19th-Century diagnostic methods make it too easy for “ESKAPE” pathogens to escape

In 2004, microbiologist Carl Nathan, M.D., wrote in a Nature commentary that:

"Treating infections with pathogen-specific rather than broad-spectrum antibiotics (whenever possible) will require prior, rapid, accurate and specific diagnosis. It makes no sense to use 21st-century technology to develop drugs targeted at specific infections whose diagnosis is delayed by 19th-century methods."1

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3 Lessons for Sepsis Committees with Dr. Sandy Estrada

The following is edited from a conversation with Sandy Estrada, Pharm.D., BCPS, Vice President, Medical Affairs, T2 Biosystems. Dr. Estrada was previously an Infectious Diseases Clinical Pharmacist for Lee Health in Ft. Myers, FL for 13 years where she served as the Co-Director of Antimicrobial Stewardship, Director of the ID Pharmacy Residency Program, and as a member of the sepsis committee.

Sepsis Committees Get It Right With Direct Patient Care Staff Involvement:

Sepsis committees often make a priority of identifying or hiring a sepsis coordinator. This position is typically held by a nurse or emergency department clinician. This leadership role for frontline caregivers helps center the committee’s actions on a passion for patient care and a desire to seek breakthroughs that can reduce sepsis mortality and improve patient outcomes.  

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“Killing the Kidneys” with Empiric Therapy?

A recent Pharmacy Practice News article ran with the jarring headline: “Killing the Kidneys to Save the Patient.”1 It drives at an issue facing many hospitals today: widespread use of antibiotics are at times negatively impacting kidney function – because hospitals have such limited data, they struggle to make timely appropriate antibiotic therapy choices. 

For millions of patients at risk of sepsis each year, the standard of care is to turn immediately to broad empiric antimicrobial therapy when a patient is suspected of a sepsis-related infection: dose patients with vancomycin and piperacillin-tazobactam, or a similarly broad-spectrum coverage. This is a pre-emptive strike while they wait for a diagnostic result that can identify the causative pathogen of the bloodstream infection – or if there is an infection at all. In fact, over 50% of the time, there is no infection at all! “Vanc” and “pip/tazo,” for example, are relatively cheap and effective – and necessary for a patient’s survival if they have a gram-positive infection like MRSA or a gram-negative bacteria like Pseudomonas aeruginosa or E. coli. When the mortality rate for sepsis rises ~8% each hour the patient goes untreated, the results of undertreatment are devastating.2 So this practice is the right thing to do, but it has consequences.

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