Omadacycline in first-line combination therapy for pulmonary Mycobacterium abscessus infection: a case series.

Mycobacterium abscessus complex (MABSC) represents the second most common cause of nontuberculous mycobacterial pulmonary disease, associated with up to 17% of cases. Treatment of MABSC disease is complex, lengthy, and involves multidrug regimens due to high rates of intrinsic antimicrobial resistance; cure rates remain poor. There are currently no approved treatments for MABSC, and only limited data are available to guide treatment decisions for individual patients. Omadacycline, a tetracycline class-derived aminomethylcycline that is not approved for treatment of nontuberculous mycobacterial pulmonary infections, has been granted orphan drug designation by the US Food and Drug Administration. Here, we describe three cases using omadacycline as part of a first-line treatment regimen for patients with MABSC pulmonary infections, based on multiple factors, including resistance profile, toxicity, minimizing use of intravenous therapy, and expert recommendation. The clinical improvements of these patients, together with promising in vitro and early clinical development data, indicate that omadacycline warrants further investigation as a potential first-line option for incorporating into MABSC pulmonary disease treatment regimens.

In-hospital outcomes and prevalence of comorbidities in patients with ST-elevation myocardial infarction with and without infective endocarditis: insight from the National Inpatient Sample (2013-2014).

In patients with infective endocarditis (IE), ST-elevation myocardial infarction (STEMI) is an uncommon phenomenon. Due to limited data, we intend to evaluate the clinical outcomes in hospitalized patients with STEMI with and without underlying IE. Mortality and morbidity are exponentially worse in STEMI with concomitant IE when compared with without IE. Patients with primary diagnosis of STEMI with and without IE were identified by querying the Healthcare Cost and Utilization Project database of the National Inpatient Sample for the years 2013 and 2014 based on International Classification of Diseases, Ninth Revision codes. During 2013 and 2014, a total of 117,386 patients were admitted with the principle diagnosis of STEMI, out of whom 305 had comorbid IE. There was a significantly increased in-hospital mortality (27.5% vs 10.8%), length of stay (LOS) (14 days vs 5 days), acute kidney injury (AKI; 44.9% vs 18.7%), stroke (23.6% vs 3%), aortic valve replacement (9.5% vs 0.3%), mitral valve replacement (0.2%-5.2%), sepsis (50% vs 6%) and acute respiratory failure (36.7% vs 16.7%) in patients with STEMI with IE when compared with patients with STEMI and without comorbid IE. STEMI without IE had a higher number of angiographies (58.7% vs 25.9%) and percutaneous coronary interventions (50.7% vs 14.4%) during the hospital course when compared with STEMI with IE. In conclusions, hospitalized patients with STEMI with a concurrent diagnosis of IE are at higher risk of in-hospital mortality, increased LOS, AKI, stroke, valve replacements, and acute respiratory failure.