Welcome to the Infectious Disease Updates section of our Hospital Medicine Cheat Sheets blog! We summarize recent practice-changing research in infectious diseases from peer-reviewed journals. Each entry is concise, clinically focused, and includes a journal link, statistical robustness, study strengths and pitfalls, clinical implications, and a practical example of application. Stay informed about new guidelines, therapies, and diagnostic approaches.
1. Cefepime–Taniborbactam for Complicated Urinary Tract Infections
The CERTAIN-1 trial in New England Journal of Medicine finds cefepime–taniborbactam superior to meropenem for complicated UTI (including pyelonephritis), with higher composite success.
Statistical Robustness
RCT (n=661) with a significant difference in the primary endpoint; narrow 95% CIs support precision.
Strengths
Robust design; inclusion of resistant pathogens.
Pitfalls
28-day follow-up; limited CKD subgroup data.
Clinical Implication
Promising carbapenem-sparing option for cUTI, especially with ESBL organisms.
Practical Example
A 50-year-old with recurrent cUTI and ESBL-positive E. coli is admitted. Start cefepime–taniborbactam per ID guidance, confirm susceptibility, and monitor renal function.
Reference: Wagenlehner FM, et al. Cefepime–taniborbactam in complicated urinary tract infection. N Engl J Med. 2024;390:611–622.
The ReSTORE trial shows rezafungin, a once-weekly echinocandin, is non-inferior to daily caspofungin for invasive candidiasis, with similar global cure at 14 days.
Statistical Robustness
Phase 3 RCT (n≈199) met non-inferiority (−10% margin). Smaller sample widens CIs for superiority.
Strengths
Novel weekly dosing; addresses treatment burden.
Pitfalls
Limited data on resistant strains; modest sample size.
Clinical Implication
Once-weekly rezafungin can simplify inpatient-to-outpatient transitions for candidemia care.
Practical Example
A 60-year-old ICU patient with Candida glabrata candidemia is started on rezafungin weekly; monitor LFTs and complete ~28 days total therapy per ID.
Reference: Thompson GR III, et al. Rezafungin versus caspofungin for candidaemia and invasive candidiasis (ReSTORE). Lancet Infect Dis. 2023.
An RCT in New England Journal of Medicine shows doxy-PEP reduces bacterial STI incidence (syphilis, chlamydia, gonorrhea) by about two-thirds in high-risk populations.
Statistical Robustness
Randomized, open-label (n≈500) with strong significance and narrow CIs for the primary endpoint.
Strengths
Addresses rising STI burden; pragmatic adherence counseling.
Pitfalls
Evidence strongest in MSM and transgender women; stewardship concerns require monitoring.
Clinical Implication
Doxy-PEP can be considered for targeted prevention in high-risk groups per local/CDC guidance.
Practical Example
A 35-year-old MSM patient with recurrent STIs: discuss 200 mg doxycycline within 72 hours post-exposure, with adherence and periodic testing.
Reference: Luetkemeyer AF, et al. Postexposure doxycycline to prevent bacterial STIs. N Engl J Med. 2023.
4. Short-Course Antibiotics for Bloodstream Infections
Evidence supports 7-day antibiotic courses for uncomplicated gram-negative bacteremia, with similar 30-day outcomes versus 14 days, advancing stewardship.
Statistical Robustness
Clin Infect Dis RCT (n≈600) met non-inferiority; newer BALANCE trial (NEJM 2024) in heterogeneous BSI also found 7 days non-inferior.
Strengths
Pragmatic design; shorter exposure reduces adverse events and resistance pressure.
Consider 7 days for stable, source-controlled gram-negative bacteremia with ID follow-up.
Practical Example
A 55-year-old with E. coli bacteremia from pyelonephritis improving on day 5 of ceftriaxone: plan 7-day course with outpatient reassessment.
Reference: Yahav D, et al. Seven vs fourteen days for uncomplicated gram-negative bacteremia. Clin Infect Dis. 2019;69:1091–1098. | Related: NEJM BALANCE (2024) 7 vs 14 days in BSI.
Guidance emphasizes vancomycin or daptomycin for MRSA bacteremia, with carefully selected oral step-down options in uncomplicated cases; routine adjunctive rifampin is not recommended.
Statistical Robustness
Recommendations draw from RCTs and meta-analyses; applicability varies with local resistance patterns.
Strengths
Evidence-based algorithms; practical advice for real-world scenarios.
Use standardized MRSA treatment pathways; consider oral step-down in strictly defined uncomplicated bacteremia.
Practical Example
A 45-year-old with uncomplicated MRSA bacteremia on day 8 of vancomycin and negative repeat cultures: evaluate oral linezolid step-down with 2-week ID follow-up.
Reference: Infectious Diseases Society of America (IDSA) – MRSA practice guideline hub (latest publicly available recommendations).
AZD7442 (tixagevimab–cilgavimab) reduced symptomatic COVID-19 by ~77–83% over 6 months in the PROVENT pre-exposure prophylaxis trial; effectiveness varies by variant era.
Statistical Robustness
Large phase 3 RCT with tight CIs; subsequent analyses show attenuated activity vs certain Omicron subvariants.
Strengths
Option for immunocompromised patients with suboptimal vaccine response.
Pitfalls
Variant-dependent efficacy; access and cost considerations.
Clinical Implication
Consider pre-exposure prophylaxis for high-risk patients when locally active variants remain susceptible; review current public health guidance.
Practical Example
A 70-year-old post-transplant patient being discharged: evaluate eligibility for long-acting antibody prophylaxis based on current variant landscape and availability.
Reference: Levin MJ, et al. Intramuscular AZD7442 for pre-exposure prophylaxis of COVID-19 (PROVENT). N Engl J Med. 2022.
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