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Breakpoints episodes
- #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:
- Mary’s paper: Microbiology Comment Nudge Improves Pneumonia Prescribing - PubMed (nih.gov)
- CDC Key Activities and Roles for Microbiology Lab Staff in Antibiotic Stewardship Programs: Key Activities and Roles for Microbiology Laboratory Staff in Antibiotic Stewardship Programs Updated: August 2020 (cdc.gov)
- CDC Selective Reporting: Selective Reporting of Antimicrobial Susceptibility Testing Results: A Primer for Antibiotic Stewardship Programs (cdc.gov)
- CLSI M100
- EUCAST Breakpoints: EUCAST: Clinical breakpoints and dosing of antibiotics
- USCAST Breakpoints: Breakpoints - USCAST
1 hr 14 min - #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/sidprxLinkedIn: https://www.linkedin.com/company/sidp/18 min - #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/sidprxLinkedIn: https://www.linkedin.com/company/sidp/24 min - #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/sidprxLinkedIn: https://www.linkedin.com/company/sidp/33 min - #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/1 hr 4 min - #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/sidprxLinkedIn: https://www.linkedin.com/company/sidp/References:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Mahoney MV, Swords KE. Fluoroquinolones: Friends or Foe? Clin Infect Dis. Clin Infect Dis. 2021 Feb 19:ciab150.
- 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.
- 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.
1 hr 3 min - #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 occurrence7:21 - Fidaxomicin cost effectiveness11:26 - Factors to consider for health systems when considering switch to fidaxomicin14:23 - Fidaxomicin vs PO vancomycin for recurrences17:52 - Role of pulsed and tapered PO vancomycin19:57 - Role of fecal microbiota transplant (FMT)22:24 - Challenges of FMT and where pharmacy fits in27:27 - Bezlotoxumab31:54 - Feasibility issues with bezlotoxumab and strategies to address them35:25 - CDI prophylaxis40:28 - Stewardship's role in reducing C. difficile infectionsReferences
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.
49 min - #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 bios03:54 Procalcitonin10:06 Pneumococcal and legionella antigen testing16:30 Outpatient CAP therapy23:40 Newer agents31:18 Inpatient CAP therapy39:09 Atypical coverage for admitted patients44:27 Beta-lactam combination therapy46:58 Ceftaroline vs ceftriaxone for pneumococcal pneumonia55:23 Steroid use in CAPLearn 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/sidprxLinkedIn: https://www.linkedin.com/company/sidp/1 hr 5 min - #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/sidprxLinkedIn: https://www.linkedin.com/company/sidp/1 hr 2 min - #31 – “Mind the Gap”: Antimicrobial Stewardship at Transitions of Care
Antimicrobial stewardship is often an inpatient effort and overlooked at transitions of care. Dr. April Dyer (@aprildyerid) and Dr. Rachel Kenney (@rkenneypharmd) share insight with host Dr. David Ha (@DHpharmD) on current practice and barriers, and strategies for pharmacists to bring antimicrobial stewardship in the discharge process.
Episode content:
- 00:14: Welcome and introductions:
- 04:39: Project overview: "Developing Patient Safety Outcome Measures and Measurement Tools for Antimicrobial Stewardship Program”
- 06:45: Scope of the problem (Scarpato et al.)
- 07:56: Michigan data (Vaughn et al.)
- 09:13: Building a business case
- 12:32: Where to Start?
- 12:54: Henry Ford Health System experience
- 15:18: IT solutions
- 17:22: 1% rule
- 20:26: Identifying and engaging key players
- 20:47: Outpatient pharmacy
- 22:29: Skilled nursing facilities
- 23:19: Case management relationship
- 24:23: Barriers to implementation
- 29:08: Quantifying total duration
- 30:00: Identify electronic methods to capture total duration therapy attributable to hospitalization
- 32:16: CDC recommendation "Use the shortest effective antibiotic duration"
- 33:16: Final remarks & acknowledgements
- 34:38: Outro
References:
- Scarpato SJ, Timko DR, Cluzet VC, et al. An Evaluation of Antibiotic Prescribing Practices Upon Hospital Discharge. Infection Control and Hospital Epidemiology. 2017;38(3):353-355. doi:10.1017/ice.2016.276
- Madaras-Kelly KJ, Burk M, Caplinger C, et al. Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: Results of a national medication utilization evaluation. Journal of Hospital Medicine. 2016;11(12):832-839. doi:10.1002/jhm.2648
- Feller J, Lund BC, Perencevich EN, et al. Post-discharge oral antimicrobial use among hospitalized patients across an integrated national healthcare network. Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 2020;26(3):327-332. doi:10.1016/j.cmi.2019.09.016
- Daniels LM, Weber DJ. Interventions to improve antibiotic prescribing at hospital discharge: A systematic review. Infection Control and Hospital Epidemiology. Published online September 1, 2020:1-4. doi:10.1017/ice.2020.367
- Vaughn VM, Gandhi TN, Chopra V, et al. Antibiotic Overuse after Hospital Discharge: A Multi-Hospital Cohort Study. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. Published online September 11, 2020. doi:10.1093/cid/ciaa1372
- Dyer AP, Dodds Ashley E, Anderson DJ, et al. Total duration of antimicrobial therapy resulting from inpatient hospitalization. Infection Control and Hospital Epidemiology. 2019;40(8):847-854. doi:10.1017/ice.2019.118
- Bianchini ML, Kenney RM, Lentz R, Zervos M, Malhotra M, Davis SL. Discharge Delays and Costs Associated with Outpatient Parenteral Antimicrobial Therapy for High priced Antibiotics. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. Published online October 31, 2019. doi:10.1093/cid/ciz1076
Disclosures
Dr. April Dyer and Rachel Kenney report no relevant financial disclosures. SIDP reports no relevant financial disclosures.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/sidprxLinkedIn: https://www.linkedin.com/company/sidp/36 min
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