Study finds benefits in short-course antibiotics for ventilator-associated pneumonia

News brief
Topics
Antimicrobial Stewardship
Pneumonia

Patient on ventilatorA review and meta-analysis of randomized controlled studies (RCTs) found that short-course antibiotic therapy for ventilator-associated pneumonia (VAP) did not result in increased recurrence or relapse, French researchers reported yesterday in eClinical Medicine.

The review identified five relevant studies comparing treatment for VAP with short-course (8 days or less) versus long-course (10 to 15 days) antibiotic therapy. Despite guidelines for VAP treatment, the optimal antibiotic duration remains unclear, especially for VAP caused by non-fermenting gram-negative bacteria (NF-GNB).

The primary end point for the meta-analysis was recurrence and relapse of VAP. Secondary end points included 28-day mortality, mechanical ventilation duration, number of extra-pulmonary infections, acquisition of multidrug-resistant (MDR) pathogens, and length of intensive care unit (ICU) stay.

The five studies included 1,069 patients, with 530 in the short-course group and 539 in the long-course group. There was no significant difference between short-course therapy (odds ratio [OR], 1.48; 95% confidence interval [CI], 0.96 to 2.28) and long-course therapy (OR, 1.45; 95% CI, 0.94 to 2.22) for recurrence and relapse of VAP. The findings were similar for VAP caused by NF-GNB (OR, 1.90; 95% CI, 0.93 to 3.33 vs OR, 1.76; 95% CI, 0.93 to 3.33). No difference was found between the two groups for 28 day-mortality, mechanical ventilation duration, number of extra-pulmonary infections, acquisition of MDR pathogens, and length of ICU stay. However, short-course therapy significantly increased the number of antibiotic-free days.

Tailored strategies (including clinical and biological endpoints) should be tested in RCTs.

The authors note that while the results suggest that short-course therapy for VAP is preferrable because it reduces exposure to antibiotics, the findings are limited by the small number of trials included in the meta-analysis, the heterogeneity of the studies, and the differences in antibiotics used by the two groups.

"Tailored strategies (including clinical and biological endpoints) should be tested in RCTs in order to individualize antibiotic duration treatment," they wrote.

Monovalent COVID booster protects well against Omicron, but it wanes over 6 months

News brief
Topics
COVID-19

SARS-CoV-2 antibodiesThe monovalent (single-strain) COVID-19 vaccine booster was 74% effective against Omicron infection compared with the primary vaccine series for 3 months, but protection waned to 42% from 3 to 6 months and 36% after 6 months, estimates a study published yesterday in Influenza and Other Respiratory Viruses.

Marshfield Clinic researchers estimated relative vaccine effectiveness (rVE) of a monovalent COVID-19 vaccine booster compared with the primary series among 883 participants aged 5 years and older living in Wisconsin from January to July 2022.

The study spanned the predominance of the SARS-CoV-2 Omicron variant, primarily the BA.2 and BA.5 substrains, and was conducted before the availability of the updated bivalent (two-strain) COVID-19 booster.

A total of 625 (71%) received a booster, while the remainder completed only the primary series. Participants completed a symptom survey and submitted a nasal swab for polymerase chain reaction (PCR) testing each week and when they had at least one COVID-like symptom.

Of 219 (25%) COVID-19 infections, 97 occurred after receipt of the primary series, and 122 occurred after a booster. Overall rVE was 51%, regardless of previous infection status or the presence of an immune-compromising condition.

Routine vaccination needed

Fifteen days to 3 months after booster receipt, rVE was 74%, dropping to 42% at 3 to 6 months and 36% after 6 months. The rVE of a second monovalent booster compared with a single booster was 24% among participants aged 50 and older—the only participants eligible for a second booster—but the 95% confidence interval ranged from –40% to 61%.

Increasing bivalent booster uptake should be a priority to increase protection likely lost due to waning immunity.

The results, the authors said, confirm that vaccine-induced protection against COVID-19 infection is temporary and influenced by evolving pandemic conditions.

"Increasing bivalent booster uptake should be a priority to increase protection likely lost due to waning immunity and antigenic change of circulating viruses," they wrote. "As is the case with influenza, routine vaccination, and regular evaluation of vaccine composition will be necessary to address ongoing SARS-CoV-2 transmission."

This week's top reads

  1. 1 in 5 US retail milk samples test positive for H5N1 avian flu fragments

    The highest concentrations were in regions where the virus has been found in dairy herds.

    Lisa Schnirring
    grocery store milk

  2. Analysis of cow, cat H5N1 avian flu samples raises concerns about spread to other animals

    The cats started showing symptoms a day after clinical disease was noted in the cows, and about half of the cats died.

    Lisa Schnirring
    barn cat with milk pails

  3. Risk of uveitis recurrence higher in year after COVID vaccination

    The odds of the condition were increased among recipients of all 4 vaccines studied: Pfizer, Moderna, AstraZeneca, and J&J.

    Mary Van Beusekom

  4. WHO COVID vaccine advisers recommend switch to JN.1 strain

    The FDA's vaccine advisory group will discuss the make-up of 2024-25 vaccines at its meeting on May 16. 

    Lisa Schnirring
    vaccine prep

  5. Common diabetes drug lowers SARS-CoV-2 levels, clinical trial finds

    The mean SARS-CoV-2 viral load was reduced 3.6-fold with metformin.

    Stephanie Soucheray
    metformin

  6. USDA to test ground beef for traces of H5N1 avian flu virus as more poultry outbreaks reported

    Dairy cows make up about 7% of US beef production.

    Lisa Schnirring
    ground beef

  7. H5N1 avian flu infects Colorado dairy cows as global experts weigh in on virus changes

    Global health groups say evolving developments, including a novel reassortant in Asia and increasing detections in mammals, require real-time monitoring.

    Lisa Schnirring
    dairy cow ear tags

  8. COVID may have eroded doctors' belief that they are obligated to treat infectious patients

    Reasons cited for accepting the option of refusing treatment included unreasonable risk to physicians and their families and labor rights and worker protection.

    Mary Van Beusekom
    Exhausted healthcare worker wearing N95

  9. High-risk patients with COVID symptoms should use PCR rather than rapid tests, study suggests

    The sensitivity of RATs was 47%, compared with RT-PCR and 80% versus viral culture.

    Mary Van Beusekom
    Stack of rapid COVID tests

  10. FDA approves new treatment for uncomplicated urinary tract infections

    Pivya (pivmecillinam) is the first antibiotic approved by the FDA for uncomplicated UTIs in more than 2 decades.

    Chris Dall
    Treatment for urinary tract infections

Our underwriters