The DOTS randomized clinical trial of dalbavancin versus standard-of-care for Staph aureus bacteremia (SAB) just landed in JAMA, where it undoubtedly will be featured in numerous ID, hospitalist, and ...

Diagnostic yield of blood cultures in febrile neutropenia—a real-world observational study from an academic medical center during blood culture bottle shortage

Vancomycin-resistant Enterococcus faecium (VREfm) bloodstream infections (BSIs) pose significant management challenges with uncertainties relating to the optimal daptomycin dose for treatment.MethodsA retrospective cohort study of adult patients receiving ≥3 days of definitive treatment for a first episode VREfm BSI between 2015 and 2022 was undertaken. Daptomycin doses were classified as low (≤7.9 mg/kg), medium (8.0 to 9.9 mg/kg) or high (≥10 mg/kg). We aimed to assess the association between daptomycin dose and in-hospital 30-day all-cause mortality in addition to other clinical outcomes (hospital length of stay, transfer to the ICU within 48 hours and microbiological failure). In addition, we undertook a comparative analysis of mortality and other outcomes in vanB VREfm BSIs receiving definitive daptomycin and teicoplanin treatment.ResultsA total of 191 patients received definitive daptomycin (n = 111) or teicoplanin (n = 80) therapy and were included in two separate analyses. Of the 111 daptomycin patients, most received high-dose daptomycin (59.5%), with 29.7% and 10.8% receiving medium and low doses, respectively. All-cause 30-day in-hospital mortality was 17.1% and there was no association between daptomycin dose groups and in-hospital 30-day mortality (log rank P = 0.369). Microbiological failure was associated with dose (P = 0.036): 33.3% in the low dose group, 12.1% for medium and 19.7% for high. No mortality difference was observed between vanB VREfm BSIs treated with daptomycin or teicoplanin [adjusted cause-specific hazard ratio 0.67 (95% CI: 0.28–1.59)].ConclusionsIn this contemporary study of predominantly high daptomycin doses, there was no association between daptomycin dose and 30-day in-hospital mortality but we did observe an association with microbiological failure.

Abstract. In outpatient parenteral antimicrobial therapy, weekly lab monitoring is often standard practice, even for antimicrobials with low complication r

Among patients with a hospital-acquired or health-care-associated Gram-negative bloodstream infection, cefiderocol resulted in non-inferior 14-day mortality compared with standard of care. Adverse eve...

Lessons learned from a diagnostic stewardship intervention in response to a blood culture bottle supply shock - Volume 5 Issue 1

Contrary to popular belief, peer review has only recently become an...

Hemophagocytic lymphohistiocytosis occurred in 20% of people with disseminated histoplasmosis at our institution in Arkansas. Very elevated serum ferritin,