In Part 2 of our episodes on Acinetobacter we talk abouit resistance, and then do a deep dive into the evidence base for the management of CRAB: Carbapenem-Resistant Acinetobacter Baumanii-calcoaceticus complex.

Do have a look at the prep notes for this episode if you want more information on Acinetobacter.

Links to podcasts mentioned in this episode

ID:IOTS Episode 41: Bugs Without Borders

Febrile episodes 76 & 77: Piece de (Gram-negative) Resistance
Episode 76
Episode 77

For links to the papers we used, see the prep notes! 

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In this episode, Callum and Jame go over the second big family of nonfermentors, Acinetobacter. In part 1 we talk about the organisms themselves, risk factors, clinical syndromes and diagnostics before talking a little about treatment. 

In Part 2 (released next week) we’ll talk about Carbapenem-Resistant Acinetobacter Baumanii-calcoaceticus (CRAB), and resistance mechanisms in general. 

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In part 2, we discuss the limited treatment options for pseudomonas infection, some wildcard options and the resistance mechanisms that make Pseudomonas such a tricky bugger to treat! 

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It was a long time coming, but it’s here. Jame and Callum set off on our mini-series, Nobbling the Nonfermentors, starting with an introduction to glucose-nonfermenting organisms before moving on to the biggie: Pseudomonas aeruginosa! 

Part 2 next week covers treatment of Pseudomonas, including a deep dive into Pseudomonas resistance mechanisms. Stay tuned!

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Prep notes for completed episodes can be found here (Not all episodes have prep notes).

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Jame and Callum were delighted to be invited as guests to the podcast Microbe Mail by host Vindana (Vin) Chibabhai. Check out the Microbe Mail podcast:
https://microbemail.captivate.fm/  @microbemail

We discuss how bactericidal and bacteriostatic are defined, what the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) are and why this isn't as simple as it first seems. We then discuss specific clinical situations and where bactercidal vs static have been compared.

Links/papers mentioned in this episode:

The basics of beta lactamases

Wald-Dickler N, Holtom P, Spellberg B. Busting the Myth of ‘Static vs Cidal’: A Systemic Literature Review. Clin Infect Dis. 2018 17;66(9):1470–4.

Use of bacteriostatic agents in Neutropenic fever:

The RCT referred to in the abstract is here:
Jaksic B, Martinelli G, Oteyza JP, Hartman CS, Leonard LB, Tack KJ. Efficacy and Safety of Linezolid Compared with Vancomycin in a Randomized, Double-Blind Study of Febrile Neutropenic Patients with Cancer. Clinical Infectious Diseases. 2006 Mar 1;42(5):597–607

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Questions, comments, suggestions to [email protected] or on Bluesky @idiots-pod.bsky.social

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Jame and Callum are together in person to talk about the importance of keeping your house in order. Being an infection specialist does not automatically make you an antimicrobial steward. We reflect on some challenges to being an antimicrobial steward  when practising infection medicine

The choosing wisely campaign mentioned by Jame:
https://www.choosingwisely.org/

A course on Antimicrobial Stewardship which is a good starting point:
https://www.futurelearn.com/courses/antimicrobial-stewardship

The IDSA guidance on AmpC production risk organisms mentioned by Jame:
https://www.idsociety.org/practice-guideline/amr-guidance/#AmpC%CE%B2-Lactamase-ProducingEnterobacterales

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We were delighted to be joined by Dr Anastasia "Tash" Theodosiou to talk about breastfeeding, antibiotics and the risks of antibiotic harm to mum and baby. Tash is an infectious diseases/medical microbiology trainee, host of the HelloMicro blog and has volunteered as a Breastfeeding Peer Supporter.

*Note the NICE guidelines have been updated and do not recommend trimethoprim in any stage of pregnancy

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2 years. It’s been a hell of a ride. Here’s to 2 more. 

Links from this episode: 

KASIC 1-page evidence-summary on aminopenicillins for resistant enterococcal UTIs:  https://bit.ly/44CtNnq

AUDIENCE SURVEY!!! 

Please do fill this out, it would mean a lot to us: https://forms.gle/aCq2djmfKPjA6tkMA. 

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This is the urine antibiotic drug penetrance you never knew you wanted. Jame might be prouder of this than his own children. Callum, as you will be able to tell, remains indifferent*.

Figure out which antibiotics you can trust, and which you can't. Use the table in the prep notes and links to win arguments, justify treating 'resistant' organisms in the urine, BREAK HEARTS - you name it!

Enjoy! 

Prep notes for this episode: https://idiots.notion.site/UTI-Drug-Choice-5deb611895254444a040bf78d2003cdb

*To the episode, he thinks Jame's children are delightful. 

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Catheter-associated UTI: Callum’s nemesis. His white whale. His Sauron. His favourite rant. 

Want to know how favourite? Listen on!

Show notes for this episode here

Useful links (see show notes for more)
RICAT study
Chlorhexidine meatal cleaning

Support the show

Questions, comments, suggestions to [email protected] or on Bluesky @idiots-pod.bsky.social

Prep notes for completed episodes can be found here (Not all episodes have prep notes).

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Feel like giving back? Donations of caffeine gratefully received!
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