Comparison of the Respiratory Resistomes and Microbiota in Children Receiving Short versus Standard Course Treatment for Community-Acquired Pneumonia

Pettigrew, Melinda M.; Kwon, Jae Hyun; Gent, Janneane F.; Kong, Yong; Wade, Martina; Williams, Derek J.; Creech, C. Buddy; Evans, Scott; Pan, Qing; Walter, Emmanuel B.; Martin, Judith M.; Gerber, Jeffrey S.; Newland, Jason G.; Hofto, Meghan E; Staat, Mary Allen; Fowler, Vance G.; Chambers, Henry F.; Huskins, W. Charles

doi:10.1128/mbio.00195-22

Cited by 19 publications

(10 citation statements)

References 46 publications

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“…In fact, recent evidence indicates that an early switch to oral therapy and, thus, a shorter initial duration of intravenous antibiotic treatment is effective in patients with PJIs (Boclé et al, 2021;Darley et al, 2011) and can potentially reduce the bacterial bioburden. As for the antibiotic stewardship and the risk reduction of antimicrobial resistance, as a new analysis of data from a randomized trial by Pettigrew et al (2022) provides more evidence in support of shorter antibiotic courses for young children with nonsevere community-acquired pneumonia (CAP) (Pettigrew et al, 2022); thus, this article supports the idea of "shorter is better" when it comes to antibiotic duration in the sense of less negative impact on the microbiota and less selection for resistance. Moreover, the shorter the duration of IV antibiotics, the less invasive the procedure is for patients, as IV therapy necessitates the use of an intravenous vascular access line, which can lead to infections and thromboembolic diseases (Tice et al, 2004).…”

Section: Discussionmentioning

confidence: 71%

Intravenous antibiotic duration in the treatment of prosthetic joint infection: systematic review and meta-analysis

Bouji

Wen

Dietz

2022

J. Bone Joint Infect.

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Abstract. Introduction: Long antibiotic courses, including intravenous (IV) and oral administrations, are utilized in prosthetic joint infection (PJI) treatment. This meta-analysis examines the non-inferiority of short courses (< 4 weeks) of IV antibiotics compared to long courses in treating PJI. Critical review of IV treatment is necessary due to the clinical, physical, and financial burden associated with it and its continued prolonged use in the US without much evidence to support the practice. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), databases were searched using predefined medical subject headings (MeSH). Results: The nine included studies reported 521 total hip arthroplasties (THAs) and 530 total knee arthroplasties (TKAs). There was no significant difference in the overall success rate in short- vs. long-duration IV antibiotics for PJI treatment: odds ratio (OR) of 1.65, 95 % confidence interval (CI) of 0.78–3.46, and p=0.18. However, due to the moderate to high heterogeneity (I2=68 %, p < 0.01) amongst studies, an adjusted success rate was calculated after the exclusion of two studies. This showed a statistically significant difference between both groups (OR of 2.45, 95 % CI of 1.21–4.96, p < 0.001) favoring a short course of antibiotics and reflecting a more homogenous population (I2=51 %, p=0.06). Conclusion: This study highlights the limited data available for evaluating IV antibiotic duration in the setting of PJI. We found that a shorter duration of IV antibiotics was non-inferior to a longer duration, with an improved OR of 2.45 for treatment success, likely shortening inpatient stay as well as lessening side effects and antimicrobial resistance with a lower cost to patients and overall healthcare.

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Section: Discussionmentioning

confidence: 71%

Intravenous antibiotic duration in the treatment of prosthetic joint infection: systematic review and meta-analysis

Bouji

Wen

Dietz

2022

J. Bone Joint Infect.

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“…In the several RCTs that evaluated the effect on resistance [ 42 ], shorter courses decreased the emergence of antibiotic resistance in respiratory secretions. For instance, children receiving 5 days of beta-lactam therapy for CAP had a significantly lower abundance of antibiotic resistance determinants than those receiving standard 10-day treatment [ 43 ].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Multidisciplinary Collaboration for the Optimization of Antibiotic Prescription: Analysis of Clinical Cases of Pneumonia between Emergency, Internal Medicine, and Pharmacy Services

et al. 2022

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Background: Pneumonia is a lung parenchyma acute infection usually treated with antibiotics. Increasing bacterial resistances force the review and control of antibiotic use criteria in different health departments. Objective: Evaluate the adequacy of antibiotic treatment in community-acquired pneumonia in patients initially attended at the emergency department and then admitted to the internal medicine service of the Alto Deba Hospital—Osakidetza Basque Country Health Service (Spain). Methods: Observational, retrospective study, based on the review of medical records of patients with community-acquired pneumonia attended at the hospital between January and May 2021. The review was made considering the following items: antimicrobial treatment indication, choice of antibiotic, time of administration of the first dose, adequacy of the de-escalation-sequential therapy, duration of treatment, monitoring of efficacy and adverse effects, and registry in the medical records. The review was made by the research team (professionals from the emergency department, internal medicine, and pharmacy services). Results: Fifty-five medical records were reviewed. The adequacy of the treatments showed that antibiotic indication, time of administration of the first dose, and monitoring of efficacy and adverse effects were the items with the greatest agreement between the three departments. This was not the case with the choice of antibiotic, de-escalation/sequential therapy, duration of treatment, and registration in the medical record, which have been widely discussed. The choice of antibiotic was optimal in 63.64% and might have been better in 25.45%. De-escalation/oral sequencing might have been better in 50.91%. The treatment duration was optimal in 45.45% of the patients and excessive in 45.45%. Discussion: The team agreed to disseminate these data among the hospital professionals and to propose audits and feedback through an antibiotic stewardship program. Besides this, implementing the local guideline and defining stability criteria to apply sequential therapy/de-escalation was considered essential.

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“…This will be an important opportunity to achieve better consensus about aetiology and diagnosis of LRTI, particularly ventilator-associated pneumonia (VAP), which has suffered from longstanding uncertainty and controversy [53,54] and drives most antimicrobial prescribing on ICU. Scoring systems have attempted to improve VAP diagnosis but are not recommended in guidelines [49], and clinical assessment without supportive microbiology contributes to pneumonia being frequently mis-diagnosed across the emergency pathway [55] treatment of LRTIs, including the impact of antibiotics on the resistome linked with treatment duration and antimicrobial stewardship decisions [56]. Over time accumulated datasets can be used to develop automated interpretation and decision support, including through machine learning linking metagenomic patterns with diagnosis, severity, treatment, and outcomes…”

Section: Clinical Service and Hospital Operational Requirementsmentioning

confidence: 99%

Respiratory metagenomics: route to routine service

Edgeworth

2023

Current Opinion in Infectious Diseases

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Purpose of reviewThe coronavirus disease 2019 pandemic demonstrated broad utility of pathogen sequencing with rapid methodological progress alongside global distribution of sequencing infrastructure. This review considers implications for now moving clinical metagenomics into routine service, with respiratory metagenomics as the exemplar use-case.Recent findingsRespiratory metagenomic workflows have completed proof-of-concept, providing organism identification and many genotypic antimicrobial resistance determinants from clinical samples in <6 h. This enables rapid escalation or de-escalation of empiric therapy for patient benefit and reducing selection of antimicrobial resistance, with genomic-typing available in the same time-frame. Attention is now focussed on demonstrating clinical, health-economic, accreditation, and regulatory requirements. More fundamentally, pathogen sequencing challenges the traditional culture-orientated time frame of microbiology laboratories, which through automation and centralisation risks becoming increasingly separated from the clinical setting. It presents an alternative future where infection experts are brought together around a single genetic output in an acute timeframe, aligning the microbiology target operating model with the wider human genomic and digital strategy.SummaryPathogen sequencing is a transformational proposition for microbiology laboratories and their infectious diseases, infection control, and public health partners. Healthcare systems that link output from routine clinical metagenomic sequencing, with pandemic and antimicrobial resistance surveillance, will create valuable tools for protecting their population against future infectious diseases threats.

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Comparison of the Respiratory Resistomes and Microbiota in Children Receiving Short versus Standard Course Treatment for Community-Acquired Pneumonia

Abstract: Antibiotic resistance is a major threat to public health. Treatment strategies involving shorter antibiotic courses have been proposed as a strategy to lower the potential for antibiotic resistance.

Cited by 19 publications

References 46 publications

Intravenous antibiotic duration in the treatment of prosthetic joint infection: systematic review and meta-analysis

Intravenous antibiotic duration in the treatment of prosthetic joint infection: systematic review and meta-analysis

Multidisciplinary Collaboration for the Optimization of Antibiotic Prescription: Analysis of Clinical Cases of Pneumonia between Emergency, Internal Medicine, and Pharmacy Services

Respiratory metagenomics: route to routine service

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