Top 5 Contagion&reg News Articles for the Week of August 20, 2017

Proton pumps inhibitors present risks for individuals living with HIV, dalbavancin can treat MRSA-related pneumonia, probiotics prove deadly against C. difficile, patient involvement increases healthcare practitioners’ hand hygiene, and why delafloxacin is a unique antibiotic for skin infections are the topics that make up this week’s Top 5 articles.

#5: Proton Pump Inhibitors Present Real Risks to People Living with HIV

The HIV-positive subjects with a history of PPI use did tend to be older (59.6 years) than those who had not taken PPIs (54.3 years), and the researchers were careful to address this disparity in their methods. “Age is a known driver of immune activation,” Jose Serpa-Alvarez, MD, MS, an assistant professor of medicine and director of the Infectious Diseases Fellowship program at Baylor College of Medicine, and the study’s lead author, told Contagion ®. “Although subjects on chronic PPIs were older than those not taking PPIs, we controlled for this variable in our multivariate model. The use of PPIs was still significantly associated with higher levels of sCD14, a marker of innate immune activation.”

Should clinicians advise patients with HIV to avoid taking PPIs at all costs? “At this point in time, there is not enough evidence to advise immediate discontinuation of PPIs,” Dr. Serpa-Alvarez told Contagion ®. “However, we think it would be prudent to use them only when strictly indicated and for short periods of time. These recommendations are valid for all people but especially for those living with HIV.”

Read more about the use of PPIs in people living with HIV, here.

#4: Dalbavancin For Treatment of MRSA Pneumonia

In an article published in the Journal of Pharmacology and Pharmacotherapeutics, Katie E. Barber, PharmD, from the University of Mississippi, Jackson, and colleagues report a case of a HIV-positive 28-year-old man with pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA) who was treated with dalbavancin.

“This case is unique because it is the first reported use of dalbavancin for MRSA pneumonia,” the authors write.

Although pneumonia is one of the most common infectious diseases, MRSA pneumonia is uncommon. Nevertheless, clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society recommend that clinicians provide antibiotic coverage for MRSA in patients with health care-associated and ventilator-associated pneumonia.

Continue reading about the use of dalbavancin against MRSA pneumonia, here.

#3: Probiotic Proves Deadly Against Clostridium difficile

The researchers studied the effects of L. reuteri on C. difficile grown in a laboratory, and found that when the probiotic was supplemented with glycerol, it converted it into the broad-spectrum antimicrobial compound reuterin. The reuterin acted as an antimicrobial agent, and worked as well as vancomycin to inhibit C. difficile growth. In addition, the researchers found that glycerol or L. reuteri alone were not effective against C. difficile, and that the reuterin did not harm the good bacteria in the complex gut community. "Probiotics are commonly used to treat a range of human diseases, yet clinical studies are generally fraught by variable clinical outcomes and protective mechanisms are poorly understood in patients,” explained senior author Tor Savidge, PhD. “This study provides important clues on why clinical efficacy may be seen in some patients treated with one probiotic bacterium but not with others.”

While the results are preliminary, the authors note that their findings suggest that the combination of L. reuteri and glycerol could be used as a novel treatment against C. difficile infections as well as preventatively in patients before they receive antibiotics. The new study is part of a growing body of research supporting the use of beneficial bacteria against antibiotic-resistant pathogens as an alternative to antibiotic drugs.

Read more about how probiotics work against C. difficile, here.

#2: Hand Hygiene in Hospitals Increases with Patient Involvement

Despite decreasing statistics, healthcare-associated infections (HAIs) continue to be a major source of infections in the United States. In fact, the Centers for Disease Control and Prevention (CDC) reports that, “on any given day, about 1 in 25 hospital patients has at least one HAI.” Arguably, one of the best ways to prevent HAIs is through performing appropriate hand-hygiene; however, reports reveal that 70% of healthcare workers and 50% of surgical teams do not routinely practice hand hygiene. Now, researchers from the West Virginia University (WVU) School of Medicine may have come up with a way to help decrease those numbers by empowering patients to take an active role in their provider’s hand hygiene.

The new research, published in the American Journal of Infection Control, and led by Allison Lastinger, MD, of the WVU School of Medicine, details the results of a cross-sectional, anonymous, self-administered questionnaire that was administered to 114 parents of hospitalized children and 108 adult patients (from December 2015 to June 2016), as well as primary care physicians (29 residents and 60 attending physicians in November 2015) at the WVU Medicine J.W. Ruby Memorial Hospital. The questionnaire surveyed the respondents on their feelings about a new patient empowerment tool (PET), designed to enable patients to take an active role in encouraging healthcare provider hand hygiene.

Learn more about how patient involvement impacts hand hygiene in hospitals, here.

#1: What Makes Delafloxacin a Unique Antibiotic for Skin Infections?

Antibiotic resistance has become a major clinical challenge in both the hospital and community setting with multidrug resistant pathogens becoming more common. Skin and skin structure infections account for over 7 million cases annually in the community with almost 2% of cases admitted to hospital. Staphylococcus aureus (S. aureus), both methicillin susceptible (MS) and resistant (MR), are the most causative species; however, Gram-negative species are emerging in certain patient types.

Almost all antibiotics are written empirically so choices should include agents with an appropriate spectrum. The US Food and Drug Administration (FDA) recently approved delafloxacin (BAXDELA) for acute bacterial skin and skin structure infections in adults. This new fluoroquinolone is available in both tablet, 450 mg, and intravenous, 300 mg, formulations and can be dosed for 5-14 days twice daily.

In common with other fluoroquinolones delafloxacin carries label warnings for tendonitis, tendon rupture, peripheral neuropathy, central nervous system effects and avoidance of delafloxacin in myasthenia gravis patients. Unlike some other class members there are no issues with QTc interval or other cardiac events and phototoxicity. Equally, the only drug-drug interaction of note is the usual chelation agents, antacids and sulcralfate. There is no interaction with CYP450 isoforms or a range of hepatic and renal transporters with exception of P-gp and BCRP inhibitors, the relevance of this is unknown.

Continue reading about delafloxacin, here.