Reminds me of the excellent editorial by Dr Burke Cunha highlighting the potential clinical relevance of testing antibiotics at urinary concentrations, in medium with urinary pH.

Doxycycline for Pseud UTI?

Eur J Clin Microbiol Infect Dis 31, 2865–2868 (2012)
rdcu.be/enkNP

Meropenem initially, once stable, switch to subcutaneous ertapenem 1g daily (assuming renal fn ok) to complete 7 days. Longer if renal tract imaging shows abscess. SubCut is well tolerated, avoids need for IV access and achieves good pK

Relevant for roadmap as well - may be informative to specifically collect use of menopausal hormone therapy

Appears to be different trajectories for women 19-50 to those over 50 in this large sepsis cohort. Pregnancy-associated, hormonal, more frequent UTI, differences in care seeking/delivery or something else??

doi.org/10.1186/s130...

Should this be further separated into (presumptive) pre- and post-menopause?

I think this is the point the authors make in their discussion - a proportion of the diagnoses were probably wrong. Patients may have been adequately treated with "limited" spectrum antibiotics or no antibiotics at all. And yet, they did worse when exposed early to broad.

#idsky

Nice analysis!

But not an entirely fair competition. Temp measured daily whereas less frequent CRP - fewer on any day and so wider confidence intervals. The point estimates of ORs for 50% fall CRP ok and consistent after day 4.

Can probably get more out of CRP with kinetic models that include age

They used a well constructed propensity score to drive the matching and looked at sicker (ICU admit) and less sick subgroups. The favorable outcome for delayed broad therapy held true for all but septic shock.

Great hypothesis in discussion as to why this might be...

#idsky

academic.oup.com/cid/article/...

In this RCT of klebsiella liver abscess, they stopped antibiotics if there had been reduction in maximum dimension on imaging and (zombie alert) CRP <20. Assessed at 4 weeks post randomisation, if criteria not met, reassessed every 2 weeks. About 70% had drainage (50% pre and 15-20% post-enrolment)

Not an RCT, but 50 cases of adult meningococcal meningitis in this NZ cohort treated with median 3 days ceftriaxone.

Matthew Broom et al. Infection. 2023 Apr.
pubmed.ncbi.nlm.nih.gov/35982367/

Levo CSF levels slightly higher than moxi in this TBM study, although doses received is unclear. Authors conclude "Assuming susceptible MICs of ... 0.5 mg/L for levofloxacin and moxifloxacin, levofloxacin may have the best potential to achieve PK/PD targets"

doi.org/10.3389/fpha...

We report doxy for all MRSA and MSSA isolates except for those from blood cultures.

However, our "doxy" is extrapolated from the tet result so probably underestimates susceptibility by 10% 😢

You missed doxy....
MRSA 96.7%
MDR MRSA 90.1%
👍👍