Obesity can cause physiological changes resulting in antibiotic pharmacokinetic alterations and suboptimal drug exposures. This systematic review aimed to summarise the available evidence on this topi...

Abstract. Over 50% of adult women experience at least 1 urinary tract infection (UTI) in their lifetime, and almost one-quarter of them will experience a r

AbstractIntroductionNon-beta-haemolytic streptococci are among the most common causative agents of infective endocarditis (IE). Patients with a heart valve prosthesis (HVP) have a high risk of IE. We aimed to determine the risk for IE in patients with HVP and non-beta-haemolytic streptococcal bacteraemia (NBHSB), and to study NBHSB relapse depending on treatment duration.MethodAdults with HVP and NBHSB 2015—2018 in the region of Skåne, Sweden, were identified through the Clinical Microbiology Laboratory in Lund and were evaluated in a population-based investigation. Data were collected from medical records according to a pre-defined protocol.ResultsA total of 110 NBHSB episodes in 89 patients with HVP were included. In 40 episodes (36%), the patients had definite IE, in 69 possible IE, and one had rejected IE according to the European Society of Cardiology 2015 criteria. Twenty-eight of the 70 patients (40%) without a definite diagnosis of IE were treated with antibiotics as if they had IE. There were seven NBHSB relapses, and six of these occurred in patients with possible IE. Four of the relapses occurred in patients who received antibiotics for less than 14 days. Three patients with possible IE were diagnosed with definite IE at the time of the relapse.ConclusionPatients with NBHSB and HVP have a high risk for IE and should be thoroughly investigated. Most patients with NBHSB and HVP who fulfilled criteria for possible IE did not receive long-course antibiotic treatment. Moreover, some patients treated with a short course of antibiotics experienced NBHSB relapse.

Treatment guidelines recommend rapidly treating all patients with suspected sepsis with broad-spectrum antibiotics. This may contribute to antibiotic overuse. We quantified the incidence of antibiotic overtreatment and possible antibiotic-associated harms among patients with suspected sepsis.MethodsWe reviewed the medical records of 600 adults treated for suspected sepsis with anti–methicillin-resistant Staphylococcus aureus and/or antipseudomonal β-lactam antibiotics in the emergency departments of 7 hospitals, 2019–2022, to assess their post hoc likelihood of infection, whether narrower antibiotics would have sufficed in retrospect, and possible antibiotic-associated complications. We used generalized estimating equations to assess associations between likelihood of infection and hospital mortality.ResultsOf 600 patients, 411 (68.5%) had definite (48.0%) or probable (20.5%) bacterial infection and 189 (31.5%) had possible but less likely (18.3%) or definitely no (13.2%) bacterial infection. Among patients with definite/probable bacterial infection, 325 of 411 (79.1%) received antibiotics that were overly broad in retrospect. Potential antibiotic-associated complications developed in 104 of 600 (17.3%) patients within 90 days, most commonly new infection or colonization with organisms resistant to first-line agents (48/600 [8.0%]). Mortality was higher for patients with less likely/definitely no bacterial infection versus definite/probable bacterial infections (9.0% vs 4.9%; adjusted odds ratio [aOR], 2.25 [95% confidence interval{CI}, 1.70–2.98]), but antibiotic-associated complication rates were similar (14.8% vs 18.5%; aOR, 0.79 [95% CI, .60–1.05]).ConclusionsAmong 600 patients treated with broad-spectrum antibiotics for possible sepsis, 1 in 3 most likely did not have a bacterial infection, 4 in 5 of those with bacterial infections were treated with regimens that were broader than necessary in retrospect, and 1 in 6 developed antibiotic-associated complications.

Blujepa is the first in a new class of oral antibiotics for uUTIs in nearly 30 years.