December ID Update

Sanford Guide ID Update features current developments in infectious diseases, curated by the Sanford Guide Editorial Board. Links marked with an asterisk (*) provide details to Web Edition subscribers, while all other links are universal. If you received this message from a colleague, subscribe now.


Sanford Guide Releases New Apps

  • Sanford Guide recently upgraded its systems to support a new generation of mobile apps. Users of the Sanford Guide Collection app will see many improvements immediately, while users of other Sanford Guide apps will see new features become available in the next few months. Among the new features now available to Collection users:
    • Clean and modern look and feel with intuitive user interface and improved visual cues to accelerate navigation.
    • Cloud-based bookmarks and notes are shared between platforms (create a bookmark on one device and it will appear automatically on your other devices).
    • The Spectra of Activity is faster on most devices, and when examining an interaction by tapping on it, Stewardship Assist users can choose to filter down to only the active data set or to view all data sets at once.
    • Stewardship Assist users can now access institutional data by tapping their hospital’s logo on the home screen.

New Parenteral Cephalosporin

  • The US FDA has approved cefiderocol* (Fetroja) for the treatment of adults with complicated UTI, including pyelonephritis*, caused by susceptible strains of E. coli, K. pneumoniae, P. mirabilis, P. aeruginosa, and E. cloacae complex. Cefiderocol functions as a siderophore, chelating ferric ions and taking advantage of the bacterial iron transport system for enhanced accumulation in the bacterial periplasmic space. The drug should be reserved for use in patients with limited or no alternative treatment options. Recommended dosage: 2 gm IV (infused over 3 hours) q8h x7-14 days.

New or Updated Treatment Guidelines

  • New clinical practice guidelines for the management of drug-resistant tuberculosis, from the American Thoracic Society, European Respiratory Society, Infectious Diseases Society of America, and Centers for Disease Control (Am J Respir Crit Care Med 2019;200:e93-e142). The guidelines are available on the journal website.
  • Guidelines for the diagnosis, treatment, and prevention of disseminated Mycobacterium chimaera infection following cardiac surgery with cardiopulmonary bypass, from the International Society of Cardiovascular Infectious Diseases (J Hosp Infect 2019 Nov 9 [Epub ahead of print]). The guidelines are available on the journal website.
  • In the recently published Committee Opinion (No. 782) on prevention of early-onset group B streptococcal disease in infants, the American College of Obstetricians and Gynecologists now recommends performing universal GBS screening between 36 0/7 and 37 6/7 weeks of gestation. All women whose vaginal-rectal cultures at 36 0/7-37 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes (Obstet Gynecol 2019;134:e19). This Committee Opinion serves as an update to and replacement of the obstetric components of CDC’s 2010 GBS guidelines and is available on the ACOG website.

From CDC

  • The newly released Antibiotic Resistance Threats in the United States, 2019 (2019 AR Threats Report) is intended to serve as a reference for information on antibiotic resistance, provide the latest US antibiotic resistance burden estimates for human health, and highlight emerging areas of concern and additional action needed. The report divides 18 antibiotic-resistant bacteria and fungi into three categories based on level of concern to human health (urgent, serious, and concerning). Like the first AR Threat Report published in 2013, the 2019 report does not include viruses or parasites. It is available on the CDC website.
  • Guidance for using tafenoquine* for prevention and antirelapse therapy for malaria (MMWR Morb Mortal Wkly Rep 2019;68:1062). If G6PD status is unknown, quantitative G6PD testing must be performed to confirm normal activity before tafenoquine is used. See report for more details.
  • CDC maintains a list of multistate foodborne outbreak investigations since 2006 in which CDC was the lead public agency. Of recent interest are 1) 67 people from 19 states infected with E. coli O157:H7 linked to romaine lettuce harvested from the Salinas, California growing region, 2) 21 people from 13 states infected with Salmonella (serovar Oranienburg), likely due to contact with pet turtles (turtles carry Salmonella in their droppings), and 3) 241 people from 11 states with laboratory-confirmed Cyclospora infection, probably resulting from exposure (which occurred in five states) to fresh basil imported from Mexico. The Cyclospora outbreak appears to be over.

Drug Shortages (US)

  • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of December 9, 2019) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons:
    • [New on the list since November 8]: Erythromycin lactobionate injection, Sulfacetamide 10%/Prednisolone 0.2% ophthalmic ointment
    • [Shortage recently resolved]: Ceftriaxone injection, Ciprofloxacin oral suspension, Erythromycin 0.5% ophthalmic ointment, Nystatin oral suspension
    • [Continue to be in reduced supply]
      • Aminoglycosides: Amikacin injection, Gentamicin ophthalmic ointment (unavailable), Tobramycin injection
      • Carbapenems: Meropenem injection
      • Cephalosporins: Cefazolin injection, Cefepime injection, Cefotaxime injection (unavailable), Cefoxitin injection, Ceftazidime injection, Cefuroxime injection
      • Clindamycin injection
      • Fluoroquinolones: Ciprofloxacin 0.3% ophthalmic solution, Gemifloxacin tablets
      • Glycopeptides, glycolipopeptides, lipopeptides: Daptomycin injection, Vancomycin injection
      • Macrolides/azalides: Azithromycin injection, Azithromycin ophthalmic solution 1% (unavailable)
      • Nitrofurantoin oral suspension
      • Nitroimidazoles: Metronidazole injection
      • Penicillins: Ampicillin/sulbactam injection, Piperacillin/tazobactam injection
      • Tetracyclines: Doxycycline hyclate injection
      • Topical (miscellaneous) antibacterials: Bacitracin ophthalmic ointment, Mupirocin calcium 2% cream, Mupirocin calcium 2% nasal ointment (unavailable), Sulfanilamide 15% vaginal cream (unavailable)
      • Antifungal drugs: Clotrimazole 10 mg oral troches, Fluconazole injection, Griseofulvin oral tablets and suspension
      • Antiparasitic drugs: Pentamidine isethionate
      • Antiretroviral drugs: None
      • Antiviral drugs: Acyclovir injection, Cidofovir injection, Letermovir injection (unavailable)
      • Vaccines: Hepatitis B vaccine recombinant, Rabies vaccine (and immune globulin), Zoster vaccine recombinant (Shingrix), Yellow Fever vaccine (YF-VAX is unavailable, but Stamaril can be obtained through a limited number of clinics in the US. Click here).
  • Antimicrobial drugs newly discontinued: 
    • Recent discontinuations: Interferon alfa-2b (Intron A, in October 2019), Quinidine gluconate IV (in December 2017), Terbinafine granules (in May 2017), MenHibrix (in February 2017), Elvitegravir (Vitekta, in December 2016), Peginterferon alfa-2b (in February 2016; 50 mcg vials still available in limited quantities), Boceprevir (in December 2015), Permethrin 1% topical lotion (in September 2015).