Infectious Disease & Sepsis

Inhaled Amikacin for the Prevention of VAP

In a multicenter, double-blind, randomized controlled trial involving critically ill adults undergoing mechanical ventilation for over 72 hours, patients were administered either inhaled amikacin (20 mg/kg ideal body weight daily) or a placebo for three days. The study aimed to determine the efficacy of preventive inhaled antibiotics in reducing ventilator-associated pneumonia.

Out of the 847 patients analyzed, 15% in the amikacin group and 22% in the placebo group developed ventilator-associated pneumonia within 28 days. The amikacin group showed a significant reduction in the incidence of pneumonia with a difference in restricted mean survival time of 1.5 days (P=0.004). Furthermore, the amikacin group had fewer infection-related ventilator complications compared to the placebo group. The research concludes that a 3-day course of inhaled amikacin can decrease the occurrence of ventilator-associated pneumonia in patients ventilated for at least three days.

Vitamin C for Patients With COVID-19

The LOVIT-COVID trial and the vitamin C section of the REMAP-CAP trial were synchronized to enhance the efficiency of the research. They included 1568 critically ill patients (1037 on vitamin C and 531 in the control group) and 1022 non-critically ill patients (456 on vitamin C and 566 in the control group). Patients were given 50 mg/kg of vitamin C through an IV every 6 hours for a maximum of 96 hours. While both trials were planned together, LOVIT-COVID used a placebo, whereas REMAP-CAP compared vitamin C to standard care. The study was halted once set criteria for potential harm and lack of effectiveness were reached. Among the critically ill patients, those on vitamin C had a median of 7 days without organ support, compared to 10 days in the control group, with an 8.6% probability of effectiveness, 91.4% of potential harm, and 99.9%…

Reliability of Admission Procalcitonin Testing for Capturing Bacteremia Across the Sepsis Spectrum: Real-World Utilization and Performance Characteristics, 65 U.S. Hospitals, 2008–2017

Procalcitonin-on-admission testing for patients with suspected bloodstream infections (BSIs) is often conducted, but its performance remains disputed. 📊 This research paper represents the largest study to date on the use of procalcitonin for identifying patients with bloodstream infections (BSI) in U.S. hospitals. Here are the key points:

• 🩺The study was a retrospective cohort study utilizing the Cerner HealthFacts Database from 2008 to 2017, and included all adult inpatients (≥ 18 years) who had blood cultures and procalcitonin tests within 24 hours of admission.

• ⚕️The study assessed the testing frequency of procalcitonin, sensitivity for detecting BSIs caused by different pathogens, and the discriminatory ability of procalcitonin-on-admission for BSI in patients with or without fever/hypothermia, ICU admission, and sepsis.

A two-day course of antibiotics for complicated appendicitis Appendicitis

This open-label, non-inferiority trial conducted across 15 Dutch hospitals assessed the efficacy and safety of reducing postoperative intravenous antibiotic duration from 5 days to 2 days in patients aged ≥8 years with complex appendicitis, amidst rising concerns regarding antimicrobial resistance. The primary endpoint was a composite of infectious complications and mortality within a 90-day post-appendicectomy period. The trial showed no significant difference in the primary endpoint between the two groups, suggesting that a shorter antibiotic course is non-inferior to a longer one, with additional benefits of lowered adverse effects, and potentially reduced hospital stay and costs.