SASPI Ltd.
RCTs having large positive / negative effect
Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis The ADAPT-Sepsis Randomized Clinical Trial
Authors: world health Organization 2024
Abstract
Key Points: Question Do critically ill adult patients hospitalized for suspected sepsis and treated with intravenous antibiotics based on procalcitonin (PCT) or C-reactive protein (CRP) protocols, have a safe reduction in treatment duration compared with standard care? Findings In this multicenter, randomized trial of 2760 patients, the daily PCT-guided protocol reduced total antibiotic duration and had noninferior all-cause mortality compared with standard care. No difference was found in total antibiotic duration between standard care and daily CRP-guided protocol, and CRP showed inconclusive results for all-cause mortality. Meaning In hospitalized adults, daily PCT-guided protocol reduced antibiotic duration safely compared with standard care, but daily CRP-guided protocol does not.
Systematic review/Scoping review with large effect size
Oral switch vs continued intravenous antibiotic therapy in patients with bacteraemia and sepsis: a systematic review and meta-analysis
Authors: Qinyuan Li et al.,
Abstract
Background: Bacteraemia and sepsis have traditionally required continued intravenous (IV) antibiotics.
Objectives: To evaluate if early transition to oral antibiotics is noninferior to continued IV antibiotic therapy in treating patients with bacteraemia and sepsis.
Data sources: MEDLINE, Embase, Web of Science, the Cochrane library, and Wanfang databases from inception to July 13, 2024, along with clinical trial registries and Google.com.
Study eligibility criteria: Randomised controlled trials (RCTs) and cohort studies.
Participants: Patients with bacteraemia and sepsis.
Interventions: Early transition to oral antibiotics versus continued IV antibiotics. Early oral switch was defined as 5-9 days for uncomplicated Staphylococcus aureus bacteraemia, <4 weeks for complicated Staphylococcus aureus bacteraemia, 3-7 days for uncomplicated Streptococcus bacteraemia, and 3-5 days for uncomplicated Enterobacterales bacteraemia.
Assessment of risk of bias: Cochrane risk of bias tool and Newcastle-Ottawa Scale.
Methods of data synthesis: Random-effects models were used to pool the data. The primary outcome was treatment failure. The non-inferiority margin for treatment failure was 10%. The GRADE approach was used to rate the certainty of the evidence.
Results: In total, 38 studies (6 RCTs, 10 adjusted cohorts, and 22 unadjusted cohorts) involving 11,566 patients were included. A primary analysis of 6 RCTs and 10 adjusted cohorts comprised 7,102 patients. High-certainty evidence from six RCTs showed that early transition to oral antibiotics was noninferior to continued IV therapy for treatment failure (n=529; OR 0.89; 95% CI: 0.54 to 1.48). Low-certainty evidence from five adjusted cohorts also found no significant difference in treatment failure between the two groups (n=929; OR 0.60; 95% CI: 0.29 to 1.72). Moderate-certainty evidence showed that oral switch therapy significantly reduced hospital stay (n=2,041; mean difference: -5.19 days; 95% CI: -8.16 to -2.22).
Conclusions: Early transition to oral antibiotics was noninferior to continued IV antibiotic treatment for bacteraemia and sepsis.
Systematic review/Scoping review with large effect size
Audit and Feedback Interventions for Antibiotic Prescribing in Primary Care: A Systematic Review and Meta-analysis
DOI: 10.1093/cid/ciae593
Authors: Alice X T Xu et al.,
Abstract
Background: This systematic review evaluates the effect of audit and feedback (A&F) interventions targeting antibiotic prescribing in primary care and examines factors that may explain the variation in effectiveness.
Methods: Randomized controlled trials (RCTs) involving A&F interventions targeting antibiotic prescribing in primary care were included in the systematic review. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and ClinicalTrials.gov were searched up to May 2024. Trial, participant, and intervention characteristics were extracted independently by two researchers. Random effects meta-analyses of trials that compared interventions with and without A&F were conducted for four outcomes:
1) total antibiotic prescribing volume;
2) unnecessary antibiotic initiation;
3) excessive prescription duration, and
4) broad-spectrum antibiotic selection. A stratified analysis was also performed based on study characteristics and A&F intervention design features for total antibiotic volume.
Results: A total of 56 RCTs fit the eligibility criteria and were included in the meta-analysis. A&F was associated with an 11% relative reduction in antibiotic prescribing volume (N=21 studies, rate ratio [RR]=0.89; 95% confidence interval [CI] 0.84, 0.95; I2=97); 23% relative reduction in unnecessary antibiotic initiation (N=16 studies, RR=0.77; 95%CI 0.68, 0.87; I2=72); 13% relative reduction in prolonged duration of antibiotic course (N=4 studies, RR=0.87 95%CI 0.81, 0.94; I2=86); and 17% relative reduction in broad-spectrum antibiotic selection (N=17 studies, RR=0.83 95%CI 0.75, 0.93; I2=96).
Discussion: A&F interventions reduce antibiotic prescribing in primary care. However, heterogeneity was substantial, outcome definitions were not standardized across the trials, and intervention fidelity was not consistently assessed.
Funding: Canadian Institutes of Health Research FRN 173704
Registration: Prospero (CRD42022298297)
Systematic review/Scoping review with large effect size
Microbiology of tattoo-associated infections since 1820
Authors: Sandeep Kondakala et al.,
Abstract
Summary: The increasing popularity of tattoos parallels the rise in microbial infections associated with tattooing. This two-part Series provides a comprehensive overview of microbial infections linked to tattoos dating back to 1820. This first paper in the Series particularly emphasises the changing landscape of infections since 2000, a period marked by enhanced public health regulations and growing awareness. It focuses on the microbiological aspects of these infections, including the types of microorganisms involved, their diversity, and prevalence. The evolving dynamics of tattoo-related microbial infections since 1820 has also been highlighted, during which the number of infections has increased substantially, from 105 cases (426 individuals) until 2000 to 215 cases (618 individuals) since then. The period since 2000 is characterised by the emergence of a more complex spectrum of microorganisms, transitioning from early observations of superficial pyogenic infections. Various species of bacteria, viruses, fungi, and parasites have been identified as novel pathogens.
Systematic review/Scoping review with large effect size
Causes, patterns, and epidemiology of tattoo-associated infections since 1820
Authors: Sunghyun Yoon et al.,
Abstract
Summary: Despite increased awareness and public health initiatives, the incidence of microbial infections related to tattoos has increased since 2000. Building on the first paper in this two-part Series, which detailed the microbiological aspects of tattoo-related infections over the past two centuries from 1820 to 2023, this second paper describes the patterns, causes, and other related epidemiological factors of these infections. Since 2000, bacterial outbreaks, particularly those caused by non-tuberculous mycobacteria, have increased, prompting a re-evaluation of tattoos as a serious public health risk. Insufficient hygiene practices have been the primary cause of microbial infections, with contaminated tattoo inks also contributing substantially, leading to 11 outbreaks and subsequent ink recalls. Although rare, the tattooing process can occasionally lead to life-threatening infections and fatalities. Tattoos by both professional and non-professional artists were associated with infections, suggesting that regulated environments do not necessarily eliminate risk. Additionally, individuals with compromised immune systems, especially those with HIV, were particularly vulnerable to infections such as Leishmania. Although permanent make-up is often perceived as safer than conventional tattoos, infections still occur, with 11 cases reported since 2010. Furthermore, polymicrobial infections involving multiple pathogens have posed challenges for diagnosis and treatment. Overall, these insights highlight the historical and emerging patterns of tattoo-related infections and can inform the development of more effective public health guidelines, enhance preventive measures, and guide future research on reducing the risks associated with tattoos.
Systematic review/Scoping review with large effect size
International consensus statement on microbiome testing in clinical practice
Authors: Serena Porcari et al.,
Abstract
Summary: There is growing interest in the potential exploitation of the gut microbiome as a diagnostic tool in medicine, but evidence supporting its clinical usefulness is scarce. An increasing number of commercial providers offer direct-to-consumer microbiome diagnostic tests without any consensus on their regulation or any proven value in clinical practice, which could result in considerable waste of individual and health-care resources and potential drawbacks in the clinical management of patients. We convened an international multidisciplinary expert panel to standardise best practices of microbiome testing for clinical implementation, including recommendations on general principles and minimum requirements for their provision, indications, pre-testing protocols, method of analyses, reporting of results, and potential clinical value. We also evaluated current knowledge gaps and future directions in this field. We aimed to establish a framework to regulate the provision of microbiome testing and minimise the use of inappropriate tests and pave the way for the evidence-based development and use of human microbiome diagnostics in clinical medicine.