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Abstract Introduction Appropriate oral antibiotic therapy for the treatment of acute bacterial skin and skin structure infections (ABSSSI) is a challenge, as current oral treatment guidelines do not fully cover the most common skin pathogens. Both linezolid and omadacycline are available as intravenous or bioequivalent oral formulations. Materials and methods This post hoc analysis of the OASIS-1 (ClinicalTrials.gov identifier NCT02378480) and OASIS-2 (ClinicalTrials.gov identifier NCT02877927) phase 3 trials assessed safety and clinical efficacy of intravenous (IV)-start versus oral (PO)-start therapy in patients treated with omadacycline or linezolid for ABSSSI. In OASIS-1, patients were randomized to IV omadacycline or linezolid, with optional switch to oral therapy, while patients in OASIS-2 received oral omadacycline or linezolid. Treatment was provided for 7–14 days in both studies. The primary endpoint was an early clinical response (ECR) at 48 to 72 h, defined as survival and ≥ 20% reduction in lesion size, without rescue antibacterial therapy. Results A total of 645 IV-start inpatients and 735 PO-start outpatients were assessed. Median age was 47 years for the IV-start group and 44 years for the PO-start group. Most patients had solely gram-positive infections (97% in each group; ECR [85.2% IV-start and 85.0% PO-start]), and the incidence of treatment-emergent adverse events (AEs) was similar between the groups. The most frequent AEs observed were nausea (11.2% [IV-start] versus 18.9% [PO-start]) and subcutaneous abscess (5.6% [IV-start] versus 1.9% [PO-start]). Discontinuation due to AEs was infrequent in both groups (2% [IV-start] versus 1.2% [PO-start]). Conclusion Oral therapy is equally efficacious to IV therapy when omadacycline or linezolid is used to treat ABSSSIs. These data strengthen the evidence for oral omadacycline as a therapeutic option for ABSSSI, particularly for patients who have experienced treatment failure because of the limitations of other therapies. Trial registration Clinicaltrials.gov, NCT02378480 and NCT02877927.

Introduction: Uncertainty surrounds the optimal routine laboratory monitoring in acne patients treated with isotretinoin. Objective: Our aim was to evaluate the risk of mild and severe laboratory abnormalities in patients with acne starting isotretinoin versus oral antibiotic treatment. Methods: A global population‐based retrospective cohort study assigned two groups of patients with acne‐prescribed isotretinoin (n = 79,012) and oral antibiotics (n = 79,012). Comprehensive propensity‐score matching was conducted. Results: Compared to acne patients treated with oral antibiotics, those under isotretinoin demonstrated an increased risk of grade ≥3 hypertriglyceridemia (hazard ratio [HR], 7.85; 95% confidence interval [CI], 5.58–11.05; P < 0.001) and grade ≥3 elevated aspartate transaminase (AST) levels (HR, 1.45; 95% CI, 1.13–1.85; P = 0.003) within the initial 3 months of treatment. The absolute risk of these abnormalities among isotretinoin initiators was 0.4% and 0.2%, respectively. The risk difference of these findings was clinically marginal: 3 and 1 additional cases per 1,000 patients starting isotretinoin, respectively. There was no significant risk of grade ≥3 impairment in cholesterol, alanine transaminase, gamma‐glutamyl transferase, or creatinine levels under isotretinoin. Most laboratory abnormalities were documented 1–3 months after drug initiation in time‐stratified analysis. Conclusion: Isotretinoin is associated with a clinically marginal increased risk of severe hypertriglyceridemia and hypertransaminasemia. Routine blood testing should be performed 1–3 months after commencing therapy. [ABSTRACT FROM AUTHOR]

Background Although intravenous antibiotics have historically been the standard of care for bone and joint infections, clinical trial data have highlighted the safety and efficacy of oral antibiotics. Despite this, intravenous antibiotics are still commonly used, and evaluations of institutional guidelines advancing oral antibiotic use are limited. Methods In April 2023, we implemented a new institutional guideline to preferentially treat patients with bone and joint infections with oral antibiotics. The postguideline cohort was compared with a historical preguideline cohort via retrospective chart review. The primary outcome was the proportion of patients discharged exclusively on oral antibiotics. Secondary outcomes included 90-day treatment failure, length of stay, and adverse effects. Results One hundred eighty-six patients (53 preguideline and 133 postguideline) were included in the analysis. Patients in the postguideline cohort were more likely to be discharged exclusively on oral antibiotics (25% vs 70%; P <.01), with no difference in 90-day treatment failure (8% vs 9%; P =.75). Patients in the postguideline cohort had a shorter length of stay than preguideline (median, 8 vs 7 days; P =.04) and trended toward fewer peripherally inserted central catheter–related adverse events (6% vs 1%; P =.07). Conclusions An institutional guideline was effective in increasing the proportion of patients with bone and joint infections discharged on oral antibiotics. We observed similar clinical outcomes after implementing the guidelines while reducing length of hospital stay. [ABSTRACT FROM AUTHOR]

Introduction: Appropriate oral antibiotic therapy for the treatment of acute bacterial skin and skin structure infections (ABSSSI) is a challenge, as current oral treatment guidelines do not fully cover the most common skin pathogens. Both linezolid and omadacycline are available as intravenous or bioequivalent oral formulations. Materials and methods: This post hoc analysis of the OASIS-1 (ClinicalTrials.gov identifier NCT02378480) and OASIS-2 (ClinicalTrials.gov identifier NCT02877927) phase 3 trials assessed safety and clinical efficacy of intravenous (IV)-start versus oral (PO)-start therapy in patients treated with omadacycline or linezolid for ABSSSI. In OASIS-1, patients were randomized to IV omadacycline or linezolid, with optional switch to oral therapy, while patients in OASIS-2 received oral omadacycline or linezolid. Treatment was provided for 7–14 days in both studies. The primary endpoint was an early clinical response (ECR) at 48 to 72 h, defined as survival and ≥ 20% reduction in lesion size, without rescue antibacterial therapy. Results: A total of 645 IV-start inpatients and 735 PO-start outpatients were assessed. Median age was 47 years for the IV-start group and 44 years for the PO-start group. Most patients had solely gram-positive infections (97% in each group; ECR [85.2% IV-start and 85.0% PO-start]), and the incidence of treatment-emergent adverse events (AEs) was similar between the groups. The most frequent AEs observed were nausea (11.2% [IV-start] versus 18.9% [PO-start]) and subcutaneous abscess (5.6% [IV-start] versus 1.9% [PO-start]). Discontinuation due to AEs was infrequent in both groups (2% [IV-start] versus 1.2% [PO-start]). Conclusion: Oral therapy is equally efficacious to IV therapy when omadacycline or linezolid is used to treat ABSSSIs. These data strengthen the evidence for oral omadacycline as a therapeutic option for ABSSSI, particularly for patients who have experienced treatment failure because of the limitations of other therapies. Trial registration: Clinicaltrials.gov, NCT02378480 and NCT02877927. [ABSTRACT FROM AUTHOR]

Background and Objectives: Recent findings suggest that combining mechanical bowel preparation (MBP) and preoperative oral antibiotics (OAs) decreases the risk of incisional surgical site infections (iSSIs) in colorectal surgery; however, this finding remains controversial. This study examined the efficacy of OAs and MBP in colorectal surgery using propensity score matching (PSM). Materials and Methods: Between January 2015 and December 2020, 559 patients with colorectal tumors underwent MBP followed by colorectal surgery. The multivariate analysis used a COX proportional hazards model to extract risk factors for iSSI. PSM was performed to balance the impact of potential co-factors of OAs with MBP (OA) and MBP alone (non-OA) on superficial SSI incidence. Results: The multivariate analysis identified non-OA use as an independent risk factor for iSSIs (odds ratio [OR]: 2.44, 95% confidence interval [CI]: 1.22–4.88, p = 0.0112). After matching the cohort, both OA and non-OA groups were divided into 217 cases each. The incisional SSI rate was significantly lower in the OA group (n = 338) than in the non-OA group (1.61% vs. 5.07%; OR 3.4; 95% CI; 0.123–0.707; p = 0.0062). Conclusions: This study revealed that OAs with MBP markedly reduced SSI rates. OAs with MBP should be adopted in colorectal surgery. [ABSTRACT FROM AUTHOR]

Mechanical bowel preparation (MBP) has long been a subject of debate in colorectal surgery. While it was historically regarded as a standard preoperative practice, recent evidence has questioned its necessity and effectiveness, especially when used in isolation. This review explores the evolving role of MBP, its combination with oral antibiotics (OA), and its impact on postoperative outcomes, such as surgical site infections (SSI) and anastomotic leakage (AL). Studies suggest that MBP combined with OA offers superior benefits compared to MBP alone, particularly in left-sided colorectal and rectal surgeries. However, the role of MBP remains contentious in right-sided resections, with conflicting evidence regarding its effectiveness. Furthermore, concerns about patient discomfort, dehydration, and electrolyte imbalances have raised doubts about its routine use. Our comprehensive analysis, based on 11 years of published research, highlights that the decision to employ MBP should be individualized, taking into account the type of surgical intervention, patient comorbidities and overall health status. While MBP+OA shows promise in reducing SSI rates, further research is needed to evaluate its broader clinical implications and to explore alternatives, including newer antibiotics, to minimize reliance on MBP. [ABSTRACT FROM AUTHOR]

Background Current guidance suggests oral antibiotics can be considered for children with acute otitis media (AOM) and ear discharge, but there is an absence of evidence regarding the relative effectiveness of antibiotic-corticosteroid eardrops. Aim To establish whether antibiotic-corticosteroid eardrops are non-inferior to oral antibiotics in children with AOM and ear discharge. Design and setting Open randomized controlled non-inferiority trial set in Dutch primary care. Methods Children were randomized to hydrocortisone-bacitracin-colistin eardrops (five drops, three times per day in the discharging ear(s)) or amoxicillin suspension (50 mg per kilogram of body weight per day, divided over three doses administered orally) for 7 days. The primary outcome was the proportion of children with resolution of ear pain and fever at day 3. Results Between December 2017 and March 2023, 58 of the planned 350 children were recruited due to slow accrual for various reasons. Children assigned to eardrops (n  = 26) had lower resolution rates of ear pain and fever at 3 days compared to those receiving oral antibiotics (n  = 31): 42% vs 65%; adjusted risk difference 20.3%, 95% confidence interval −5.3% to 41.9%), longer parent-reported ear discharge (6 vs 3 days; P  = .04), and slightly higher mean ear pain scores (Likert scale 0–6) over days 1–3 (2.1 vs 1.4, P  = .02), but received fewer oral antibiotic courses in 3months (11 for 25 children vs 33 for 30 children), and had less GI upset and rash (12% vs 32% and 8% vs 16%, respectively). Conclusion Early termination stopped us from determining non-inferiority of antibiotic-corticosteroid eardrops. Our limited data, requiring confirmation, suggest that oral antibiotics may be more effective than antibiotic-corticosteroid eardrops in resolving symptoms and shortening the duration of ear discharge. [ABSTRACT FROM AUTHOR]

Helicobacter pylori is a gram-negative, spiral-shaped, flagellated bacterium that colonizes the stomach of half the world's population. Helicobacter pylori infection causes pathologies of varying severity. Standard oral therapy fails in 15–20% since the barriers of the oral route decrease the bioavailability of antibiotics and the intrinsic factors of bacteria increase the rates of resistance. Nanoparticles and microparticles are promising strategies for drug delivery into the gastric mucosa and targeting H. pylori. The variety of building blocks creates systems with distinct colloidal, surface, and biological properties. These features improve drug-pathogen interactions, eliminate drug depletion and overuse, and enable the association of multiple actives combating H. pylori on several fronts. Nanoparticles and microparticles are successfully used to overcome the barriers of the oral route, physicochemical inconveniences, and lack of selectivity of current therapy. They have proven efficient in employing promising anti-H. pylori compounds whose limitation is oral route instability, such as some antibiotics and natural products. However, the current challenge is the applicability of these strategies in clinical practice. For this reason, strategies employing a rational design are necessary, including in the development of nano- and microsystems for the oral route. [ABSTRACT FROM AUTHOR]

Background Traditional blood cultures for gram-negative bacteremia can take up to 72 hours or more to return results, prolonging the duration of empiric broad-spectrum intravenous antibiotics. The Accelerate Pheno system provides rapid identification and susceptibilities for blood cultures in gram-negative bacteremia. Current data on its clinical utility are mixed overall, so the system requires further research. Methods A multicenter, retrospective quasi-experimental study was conducted comparing the Accelerate Pheno rapid diagnostic system with antimicrobial stewardship intervention and traditional blood cultures alone. Results A total of 264 patients with blood cultures with gram-negative bacteria growth were included in the final analysis (102 pre-intervention, 162 post-intervention). The antimicrobial stewardship team made 364 recommendations in 152/162 (93.8%) patients in the post group. Duration of intravenous therapy was shorter (P <.001) for the post-intervention group (median, 4.0 days) compared with the pre-intervention group (median, 7.5 days). Hospital length of stay was also shorter (P <.001) for the post-intervention group (median, 5.1 days) compared with the pre-intervention group (median, 7.0 days). Readmission rates within 30 days were reduced (P =.042) post-intervention (13.0%) compared with pre-intervention (22.6%). In the post-intervention group, a larger proportion of patients were transitioned to oral therapy at any point (126/162, 77.8%) compared with pre-intervention (62/102, 60.8%; P <.001). Conclusions These results suggest that the Accelerate Pheno system, with active review and intervention by a multidisciplinary antimicrobial stewardship team, is a useful tool in improving both patient-centric and antimicrobial stewardship outcomes. [ABSTRACT FROM AUTHOR]

Background We assessed the safety and efficacy of oral antibiotic step-down therapy for uncomplicated gram-negative blood stream infections in solid-organ transplant recipients. Methods We identified all solid-organ transplant recipients within the Massachusetts General and Brigham and Women's Hospital systems from 2016 to 2021 with uncomplicated gram-negative bacteremia involving an organism susceptible to an acceptably bioavailable oral antibiotic agent. Using inverse probability of treatment-weighted models based on propensity scores adjusting for potential clinical confounders, we compared outcomes of those transitioned to oral antibiotics with those who continued intravenous (IV) therapy for the duration of treatment. Primary endpoints were mortality, bacteremia recurrence, and reinitiation of IV antibiotics. Secondary endpoints included length of stay, Clostridioides difficile infection, treatment-associated complications, and tunneled central venous catheter placement. Results A total of 120 bacteremia events from 107 patients met inclusion criteria in the oral group and 42 events from 40 patients in the IV group. There were no significant differences in mortality, bacteremia recurrence, or reinitiation of IV antibiotics between groups. Patients transitioned to oral antibiotics had an average length of stay that was 1.97 days shorter (95% confidence interval [CI], −.39 to 3.56 days; P =.005). Odds of developing C. difficile and other treatment-associated complications were 8.4 times higher (95% CI, 1.5–46.6; P =.015) and 6.4 times higher (95% CI, 1.9–20.9; P =.002), respectively, in the IV group. Fifty-five percent of patients in the IV group required tunneled catheter placement. There was no difference in treatment duration between groups. Conclusions Oral step-down therapy was effective and associated with fewer treatment-related adverse events. [ABSTRACT FROM AUTHOR]

Preoperative bowel preparation, through iterations over time, has evolved with the goal of optimizing surgical outcomes after colon and rectal surgery. Although bowel preparation is commonplace in current practice, its precise mechanism of action, particularly its effect on the human gut microbiome, has yet to be fully elucidated. Absent intervention, the gut microbiota is largely stable, yet reacts to dietary influences, tissue injury, and microbiota-specific byproducts of metabolism. The routine use of oral antibiotics and mechanical bowel preparation prior to intestinal surgical procedures may have detrimental effects previously thought to be negligible. Recent evidence highlights the sensitivity of gut microbiota to antibiotics, bowel preparation, and surgery; however, there is a lack of knowledge regarding specific causal pathways that could lead to therapeutic interventions. As our understanding of the complex interactions between the human host and gut microbiota grows, we can explore the role of bowel preparation in specific microbiome alterations to refine perioperative care and improve outcomes. In this review, we outline the current fund of information regarding the impact of surgical bowel preparation and its components on the adult gut microbiome. We also emphasize key questions pertinent to future microbiome research and their implications for patients undergoing colorectal surgery. [ABSTRACT FROM AUTHOR]

The article discusses the use of preoperative oral antibiotics in colorectal surgery, highlighting the divergent practices between Europe and North America. Various meta-analyses have shown that combining oral and IV antibiotics can reduce surgical site infections and anastomotic leaks. While there is no international consensus on the use of oral antibiotics, ongoing research, such as the CABE trial, aims to evaluate their effectiveness in improving patient outcomes. The article also emphasizes the importance of antimicrobial stewardship to avoid bacterial resistance. [Extracted from the article]

Background: Diabetic foot osteomyelitis (DFO) is a major complication and can lead to significant morbidity and mortality. Systemic antibiotic therapy is often initiated first line to achieve quiescence of infection. To perform a multi-centre case review of systemic antibiotic intervention to treat adults with DFO in England and Wales and compare with national guidelines 'Diabetic foot problems: prevention and management'. Methods: Eight centres from England and Wales retrospectively collated data from a minimum of five adults (aged ≥ 18 years) from electronic case records. All patients were treated with systemic antibiotics following a new diagnosis of DFO (1 June 2021–31 December 2021). Results: 40 patients (35 males and 5 females) were included; the mean age was 62.3 years (standard deviation (SD) 13.0). Patients commenced systemic oral 14 (35%) or intravenous 26 (65%) antibiotic therapy following a new diagnosis of DFO. Twenty-seven (67.5%) patients were medically or surgically managed in the 12-week period with clinical quiescence of infection. Twenty-one patients (52.5%) had no recurrence of DFO infection within 12 weeks; seventeen (42.5%) of these patients had clinical quiescence of infection with systemic antibiotics alone without surgical intervention and nine (22.5%) of these cases had no recurrence of DFO. There were no cases of major amputation or death. All centres showed significant in-centre variability in systemic antibiotic management; variability was reported in the clinical and quantity indicators specifically to antibiotic selection, single versus dual therapy, mode of delivery and duration of treatment. Conclusions: This case review identifies there is existing variation when treating adults with systemic antibiotics for DFO. Further national guidance is required to standardise service delivery and care to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate effects of 7 days oral antibiotic prophylaxis versus no antibiotics in the patients with DJ stents after 3 days iv antibiotic on discharge with respect to urinary tract infection and stent related symptoms. Material and methods: A prospective randomized study in 90 patients being stented post PCNL/URSL. Group A: no oral antibiotics was given at the time of discharge, Group B: 7 days of oral antibiotic was given at the time of discharge. Patients were followed up and outcomes were assessed in the form of lower urinary symptoms (LUTS), urine culture and sensitivity at 1 and 3 weeks and DJ stent culture and sensitivity on removal at 3 weeks. Results: There was no significant difference in age, gender, type of surgery (PCNL/URSL), duration of DJ stent between the two groups. Patients in group A and Group B have comparable UTI and stent related symptoms at 1 and 3 weeks respectively (p = 0.95 and p = 0.916 respectively). Similarly, there were no marked difference in urine culture at 1 and 3 weeks, respectively between two groups (p = 0.71 and p = 0.63, respectively). Overall there were no significant differences in Urinary symptoms, urine culture/sensitivity at 1 and 3 weeks and also DJ stent culture and sensitivity on removal at 3 weeks between the two groups. Conclusion: The incidence of UTI and stent related symptoms are same in both the groups. Therefore, prescribing oral antibiotics on discharge in selected patient with DJ stent has no added benefit and should be avoided. [ABSTRACT FROM AUTHOR]

Background: Current evidence concerning bowel preparation before elective colorectal surgery is still controversial. This study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation. Methods: A prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). Twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. The primary endpoints were AL, SSIs, and OM. All the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI). Results: Compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23–2.71; p =.003) and OM risk (OR 1.38; 95% CI 1.10–1.72; p =.005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25–0.79; p =.008). Conclusions: MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP. [ABSTRACT FROM AUTHOR]

Background: A combination of oral antibiotics and mechanical bowel preparation is recommended for patients scheduled to undergo elective colorectal surgery on the basis of recent large trials that have reported the superiority of this approach in preventing surgical site infections (SSIs). However, there are no standard recommendations for this approach. Therefore, in this study, we evaluated the efficacy of rifaximin and metronidazole and mechanical bowel preparation for preventing SSIs in cases of minimally invasive surgery for colorectal cancer. Methods: This single-arm prospective observational study included 256 individuals. The primary end point was the rate of SSI. Rifaximin 400 mg and metronidazole 500 mg were administered twice daily (10 am and 10 pm), and mechanical bowel preparation was administered the day before the operation. Results: After excluding 15 patients, 241 were enrolled. No adverse event occurred following the administration of oral antibiotics and mechanical bowel preparation; there was 100% compliance. The total SSI rate was 2.9%; the rates of incisional and organ/space SSIs were 1.2% and 1.7%, respectively. All patients were treated conservatively. Univariate analyses revealed preoperative anemia, hypoalbuminemia, and transfusion and postoperative transfusion were significantly associated with SSIs. Discussion: A 1 day rifaximin and metronidazole regimen with mechanical bowel preparation for elective minimally invasive surgery for colorectal cancer was associated with a favorable SSI rate of 2.9%, safety, and high compliance. This approach is appropriate for inclusion in the current guidelines for perioperative management of patients scheduled to undergo minimally invasive surgery for colorectal cancer. [ABSTRACT FROM AUTHOR]

Background and Objectives: Recent findings suggest that combining mechanical bowel preparation (MBP) and preoperative oral antibiotics (OAs) decreases the risk of incisional surgical site infections (iSSIs) in colorectal surgery; however, this finding remains controversial. This study examined the efficacy of OAs and MBP in colorectal surgery using propensity score matching (PSM). Materials and Methods: Between January 2015 and December 2020, 559 patients with colorectal tumors underwent MBP followed by colorectal surgery. The multivariate analysis used a COX proportional hazards model to extract risk factors for iSSI. PSM was performed to balance the impact of potential co-factors of OAs with MBP (OA) and MBP alone (non-OA) on superficial SSI incidence. Results: The multivariate analysis identified non-OA use as an independent risk factor for iSSIs (odds ratio [OR]: 2.44, 95% confidence interval [CI]: 1.22–4.88, p = 0.0112). After matching the cohort, both OA and non-OA groups were divided into 217 cases each. The incisional SSI rate was significantly lower in the OA group (n = 338) than in the non-OA group (1.61% vs. 5.07%; OR 3.4; 95% CI; 0.123–0.707; p = 0.0062). Conclusions: This study revealed that OAs with MBP markedly reduced SSI rates. OAs with MBP should be adopted in colorectal surgery.

The evidence regarding the role of oral antibiotics alone (oA) or combined with mechanical bowel preparation (MoABP) for elective colorectal surgery remains controversial. A prospective database of 8359 colorectal resections gathered over a 32-month period from 78 Italian surgical units (the iCral 2 and 3 studies), reporting patient-, disease-, and procedure-related variables together with 60-day adverse events, was re-analyzed to identify a subgroup of 1013 cases (12.1%) that received either oA or MoABP. This dataset was analyzed using a 1:1 propensity score-matching model including 20 covariates. Two well-balanced groups of 243 patients each were obtained: group A (oA) and group B (MoABP). The primary endpoints were anastomotic leakage (AL) and surgical site infection (SSI) rates. Group A vs. group B showed a significantly higher AL risk [14 (5.8%) vs. 6 (2.5%) events; OR: 3.77; 95%CI: 1.22–11.67; p = 0.021], while no significant difference was recorded between the two groups regarding SSIs. These results strongly support the use of MoABP for elective colorectal resections. [ABSTRACT FROM AUTHOR]

Background: Staphylococcus aureus bacteraemia (SAB) is a serious infection associated with high mortality. Current treatment often consists of 14 days of intravenous antibiotics. Significant variability in practice is seen, with some advocating an intravenous to oral antibiotic switch can be considered in uncomplicated SAB.We aimed to describe current antimicrobial strategies used to manage uncomplicated SAB in our UK based hospital. We also assessed outcomes of patients with uncomplicated SAB in those treated with a intravenous to oral antibiotic switch within 14 days. Methods: This was a single-centre, retrospective, cohort study between 2018 and 2020 of patients with SAB. Patients with complicated SAB were excluded. Outcomes measured were 90-day relapse, 30-day mortality and length of stay. Results: We identified 237 patients with SAB, 103 of whom had uncomplicated bacteraemia and were included in the analysis. Of these, 38 (37 %) had an intravenous to oral antibiotic switch within 14 days. Oral antibiotics used included flucloxacillin (n = 32, 84 %), linezolid (n = 4, 11 %), co-trimoxazole (n = 1, 3 %), and doxycycline (n = 1, 3 %). 30-day mortality was lower in patients who received an intravenous to oral switch within 14 days compared to those who did not (16 % vs 37 % p = 0.026). In order to exclude patients who died early or had inadequate courses of antibiotics, we removed those who received less than 7 days antibiotics. On re-analysis there was no statistical difference in outcomes except for median length of stay (14 days vs 32 days p

Purpose: Surgical site infection (SSI) impacts 5-20% of patients after elective colorectal surgery. There are varying reports on the effectiveness of oral antibiotics (OAB) with preoperative mechanical bowel preparation (MBP) in preventing SSI. We aim to determine the role of OAB and MBP in preventing SSI after elective colorectal surgery. We also determine if a specific OAB regimen will be more effective than others. Methods: This study investigated the impact of OAB and MBP in patients undergoing elective colorectal surgery. PubMed, MEDLINE, Ovid, Cochrane Central Register of Controlled Trials, ACP Journal Club, and Embase databases were searched for randomized clinical trials (RCTs) published by June 2022. All RCTs comparing various preoperative bowel preparation regimens, including pairwise or multi-intervention comparisons, were included. To establish the role of OAB and MBP in preventing SSI, we conducted a Bayesian network meta-analysis on all RCTs. We further performed subgroup analysis to determine the most effective OAB regimen. Results: Among included 46 studies with a total of 12690 patients, patients in the MBP + OAB group were less likely to have SSI than those having MBP-only (OR 0.55, 95% CrI 0.39-0.76), and without MBP and OAB (OR 0.52, 95% CrI 0.32-0.84). OAB regimen C (kanamycin + metronidazole) and A (neomycin + metronidazole) demonstrated a significantly reduced incidence of SSI, compared to regimen B (neomycin + erythromycin) with OR 0.24 (95% CrI 0.07-0.79) and 0.26 (95% CrI 0.07-0.99) respectively. Conclusions: OAB with MBP reduces the risk of SSI after elective colorectal surgery. Providing adequate aerobic and anaerobic coverage with OAB may confer better protection against SSI. [ABSTRACT FROM AUTHOR]

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Aim: There are many reports that preoperative oral antibiotics (OAs) are effective in preventing surgical site infections (SSIs) in colorectal surgery. However, there is no consensus on the optimal dose of OAs. In this study, we investigated the efficacy of OAs in preventing SSIs and the possibility that OAs induce enterobacterial alteration in the intestinal tract. Method: We performed a retrospective cross‐sectional analysis of 389 patients who underwent R0 resection and stoma creation for colorectal cancer in our department between 2009 and 2020. We focused on the incidence of peristomal candidiasis (PSC) as an indicator of enterobacterial alteration and used kanamycin (KM) and metronidazole (MNZ) as the OAs. A low‐dose group received 1000 mg/day of both KM and MNZ, and a high‐dose group received 2000 mg/day of both KM and MNZ. Results: SSI occurred in 60 of the 389 cases (15.4%). Regardless of stoma type, SSI was significantly more common in the non‐OA group, while PSC was significantly less common. When examined by OA dose, the incidence of SSI was not significantly different between the low‐dose and high‐dose groups. However, PSC was significantly more common in the high‐dose group than in the non‐OA and low‐dose groups. Analysis of bacterial and fungal levels in stool samples showed that bacterial levels after OAs were significantly lower than before OAs, while fungal levels increased. Conclusion: OAs significantly reduce SSI in colorectal cancer surgery. However, excess OAs were significantly associated with the occurrence of PSC without contributing to further reduction in SSI. [ABSTRACT FROM AUTHOR]

Background: Oral antibiotics (OA) combined with mechanical bowel preparation (MBP) significantly decrease the rate of surgical site infections (SSIs). However, the prophylactic effects in region-specific colorectal surgery have not been assessed. Materials and methods: A single-centre, single-blind, randomized controlled trial was conducted from 2019 to 2022. Patients were eligible if they were diagnosed with nonmetastatic colorectal malignancy, and laparoscopic colorectal surgery was indicated. Participants were randomly assigned (1:1) to the experimental (OA+MBP preparation) or control group (MBP preparation). The randomization was further stratified by resected region. The primary outcome was the incidence of SSIs. Patients were followed up for 1 month postoperatively, and all complications were recorded. Result: Between 2019 and 2022, 157 and 152 patients were assigned to the experimental and control groups, respectively, after 51 patients were excluded. The incidence of SSIs in the control group (27/152) was significantly higher than that in the experimental group (13/157; P=0.013), as was the incidence of superficial SSIs (5/157 vs. 14/152, P=0.027) and deep SSIs (7/157 vs. 16/152, P=0.042). After redistribution according to the resected region, the incidence of SSIs was significantly higher in the control group with left-sided colorectal resection (descending, sigmoid colon, and rectum) (9/115 vs. 20/111, P=0.022) but was similar between the groups with right-sided colon resection (ascending colon) (3/37 vs. 7/36, P=0.286). No differences were noted between the groups in terms of other perioperative complications. Conclusion: OA+MBP before colorectal surgery significantly reduced the incidence of SSIs. Such a prophylactic effect was particularly significant for left-sided resection. This preparation mode should be routinely adopted before elective left-region colorectal surgeries. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this retrospective study was to investigate whether oral antibiotics (doxycycline and metronidazole) combined with intrauterine perfusion (gentamicin and dexamethasone) are beneficial for patients with repeated implantation failure (RIF) and chronic endometritis (CE) to improve clinical pregnancy outcomes. Methods Patients with RIF and CE were diagnosed using hysteroscopy and histology together. A total of 42 patients were enrolled in the study. All patients received oral antibiotics (doxycycline combined with metronidazole) and 22 patients underwent intrauterine perfusion (gentamicin combined with dexamethasone) immediately after the end of oral antibiotic therapy. Pregnancy outcomes were evaluated during the first in vitro fertilization (IVF) and embryo transfer (ET) cycle. Results For the first D3 ET after treatment with oral antibiotics (doxycycline and metronidazole) combined with intrauterine perfusion (gentamicin and dexamethasone), higher embryo implantation rate (30.95% vs. 26.67%, P = 0.0308), clinical pregnancy rate (30% vs. 50%, P

Oral antibiotics have served as a primary strategy for bacterial infection. However, the increasingly prominent issues including antibiotics resistance and intestinal dysbiosis sounded the alarm to this traditional administration strategy. Herein, we summarize the state-of-the-art advances in the delivery of oral antibiotics. In this review, the emergency of bacterial infection and the effect of excessive antibiotics are discussed at first. Then, current attempts to prevent microflorae from resistance and dysbiosis are briefly enumerated, including oral co-administration systems (like protectors, adsorbents, activity enhancers, etc.) and nanoparticle-based delivery systems. Moreover, we also briefly introduce the development of mimetic antibiotics based on metal particles and highlight a novel micelle nanoparticle system, which possesses a positive charge and glucosylated surface to achieve targeted treatment. We strongly believe such an ingenious design could be applied in more scenarios for oral antibiotics delivery. Ultimately, we also put forward a concise summary and perspective of this field.

• Drop from baseline to Day 0 FEV 1 was strongly associated with lung function response to oral antibiotic therapy for pulmonary exacerbations (p<0.001). • Greater FEV 1 improvements were associated with longer antibiotic treatment durations. • Older, female patients had less improvements in FEV 1 at end of treatment compared to younger, male patients. Pulmonary exacerbations treated with oral antibiotics (oPEx) have a significant effect on lung function decline in people with cystic fibrosis (CF). However, factors associated with lung function response with oPExs are not well defined. We performed a retrospective cohort study of pediatric and adult patients with CF followed in the Toronto CF Database. Lung function response was measured both as the change in forced expiratory volume in 1 second (FEV 1) from Day 0 of antibiotic therapy to end of treatment as well as from baseline to end of treatment. Drop from baseline to Day 0 FEV 1 was strongly associated with lung function response (p<0.001). Greater FEV 1 improvements were associated with longer antibiotic treatment durations. Older, female patients had less improvements in FEV 1 at end of treatment compared to younger, male patients. [ABSTRACT FROM AUTHOR]

The belief that antibiotics must be administered intravenously (IV) to treat bacteraemia and endocarditis has its origins 70 years ago and has engrained itself in the psyche of the medical community and the public at large. This has led to hesitancy in adopting evidence-based strategies utilizing oral transitional therapy for the treatment of these infections. We aim to reframe the narrative around this debate, focusing on patient safety over vestigial psychology. This narrative review summarizes the current state of the literature regarding the use of oral transitional therapy for the treatment of bacteraemia and infective endocarditis, focusing on studies comparing it to the traditional, IV-only approach. Relevant studies and abstracts from PubMed reviewed in April 2023. Treating bacteraemia with oral transitional therapy has been studied in 9 randomized controlled trials (RCTs), totalling 625 patients, as well as numerous large, retrospective cohorts, including 3 published in the last 5 years alone, totalling 4763 patients. We identified 3 large, retrospective cohort studies; one quasi-experimental, pre-post study, and 3 RCTs of patients with endocarditis, totalling 748 patients in the retrospective cohorts and 815 patients in prospective, controlled studies. In all these studies, no worse outcomes were observed in the oral transitional therapy arm as compared with IV-only therapy. The main difference has consistently been longer durations of inpatient hospitalization and increased risk of catheter-related adverse events like venous thrombosis and line-associated blood stream infections in the IV-only groups. There are ample data showing that choosing oral therapy reduces hospital stay and has fewer adverse events for patients than IV-only therapy, all with similar or better outcomes. In selected patients, choosing IV-only therapy may serve more as an anxiolytic "placebo" for the patient and provider rather than a necessity for treating the actual infection. [ABSTRACT FROM AUTHOR]

Surgical site infection in colorectal surgery is prevalent compared to other surgeries due to colonic bacterial load. This has serious implication on recovery, length of stay, readmission, mortality and duration to oncological treatment. We hypothesized that mechanical bowel preparation and oral antibiotics (MBP + OA) reduces surgical site infection in patients undergoing colorectal resection. Our institution introduced MBP + OA for elective colorectal surgeries in 2020. Inclusion criteria were as follows: (1) open colorectal resection, (2) low rectal resection with defunctioning ileostomy and (3) resection of locally advanced colorectal tumour requiring laparoscopically assisted approach. All patients who met these criteria were enrolled. Characteristics and outcomes were compared with control population from previous year that met the criteria but did not receive MBP + OA. 148 patients were studied between January 2019 and June 2021. 68 received MBP + OA; 80 did not. The MBP + OA group had a lower surgical site infection rate of 8.8% vs. 25.0% in the control group (p = 0.018). Multivariate analysis revealed that MBP + OA is an independent protective factor for surgical site infection (odds ratio = 0.30, confidence interval 0.106–0.851; p = 0.024) while open approach is an independent predictor for surgical site infection (odds ratio = 7.435, confidence interval 1.863–29.666; p = 0.004). There was no difference in anastomotic leak rate (p = 0.45). With regards to ERAS-specific outcomes, the MBP + OA group had higher rate of establishing solid diet by POD2 (57.4% vs. 33.8%, p = 0.0067) and shorter day to bowel opening (1.88SD1.08 vs. 2.39SD1.79). MBP + OA is effective in reducing surgical site infection and complements ERAS. This is one of the first studies to be conducted in the Asian population. [ABSTRACT FROM AUTHOR]

Background: Oral antibiotics (OAB) in colorectal surgery have been shown to reduce surgical site infections (SSIs) and possibly anastomotic leakage. However, evidence on long-term follow-up, reintervention rates and 5-year oncological follow-up is lacking. The current study aims at elucidating this knowledge gap. Methods: This study evaluated the long-term effectiveness of perioperative 'Selective decontamination of the digestive tract' (SDD) in colorectal cancer surgery. The primary outcome was anastomotic leakage within 90 days, secondary outcomes included infectious complications, reinterventions, readmission, hospital stay, and 5-year overall and disease-free-survival. Statistical analysis including univariate and multivariate analysis was performed to identify predictors of 90-day outcomes, and Kaplan–Meier survival analysis was used for the 5-year survival outcomes. Results: In total 455 patients were analyzed, 228 participants in the SDD group and 227 in the control group. Anastomotic leakage rate was not statistically different between the SDD and control group (6.6% versus 9.7%). One or more infectious complications occurred in 15.4% of patients in the SDD group and in 28.2% in the control group (OR 0.46, 95% C.I. 0.29 – 0.73). In the SDD group 8,8% of patients required a reintervention compared to 16,3% of patients in the control group (OR 0.47, 95% C.I. 0.26 – 0.84). After multivariable analysis SDD remained significant in reducing both infectious complications and reinterventions after 90-days follow-up. There was no difference between SDD and control group in 5-year overall survival and disease-free-survival. Conclusion: SDD as OAB is effective in reducing 90-days postoperative infectious complications and reinterventions. As such, SDD as standard OAB in elective colorectal surgery is highly recommended. [ABSTRACT FROM AUTHOR]

Background In the POET (Partial Oral Endocarditis Treatment) trial, oral step-down therapy was noninferior to full-length intravenous antibiotic administration. The aim of the present study was to perform pharmacokinetic/pharmacodynamic analyses for oral treatments of infective endocarditis to assess the probabilities of target attainment (PTAs). Methods Plasma concentrations of oral antibiotics were measured at day 1 and 5. Minimal inhibitory concentrations (MICs) were determined for the bacteria causing infective endocarditis (streptococci, staphylococci, or enterococci). Pharmacokinetic/pharmacodynamic targets were predefined according to literature using time above MIC or the ratio of area under the curve to MIC. Population pharmacokinetic modeling and pharmacokinetic/pharmacodynamic analyses were done for amoxicillin, dicloxacillin, linezolid, moxifloxacin, and rifampicin, and PTAs were calculated. Results A total of 236 patients participated in this POET substudy. For amoxicillin and linezolid, the PTAs were 88%–100%. For moxifloxacin and rifampicin, the PTAs were 71%–100%. Using a clinical breakpoint for staphylococci, the PTAs for dicloxacillin were 9%–17%. Seventy-four patients at day 1 and 65 patients at day 5 had available pharmacokinetic and MIC data for 2 oral antibiotics. Of those, 13 patients at day 1 and 14 patients at day 5 did only reach the target for 1 antibiotic. One patient did not reach target for any of the 2 antibiotics. Conclusions For the individual orally administered antibiotic, the majority reached the target level. Patients with sub-target levels were compensated by the administration of 2 different antibiotics. The findings support the efficacy of oral step-down antibiotic treatment in patients with infective endocarditis. [ABSTRACT FROM AUTHOR]

Preoperative bowel preparation, through iterations over time, has evolved with the goal of optimizing surgical outcomes after colon and rectal surgery. Although bowel preparation is commonplace in current practice, its precise mechanism of action, particularly its effect on the human gut microbiome, has yet to be fully elucidated. Absent intervention, the gut microbiota is largely stable, yet reacts to dietary influences, tissue injury, and microbiota-specific byproducts of metabolism. The routine use of oral antibiotics and mechanical bowel preparation prior to intestinal surgical procedures may have detrimental effects previously thought to be negligible. Recent evidence highlights the sensitivity of gut microbiota to antibiotics, bowel preparation, and surgery; however, there is a lack of knowledge regarding specific causal pathways that could lead to therapeutic interventions. As our understanding of the complex interactions between the human host and gut microbiota grows, we can explore the role of bowel preparation in specific microbiome alterations to refine perioperative care and improve outcomes. In this review, we outline the current fund of information regarding the impact of surgical bowel preparation and its components on the adult gut microbiome. We also emphasize key questions pertinent to future microbiome research and their implications for patients undergoing colorectal surgery.

A study published in the Open Forum Infectious Diseases journal compared outcomes in patients with methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSIs) who were discharged on outpatient parenteral antimicrobial therapy (OPAT) using ceftriaxone or traditional antibiotics. The study found no statistically significant difference in readmission rates between the two groups. The study's strengths include its large sample size and balanced representation of different infection types commonly treated with OPAT. However, limitations include the inability to determine how patients are deemed ready for discharge and the lack of information on factors such as blood culture clearance and source control. The study raises questions about the ideal intravenous OPAT option for MSSA BSI and the potential for oral therapy as an alternative to intravenous antibiotics. Further research is needed to address these questions. [Extracted from the article]

Background: Acne vulgaris (AV) is not a deadly condition may affect one’s quality of life. Treatment of AV includes topical and oral, depending on the severity. Antibiotics as oral treatment should not be given alone because it can precipitate resistance. Purpose: To describe the clinical characteristics of AV in a tertiary hospital in Indonesia and evaluate the treatment given. Methods: This is a descriptive, retrospective study with a cross-sectional design. The study subject was classified based on severity according to Plewig and Kligman’s acne grading. Further evaluation was made according to the type of lesion, the risk factortopical and oral treatment in subjects with grades 2, 3, and 4. This research was conducted at the Cosmetic Medic Division, Dermatology and Venereology Outpatient Clinic at Dr. Soetomo General Academic Hospital Surabaya based on medical records from the period of 2017 to 2019. Result: From 2017 to 2019, there were 525 (1.1%) new AV patients out of a total of 45,754 new patients. AV was the major diagnosis in the Cosmetic Medic division. AV grades 2, 3, and 4 were found in 167 patients (32.0%). The most common lesion was papulopustular (75.4%) and the most common risk factor was hormonal (58.7%). All the patients received tretinoin, clindamycin gel 1.2%, and sunscreen for topical treatment. Doxycycline was the most common oral antibiotic used (98.2%) Conclusion: The most common AV grade in this study was mild AV. Oral antibiotics were given to moderate-to-severe AV patients in combination with topical treatment to prevent resistance.

IntroductionThe 2019 American Thoracic Society/Infectious Disease Society of America guidelines recommend respiratory fluoroquinolones to treat community-acquired bacterial pneumonia (CABP) in adults with comorbidities. Fluoroquinolones are effective against both typical and atypical pathogens. However, fluoroquinolone treatment has a risk of adverse effects, and the Food and Drug Administration has issued black box safety warnings for their use. Inpatient use of fluoroquinolones has reduced as a result; however, most antibiotic courses are completed as outpatients and discharge prescriptions account for the majority of fluoroquinolone use. As such, a new treatment option is needed to replace fluoroquinolones. Omadacycline is an aminomethylcycline antibiotic with a broad spectrum of activity and is available as a once-daily intravenous or bioequivalent oral formulation.MethodsThis study assessed the safety and clinical efficacy of omadacycline compared with moxifloxacin for the treatment of adult CABP patients with Pneumonia Severity Index (PSI) risk class II/III and ≥1 comorbidity through a post-hoc analysis of the phase 3 OPTIC study (NCT02531438).ResultsIn total, 239 omadacycline- and 222 moxifloxacin-treated patients were assessed. The median age was similar between groups (omadacycline: 57 years; moxifloxacin: 58 years), with 26.0% and 26.6%, respectively, ≥65 years of age. Early clinical response was 91.6% for patients with ≥1 comorbidity treated with omadacycline and 91.4% for those treated with moxifloxacin. Post-treatment evaluation results for overall response were 89.1% in the omadacycline group and 87.4% in the moxifloxacin group.ConclusionSafety warnings have reduced inpatient use of fluoroquinolones; however, outpatient and discharge prescriptions account for the majority of fluoroquinolone use. Outpatients with comorbidities need an efficacious alternative to fluoroquinolones. Omadacycline maintains the similar efficacy and benefits of fluoroquinolones as a once-daily, monotherapy, bioequivalent oral option with potent in vitro activity against the most common CABP pathogens, including S. pneumoniae and atypical pathogens, but offers a materially different safety profile consistent with its tetracycline heritage. In conclusion, both omadacycline and moxifloxacin exhibited similar efficacy in patients with PSI risk class II/III and comorbidities. Omadacycline fulfills an unmet need as an oral monotherapy treatment option for adult patients with CABP, which will further reduce the use of fluoroquinolones.Clinical trial registrationhttps://www.clinicaltrials.gov/study/NCT02531438, identifer: NCT02531438; https://www.clinicaltrialsregister.eu/ctr-search/search?query=2013-004071-13, identifier: EudraCT #2013-004071-13.

Background: The aim of this retrospective study was to investigate whether oral antibiotics (doxycycline and metronidazole) combined with intrauterine perfusion (gentamicin and dexamethasone) are beneficial for patients with repeated implantation failure (RIF) and chronic endometritis (CE) to improve clinical pregnancy outcomes. Methods: Patients with RIF and CE were diagnosed using hysteroscopy and histology together. A total of 42 patients were enrolled in the study. All patients received oral antibiotics (doxycycline combined with metronidazole) and 22 patients underwent intrauterine perfusion (gentamicin combined with dexamethasone) immediately after the end of oral antibiotic therapy. Pregnancy outcomes were evaluated during the first in vitro fertilization (IVF) and embryo transfer (ET) cycle. Results: For the first D3 ET after treatment with oral antibiotics (doxycycline and metronidazole) combined with intrauterine perfusion (gentamicin and dexamethasone), higher embryo implantation rate (30.95% vs. 26.67%, P = 0.0308), clinical pregnancy rate (30% vs. 50%, P < 0.001), live birth rate (33.33% vs. 45.45%, P < 0.0001). No fetal malformations or ectopic pregnancies were observed. Conclusion: We report oral antibiotics (doxycycline and metronidazole) combined with intrauterine perfusion (gentamicin and dexamethasone) as a novel treatment for CE to improve the outcomes of successful pregnancy compared with those of oral antibiotics alone. [ABSTRACT FROM AUTHOR]

Purpose: Anastomotic leakage after colorectal cancer resection is a feared postoperative complication seen among up till 10–20% of patients, with a higher risk following rectal resection than colon resection. Recent studies suggest that the combined use of preoperative mechanical bowel preparation and oral antibiotics may have a preventive effect on anastomotic leakage. This systematic review aims to explore the association between preoperative mechanical bowel preparation combined with oral antibiotics and the risk of anastomotic leakage following restorative resection for primary rectal cancer. Methods: Three databases were systematically searched in February 2022. Studies reporting anastomotic leakage rate in patients, who received mechanical bowel preparation and oral antibiotics before elective restorative resection for primary rectal cancer, were included. A meta-analysis was conducted based on the risk ratios of anastomotic leakage. Results: Among 839 studies, 5 studies met the eligibility criteria. The median number of patients were 6111 (80-29,739). The combination of preoperative mechanical bowel preparation and oral antibiotics was associated with a decreased risk of anastomotic leakage (risk ratio = 0.52 (95% confidence interval 0.39-0.69), p-value < 0.001). Limitations included a low number of studies, small sample sizes and the studies being rather heterogenous. Conclusion: This systematic review and meta-analysis found that the use of mechanical bowel preparation and oral antibiotics is associated with a decreased risk of anastomotic leakage among patients undergoing restorative resection for primary rectal cancer. The limitations of the review should be taken into consideration when interpreting the results. [ABSTRACT FROM AUTHOR]

Introduction: To date, all meta-analyses on oral antibiotic prophylaxis (OA) and mechanical bowel preparation (MBP) in colorectal surgery have included results of both open and minimally invasive approaches. Mixing both procedures may lead to false conclusions. The aim of the study was to assess the available evidence of mechanical and oral antibiotic bowel preparation in reducing the incidence of surgical site infection (SSI) and other complications following minimally invasive elective colorectal surgery. Methods: We searched PubMed, Science Direct, Google Scholar and Cochrane Library from 2000 to May 1, 2022. Comparative randomized and non-randomized studies were included. We reviewed the use of oral OA, MBP and combinations of these treatments. The methodological quality of the included studies was assessed using the Rob v2 and Robins-I tools. Results: We included 18 studies (7 randomized controlled trials and 11 cohort studies). Meta-analysis of the included studies showed that the combination of MBP + OA was associated with a significant reduction in SSI, AL and overall morbidity compared with the other options no preparation, MBP only and OA only. Conclusion: Adding OA with MBP has a positive impact in reducing the incidence of SSI, AL and overall morbidity after minimally invasive colorectal surgery. Therefore, the combination of OA and MBP should be encouraged in this selected group of patients undergoing minimally invasive surgery. [ABSTRACT FROM AUTHOR]

Recent evidence has suggested a benefit to extended postoperative prophylactic oral antibiotics after two-stage exchange arthroplasty for treatment of periprosthetic joint infections. We sought to determine reinfection rates with and without a short course of oral antibiotics after two-stage exchange procedures. A retrospective review identified patients undergoing two-stage exchange arthroplasty for periprosthetic joint infection of the hip or knee. Patients were excluded if they failed a prior two-stage exchange, had positive cultures at reimplantation, prolonged intravenous antibiotics postoperatively, and/or life-long suppression. This resulted in 444 reimplantations (210 hips and 234 knees). Patients were divided into three cohorts based on the duration of oral antibiotics after reimplantation: no antibiotics (102), ≤2 weeks (266), or >2 weeks (76). The primary endpoint was reinfection within 1 year of reimplantation. Within 1 year of reimplantation, there were 34 reinfections. In the no-antibiotic, ≤ 2-week, and >2-week cohorts the reinfection rates were 14.1, 7.0, and 6.4%, respectively. Multivariate Cox regression showed a reduced reinfection rate in the ≤2-week cohort relative to no antibiotics (hazard ratio [HR]: 0.38, P =.01). While the smaller cohort with >2 weeks of antibiotics did not significantly reduce the reinfection rate (HR: 0.41, P =.12), when combined with the ≤2-week cohort, use of oral antibiotics had an overall reduction of the reinfection rate (HR: 0.39, P =.01). These data support the hypothesis that a short course of oral antibiotics after reimplantation decreases the 1-year reinfection rate. Future randomized studies should seek to examine the efficacy of different durations of oral antibiotics to reduce reinfection. Prognostic Level IV. [ABSTRACT FROM AUTHOR]

Infectious complications following bowel surgery continues to be a leading cause of postoperative morbidity. Both patient- and procedure-related factors contribute to risk. Compliance with evidence-based process measures is the best strategy for prevention of surgical site infections. Three process measures that aim to reduce the bacterial load present at the time of surgery are mechanical bowel preparation, oral antibiotics, and chlorhexidine bathing. There is heightened awareness of surgical site infections, in part due to improved access to reliable postoperative complication data for colon surgery as well as incorporation of surgical site infection into public reporting and pay-for-performance payment models. As a result, the literature has improved with regard to the effectiveness of these methods in reducing infectious complications. Herein, we provide the evidence to support adoption of these practices into colorectal surgery infection prevention programs. [ABSTRACT FROM AUTHOR]

Chlamydia trachomatis is one of the most common sexually infections that cause infertility, and its genital infection induces tubal adhesion and hydrosalpinx. Intravaginal Chlamydia muridarum infection in mice can induce hydrosalpinx in the upper genital tract and it has been used for studying C. trachomatis pathogenicity. DBA2/J strain mice were known to be resistant to the chlamydial induction of hydrosalpinx. In this study, we took advantage of this feature of DBA2/J mice to evaluate the role of antibiotic induced dysbiosis in chlamydial pathogenicity. Antibiotics (vancomycin and gentamicin) were orally administrated to induce dysbiosis in the gut of DBA2/J mice. The mice with or without antibiotic treatment were evaluated for gut and genital dysbiosis and then intravaginally challenged by C. muridarum. Chlamydial burden was tested and genital pathologies were evaluated. We found that oral antibiotics significantly enhanced chlamydial induction of genital hydrosalpinx. And the antibiotic treatment induced severe dysbiosis in the GI tract, including significantly reduced fecal DNA and increased ratios of firmicutes over bacteroidetes. The oral antibiotic did not alter chlamydial infection or microbiota in the mouse genital tracts. Our study showed that the oral antibiotics-enhanced hydrosalpinx correlated with dysbiosis in gut, providing the evidence for associating gut microbiome with chlamydial genital pathogenicity. [ABSTRACT FROM AUTHOR]

(Background) To date, few reports have examined the early switch from intravenous to oral antibiotics in cases of calculous pyelonephritis. Nottingham University reported the COMS criteria for use as a guideline for switching from intravenous to oral antibiotics. In this study, we investigated the usefulness of the COMS criteria in patients with calculous pyelonephritis. (Methods) This was a retrospective study of patients diagnosed with calculous pyelonephritis between 2013 and 2021 at Hiroshima Prefectural Hospital. Patients who switched to oral antibiotics were divided into an Early switch group (patients meeting the COMS criteria within two days) and a Late switch group (patients meeting the COMS criteria on the third day or later). Exclusion criteria were cases with concomitant infections other than calculous pyelonephritis, and cases with concomitant diseases that required long-term intravenous administration of antibiotics as specified in the COMS criteria. Patient backgrounds of the two groups were compared, and the recurrence rate, number of infusion days, and number of hospitalization days were examined retrospectively. (Results) Of a total of 214 patients, 192 were included in the study. There was no significant difference in the recurrence rate between the Early and the Late switch groups [8.9% vs. 2.8%, p=0.171]. The number of infusion days [p < 0.001] and hospitalization days [p < 0.001] were significantly shorter in the Early switch group. (Conclusion) Using COMS criteria in calculous pyelonephritis, there was no significant difference in recurrence rate by the duration of medical treatment, but the duration of infusion and hospitalization was shorter. [ABSTRACT FROM AUTHOR]

Risk of inflammatory bowel disease under isotretinoin is a scope of a long-standing controversy. The burden of isotretinoin-related irritable bowel syndrome has not been investigated. To evaluate the risk of Crohn's disease, ulcerative colitis (UC), and irritable bowel syndrome in patients with acne starting isotretinoin vs oral antibiotics treatment. A global population-based retrospective cohort study assigned 2 groups of patients with acne initiating isotretinoin (n = 77,005) and oral antibiotics (n = 77,005). Comprehensive propensity-score matching was conducted. The lifetime risk of Crohn's disease (hazard ratio [HR], 1.05; 95% CI, 0.89-1.24; P =.583) and UC (HR, 1.13; 95% CI, 0.95-1.34; P =.162) was comparable between study groups, whereas the lifetime risk of irritable bowel syndrome was lower in isotretinoin-prescribed patients (HR, 0.82; 95% CI, 0.76-0.89; P <.001). In time-stratified analysis, isotretinoin-related risk of UC was significantly increased during the first 6 months following drug initiation (HR, 1.93; 95% CI, 1.29-2.88; P =.001), but decreased afterward to level the risk of the comparator group. The absolute risk difference within the first 6 months was clinically marginal (5.0 additional UC cases/10,000 patients starting isotretinoin; 95% CI, 2.5-7.7). Retrospective data collection. Isotretinoin does not confer an elevated risk of Crohn's disease, whilst it might be associated with a slight and transient increase in UC risk. [ABSTRACT FROM AUTHOR]

Abstract Objectives Acute exacerbations of chronic rhinosinusitis (AECRS) are distinct from baseline symptomatology related to chronic rhinosinusitis (CRS). In this review, we seek to examine the literature on AECRS to synthesize the definition, epidemiology, pathophysiology, treatment, and impact of AECRS on CRS patients. Methods A comprehensive narrative review of the scientific literature, identified by searching PubMed from inception through April 2022, was performed. Results AECRS is defined in consensus guidelines as a worsening of chronic sinus disease symptomatology, with a return to baseline, typically after intervention with systemic antibiotics and/or corticosteroids. The working definition used across the literature, however, is broad and heterogeneous. The pathophysiology of AECRS is incompletely understood but is hypothesized to include an interplay of environmental and patient‐specific factors. AECRS have been found to have a negative impact on quality‐of‐life measures, independent of baseline CRS symptomatology, and impact how patients and physicians view overall disease control. Treatment for AECRS includes oral antibiotics and systemic corticosteroids, although their efficacy for AECRS is unclear. Appropriate use of medical and surgical treatment for CRS can reduce the frequency of AECRS. Conclusions AECRS are a distinct entity in CRS patients and should be independently assessed when evaluating patients for CRS control. The efficacy of systemic medication usage for AECRS is currently unclear, but appropriate medical management of baseline CRS can reduce the frequency of AECRS. More research is needed to further understand this phenomenon, including a more precise and prospective definition, defined epidemiology, and how to appropriately treat. Level of Evidence 5

The evidence regarding the role of oral antibiotics alone (oA) or combined with mechanical bowel preparation (MoABP) for elective colorectal surgery remains controversial. A prospective database of 8359 colorectal resections gathered over a 32-month period from 78 Italian surgical units (the iCral 2 and 3 studies), reporting patient-, disease-, and procedure-related variables together with 60-day adverse events, was re-analyzed to identify a subgroup of 1013 cases (12.1%) that received either oA or MoABP. This dataset was analyzed using a 1:1 propensity score-matching model including 20 covariates. Two well-balanced groups of 243 patients each were obtained: group A (oA) and group B (MoABP). The primary endpoints were anastomotic leakage (AL) and surgical site infection (SSI) rates. Group A vs. group B showed a significantly higher AL risk [14 (5.8%) vs. 6 (2.5%) events; OR: 3.77; 95%CI: 1.22–11.67; p = 0.021], while no significant difference was recorded between the two groups regarding SSIs. These results strongly support the use of MoABP for elective colorectal resections.

Isotretinoin-related risk of depression and suicidal behavior is a topic of inconclusiveness. A crucial knowledge gap exists in defining the association of isotretinoin with other psychiatric comorbidities. To evaluate the risk of psychiatric outcomes among patients with acne treated with isotretinoin versus oral antibiotics. A global population-based retrospective cohort study enrolled 2 groups of patients with acne managed by isotretinoin (n = 75,708) and oral antibiotics (n = 75,708). Patients were compared regarding the risk of 9 psychiatric outcomes. Relative to those treated with oral antibiotics, patients prescribed isotretinoin experienced lower risk of depression (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.87-0.93; P <.001), but comparable risk of major depressive disorder (HR, 0.97; 95% CI, 0.92-1.03; P =.318). Risk of suicidal attempts was comparable between groups (HR, 0.97; 95% CI, 0.85-1.11; P =.663), despite the elevated risk of suicidal ideation in those under isotretinoin (HR, 1.41; 95% CI, 1.32-1.50; P <.001). Patients under isotretinoin had lower risk of post-traumatic stress disorder (HR, 0.75; 95% CI, 0.68-0.82; P <.001), anxiety (HR, 0.84; 95% CI, 0.82-0.87; P <.001), bipolar disorder (HR, 0.65; 95% CI, 0.59-0.72; P <.001), schizophrenia (HR, 0.60; 95% CI, 0.48-0.76; P <.001), and adjustment disorder (HR, 0.82; 95% CI, 0.77-0.87; P <.001). Retrospective data collection. Isotretinoin confers lower risk of 6 psychiatric comorbidities and comparable risk of suicidal attempts. [ABSTRACT FROM AUTHOR]