Inpatient Insights
APhA Staff
What is the most effective antibiotic treatment of Pseudomonas aeruginosa bacteremia?
Pseudomonas aeruginosa bloodstream infections remain a major cause of mortality in ICUs, posing many treatment uncertainties. Although several antibiotics have been used to treat these infections, comparative effectiveness is unclear. Members of the Young Investigators Group of the Società Italiana Terapia Antinfettiva in Italy conducted a multicenter, retrospective study using data from 14 Italian hospitals that included all adult patients who developed P. aeruginosa bloodstream infections in the ICU during 2021–2022 and were treated with antibiotics for at least 48 hours.
Of the 170 patients included in the study, 68% of patients had high-risk bloodstream infections (lung, intra-abdominal, CNS) and 32% had septic shock. Definitive backbone treatment was piperacillin/tazobactam for 22% of patients, carbapenems for 43% of patients, colistin for 7%, and new antipseudomonal cephalosporins (ceftolozane/tazobactam, ceftazidime/avibactam, cefiderocol) for 28% of patients. In addition, 34% of patients received a second drug as combination therapy. The study was published online in the Journal of Antimicrobial Chemotherapy on March 15, 2025.
The incidence of 30-day all-cause mortality was 27.6% (47 patients). After inverse probability of treatment weighting adjustment, data showed that only cephalosporins were effective in reducing mortality risk. The researchers concluded that antipseudomonal cephalosporins may be the preferred target therapy for the treatment of P. aeruginosa bloodstream infections. In addition, initial combination therapy may be protective in the case of septic shock. ■
Researchers study benefits of semaglutide for cardiovascular health
Cardiovascular efficacy of the injectable formulation of semaglutide has been established in patients with T2D and CVD or a high risk of CVD, as well as in those with T2D and chronic kidney disease. For the oral formulation of semaglutide, cardiovascular safety has been established in patients with T2D and high cardiovascular risk, but an assessment of cardiovascular efficacy has not been established. Members of the SOUL Study Group assessed the cardiovascular efficacy of oral semaglutide in patients with T2D and atherosclerotic CVD, chronic kidney disease, or both.
In the double-blind, placebo-controlled, event-driven, superiority trial, published online in NEJM on March 29, 2025, participants who were 50 years or older, had T2D with a glycated hemoglobin level of 6.5% to 10.0%, and had known atherosclerotic CVD, chronic kidney disease, or both were randomly assigned to receive either once-daily oral semaglutide (maximum dose, 14 mg) or placebo, in addition to standard care. The primary outcome was major adverse cardiovascular events (a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke), assessed in a time-to-first-event analysis.
Among the more than 9,600 participants, the median follow-up was 49.5 months. A primary-outcome event occurred in 12% of patients in the oral semaglutide group, compared with 13.8% of patients in the placebo group. The results for the confirmatory secondary outcomes did not differ significantly between the two groups. The incidence of serious adverse events was 47.9% in the oral semaglutide group and 50.3% in the placebo group. ■
NSAID prescribing after gastrojejunostomy appears related to marginal ulcer
Marginal ulcer (MU) is a common complication after gastrojejunostomy surgery, developing at the gastrojejunal anastomosis (where the stomach and small intestine are joined). It can cause symptoms like abdominal pain, nausea, and vomiting and, in some cases, complications like bleeding or perforation.
Despite an increased understanding of the risk factors that contribute to the formation of MUs, the role of NSAIDs in the development of MUs remains controversial. A number of studies have found no association between NSAID exposures and MU development, whereas others have reported an association between NSAID use and the rate of MU. Researchers from the Cleveland Clinic aimed to evaluate whether NSAIDs are associated with MU after gastrojejunostomy and describe the current state of NSAID prescribing to patients after gastrojejunostomy.
This retrospective cohort included almost 7,000 adult patients with a history of gastrojejunostomy documented between 2004 and 2023. The electronic medical record was queried for NSAID prescriptions, MU diagnosis, and comorbidities. Multivariable logistic regression was performed to assess the association between MU and NSAID exposures, controlling for smoking, Helicobacter pylori history, acid-suppressing therapy, diabetes, age, and sex. The study was published in the March 2025 issue of Surgery.
During the study period, 45.2% of patients were exposed to an NSAID and 10.12% developed a MU. The risk of MU was found to be dose-dependent, with increasing odds of MU with an increasing number of NSAID exposures from a 1.67 odds ratio with one to two NSAID exposures to a 2.42 odds ratio with >8 NSAID exposures. Acid-suppressing therapy was found to be protective.
The authors indicated that over the last decade, the number of NSAIDs prescribed to patients with gastrojejunostomy has significantly increased from 15.87 to 531.02 prescriptions per 1,000 patients per year. They suggested that quality improvement efforts should focus on decreasing NSAID prescriptions in this population. ■
Antibiotics could be safe alternative to surgery for adults with acute appendicitis
Recent randomized controlled trials have shown antibiotics to be a safe alternative to appendicectomy in adults with imaging-confirmed acute appendicitis. However, patient inclusion criteria and outcome definitions vary greatly between trials. A global group of researchers aimed to compare antibiotics with appendicectomy for the treatment of acute appendicitis using individual patient data and uniform outcome definitions from PubMed, Embase, and the Cochrane Central Register of Controlled Trials between database inception and June 6, 2023. Randomized clinical trials comparing appendicectomy with antibiotics for the treatment of adults with imaging-confirmed acute appendicitis and with at least 1-year follow-up data on complications were included.
Of 887 potentially relevant articles, eight were eligible for inclusion, of which six trials could provide data for 2,101 eligible patients (1,050 assigned to antibiotics and 1,051 assigned to appendicectomy). All studies raised some bias concerns due to absence of blinding. At 1 year, 5.4% of patients randomly assigned to antibiotics had a complication compared with 8.3% of patients randomly assigned to appendicectomy. At 1 year, 97.5% of patients in the appendicectomy group had undergone appendicectomy compared with 33.9% of patients in the antibiotics group.
Results of the study, published in the March 2025 issue of The Lancet Gastroenterology & Hepatology, showed that antibiotic treatment in adults with imaging-confirmed acute appendicitis was a safe alternative to surgery and resulted in around two-thirds of patients avoiding appendicectomy during the first year. The researchers concluded that these data should be key components in shared decision making. ■