PROA_HUCA-HMN

Routine antipseudomonal therapy may be unnecessary in high-risk FN patients! Challenging the Dogma: Can Rectal Colonization Status Guide Narrow-Spectrum Empiric Antibiotic Therapy in Febrile Neutropenia? 🆕💥🔴Retrospective study Among high-risk neutropenic patients, negative rectal swab predicted very low risk of PA or MDR-GNB BSI, challenging routine empiric antipseudomonal coverage #IDXposts sciencedirect.com/science/ar…

🔥CDC just released the 2026 update to the Antimicrobial Resistance Threats Report (AR Threats Report)🔥 The 2026 update estimates that 19 bacteria and fungi result in 9.7 million infections & 50,800 deaths in the United States each year #IDXposts arpsp.cdc.gov/artr?ACSTracki…

🚨The MBL tide is rising. Even the Trojan horse has its Achilles’ heel. 🆕💥🟢US surveillance of 80,927 Enterobacterales collected from 103 US medical centres (2016–2024): Helio Sader et Al. • 194 (0.24%) were NS to CZA or MVB • 115 (0.14%) were NS to both CZA + MVB • 832 (1.0%) were carbapenem-resistant ⚠️ 36.1% (73/202) of CRE collected in 2023–24 were MBL producers, with NDM predominating. Among isolates NS to CZA and/or MVB, NDM was the most common carbapenemase (114; 58.8%). 🧬 Aztreonam/avibactam: • 98.1% active vs CRE • 98.4% vs MBL producers • 91.9% vs CZA-NS • 94.0% vs MVB-NS Species-level activity: • K. pneumoniae: 98.0% • E. cloacae complex: 100% • E. coli: 87.5% Among ATM/AVI-NS CRE, carbapenemases included NDM-5 (2 E. coli). 🔬 Cefiderocol was active • 78.8% vs CZA-NS • 83.2% vs MVB-NS • 94.7% vs CRE • 82.1% vs MBL producers Among cefiderocol-NS isolates, 71.1% carried a carbapenemase, including NDM-1/NDM-5 in 19 isolates, plus KPC-3/4, KPC-65 + NDM-5, NDM-1 + OXA-232, IMI-4 and VIM-1. 🔄 Cross-resistance was not absolute: • ATM/AVI active vs 92.1% of cefiderocol-NS isolates • Cefiderocol active vs 81.2% of ATM/AVI-NS isolates 🎯 Cefiderocol was less reliable against MBL producers (82.1% susceptible) than ATM/AVI (98.4%). Notably, 71.1% of cefiderocol-NS isolates carried a carbapenemase, including NDM-1/NDM-5. #idxposts academic.oup.com/jac/article…

🆕💥🔴Population pharmacokinetics of daptomycin in patients with haematological malignancies and VRE bloodstream infections 🔺1200 mg was the only dose able to achieve PTA>90% for MICs of 4 mg/L when targeting fAUC24h,ss/MIC >27.43, PB 86% 🔺PTA >90% was achievable for MICs ≤1 mg/L with doses ≥10 mg/kg or doses ≥850 mg daily (fAUC24h,ss/MIC>81.87, PB 86%). 🔺No doses achieved PTA >90% for MICs >4 mg/L for either efficacy target. 🔺Protein binding significantly affected PTA for VREfm BSI efficacy targets #idxposts sciencedirect.com/science/ar…

What drives levofloxacin prophylaxis failure in high-risk hematology patients? 🆕💥🟢Prospective observational study of 120 neutropenic episodes examined why levofloxacin prophylaxis fails in high-risk hematology patients: 🔺Profound neutropenia → higher risk of prophylaxis failure (OR 4.17) 🔺fAUC₀–₂₄/MIC ≥80 → lower risk of failure (OR 0.12) 🔺ROC analysis identified fAUC/MIC ≥48.46 as the optimal cutoff 🔺Target non-attainment was strongly associated with levofloxacin-resistant GNB colonization, indicating that PK/PD failure was predominantly MIC driven. 🔺750 mg/day was insufficient to achieve the PK/PD target in a significant proportion of patients 🔑 Levofloxacin prophylaxis failure appears to reflect an interplay between host factors and inadequate PK/PD target attainment, which was largely influenced by levofloxacin-resistant GNB colonization. #idxposts academic.oup.com/jac/article…