Erin McCreary Profile picture
Apr 26, 2022 9 tweets 8 min read Read on X
ATTACK Trial results #ECCMID2022: efficacy & safety of sulbactam-durlobactam (SUL-DUR) vs colistin for Acinetobacter baumannii complex. Sulbactam has intrinsic activity against AB (PBP binding); durlobactam potent inhibition of class A, C,D beta-lactamases
pubmed.ncbi.nlm.nih.gov/28665414/ ImageImage
this was a phase 3 non-inferiority trial of HAP, VAP, BSI randomized 1:1 to SUL-DUR plus IMI or Colistin + IMI. primary efficacy outcome 28-day ACM, safety = nephrotoxicity measured by RIFLE #ECCMID2022 ImageImage
study enrollment was as follows, 95% of isolates were CRAB #ECCMID2022 Image
while the study used imipenem as the partner carbapenem, meropenem likely okay as well based on HFIM results presented. there's also one published case report on use in combo with FDC pubmed.ncbi.nlm.nih.gov/34370576/ #ECCMID2022 ImageImageImageImage
baseline characteristics well matched, but more ventilated patients in SUL-DUR group #ECCMID2022 Image
here's the money shot: efficacy endpt achieved! 19% ACM SUL-DUR vs 32.3% in colistin. this is SUPER exciting as seemingly we finally have a drug that works for CRAB. however, have to point out that ACM rate in SUL-DUR is 1% higher than BAT @ 28d for FDC in CREDIBLE #ECCMID2022 ImageImage
more clinical cure and safer than colistin, this is exciting stuff #ECCMID2022 ImageImageImageImage
the results of the part B, open label aspect of the trial were also presented #ECCMID2022 ImageImageImageImage
in conclusion,SUL-DUR could be a promising addition to the CRAB toolkit which is currently somewhat of a hot mess. authors stated they did WGS of isolates, haven’t reported results out, looking at efficacy across geographies the results are consistent across endpoints #ECCMID2022 Image

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More from @ErinMcCreary

Jan 21, 2021
With the Jan 7th announcement of the @remap_cap IL-6ra results: medrxiv.org/content/10.110…

and last nights @BMJ_Latest RCT drop: bmj.com/content/372/bm…

let’s talk about tocilizumab [thread, 1/n]
COI: I am the pharmacist lead for @remap_cap @UPMC, however, we didn’t enroll to the tocilizumab domain due to supply issues in the US—drug was reserved for RA and CAR T patients. I saw the data with the rest of the world the day the pre-print was posted. [2/n]
In @BMJ_latest, Veiga et al enrolled 129 patients to tocilizumab or standard care. Enrollment was stopped early since tocilizumab was associated with increased death at day 15 (16.9% vs 3.1%, OR 6.42; 95% CI 1.59 to 43.2). Woof. That is… suboptimal. We’ll come back to this.[3/n]
Read 30 tweets
Dec 8, 2019
up bright and early to hear @IDpharmresearch, Dr. Jennifer Le, and Dr. Tom Lodise to go through the new #vancomycin guidelines at #ASHP19
@IDpharmresearch 61 years of vanco and "we are still not confident the best way to dose" #ASHP19
@IDpharmresearch AUC/MIC is the PK/PD target for all lipoglycopeptides, including newer agents #ASHP19
Read 29 tweets
Oct 26, 2019
Antifungal Stewardship in Solid Organ Transplantation presented by @JGPharmD at #ACCPAM19
@JGPharmD hard to follow the CAP guidelines, but Dr. Gallagher starts with a nice overview of the kingdom myceteae #ACCPAM19
@JGPharmD incidence of fungal infections in solid organ transplant patients: small bowel > lung> liver > panc > heart > kidney #accpam19
Read 18 tweets
Oct 26, 2019
starting #ACCPAM19 with the amazing @emilylheil presenting an update on the recently-published community-acquired pneumonia #CAP guidelines ncbi.nlm.nih.gov/pubmed/31573350
@emilylheil So what actually causes CAP? @emilylheil states "the pathogenesis and etiology of CAP has changed over time with increased rates of vaccination and better diagnostics." Jain et al 2015 unable to identify a pathogen in > 60% of patients, viruses most common
ncbi.nlm.nih.gov/pubmed/26172429
@emilylheil Since etiology a great unknown, do we need to cover atypicals? Garin et al found BL monotherapy NOT non-inferior to combo, but on flip CAP-START suggested atypical coverage perhaps unneeded...
ncbi.nlm.nih.gov/pubmed/25286173
ncbi.nlm.nih.gov/pubmed/25830421
Read 19 tweets
Sep 3, 2019
my grandpa has been in the hospital for the past week w/ Acinetobacter baumannii bacteremia.

I keep deleting this, but I think I need to share what I learned about antibiotics and fear, and reinforce the life-saving nature of stewardship [thread] 1/
First, I just want to say my grandpa is the best human. From a tiny town in WV. He started the cable company back in the day bc "people deserved to know the news" Sold it for a song once it was established because he had achieved his goal. Help people, at no personal gain. 2/
He stopped driving ~1 yr ago. Sometimes he’s frustrated by this.

“I am sure people in town would drive you, Grandpa”

Grandpa, sincerely, “I’d rather give than take.”

He’s the kind of selfless we don’t deserve.

He is also hilarious and a great drinking buddy. 3/ Image
Read 31 tweets
Dec 6, 2018
Round 2 of the Great ID Debates of #ASHP18 @ASHPOfficial comes to us from the brilliant minds of @SIDPharm members @TimbrookTT and @julie_justo. To start us off, Tristan makes the case for #fidaxomicin (FID) for treatment of Clostridioides difficile (#cdiff) infection
.@TimbrookTT sets up the major points for FID in the treatment of #Cdiff: 1- ⬇️recurrence compared to #vancomycin (VAN) in RCTs + ⬆️in cure without recurrence (aka global clinical cure) 2- this held up in real-world data 3- cost-effectiveness analyses support 1st line use #ASHP18
.@TimbrookTT notes the 2018 @IDSAInfo guidelines for #cdiff (idsociety.org/practice-guide…) recommend FID equally to VAN and for first recurrence, quality of evidence is higher 👀🤔#ASHP18
Read 23 tweets

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