Did POET look at left or right side IE or both?
Left sided only (10 days IV then po)
Did POET have any abscesses or prosthetic valves? Did POET include MRSA?
No abscesses but yes prosthetic valves and also pacemakers! Did not include MRSA.
What is the population who gets doxyPep per CDC 2024
Shared decision making to all MSM with bacterial STI in the last 12 months or if high risk. Reduces risk of syphilis and Chlamydia with smaller reduction in gonorrhea. Evidence low for cisgender women and hetero male
Endo Oral CID 2025, what were the added factors of this study compared to POET? What did they find, generally?
44% would have been ineligible for POET:
included right-sided IE, obese >40 BMI, immunosuppression, and abscesses among categories which would have excluded from POET.
Still found noninferiority in this group although noted that if patients switched prior to 10 days IV to po that they were more likely to have treatment failure.
Reminder: guidelines from 2020 AHA/ACC don’t recommend switching to oral with right sided endocarditis, still with POET only considering left-sided for now.
What time frame was compared in the CID 2021 article for diabetic osteo of the foot antibiotic duration, and what did they find?
6 weeks and 3 weeks noninferior, incidences of remission similar in both groups post-debridement
What did the STOP-IT trial find in NEJM 2015 regarding abdominal infections?
4 days non-inferior to 8-10 day treatment of post source control intra-abdominal infection. Similar high rate of infectious complications (20%) :(
What was the difference between findings of the OFID 2018 article and the JAC 2024 review regarding outcomes of the inoculum effect with cefazolin in treating MSSA infections?
2018 said mortality worse with cefazolin, but JAC found no other studies that confirmed that - clinical effect uncertain.
Unclear, but high dose dapto + ceftaroline may help with this in MRSA IE if having trouble clearing cultures, need more data but maybe also helps to have linezolid.
With inoculum effect, efficacy of certain antibiotics is reduced when bacterial burden is high, resulting in increased MIC to kill, affects both beta lactams and glycopeptides
What did the SABATO trial compare?
staph aureus bacteremia, 2 weeks total compared IV vs transition to PO after 5-7 days, had similar outcomes but excluded a lot of conditions
po included mostly bactrim 2nd choice clinda or linezolid depending on type of staph.
noninferior 34% serious event vs 26%
in xanthogranulomatous pyelo, what does the data say regarding long courses of antibiotics prior to nephrectomy?
There is a urology journal article (2021 Journal of Urology) which supports 4 weeks antibiotics prior to surgery, associated with shorter LOS and less severe and fewer post op complications vs 5 days antibiotics.
-61 patients
-when controlling for drainage prior to surgery, did have significantly better outcomes
-HOWEVER, the group was titled >28 days for the study but median number of days was 87 days compared to median of 5 days.
What did the OVIVA trial study?
randomized noninferiority trial, extraaxial and vertebral osteo, pji, ortho device infection, native joint infection requiring excision arthroplasty
In the CID 2019 article switching to PO linezolid therapy for staph aureus bacteremia, what were the normal sources?
mostly catheter associated and SSTI, excluded metastatic disease, osteoarthritis, IE, vascular sources.
switched after 3-9 days of IV therapy
CID 2020 Cefazolin was combined with what extra therapy for salvage MSSA bacteremia treatment?
Ertapenem.
clearance was achieved in <24 hours in 8 of the 11 cases, 6 had IE, even worked for some vegetations > 2 cm.
is ertapenem helping to fight against the inoculum effect?
in the 2024 BALANCE trial in NEJM. studied 7 vs 14 days antibiotics for bacteremia, randomized. what was the finding?
noninferior
Excluded: immunocompromised, prosthetic valve, endovascular graft, staph aureus and lung.
Most common cases were urinary and abdominal source
notably 23% of patients in the 7 day group went 1-2 days longer.
unfortunately, noninferiority margin crossed in several subgroups regarding uncertainty in inferiority regarding mortality –> lung, vascular catheter, gram positive or polymicrobial bacteremia. (may not have been enough power here)
Overall seems safe to limit gram negative bacteremia to 7 days for the included groups if urinary or abdominal
