00113-y 
6. ASHP Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery: https://www.ashp.org/surgical-guidelines 
7. Surgeons as Stewards: https://journals.lww.com/journalacs/citation/2020/12000/perioperative_antibiotic_prophylaxis__surgeons_as.23.aspx 
8. Li et al, Arthroplasty 2022: https://arthroplasty.biomedcentral.com/articles/10.1186/s42836-022-00113-y 
9. Dutch Arthroplasty Register Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023957/ 
10. de Jonge Meta-Analysis on duration and incidence of SSI: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30084-0/abstract 
11. Prolonged Antibiotic Prophylaxis After Cardiovascular Surgery and Its Effect on Surgical Site Infections and Antimicrobial Resistance: https://www.ahajournals.org/doi/10.1161/01.cir.101.25.2916?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
12. RCT - Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs: https://jamanetwork.com/journals/jama/article-abstract/2810510 
13. NYU Langone Study - Preventing Surgical Site Infections: A Randomized, Open-Label Trial of Nasal Mupirocin Ointment and Nasal Povidone-Iodine Solution: https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=91dee3e1445adb80d533f2c210816a3285254e3a 
14. Trial of Vancomycin and Cefazolin as Surgical Prophylaxis in Arthroplasty: https://www.nejm.org/doi/full/10.1056/NEJMoa2301401
15. What Is the Primary Driver of Preoperative Vancomycin Use? It’s Not Methicillin-resistant Staphylococcus aureus—or Allergy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744972/ 
16. Drug allergy: a 2022 practice parameter update: https://www.jacionline.org/article/S0091-6749(22)01186-1/fulltext 
17. Perioperative use of cefazolin without preliminary skin testing in patients with reported penicillin allergy: https://www.surgjournal.com/article/S0039-6060(18)30307-6/abstract#%20 
18. Timing of Surgical Prophylaxis RCT: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30176-7/abstract 
19. Propensity Score-Weighted Analysis of Postoperative Infection in Patients With and Without Preoperative Urine Culture: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815528

In this episode, Drs. Helen Boucher (@hboucher3), Ramy Elshaboury, and Mike Dudley (@MikeMNDudley) join host, Megan Klatt (@MeganKlatt3), to discuss barriers to antimicrobial drug development, potential incentives and legislation to promote market growth, and what we can do to ensure the antimicrobial pipeline doesn’t run dry.

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. An analysis of antibacterial drug development trends in the United States, 1980-2019: Dheman N, et al. Clin Infect Dis. 2021 Dec 6;73(11):e4444-e4450. doi:10.1093/cid/ciaa859. PMID: 32584952.
2. Antibacterial R&D at a crossroads: we’ve pushed as hard as we can…now we need to start pulling!: Rex JH, Outterson K. Clin Infect Dis. 2021 Dec 6;73(11):e4451-4453. doi:10.1093/cid/ciaa852. PMID: 32584949.
3. No Patient Left Behind (website): https://www.nopatientleftbehind.org/ (many useful explainers of how the investment, innovation cycle, and drug pricing work)
4. ISPOR special task force report on defining elements of value in health care – a health economics approach: Lakdawalla DN, et al. Value Health. 2018 2018 Feb;21(2):131-139. doi: 10.1016/j.jval.2017.12.007. PMID: 29477390.
5. Generalized cost-effectiveness analysis to assess treatment value in hepatitis C: Chou JW, et al. Am J Manag Care. 2023 Dec;29(12):696-703. doi: 10.37765/ajmc.2023.89468. PMID: 38170486.

It's time to arm yourselves with all the resources on antimicrobial locks! Join our experts, Drs. Louise-Marie Oleksiuk (@CanRowPharm), Nasia Safdar (@NasiaSafdar), Joel Topf (@kidney_boy), and our wonderful host, Dr. Julie Justo (@julie_justo), to discuss the ins and outs of antimicrobial locks and how to implement them! Funding for this podcast was provided by CorMedix Inc

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. https://drive.google.com/file/d/1K0A4Bomhbcn7AZJ1JFOWW8EdEZq-aZcd/view?usp=sharing
2. https://drive.google.com/file/d/1PRoQzEKJ1c0pa1XFc4yasxsMhx2A1DFU/view?usp=sharing
3. Helpful antimicrobial lock review: Justo JA, Bookstaver PB. Infect Drug Resist. 2014 Dec 12;7:343-63. doi: 10.2147/IDR.S51388. PMID: 25548523.
4. LOCK IT-100 Trial: Agarwal AK, et al. Clin J Am Soc Nephrol. 2023 Nov 1;18(11):1446-1455. doi: 10.2215/CJN.0000000000000278. PMID: 37678222.
5. Cochrane review: Arechabala MC, et al. Cochrane Database Syst Rev. 2018 Apr 3;4(4):CD010597. doi: 10.1002/14651858.CD010597.pub2. PMID: 29611180.
6. Cost-effectiveness of ethanol lock ppx with newer dehydrated alcohol product: Raghu VK, et al. JPEN J Parenter Enteral Nutr. 2022 Feb;46(2):324-329. doi: 10.1002/jpen.2130. PMID: 33908050.
7. Antimicrobial lock development/implementation in a pediatric hospital: Zembles TN, et al. Am J Health Syst Pharm. 2018 Mar 1;75(5):299-303. doi: 10.2146/ajhp161056. PMID: 29472511.
8. Dr. Topf’s tweet surveying the prevalence of antimicrobial lock use in dialysis units
9. CRBSIs in hemodialysis patients before and during the COVID-19 pandemic: Johansen KL, et al. Clin J Am Soc Nephrol. 2022 Mar;17(3):429-433. doi: 10.2215/CJN.11360821. PMID: 35110377.
10. Antiseptic barrier caps review and meta-analysis: Gillis VELM, et al. Am J Infect Control. 2023 Jul;51(7):827-835. doi: 10.1016/j.ajic.2022.09.005. PMID: 36116679.

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Drs. Thomas Holland and Vance Fowler (@VanceFowler5) join Drs. Steven Tong (@syctong) and Erin McCreary (@ErinMcCreary) to discuss the ERADICATE study and the role of ceftobiprole for the treatment of complicated Staphylococcus aureus bacteremia. This session was recorded live on Tuesday, February 6th, 2024 featuring an international audience.

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Article: https://www.nejm.org/doi/full/10.1056/NEJMoa2300220

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Drs. Robert Bonomo, Ryan Shields (@ryankshields), and Erin McCreary (@ErinMcCreary) deep dive into the world of metallo-beta-lactamases. This riveting discussion is full of the nerdiest pub trivia nuggets and the “must know” details of novel beta lactams and beta-lactamase inhibitors, and their uses for MBLs. Funding for this podcast was provided by Shionogi Inc.

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. Urgent need for metallo B lactamase: DOI: 10.1016/S1473-3099(20)30868-9
2. NDM-9 Resistance to Taniborbactam: DOI 10.1016/S1473-3099(23)00069-5
3. AAC Taniborbactam inhibition of NDM-1: DOI 10.1128/aac.01332-23
4. OFID NDM E. coli with cefiderocol and aztreonam/avibactam resistance: DOI 10.1093/ofid/ofad276

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New accreditation standards making your head spin? Are you stressed and don’t know where to start? Well, on this episode of Breakpoints Drs. Arjun Srinivasan and Jose Alexander (Alex) join Luis Plaza from Let’s Talk Micro (@letstalkmicro1) and Dr. Jeannette Bouchard (@jlbouchard001) to breakdown what you need to know and where to start when it comes to the NHSN Antimicrobial Resistance (AR) module and the new College of American Pathologist’s standards.   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. CDC AR Validation Guide: https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/aur/ar-validation-508.pdf
2. CLSI Toolkit: https://clsi.org/meetings/ast/breakpoints-in-use-toolkit/

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We are back with more exciting IDWeek 2023 content! If you listened to the last episode and want more? Than look no further.

Join your Breakpoints hosts, Drs. Erin McCreary (@ErinMcCreary), Julie Ann Justo (@julie_justo), and Jeannette Bouchard (@jlbouchard001) for a review of key pipeline agents at IDWeek and highlights from everyone’s favorite session “Clinical Trials That May Change Your Practice”.

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

References:

1. Oral Amphotericin for Cryptococcal Meningitis: doi 10.1093/cid/ciad440
2. PALACE: doi 10.1001/jamainternmed.2023.2986
3. DoxyPEP: doi 10.1056/NEJMoa2211934
4. RSV Vaccine in Pregnancy: doi 10.1056/NEJMoa2216480
5. RSV Vaccines in Older Adults: doi 10.1056/NEJMoa2209604 and doi 10.1056/NEJMoa2213836
6. AURORA: doi 10.1093/cid/ciad709
7. Mycoses Mapping: doi 10.1093/cid/ciac882

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Need help narrowing down your IDWeek re-watch content? Or maybe you were unable to make IDWeek so you want the pharmacy driven highlights? Well, look no further, Breakpoints has what you need!   Join your Breakpoints hosts, Drs. Erin McCreary (@ErinMcCreary), Julie Ann Justo (@julie_justo), and Jeannette Bouchard (@jlbouchard001) for a review of some of the late breaking clinical trials presented at IDWeek 2023.   Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Google Podcasts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/    References: 1. Oral Fosfomycin vs IV BL/BLI/Carbapenem in cUTI: doi:10.1093/ofid/ofad500.002 2. Oral Fosfomycin for male UTIs: doi:10.3390/antibiotics11020198 and prostatitis: doi:10.1093/jac/dkz015 3. ATM-AVI for cIAIA or HAP/VAP (REVISIT): doi:10.1093/ofid/ofad500.2476 4. CAZ-AVI for neonates: doi:10.1093/ofid/ofad500.2473 5. ACORN RCT: doi:10.1001/jama.2023.20583

1. HARMONIE RCT: doi:10.1093/ofid/ofad500.005

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Drs. Nicholas Torney (@NPT_PharmD) and Sunish Shah join Dr. Jeannette Bouchard (@jlbouchard001) to discuss our next topic in our Dosing Consult series: BID vs TID dosing for metronidazole. Deep dive into the PK/PD and real-world application of this switch with experts in this dosing strategy.

References:

• Addition of anaerobic coverage in biliary infections: Addition of anaerobic coverage for treatment of biliary tract infections: a propensity score-matched cohort study
• Eggerthella lenta and Pipercillin-tazobactam: Eggerthella lenta Bloodstream Infections Are Associated With Increased Mortality Following Empiric Piperacillin-Tazobactam (TZP) Monotherapy: A Population-based Cohort Study
• Q12H Dose Schedule in Surgery Prophylaxis: Twelve-hourly dosage schedule for oral and intravenous metronidazole
• 2018 Clinical Data on Q12H Dosing in Mixed Infections: Clinical efficacy of 12-h metronidazole dosing regimens in patients with anaerobic or mixed anaerobic infections
• 2021 Clinical Data on Q12H Dosing: Three is a crowd: Clinical outcomes of a twice daily versus a thrice daily metronidazole dosing strategy from a multicenter study

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/

SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member

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Dr. Ajit Limaye and Dr. Camille Kotton (@KottonNelson) join Dr. Erin McCreary (@ErinMcCreary) to discuss fascinating updates in the CMV space including new RCTs for prevention, vaccines, and more! Learn why a little "hair of the dog" might be a good thing, how great T cells are, and the trials we still need.

References:

• CAPSIL study: Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial - PubMed (nih.gov)
• Extended CAPSIL data: Association of CMV DNAemia with Long-Term Mortality in a Randomized Trial of Preemptive Therapy (PET) and Antiviral Prophylaxis (AP) for Prevention of CMV Disease in High-Risk Donor Seropositive, Recipient Seronegative (D+R-) Liver Transplant Recipients - PubMed (nih.gov)
• Kidney transplant review: A Systematic Review and Meta-analysis of Optimized CMV Preemptive Therapy and Antiviral Prophylaxis for CMV Disease Prevention in CMV High-Risk (D+R-) Kidney Transplant Recipients - PubMed (nih.gov)
• Letermovir vs Valganciclovir for Prevention in Kidney Transplant: Letermovir vs Valganciclovir for Prophylaxis of Cytomegalovirus in High-Risk Kidney Transplant Recipients: A Randomized Clinical Trial - PubMed (nih.gov)

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/

SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member

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

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Episode Notes

Drs. Paul Ambrose and Michael Dudley (@MikeMndudley) join Dr. Julie Ann Justo (@julie_justo) for a review of beta-lactamase inhibitor (BLI) pharmacokinetics & pharmacodynamics. They discuss factors affecting BLI’s restorative activity, the convoluted math behind establishing exposure-response relationships for BLIs, some geeky medicinal chemistry, and a little-known easter egg in the published literature.

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/

SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member

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

References

1. SIDP Insight on Tazobactam for ESBLs: Monogue M, et al. Pharmacotherapy. 2021 Oct;41(10):864-880. doi: 10.1002/phar.2623. PMID 34689349.
2. Tazobactam with cefepime: VanScoy BD, et al. Antimicrob Agents Chemother. 2017 Nov 22;61(12):e01052-17. doi: 10.1128/AAC.01052-17. PMID: 28947475.
3. Another great review of BLIs: Ambrose PG, et al. Curr Opin Pharmacol. 2017 Oct;36:86-93. doi: 10.1016/j.coph.2017.09.001. PMID: 29096172.
4. Meropenem-vaborbactam target attainment: Bhavnani SM, et al. Antimicrob Agents Chemother. 2022 Dec 20;66(12):e0213021. doi: 10.1128/aac.02130-21. PMID: 36374023.
5. Meropenem-vaborbactam pulmonary exposures: Wenzler E, et al. Antimicrob Agents Chemother. 2015 Dec;59(12):7232-9. doi: 10.1128/AAC.01713-15. PMID: 26349830.
6. Stand-alone BLI discussion based on CB-618: Ambrose PG, et al.. Antimicrob Agents Chemother. 2017 Nov 22;61(12):e00630-17. doi: 10.1128/AAC.00630-17. PMID: 28947474.
7. NDM-9 resistance to taniborbactam: Le Terrier C, et al. Lancet Infect Dis. 2023 Apr;23(4):401-402. doi: 10.1016/S1473-3099(23)00069-5. PMID: 36796395.
8. New boronate drugs and NDM: Lomovskaya O, et al. Antimicrob Agents Chemother. 2023 Aug 31:e0057923. doi: 10.1128/aac.00579-23. PMID: 37650617.
9. Helpful BLI PK-PD review: Crass R, Pai MP. Pharmacotherapy. 2019 Feb;39(2):182–195. doi: 10.1002/phar.2210. PMID 30589457.
10. Discovery of QPX7728 (Xeruborbactam): Hecker SJ, et al. J Med Chem. 2020 Jul 23;63(14):7491-7507. doi: 10.1021/acs.jmedchem.9b01976. PMID 32150407.
11. Xeruborbactam binding to PBPs directly: Lomovskaya O, et al. Antimicrob Agents Chemother. 2022 Feb 15;66(2):e0216821. doi: 10.1128/AAC.02168-21. PMID: 34902261.
12. Xeruborbactam predicted best by fAUC/MIC with oral ceftibuten: Tarazi Z, et al. Open Forum Infect Dis. Volume 9, Issue Supplement_2, December 2022, ofac492.666, https://doi.org/10.1093/ofid/ofac492.666 (Poster 614)
13. Xeruborbactam predicted best by fAUC/MIC with meropenem: Tarazi Z, et al. Open Forum Infect Dis. Volume 9, Issue Supplement_2, December 2022, ofac492.667, https://doi.org/10.1093/ofid/ofac492.667 (Poster 615)
14. First 2013 AAC paper on tazobactam with ceftolozane from Ambrose group: VanScoy B, et al. Antimicrob Agents Chemother. 2013 Jun;57(6):2809-14. doi: 10.1128/AAC.02513-12. PMID: 23629705.
15. Second 2013 AAC paper on tazobactam with ceftolozane from Ambrose group: Vanscoy B, et al. Antimicrob Agents Chemother. 2013 Dec;57(12):5924-30. doi: 10.1128/AAC.00656-13. PMID: 24041895.
16. Electric Telescope, 52 Class 530 Series 1080p LCD/HD; Samsung Group, Seoul, South Korea, available at: https://www.samsung.com/ca/support/model/LN52C530F1FXZC/
17. Tazobactam with Piperacillin from Ambrose group: Nicasio AM, et al. Antimicrob Agents Chemother. 2016 Mar 25;60(4):2075-80. doi: 10.1128/AAC.02747-15. PMID: 26787689.

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