Top 5 Infectious Disease News of the Week—May 20, 2018

#5: Exploring Cephalosporin/β-Lactamase Inhibitor Combinations for Treatment of Pseudomonas

Peter Salgo, MD; Yoav Golan, MD; Andrew Shorr, MD; and Marin Hristos Kollef, MD, provide their perspective on the cephalosporin/β-lactamase inhibitor combinations Zerbaxa, Avycaz, and Vabomere, with considerations for mechanisms of action and effectiveness.

Peter L. Salgo, MD: We have some new antibiotics. These are cephalosporin/β-lactamase inhibitors. We have 3 new ones. We have Zerbaxa, Avycaz, and Vabomere. Where do we go with these things? Can you run them down?

Yoav Golan, MD: All those antibiotics are a combination of some kind of a β-lactam and a β-lactamase inhibitor. The β-lactamase inhibitor will be a bodyguard. So, you give an antibiotic, and the bodyguard, knowing that the bacteria are going to try to break through, is going to take care of that. There are 2 different approaches. One approach is to take an antibiotic that has been very useful for many, many years—like a carbapenem or ceftazidime that we’ve been using—where a resistance to it has developed over the past several years and attach to it a bodyguard that will prevent the enzyme and reinstitute the susceptibility to this antibiotic.

Watch the rest of the Peer Exchange discussion.

#4: Co-Infection with HIV Means Less Likelihood of Cancer Treatment

One result of people with HIV now living normal or near-normal lifespans is that they can fall prey to the same cancers that affect the non-HIV-positive aging population. As more people deal with HIV and cancer simultaneously, it’s important that health care providers know how to treat both diseases. However, several studies have indicated that those who have both cancer and HIV are not as likely to receive cancer treatment as those who have only cancer and not HIV. If they do receive cancer treatment, it’s often offered at a later stage than with patients without HIV.

A team from the Johns Hopkins Bloomberg School of Public Health, the National Cancer Institute, and Duke University Medical School decided to conduct a retrospective study of 930,359 older Americans to determine, if possible, the factors that may lead to timely cancer treatment in the HIV-positive population.

Read more about HIV and cancer treatment.

#3: HIV Prevention and Treatment Efforts Go High-Tech in New York

An HIV primary care program in Queens and Long Island, New York, is using data gleaned from an innovative heatmap, web-based software, and a survey, to identify hotspots of HIV activity in an attempt to help facilitate prevention and treatment efforts in these areas.

The initiative was created by a team from Northwell Health’s Center for AIDS Research and Treatment (CART) at North Shore University Hospital. The multidisciplinary team, made up of not only physicians, but also social workers, nurse case managers, health educators, and dieticians, has been able to boast a 93.6% viral suppression rate among their patients. “But, we wanted to look forward and say, ‘Is everyone doing well?’ We wanted to see if there were some people not benefitting equally," explained Joseph McGowan, MD, medical director, CART, in an interview with Contagion^®’s sister journal, The American Journal of Managed Care^® (AJMC).

Read more about HIV prevention and treatment efforts.

#2: Test for Bacteria vs Virus Doesn’t Influence Antibiotic Prescribing

Treatment guidelines linked to procalcitonin levels, from an assay approved by the US Food and Drug Administration (FDA) in 2017 to help distinguish bacterial from viral lower respiratory tract infections, did not appear to influence whether antibiotics were prescribed, according to the results of a study of the lab test effect on antibiotic utilization in hospital emergency departments reported at the 2018 American Thoracic Society (ATS) International Conference, San Diego, California, May 18-23.

The findings from the Procalcitonin Consensus Trial (ProACT) were presented by David Huang, MD, MPH, director of the Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Administrative Core, and associate professor, Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh Pennsylvania. The results were published simultaneously in the New England Journal of Medicine.

Read more about antibiotic prescribing influencers.

#1: Just How Sterile Is Your Biodebris After Autoclaving?

It’s an ugly truth—cannulated drills and reamers often get fragments of biological debris (biodebris) stuck in them that autoclaving doesn’t always remove. Such tools are critical for surgical cases and when the situation arises that a surgeon finds biodebris in the instrument, some opt for caution while others subscribe to the notion that autoclaving has sterilized the debris, but, is the sterilization process of the instrument, in fact, killing the infection-causing potential in the retained biodebris?

The US Centers for Disease Control and Prevention (CDC) states that annually, there are 722,000 health care-associated infections reported in the United States, but this number is likely higher. Of these infections, 157,500 are surgical site infections (SSI). Although there have been infection clusters related to surgery that mentioned retained biodebris, no definitive epidemiological link between orthopedic SSIs has been linked with the biodebris retained in cannulated instruments. Furthermore, manufacturers work to make instruments less vulnerable to bioburden contamination and easier to reprocess; however, there is an inherent risk with some tools even after proper sterilizing per manufacturer recommendations. Seeking to address just how much microbial life is left on biodebris in cannulated instruments following autoclaving, a research team found some fascinating results.

The research team attempted to replicate a typical orthopedic surgical scenario by creating a hole in cortical and cancellous bone and then letting the instrument set for a period of time (mimicking that of non-use during surgery) prior to cleaning and disinfection. Different wait times were used for the instrument after drilling. The team used 15 cannulated drill bits, 12 of which were exposed to a bacterial mixture for 60, 120, or 180 minutes before reprocessing. “Three of the 12 bits, designated as positive controls, were not sterilized,” the authors write. “The remaining 3 drill bits, designated as negative controls, received only sterile water. Thus, we had 5 separate groups with 3 drill bits in each group. The drill bits were autoclave sterilized and then examined for bacterial growth.”

Read more about biodebris after autoclaving.