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Stewardship / Resistance Scan for Sep 16, 2022
Inappropriate antibiotics for pneumonia;
Antibiotic prophylaxis for breast reconstruction
Filed Under:
Antimicrobial Stewardship
Unneeded broad-spectrum antibiotics may harm pneumonia patients
An analysis of data on patients hospitalized with community-acquired pneumonia (CAP) found that extended-spectrum antibiotic therapy was associated with increased mortality compared with standard antibiotic therapy, Japanese researchers reported yesterday in the International Journal of Infectious Diseases.
For the study, researchers conducted a post hoc analysis of a prospective observational study conducted at four hospitals in Japan that evaluated antibiotic treatment for CAP. Their aim was to clarify the impact of extended-spectrum antibiotic use in CAP patients at low risk of infections caused by drug-resistant pathogens (DRPs).
Physicians often suggest the administration of unnecessary extended-spectrum antibiotics, such as antipseudomonal and anti-methicillin–resistant Staphylococcus aureus (MRSA) drugs, for pneumonia patients to avoid potential delays in initiation of appropriate therapy, but many CAP patients don't need extended-spectrum antibiotics, and recent international guidelines on CAP have emphasized risk assessment for DRPs before using these broader-spectrum drugs.
Of the 750 CAP patients eligible for the study, 416 with a low risk of DRPs were analyzed; of these, 257 had been treated with standard antibiotic therapy, and 159 received extended-spectrum therapy. The 30-day mortality was 3.9% and 13.8% in the standard and extended-spectrum therapy groups, respectively.
Primary multivariable logistic regression analysis revealed that extended-spectrum therapy was associated with a nearly three-fold increase in 30-day mortality compared with standard therapy (adjusted odds ratio, 2.82; 95% confidence interval [CI], 1.20 to 6.66). The results of the sensitivity analyses were consistent with those of the primary analysis.
"These results suggest that the administration of extended-spectrum antibiotics is harmful in patients with CAP with a low risk of DRPs," the study authors wrote. "Physicians should therefore acknowledge the significance of DRPs risk assessment when determining the empirical antibiotic therapy and should refrain from administering extended-spectrum antibiotics to patients with a low risk of DRPs."
The authors say the possible explanations for the link between extended-spectrum antibiotics and increased mortality in CAP patients could include changes in the composition of gut microbiota and the risk of adverse events connected to these drugs, such as acute kidney injury and Clostridioides difficile infection.
Sep 15 Int J Infect Dis study
Trial: Multi-dose antibiotic preventive not needed for breast reconstruction
A randomized clinical trial conducted in Sweden found that multiple-dose intravenous antibiotic prophylaxis is not superior to a single-dose regimen for preventing postoperative infection following implant-based breast reconstruction and comes with a higher risk of adverse events, researchers reported today in JAMA Network Open.
In the multicenter randomized superiority trial, women who planned to undergo immediate or delayed implant-based breast reconstruction were randomized 1:1 to receive either multiple-dose antibiotic prophylaxis extending over 24 hours after surgery or a single dose of intravenous antibiotic.
The primary outcome was a surgical site infection (SSI) leading to removal of the implant within 6 months of surgery, and secondary outcomes included the rate of SSIs necessitating readmission and administration of intravenous antibiotics and clinically suspected SSIs not necessitating readmission but administration of oral antibiotics.
A total of 698 women were randomized, with 345 in the single-dose group and 353 in the multiple-dose group. Median ages were 46 in the single-dose group and 47 in the multiple-dose group. Within 6 months of follow-up, 30 patients (4.3%) had their implant removed because of an SSI (3.8% in the single-dose group vs 4.8% in the multiple-dose group). Readmission for intravenous antibiotics because of SSI occurred in 47 patients (7.0%; 6.1% vs 7.4%), and 190 women who received oral antibiotics because of clinically suspected SSI (27.7%; 30.4% vs 24.4%).
There was no significant difference between the randomization groups for the primary outcome of implant removal (OR, 1.26; 95% CI, 0.69 to 2.65) or for the secondary outcomes of readmission for intravenous antibiotics (OR, 1.18; 95% CI, 0.65 to 2.15) and prescription of oral antibiotics (OR, 0.72; 95% CI, 0.51 to 1.02). Adverse events associated with antibiotic treatment were more common in the multiple-dose group than in the single-dose group (16.4% [58 patients] vs 10.7% [37 patients]; OR, 1.64; 95% CI, 1.05 to 2.55).
"Multiple-dose antibiotic prophylaxis is not superior to a single-dose regimen in preventing implant removal due to SSI in implant-based breast reconstruction but is associated with more adverse events," the study authors concluded. "Thus, multiple-dose antibiotic prophylaxis is not recommended."
Sep 16 JAMA Netw Open study
Stewardship / Resistance Scan for Sep 16, 2022
Inappropriate antibiotics for pneumonia;
Antibiotic prophylaxis for breast reconstruction
Filed Under:
Antimicrobial Stewardship
Unneeded broad-spectrum antibiotics may harm pneumonia patients
An analysis of data on patients hospitalized with community-acquired pneumonia (CAP) found that extended-spectrum antibiotic therapy was associated with increased mortality compared with standard antibiotic therapy, Japanese researchers reported yesterday in the International Journal of Infectious Diseases.
For the study, researchers conducted a post hoc analysis of a prospective observational study conducted at four hospitals in Japan that evaluated antibiotic treatment for CAP. Their aim was to clarify the impact of extended-spectrum antibiotic use in CAP patients at low risk of infections caused by drug-resistant pathogens (DRPs).
Physicians often suggest the administration of unnecessary extended-spectrum antibiotics, such as antipseudomonal and anti-methicillin–resistant Staphylococcus aureus (MRSA) drugs, for pneumonia patients to avoid potential delays in initiation of appropriate therapy, but many CAP patients don't need extended-spectrum antibiotics, and recent international guidelines on CAP have emphasized risk assessment for DRPs before using these broader-spectrum drugs.
Of the 750 CAP patients eligible for the study, 416 with a low risk of DRPs were analyzed; of these, 257 had been treated with standard antibiotic therapy, and 159 received extended-spectrum therapy. The 30-day mortality was 3.9% and 13.8% in the standard and extended-spectrum therapy groups, respectively.
Primary multivariable logistic regression analysis revealed that extended-spectrum therapy was associated with a nearly three-fold increase in 30-day mortality compared with standard therapy (adjusted odds ratio, 2.82; 95% confidence interval [CI], 1.20 to 6.66). The results of the sensitivity analyses were consistent with those of the primary analysis.
"These results suggest that the administration of extended-spectrum antibiotics is harmful in patients with CAP with a low risk of DRPs," the study authors wrote. "Physicians should therefore acknowledge the significance of DRPs risk assessment when determining the empirical antibiotic therapy and should refrain from administering extended-spectrum antibiotics to patients with a low risk of DRPs."
The authors say the possible explanations for the link between extended-spectrum antibiotics and increased mortality in CAP patients could include changes in the composition of gut microbiota and the risk of adverse events connected to these drugs, such as acute kidney injury and Clostridioides difficile infection.
Sep 15 Int J Infect Dis study
Trial: Multi-dose antibiotic preventive not needed for breast reconstruction
A randomized clinical trial conducted in Sweden found that multiple-dose intravenous antibiotic prophylaxis is not superior to a single-dose regimen for preventing postoperative infection following implant-based breast reconstruction and comes with a higher risk of adverse events, researchers reported today in JAMA Network Open.
In the multicenter randomized superiority trial, women who planned to undergo immediate or delayed implant-based breast reconstruction were randomized 1:1 to receive either multiple-dose antibiotic prophylaxis extending over 24 hours after surgery or a single dose of intravenous antibiotic.
The primary outcome was a surgical site infection (SSI) leading to removal of the implant within 6 months of surgery, and secondary outcomes included the rate of SSIs necessitating readmission and administration of intravenous antibiotics and clinically suspected SSIs not necessitating readmission but administration of oral antibiotics.
A total of 698 women were randomized, with 345 in the single-dose group and 353 in the multiple-dose group. Median ages were 46 in the single-dose group and 47 in the multiple-dose group. Within 6 months of follow-up, 30 patients (4.3%) had their implant removed because of an SSI (3.8% in the single-dose group vs 4.8% in the multiple-dose group). Readmission for intravenous antibiotics because of SSI occurred in 47 patients (7.0%; 6.1% vs 7.4%), and 190 women who received oral antibiotics because of clinically suspected SSI (27.7%; 30.4% vs 24.4%).
There was no significant difference between the randomization groups for the primary outcome of implant removal (OR, 1.26; 95% CI, 0.69 to 2.65) or for the secondary outcomes of readmission for intravenous antibiotics (OR, 1.18; 95% CI, 0.65 to 2.15) and prescription of oral antibiotics (OR, 0.72; 95% CI, 0.51 to 1.02). Adverse events associated with antibiotic treatment were more common in the multiple-dose group than in the single-dose group (16.4% [58 patients] vs 10.7% [37 patients]; OR, 1.64; 95% CI, 1.05 to 2.55).
"Multiple-dose antibiotic prophylaxis is not superior to a single-dose regimen in preventing implant removal due to SSI in implant-based breast reconstruction but is associated with more adverse events," the study authors concluded. "Thus, multiple-dose antibiotic prophylaxis is not recommended."
Sep 16 JAMA Netw Open study