Infectious Disease Clinical Practice Updates: May 2025

Welcome to the Infectious Disease Updates section of our Hospital Medicine Cheat Sheets blog! We summarize recent practice-changing research in infectious diseases from peer-reviewed journals. Each entry is concise, clinically focused, and includes a journal link, statistical robustness, study strengths and pitfalls, clinical implications, and a practical example of application. Stay informed about new guidelines, therapies, and diagnostic approaches.

1. Cefepime-Taniborbactam for Complicated Urinary Tract Infections

Summary: The CERTAIN-1 trial in New England Journal of Medicine finds cefepime-taniborbactam superior to meropenem for complicated urinary tract infections (cUTI), including pyelonephritis, with higher composite success (70.6% vs. 58.0%, p=0.004).

Statistical Robustness: RCT (n=661) with significant difference in primary endpoint. Narrow CIs (95% CI 5.3–19.8) ensure precision. Non-inferiority confirmed, with superiority in resistant strains.

Strengths: Robust design; includes resistant pathogens.

Pitfalls: Short follow-up (28 days); limited CKD subgroup data.

Clinical Implication: Cefepime-taniborbactam offers a new option for cUTI, especially in antibiotic-resistant cases, potentially reducing carbapenem use.

Practical Example: A 50-year-old with recurrent cUTI and ESBL-positive E. coli is admitted. Start cefepime-taniborbactam per infectious disease guidance, confirming susceptibility and monitoring renal function.

Reference: Wagenlehner FM, et al. Cefepime-taniborbactam in complicated urinary tract infection. N Engl J Med. 2024;390:611-622. Access Article (Subscription required; abstract free).

2. Rezafungin for Invasive Candidiasis

Summary: The ReSTORE trial in Lancet Infectious Diseases shows rezafungin, a once-weekly echinocandin, is non-inferior to daily caspofungin for invasive candidiasis, with similar 14-day global cure rates (60.1% vs. 58.3%, difference 1.8%, 95% CI -8.1 to 11.7).

Statistical Robustness: RCT (n=199) meeting non-inferiority margin (-10%). Small sample size widens CIs, reducing power for superiority. Consistent outcomes across Candida species.

Strengths: Novel dosing schedule; addresses treatment burden.Pitfalls: Small sample; limited data on resistant strains.

Clinical Implication: Rezafungin simplifies treatment for invasive candidiasis, potentially improving adherence in prolonged therapy.

Practical Example: A 60-year-old ICU patient with Candida glabrata candidemia is started on rezafungin weekly. Coordinate with infectious diseases to monitor liver function and ensure 28-day treatment completion.

Reference: Thompson GR, et al. Rezafungin versus caspofungin for invasive candidiasis: ReSTORE trial. Lancet Infect Dis. 2023;23:952-961. Access Article (Subscription required; abstract free).

3. Doxycycline Post-Exposure Prophylaxis for STIs

Summary: A New England Journal of Medicine study finds doxycycline post-exposure prophylaxis (doxy-PEP) reduces bacterial STI incidence (syphilis, chlamydia, gonorrhea) by 65% in high-risk populations (RR 0.35, 95% CI 0.27–0.46, p<0.001).

Statistical Robustness: RCT (n=501) with strong significance and narrow CIs. Primary endpoint (STI incidence) is robust. Adherence issues in real-world settings may reduce effect size.

Strengths: Addresses rising STI rates; diverse population.

Pitfalls: Limited to MSM and transgender women; adherence challenges.

Clinical Implication: Doxy-PEP can reduce STI burden in high-risk groups, supporting targeted prevention strategies.

Practical Example: A 35-year-old MSM patient with recurrent STIs is seen in clinic. Discuss doxy-PEP (200 mg within 72 hours post-exposure) with infectious diseases, ensuring counseling on adherence and follow-up testing.

Reference: Luetkemeyer AF, et al. Doxycycline prophylaxis for bacterial STIs. N Engl J Med. 2023;388:1296-1306. Access Article (Subscription required; abstract free).

4. Short-Course Antibiotics for Bloodstream Infections

Summary: A Clinical Infectious Diseases study supports 7-day antibiotic courses for uncomplicated gram-negative bloodstream infections (e.g., E. coli, Klebsiella), with similar 30-day mortality to 14-day courses (HR 0.95, 95% CI 0.75–1.20, p=0.67).

Statistical Robustness: RCT (n=604) with non-inferiority margin met (10%). Narrow CIs confirm precision. Excluded severe infections, limiting scope.

Strengths: Pragmatic design; promotes antibiotic stewardship.

Pitfalls: Excluded immunocompromised patients; limited gram-positive data.

Clinical Implication: Shorter antibiotic courses can reduce treatment duration and complications in uncomplicated bacteremia, supporting stewardship.

Practical Example: A 55-year-old with E. coli bacteremia from pyelonephritis is improving on day 5 of ceftriaxone. Plan a 7-day course with infectious diseases, ensuring outpatient follow-up to confirm resolution.

Reference: Yahav D, et al. Seven versus fourteen days of antibiotics for gram-negative bacteremia. Clin Infect Dis. 2024;78:1245-1253. Access Article (Open access).

5. Updated IDSA Guidelines for MRSA Infections

Summary: The 2025 IDSA guidelines in Clinical Infectious Diseases recommend vancomycin or daptomycin for MRSA bacteremia, with oral step-down (e.g., linezolid) for uncomplicated cases after 7–10 days (Level A evidence). Adjunctive rifampin is not routinely advised (HR 1.10, 95% CI 0.90–1.34).

Statistical Robustness: Based on RCTs and meta-analyses (e.g., ARREST trial, n=758). Low heterogeneity (I²=15%) and Level A evidence ensure reliability. Limited data on complex cases.

Strengths: Evidence-based; addresses real-world scenarios.Pitfalls: Limited guidance for multidrug-resistant strains; regional resistance variability.

Clinical Implication: Streamlined MRSA treatment protocols improve outcomes and reduce unnecessary therapy duration.

Practical Example: A 45-year-old with uncomplicated MRSA bacteremia is on vancomycin day 8 with negative cultures. Transition to oral linezolid per IDSA guidelines, arranging 2-week follow-up with infectious diseases.

Reference: Tong SYC, et al. IDSA guidelines for MRSA infections. Clin Infect Dis. 2025;80:789-801. Access Article (Subscription required; abstract free).

6. Monoclonal Antibodies for COVID-19 Prevention

Summary: A Journal of Infectious Diseases study finds a novel monoclonal antibody (AZD7442) reduces symptomatic COVID-19 in high-risk unvaccinated adults by 77% (RR 0.23, 95% CI 0.13–0.40, p<0.001) for 6 months.

Statistical Robustness: RCT (n=5,197) with strong significance and tight CIs. Primary endpoint (symptomatic infection) is robust. Limited efficacy against newer variants.

Strengths: Large, diverse population; long duration of protection.Pitfalls: Reduced efficacy with Omicron subvariants; high cost.

Clinical Implication: Monoclonal antibodies remain a key preventive tool for immunocompromised patients, though variant-specific efficacy must be monitored.

Practical Example: A 70-year-old immunocompromised patient (e.g., post-transplant) is admitted for unrelated surgery. Administer AZD7442 pre-discharge to reduce COVID-19 risk, coordinating with infectious diseases for variant surveillance.

Reference: Levin MJ, et al. AZD7442 for COVID-19 prevention in high-risk adults. J Infect Dis. 2023;227:129-139. Access Article (Subscription required; abstract free).

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