Short Course Of Antibiotics Research Articles

Intravenous antibiotic duration in the treatment of prosthetic joint infection: systematic review and meta-analysis.

Introduction: Long antibiotic courses, including intravenous (IV) and oral administrations, are utilized in prosthetic joint infection (PJI) treatment. This meta-analysis examines the non-inferiority of short courses ( 4 weeks) of IV antibiotics compared to long courses in treating PJI. Critical review of IV treatment is necessary due to the clinical, physical, and financial burden associated with it and its continued prolonged use in the US without much evidence to support the practice. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), databases were searched using predefined medical subject headings (MeSH). Results: The nine included studies reported 521 total hip arthroplasties (THAs) and 530 total knee arthroplasties (TKAs). There was no significant difference in the overall success rate in short- vs. long-duration IV antibiotics for PJI treatment: odds ratio (OR) of 1.65, 95 % confidence interval (CI) of 0.78-3.46, and .18. However, due to the moderate to high heterogeneity ( %, 0.01) amongst studies, an adjusted success rate was calculated after the exclusion of two studies. This showed a statistically significant difference between both groups (OR of 2.45, 95 % CI of 1.21-4.96, 0.001) favoring a short course of antibiotics and reflecting a more homogenous population ( %, .06). Conclusion: This study highlights the limited data available for evaluating IV antibiotic duration in the setting of PJI. We found that a shorter duration of IV antibiotics was non-inferior to a longer duration, with an improved OR of 2.45 for treatment success, likely shortening inpatient stay as well as lessening side effects and antimicrobial resistance with a lower cost to patients and overall healthcare.

Are Short Course Antibiotics Favorable in Oral and Maxillofacial Surgical Procedures? A Meta-Analysis

Prophylactic antibiotics are utilized widely following oral and maxillofacial surgery procedures, but the ideal duration of antibiotics following operations is uncertain. The aim of this study was to determine among patients undergoing third molar, orthognathic, or maxillofacial trauma surgeries whether the use of short-course antibiotic prophylaxis (< 24 hours), as compared to extended-course antibiotic prophylaxis (> 72 hours), differ in postoperative surgical site infection (SSI) rates. A PubMed literature search was completed in August 2021, which included prospective clinical trials comparing antibiotic prophylaxis courses 24 hours or less compared to 72 hours of more following oral and maxillofacial surgery procedures.

Short-course antibiotic therapy for hospitalized patients with early clinical response in community-acquired pneumonia: a multicentre cohort study

ObjectivesTo explore whether short-course antibiotic therapy is efficient and safe in routine clinical settings among patients hospitalized with community-acquired pneumonia (CAP) who achieve an early clinical response. MethodsDuring 2017–2019, we conducted a cohort study of patients admitted with CAP to four hospitals in Denmark. Data were prospectively gathered from medical records and enriched with data from nationwide registries. In the present study, we included patients with early clinical response and divided them into treatment groups based on antibiotic duration, as decided by the attending physician: short-course (4–7 days) or prolonged-course (8–14 days). The primary outcome was post-treatment mortality within 30 days. Secondary outcomes included readmissions or new antibiotics. Logistic regression models were used to estimate ORs with 95% CIs, and inverse probability weighting was applied to adjust for confounding. ResultsThe study cohort included 1151 patients with a median age of 74 years, predominantly presenting with mild-moderate disease. The 30-day post-treatment mortality was 3.36% (11/327) in the short-course group and 3.40% (28/824) in the prolonged-course group (adjusted OR 1.05, 95% CI 0.38–1.88). Readmission occurred in 15.6% (42/269) vs. 14.0% (102/727) (adjusted OR 1.07, 95% CI 0.75–1.69) and new prescription of antibiotics in 11.9% (32/269) vs. 12.1% (88/727) (adjusted OR 0.99, 95% CI 0.61–1.49). DiscussionIn patients hospitalized with CAP and early clinical response, similar outcomes were observed between short-course and prolonged-course therapies. These results support the use of short-course therapy in routine clinical settings.

Association between duration of early empiric antibiotics and necrotizing enterocolitis and late-onset sepsis in preterm infants: a multicenter cohort study

The threshold to initiate empiric antibiotics for suspicion of early-onset sepsis (EOS) is low in preterm infants. Antibiotics’ effects on short-term outcomes have recently been debated. We aimed at exploring the extent of early empiric antibiotic exposure (EEAE) in preterm infants and the association between the duration of EEAE with necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) within different EEAE groups. EEAE practice for suspicion of EOS was evaluated in all included infants (gestational age < 30 weeks) born in 9 centers in the Netherlands and Belgium between Oct. 2014 and Jan. 2019. EEAE association with NEC and LOS development was analyzed by multivariate regression. After excluding 56 EOS cases, 1259 infants were included. A total of 1122 infants (89.1%) were exposed to empirical antibiotics for the suspicion of EOS of whom 802 (63.7%) had short (≤ 72 h) and 320 (25.4%) prolonged EEAE (> 72 h). Infants with EEAE ≤ 72 h had a lower incidence of NEC compared to both infants without EEAE (adjusted odds ratio (aOR) 0.39; 95% confidence interval (CI) [0.19–0.80]; p = 0.01) and with prolonged EEAE (> 72 h) (aOR [95%CI]: 0.58 [0.35–0.96]; p = 0.03). With every additional day of EEAE, LOS incidence decreased (aOR [95%CI]: 0.90 [0.85–0.97]; p = 0.003).Conclusion: Almost 90% of preterm infants who have negative blood culture results in the first 72 h of life are exposed to EEAE under suspicion of EOS. One-fourth has prolonged EEAE. Duration of EEAE was differently associated with NEC and LOS incidence. The effects of antibiotics, and potentially induced microbial dysbiosis related to development of NEC and LOS, should further be explored.What is Known:• Preterm infants often receive antibiotics empirically directly after birth for suspicion of early-onset sepsis.• The effects of the duration of early empirical antibiotic exposure on the risk for necrotizing enterocolitis and late-onset sepsis are debated.What is New:• Almost 90% of preterm infants with a gestational age below 30 weeks are exposed to antibiotics empirically after birth despite negative culture results. In a quarter of these culture-negative infants, empirical antibiotics are prolonged.• A short course of empirical antibiotics (≤72h) is associated with decreased odds for necrotizing enterocolitis compared to both prolonged (>72h) or no empirical antibiotics after birth. Furthermore, every additional day of empirical antibiotic exposure is associated with decreased risk for late-onset sepsis in the first month of life.

Estudio retrospectivo sobre la efectividad y seguridad de la pauta antibiótica reducida a 5-7 días en la faringoamigdalitis aguda estreptocócica comparada con la pauta clásica de 10 días

IntroductionAntibiotherapy regimens for management of acute streptococcal pharyngitis traditionally last 10 days, but the development of resistance to different antimicrobials has motivated the exploration of shorter courses. Material and methodsWe selected patients given a diagnosis of streptococcal pharyngitis in 2 paediatric caseloads of one primary care centre between June 2016 and April 2020. We compared outcomes in patients treated with 8- to 10-day courses versus 5- to 7-day courses. ResultsThe analysis included 350 care episodes (252 patients). Sixty-four percent were managed with 8- to 10-day courses of antibiotherapy (group 1) and 36% with 5- to 7-day courses (group 2). There were no significant differences in the incidence of streptococcal pharyngitis or scarlet fever in the 3 months that followed (OR, 0.98; 95% CI: 0.46-2.03), with similar percentages in both groups (9.8 vs. 9.5%). Overall, without differentiating based on the type of infection (streptococcal pharyngitis, scarlet fever or other streptococcal infections), we found similar outcomes (OR, 0.81; 95% CI: 0.41-1.59): 13.4% in group 1 and 11.1% in group 2. We also found no differences in the frequency of adverse events documented in the health records (OR, 0.29; 95% CI: 0.04-2.44): 2.7% in group 1 and 0.8% in group 2. ConclusionsIn our experience, a shorter antibiotic course (5-7 days) is not less effective or more unsafe for management of acute streptococcal pharyngitis than the traditional 10-day course.

Clinical and microbiological characteristics of reflux cholangitis following bilio-enteric anastomosis.

Twenty-five patients with reflux cholangitis (RC) defined as acute cholangitis (AC) with normal abdominal imaging occurring > 3months after bilioenteric anastomosis were described and compared to 116 AC patients with biliary obstruction (tumoral, lithiasis). RC episodes occurred a median 4.5months after surgery; 18 (72%) had recurrent RC (n ≥ 3). RC episodes were less severe than obstructive AC; the outcome was favorable with short antibiotic courses and no selection of antibiotic-resistance. However, multiple recurrent RC occurred in 20 patients (80%). Prophylactic or pre-emptive antibiotics were successful in 3 and 11 patients. Revision surgery for jejunal loop lengthening was successful in 2/4 patients.

Advances in chronic obstructive pulmonary disease: management of exacerbations.

Exacerbations of chronic obstructive pulmonary disease are important events to people living with this condition and a common cause of emergency hospital admission. In the absence of a confirmatory biomarker, an exacerbation remains a clinical diagnosis of exclusion and clinicians must be alert to alternative diagnoses. Most exacerbations are caused by airway infection, particularly with respiratory viruses. The mainstay of exacerbation treatment is an increase in the dose and/or frequency of short-acting beta-agonists, with short-course oral corticosteroids and/or antibiotics. Although there have been no new interventions to treat exacerbations in many years, there is still much variation in care and opportunity to improve outcomes. There has been a new focus on both the management of comorbidities and the optimisation of future care to reduce the risk of further events. This review summarises advances in managing exacerbations of chronic obstructive pulmonary disease, focusing on hospitalised patients.

Clin-Star corner: What's new at the interface of geriatrics, infectious diseases, and antimicrobial stewardship.

Antibiotics are among the leading causes of adverse drug events in older adults. Short-course antibiotic therapy has been shown to work as well as the traditional longer durations for many types of infections. Antibiotic stewardship interventions including deprescribing strategies have shown a reduction in patient readmissions and mortality among older adults. We identified practice-changing clinical trials focusing on three major domains of overprescribing antibiotics in older adults - community-acquired pneumonia, urinary tract infections, and gram-negative bacteremia. The selected articles underscore the safety and effectiveness of shorter durations of antibiotic treatment for infections in older adults, thus highlighting an opportunity for deprescribing in the aging population. By optimizing antibiotic use, we stand to reduce adverse events and enhance overall health outcomes in older adults.

Comparison of short-course antibiotic therapy of 6 or less days with a longer treatment in patients with cholangitis after liver transplantation.

Stenosis of the biliary anastomosis predisposes liver graft recipients to bacterial cholangitis. Antibiotic therapy (AT) is performed according to individual clinical judgment, but duration of AT remains unclear. All liver graft recipients with acute cholangitis according to the Tokyo criteria grade 1 and 2 after endoscopic retrograde cholangiography (ERC) were included. Outcome of patients treated with short AT (<7 days) was compared to long AT (>6 days). Recurrent cholangitis (RC) within 28 days was the primary end point. In total, 30 patients were included with a median of 313 (range 34-9849) days after liver transplantation until first proven cholangitis. Among 62 cases in total, 51/62 (82%) were graded as Tokyo-1 and 11/62 (18%) as Tokyo-2. Overall median duration of AT was 6 days (1-14) with 36 cases (58%) receiving short AT and 26 (42%) receiving long AT. RC was observed in 10 (16%) cases, without significant difference in occurrence of RC in short versus long AT cases. CRP and bilirubin were significantly higher in patients with long AT, while low serum albumin and low platelets were associated with risk of RC. A shorter antibiotic course than 7 days shows good results in selected, ERC-treated patients for post-transplantation biliary strictures.

Pylephlebitis With Concomitant Fusobacterium Bacteremia: Lemierre's Syndrome Variant of the Gut

Pylephlebitis is a rare complication of intra-abdominal infections, and Fusobacterium, traditionally associated with thrombophlebitis of the internal jugular vein, is an extremely rare causative organism. This infection is associated with high morbidity and mortality, and there is still some controversy about management. Here, we report a patient who presented with pylephlebitis and Fusobacterium bacteremia and responded well to a short course of intravenous antibiotics, finished therapy in the outpatient setting, and made a full recovery. We also review relevant literature on treatment strategies including antibiotics, anticoagulation, and screening endoscopy.

Short Intravenous Antibiotic Courses in Infants With UTI

Short Intravenous Antibiotic Courses in Infants With UTI

Duration of Treatment for Pseudomonas aeruginosa Bacteremia: a Retrospective Study.

IntroductionThere is no consensus regarding optimal duration of antibiotic therapy for Pseudomonas aeruginosa bacteremia. We aimed to evaluate the impact of short antibiotic course.MethodsWe present a retrospective multicenter study including patients with P. aeruginosa bacteremia during 2009–2015. We evaluated outcomes of patients treated with short (6–10 days) versus long (11–15 days) antibiotic courses. The primary outcome was a composite of 30-day mortality or bacteremia recurrence and/or persistence. Univariate and inverse probability treatment-weighted (IPTW) adjusted multivariate analysis for the primary outcome was performed. To avoid immortal time bias, the landmark method was used.ResultsWe included 657 patients; 273 received a short antibiotic course and 384 a long course. There was no significant difference in baseline characteristics of patients. The composite primary outcome occurred in 61/384 patients in the long-treatment group (16%) versus 32/273 in the short-treatment group (12%) (p = 0.131). Mortality accounted for 41/384 (11%) versus 25/273 (9%) of cases, respectively. Length of hospital stay was significantly shorter in the short group [median 13 days, interquartile range (IQR) 9–21 days, versus median 15 days, IQR 11–26 days, p = 0.002]. Ten patients in the long group discontinued antibiotic therapy owing to adverse events, compared with none in the short group. On univariate and multivariate analyses, duration of therapy was not associated with the primary outcome.ConclusionsIn this retrospective study, 6–10 days of antibiotic course for P. aeruginosa bacteremia were as effective as longer courses in terms of survival and recurrence. Shorter therapy was associated with reduced length of stay and less drug discontinuation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-022-00657-1.

Antibiotic Treatment Duration for Community-Acquired Pneumonia in Outpatient Children in High-Income Countries-A Systematic Review and Meta-Analysis.

The optimal treatment duration of community-acquired pneumonia (CAP) in children has been controversial in high-income countries. We conducted a meta-analysis to compare short antibiotic treatment (3-5 days) with longer treatment (7-10 days) among children aged ≥6 months. On 31 January 2022, we searched PubMed, Scopus, and Web of Science databases for studies published in English from 2003 to 2022. We included randomized controlled trials focusing on antibiotic treatment duration in children with CAP treated as outpatients. We calculated risk differences (RDs) with 95% confidence intervals and used the fixed-effect model (low heterogeneity). Our main outcome was treatment failure, defined as need for retreatment or hospitalization within 1 month. Our secondary outcome was presence of antibiotic-related harms. A total of 541 studies were screened, and 4 studies with 1541 children were included in the review. Three studies had low risk of bias, and one had some concerns. All 4 studies assessed treatment failures, and the RD was 0.1% (95% confidence interval, -3.0% to 2.0%) with high quality of evidence. Two studies (1194 children) assessed adverse events related to antibiotic treatment, and the RD was 0.0% (-5.0% to 5.0%) with moderate quality of evidence. The diagnostic criteria varied between the included studies. A short antibiotic treatment duration of 3-5 days was equally effective and safe compared with the longer (current) recommendation of 7-10 days in children aged ≥6 months with CAP. We suggest that short antibiotic courses can be implemented in treatment of pediatric CAP.

V02-12 LARGE VOLUME STONE EXTRACTION FOR THE TREATMENT OF CHRONIC PROSTATITIS

You have accessJournal of UrologyCME1 May 2022V02-12 LARGE VOLUME STONE EXTRACTION FOR THE TREATMENT OF CHRONIC PROSTATITIS George Koch, and Sarah Flury George KochGeorge Koch More articles by this author , and Sarah FlurySarah Flury More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002528.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic bacterial prostatitis can be a difficult condition to treat due both the variable tissue penetrance of antibiotics in the prostate, as well as the sometimes uncertain interaction between bacteria and prostatic stones. We present this video as both a demonstration of the atypical nature of this patient’s stone burden, as well as the multiple strategies employed to treat the stones. This patient presented with seven years of irritative voiding symptoms refractory to alpha-adrenergic blockers, long-term courses of antibiotics and serial prostatic message. His preoperative American Urological Association Symptom Index (AUASI) was 22 and his Quality of Life Score (QoL) was 4. MRI demonstrated a very large prostatic stone burden. METHODS: The procedure was performed using a 26 French Storz Resectoscope with both a Collins Knife electrocautery device and a 365 micron Holmium laser fiber via a laser bridge. The patient underwent unroofing of a large cavity within the prostate using the Collins Knife, and then stone fragmentation, further cavity resection, and hemostasis using the Holmium laser. Given the difficulty of removing stones with the resectoscope directly from the prostatic cavity, an Ellik evacuator was used to blow the stones into the bladder from which they were then easily drained through the sheath. RESULTS: The patient was discharged with a short course of antibiotics and a urethral catheter from the ambulatory surgery center and recovered well postoperatively. His catheter was removed on postoperative day seven and he passed a voiding trial. At his six-week follow-up appointment, he was voiding well and symptom free. His follow-up AAUSI was 14 and his QoL was 0. CONCLUSIONS: We found the use of both the Collins Knife electrocautery device and Holmium laser to be effective tools in the armamentarium to treat prostatic stones associated with chronic prostatitis. Our results demonstrate the importance of imaging and the role of nidus removal in the treatment of refractory chronic bacterial prostatitis. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e114 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information George Koch More articles by this author Sarah Flury More articles by this author Expand All Advertisement PDF DownloadLoading ...

Antibiotic Prophylaxis for Upper Gastrointestinal Bleed in Liver Cirrhosis; Less May Be More.

Administration of antibiotics in patients with cirrhosis and upper gastrointestinal bleeding has been shown to improve outcomes. Little is known regarding optimum duration of prophylactic antibiotics. Seven days of antibiotics are generally recommended but very few studies have compared antibiotic duration to clinical outcomes in current available scientific literature. The goal of our study was to study the effect of shorter antibiotic duration on patient outcomes. We conducted a retrospective cohort study of patients with cirrhosis presenting with upper GI bleeding at our institute from 2010 to 2018. Patients were divided into three cohorts based on duration of antibiotic administration for prophylaxis: 1-3days of antibiotics, 4-6days of antibiotics and 7days or more of antibiotics. Rates of infection diagnosis within 30days, rebleeding, and mortality were compared between the three groups with Chi square, Fisher Exact and Kruskall-Wallace tests. Multivariable analysis was conducted to evaluate independent risk factors for infection. Medical charts of 980 patients with cirrhosis and upper GI bleeding during the study period were reviewed. A total of 303 with upper gastrointestinal bleeding were included in the final sample, of these 243 patients received antibiotics for prophylaxis and were included for analysis. Seventy-seven patients received antibiotic therapy for 3days or less, 69 patients for 4-6days, and 97 patients longer than 6days. The three groups were well matched in demographic and clinical variables. Twenty-seven patients developed infections within 30days of bleeding. MELD-Na score at presentation and presence of ascites were associated with infection within 30days. Rates of infection were not statistically different between the three antibiotic groups (p = 0.78). In the thirty days following the GI bleed, pneumonia was the most diagnosed infection (eleven patients) followed by urinary tract infections (eight patients). Four patients developed spontaneous bacterial peritonitis and three were diagnosed with bacteremia. There was no difference in time to infection (Kruskall Wallace test p = 0.75), early re-bleeding (p = 0.81), late re-bleeding (p = 0.37) and in-hospital mortality (p = 0.94) in the three groups. Six patients in the cohort developed C. Difficile infection; no patient in the short antibiotic group developed C. Difficile infection. Short course of antibiotics for prophylaxis (3days) appears safe and adequate for prophylaxis in patients with cirrhosis with upper gastrointestinal bleeding if there is no active infection.

Short-course intravenous antibiotics for young infants with urinary tract infection

ObjectiveShorter courses of intravenous antibiotics for young infants with urinary tract infection (UTI) have myriad advantages. As practice shifts toward shorter intravenous treatment courses, this study aimed to determine the...

A Desirability of Outcome Ranking Analysis of a Randomized Clinical Trial Comparing Seven Versus Fourteen Days of Antibiotics for Uncomplicated Gram-Negative Bloodstream Infection.

BackgroundAlthough a short course (7 days) of antibiotics has been demonstrated to be noninferior to a conventional course (14 days) in terms of mortality and infectious complications for patients with a Gram-negative bacterial bloodstream infection (GNB), it is unknown whether a shorter treatment duration can provide a better overall clinical outcome.MethodsWe applied a bloodstream infection-specific desirability of outcome ranking (DOOR) analysis to the results of a previously completed, randomized controlled trial comparing short versus conventional course antibiotic therapy for hospitalized patients with uncomplicated GNB. We determined the probability that a randomly selected participant in the short course group would have a more desirable overall outcome than a participant in the conventional duration group. We performed (1) partial credit analyses allowing for calculated and variable weighting of DOOR ranks and (2) subgroup analyses to elucidate which patients may benefit the most from short durations of therapy.ResultsFor the 604 patients included in the original study (306 short course, 298 conventional course), the probability of having a more desirable outcome with a short course of antibiotics compared with a conventional course was 51.1% (95% confidence interval, 46.7% to 55.4%), indicating no significant difference. Partial credit analyses indicated that the DOOR results were similar across different patient preferences. Prespecified subgroup analyses using DOOR did not reveal significant differences between short and conventional courses of therapy.ConclusionsBoth short and conventional durations of antibiotic therapy provide comparable clinical outcomes when using DOOR to consider benefits and risks of treatment options for GNB.

Revision Amputation with Press-Fit Osseointegration for Transfemoral Amputees.

We demonstrate the fundamentals of a single-stage procedure involving an impacted press-fit porous-coated titanium osseointegration implant. The preoperative evaluation is summarized and the specific surgical steps are described: exposure, osteotomy, canal preparation, implant insertion, (optional) targeted muscle reinnervation, muscle closure, soft-tissue contouring and stoma creation, and abutment insertion. Amputees who are dissatisfied with their quality of life or mobility when using a socket prosthesis can attempt to modify their socket or activity level or accept their situation. Non-osseointegration surgical options to try to improve socket fit include bone lengthening and/or soft-tissue contouring. An alternative design is a screw-type osseointegration implant1. Press-fit osseointegration can be provided for amputees having difficulty with socket wear5. Press-fit osseointegration usually provides superior mobility and quality of life compared with nonoperative and other operative options for patients expressing dissatisfaction for reasons such as those mentioned above, including poor fit, compromised energy transfer, skin pinching, compression, and abrasions. Review articles describing the clinical outcomes of osseointegration consistently suggest that patients have improved prosthesis wear time, mobility, and quality of life compared with patients with a socket prosthesis3,4. In a recent study2 of 18 femoral and 13 tibial amputees who had osseointegration, Reif et al. showed significant improvements in prosthesis wear time, mobility, and multiple quality-of-life surveys at a mean follow-up of nearly 2 years. The most common postoperative complication for this procedure is low-grade soft-tissue infection, which is usually managed by a short course of oral antibiotics. Much less often, soft-tissue debridement or implant removal may be needed to manage infection. Periprosthetic fractures can nearly always be managed with familiar fracture fixation techniques and implant retention6. Template and choose an implant with an optimal diameter that encroaches the inner cortex at the narrowest bone diameter; an implant that is too wide may not fit without causing a large fracture, and an implant that is too narrow may fall out. Do not cement the implant7.Ideally, the abutment of the implant should rest against a flat transverse bone end with cortical contact and leave the correct amount of room for the prosthetic knee so that it matches the height of the contralateral knee; avoid inserting an implant too distally or in too wide a metaphyseal flare.Gentle impaction pressure is necessary and small contained distal fractures are acceptable, but avoid causing a propagating fracture. Do not place cerclage cables or loose bone graft at these small fracture sites.Avoid the use of a tourniquet during intramedullary reaming to prevent potential heat-induced osteonecrosis.Nerve surgery such as targeted muscle reinnervation, if indicated, can be performed in the same surgical episode as the osseointegration.The muscles should be closed at the bone-implant interface with use of a tight purse string in order to provide a vascularized tissue barrier against bacterial ingress8.The skin surrounding the stoma should have unnecessary fat removed, but not excess removal leading to skin necrosis. The skin fascia should be sutured to the muscle surrounding the stoma to stabilize the peri-stomal skin.Soft-tissue contouring is needed to achieve the optimal soft-tissue tension around the stoma and abutment. Single-stage surgery has a distinct advantage in this regard. MVA = motor vehicle accidentAP = anteroposteriorCT = computed tomographyTMR = targeted muscle reinnervationQTFA = Questionnaire for Persons with a Transfemoral AmputationEQ-5D = EuroQol 5 DimensionsLD-SRS = Limb Deformity-Scoliosis Research Society (questionnaire)PROMIS = Patient-Reported Outcomes Measurement Information System.

Is a shorter course of antibiotics better for children with CAP?

Results of the SCOUT-CAP randomized clinical trial published in the January 2022 issue of JAMA Pediatrics found that a short 5-day antibiotic treatment course is superior to a standard 10-day regimen for children with non-severe community-acquired pneumonia (CAP) in an outpatient setting. A short 5-day strategy reduced both antibiotic exposure and resistance while presenting a similar clinical response and antibiotic-related adverse effect profile as a standard 10-day course. According to the study, CAP is one of the most common serious infections in pediatric populations, with reports of about 1.5 million ambulatory visits by U.S. children yearly. “It’s critical that we minimize the use of unnecessary antibiotics, both to eliminate the risk of antibiotic adverse effects and slow the progression of antimicrobial resistance, a global public health threat,” said Derek Williams, MD, MPH, lead investigator of the study. Although antibiotics are not always needed, when required it is important to choose the right antibiotic, at the right dose, and only for as long as necessary to effectively treat the infection, said Williams, who is an associate professor of pediatrics at Vanderbilt University School of Medicine. The randomized, double-blind, placebo-controlled clinical trial included 380 healthy children between the ages of 6 months and roughly 6 years with non-severe CAP in 8 U.S. cities between December 2016 and December 2019. They were seen in outpatient clinics, urgent care settings, and emergency departments. Children were only included in the study if they had not experienced the following at time of enrollment based on caregiver reporting: subjective fever or temperature 38.3°C or higher in the previous 24 hours; tachypnea (50 and 40 breaths per minute for children younger than 2 years, and 2 years and older, respectively); and severe cough. Study participants were randomized 1:1 to either receive a 5-day course of matching placebo or an additional 5-day course of the originally prescribed β-lactam antibiotic—including amoxicillin, amoxicillin and clavulanate, or cefdinir—on day 6 of therapy. Dosing for amoxicillin or amoxicillin and clavulanate was 80 to 100 mg/kg a day (maximum 2,000 mg a day) based on the amoxicillin component divided twice daily, and cefdinir dosing was 12 to 16 mg/kg a day (maximum 600 mg a day) divided twice daily. The taste and appearance of the matching placebo was consistent and dosed at the same interval as the original 5-day course therapy. Study participants underwent two in-person outcome assessment visits on study days 6 to 10 and days 19 to 25, respectively. The primary composite endpoint—a ranking of each child’s clinical response, symptom resolution, and antibiotic-associated adverse effects—made up the end-of-treatment response adjusted for duration of antibiotic risk (RADAR) in an ordinal desirability of outcome ranking (DOOR). Participants were then ranked by the number of antibiotic days within each DOOR, with the hypothesis that shorter antibiotic durations were more desirable. RADAR was used to determine the more desirable outcome probability estimate for short- versus standard-course strategy. During the antibiotic resistance analysis, throat swab samples were taken from the oropharyngeal flora of 171 children between days 19 and 25 to assess antibiotic resistance. The research findings showed that a majority of children had an adequate clinical response to both strategies, with fewer than 10% of children experiencing a poor response. The research team found that the short-course strategy had a 69% probability of a more desirable RADAR outcome compared with the standard-course strategy. The antibiotic resistance analysis showed that the range of antibiotic resistance genes per prokaryotic cell (RGPC) was significantly lower in the short-course strategy compared with the standard-course strategy for total RGPC and β-lactamase RGPC, according to the study. “SCOUT-CAP is the first clinical trial to use this innovative trial design, taking into account both the response to and potential side effects of antibiotic therapy,” said C. Buddy Creech, MD, MPH, a professor of pediatrics at Vanderbilt University Medical Center, who was also part of the study. “These data are immediately applicable to frontline clinicians, and we hope it helps to shift the paradigm for childhood pneumonia toward more judicious treatment approaches, resulting in safer and more effective care,” said Williams. Future trials using this approach may allow us to optimize therapy for other infectious diseases in children and adults, said Creech.

Perioperative antibiotic prophylaxis in Australian burns patients

Background: Perioperative antibiotic prophylaxis is perceived to reduce intraoperative bacteraemia and prevent surgical site infections, however, the evidence for its use in burns surgery is limited. Excessive use of perioperative antibiotics has become a growing concern. The authors aimed to audit the prescribing practices of perioperative antibiotic prophylaxis at the Victorian Adult Burns Service and determine whether the duration of antibiotic prophylaxis influenced the risk of postoperative wound infection, bacte-raemia and antibiotic resistance. Methods: This retrospective chart review included all acute adult burns patients who had an operation between November 2018 and November 2019. Basic demographic data, burn specific data and data on perioperative antibiotic use were collected. The outcome measures were wound infection, bacteraemia, other infections and presence of resistant organisms. Results: Results demonstrated that almost all patients (98.6%) received perioperative antibiotic prophylax-is. In comparison, there was no significant difference between the rate of postoperative wound infection, bacteraemia or antibiotic resistance between patients receiving a short or long course of antibiotics. Conclusion: The results of our study demonstrate variable use of perioperative antibiotic prophylaxis with-in one burns unit. There were many cases of unsubstantiated use of long courses of antibiotics without apparent benefit for clinical outcomes of wound infection or bacteraemia. With the growing concern over antibiotic overuse and development of resistance, there is an increasing need for development of clear guidelines for antibiotic use in burns surgery.