Guidelines for Diagnosis and Management of Infective Endocarditis in Adults

JAMA Network Open, Год журнала: 2023, Номер 6(7), С. e2326366 - e2326366

Опубликована: Июль 31, 2023

Importance Practice guidelines often provide recommendations in which the strength of recommendation is dissociated from quality evidence. Objective To create a clinical guideline for diagnosis and management adult bacterial infective endocarditis (IE) that addresses gap between evidence strength. Evidence Review This consensus statement systematic review applied an approach previously established by WikiGuidelines Group to construct collaborative guidelines. In April 2022 call new existing members was released electronically (social media email) next topic, subsequently, topics questions related IE were crowdsourced prioritized vote. For each PubMed literature searches conducted including all years languages. reported according charter: clear only when reproducible, prospective, controlled studies provided hypothesis-confirming absence such data, reviews crafted discussing risks benefits different approaches. Findings A total 51 10 countries reviewed 587 articles submitted information relevant 4 sections: establishing (9 questions); multidisciplinary teams (1 question); prophylaxis (2 treatment (5 questions). Of 17 unique questions, could be 1 question: 3 randomized trials have oral transitional therapy at least as effective intravenous (IV)–only IE. Clinical generated remaining questions. Conclusions Relevance this WikiGuideline method development, IV-only Several are underway inform other areas practice, further research needed.

Язык: Английский

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Sustainable Solutions to the Continuous Threat of Antimicrobial Resistance

Health Affairs Scholar, Год журнала: 2025, Номер 3(2)

Опубликована: Янв. 24, 2025

Abstract To combat antimicrobial resistance (AMR), advocates have called for passage of the Pioneering Antimicrobial Subscriptions End Upsurging Resistance (PASTEUR) Act in United States, which would appropriate $6 billion new taxpayer-funded subsidies antibiotic development. However, number antibiotics clinical development, and US Food Drug Administration approvals antibiotics, already markedly increased last 15 years. Thus, instead focusing on more economic subsidies, we recommend reducing selective pressure driving AMR by (1) establishing pay-for-performance mechanisms that disincentivize overprescribing (2) existing research development funding strategies decrease reliance (3) changing regulation or law to require specialized training stewardship a clinician be able prescribe target unmet need. stabilize market, establishment an advisory board practitioners accurately incentives endowment nonprofit companies sustainably self-fund discovery, creating bench molecules can partnered with industry at later stages

Язык: Английский

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Tackling antibiotic resistance by inducing transient and robust collateral sensitivity

Nature Communications, Год журнала: 2023, Номер 14(1)

Опубликована: Март 30, 2023

Abstract Collateral sensitivity (CS) is an evolutionary trade-off traditionally linked to the mutational acquisition of antibiotic resistance (AR). However, AR can be temporally induced, and possibility that this causes transient, non-inherited CS, has not been addressed. Mutational ciprofloxacin leads robust CS tobramycin in pre-existing antibiotic-resistant mutants Pseudomonas aeruginosa . Further, strength phenotype higher when nfxB mutants, over-producing efflux pump MexCD-OprJ, are selected. Here, we induce transient -mediated by using antiseptic dequalinium chloride. Notably, induction renders analyzed clinical isolates, including tobramycin-resistant isolates. combining with chloride drive these strains extinction. Our results support could allow design new strategies tackle infections, avoiding mutations on which inherited depends.

Язык: Английский

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Personalising intravenous to oral antibiotic switch decision making through fair interpretable machine learning

Nature Communications, Год журнала: 2024, Номер 15(1)

Опубликована: Янв. 13, 2024

Abstract Antimicrobial resistance (AMR) and healthcare associated infections pose a significant threat globally. One key prevention strategy is to follow antimicrobial stewardship practices, in particular, maximise targeted oral therapy reduce the use of indwelling vascular devices for intravenous (IV) administration. Appreciating when an individual patient can switch from IV antibiotic treatment often non-trivial not standardised. To tackle this problem we created machine learning model predict could based on routinely collected clinical parameters. 10,362 unique intensive care unit stays were extracted two informative feature sets identified. Our best achieved mean AUROC 0.80 (SD 0.01) hold-out set while being biased individuals protected characteristics. Interpretability methodologies employed create clinically useful visual explanations. In summary, our provides individualised, fair, interpretable predictions IV-to-oral treatment. Prospectively evaluation safety efficacy needed before such technology be applied clinically.

Язык: Английский

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Seven vs Fourteen Days of Antibiotics for Gram-Negative Bloodstream Infection

JAMA Network Open, Год журнала: 2025, Номер 8(3), С. e251421 - e251421

Опубликована: Март 21, 2025

Importance Gram-negative bloodstream infections are a common cause of hospitalization. A 2-week duration antibiotic therapy has been commonly used, but shorter durations may have similar outcomes. Objectives To assess whether 7 days was noninferior to 14 days. Data Sources Starting with 2022 individual patient data meta-analysis, PubMed, Cochrane Central Register Controlled Trials, and Web Science were searched identify additional eligible randomized clinical trials (RCTs) conducted from May 1, 2022, until November 30, 2024. Study Selection RCTs involving primarily adults who hospitalized at the time infection allocated or therapy. Studies independently reviewed by 2 investigators. Extraction Synthesis PRISMA guidelines followed. extracted Any unpublished obtained directly study authors. Risk bias certainty evidence assessed in duplicate using Bias Tool, version 2, Grading Recommendations Assessment, Development Evaluation approach. pooled separate random-effects meta-analyses for intention-to-treat (ITT) per-protocol (PP) populations. noninformative prior probability used effect, an evidence-based weakly informative heterogeneity. ratios (RRs), 95% credible intervals (CrIs), noninferiority calculated prespecified upper bound 1.25 less. Main Outcomes Measures Ninety-day all-cause mortality. Results Four contributed 3729 patients ITT population (1912 women [51.3%]; median age range, 67-79 years) 3126 PP population. In analysis, within 90 days, 226 (12.8%) receiving antibiotics died compared 253 (13.7%) corresponding RR 90-day mortality 0.91 (95% CrI, 0.69-1.22) 97.8% noninferiority. 0.93 0.68-1.32), 95.1% Conclusions Relevance this systematic review meta-analysis adequate source control, had high being These findings support appropriately selected like those included RCTs.

Язык: Английский

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Clinical pharmacological considerations in an early intravenous to oral antibiotic switch: are barriers real or simply perceived?

Clinical Microbiology and Infection, Год журнала: 2023, Номер 29(9), С. 1120 - 1125

Опубликована: Апрель 12, 2023

Язык: Английский

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Prioritization of Randomized Clinical Trial Questions for Children Hospitalized With Common Conditions

JAMA Network Open, Год журнала: 2024, Номер 7(5), С. e2411259 - e2411259

Опубликована: Май 15, 2024

Importance There is a lack of randomized clinical trial (RCT) data to guide many routine decisions in the care children hospitalized for common conditions. A first step addressing shortage RCTs this population identify most pressing RCT questions with Objective To important and feasible Design, Setting, Participants For consensus statement, 3-stage modified Delphi process was used virtual conference series spanning January 1 September 29, 2022. Forty-six individuals from 30 different institutions participated process. Stage involved construction 10 pediatric conditions leading hospitalization. condition-specific guidelines reviews structured literature search inform their development questions. During stage 2, were refined scored according importance. 3 incorporated public comment feasibility prioritization Main Outcomes Measures The main outcome framed PICO (population, intervention, control, outcome) format ranked importance feasibility; score choices ranged 9, higher scores indicating greater feasibility. Results (38 who shared demographic data; 24 women [63%]) our included children’s hospital (n = 14) community 13) pediatricians, parents 4), other clinicians 2), biostatisticians researchers 11). yielded 62 unique questions, which are pragmatic, comparing interventions widespread use definitive effectiveness lacking. Overall median 5 (IQR, 4-7). Six top selected focused on determining optimal antibiotic regimens infections (pneumonia, urinary tract infection, cellulitis). Conclusions Relevance This statementhas identified list can investigators funders conducting impactful trials improve outcomes children.

Язык: Английский

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Global collaborations in antimicrobial stewardship: All hands on deck

Antimicrobial Stewardship & Healthcare Epidemiology, Год журнала: 2023, Номер 3(1)

Опубликована: Янв. 1, 2023

Tackling antimicrobial resistance (AMR) through stewardship (AMS) interventions is a key objective within the World Health Organization (WHO)'s Global Action on AMR. We outline reasons why global collaborations for AMS are needed. provide examples of collaborations, and we offer considerations when starting health journey focused AMS.

Язык: Английский

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Bone Voyage: Navigating Updates in the Management of Bone and Joint Infections

Current Infectious Disease Reports, Год журнала: 2025, Номер 27(1)

Опубликована: Янв. 2, 2025

Язык: Английский

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Managing Bacteremia: Insights Into Pathogen-Specific Treatment

Cureus, Год журнала: 2025, Номер unknown

Опубликована: Фев. 7, 2025

Recent advances in the treatment of bacteremia have challenged traditional approaches, particularly regarding duration antibiotic therapy and transition from intravenous to oral regimens. This paper reviews these updates, focusing on evidence-based strategies for managing caused by Gram-positive Gram-negative organisms. Criteria transitioning therapy, clinical decision-making uncomplicated cases, evidence supporting shorter courses are discussed. article is a narrative review current literature, integrating guidelines, trial data, specific considerations diverse pathogens, ensuring comprehensive perspective.

Язык: Английский

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