SASPI Ltd.
RCTs having large positive / negative effect
Cost-effectiveness of faecal microbiota transplantation compared with vancomycin monotherapy for early Clostridioides difficile infection: economic evaluation alongside a randomised controlled trial
Authors: Camilla R. Birch et al.,
Abstract
For Clostridioides difficile infection (CDI), faecal microbiota transplantation (FMT) is currently recommended for patients with three or more CDI episodes. A recent randomised controlled trial (RCT) show that FMT may be considered early, defined as intervention during the first or second CDI episode. Compared with standard care for first or second CDI, patients randomised to FMT had €1,645 lower hospital costs over 26 weeks owing to fewer admissions and hospital contacts and less medication use.neumonia in high burden settings was predominantly in young infants and clinically indistinguishable from RSV. HMPV-positives had low case fatality, similar to that in RSV-positives.
Position Statement based on review/RCTs, Guideline based on systematic review
Preventing Ventilator-Associated Pneumonia: A position paper of the International Society for Infectious Diseases, 2024 update
Authors: Victor Daniel Rosentha et al.,
Abstract
Highlights
* The VAP rates continue to be very high, especially in resource-limited regions.
* VAP s are associated with extra hospital stays, costs, and mortality.
* This document presents the main risk factors for VAP.
* We updated the recommendations for VAP prevention including resource-limited regions.
Objectives: This review by a panel of experts convened by the International Society for Infectious Diseases (ISID) aims to consolidate current recommendations for preventing ventilator-associated pneumonia (VAP). It provides insights into VAP rates, the attributable extra length of stay, costs, mortality, and risk factors in high-income and low- and middle-income countries.
Methods: A comprehensive review of existing recommendations and evidence-based strategies for preventing VAP was conducted. The expert panel analyzed data on VAP incidence, associated healthcare burdens, and risk factors across different economic settings to formulate applicable preventive measures.
Results: The review identifies significant differences in VAP rates, healthcare costs, extra length of hospital stay, and mortality between high-income and low- and middle-income countries. Evidence-based strategies for preventing VAP were highlighted, demonstrating their effectiveness across different healthcare settings.
Conclusions: The recommendations and insights provided in this position paper aim to guide healthcare professionals in effectively preventing ventilator-associated pneumonia. The adoption of evidence-based preventive strategies can potentially reduce VAP rates, and associated costs, and improve patient outcomes in both high-income and low- and middle-income countries.
Position Statement based on review/RCTs, Guideline based on systematic review
Preventing Catheter-Associated Urinary Tract Infections: A position paper of the International Society for Infectious Diseases, 2024 update
Authors: Victor Daniel Rosentha et al.,
Abstract
Highlights
* CAUTI rates continue to be very high, especially in resource-limited regions.
* CAUTIs are associated with extra hospital stays, costs, and mortality.
* This document presents the main risk factors for CAUTI.
* We updated the recommendations for CAUTI prevention including resource-limited regions.
Objectives: This review, conducted by a panel of experts assembled by the International Society for Infectious Diseases (ISID), seeks to consolidate the latest recommendations for preventing catheter-associated urinary tract infections (CAUTI). It offers insights into CAUTI rates, the associated extended hospital stays, costs, mortality, and risk factors across both high-income and low- to middle-income countries.
Methods: An in-depth review of current recommendations and evidence-based strategies for CAUTI prevention was undertaken. To develop practical preventive measures, the expert panel examined data on CAUTI incidence, related healthcare impacts, and risk factors across various economic contexts.
Results: The review highlights notable differences in CAUTI rates, healthcare costs, extended hospital stays, and mortality between high-income and low- to middle-income countries. It emphasizes evidence-based strategies for CAUTI prevention, demonstrating their effectiveness across diverse healthcare environments.
Conclusions: This position paper offers recommendations and insights intended to assist healthcare professionals in effectively preventing CAUTI. Implementing evidence-based preventive strategies has the potential to lower CAUTI rates, reduce related costs, and enhance patient outcomes in both high-income and low- to middle-income countries.
Position Statement based on review/RCTs, Guideline based on systematic review
Antibiotic therapy and prophylaxis of infective endocarditis – A SPILF-AEPEI position statement on the ESC 2023 guidelines
Authors: Vincent Le Moing et al.,
Abstract
Highlights
The Association pour l’Étude et la Prévention de l’Endocardite Infectieuse (AEPEI) and The Société de Pathologie Infectieuse de Langue Française (SPILF) are providing a consensus statement on the antibiotic treatment and prophylaxis of infective endocarditis (IE) based on the European Society of Cardiology guidelines published in 2023.
Antibiotic prophylaxis in patients at high risk of IE should be prescribed only before at-risk oro-dental situations.
In streptococcal IE, choice of β-lactam should be based on the Minimal Inhibitory Concentration (MIC).
In staphylococcal prosthetic valve IE, two antibiotics should be used, combining an antistaphylococcal agent (β-lactam or daptomycin) and gentamicin replaced by rifampicin after sterilization of blood cultures.
Switch to oral antibiotic therapy may be implemented for patients with streptococcal IE meeting the relevant stability criteria (apyrexia for at least 2 days, C-reactive protein < 25 % of its maximum value or < 20 mg/L, and leukocytes < 15 x10^9/L) after at least 10 days of effective IV antibiotic therapy and at least 7 days after valve surgery in stable patients.
Position Statement based on review/RCTs
Global vaccination against hepatitis E virus: position paper from the ESGVH-ESCMID
Authors: Susanne Dudman et al.,
Abstract
Scope: Hepatitis E Virus (HEV) is a significant global health issue, impacting both low- and middle-income countries (LMICs) and industrialized nations. HEV genotypes 1 and 2, primarily transmitted through contaminated water, are endemic in LMICs, while genotypes 3 and 4 are zoonotically transmitted in industrialized regions. Acute HEV infection poses severe risks, particularly to pregnant women and immunocompromised individuals, while chronic HEV infection leads to serious complications in those with pre-existing liver disease and transplant recipients. The development of an HEV vaccine offers new prevention opportunities, though its availability and integration into global immunization programs remain limited.
Methods: This position paper was developed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Viral Hepatitis Study Group (ESGVH) through an extensive review of clinical data, safety profiles, efficacy, and immunogenicity of HEV vaccines. The study group focused particularly on high-risk and special populations, synthesizing global health insights and incorporating recommendations from the Strategic Advisory Group of Experts (SAGE) to formulate strategies for wider HEV vaccination use.
Questions Addressed in the Position Paper: The position paper evaluates the efficacy and safety of HEV vaccines in both general and special populations. It identifies key barriers to the integration of HEV vaccines into routine immunization programs, including infrastructure limitations, costs, and vaccine accessibility. The paper also proposes strategies to overcome these challenges and improve vaccine distribution. Furthermore, it addresses ways to enhance public awareness and international cooperation to promote HEV vaccination efforts globally.
Implications: ESGVH-ESCMID recommends HEV vaccination for high-risk groups, including women of childbearing age, patients with chronic liver diseases, and immunosuppressed individuals. Prioritizing investments in vaccine logistics, integrating diagnostics, and educational outreach can enhance uptake.
Other specific ISP article suggested by Editorial Board
No detrimental effect on the hand microbiome of health care staff by frequent alcohol-based antisepsis
Authors: Axel Kramer et al.,
Abstract
Highlights
* Effect of frequent ethanol-based hand rubs (EBHR) on hand microbiome was unknown
* More than 100 daily uses of EBHR did not significantly affect the hand microbiome
* Consistent use of EBHR causes end-of-day increase of Gram-positive bacteria
* Over a 28-day period, EBHR usage led to higher similarity of the Eukaryota
Background: The importance of ethanol-based hand rubs (EBHR) to prevent health care-associated infections is undisputed. However, there is a lack of meaningful data regarding the influence of EBHRs on skin microbiome.
Methods: Four nurses in a neonatal intensive care unit were included. After a leave of 14 days, samples were taken before the first hand rubbing action and at the end of shift, with continued sampling on days 1, 7 and 28. To analyze the hand microbiome, microbial cells were collected using the glove-juice technique. Pro- and eukaryotic community profiles were created using amplicon sequencing of 16S and 18S rRNA gene markers.
Results: On average, hand antisepsis was performed 108 times per 8-hour work shift. Microbial communities were dominated by typical taxa found on human skin. In addition, a clear nurse-specific (i.e. individual) microbiome signature could be observed. For Prokaryota, daily exposure led to the end-of-the-day microbiomes being more similar to each other across nurses. In contrast, longitudinal effect of 28 day-application revealed more similarity of the Eukaryotic community.
Conclusions: Frequent occupational use of EBHR did not adversely affect the composition of the human hand microbiome. Thus, daily hand antisepsis retains its significance as the most important procedure for infection control.
Other specific ASP article suggested by Editorial Board
Efficacy and safety of antistaphylococcal penicilin or cephazolin-based combinations versus monotherapy for methicillin-susceptible Staphylococcus aureus infective endocarditis. A propensity score analysis of nationwide prospective cohort.
Authors: Jorge Calderón-Parra et al.,
Abstract
Highlights
* Propensity score analysis of a prospective multicenter endocarditis cohort.
* Antistaphylococcal penicillin or cephazolin alone versus in combination therapy.
* Patients with native valve infective endocarditis due to Staphylococcus aureus.
* Combination treatment did not result in better clinical outcomes.
* Combination antibiotics were associated with more frequent adverse effects.
Objectives: We aimed to evaluate the usefulness of antistaphylococcal penicillin (ASP) or cephazolin-based combinations versus monotherapy in patients with native-valve infective endocarditis (IE) caused by methicillin-susceptible Staphylococcus aureus (MSSA).
Methods: Post-hoc analysis of a multicentre prospective cohort. We include patients from 2008 to 2022, with definite native-valve, left-side IE due to MSSA treated primarily with ASP/cephazolin. Patients were categorized according to whether they initially received monotherapy or combination therapy for more than 72 hours. A propensity score-matched cohort was planned.
Results: Out of 420 included cases, 94 (22.4%) received monotherapy and 326 (77.6%) combination. Median combination duration was 14 days (interquartile range 10-20).
Sixty-eight combination cases were matched with 68 monotherapy controls. Baseline characteristics were well balanced. There were no differences in in-hospital or one-year mortality between groups (OR 0.85, 95%CI 0.33-2.18 and HR 0.68, 95%CI 0.35-1.31, respectively). Endocarditis relapses and persistent bacteraemia rates were similar (0% vs 1.5%, p=1.000; and 19.1% vs 13.2%, p=0.352, respectively). Drug-related adverse events were more frequent in combination group (15.0% vs 1.1%, p<0.001).
Conclusions: Antibiotic combination for patients with native valve left-sided MSSA endocarditis did not improve patient’s outcomes. Drug-related adverse events were more frequent in combination patients.
Other specific ASP article suggested by Editorial Board
Evolution of Pharmacist Roles in Antimicrobial Stewardship: A 20-Year Systematic Review
Authors: Vrinda Nampoothiri et al.,
Abstract
Highlights
* Pharmacist roles in antimicrobial stewardship (AMS) predominantly from the USA.
* Evidence from lower-middle and low-income countries is gradually emerging.
* Pharmacists’ involvement in AMS positively impacts patient outcomes.
* Efforts to facilitate pharmacists’ roles in AMS across all countries are required.
Introduction: Whilst pharmacists are recognized as key contributors to antimicrobial stewardship (AMS) programs, the extent of their participation varies in different countries. We report a systematic review of pharmacists’ roles in AMS over 20 years.
Methods: A systematic review of the literature describing pharmacist-led or driven AMS and its outcomes published in English between 01 January 2000 and 30 June 2020 was conducted across the main databases for research publication.
Results: The analysis included 111 papers, of which 77.5% (86/111) were from high-income countries (HIC) predominantly from the USA. While pharmacist-led or driven AMS interventions were reported only from HICs in the early 2000s, the review found a progressive rise in such studies from all income settings with audit and feedback being the most frequent intervention reported. Between 2016 and 2020, studies on pharmacists-led or driven outpatient AMS and interventions related to beta-lactam or penicillin allergy were reported from HICs. Key outcomes reported include improved appropriateness of antimicrobial therapy and decreased consumption of antimicrobials.
Conclusion: Existing evidence demonstrates the positive impact of pharmacists’ involvement in AMS. There needs to be a concerted effort in facilitating pharmacists’ roles in AMS across all countries, irrespective of income setting.