geoffrey modest medical blogs

  A recent study found that antibiotic -resistant microbes  can  spread  to the broader community not exposed to antibiotics (see  microbiome population effect of antibiotics NatCommunic2023  in dropbox, or  doi.org/10.1038/s41467-023-36633-7 )    Details :  -- 8972 human microbiome samples were analyzed, the vast majority from the gut microbiome (7589  of them) , analyzing  the amino acid spans of DNA that help with predicting actual gene function (for those in the know,  the open reading frames or ORFs)     -- the study focused on 3096 gut microbiomes from healthy individuals not taking antibiotics, assessing  them for  many of the  known  antimicrobial resistance genes (ARGs)          --  healthy individuals  were defined as  those with out  C difficile infections, cholera, colorectal adenomas  and  cancer, inflammat...

Given the emergence of methicillin-resistant Staphylococcus aureus (MRSA), there are concerns about what empiric therapy to prescribe for skin infections, including cellulitis. A recent article in JAMA assessed the utility of adding trimethoprim-sulfamethoxazole (TMP-SMX) to cephalexin in treating uncomplicated cellulitis (see  cellulitis cephalex vs cephalex tmpsmx jama2017  in dropbox, or doi:10.1001/jama.2017.5653) . Details: -- 5 US emergency departments participated in an outpatient double-blind study of 500 patients >12 years old with cellulitis but without wound, purulent drainage, or abscess, seen from 2009-2012. -- Median age 40, 58% male, 57% white/35% black/1% Asian, symptom duration 3 days, 20% with a history of fever in the week prior to enrollment, 56% of infections were in the lower extremity/24% upper extremity/9% trunk abdomen or back/6% head or neck/4% groin or buttocks, 11% diabetics; mean length and width of erythema was 13...

the US White House just released a report (see  https://www.cdc.gov/drugresistance/pdf/report-to-the-president-on-combating-antibiotic-resistance.pdf ) outlining a 5-point 5-year plan to  r educe and combat antimicrobial resistance, including plans to:         --improve surveillance efforts         --slow the emergence and spread of resistant bacteria         --develop rapid tests to identify and characterized resistant bacteria         --accelerate development of antibiotics and vaccines         --improve international collaboration specific targets include:         --c. difficile: reducing incidence of infection by 50% over 2011 estimates         --carbapenem-resistance Enterobacteri...