Recent Publications by CFE Educators

BACKGROUND

Patients with cystic fibrosis (CF) often have a history of antibiotic adverse drug reactions (ADRs) that pose a barrier to receiving recommended first-line treatment. Targeted antibiotic allergy evaluations are increasingly recognized as an important strategy for optimization of antimicrobial stewardship.

OBJECTIVE

To improve first-line antibiotic use in patients with CF with antibiotic ADRs by streamlining access to antibiotic allergy evaluations and standardizing documentation of plans for antibiotic reintroduction.

METHODS

We incorporated allergy evaluations into a multidisciplinary CF clinic and used telemedicine when allergy evaluations could not be performed during CF clinic. Standard documentation of antibiotic allergy plans was used to enable safe reintroduction of first-line antibiotics by CF providers.

RESULTS

Strategies used in this study allowed 81.3% (26 of 32) of patients with CF to receive allergy evaluations and antibiotic allergy plans for prioritized antibiotics (penicillin, cephalosporin, sulfonamide), with removal of 41.0% (16 of 39) of prioritized antibiotic ADRs. Only 5.1% (2 of 39) of prioritized antibiotic ADRs evaluated required strict avoidance after evaluation. There were 9 patients who received at least 1 prioritized antibiotic, with 66.6% (6 of 9) of these patients given the antibiotic after only 1 allergy evaluation visit. Furthermore, these strategies allowed allergy evaluations of 23 nonprioritized antibiotics to occur, with removal of the ADR in 39.1% (9 of 23) and use of 77.8% (7 of 9) of nonprioritized antibiotics after removal.

CONCLUSION

Incorporating allergy evaluations into a multidisciplinary CF clinic can liberalize first-line antibiotic use in patients with CF. Standard documentation of antibiotic allergy plans allowed antibiotic reintroduction to occur even before complete removal of documented antibiotic ADRs.

INTRODUCTION

Cycling can lead to microtrauma due to increased perineal pressure, possibly contributing to genital numbness and sexual dysfunction in female cyclists.

AIM

We aim to explore the associations between cycling characteristics, female genital numbness, and female sexual dysfunction.

METHODS

We conducted a cross-sectional study on female cyclists and sexual wellness. Participants were recruited through Facebook® advertisements and online outreach at athletic clubs. Participants were asked about their cycling characteristics, genital numbness, and female sexual function using the Female Sexual Function Index (FSFI). Univariate and multivariable linear and logistic regression were used to assess risk factors for genital numbness and the association between genital numbness and the FSFI.

OUTCOME MEASURES

The outcome measures were cycling characteristics, questions regarding numbness (intensity, duration, location), and the FSFI score.

RESULTS

Eight-hundred and seventy-five women were included in the study. Total lifetime miles cycled, biking duration, frequency, distance, speed, and biking surface were not significantly associated with genital numbness. Higher handlebar height was associated with less numbness. The prevalence of sexual dysfunction in the cohort was 52%. Genital numbness was significantly associated with sexual dysfunction (OR: 1.43, 95% CI: 1.05 - 1.95). Sub-group analysis for location of numbness demonstrated significant increase in risk for sexual dysfunction in cyclists who described numbness aro`und the perineum (OR: 2.72, 95% CI: 1.05 - 7.02) and the vulva (OR: 1.55, 95% CI: 1.13 - 2.13). There was also a significant increase in the risk of sexual dysfunction in cyclists who reported a longer duration of numbness (OR: 6.58, 95% CI: 2.27 - 19.07).

CONCLUSIONS

Genital numbness is common in women who cycle and is associated with increased risk of FSD and lower average sexual response scores on FSFI. Lui H, Mmonu N, Awad MA, et al. Association of Bicycle-Related Genital Numbness and Female Sexual Dysfunction: Results From a Large, Multinational, Cross-Sectional Study. Sex Med 2021;9:100365.

Obstetrics and gynecology (OBGYN) is rife with exploitation and oppression of Black individuals and disparate health outcomes. We posit that racial disparities in OBGYN are fueled by racism and the racial wealth gap stemming from slavery, legal segregation, and institutionalized discrimination against Black Americans. We believe reparations are not only morally requisite, but would also improve health outcomes for our patients. Supporting legislation to explore and remedy the harms of slavery and its legacy is critical to address systemic racism that results in disparate health outcomes.

BACKGROUND

Methicillin-resistant (MRSA) bloodstream infection (BSI) management remains challenging for clinicians. Numerous in vitro studies report synergy when vancomycin (VAN) and daptomycin (DAP) are combined with beta-lactams (BLs), which has led to clinical implementation of these combinations. While shorter durations of bacteremia have often been reported, there has been no significant impact on mortality.

METHODS

The Detroit Medical Center (DMC) developed and implemented a clinical pathway algorithm for MRSA BSI treatment in 2016 that included the early use of BL combination therapy with standard of care (VAN or DAP) and a mandatory Infectious Diseases consultation. This was a retrospective, quasi-experimental study at the DMC between 2013 and 2020. Multivariable logistic regression was used to assess the independent association between pathway implementation and 30-day mortality while adjusting for confounding variables.

RESULTS

Overall, 813 adult patients treated for MRSA BSI were evaluated. Compared with prepathway (PRE) patients (n = 379), those treated postpathway (POST; n = 434) had a significant reduction in 30-day and 90-day mortality: 9.7% in POST vs 15.6% in PRE ( = .011) and 12.2% in POST vs 19.0% in PRE ( = .007), respectively.The incidence of acute kidney injury (AKI) was higher in the PRE compared with the POST group: 9.6% vs 7.2% ( = .282), respectively. After adjusting for confounding variables including Infectious Diseases consult, POST was independently associated with a reduction in 30-day mortality (adjusted odds ratio [aOR], 0.608; 95% CI, 0.375-0.986).

CONCLUSIONS

Implementation of an MRSA BSI treatment pathway with early use of BL reduced mortality with no increased rate of AKI. Further prospective evaluation of this pathway approach is warranted.

OBJECTIVE

To identify clinical and radiographic factors that predict successful medical management in children with suspected deep neck space infection.

METHODS

Retrospective chart review of 313 immunocompetent children admitted to a tertiary care children's hospital after undergoing a CT scan for a suspected neck abscess.

RESULTS

A rim-enhancing hypodensity, suggestive of an abscess, was identified in 131/313 patients (42%). Medical management with IV antibiotics was utilized for more than 24 h in 57/131 (43%) of children with radiographic findings suggestive of a coalescent or evolving abscess. Medical management was successful in 36/57 (63%) of patients with a rim-enhancing collection. Children who underwent incision and drainage within 24 h had a larger fluid collection than those who underwent initial medical management (mean diameter 30 mm vs 20.5 mm; p  0.0001), however, there was no difference between the size of abscesses that failed medical management compared to those successfully managed with IV antibiotics (22.9 mm vs 19.1 mm; p = 0.07). Clinical factors and white blood cell count were not predictive of response to antibiosis.

CONCLUSION

The majority of children with suspected DNSI were successfully managed with IV antibiotics alone, however, clinical and radiographic factors are not reliable predictors of successful medical management. In children who are hemodynamically stable without airway symptoms, one should consider a trial of IV antibiotics prior to requesting a CT scan.