Purpose: To provide summarization of the most significant infectious diseases (ID) pharmacotherapy articles published in peer-reviewed literature in 2022. Summary: Members of the Houston Infectious Diseases Network (HIDN) nominated notable articles providing significant contributions to ID pharmacotherapy in 2022. Article nominations included those pertaining to general ID, as well as those including coronavirus disease 2019 (COVID-19), and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy. A total of 71 articles were nominated by HIDN. Members: 68 articles pertaining to general ID pharmacotherapy and 3 articles focusing on HIV/AIDS. To aid selection of the most these most notable articles of 2022, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP). Of the 153 SIDP members who participated in the survey, there were 128 recorded votes for the top 10 general ID pharmacotherapy articles and 30 votes recorded for the top HIV/AIDS article. The most notable publications are summarized. Conclusion: Post pandemic significant advances in antimicrobial stewardship and infectious disease states continues to occur in a world recently focused on the coronavirus disease 2019 (COVID-19) global pandemic. Continuous growth in publication of ID-related articles over the past year lends towards the aims of this review to aid clinicians in remaining current on key practice-changing ID pharmacotherapy publications from 2022.

Background:In recent years, there has been a growing body of evidence that supports oral step-down therapy for the treatment of gram-negative bacteremia. The purpose of this study was to compare outcomes for hospitalized patients who received intravenous-only (IV-only) therapy versus oral step-down therapy with low, moderate, and highly bioavailable antimicrobials for the treatment of gram-negative bacteremia.Methods:In this retrospective, single-center, observational study, we examined data from adult patients hospitalized with gram-negative bacteremia in a 1-year period. Data analysis was performed using information collected from electronic medical records and a clinical surveillance system.Results:A total of 199 patients were included in this study. Patients in the IV-only group had higher Charlson comorbidity index scores at baseline and higher rates of intensive care unit admission while bacteremic (P = .0096 and .0026, respectively). The primary outcome of 30-day all-cause mortality was significantly lower in the oral step-down group (P < .0001). Secondary outcomes of 30-day bacteremia recurrence, line-associated complications, and hospital length of stay were similar between groups. The total duration of antibiotic therapy was one day longer for oral step-down patients (P = .0015) and the estimated cost of antibiotic therapy was significantly lower in this group (P < .00001).Conclusion:In this retrospective study, oral step-down therapy was not associated with increased 30- day all-cause mortality. Oral step-down therapy was also more cost-effective than IV-only therapy, while both groups had similar bacteremia recurrence within 30 days.

Abstract Background Fluoroquinolone (FQ) use is generally discouraged in uncomplicated infections when alternative therapies exist. Antimicrobial stewardship programs use diverse strategies to encourage appropriate prescribing of antibiotics, and FQ stewardship is often a priority due to the known toxicity risks. This study aimed to evaluate how the coordinated implementation of several stewardship strategies impacted FQ prescribing at eight community hospitals. Methods This retrospective, observational study includes data from January 2017 to January 2022. In 2018, the facility clinical pharmacy programs established formal clinical metrics to be tracked and reported on a regular basis. One such metric tracked FQ prescribing in urinary tract infections (UTI), and this metric has remained active since 2018. In early 2019, the health-system implemented a clinical decision support alert in the electronic health record, which requires acknowledgement of a risk/benefit assessment upon FQ order entry. In late 2019, some facilities began suppressing automated susceptibility results for FQ on cultures, due to technological limitations with new minimum inhibitory concentration breakpoints. Using a clinical surveillance system, a report was generated to assess the year-over-year changes in FQ days of therapy (DOT) per 1000 patient days at each facility. Results An 83% reduction in FQ use was observed over five years (737 DOT/1000 patient days vs. 125 DOT/1000 patient days), with facility-level reductions ranging from 62% to 96%. The smallest decrease in FQ use (18%) occurred from 2017–2018, before any system-wide FQ stewardship initiatives were adopted. A larger decrease in FQ use (33%) was seen from 2018–2019, after introducing the formal FQ UTI metric. The biggest decrease in FQ use (50%) occurred from 2019–2020, when the FQ alert and susceptibility suppression strategies were implemented alongside the existing UTI metric. An additional 39% decrease in FQ use was seen from 2020–2022, when no additional FQ interventions were implemented. Conclusion Substantial decreases in FQ prescribing were observed when multiple FQ stewardship strategies were utilized. The decreases were sustained over several years across multiple hospitals. Disclosures All Authors: No reported disclosures.

Purpose: To summarize the most noteworthy infectious diseases (ID) pharmacotherapy articles published in peer-reviewed literature in 2021. Summary: Members of the Houston Infectious Diseases Network (HIDN) nominated articles that were deemed to have significant contributions to ID pharmacotherapy in 2021. These nominations included articles pertaining to both general ID, including coronavirus disease 2019 (COVID-19), and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy. A total of 35 articles were nominated by HIDN: 30 articles pertaining to general ID pharmacotherapy and 5 articles with HIV/AIDS focus. To select the most influential articles of 2021, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP). Of the 239 SIDP members who responded to the survey, there were 192 recorded votes for the top 10 general ID pharmacotherapy articles and 47 recorded votes for the top HIV/AIDS article, respectively. The top publications are summarized. Conclusion: Antimicrobial stewardship and the optimal management of infectious disease states continues to be a priority in the midst of the ongoing coronavirus disease 2019 (COVID-19) global pandemic. In light of the sheer volume of ID-related articles published in the past year, this review aims to aid clinicians in remaining up-to-date on key practice-changing ID pharmacotherapy publications from 2021.

Purpose. To summarize the most highly esteemed, peer-reviewed, infectious diseases (ID) pharmacotherapy articles published in 2020. Summary. Members of the Houston Infectious Diseases Network (HIDN) nominated articles that were deemed to have noteworthy contributions to ID pharmacotherapy in 2020, including those on coronavirus disease 2019 (COVID-19) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). To select the most significant articles of 2020, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP) to vote on their top 10 articles of general ID and COVID-19 pharmacotherapy and one noteworthy HIV/AIDS publication. A total of 40 articles were nominated by HIDN: 35 articles pertaining to general ID/COVID-19 pharmacotherapy and 5 articles with HIV/AIDS involvement. Of the 247 SIDP members who responded to the survey, 205 and 42 members voted for general ID/COVID-19 pharmacotherapy articles and HIV/AIDS related articles, respectively. The top publications are summarized. Conclusion. In a taxing year of a global pandemic, the abundant and rapid distribution of ID literature has made it challenging for clinicians to stay informed of significant publications across the ID spectrum. This review summarizes significant ID-related publications in 2020 with the goal of aiding clinicians in staying up to date on the most relevant publications in ID pharmacotherapy.

Methicillin-resistant Staphylococcus aureus (MRSA) is a relevant pathogen for patients with pneumonia in the presence of certain risk factors. Empiric broad-spectrum antimicrobial therapy, including anti-MRSA therapy, is frequently initiated in patients hospitalized with pneumonia. The low yield of respiratory cultures makes antimicrobial de-escalation difficult, potentially leading to extended durations of anti-MRSA therapy and increasing risk for significant drug-related adverse effects. A polymerase chain reaction (PCR) test that was previously utilized for nasal MRSA screening was internally validated to identify the presence of MRSA in respiratory specimens within 2 hours of sample collection. The primary objective of this study was to determine the effect of this respiratory PCR test on duration of anti-MRSA therapy in nonintensive care unit (ICU) patients hospitalized with pneumonia. Implementation of the PCR test in non-ICU units occurred December 1, 2017. During the post-intervention (INT) period (December 1, 2017–March 31, 2018), PCR results were evaluated daily by antimicrobial stewardship and decentralized staff pharmacists for therapy de-escalation opportunities, with recommendations communicated to prescribers. The pre-INT group (December 1, 2016–March 31, 2017) consisted of non-ICU patients hospitalized with pneumonia who received anti-MRSA therapy for at least 48 hours, or who qualified for anti-MRSA therapy per institutional guidelines. A total of 169 patients were evaluated; 109 in the post-INT group and 60 in the pre-INT group. Anti-MRSA therapy was administered to 74 patients (68%) in the post-INT group, compared with 56 patients (93%) in the pre-INT group. The median duration of anti-MRSA therapy post-INT was 23.5 hours, which was significantly shorter than the pre-INT duration of 55.5 hours (P < 0.0001). The post-INT group also had significantly less vancomycin-induced nephrotoxicity (P < 0.0383) and a shorter time to targeted therapy (P < 0.0001). No difference in 30-day all-cause mortality was observed (P < 0.1338). Utilization of a PCR test to detect MRSA in respiratory specimens decreased duration of anti-MRSA therapy in non-ICU patients hospitalized with pneumonia. All authors: No reported disclosures.