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Rossana Rosa

@drrossanarosa.bsky.social

Infectious Diseases physician, IP, stewie R💗R💗— Doodler ✏️🖍️🎨 Garra catracha🇭🇳 in Atlantic 🇨🇦| Married into Arsenal and Minnesota Sports fandom 🥰⚽️🏈⚾️ https://www.etsy.com/shop/theipcshop/?etsrc=sdt https://www.instagram.com/drrossanarosa?igsh=emRvNnl0NGVpaXVy

1629 Posts2345 Follower1059 Folgt
IDJClub@idjclub.bsky.social · 2w ago

Results: 1° Efficacy: Median of 183 (short) vs 169 (standard) days alive without antibiotics (HL diff 13 d, 95% CI 12–13, p<0.001). The short arm wins by design. More importantly, “days alive without antibiotics” insufficiently captures excess death or relapses. See figure below.

A closer look at how excess relapses only slowly erodes this outcome (assuming that each was re-treated 6w) : 41 excess relapses needed in the short arm to lose superiority! Excess deaths (assuming to occur at 90d = mid-FUP): if not penalized, same story short: 16 excess deaths needed to lose superiority!
IDJClub@idjclub.bsky.social · 2w ago

Relapse: 5.1% (short arm) vs 1.6% (HR 3.3, 95% CI 1.1–10.1), ~1 extra relapse per 29 patients treated. By pathogen: Strep 3.5% vs 1.3% (5/142 vs 2/149) S. aureus 4.9% vs 1.6% (3/61 vs 1/62) E. faecalis 9.6% vs 2.4% (5/52 vs 1/42). Same direction for all. How do you weigh relapses?

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Angela Huttner @angelahuttner.bsky.social · 2mo ago

Yikes! We have this but it's true we didn't report explicitly. It might take some time but I will go in & get it. If it helps, I can already say that in the 3 sites, common practice for uncomplicated GN bacteremia is to switch on ~D3 (culture results back, patient afeb). But I'll come back! #IDSky

Joseph Marcus@josephmarcusid.medsky.social · 2mo ago

doi.org/10.1177/2049... At our center, we found minimal utility in pts receiving ECMO: -Often elevated -Doesn’t discriminate between positive cultures and negative cultures -Doesn’t reliably decrease with treatment #IDSky

The utility of procalcitonin for identifying secondary infections in patients with influenza or COVID-19 receiving extracorporeal membrane oxygenation - Kajal D. Patel, James K. Aden, Michal J. Sobies...

Background: Identifying secondary infections in patients receiving extracorporeal membrane oxygenation (ECMO) presents challenges due to the ECMO circuit’s infl...

doi.org

Rossana Rosa@drrossanarosa.bsky.social · 2mo ago

Help #IDSky: The von Dach study on treatment of GNR bacteremia allowed IV to PO switch. Does anyone know the median time to switch? I reviewed the paper and the supplement but couldn’t find 😅 (maybe I missed it but help me plz 🫣😇). @angelahuttner.bsky.social jamanetwork.com/journals/jam...

Effect of C-Reactive Protein–Guided or Fixed Antibiotic Duration on Clinical Failure in Patients With Gram-Negative Bacteremia

This randomized trial compares the effects of C-reactive protein (CRP)–guided antibiotic duration (discontinuation once CRP declined by 75% of peak value) vs fixed 7- vs 14-day durations on 30-day cli...

jamanetwork.com

José Molina@josemolinagb.bsky.social · 2mo ago

I find cefepime very useful to diversify empiric antipseudomonal treatments among immunocompromised hosts, and as a carbapenem-sparing agent against ampC producers. This recent metaanalysis made me wonder if I should stop using it… 🧵(1/5) jamanetwork.com/journals/jam... #IDSky #AMSsky #IDOnc

Cefepime and Mortality

This systematic review with bayesian meta-analysis of randomized clinical trials examined the association of cefepime with all-cause mortality compared with other β-lactam antibiotics.

jamanetwork.com