Emerging Resistance to Empiric Antimicrobial Regimens for Pediatric Bloodstream Infections in Malawi (1998–2017)

By Pui-Ying Iroh Tam, Patrick Musicha, Kondwani Kawaza, Jenifer Cornick, Brigitte Denis, Bridget Freyne,  Dean Everett, Queen Dube, Neil French, Nicholas Feasey,Robert Heyderman

Clinical Infectious Diseases, To be Published July 2019

 

The adequacy of the World Health Organization’s Integrated Management of Childhood Illness (IMCI) antimicrobial guidelines for the treatment of suspected severe bacterial infections is dependent on a low prevalence of antimicrobial resistance (AMR). We describe trends in etiologies and susceptibility patterns of bloodstream infections (BSI) in hospitalized children in Malawi.

We determined the change in the population-based incidence of BSI in children admitted to Queen Elizabeth Central Hospital, Blantyre, Malawi (1998–2017). AMR profiles were assessed by the disc diffusion method, and trends over time were evaluated.

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Early Oseltamivir After Hospital Admission Is Associated With Shortened Hospitalization: A 5-Year Analysis of Oseltamivir Timing and Clinical Outcomes

By Jeremy Katzen, Rachel Kohn, Jessica L Houk, Michael G Ison

 Clinical Infectious Diseases, To be Published July 2019

 

Neuraminidase inhibitors (NAIs) are the only effective therapy for influenza, but few studies have assessed the impact of early NAI therapy on clinical outcomes or the patient-level factors that determine early NAI delivery in hospitalized patients.

We conducted a retrospective cohort study of all adults hospitalized in a metropolitan tertiary care hospital with confirmed influenza from April 2009 to March 2014. We performed logistic regression to determine patient-level factors that were associated with early NAI therapy. We analyzed the association of early NAI therapy with hospital lengths of stay (LOS) and in-hospital mortality rates using linear and logistic regression, respectively.

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The Infectious Diseases Society of America’s 10 × ’20 Initiative (10 New Systemic Antibacterial Agents US Food and Drug Administration Approved by 2020): Is 20 × ’20 a Possibility?

By George H Talbot, Amanda Jezek, Barbara E Murray, Ronald N Jones, Richard H Ebright, Gerard J Nau,  Keith A Rodvold, Jason G Newland,  Helen W Boucher

Clinical Infectious Diseases, To be Published July 2019

 

Infections caused by antibiotic-resistant bacteria, including carbapenem-resistant Enterobacteriaceae, have increased in frequency, resulting in significant patient morbidity and mortality. The Infectious Diseases Society of America continues to propose legislative, regulatory, and funding solutions to address this escalating crisis. This report updates the status of development and approval of systemic antibiotics in the United States as of late 2018.

We performed a review of the published literature and on-line clinical trials registry at www.clinicaltrials.gov to identify new systemically acting orally and/or intravenously administered antibiotic drug candidates in the development pipeline, as well as agents approved by the US Food and Drug Administration since 2012.

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Breakthrough pneumonia, meningitis and bloodstream infection due to Streptococcus pneumoniae during cefixime therapy.

By Novella Carannante, Carlo Pallotto, Mariano Bernardo, Enza Mallardo, Giovanni Di Caprio, Giulia Palmiero, Vittorio Attanasio & Carlo Tascini

Journal of Chemotherapy, June 19, 2019

 

Streptococcus pneumoniae is the main pathogen in invasive, life-threatening diseases such as bacteremia, meningitis, and pneumonia. We describe three cases of breakthrough pneumococcal severe life-threatening infections, including two meningitis and one bloodstream infection in patients treated with cefixime for otitis, sinusitis and pneumonia, respectively. Cefixime does not seem to be fully effective in treating invasive pneumococcal diseases. Because penicillin non-susceptibility might be linked to cefixime failure, the prompt knowledge of susceptibility to penicillin in S. pneumoniae might be very useful. Furthermore, MIC of cefixime should be measured because values >0.5 mg/L might be related to failure.

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Longer-Term Assessment of Azithromycin for Reducing Childhood Mortality in Africa

By Jeremy D. Keenan, M.D., Ahmed M. Arzika, M.S., Ramatou Maliki, M.S., Nameywa Boubacar, M.D., Sanoussi Elh Adamou, M.D., Maria Moussa Ali, M.P.H., Catherine Cook, M.P.H., Elodie Lebas, R.N., Ying Lin, M.P.H., Kathryn J. Ray, Ph.D., Kieran S. O’Brien, M.P.H., Thuy Doan, M.D., Ph.D., Catherine E. Oldenburg, Sc.D., M.P.H., E. Kelly Callahan, M.P.H., Paul M. Emerson, Ph.D., Travis C. Porco, Ph.D., M.P.H., and Thomas M. Lietman, M.D.

The New England Journal of Medicine, June 6, 2019

 

The MORDOR I trial (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) showed that in Niger, mass administration of azithromycin twice a year for 2 years resulted in 18% lower postneonatal childhood mortality than administration of placebo. Whether this benefit could increase with each administration or wane owing to antibiotic resistance was unknown.

In the Niger component of the MORDOR I trial, we randomly assigned 594 communities to four twice-yearly distributions of either azithromycin or placebo to children 1 to 59 months of age. In MORDOR II, all these communities received two additional open-label azithromycin distributions. All-cause mortality was assessed twice yearly by census workers who were unaware of participants’ original assignments.

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