Division of Infectious Diseases

Ongoing Debate on the Treatment of Staphylococcus aureus Bacteremia

Dr. Andre Kalil, our Director of Transplant Infectious Diseases, recently co-authored a reply to Geriak et al.: “Clinical Data on Daptomycin plus Ceftaroline versus Standard of Care Monotherapy in the Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia.” Debate around the findings of this article was recently featured by Dr. Razan El Ramahi in the IDSA ID journal club and on this blog. In their reply to… Continue Reading

Contraception and Antiretroviral Therapy: Important Interactions to Keep in Mind

Dr. Kimberly Scarsi recently published an important study in Lancet HIV: “Antiretroviral therapy and vaginally administered contraceptive hormones: a three-arm, pharmacokinetic study.”  We were excited to learn more about and feature her work! Could you please give us a brief summary of the study you performed? This was a pharmacokinetic evaluation of the effect of antiretroviral therapy (ART) on vaginally administered hormones. Overall, 84 women… Continue Reading

Blood culture contamination–it’s a big deal

Blood cultures are a key diagnostic test to detect bacteremia and appropriately treat patients with sepsis and are performed approximately 30 million times in the United States yearly. Unfortunately, contamination of blood cultures occurs in the 0.5% to 5% of samples (approximately 25% of positive blood cultures are due to contamination) which leads to inappropriate antibiotic treatment, additional unneeded tests, extended hospital length of stay,… Continue Reading

Decisive De-labelling in Cancer Patients: Just what the Doctor Ordered

The following was previously posted by Dr. Marcelin to SHEA Journal Club published online in January 2019. Although 10% of Americans report penicillin allergies, 90% of those allergies are not substantiated. Up to 25% of patients living with cancer report penicillin allergies, but more than half of these are low risk and could tolerate beta-lactams. Cancer patients are likely to receive inappropriate antibiotics for a… Continue Reading

Technology vs. Humans: Role of Rapid Diagnostics and Antimicrobial Stewardship in Cancer Patients

Rapid diagnostic testing (RDTs) plays an important role in Antimicrobial Stewardship Programs (ASP) and highlights the impact of the Microbiology laboratory on reducing inappropriate antibiotic use, particularly in hospitalized patients. Early microbial identification with RDTs can lead to earlier initiation of targeted antimicrobial therapy, which can in turn result in shorter hospitalization, fewer adverse events and reduced C. difficile infections. Other studies have shown that… Continue Reading

Ceftazidime-avibactam resistance in carbapenem-resistant Enterobacteriaceae: what’s next on the horizon?

Ceftazidime-avibactam is approved by the Food & Drug Administration (FDA) for treatment of complicated intra-abdominal and urinary tract infections, and has activity against carbapenem-resistant Enterobacteriaceae (CRE). Data regarding its real-world application and potential pitfalls is still emerging, and this review illustrates some experiences with use and emerging resistance to ceftazidime-avibactam. The authors of the first paper in this review “Pneumonia and Renal Replacement Therapy Are… Continue Reading

ID Journal Club – BLASTing Inappropriate Allergies out of the EMR with Antimicrobial Stewardship

BLASTing Inappropriate Allergies out of the EMR with Antimicrobial Stewardship The following is a review by one of our fellows Dr. Rajendra Karnatak from our last Journal Club, who discussed the article by Leis et al: Point-of-Care β-Lactam Allergy Skin Testing by Antimicrobial Stewardship Programs: A Pragmatic Multicenter Prospective Evaluation, Clinical Infectious Diseases, Volume 65, Issue 7, 1 October 2017, Pages 1059–1065. There is mounting evidence… Continue Reading

Dogma vs. Necessity: Follow-up blood cultures in patients with gram-negative negative bacteremia

Attending on the inpatient Infectious Disease service always stimulates discussion regarding management of bloodstream infections: What is the optimal duration? Can we use oral antibiotics? Do we need to document clearance of blood cultures? When these discussions lead to review of literature, one will find that the data is evolving in an attempt to answer these questions. Last month’s ID journal club included spirited discussions… Continue Reading

ID Journal Club Presents… Molecular Rapid Diagnostic Tests Improve Clinical Outcome

Bloodstream infections are associated with high mortality.  Blood cultures are a reliable and accurate method for the identification of bloodstream infections but can take up to 5 days or even more being finalized, leading to delays in initiation of effective antibiotic therapy. The Infectious Disease Society of America (IDSA) recommends the use of rapid diagnostic testing with support of antimicrobial stewardship for better clinical outcomes,… Continue Reading

Infectious Diseases Journal Club – Should Patients with CAUTI Receive Early Empiric Antibiotics?

On 10/17/2017, Dr. Ashraf discussed an interesting study during UNMC Infectious Diseases Division Journal Club. The study entitled, “Empirical Antibiotic Treatment Does Not Improve Outcomes in Catheter-Associated Urinary Tract Infection: Prospective Cohort Study” was conducted in Israel and published in the Journal Clinical Infectious Diseases in August 2017. In this prospective observational cohort study, the authors studied the outcome of adult patients with indwelling urinary catheters who… Continue Reading