Breakpoints Society of Infectious Diseases Pharmacists

Episode Notes
The Society of Infectious Diseases Pharmacists is excited to invite you to the first ever meeting (via Breakpoints) of The Tortured Stewards & Surgeons Department. Today’s agenda items: optimal management of perioperative antibiotics and prevention of surgical site infections.

Drs. Trisha Peel (@DrTrishaPeel), Michael Calderwood (@CalderwoodMD) and Patch Dellinger join Dr. Jillian Hayes (@thejillianhayes) to discuss some of the controversies we encounter while managing antibiotics in the perioperative space. Does anyone really need post-op antimicrobial prophylaxis longer than 24 hours? Where should vancomycin be fitting into surgical prophylaxis regimens? Can we truly give pre-operative cefazolin to patients with a penicillin allergy? Tune in for the answers to these questions and more!

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About
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If you’d like more information about the CALIPSO trial, please visit this link: https://www.anzca.edu.au/profiles/ctn-trials/underway/calipso

Bibliography


SSI Infection Prevention Review: https://jamanetwork.com/journals/jama/article-abstract/2800424#:~:text=Six%20are%20supported%20by%20randomized,use%20a%20chlorhexidine%20gluconate%2Dalcoho
Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update: https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/strategies-to-prevent-surgical-site-infections-in-acutecare-hospitals-2022-update/2F824B9ADD6066B29F89C8A2A127A9D
American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update: https://journals.lww.com/journalacs/citation/2017/01000/american_college_of_surgeons_and_surgical.8.aspx 
2017 CDC Guidelines: https://jamanetwork.com/journals/jamasurgery/fullarticle/2623725 
2018 WHO Guidelines: https://arthroplasty.biomedcentral.com/articles/10.1186/s42836-022-00113-y 
ASHP Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery: https://www.ashp.org/surgical-guidelines 
Surgeons as Stewards: https://journals.lww.com/journalacs/citation/2020/12000/perioperative_antibiotic_prophylaxis__surgeons_as.23.aspx 
Li et al, Arthroplasty 2022: https://arthroplasty.biomedcentral.com/articles/10.1186/s42836-022-00113-y 
Dutch Arthroplasty Register Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023957/ 
de Jonge Meta-Analysis on duration and incidence of SSI: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30084-0/abstract 
Prolonged Antibiotic Prophylaxis After Cardiovascular Surgery and Its Effect on Surgical Site Infections and Antimicrobial Resistance: https://www.ahajournals.org/doi/10.1161/01.cir.101.25.2916?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
RCT - Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs: https://jamanetwork.com/journals/jama/article-abstract/2810510 
NYU Langone Study - Preventing Surgical Site Infections: A Randomized, Open-Label Trial of Nasal Mupirocin Ointment and Nasal Povidone-Iodine Solution: https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=91dee3e1445adb80d533f2c210816a3285254e3a 
Trial of Vancomycin and Cefazolin as Surgical Prophylaxis in Arthroplasty: https://www.nejm.org/doi/full/10.1056/NEJMoa2301401
What Is the Primary Driver of Preoperative Vancomycin Use? It’s Not Methicillin-resistant Staphylococcus aureus—or Allergy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744972/ 
Drug allergy: a 2022 practice parameter update: https://www.jacionline.org/article/S0091-6749(22)01186-1/fulltext 
Perioperative use of cefazolin without preliminary skin testing in patients with reported peni

In this episode, Drs. Helen Boucher (@hboucher3), Ramy Elshaboury, and Mike Dudley (@MikeMNDudley) join host, Megan Klatt (@MeganKlatt3), to discuss barriers to antimicrobial drug development, potential incentives and legislation to promote market growth, and what we can do to ensure the antimicrobial pipeline doesn’t run dry.

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @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

References


An analysis of antibacterial drug development trends in the United States, 1980-2019: Dheman N, et al. Clin Infect Dis. 2021 Dec 6;73(11):e4444-e4450. doi:10.1093/cid/ciaa859. PMID: 32584952.
Antibacterial R&D at a crossroads: we’ve pushed as hard as we can…now we need to start pulling!: Rex JH, Outterson K. Clin Infect Dis. 2021 Dec 6;73(11):e4451-4453. doi:10.1093/cid/ciaa852. PMID: 32584949.
No Patient Left Behind (website): https://www.nopatientleftbehind.org/ (many useful explainers of how the investment, innovation cycle, and drug pricing work)
ISPOR special task force report on defining elements of value in health care – a health economics approach: Lakdawalla DN, et al. Value Health. 2018 2018 Feb;21(2):131-139. doi: 10.1016/j.jval.2017.12.007. PMID: 29477390.
Generalized cost-effectiveness analysis to assess treatment value in hepatitis C: Chou JW, et al. Am J Manag Care. 2023 Dec;29(12):696-703. doi: 10.37765/ajmc.2023.89468. PMID: 38170486.

It's time to arm yourselves with all the resources on antimicrobial locks! Join our experts, Drs. Louise-Marie Oleksiuk (@CanRowPharm), Nasia Safdar (@NasiaSafdar), Joel Topf (@kidney_boy), and our wonderful host, Dr. Julie Justo (@julie_justo), to discuss the ins and outs of antimicrobial locks and how to implement them! Funding for this podcast was provided by CorMedix Inc

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @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

References


https://drive.google.com/file/d/1K0A4Bomhbcn7AZJ1JFOWW8EdEZq-aZcd/view?usp=sharing
https://drive.google.com/file/d/1PRoQzEKJ1c0pa1XFc4yasxsMhx2A1DFU/view?usp=sharing
Helpful antimicrobial lock review: Justo JA, Bookstaver PB. Infect Drug Resist. 2014 Dec 12;7:343-63. doi: 10.2147/IDR.S51388. PMID: 25548523.
LOCK IT-100 Trial: Agarwal AK, et al. Clin J Am Soc Nephrol. 2023 Nov 1;18(11):1446-1455. doi: 10.2215/CJN.0000000000000278. PMID: 37678222.
Cochrane review: Arechabala MC, et al. Cochrane Database Syst Rev. 2018 Apr 3;4(4):CD010597. doi: 10.1002/14651858.CD010597.pub2. PMID: 29611180.
Cost-effectiveness of ethanol lock ppx with newer dehydrated alcohol product: Raghu VK, et al. JPEN J Parenter Enteral Nutr. 2022 Feb;46(2):324-329. doi: 10.1002/jpen.2130. PMID: 33908050.
Antimicrobial lock development/implementation in a pediatric hospital: Zembles TN, et al. Am J Health Syst Pharm. 2018 Mar 1;75(5):299-303. doi: 10.2146/ajhp161056. PMID: 29472511.
Dr. Topf’s tweet surveying the prevalence of antimicrobial lock use in dialysis units
CRBSIs in hemodialysis patients before and during the COVID-19 pandemic: Johansen KL, et al. Clin J Am Soc Nephrol. 2022 Mar;17(3):429-433. doi: 10.2215/CJN.11360821. PMID: 35110377.
Antiseptic barrier caps review and meta-analysis: Gillis VELM, et al. Am J Infect Control. 2023 Jul;51(7):827-835. doi: 10.1016/j.ajic.2022.09.005. PMID: 36116679.

Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.

Drs. Thomas Holland and Vance Fowler (@VanceFowler5) join Drs. Steven Tong (@syctong) and Erin McCreary (@ErinMcCreary) to discuss the ERADICATE study and the role of ceftobiprole for the treatment of complicated Staphylococcus aureus bacteremia. This session was recorded live on Tuesday, February 6th, 2024 featuring an international audience.

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Article: https://www.nejm.org/doi/full/10.1056/NEJMoa2300220

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Drs. Robert Bonomo, Ryan Shields (@ryankshields), and Erin McCreary (@ErinMcCreary) deep dive into the world of metallo-beta-lactamases. This riveting discussion is full of the nerdiest pub trivia nuggets and the “must know” details of novel beta lactams and beta-lactamase inhibitors, and their uses for MBLs. Funding for this podcast was provided by Shionogi Inc.

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References:


Urgent need for metallo B lactamase: DOI: 10.1016/S1473-3099(20)30868-9
NDM-9 Resistance to Taniborbactam: DOI 10.1016/S1473-3099(23)00069-5
AAC Taniborbactam inhibition of NDM-1: DOI 10.1128/aac.01332-23
OFID NDM E. coli with cefiderocol and aztreonam/avibactam resistance: DOI 10.1093/ofid/ofad276

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New accreditation standards making your head spin? Are you stressed and don’t know where to start? Well, on this episode of Breakpoints Drs. Arjun Srinivasan and Jose Alexander (Alex) join Luis Plaza from Let’s Talk Micro (@letstalkmicro1) and Dr. Jeannette Bouchard (@jlbouchard001) to breakdown what you need to know and where to start when it comes to the NHSN Antimicrobial Resistance (AR) module and the new College of American Pathologist’s standards.
 
Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/ 

References:


CDC AR Validation Guide: https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/aur/ar-validation-508.pdf
CLSI Toolkit: https://clsi.org/meetings/ast/breakpoints-in-use-toolkit/

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