Breakpoints

Drs. Maria Mojica, Robert Bonomo, and Ryan Shields join Dr. Erin McCreary (@erinmccreary) for a Halloween special reviewing the scariest resistance mechanisms and baddest bugs – Burkholderia spp., Achromobacter spp., and Elizabethkingia spp. Never have beta lactamase enzymes and other complexities been explained so hauntingly well. We don’t want to spook you, but these environmental, opportunistic pathogens are found around the globe. While we hope you don’t encounter them, take a listen to prepare in case one jumps out in your practice! This episode was sponsored by an unrestricted grant from Shionogi Inc. References: Spencer HK, Spitznogle SL, Borjan J, Aitken SL. An Overview of the Treatment of Less Common Non-Lactose-Fermenting Gram-Negative Bacteria. Pharmacotherapy. 2020 Sep;40(9):936-951. doi: 10.1002/phar.2447. Epub 2020 Aug 14. PMID: 32687670. Defining antimicrobial susceptibility testing methods and breakpoints among Achromobacter species SIDP 2025 Webinar | Mind the Gap: CLSI M100 Updates to Optimize Stewardship and Patient Care Outcomes Yasmin M, Rojas LJ, Marshall SH, Hujer AM, Cmolik A, Marshall E, Boucher HW, Vila AJ, Soldevila M, Diene SM, Rolain JM, Bonomo RA. Characterization of a Novel Pathogen in Immunocompromised Patients: Elizabethkingia anophelis-Exploring the Scope of Resistance to Contemporary Antimicrobial Agents and β-lactamase Inhibitors. Open Forum Infect Dis. 2023 Jan 31;10(2):ofad014. doi: 10.1093/ofid/ofad014. PMID: 36820316; PMCID: PMC9938519. Warner NC, Bartelt LA, Lachiewicz AM, Tompkins KM, Miller MB, Alby K, Jones MB, Carr AL, Alexander J, Gainey AB, Daniels R, Burch AK, Brown DE, Brownstein MJ, Cheema F, Linder KE, Shields RK, Longworth S, van Duin D. Cefiderocol for the Treatment of Adult and Pediatric Patients With Cystic Fibrosis and Achromobacter xylosoxidans Infections. Clin Infect Dis. 2021 Oct 5;73(7):e1754-e1757. doi: 10.1093/cid/ciaa1847. PMID: 33313656; PMCID: PMC8678443. El Chakhtoura NG, Saade E, Wilson BM, Perez F, Papp-Wallace KM, Bonomo RA. A 17-Year Nationwide Study of Burkholderia cepacia Complex Bloodstream Infections Among Patients in the United States Veterans Health Administration. Clin Infect Dis. 2017 Oct 15;65(8):1253-1259. doi: 10.1093/cid/cix559. PMID: 29017247; PMCID: PMC5848224.

Drs. Erin Barreto (@erin_barreto) and Jeffrey Lipman join Dr. Whitney Buckel for a conversation on ideal dosing of cefepime. Hear from the experts on the differences between package insert and “high-dose” regimens, adjustments for renal impairment/augmented renal clearance, and the role of cefepime therapeutic drug monitoring. References: Barreto EF, et al. Setting the Beta-Lactam Therapeutic Range for Critically Ill Patients: Is There a Floor or Even a Ceiling? Crit Care Explor. 2021 Jun 11;3(6):e0446.PMID: https://pubmed.ncbi.nlm.nih.gov/34136822/ Barreto EF, et al. Adequacy of cefepime concentrations in the early phase of critical illness: A case for precision pharmacotherapy. Pharmacotherapy. 2023 Nov;43(11):1112-1120. https://pubmed.ncbi.nlm.nih.gov/36648390/ ** **Udy AA, et al. Augmented renal clearance: implications for antibacterial dosing in the critically ill. Clin Pharmacokinet. 2010;49(1):1-16. https://pubmed.ncbi.nlm.nih.gov/20000886/ Lipman J, Wallis SC, Boots RJ. Cefepime versus cefpirome: the importance of creatinine clearance.   Anesth Analg. 2003 Oct;97(4):1149-1154. doi: 10.1213/01.ANE.0000077077.54084.B0.PMID: 14500173 Roberts JA, Ulldemolins M, Roberts MS, McWhinney B, Ungerer J, Paterson DL, Lipman J. Therapeutic drug monitoring of beta-lactams in critically ill patients: proof of concept.  Int J Antimicrob Agents. 2010 Oct;36(4):332-9. doi: 10.1016/j.ijantimicag.2010.06.008. Epub 2010 Aug 3.PMID: 20685085

En nuestro primer episodio publicado tanto en inglés como en español, la Dra. Laila Woc-Colburn y el QF. Nicolás Ignacio Valdebenito Farías se unen al Dr. José Pablo Díaz Madriz para hablar sobre el papel del farmacéutico en los PROA en América Latina. Ellos discuten la necesidad de expandir los PROA en toda la región, cómo los farmacéuticos pueden ampliar sus funciones para apoyar equipos multidisciplinarios dedicados a esta labor, ¡y mucho más! Ciapponi A, Bardach A, Sandoval MM, Palermo MC, Navarro E, Espinal C, Quirós R. Systematic review and meta-analysis of deaths attributable to antimicrobial resistance, Latin America. Emerg Infect Dis. 2023 Nov;29(11):2335-44. doi:10.3201/eid2911.230753. PMID:37877573; PMCID:PMC10617342. Antimicrobial Resistance Collaborators. The burden of antimicrobial resistance in the Americas in 2019: a cross-country systematic analysis. Lancet Reg Health Am. 2023 Aug 8;25:100561. doi:10.1016/j.lana.2023.100561. Erratum in: Lancet Reg Health Am. 2023 Nov 10;28:100632. doi:10.1016/j.lana.2023.100632. PMID:37727594; PMCID:PMC10505822. Fabre V, Secaira C, Cosgrove SE, Lessa FC, Patel TS, Alvarez AA, Anchiraico LM, Del Carmen Bangher M, Barberis MF, Burokas MS, Castañeda X, Colque AM, De Ascencao G, Esquivel C, Ezcurra C, Falleroni LA, Frassone N, Garzón MI, Gomez C, Gonzalez JA, Hernandez D, Laplume D, Lemir CG, Maldonado Briones H, Melgar M, Mesplet F, Martinez G, Pertuz CM, Moreno C, Nemirovsky C, Nuccetelli Y, Palacio B, Sandoval N, Vergara H, Videla H, Villamandos S, Villareal O, Viteri A, Quiros R. Deep dive into gaps and barriers to implementation of antimicrobial stewardship programs in hospitals in Latin America. Clin Infect Dis. 2023 Jul 5;77(Suppl 1):S53-S61. doi:10.1093/cid/ciad184. PMID:37406044; PMCID:PMC10321692. Charani E, Smith I, Skodvin B, Perozziello A, Lucet JC, Lescure FX, Birgand G, Poda A, Ahmad R, Singh S, Holmes AH. Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries: a qualitative study. PLoS One. 2019 Jan 16;14(1):e0209847. doi:10.1371/journal.pone.0209847. PMID:30650099; PMCID:PMC6335060. Bavestrello L, Cabello Á, Casanova D. Impact of regulatory measures on antibiotic sales in Chile. Rev Med Chil. 2002 Nov;130(11):1265-72. doi:10.4067/S0034-98872002001100009. ISSN 0034-9887. Díaz-Madriz JP, et al. Impact of a pharmacist-driven antimicrobial stewardship program in a private hospital in Costa Rica. Rev Panam Salud Publica. 2020;44:e57. doi:10.26633/RPSP.2020.57. Díaz-Madriz JP, et al. Impact of a pharmacist-driven antimicrobial stewardship program on the prescription of antibiotics by intensive care physicians in a Latin American hospital: a retrospective study. J Am Coll Clin Pharm. 2022;5(11):1148-55. doi:10.1002/jac5.1708. Domínguez I, et al. Evaluación del consumo de antimicrobianos en 15 hospitales chilenos: resultados de un trabajo colaborativo, 2013. Rev Chil Infectol. 2016 Jun;33(3):307-12. doi:10.4067/S0716-10182016000300010. ISSN 0716-1018. Ministerio de Salud de Chile. Norma general técnica N°210 para la racionalización del uso de antimicrobianos en la atención clínica. Resolución Exenta N°1146, 2020. Disponible en: https://diprece.minsal.cl/wp-content/uploads/2021/01/RES.-EXENTA-N%C2%B01146-Aprueba-Norma-Gral.-Te%CC%81cnica-N%C2%B00210-para-la-racionalizacio%CC%81n-del-uso-de-antimicrobianos-en-la-Atencio%CC%81n-Cli%CC%81nica_v2.pdf

In our first episode released in both English and Spanish, Drs. Laila Woc-Colburn and Nicholás Ignacio Valdebenito Farías join Dr. José Pablo Díaz Madriz to discuss the role of the pharmacist in antimicrobial stewardship in Latin America. They discuss the need for growth of antimicrobial stewardship programs across Latin America, how pharmacists can expand their roles to support multidisciplinary antimicrobial stewardship teams, and much more!   Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/. Visit our website! https://breakpoints-sidp.org/ References: Ciapponi A, Bardach A, Sandoval MM, Palermo MC, Navarro E, Espinal C, Quirós R. Systematic review and meta-analysis of deaths attributable to antimicrobial resistance, Latin America. Emerg Infect Dis. 2023 Nov;29(11):2335-44. doi:10.3201/eid2911.230753. PMID:37877573; PMCID:PMC10617342. Antimicrobial Resistance Collaborators. The burden of antimicrobial resistance in the Americas in 2019: a cross-country systematic analysis. Lancet Reg Health Am. 2023 Aug 8;25:100561. doi:10.1016/j.lana.2023.100561. Erratum in: Lancet Reg Health Am. 2023 Nov 10;28:100632. doi:10.1016/j.lana.2023.100632. PMID:37727594; PMCID:PMC10505822. Fabre V, Secaira C, Cosgrove SE, Lessa FC, Patel TS, Alvarez AA, Anchiraico LM, Del Carmen Bangher M, Barberis MF, Burokas MS, Castañeda X, Colque AM, De Ascencao G, Esquivel C, Ezcurra C, Falleroni LA, Frassone N, Garzón MI, Gomez C, Gonzalez JA, Hernandez D, Laplume D, Lemir CG, Maldonado Briones H, Melgar M, Mesplet F, Martinez G, Pertuz CM, Moreno C, Nemirovsky C, Nuccetelli Y, Palacio B, Sandoval N, Vergara H, Videla H, Villamandos S, Villareal O, Viteri A, Quiros R. Deep dive into gaps and barriers to implementation of antimicrobial stewardship programs in hospitals in Latin America. Clin Infect Dis. 2023 Jul 5;77(Suppl 1):S53-S61. doi:10.1093/cid/ciad184. PMID:37406044; PMCID:PMC10321692. Charani E, Smith I, Skodvin B, Perozziello A, Lucet JC, Lescure FX, Birgand G, Poda A, Ahmad R, Singh S, Holmes AH. Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries: a qualitative study. PLoS One. 2019 Jan 16;14(1):e0209847. doi:10.1371/journal.pone.0209847. PMID:30650099; PMCID:PMC6335060. Bavestrello L, Cabello Á, Casanova D. Impact of regulatory measures on antibiotic sales in Chile. Rev Med Chil. 2002 Nov;130(11):1265-72. doi:10.4067/S0034-98872002001100009. ISSN 0034-9887. Díaz-Madriz JP, et al. Impact of a pharmacist-driven antimicrobial stewardship program in a private hospital in Costa Rica. Rev Panam Salud Publica. 2020;44:e57. doi:10.26633/RPSP.2020.57. Díaz-Madriz JP, et al. Impact of a pharmacist-driven antimicrobial stewardship program on the prescription of antibiotics by intensive care physicians in a Latin American hospital: a retrospective study. J Am Coll Clin Pharm. 2022;5(11):1148-55. doi:10.1002/jac5.1708. Domínguez I, et al. Evaluación del consumo de antimicrobianos en 15 hospitales chilenos: resultados de un trabajo colaborativo, 2013. Rev Chil Infectol. 2016 Jun;33(3):307-12. doi:10.4067/S0716-10182016000300010. ISSN 0716-1018. Ministerio de Salud de Chile. Norma general técnica N°210 para la racionalización del uso de antimicrobianos en la atención clínica. Resolución Exenta N°1146, 2020. Disponible en: https://diprece.minsal.cl/wp-content/uploads/2021/01/RES.-EXENTA-N%C2%B01146-Aprueba-Norma-Gral.-Te%CC%81cnica-N%C2%B00210-para-la-racionalizacio%CC%81n-del-uso-de-antimicrobianos-en-la-Atencio%CC%81n-Cli%CC%81nica_v2.pdf

In this second-ever collaboration between SIDP’s Breakpoints and ESCMID’s Communicable podcasts, hosts Erin McCreary and Angela Huttner invite the two principal investigators and visionaries who spearheaded the Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) trial, Nick Daneman and Rob Fowler from Sunnybrook Health Sciences Centre in Toronto, for a “deep dive into all things that went into this trial.” The BALANCE trial spanned over ten years investigating - as the acronym title suggests - whether a shorter treatment duration of seven days was non-inferior to the standard of care of fourteen days for bacteremia. The conversation covers everything from the initial hallway discussions that sparked the trial, the trial itself that screened over 36,000 patients and enrolled +3,600, its impact on clinical practice, key takeaways, and what’s next for Daneman and Fowler. References: BALANCE Investigators, et al. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. 2025 March. DOI: https://doi.org/10.1056/NEJMoa2404991

Drs. Whitney Hartlage (@whithartlage11) and Sam Windham join Dr. Ryan Moenster to discuss updates in the diagnosis and management of community-acquire pneumonia. Hear from our guests on the role of rapid diagnostic tests such as multiplex PCR and urinary antigen tests in the inpatient and outpatient setting, considerations for initiating steroids and withholding macrolides, and when to use short antibiotic durations. Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/. Visit our website! https://breakpoints-sidp.org/ References: Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. PMID: 31573350; PMCID: PMC6812437. Chaudhuri D, Nei AM, Rochwerg B, Balk RA, Asehnoune K, Cadena R, Carcillo JA, Correa R, Drover K, Esper AM, Gershengorn HB, Hammond NE, Jayaprakash N, Menon K, Nazer L, Pitre T, Qasim ZA, Russell JA, Santos AP, Sarwal A, Spencer-Segal J, Tilouche N, Annane D, Pastores SM. 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Med. 2024 May 1;52(5):e219-e233. doi: 10.1097/CCM.0000000000006172. Epub 2024 Jan 19. PMID: 38240492. Odeyemi Y, Tekin A, Schanz C, Schreier D, Cole K, Gajic O, Barreto E. Comparative effectiveness of azithromycin versus doxycycline in hospitalized patients with community acquired pneumonia treated with beta-lactams: A multicenter matched cohort study. Clin Infect Dis. 2025 May 16:ciaf252. doi: 10.1093/cid/ciaf252. Epub ahead of print. PMID: 40378193. Butler AM, Nickel KB, Olsen MA, Sahrmann JM, Colvin R, Neuner E, O'Neil CA, Fraser VJ, Durkin MJ. Comparative safety of different antibiotic regimens for the treatment of outpatient community-acquired pneumonia among otherwise healthy adults. Clin Infect Dis. 2024 Oct 23:ciae519. doi: 10.1093/cid/ciae519. Epub ahead of print. PMID: 39442057; PMCID: PMC12355227. Furukawa Y, Luo Y, Funada S, Onishi A, Ostinelli E, Hamza T, Furukawa TA, Kataoka Y. Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis. BMJ Open. 2023 Mar 22;13(3):e061023. doi: 10.1136/bmjopen-2022-061023. PMID: 36948555; PMCID: PMC10040075 Schober T, Wong K, DeLisle G, et al. Clinical outcomes of rapid respiratory virus testing in emergency departments. JAMA Intern Med. 2024;184(5):528-536. Clark T, Lindsley K, Wigmosta T, et al. Rapid multiplex PCR for respiratory viruses reduces time to result and improves clinical care: results of a systematic review and meta-analysis. J Infect. 2023;86(5):462-475. May L, Robbins EM, Canchola JA, Chugh K, Tran NK. A study to assess the impact of the cobas point-of-care RT-PCR assay (SARS-CoV-2 and Influenza A/B) on patient clinical management in the emergency department of the University of California at David Medical Center. J Clin Virol. 2023:168:105597. Cartuliares MB, Rosenvinge FS, Mogensen CB, Skovsted TA, Andersen SL, Østergaard C, et al. Evaluation of point-of-care multiplex polymerase chain reaction in guiding antibiotic treatment of patients acutely admitted with suspected community-acquired pneumonia in Denmark: a multicentre randomised controlled trial. PLoS Med. 2023;20:e1004314. doi: 10.1371/ journal.pmed.1004314. Vaughn VM, Dickson RP, Horowitz JK, Flanders SA. Community-acquired pneumonia: a review. JAMA. 2024;332(15):1282-1295. Davis MR, McCreary EK, Trzebucki AM. Things we do for no reason – ordering Streptococcus pneumoniae urinary antigen in patients with community-acquired pneumonia. Open Forum Infect Dis. 2024;11(3):ofae089. Centers for Disease Control and Prevention. Laboratory Testing for Legionella. Updated June 9, 2025. Accessed July 13, 2025. https://www.cdc.gov/legionella/php/laboratories/index.html. Jain S, Self WH, Wunderink RG. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415-427. Kamat IS, Ramachandram V, Eswaran H, Guffey D, Musher DM. Procalcitonin to distinguish viral from bacterial pneumonia: a systematic review and meta-analysis. Clin Infect Dis. 2020;70(3):538-542. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single blinded intervention trial. Lancet. 2004;363:600–7. doi: 10.1016/S0140- 6736(04)15591-8. Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, Widmer I, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA. 2009;302:1059–66. Schuetz P, Muller B, Christ-Crain M, Stolz D, Tamm M, Bouadma L, et al. Procalci- € tonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Datab System Rev. 2017;10(10):CD007498. doi: 10.1002/14651858. cd007498.pub2. Huang DT, Yealy DM, Filbin MR, Brown AM, Chang C-CH, Doi Y, et al. Procalcitonin-guided use of antibiotics for lower Respiratory tract infection. New Engl J Med. 2018;379:236–49. doi: 10.1056/NEJMoa1802670. Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in severe community-acquired pneumonia. N Engl J Med. 2023;389(19):1623-1634. doi:10.1056/NEJMoa2215145. Gupta AB, Flanders SA, Petty LA, et al. Inappropriate diagnosis of pneumonia among hospitalized adults. JAMA Intern Med. 2024;184(5):548-556. Jones BE, Chapman AB, Ying J, et al. Diagnostic Discordance, Uncertainty, and Treatment Ambiguity in Community-Acquired Pneumonia: A National Cohort Study of 115 U.S. Veterans Affairs Hospitals. Ann Intern Med. 2024;177(9):1179-1189. doi:10.7326/M23-2505. Hartlage W, Imlay H, Spivak ES. The role of empiric atypical antibiotic coverage in non-severe community-acquired pneumonia. Antimicrob Steward Healthc Epidemiol. 2024;4(1):e214. doi:10.1017/ash.2024.453. Dinh A, Barbier F, Bedos JP, et al. Update of guidelines for management of community acquired pneumonia in adults by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF). Endorsed by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF); endorsed by the French Intensive Care Society (SRLF), the French Microbiology Society (SFM), the French Radiology Society (SFR), and the French Emergency Society (SFMU). Respir Med and Res. 2025. El Moussaoui R, de Borgie CAJM, van den Broek P, et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ. 2006;332(7554):1355. doi:10.1136/bmj.332.7554.1355. Dinh A, Ropers J, Duran C, et al. Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia: a randomized, non-inferiority trial. Lancet. 2021;397(10280):1195-1203.

Drs. David Andes and Isabel Spriet join Dr. Jeannette Bouchard to discuss all of the top questions our audience had on fluconazole dosing. Who needs a load? How much fluconazole is too much fluconazole? And what did one of our experts do when they were asked about dosing fluconazole in a dolphin? Listen in to find out! Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/. Visit our website! https://breakpoints-sidp.org/ References: Fluconazole PK Variability in Critically Ill: DOI 10.3390/microorganisms9102068 DALI Antifungal Follow-up: DOI 10.1186/s13054-015-0758-3

In this special LIVE podcast episode, Drs. Zahra Kassamali Escobar (@zkepharmD) and Jamie Wagner (@jamiewagner) present the latest and greatest in ID literature from MAD-ID 2025 (@MAD_ID_ASP) in Orlando, FL. They cover everything from ground-breaking randomized controlled trials and updates to the treatment of resistant gram-negatives to exciting pipeline agents. If you’re behind on what has been published recently in ID, this episode is for you! Google Drive to Slides from Live Session: https://drive.google.com/file/d/1HdPEJUA2EXk0xL3JKJfuV9-HdGjgRnSD/view?usp=drivesdk How to Obtain BCIDP Recertification Credit for this Episode: Visit sidp.org/BCIDP for more information Breakpoints merchandise is available at https://sidp.toptierstores.com/ Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/. Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.

Drs. Amy Crockett (@amyhcrockett), Ben Ereshefsky (@brainofbpharm), and Pamela Bailey (@pamipenem) join Dr. Julie Ann Justo (@julie_justo) to discuss new treatment strategies for management of intraamniotic infections, also known as chorioamnionitis. They discuss whether it is time to move away from the combination of ampicillin, gentamicin, and/or clindamycin, alternative antibiotic regimens to consider, and stewardship strategies to approach this practice change at a local level. References: Basic stats/epi on chorioamnionitis: Romero R, et al. Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques. J Perinat Med. 2015 Jan;43(1):19-36. doi: 10.1515/jpm-2014-0249. PMID: 25720095. ACOG 2017 Guideline for IAI: Committee Opinion No. 712: Intrapartum Management of Intraamniotic Infection. Obstet Gynecol. 2017 Aug;130(2):e95-e101. doi: 10.1097/AOG.0000000000002236. PMID: 28742677. ACOG 2024 Update on clinical criteria for IAI: ACOG Clinical Practice Update: Update on Criteria for Suspected Diagnosis of Intraamniotic Infection. Obstetrics & Gynecology 144(1):p e17-e19, July 2024. doi: 10.1097/AOG.0000000000005593 Helpful review with more recent microorganisms : Jung E, et al. Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment. Am J Obstet Gynecol. 2024 Mar;230(3S):S807-S840. doi: 10.1016/j.ajog.2023.02.002. PMID: 38233317. Cochrane Review: Chapman E, et al. Antibiotic regimens for management of intra-amniotic infection. Cochrane Database Syst Rev. 2014 Dec 19;2014(12):CD010976. doi: 10.1002/14651858.CD010976.pub2. PMID: 25526426. Helpful recent review on intrapartum infections: Bailey, P, et al_._ Out with the Old, In with the New: A Review of the Treatment of Intrapartum Infections. Curr Infect Dis Rep. 2024;26:107–113 doi: 10.1007/s11908-024-00838-8. Role of genital mycoplasmas in IAI: Romero R, et al. Evidence that intra-amniotic infections are often the result of an ascending invasion - a molecular microbiological study. J Perinat Med. 2019 Nov 26;47(9):915-931. doi: 10.1515/jpm-2019-0297. PMID: 31693497. Regimens without enterococcal coverage with similar clinical outcomes: Blanco JD, et al. Randomized comparison of ceftazidime versus clindamycin-tobramycin in the treatment of obstetrical and gynecological infections. Antimicrob Agents Chemother. 1983 Oct;24(4):500-4. doi: 10.1128/AAC.24.4.500. PMID: 6360038. Bookstaver PB, et al. A review of antibiotic use in pregnancy. Pharmacotherapy. 2015 Nov;35(11):1052-62. doi: 10.1002/phar.1649. PMID: 26598097. Updated review in pregnancy, includes data on frequency of antibiotic use in pregnancy: Nguyen J, et al. A review of antibiotic safety in pregnancy-2025 update. Pharmacotherapy. 2025 Apr;45(4):227-237. doi: 10.1002/phar.70010. Epub 2025 Mar 19. PMID: 40105039. Locksmith GJ, et al. High compared with standard gentamicin dosing for chorioamnionitis: a comparison of maternal and fetal serum drug levels. Obstet Gynecol. 2005 Mar;105(3):473-9. doi: 10.1097/01.AOG.0000151106.87930.1a. PMID: 15738010. Clindamycin CDI Risk: Miller AC, et al. Comparison of Different Antibiotics and the Risk for Community-Associated Clostridioides difficile Infection: A Case-Control Study. Open Forum Infect Dis. 2023 Aug 5;10(8):ofad413. doi: 10.1093/ofid/ofad413. PMID: 37622034. Impact of penicillin allergy on clindamycin use & cites 47% clindamycin resistance per CDC among GBS: Snider JB, et al. Antibiotic choice for Group B Streptococcus prophylaxis in mothers with reported penicillin allergy and associated newborn outcomes. BMC Pregnancy Childbirth. 2023 May 30;23(1):400. doi: 10.1186/s12884-023-05697-0. PMID: 37254067. Clindamycin anaerobic coverage data: Hastey CJ, et al. Changes in the antibiotic susceptibility of anaerobic bacteria from 2007-2009 to 2010-2012 based on the CLSI methodology. Anaerobe. 2016 Dec;42:27-30. doi: 10.1016/j.anaerobe.2016.07.003. PMID: 27427465. Older PK study of ampicillin & gentamicin for chorioamnionitis: Gilstrap LC 3rd, Bawdon RE, Burris J. Antibiotic concentration in maternal blood, cord blood, and placental membranes in chorioamnionitis. Obstet Gynecol. 1988 Jul;72(1):124-5. PMID: 3380500. Paper putting out the call for modernization of OB/Gyn antibiotic regimens: Pek Z, Heil E, Wilson E. Getting With the Times: A Review of Peripartum Infections and Proposed Modernized Treatment Regimens. Open Forum Infect Dis. 2022 Sep 5;9(9):ofac460. doi: 10.1093/ofid/ofac460. PMID: 36168554. Vanderbilt University Medical Center experience with modernizing OB/Gyn infection regimens: Smiley C, et al. Implementing Updated Intraamniotic Infection Guidelines at a Large Academic Medical Center. Open Forum Infect Dis. 2024 Sep 5;11(9):ofae475. doi: 10.1093/ofid/ofae475. PMID: 39252868. Prisma Health/University of South Carolina experience with modernizing OB/Gyn infection regimens: Bailey P, et al. Cefoxitin for Intra-amniotic Infections and Endometritis: A Retrospective Comparison to Traditional Antimicrobial Therapy Regimens Within a Healthcare System. Clin Infect Dis. 2024 Jul 19;79(1):247-254. doi: 10.1093/cid/ciae042. PMID: 38297884.

Breakpoints joins forces with CMI Communications’ Communicable podcast to discuss the highly anticipated SNAP trial updates presented at ESCMID Global 2025. Hosts Drs. Erin McCreary and Angela Huttner interview SNAP trial investigators, Drs. Joshua Davis and Steven Tong, on results from penicillin-susceptible and methicillin-susceptible Staphylococcus aureus domains. Conflict of Interest for DSMC Members: Conflicts of interest were evaluated when choosing individuals to serve on the SNAP DSMC. Aside from being compensated for their duties on the committee, DSMC members have no ongoing financial relationship that relate to the trial and are not involved in the conduct of the trial in any role other than that of a DSMC member. DSMC members have no intellectual conflict of interest or bias and reviewed SNAP data in a fully objective manner. Each DSMC candidate was well vetted.

Dr. Jeannette Bouchard is joined by experts Dr. Romney Humphries, Emily Fox, and Matt Miller to discuss the hot topic of blood culture stewardship and the details of how these experts persevered through the recent blood culture bottle shortage that caused chaos throughout health care institutions at the end of 2024! This medical education was provided by an education grant from bioMerieux. References: Fabre BCx Stewardship Article doi: 10.1128/JCM.01005-21 ED Bcx Stewardship doi: 10.1016/j.ajic.2024.04.198 CT Surgery Stewardship doi: 10.1093/icvts/ivaf005 Every Crisis is an Opportunity doi:  10.1093/ofid/ofae479 Fun IV Coconut Water from I Feel Nerdy section: https://dr-martins.com/wp-content/uploads/2015/07/2000_the-intravenous-use-of-coconut-water.pdf

Drs. Pier Giorgio Cojutti and Navaneeth Narayanan join Dr. Megan Klatt to break down what you need to know about amoxicillin/clavulanate dosing. Tune in to learn more about the PK/PD of amoxicillin and clavulanic acid, how we landed on certain ratios for the treatment of common infections, strategies to optimize dosing for serious infections, and more! References: Oral amoxicillin and amoxicillin-clavulanic acid: properties, indications and usage. Clin Microbiol Infect. 2020 Jul;26(7):871-879. doi: 10.1016/j.cmi.2019.11.028. Epub 2019 Dec 4. PMID: 31811919. New formulations of amoxicillin/clavulanic acid: a pharmacokinetic and pharmacodynamic review. Clin Pharmacokinet. 2005;44(11):1097-115. doi: 10.2165/00003088-200544110-00001. PMID: 16231964. Non-linear absorption pharmacokinetics of amoxicillin: consequences for dosing regimens and clinical breakpoints. J Antimicrob Chemother. 2016 Oct;71(10):2909-17. doi: 10.1093/jac/dkw226. Epub 2016 Jun 20. PMID: 27330071. Augmentin (amoxicillin/clavulanate) in the treatment of community-acquired respiratory tract infection: a review of the continuing development of an innovative antimicrobial agent. J Antimicrob Chemother. 2004 Jan:53 Suppl 1:i3-20. doi: 10.1093/jac/dkh050. PMID: 14726431. Is the standard dose of amoxicillin-clavulanic acid sufficient? BMC Pharmacol Toxicol. 2014 Jul 21:15:38. doi: 10.1186/2050-6511-15-38. PMID: 25047044. MIC of amoxicillin/clavulanate according to CLSI and EUCAST: discrepancies and clinical impact in patients with bloodstream infections due to Enterobacteriaceae. J Antimicrob Chemother. 2017 May 1;72(5):1478-1487. doi: 10.1093/jac/dkw562. PMID: 28093484. Amoxicillin-Clavulanate Breakpoints Against Enterobacterales: Rationale for Revision by the Clinical and Laboratory Standards Institute. Clin Infect Dis. 2024 Aug 16;79(2):516-523. doi: 10.1093/cid/ciae201. PMID: 38626241. Amoxicillin-Clavulanate Breakpoints Against Haemophilus influenzae: Rationale for Revision by the Clinical and Laboratory Standards Institute. Clin Infect Dis. 2025 Feb 24;80(2):481-482. doi: 10.1093/cid/ciae246. PMID: 38709848. No evidence of difference in mortality with amoxicillin versus co-amoxiclav for hospital treatment of community-acquired pneumonia. J Infect. 2024 Jun;88(6):106161. doi: 10.1016/j.jinf.2024.106161. Epub 2024 Apr 23. PMID: 38663754. Population pharmacokinetics and dosing simulations of amoxicillin in obese adults receiving co-amoxiclav. J Antimicrob Chemother. 2020 Dec 1;75(12):3611-3618. doi: 10.1093/jac/dkaa368. PMID: 32888018. Comprehensive guidance for antibiotic dosing in obese adults: 2022 update. Pharmacotherapy. 2023 Mar;43(3):226-246. doi: 10.1002/phar.2769. Epub 2023 Feb 18. PMID: 36703246.

Dr. Brent Richards joins Dr. Erin McCreary to discuss the growing capability for artificial intelligence (AI) and big data in the healthcare industry. What is AI and machine learning, how can these tools enhance patient care, and what can we expect in the future from this space?   Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/.   Visit our website! https://breakpoints-sidp.org/

Drs. Amy Mathers and Julie Ann Justo join Dr. Erin McCreary to talk all things Stenotrophomonas maltophilia, a water-loving organism and frequent colonizer. Hear from the experts on why this organism is so difficult to treat, which agents have in vitro activity, and how to optimize antimicrobial regimens, including the use of combination therapy, in the setting of true infections. This medical education was provided by an unrestricted grant from Shionogi. References: Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections. Clin Infect Dis. 2024 Aug 7:ciae403. doi: 10.1093/cid/ciae403. PMID: 39108079. Clinical challenges treating Stenotrophomonas maltophilia infections: an update. JAC Antimicrob Resist. 2022 May 5;4(3):dlac040. doi: 10.1093/jacamr/dlac040. PMID: 35529051. Alterations of the Oral Microbiome and Cumulative Carbapenem Exposure Are Associated With Stenotrophomonas maltophilia Infection in Patients With Acute Myeloid Leukemia Receiving Chemotherapy. Clin Infect Dis. 2021 May 4;72(9):1507-1513. doi: 10.1093/cid/ciaa778. PMID: 32544947. An Overview of the Treatment of Less Common Non–Lactose-Fermenting Gram-Negative Bacteria. Pharmacotherapy. 2020 Sep;40(9):936-951. doi: 10.1002/phar.2447. PMID: 32687670.

Drs. Henry “Chip” Chambers and Warren Rose join Dr. Megan Klatt to tackle rifampin dosing for gram-positive infections. In this episode, they break down rifampin synergy studies and discuss what is the optimal dosing of rifampin for challenging gram-positive bacterial cases, in particular Staphylococcus aureus infections with or without retained hardware/devices.   Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/ References: Deconstructing the Dogma: Systematic Literature Review and Meta-analysis of Adjunctive Gentamicin and Rifampin in Staphylococcal Prosthetic Valve Endocarditis. Open Forum Infect Dis. 2022 Oct 31;9(11):ofac583. doi: 10.1093/ofid/ofac583. PMID: 36408468. Effectiveness of adjunctive rifampicin for treatment of Staphylococcus aureus bacteraemia: a systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother. 2023 Oct 3;78(10):2419-2427. doi: 10.1093/jac/dkad214. PMID: 37583062. Adjunctive Rifampin Following Debridement and Implant Retention for Staphylococcal Prosthetic Joint Infection: Is it Effective if not Combined With a Fluoroquinolone? Open Forum Infect Dis. 2022 Oct 31;9(12):ofac582. doi: 10.1093/ofid/ofac582. PMID: 36504699.

Drs. Nico Cortes-Penfield (@Cortes-Penfield), Kerry LaPlante (@Kerry_LaPlante), Jessica Seidelman (@JessieLSeidel) join Dr. Julie Ann Justo (@julie_justo) to discuss the pesky slime that is biofilm in periprosthetic joint infections. They review biofilm composition & development, have an honest discussion about whether antibiotics can ever really eradicate it, and provide updates on the promising non-pharmacologic strategies on the horizon (bacteriophages, electromagnetism, & more). Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp References Nixing the Nidus: Managing Retained Sources in Prosthetic Joint Infections. Breakpoints Podcast Episode #67. Society of Infectious Diseases Pharmacists. Dosing Consult: Rifampin Part 1. Breakpoints Podcast Episode #104. Society of Infectious Diseases Pharmacists. Review on Staphylococcal biofilm development: Schilcher K, Horswill AR. 2020 Aug 12;84(3):e00026-19. doi: 10.1128/MMBR.00026-19. PMID: 32792334. Antibiotics can fail to kill biofilm cells even if they penetrate the biofilm: Singh R, et al. Pathog Dis. 2016 Aug;74(6):ftw056. doi: 10.1093/femspd/ftw056. Epub 2016 Jul 7. PMID: 27402781. Subinhibitory antibiotic concentrations can promote biofilm formation: Schilcher K, et al. Antimicrob Agents Chemother. 2016 Sep 23;60(10):5957-67. doi: 10.1128/AAC.00463-16. PMID: 27458233. Clinical and genetic risk factors for biofilm-forming Staphylococcus aureus: Luther MK, et al. Antimicrob Agents Chemother. 2018 Apr 26;62(5):e02252-17. doi: 10.1128/AAC.02252-17. PMID: 29530854. Meta-analysis showing poor clinical outcomes with debridement, antibiotics, and implant retention (DAIR): Kunutsor SK, et al. J Infect. 2018 Dec;77(6):479-488. doi: 10.1016/j.jinf.2018.08.017. PMID: 30205122. Thieme L, et al. MBEC versus MBIC: the lack of differentiation between biofilm reducing and inhibitory effects as a current problem in biofilm methodology. Biol Proced Online 21, 18 (2019). https://doi.org/10.1186/s12575-019-0106-0. Ongoing trial investigating use of MBEC in the treatment of PJIs: Tillander JAN, et al. BMJ Open. 2022 Sep 15;12(9):e058168. doi: 10.1136/bmjopen-2021-058168. PMID: 36109038. Maale, G. Complete eradication of biofilm using low frequency electromagnetic force (EMF) and antibiotics at MIC. 34th Annual Meeting Musculoskeletal Infection Society. 2024 Aug. Abstract 1232 (see full program). Meta-analysis on bacteriophages for biofilm: Kovacs CJ, et al. Mil Med. 2024 May 18;189(5-6):e1294-e1302. doi: 10.1093/milmed/usad385. PMID: 37847552. Berking BB, et al. Biofilm disruption from within: light-activated molecular drill-functionalized polymersomes bridge the gap between membrane damage and quorum sensing-mediated cell death. ACS Biomater Sci Eng. 2024 Sep 9;10(9):5881-5891. doi: 10.1021/acsbiomaterials.4c01177. PMID: 39176452. Aboelnaga N, et al. Deciphering the dynamics of methicillin-resistant Staphylococcus aureus biofilm formation: from molecular signaling to nanotherapeutic advances. Cell Commun Signal. 2024 Mar 22;22(1):188. doi: 10.1186/s12964-024-01511-2. PMID: 38519959. Conway J, et al. Phase 1 study of the pharmacokinetics and clinical proof-of-concept activity of a biofilm-disrupting human monoclonal antibody in patients with chronic prosthetic joint infection of the knee or hip. Antimicrob Agents Chemother. 2024 Aug 7;68(8):e0065524. doi: 10.1128/aac.00655-24. PMID: 39012102. Mulpur P, et al. Efficacy of intrawound vancomycin in prevention of periprosthetic joint infection after primary total knee arthroplasty: a prospective double-blinded randomized control trial. J Arthroplasty. 2024 Jun;39(6):1569-1576. doi: 10.1016/j.arth.2024.01.003. PMID: 38749600. Dong Y, et al. Synergy of ultrasound microbubbles and vancomycin against Staphylococcus epidermidis biofilm. J Antimicrob Chemother. 2013 Apr;68(4):816-26. doi: 10.1093/jac/dks490. PMID: 23248238. Miltenberg B, et al. Intraosseous Regional Administration of Antibiotic Prophylaxis for Total Knee Arthroplasty: A Systematic Review. J Arthroplasty. 2023 Apr;38(4):769-774. doi: 10.1016/j.arth.2022.10.023. PMID: 36280158. Viswanathan VK, et al. Intraosseous regional antibiotic prophylaxis in total joint arthroplasty (TJA): Systematic review and meta-analysis. J Clin Orthop Trauma. 2024 Oct 3;57:102553. doi: 10.1016/j.jcot.2024.102553. PMID: 39435324. SOLARIO trial: Dudareva M, et al. The European Bone and Joint Infection Society Meeting, 2024 Sept. SOLARIO trial press release from BoneSupportTM. 2024 Oct 3. Fehring TK, et al. Does treatment at a specialized prosthetic joint infection center improve the rate of reimplantation. J Arthroplasty. 2023 Jun;38(6S):S314-7. PMID 37004968. ROADMAP trial website. 2024.

We are back with more exciting IDWeek 2024 content. In this episode, Breakpoints hostesses Drs. Erin McCreary, Julie Ann Justo, Jeannette Bouchard, and Megan Klatt highlight more of our favorite sessions and posters at IDWeek, this episode is a must listen if you are an IDWeek nerd like us! References: Perret et al. Application of OpenAI GPT-4 for the retrospective detection of catheter-associated urinary tract infections in a fictitious and curated patient data set. 10.1017/ice.2023.189 Wiemken et al. Assisting the infection preventionist: Use of artificial intelligence for health care–associated infection surveillance. 10.1016/j.ajic.2024.02.007 Leekha et al. Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study. 10.1136/bmjqs-2023-016831 Diekema et al. Are Contact Precautions "Essential" for the Prevention of Healthcare-associated Methicillin-Resistant Staphylococcus aureus? 10.1093/cid/ciad571 Martin et al. Contact precautions for MRSA and VRE: where are we now? A survey of the Society for Healthcare Epidemiology of America Research Network. 10.1017/ash.2024.350 Browne et al. Investigating the effect of enhanced cleaning and disinfection of shared medical equipment on health-care-associated infections in Australia (CLEEN): a stepped-wedge, cluster randomised, controlled trial. 10.1016/S1473-3099(24)00399-2 Protect trial: Decolonization in Nursing Homes to Prevent Infection and Hospitalization. 10.1056/NEJMoa2215254 Aldardeer et al. Early Versus Late Antipseudomonal β-Lactam Antibiotic Dose Adjustment in Critically Ill Sepsis Patients With Acute Kidney Injury: A Prospective Observational Cohort Study. 10.1093/ofid/ofae059 Schmiemann et al. Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial. 10.1136/bmj-2023-076305 Vernacchio et al. Improving Short Course Treatment of Pediatric Infections: A Randomized Quality Improvement Trial. 10.1542/peds.2023-063691 Advani et al. Bacteremia From a Presumed Urinary Source in Hospitalized Adults With Asymptomatic Bacteriuria. 10.1001/jamanetworkopen.2024.2283 Saif et al. Clinical decision support for gastrointestinal panel testing. 10.1017/ash.2024.15 Bekker et al. Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention in Cisgender Women. 10.1056/NEJMoa2407001 Montini et al. Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial. 10.1542/peds.2023-062598 Nielsen et al. Oral versus intravenous empirical antibiotics in children and adolescents with uncomplicated bone and joint infections: a nationwide, randomised, controlled, non-inferiority trial in Denmark. 10.1016/S2352-4642(24)00133-0 Kaasch et al. Efficacy and safety of an early oral switch in low-risk Staphylococcus aureus bloodstream infection (SABATO): an international, open-label, parallel-group, randomised, controlled, non-inferiority trial. 10.1016/S1473-3099(23)00756-9 AMIKINHAL: Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia. 10.1056/NEJMoa2310307 PROPHY-VAP: Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial. 10.1016/S2213-2600(23)00471-X AVENIR: Azithromycin to Reduce Mortality — An Adaptive Cluster-Randomized Trial. 10.1056/NEJMoa2312093 Thomas et al. Comparison of Two High-Dose Versus Two Standard-Dose Influenza Vaccines in Adult Allogeneic Hematopoietic Cell Transplant Recipients. 10.1093/cid/ciad458 Schuster et al. The Durability of Antibody Responses of Two Doses of High-Dose Relative to Two Doses of Standard-Dose Inactivated Influenza Vaccine in Pediatric Hematopoietic Cell Transplant Recipients: A Multi-Center Randomized Controlled Trial. 10.1093/cid/ciad534 Mahadeo et al. Tabelecleucel for allogeneic haematopoietic stem-cell or solid organ transplant recipients with Epstein-Barr virus-positive post-transplant lymphoproliferative disease after failure of rituximab or rituximab and chemotherapy (ALLELE): a phase 3, multicentre, open-label trial. 10.1016/S1470-2045(23)00649-6 Khoury et al. Third-party virus-specific T cells for the treatment of double-stranded DNA viral reactivation and posttransplant lymphoproliferative disease after solid organ transplant. 10.1016/j.ajt.2024.04.009 Spec et al. MSG-15: Super-Bioavailability Itraconazole Versus Conventional Itraconazole in the Treatment of Endemic Mycoses—A Multicenter, Open-Label, Randomized Comparative Trial. 10.1093/ofid/ofae010

Did you miss IDWeek this year and trying to catch up on the hot topics? Or was there just too many good sessions and you want to catch up on the ones you missed? Let the Breakpoints Hostesses help you out! In the first of two IDWeek 2024 recap episodes, join Drs. Erin McCreary, Julie Ann Justo, Jeannette Bouchard, and Megan Klatt as they cover top late breaking abstracts and stewardship data that you won’t want to miss! References: BALANCE Trial: Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. 10.1056/NEJMoa2404991 White et al. Antibiotic stewardship targets in the outpatient setting. 10.1016/j.ajic.2019.01.027 Wattengel et al. Outpatient antimicrobial stewardship: Optimizing patient care via pharmacist led microbiology review. 10.1016/j.ajic.2019.07.018 Augostini et al. An evaluation of antimicrobial prophylaxis for transrectal prostate biopsies: A potential stewardship target. 10.1016/j.ajic.2024.05.012 Cotter et al. Antibiotic use and outcomes among children hospitalized with suspected pneumonia. 10.1002/jhm.13002

Drs. Anne-Grete Märtson, Megan Wimmer, and Evan Clemens join Dr. Erin McCreary to tackle the one of the hottest debates among providers taking care of immunocompromised patients, valganciclovir dosing! Learn all about the history of valganciclovir dosing, what is valganciclovir’s PK/PD target, and even valganciclovir therapeutic drug monitoring. References: Märtson AG, Edwina AE, Kim HY, Knoester M, Touw DJ, Sturkenboom MGG, Alffenaar JC. Therapeutic Drug Monitoring of Ganciclovir: Where Are We? Ther Drug Monit. 2022 Feb 1;44(1):138-147. doi: 10.1097/FTD.0000000000000925. PMID: 34610621; PMCID: PMC8746890. Wiltshire H, Paya CV, Pescovitz MD, Humar A, Dominguez E, Washburn K, Blumberg E, Alexander B, Freeman R, Heaton N, Zuideveld KP; Valganciclovir Solid Organ Transplant Study Group. Pharmacodynamics of oral ganciclovir and valganciclovir in solid organ transplant recipients. Transplantation. 2005 Jun 15;79(11):1477-83. doi: 10.1097/01.tp.0000164512.99703.ad. PMID: 15940035. This podcast is powered by Pinecast.

Drs. Ed Septimus and Whitney Buckel join Dr. Jeannette Bouchard for our second episode in the series “Stewie Struggles.” In this episode, we focus on interventions within the EHR and what we can do on the end-user side of antimicrobials. We discuss how to use unique tools within the EHR and get a VIP look at the efforts to pull off the amazing INSPIRE trials! You don’t want to miss this! Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/  References: INSPIRE PNA: doi:10.1001/jama.2024.6248 INSPIRE UTI: doi:10.1001/jama.2024.6259 Order set study by Kufel et al: doi:10/1017/ice.2023.293 This podcast is powered by Pinecast.