Clinical Edge Journal Scan

Key clinical point: Heparin-binding protein (HBP) may outperform the conventional biomarkers in predicting disease progression in children with severe community-acquired pneumonia (CAP).

Main finding: After adjusting for age, high HBP levels showed an independent correlation with respiratory failure (RF; odds ratio [OR] 1.008; 95% CI 1.003-1.013) in children with severe CAP. Among other biomarkers, HBP exhibited the highest predictive power for identifying children developing RF or sepsis, yielding areas under the receiver operating characteristic curves of 0.68 and 0.85, respectively, along with the best specificity at 96.3%.

Study details: Findings are from a retrospective observational study on 157 children who were admitted to an ICU ward for severe CAP, of which 106 presented with RF and 48 developed sepsis.

Disclosures: The study was sponsored by the Changsha Science and Technology Bureau Science Foundation, China. The authors declared no conflict of interests.

Source: Huang C et al. Front Pediatr. 2021 (Oct 28). Doi: 10.3389/fped.2021.759535.

Key clinical point: Heparin-binding protein (HBP) may outperform the conventional biomarkers in predicting disease progression in children with severe community-acquired pneumonia (CAP).

Main finding: After adjusting for age, high HBP levels showed an independent correlation with respiratory failure (RF; odds ratio [OR] 1.008; 95% CI 1.003-1.013) in children with severe CAP. Among other biomarkers, HBP exhibited the highest predictive power for identifying children developing RF or sepsis, yielding areas under the receiver operating characteristic curves of 0.68 and 0.85, respectively, along with the best specificity at 96.3%.

Study details: Findings are from a retrospective observational study on 157 children who were admitted to an ICU ward for severe CAP, of which 106 presented with RF and 48 developed sepsis.

Disclosures: The study was sponsored by the Changsha Science and Technology Bureau Science Foundation, China. The authors declared no conflict of interests.

Source: Huang C et al. Front Pediatr. 2021 (Oct 28). Doi: 10.3389/fped.2021.759535.

Key clinical point: Heparin-binding protein (HBP) may outperform the conventional biomarkers in predicting disease progression in children with severe community-acquired pneumonia (CAP).

Main finding: After adjusting for age, high HBP levels showed an independent correlation with respiratory failure (RF; odds ratio [OR] 1.008; 95% CI 1.003-1.013) in children with severe CAP. Among other biomarkers, HBP exhibited the highest predictive power for identifying children developing RF or sepsis, yielding areas under the receiver operating characteristic curves of 0.68 and 0.85, respectively, along with the best specificity at 96.3%.

Study details: Findings are from a retrospective observational study on 157 children who were admitted to an ICU ward for severe CAP, of which 106 presented with RF and 48 developed sepsis.

Disclosures: The study was sponsored by the Changsha Science and Technology Bureau Science Foundation, China. The authors declared no conflict of interests.

Source: Huang C et al. Front Pediatr. 2021 (Oct 28). Doi: 10.3389/fped.2021.759535.

Key clinical point: Administration of ceftaroline alone or in combination resulted in lower in-hospital mortality rates in patients with community-acquired pneumonia (CAP) vs. standard therapy.

Main finding: After adjustment for confounding factors, patients receiving ceftaroline had a lower in-hospital mortality rate (13% vs. 21%; adjusted hazard ratio 0.41; P = .031) and longer median hospital stay (13 days vs. 10 days; P = .007) than those receiving standard therapy.

Study details: This retrospective observational study matched 78 patients with CAP who received ceftaroline (as monotherapy or in combination with azithromycin, levofloxacin, etc.) with 78 control patients who received standard therapy.

Disclosures: The study received financial support from Pfizer, CIBER de Enfermedades Respiratorias, and 2009 Support to Research Groups of Catalonia 911, IDIBAPS. Pfizer, in addition to a couple of other sources, provided research grants/fellowships to Dr. Cilloniz and other authors.

Source: Cilloniz C et al. Eur J Clin Microbiol Infect Dis. 2021 (Nov 12). Doi: 10.1007/s10096-021-04378-0.

Key clinical point: Administration of ceftaroline alone or in combination resulted in lower in-hospital mortality rates in patients with community-acquired pneumonia (CAP) vs. standard therapy.

Main finding: After adjustment for confounding factors, patients receiving ceftaroline had a lower in-hospital mortality rate (13% vs. 21%; adjusted hazard ratio 0.41; P = .031) and longer median hospital stay (13 days vs. 10 days; P = .007) than those receiving standard therapy.

Study details: This retrospective observational study matched 78 patients with CAP who received ceftaroline (as monotherapy or in combination with azithromycin, levofloxacin, etc.) with 78 control patients who received standard therapy.

Disclosures: The study received financial support from Pfizer, CIBER de Enfermedades Respiratorias, and 2009 Support to Research Groups of Catalonia 911, IDIBAPS. Pfizer, in addition to a couple of other sources, provided research grants/fellowships to Dr. Cilloniz and other authors.

Source: Cilloniz C et al. Eur J Clin Microbiol Infect Dis. 2021 (Nov 12). Doi: 10.1007/s10096-021-04378-0.

Key clinical point: Administration of ceftaroline alone or in combination resulted in lower in-hospital mortality rates in patients with community-acquired pneumonia (CAP) vs. standard therapy.

Main finding: After adjustment for confounding factors, patients receiving ceftaroline had a lower in-hospital mortality rate (13% vs. 21%; adjusted hazard ratio 0.41; P = .031) and longer median hospital stay (13 days vs. 10 days; P = .007) than those receiving standard therapy.

Study details: This retrospective observational study matched 78 patients with CAP who received ceftaroline (as monotherapy or in combination with azithromycin, levofloxacin, etc.) with 78 control patients who received standard therapy.

Disclosures: The study received financial support from Pfizer, CIBER de Enfermedades Respiratorias, and 2009 Support to Research Groups of Catalonia 911, IDIBAPS. Pfizer, in addition to a couple of other sources, provided research grants/fellowships to Dr. Cilloniz and other authors.

Source: Cilloniz C et al. Eur J Clin Microbiol Infect Dis. 2021 (Nov 12). Doi: 10.1007/s10096-021-04378-0.

Key clinical point: On comparing regimes recommended by the 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines, those containing doxycycline were associated with decreased mortality in elderly patients with community-acquired pneumonia (CAP).

Main finding: After propensity-matching, patients receiving beta-lactam + doxycycline showed significantly reduced 30-day (odds ratio [OR] 0.72; 95% CI 0.63-0.84) and 90-day (OR 0.83; 95% CI 0.74-0.92) mortality vs. those on nondoxycycline-containing regimes.

Study details: This retrospective observational cohort study included 70,533 patients aged ≥65 years who were admitted to a non-ICU hospital ward for CAP and received at least 1 dose of the 2019 ATS/IDSA guideline-recommended antimicrobial therapy within 48 hours after admission. Of these, 5,282 patients received doxycycline-containing combinations.

Disclosures: The study was supported by the US National Institute of Nursing Research. CA Alvarez declared serving as an advisory board member for a pharmaceutical organization.

Source: Uddin M et al. Clin Infect Dis. 2021;ciab863 (Nov 9). Doi: 10.1093/cid/ciab863.

Key clinical point: On comparing regimes recommended by the 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines, those containing doxycycline were associated with decreased mortality in elderly patients with community-acquired pneumonia (CAP).

Main finding: After propensity-matching, patients receiving beta-lactam + doxycycline showed significantly reduced 30-day (odds ratio [OR] 0.72; 95% CI 0.63-0.84) and 90-day (OR 0.83; 95% CI 0.74-0.92) mortality vs. those on nondoxycycline-containing regimes.

Study details: This retrospective observational cohort study included 70,533 patients aged ≥65 years who were admitted to a non-ICU hospital ward for CAP and received at least 1 dose of the 2019 ATS/IDSA guideline-recommended antimicrobial therapy within 48 hours after admission. Of these, 5,282 patients received doxycycline-containing combinations.

Disclosures: The study was supported by the US National Institute of Nursing Research. CA Alvarez declared serving as an advisory board member for a pharmaceutical organization.

Source: Uddin M et al. Clin Infect Dis. 2021;ciab863 (Nov 9). Doi: 10.1093/cid/ciab863.

Key clinical point: On comparing regimes recommended by the 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines, those containing doxycycline were associated with decreased mortality in elderly patients with community-acquired pneumonia (CAP).

Main finding: After propensity-matching, patients receiving beta-lactam + doxycycline showed significantly reduced 30-day (odds ratio [OR] 0.72; 95% CI 0.63-0.84) and 90-day (OR 0.83; 95% CI 0.74-0.92) mortality vs. those on nondoxycycline-containing regimes.

Study details: This retrospective observational cohort study included 70,533 patients aged ≥65 years who were admitted to a non-ICU hospital ward for CAP and received at least 1 dose of the 2019 ATS/IDSA guideline-recommended antimicrobial therapy within 48 hours after admission. Of these, 5,282 patients received doxycycline-containing combinations.

Disclosures: The study was supported by the US National Institute of Nursing Research. CA Alvarez declared serving as an advisory board member for a pharmaceutical organization.

Source: Uddin M et al. Clin Infect Dis. 2021;ciab863 (Nov 9). Doi: 10.1093/cid/ciab863.

Key clinical point: Occurrence of community-acquired pneumonia (CAP) in infants aged below 2 years increases their risk for subsequent respiratory disease when between 2 and 5 years of age.

Main finding: The rate of chronic respiratory disorder from 2-5 years of age, reactive airway disease, and CAP hospitalization after 2 years of age was 2.4-fold (95% CI 2.1-2.6), 3.2-fold (95% CI 2.6-3.8), and 6.3-fold (95% CI 3.6-10.9) higher in patients with CAP vs. comparison patients.

Study details: The data come from a retrospective study including 1,343 infants less than 2 years of age who were hospitalized once or more for CAP and matched with 6,715 comparator infants with no evidence of pneumonia.

Disclosures: The study was sponsored by Pfizer Inc. Some of the authors declared being directly employed by Pfizer or another organization that received financial support from Pfizer.

Source: Lapidot R et al. Repir Med. 2021:106671 (Oct 27). Doi: 10.1016/j.rmed.2021.106671.

Key clinical point: Occurrence of community-acquired pneumonia (CAP) in infants aged below 2 years increases their risk for subsequent respiratory disease when between 2 and 5 years of age.

Main finding: The rate of chronic respiratory disorder from 2-5 years of age, reactive airway disease, and CAP hospitalization after 2 years of age was 2.4-fold (95% CI 2.1-2.6), 3.2-fold (95% CI 2.6-3.8), and 6.3-fold (95% CI 3.6-10.9) higher in patients with CAP vs. comparison patients.

Study details: The data come from a retrospective study including 1,343 infants less than 2 years of age who were hospitalized once or more for CAP and matched with 6,715 comparator infants with no evidence of pneumonia.

Disclosures: The study was sponsored by Pfizer Inc. Some of the authors declared being directly employed by Pfizer or another organization that received financial support from Pfizer.

Source: Lapidot R et al. Repir Med. 2021:106671 (Oct 27). Doi: 10.1016/j.rmed.2021.106671.

Key clinical point: Occurrence of community-acquired pneumonia (CAP) in infants aged below 2 years increases their risk for subsequent respiratory disease when between 2 and 5 years of age.

Main finding: The rate of chronic respiratory disorder from 2-5 years of age, reactive airway disease, and CAP hospitalization after 2 years of age was 2.4-fold (95% CI 2.1-2.6), 3.2-fold (95% CI 2.6-3.8), and 6.3-fold (95% CI 3.6-10.9) higher in patients with CAP vs. comparison patients.

Study details: The data come from a retrospective study including 1,343 infants less than 2 years of age who were hospitalized once or more for CAP and matched with 6,715 comparator infants with no evidence of pneumonia.

Disclosures: The study was sponsored by Pfizer Inc. Some of the authors declared being directly employed by Pfizer or another organization that received financial support from Pfizer.

Source: Lapidot R et al. Repir Med. 2021:106671 (Oct 27). Doi: 10.1016/j.rmed.2021.106671.

Key clinical point: Pneumonia Severity Index (PSI) and the confusion, urea, respiratory rate, and blood pressure (CURB)-65 score are as effective at predicting in-hospital mortality in patients with SARS-CoV-2 community-acquired pneumonia (CAP) as they are in those with non-SARS-CoV-2 CAP.

Main finding: The area under the receiver operating characteristic curve in patients with SARS-CoV-2 CAP and non-SARS-CoV-2 CAP for PSI was 0.82 (95% Bayesian credible interval [bCI] 0.78-0.86) and 0.79 (95% bCI 0.77-0.80) and that for CURB-65 was 0.79 (95% bCI 0.75-0.84) and 0.75 (95% bCI 0.73-0.77), respectively.

Study details: This was a secondary analysis of 8,081 patients from 2 population-based cohort studies, each of which included adults hospitalized for either SARS-CoV-2 CAP or non-SARS-CoV-2 CAP.

Disclosures: The study was supported by the Center for Excellence for Research in Infectious Diseases at the University of Louisville. None of the authors declared any potential conflict of interests.

Source: Bradley J et al. Chest. 2021 (Nov 2). Doi: 10.1016/j.chest.2021.10.031.

Key clinical point: Pneumonia Severity Index (PSI) and the confusion, urea, respiratory rate, and blood pressure (CURB)-65 score are as effective at predicting in-hospital mortality in patients with SARS-CoV-2 community-acquired pneumonia (CAP) as they are in those with non-SARS-CoV-2 CAP.

Main finding: The area under the receiver operating characteristic curve in patients with SARS-CoV-2 CAP and non-SARS-CoV-2 CAP for PSI was 0.82 (95% Bayesian credible interval [bCI] 0.78-0.86) and 0.79 (95% bCI 0.77-0.80) and that for CURB-65 was 0.79 (95% bCI 0.75-0.84) and 0.75 (95% bCI 0.73-0.77), respectively.

Study details: This was a secondary analysis of 8,081 patients from 2 population-based cohort studies, each of which included adults hospitalized for either SARS-CoV-2 CAP or non-SARS-CoV-2 CAP.

Disclosures: The study was supported by the Center for Excellence for Research in Infectious Diseases at the University of Louisville. None of the authors declared any potential conflict of interests.

Source: Bradley J et al. Chest. 2021 (Nov 2). Doi: 10.1016/j.chest.2021.10.031.

Key clinical point: Pneumonia Severity Index (PSI) and the confusion, urea, respiratory rate, and blood pressure (CURB)-65 score are as effective at predicting in-hospital mortality in patients with SARS-CoV-2 community-acquired pneumonia (CAP) as they are in those with non-SARS-CoV-2 CAP.

Main finding: The area under the receiver operating characteristic curve in patients with SARS-CoV-2 CAP and non-SARS-CoV-2 CAP for PSI was 0.82 (95% Bayesian credible interval [bCI] 0.78-0.86) and 0.79 (95% bCI 0.77-0.80) and that for CURB-65 was 0.79 (95% bCI 0.75-0.84) and 0.75 (95% bCI 0.73-0.77), respectively.

Study details: This was a secondary analysis of 8,081 patients from 2 population-based cohort studies, each of which included adults hospitalized for either SARS-CoV-2 CAP or non-SARS-CoV-2 CAP.

Disclosures: The study was supported by the Center for Excellence for Research in Infectious Diseases at the University of Louisville. None of the authors declared any potential conflict of interests.

Source: Bradley J et al. Chest. 2021 (Nov 2). Doi: 10.1016/j.chest.2021.10.031.

Key clinical point: In patients with moderately severe community-acquired pneumonia (CAP) who reached clinical stability after 3 days of antibiotic treatment, male sex and age were the main risk factors for treatment failure.

Main finding: After excluding the Pneumonia Severity Index score and urea level at day 0, male sex (odds ratio [OR] 1.92; 95% CI 1.08-3.49) and age per year (OR 1.02; 95% CI 1.00-1.05) showed a significant association with treatment failure at day 15.

Study details: This was a secondary analysis including 291 of the 310 patients from the Pneumonia Short Treatment trial who were hospitalized for moderately severe CAP and were clinically stable after 3 days of receiving β-lactams, which is when they were randomly assigned to receive oral amoxicillin-clavulanate or placebo for 5 further days.

Disclosures: The study was supported by the French Ministry of Health and DRCI of Versailles. Dr. Crémieux reported receiving grants from an additional source outside the study.

Source: Dinh A et al. JAMA Netw Open. 2021;4(10):e2129566 (Oct 15). Doi: 10.1001/jamanetworkopen.2021.29566.

Key clinical point: In patients with moderately severe community-acquired pneumonia (CAP) who reached clinical stability after 3 days of antibiotic treatment, male sex and age were the main risk factors for treatment failure.

Main finding: After excluding the Pneumonia Severity Index score and urea level at day 0, male sex (odds ratio [OR] 1.92; 95% CI 1.08-3.49) and age per year (OR 1.02; 95% CI 1.00-1.05) showed a significant association with treatment failure at day 15.

Study details: This was a secondary analysis including 291 of the 310 patients from the Pneumonia Short Treatment trial who were hospitalized for moderately severe CAP and were clinically stable after 3 days of receiving β-lactams, which is when they were randomly assigned to receive oral amoxicillin-clavulanate or placebo for 5 further days.

Disclosures: The study was supported by the French Ministry of Health and DRCI of Versailles. Dr. Crémieux reported receiving grants from an additional source outside the study.

Source: Dinh A et al. JAMA Netw Open. 2021;4(10):e2129566 (Oct 15). Doi: 10.1001/jamanetworkopen.2021.29566.

Key clinical point: In patients with moderately severe community-acquired pneumonia (CAP) who reached clinical stability after 3 days of antibiotic treatment, male sex and age were the main risk factors for treatment failure.

Main finding: After excluding the Pneumonia Severity Index score and urea level at day 0, male sex (odds ratio [OR] 1.92; 95% CI 1.08-3.49) and age per year (OR 1.02; 95% CI 1.00-1.05) showed a significant association with treatment failure at day 15.

Study details: This was a secondary analysis including 291 of the 310 patients from the Pneumonia Short Treatment trial who were hospitalized for moderately severe CAP and were clinically stable after 3 days of receiving β-lactams, which is when they were randomly assigned to receive oral amoxicillin-clavulanate or placebo for 5 further days.

Disclosures: The study was supported by the French Ministry of Health and DRCI of Versailles. Dr. Crémieux reported receiving grants from an additional source outside the study.

Source: Dinh A et al. JAMA Netw Open. 2021;4(10):e2129566 (Oct 15). Doi: 10.1001/jamanetworkopen.2021.29566.

Key clinical point: In children with community-acquired pneumonia (CAP) discharged from emergency departments or inpatient wards, further outpatient treatment with amoxicillin at a lower dose was not inferior to a higher dose, and a 3-day treatment course was not inferior to a 7-day treatment course.

Main finding: Antibiotic retreatment rates in the 4-week period after hospital discharge in the lower dose vs. the higher dose group were 12.6% vs. 12.4% (difference 0.2%; 95% CI –∞ to 4.0%) and those in the shorter duration vs. the longer duration group were 12.5% vs. 12.5% (difference 0.1%; 95% CI –∞ to 3.9%).

Study details: Findings are from the CAP-IT trial including 814 children > 6 months old with CAP who were randomly assigned 1:1 after hospital discharge to receive the 4 possible combinations of amoxicillin dose (35-50 or 70-90 mg/kg) and duration (3 or 7 days).

Disclosures: The trial was funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Program and Antimicrobial Resistance Themed Call. Some of the authors including the lead author reported receiving research grants from the NIHR/HTA.

Source: Bielicki JA et al. JAMA. 2021;326(17):1713-1724 (Nov 2). Doi: 10.1001/jama.2021.17843.

Key clinical point: In children with community-acquired pneumonia (CAP) discharged from emergency departments or inpatient wards, further outpatient treatment with amoxicillin at a lower dose was not inferior to a higher dose, and a 3-day treatment course was not inferior to a 7-day treatment course.

Main finding: Antibiotic retreatment rates in the 4-week period after hospital discharge in the lower dose vs. the higher dose group were 12.6% vs. 12.4% (difference 0.2%; 95% CI –∞ to 4.0%) and those in the shorter duration vs. the longer duration group were 12.5% vs. 12.5% (difference 0.1%; 95% CI –∞ to 3.9%).

Study details: Findings are from the CAP-IT trial including 814 children > 6 months old with CAP who were randomly assigned 1:1 after hospital discharge to receive the 4 possible combinations of amoxicillin dose (35-50 or 70-90 mg/kg) and duration (3 or 7 days).

Disclosures: The trial was funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Program and Antimicrobial Resistance Themed Call. Some of the authors including the lead author reported receiving research grants from the NIHR/HTA.

Source: Bielicki JA et al. JAMA. 2021;326(17):1713-1724 (Nov 2). Doi: 10.1001/jama.2021.17843.

Key clinical point: In children with community-acquired pneumonia (CAP) discharged from emergency departments or inpatient wards, further outpatient treatment with amoxicillin at a lower dose was not inferior to a higher dose, and a 3-day treatment course was not inferior to a 7-day treatment course.

Main finding: Antibiotic retreatment rates in the 4-week period after hospital discharge in the lower dose vs. the higher dose group were 12.6% vs. 12.4% (difference 0.2%; 95% CI –∞ to 4.0%) and those in the shorter duration vs. the longer duration group were 12.5% vs. 12.5% (difference 0.1%; 95% CI –∞ to 3.9%).

Study details: Findings are from the CAP-IT trial including 814 children > 6 months old with CAP who were randomly assigned 1:1 after hospital discharge to receive the 4 possible combinations of amoxicillin dose (35-50 or 70-90 mg/kg) and duration (3 or 7 days).

Disclosures: The trial was funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Program and Antimicrobial Resistance Themed Call. Some of the authors including the lead author reported receiving research grants from the NIHR/HTA.

Source: Bielicki JA et al. JAMA. 2021;326(17):1713-1724 (Nov 2). Doi: 10.1001/jama.2021.17843.

Key clinical point: Antimicrobial stewardship intervention emerged successful in advocating a shift from broad-spectrum to narrow-spectrum antibiotics for treating moderately severe community-acquired pneumonia (CAP) while averting any safety concerns.

Main finding: Antimicrobial stewardship intervention effectuated a decrease in the adjusted mean broad-spectrum days of therapy per patient from 6.5 days to 4.8 days, with an adjusted relative reduction of 26.6% (95% CI 18.0%-35.3%). The adjusted risk difference of 0.4% (90% CI –2.7% to 2.4%) indicated noninferiority.

Study details: The data come from the investigator-initiated, noninferiority, CAP-PACT trial including 4,084 adult patients receiving antibiotics for moderately severe CAP post admission to a non-ICU hospital ward, of whom 2,235 patients were admitted during the control period and 1,849 during the intervention period.

Disclosures: The authors received no financial support for the study. CH van Werkhoven reported receiving grants, personal fees, and nonfinancial support from a few sources outside the study, in addition to obtaining a patent for the prediction of clinical manifestations of gut microbiota.

Source: Schweitzer VA et al. Lancet Infect Dis. 2021(Oct 7). Doi: 10.1016/S1473-3099(21)00255-3.

Key clinical point: Antimicrobial stewardship intervention emerged successful in advocating a shift from broad-spectrum to narrow-spectrum antibiotics for treating moderately severe community-acquired pneumonia (CAP) while averting any safety concerns.

Main finding: Antimicrobial stewardship intervention effectuated a decrease in the adjusted mean broad-spectrum days of therapy per patient from 6.5 days to 4.8 days, with an adjusted relative reduction of 26.6% (95% CI 18.0%-35.3%). The adjusted risk difference of 0.4% (90% CI –2.7% to 2.4%) indicated noninferiority.

Study details: The data come from the investigator-initiated, noninferiority, CAP-PACT trial including 4,084 adult patients receiving antibiotics for moderately severe CAP post admission to a non-ICU hospital ward, of whom 2,235 patients were admitted during the control period and 1,849 during the intervention period.

Disclosures: The authors received no financial support for the study. CH van Werkhoven reported receiving grants, personal fees, and nonfinancial support from a few sources outside the study, in addition to obtaining a patent for the prediction of clinical manifestations of gut microbiota.

Source: Schweitzer VA et al. Lancet Infect Dis. 2021(Oct 7). Doi: 10.1016/S1473-3099(21)00255-3.

Key clinical point: Antimicrobial stewardship intervention emerged successful in advocating a shift from broad-spectrum to narrow-spectrum antibiotics for treating moderately severe community-acquired pneumonia (CAP) while averting any safety concerns.

Main finding: Antimicrobial stewardship intervention effectuated a decrease in the adjusted mean broad-spectrum days of therapy per patient from 6.5 days to 4.8 days, with an adjusted relative reduction of 26.6% (95% CI 18.0%-35.3%). The adjusted risk difference of 0.4% (90% CI –2.7% to 2.4%) indicated noninferiority.

Study details: The data come from the investigator-initiated, noninferiority, CAP-PACT trial including 4,084 adult patients receiving antibiotics for moderately severe CAP post admission to a non-ICU hospital ward, of whom 2,235 patients were admitted during the control period and 1,849 during the intervention period.

Disclosures: The authors received no financial support for the study. CH van Werkhoven reported receiving grants, personal fees, and nonfinancial support from a few sources outside the study, in addition to obtaining a patent for the prediction of clinical manifestations of gut microbiota.

Source: Schweitzer VA et al. Lancet Infect Dis. 2021(Oct 7). Doi: 10.1016/S1473-3099(21)00255-3.

A retrospective observational study of nearly 1200 prior biologic-experienced adult patients with psoriasis now receiving either secukinumab (n=780) or ixekizumab (n=411), both of which inhibit IL-17A, examined drug persistence after 18 months. Ixekizumab was associated with significantly higher rates of high treatment adherence (42% vs 35%; P = .019) and persistence (44.9% vs 36.9%; P = .007) and lower discontinuation (48.4% vs 56.0%; P = .018) and switching (26.6% vs 34.0%; P = .009) rates than secukinumab. Both drugs are dosed monthly after an initial loading dose (Blauvelt A et al. Dermatol Ther (Heidelb).

With several biologic options available, patients may be switched from one biologic to another if they are not having an adequate response. Separate studies have shown that patients with an inadequate response to ustekinumab are likely to have a better response when switched to brodalumab or guselkumab, although this does not tell us if one is more likely to be effective than the other. In a recent matching-adjusted indirect comparison study using data for patients with psoriasis who responded inadequately to ustekinumab and switched to receive brodalumab (n=121) or guselkumab (n=135) the authors found that brodalumab was associated with greater improvements than guselkumab in inadequate responders to ustekinumab with a PASI 100 rate at week 36 of 40.3% for brodalumab vs 20.0% for guselkumab; P < 0.001. (Hampton P et al. Psoriasis (Auckl).

While biologics have revolutionized the treatment of psoriasis, not all patients with extensive disease desire or are appropriate for a systemic therapy. Topical steroids, the most commonly used topical psoriasis therapy, still carry some risk of systemic absorption and are associate with cutaneous side effects such as atrophy with prolonged use. Tarpinarof 1% cream is a novel aryl hydrocarbon receptor modulating agent that has been shown in phase 3 studies to be an effective treatment for psoriasis when applied once a day. A recent open label study of 21 adult patients with extensive plaque psoriasis (20% or more body surface area (BSA) involvement, mean baseline BSA 27.2%) who applied tapinarof cream 1% QD daily showed that 94.7% of patients had a decrease in their PASI score (mean PASI decrease of 59.6%). Despite the large BSA being treated, tapinarof plasma concentration were low and remained below the quantification level in the majority (67.9%) of samples tested. There were also no concerning EKG changes such as QT prolongation. Folliculitis and headache were the most common adverse events (each reported by 4 patients) (Jett JE et al. Am J Clin Dermatol).

These studies all provide valuable data in helping us to make the best treatment decisions for patients with moderate to severe plaque psoriasis.

A retrospective observational study of nearly 1200 prior biologic-experienced adult patients with psoriasis now receiving either secukinumab (n=780) or ixekizumab (n=411), both of which inhibit IL-17A, examined drug persistence after 18 months. Ixekizumab was associated with significantly higher rates of high treatment adherence (42% vs 35%; P = .019) and persistence (44.9% vs 36.9%; P = .007) and lower discontinuation (48.4% vs 56.0%; P = .018) and switching (26.6% vs 34.0%; P = .009) rates than secukinumab. Both drugs are dosed monthly after an initial loading dose (Blauvelt A et al. Dermatol Ther (Heidelb).

With several biologic options available, patients may be switched from one biologic to another if they are not having an adequate response. Separate studies have shown that patients with an inadequate response to ustekinumab are likely to have a better response when switched to brodalumab or guselkumab, although this does not tell us if one is more likely to be effective than the other. In a recent matching-adjusted indirect comparison study using data for patients with psoriasis who responded inadequately to ustekinumab and switched to receive brodalumab (n=121) or guselkumab (n=135) the authors found that brodalumab was associated with greater improvements than guselkumab in inadequate responders to ustekinumab with a PASI 100 rate at week 36 of 40.3% for brodalumab vs 20.0% for guselkumab; P < 0.001. (Hampton P et al. Psoriasis (Auckl).

While biologics have revolutionized the treatment of psoriasis, not all patients with extensive disease desire or are appropriate for a systemic therapy. Topical steroids, the most commonly used topical psoriasis therapy, still carry some risk of systemic absorption and are associate with cutaneous side effects such as atrophy with prolonged use. Tarpinarof 1% cream is a novel aryl hydrocarbon receptor modulating agent that has been shown in phase 3 studies to be an effective treatment for psoriasis when applied once a day. A recent open label study of 21 adult patients with extensive plaque psoriasis (20% or more body surface area (BSA) involvement, mean baseline BSA 27.2%) who applied tapinarof cream 1% QD daily showed that 94.7% of patients had a decrease in their PASI score (mean PASI decrease of 59.6%). Despite the large BSA being treated, tapinarof plasma concentration were low and remained below the quantification level in the majority (67.9%) of samples tested. There were also no concerning EKG changes such as QT prolongation. Folliculitis and headache were the most common adverse events (each reported by 4 patients) (Jett JE et al. Am J Clin Dermatol).

These studies all provide valuable data in helping us to make the best treatment decisions for patients with moderate to severe plaque psoriasis.

A retrospective observational study of nearly 1200 prior biologic-experienced adult patients with psoriasis now receiving either secukinumab (n=780) or ixekizumab (n=411), both of which inhibit IL-17A, examined drug persistence after 18 months. Ixekizumab was associated with significantly higher rates of high treatment adherence (42% vs 35%; P = .019) and persistence (44.9% vs 36.9%; P = .007) and lower discontinuation (48.4% vs 56.0%; P = .018) and switching (26.6% vs 34.0%; P = .009) rates than secukinumab. Both drugs are dosed monthly after an initial loading dose (Blauvelt A et al. Dermatol Ther (Heidelb).

With several biologic options available, patients may be switched from one biologic to another if they are not having an adequate response. Separate studies have shown that patients with an inadequate response to ustekinumab are likely to have a better response when switched to brodalumab or guselkumab, although this does not tell us if one is more likely to be effective than the other. In a recent matching-adjusted indirect comparison study using data for patients with psoriasis who responded inadequately to ustekinumab and switched to receive brodalumab (n=121) or guselkumab (n=135) the authors found that brodalumab was associated with greater improvements than guselkumab in inadequate responders to ustekinumab with a PASI 100 rate at week 36 of 40.3% for brodalumab vs 20.0% for guselkumab; P < 0.001. (Hampton P et al. Psoriasis (Auckl).

While biologics have revolutionized the treatment of psoriasis, not all patients with extensive disease desire or are appropriate for a systemic therapy. Topical steroids, the most commonly used topical psoriasis therapy, still carry some risk of systemic absorption and are associate with cutaneous side effects such as atrophy with prolonged use. Tarpinarof 1% cream is a novel aryl hydrocarbon receptor modulating agent that has been shown in phase 3 studies to be an effective treatment for psoriasis when applied once a day. A recent open label study of 21 adult patients with extensive plaque psoriasis (20% or more body surface area (BSA) involvement, mean baseline BSA 27.2%) who applied tapinarof cream 1% QD daily showed that 94.7% of patients had a decrease in their PASI score (mean PASI decrease of 59.6%). Despite the large BSA being treated, tapinarof plasma concentration were low and remained below the quantification level in the majority (67.9%) of samples tested. There were also no concerning EKG changes such as QT prolongation. Folliculitis and headache were the most common adverse events (each reported by 4 patients) (Jett JE et al. Am J Clin Dermatol).

These studies all provide valuable data in helping us to make the best treatment decisions for patients with moderate to severe plaque psoriasis.

A recent study by Lee et al in the Journal of Obstetrics and Gynaecology Research evaluated the feasibility of robotic single-port myomectomy (RSPM) using the da Vinci SP surgical system. In this prospective observational study, 61 women with symptomatic fibroids underwent RSPM. In women with less than 7 resected uterine fibroids (maximal diameter < 10 cm) as well as those with at least 7 resected fibroids (maximal diameter of resected fibroids ≥10 cm), there was no conversion to single-port laparoscopic myomectomy, multiport laparoscopic myomectomy, or laparotomy. Reported complications were minor and included fever, transient ileus and blood transfusion in 15 patients. The authors proposed that robotic single-port myomectomy could solve many of the ergonomic problems associated with single-port laparoscopic myomectomy.

When performing myomectomy during C-section, is there a method that is advantageous? This question was evaluated by Karaca SY et al in European Journal of Obstetrics and Gynecology and Reproductive Biology who compared transendometrial myomectomy with conventional myomectomy. Overall, 41 patients underwent transendometrial myomectomy, and 52 patients underwent conventional myomectomy, with all patients having one single anterior intramural fibroid removed. The mean duration of surgery (50.5 minutes vs 63.6 minutes; P = .001) was lower in the transendometrial group versus the conventional myomectomy group. Additionally, patients who underwent transendometrial myomectomy (0.58 ± 0.61) had significantly lower adhesion scores in their subsequent pregnancy compared to patients who underwent conventional myomectomy (1,76 ± 1,1) (P = 0.001). Length of hospital stay, procedure-related hemoglobin difference, blood transfusion requirement, and postoperative fever were similar in both groups.

A recent study by Lee et al in the Journal of Obstetrics and Gynaecology Research evaluated the feasibility of robotic single-port myomectomy (RSPM) using the da Vinci SP surgical system. In this prospective observational study, 61 women with symptomatic fibroids underwent RSPM. In women with less than 7 resected uterine fibroids (maximal diameter < 10 cm) as well as those with at least 7 resected fibroids (maximal diameter of resected fibroids ≥10 cm), there was no conversion to single-port laparoscopic myomectomy, multiport laparoscopic myomectomy, or laparotomy. Reported complications were minor and included fever, transient ileus and blood transfusion in 15 patients. The authors proposed that robotic single-port myomectomy could solve many of the ergonomic problems associated with single-port laparoscopic myomectomy.

When performing myomectomy during C-section, is there a method that is advantageous? This question was evaluated by Karaca SY et al in European Journal of Obstetrics and Gynecology and Reproductive Biology who compared transendometrial myomectomy with conventional myomectomy. Overall, 41 patients underwent transendometrial myomectomy, and 52 patients underwent conventional myomectomy, with all patients having one single anterior intramural fibroid removed. The mean duration of surgery (50.5 minutes vs 63.6 minutes; P = .001) was lower in the transendometrial group versus the conventional myomectomy group. Additionally, patients who underwent transendometrial myomectomy (0.58 ± 0.61) had significantly lower adhesion scores in their subsequent pregnancy compared to patients who underwent conventional myomectomy (1,76 ± 1,1) (P = 0.001). Length of hospital stay, procedure-related hemoglobin difference, blood transfusion requirement, and postoperative fever were similar in both groups.

A recent study by Lee et al in the Journal of Obstetrics and Gynaecology Research evaluated the feasibility of robotic single-port myomectomy (RSPM) using the da Vinci SP surgical system. In this prospective observational study, 61 women with symptomatic fibroids underwent RSPM. In women with less than 7 resected uterine fibroids (maximal diameter < 10 cm) as well as those with at least 7 resected fibroids (maximal diameter of resected fibroids ≥10 cm), there was no conversion to single-port laparoscopic myomectomy, multiport laparoscopic myomectomy, or laparotomy. Reported complications were minor and included fever, transient ileus and blood transfusion in 15 patients. The authors proposed that robotic single-port myomectomy could solve many of the ergonomic problems associated with single-port laparoscopic myomectomy.

When performing myomectomy during C-section, is there a method that is advantageous? This question was evaluated by Karaca SY et al in European Journal of Obstetrics and Gynecology and Reproductive Biology who compared transendometrial myomectomy with conventional myomectomy. Overall, 41 patients underwent transendometrial myomectomy, and 52 patients underwent conventional myomectomy, with all patients having one single anterior intramural fibroid removed. The mean duration of surgery (50.5 minutes vs 63.6 minutes; P = .001) was lower in the transendometrial group versus the conventional myomectomy group. Additionally, patients who underwent transendometrial myomectomy (0.58 ± 0.61) had significantly lower adhesion scores in their subsequent pregnancy compared to patients who underwent conventional myomectomy (1,76 ± 1,1) (P = 0.001). Length of hospital stay, procedure-related hemoglobin difference, blood transfusion requirement, and postoperative fever were similar in both groups.