Bugs & Guts: Carbapenem-Sparing Agents in Resistant Infections and Omeprazole in Coronary Artery Disease
Kieran Quinn is joined by Kevin Venus, fellow in General Internal Medicine at the University of Toronto, on this week’s episode of The Rounds Table. Together they cover the use of a carbapenem versus a carbapenem-sparing agent in resistant bacteremias and the efficacy of proton-pump inhibitors (PPIs) in preventing gastrointestinal bleeding when using anti-thrombotic therapy in coronary artery disease.
Antibiotic resistance is becoming a major health care issue, and one of the ways this occurs is via extended-spectrum beta-lactamases. As such, significant infections are usually treated with carbapenems. Kevin shares with listeners the MERINO trial in which researchers evaluated Escherichia coli and Klebsiella pneumoniae bacteremia with ceftriaxone resistance. The outcomes in terms of 30-day mortality were compared when treating with meropenem versus a carbapenem-sparing agent, piperacillin-tazobactam.
PPIs and anti-platelet therapy often go hand-in-hand. Kieran covers the COGENT trial which evaluated the use of a PPI, omeprazole, and dual anti-platelet therapy for coronary artery disease and the efficacy of the PPI in preventing gastrointestinal bleeding. Recently, concerns have been raised that there is potential for PPIs to blunt the efficacy of clopidogrel. The trial also assessed the safety of PPIs in the context of co-administration of clopidogrel.
Finally, the Good Stuff segment. Kevin details a short communication on a group of United States government personnel that returned from Cuba with various neurological symptoms after a specific auditory and sensory exposure of unknown etiology. Kieran discusses the phrase “well, I wouldn’t want to be a vegetable” and how this relates to post-resuscitation preferences for care.
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2. The Vegetable Clause: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2697393
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