The edition · Infectious Diseases
Adding chlorhexidine to ICU oral care did not prevent ventilator pneumonia in an Indian trial
A cluster-randomised crossover trial in six medical ICUs in Bhubaneswar found no benefit and slightly longer stays. Also: daptomycin dosing for enterococci, a community stewardship trial, and a linezolid label action.
The edition in brief
A pragmatic cluster-randomised crossover trial in six medical ICUs at one Indian hospital (1,035 ventilated adults) found that adding 0.12% chlorhexidine to a standardised oral-care bundle did not lower ventilator-associated pneumonia (IRR 1.08, CI 0.84–1.38) or 28-day mortality, and ICU stay was about 0.9 days longer. A Lancet Infectious Diseases review argues daptomycin for enterococcal bacteraemia and endocarditis is often underdosed, proposing at least 8 mg/kg daily for E faecium, 10–12 mg/kg for vancomycin-resistant disease, beta-lactam combination in endocarditis and weekly CK monitoring. A cluster-randomised trial in Burkina Faso and DR Congo found a community and provider education bundle based on WHO AWaRe cut Watch-group antibiotic use (adjusted prevalence ratio 0.33). The FDA recorded a supplemental action on the linezolid (Zyvox) application; the record does not specify the change. The pearl covers linezolid monitoring.
Daptomycin for enterococcal bacteraemia: the case for higher doses
For serious E faecium infection, consider daptomycin at 8 mg/kg daily or more, with weekly CK monitoring.
FDA records a supplement to the linezolid (Zyvox) application
No action is needed on linezolid prescribing until the revised label is published.
A community stewardship bundle cut Watch-group antibiotic use by two thirds
Stewardship that reaches pharmacies and informal providers, as well as clinicians, can substantially cut broad-spectrum antibiotic use.
What to watch on linezolid
On linezolid, check blood counts weekly and review serotonergic drugs before the first dose.
Chlorhexidine added nothing to a good ICU oral-care bundle
In medical ICUs, consider removing routine chlorhexidine from oral care and keeping the rest of the bundle.
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