Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟

Stay up-to-date in Infectious Diseases, Clinical Pharmacist, Antibiotics #IDXposts AKA #IDTwitter T🌟P influencer,@Wiki_Guidelines ,#Interstellar,#Dune,🌹❤️Misk

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

🔥🔥Wow. Our article is published! @BradSpellberg 🎉🔥🔥

A journey that started with a simple question: What’s in a name?

Today, I’m incredibly grateful to see our article published in @CMIComms :

“What’s in a Name? The Rise of Klebsiella pneumoniae: From Friedländer to Klebs”

This is my first publication as first author, and having this journey with my mentor, co-author, and friend, Dr. Spellberg, makes this milestone even more special.

K. pneumoniae is an organism I deal with almost every day—often as a notorious MDR pathogen. Writing this article gave me the opportunity to step back from the daily clinical challenge and explore the fascinating story behind its name.

From Friedländer → Klebs → K.pneumoniae.

Alhamdulillah. 🤲🏻

EnJoy!

#IDXposts
https://t.co/uDB9UsL53S

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

Notably, the patient had no history of colonization by S. maltophilia prior to the culture of PA-NM-086. L2 is a chromosomal class A serine β-lactamase in S. maltophilia . Hence, it is less likely to be readily transferred across species than the genes encoded on plasmids, which may explain why blaL2 was identified in only a handful of P. aeruginosa genomes. Both P. aeruginosa and S. maltophilia are ubiquitous environmental organisms found in soil, plant material, rivers, lakes, and streams and are cultured from individuals with cystic fibrosis , which may offer opportunities for genetic exchange

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

Super interesting 👀😎
🆕💥🟢L2 β-lactamase , a serine-based class A β-lactamases expressed by Stenotrophomonas maltophilia, contributes to ceftolozane-tazobactam resistance in Pseudomonas aeruginosa.

The authors report a novel mechanism of C/T resistance in P. aeruginosa partially mediated by an L2 β-lactamase independently of its canonical regulator, AmpRL2.

Additional studies are needed to better understand the processes that select for the transfer of resistance genes between P. aeruginosa and S. maltophilia. #idxposts https://t.co/Y4d3NyMazM

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

@drgabx @BradSpellberg @Contagion_Live @sebpoule

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

🆕💥 Beyond Approval: Finding the Right Place for Emerging Gram-Negative Antibiotics

Does US FDA approval tell us where a drug belongs in practice?

Not necessarily.

A great piece by @drgabx asking 3 important questions:

🎯 What unmet need does it address?
📊 What does the evidence actually support?
🛡️ How should stewardship guide its use?

Novelty is not synonymous with necessity. Stewardship should keep pace with—not outrun—the evidence.
https://t.co/kkLjrdWOFj #IDXposts

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

This is an excellent infographic ,a summary of the beta-lactamase inhibitors reviewed in the new @SIDPharm #Breakpoints episode "Beta-lactamase inhibitors: Scientifically elegant, just complex."
Link to podcast: EnJoy! https://t.co/b3bkwBRDkm
#idxposts #bookmark

[GreenDoc Gwen @ecogwendoc]

@PulmCrit @ABsteward And yet by lunchtime someone on the ward is on fluconazole because the sputum flagged Candida. Sasquatch still gets hunted.

[Asher Mendelson, MD PhD @AsherMendelson]

@PulmCrit @ABsteward @BraedonMcdonald is leading some very interesting research on this.

Patients with candida show higher rates of bacterial VAP, suggesting that it modulates the host-microbiome response.

But that doesn’t mean it needs to be treated, but more to learn.

[Brad Spellberg @BradSpellberg]

@PulmCrit @ABsteward Even in mouse models, during lethal infection you really don’t seed the lung. Candida does not like being in the lungs of mammals.

[Josh Farkas MD 💊 @PulmCrit]

@ABsteward Candida pneumonia is the Sasquatch of pulmonary infectious diseases.

I can't exclude that it exists somewhere, but I have yet to actually see it.

Nearly always contamination.

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

🆕💥🔴 Review Article
Antimicrobial dosing in critically ill patients with renal dysfunction #idxposts
https://t.co/xoxFulDoL0

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

Candida spp. are often recovered from respiratory cultures and usually interpreted as colonization
🆕💥🟢Single-center retrospective cohort study in #OFID
Antifungal therapy was not associated with lower 30-day mortality in time-dependent analysis (aHR, 1.25; 95% CI, 0.80-1.95) or weighted analysis (HR, 1.06; 95% CI, 0.64-1.75); 90-day analyses were also null. #IDXposts https://t.co/HARjwZBHE2

[Brad Spellberg @BradSpellberg]

@ABsteward Serious question. How is that procalcitonin has like 40 RCTs and all other diagnostic tests have almost none?

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

🆕💥💥🟢PROCALBAN RCT
In this single-centre trial in Bangladesh, procalcitonin-guided de-escalation reduced the duration of antibiotic therapy in adults with suspected bacterial sepsis
Median (interquartile range [IQR]) length of antibiotic therapy was 4.7 (2.8–8.0) days with procalcitonin-guided therapy compared to 9.0 (5.8–12.0) days in the control arm (p < 0.0001).
Thanks @Inox94 #idxposts @BradSpellberg
https://t.co/PqaIt0KQtA

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

@ITSaurabh87 @DrToddLee @BradSpellberg RE: dosing ? What dose they used for ASPs in SNAP ? They probably used the standard dosing, right?

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

In my opinion, this study shouldn’t even have been published in CID!
The authors are trying to convince us that pip tazo is worse than cefepime in pneumoniae using in vitro pk pd ELF etc while essentially ignoring all clinical data exactly what IDSA are doing in it's AMR guidance!
C'mon ...200 patients?
This study doesn’t prove what the authors are claiming.! @DrToddLee @BradSpellberg #idxposts

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

It's a small study ( n: 204) but published in CID!
In the same direction that anaerobic antibiotics causes higher mortality
The debate continues!
🆕💥🟢 Single-center retrospective cohort study
Cefepime vs piperacillin-tazobactam for the treatment of Pseudomonas aeruginosa pneumonia
All-cause mortality occurred more frequently in patients who received piperacillin-tazobactam (23.1%) compared with those receiving cefepime (11.5%; p = 0.04, OW odds ratio 2.38, 95% CI 1.05–5.42). No statistically significant differences in DOOR, clinical success, or resistance were observed #idxposts @DrToddLee https://t.co/PKMKKqqhZc

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

It's just one assumption, they are other reasons but I don't believe a single center 200 patients study just because it's published in CID proves cefepime is better than pip tazo in pseudo pneumoniae
All the reasons they mentioned including the one you add here are in vitro assumptions that may or may not translate into clinical outcomes
Can't wait @DrToddLee upcoming data

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

It's a small study ( n: 204) but published in CID!
In the same direction that anaerobic antibiotics causes higher mortality
The debate continues!
🆕💥🟢 Single-center retrospective cohort study
Cefepime vs piperacillin-tazobactam for the treatment of Pseudomonas aeruginosa pneumonia
All-cause mortality occurred more frequently in patients who received piperacillin-tazobactam (23.1%) compared with those receiving cefepime (11.5%; p = 0.04, OW odds ratio 2.38, 95% CI 1.05–5.42). No statistically significant differences in DOOR, clinical success, or resistance were observed #idxposts @DrToddLee https://t.co/PKMKKqqhZc

[Todd C. Lee @DrToddLee]

@ABsteward Look. It's just not possible this is real at odds ratio 2 when acorn trial exists (plus the other pip tazo vs cefepime trials)

I don't understand why journals will publish these sensational things which are impossible when compared to the actual randomized data

@gushamilton

[Todd C. Lee @DrToddLee]

@ABsteward Yes!!!! I don't know why our cefepime SR/MA isn't out yet --- but there are thousands of randomized patients comparing pip tazo to cefepime and guess which drug looks worse for mortality?

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

@BradSpellberg @DrToddLee Very interesting, thanks for sharing

[Brad Spellberg @BradSpellberg]

@ABsteward @DrToddLee Literature on thymidine or related metabolic changes in S. aureus during TMP-SMX Tx goes back to the 1970s. It's a little mixed, and clearly a complicated story. But may be a real phenomenon in high density bloodstream infections. One more recent paper: https://t.co/gHwy6Ct8kZ