The IV antibiotic tigecycline received a label change and warning from the FDA, given the drug has been associated with higher mortality than similar broad spectrum antibiotics. Although a mechanism for the higher mortality has not been elucidated, the FDA is recommending the use of alternative antibiotics, rather than tigecycline, in hospitalized patients wtih serious infections (FDA site)

In this large retrospective database analysis of healthcare associated invasive MRSA infections, rates decreased 9% per year from 2005-2008. This is a very encouraging report, and likely due to multi-faceted MRSA prevention programs (abstract).

In this double dummy trial of 170 patients admitted to the ICU with COPD/respiratory failure (without pneumonia), there were no differences in outcomes (death, need for additional antibiotics, length of stay, or ventilator days) between the 2 groups. This study and others confirms TMP-SMX works just as well as cipro for acute COPD exacerbations (abstract)

In this large systematic review of QI interventions to reduce the rates of CA-UTIs, the use of reminders (to nurses or physicians) and automatic stop orders reduced the rate of CA-UTI by 52%, resulting in 2.6 fewer catheter days per patient in the intervention groups. Automated reminders or stop orders should be routinely implemented in medical centers to reduce CA-UTI rates (abstract)

In this large retrospective database analysis, researchers found that composite measure adherence to SCIP measures was associated with lower rates of postoperative infections, but not with the individual measures. This is consistent with “bundling” theory, whereby outcomes can be affected by a number of processes, which need to be combined to successfully improve the outcome of interest (abstract)

The duration of treatment for endocarditis caused by coxiella burnetti should be 18 months (or 24 for prosthetic valves) based on a recently published large 20-year cohort. Treatment with doxycycline and hydroxychloroquine are recommended (abstract) with 5 years of follow up to assess for relapse.

In this population-based case-control study of elderly patients on an ACE or ARB, the risk of hyperkalemia-associated hospitalization was 7 times higher for patients with a recent prescription for trimethoprim-sulfamethoxazole, compared to amoxicillin (with no increased risk with other comparator antibiotics), even after matching for age, sex, renal insufficiency, and diabetes. For elderly patients on an ACE or ARB, the risk of hyperkalemia should be considered before being prescribed trimethoprim-sulfamethoxazole (abstract)

In this large retrospective cohort of 341 patients with staph aureus bacteremia, only 1/3 of them had an ID specialist consulted. Overall, 16% of the patients died within 4 weeks, and having an ID consult was associated with a 56% reduction in the risk of dying. Routine use of ID consults should be considered in patients with staph aureas bacteremia (abstract)

Stool transplants have been successful in a few case series of patients with recurrent or refractory Cdiff. This case series describes self-administered (by enema) stool transplants (from family members) in 7 patients with refractory Cdiff. They report 100% clinical success with 14 months of follow up. The donor was extensively tested for infectious agents before donating the fecal specimen. Although cumbersome, this may be a feasible option in patients with ongoing Cdiff that is refractory to other treatments (abstract).

This large retrospective analysis of >84,000 patients hospitalized with COPD confirms the benefits of antibiotics; antibiotic treated patients had lower risks of mechanical ventilation, inpatient mortality, and COPD readmissions (although higher Cdiff readmission rates). This large analysis confirms guideline recommendations for antibiotic therapy in patients hospitalized with COPD exacerbations (abstract)