An AI-based auxiliary empirical antibiotic therapy model for children with bacterial pneumonia using low-dose chest CT images

Abstract Purpose To construct an auxiliary empirical antibiotic therapy (EAT) multi-class classification model for children with bacterial pneumonia using radiomics features based on artificial intelligence and low-dose chest CT images. Materials and methods Data were retrospectively collected from children with pathogen-confirmed bacterial pneumonia including Gram-positive bacterial pneumonia (122/389, 31%), Gram-negative bacterial pneumonia (159/389, 41%) and atypical bacterial pneumonia (108/389, 28%) from January 1 to June 30, 2019. Nine machine-learning models were separately evaluated based on radiomics features extracted from CT images; three optimal submodels were constructed and integrated to form a multi-class classification model. Results We selected five features to develop three radiomics submodels: a Gram-positive model, a Gram-negative model and an atypical model. The comprehensive radiomics model using support vector machine method yielded an average area under the curve (AUC) of 0.75 [95% confidence interval (CI), 0.65–0.83] and accuracy (ACC) of 0.58 [sensitivity (SEN), 0.57; specificity (SPE), 0.78] in the training set, and an average AUC of 0.73 (95% CI 0.61–0.79) and ACC of 0.54 (SEN, 0.52; SPE, 0.75) in the test set. Conclusion This auxiliary EAT radiomics multi-class classification model was deserved to be researched in differential diagnosing bacterial pneumonias in children.

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Culturing Periprosthetic Tissues in BacT/Alert® Virtuo Blood Culture Bottles for a Short Duration of Post-operative Empirical Antibiotic Therapy

Journal of Bone and Joint Infection ◽

10.7150/jbji.44621 ◽

2020 ◽

Vol 5 (3) ◽

pp. 145-150

Author(s):

Claire Duployez ◽

Frédéric Wallet ◽

Henri Migaud ◽

Eric Senneville ◽

Caroline Loiez

Keyword(s):

Blood Culture ◽

Antibiotic Therapy ◽

Joint Infection ◽

Length Of Hospital Stay ◽

Empirical Antibiotic Therapy ◽

Gram Positive ◽

Gram Negative ◽

Surgical Interventions ◽

Joint Infections ◽

Gram Positive Cocci

Abstract. Introduction: A post-operative empirical antibiotic therapy (PEAT) is required in periprosthetic joint infections. It commonly uses broad-spectrum antibiotics to cover most Gram-positive cocci and Gram-negative bacilli. It is currently continued until first microbiological results are available, no less than five days later.Methods: We performed a retrospective study in order to evaluate duration of incubation required for surgical samples using the BacT/Alert® Virtuo blood culture bottles system.Results: Among 216 surgical interventions and 199 clinical strains (53.8% staphylococci, 22,1% streptococci and enterococci, 14,6% Gram-negative bacilli, 5,5% anaerobes), 90.5% of the strains were detected between day 0 and day 2; 15 infective strains are cultured from day 3 including 8 Cutibacterium sp., 4 staphylococci, 2 streptococci and 1 Enterococcus.Conclusions: We suggest that the duration of PEAT in patients operated for a periprosthetic joint infection may be shortened to three days as Gram-negative rods are unlikely to grow after three days of culture by using BacT/Alert® Virtuo blood culture bottles. This is likely to shorten the overall length of hospital stay, to diminish the occurrence of adverse side effects, and the emergence of antimicrobial resistance. However, coverage of Gram-positive cocci should be maintained for 14 days until the definite culture results are available.

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Differential effects of inappropriate empirical antibiotic therapy in adults with community-onset gram-positive and gram-negative aerobe bacteremia

Journal of Infection and Chemotherapy ◽

10.1016/j.jiac.2019.08.021 ◽

2020 ◽

Vol 26 (2) ◽

pp. 222-229

Author(s):

Chao-Yung Yang ◽

Chung-Hsun Lee ◽

Chih-Chia Hsieh ◽

Ming-Yuan Hong ◽

Mei-Ju Chen ◽

...

Keyword(s):

Antibiotic Therapy ◽

Empirical Antibiotic Therapy ◽

Gram Positive ◽

Gram Negative ◽

Differential Effects ◽

Community Onset

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Colonization by Antibiotic-Resistant Gram-Negative Bacteria and Appropriate Empirical Antibiotic Therapy in Intensive Care Unit Patients

Infection Control and Hospital Epidemiology ◽

10.1086/500284 ◽

2006 ◽

Vol 27 (1) ◽

pp. 104-104 ◽

Cited By ~ 1

Author(s):

Fernando Bellíssimo-Rodrigues ◽

José Fernando de Castro Figueiredo ◽

Roberto Martinez

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antibiotic Therapy ◽

Gram Negative Bacteria ◽

Empirical Antibiotic Therapy ◽

Antibiotic Resistant ◽

Gram Negative

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Segmentation of the whole breast from low-dose chest CT images

10.1117/12.2082410 ◽

2015 ◽

Cited By ~ 3

Author(s):

Shuang Liu ◽

Mary Salvatore ◽

David F. Yankelevitz ◽

Claudia I. Henschke ◽

Anthony P. Reeves

Keyword(s):

Low Dose ◽

Ct Images ◽

Chest Ct

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194. Description of Positive Blood Culture Results not Identified by Verigene Informs Empiric Antibiotic Selection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.269 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S116-S117

Author(s):

Connor Deri ◽

Whitney Nesbitt ◽

George Nelson ◽

Jessica Keefe

Keyword(s):

Antibiotic Therapy ◽

Resistance Mechanism ◽

Bloodstream Infections ◽

Blood Cultures ◽

Aerobic Bacteria ◽

Gram Positive ◽

Antibiotic Selection ◽

Gram Negative ◽

Empiric Antibiotic ◽

Gram Negative Organisms

Abstract Background Bloodstream infections are a leading cause of mortality amongst hospitalized patients. Optimizing time to pathogen identification and receipt of appropriate antibiotic therapy significantly decreases mortality, morbidity, and length of hospitalization. Rapid diagnostic tests, such as Verigene, assist in the early identification of bacteria and resistance determinants from positive blood cultures; however, Verigene assays are limited to the detection of 13 gram-positive and 9 gram-negative bacteria. Methods The purpose of this study was to describe gram-negative and gram-positive aerobic bacteria identified from positive blood cultures with no Verigene target detected and to use the susceptibilities to create an antibiogram to assist in empiric antibiotic selection. A total of 2325 positive blood cultures resulted between January 2017 and October 2018 underwent Verigene testing. Results Of the 2325 isolates, 383 (16.5%), had no Verigene organism or resistance mechanism detected. Of these, there were 239 (62.4%) gram-positive isolates, 141 (36.8%) gram-negative isolates, and 3 yeast isolates with 96 unique organisms. Seventy-six (19.8%) of the organisms identified by standard culture, but not Verigene testing, are included on Verigene panel. We analyzed nine common antibiotics active against gram-negative organisms to determine percent susceptibilities against the isolated aerobic pathogens: amikacin (92.1%), cefepime (93.5%), ceftazidime (94.0%), ceftriaxone (79.7%), ciprofloxacin (88.5%), gentamicin (91.9%), levofloxacin (86.9%), piperacillin–tazobactam (83.8%), and tobramycin (85.5%). Additionally, four antibiotics active against gram-positive organisms were analyzed for gram-positive susceptibilities: cefotaxime (91.8%), ceftriaxone (98.1%), levofloxacin (82.5%), and vancomycin (91.8%). Conclusion The results of this study provide clinicians with antibiotic susceptibilities against organisms that were not identified through Verigene to better guide timely and appropriate antibiotic therapy against gram-negative and gram-positive aerobic bacteria. Disclosures All authors: No reported disclosures.

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Empirical antibiotic therapy of complicated skin and soft tissue infections in dermatological practice

Orvosi Hetilap ◽

10.1556/oh.2011.28968 ◽

2011 ◽

Vol 152 (7) ◽

pp. 252-258

Author(s):

Andrea Magyar ◽

Edina Garaczi ◽

Edit Hajdú ◽

Lajos Kemény

Keyword(s):

Soft Tissue ◽

Antibiotic Therapy ◽

Streptococcus Pyogenes ◽

Anaerobic Bacteria ◽

Empirical Therapy ◽

Soft Tissue Infections ◽

Empirical Antibiotic Therapy ◽

Gram Negative ◽

First Choice ◽

Complicated Skin

Erysipelas is an acute bacterial infection of the skin predominantly caused by Streptococcus pyogenes. According to the international classification complicated erysipelas belongs to the complicated skin and soft tissue infections. Complicated infections are defined as severe skin involvement or when the infection occurs in compromised hosts. These infections frequently involve Gram-negative bacilli and anaerobic bacteria. Aims: The aim of this study was to compare the efficacy of the empirical antibiotic therapy for the patients who were admitted to the Department of Dermatology and Allergology, University of Szeged. Methods: The empirical therapy was started according to a previously determined protocol. The data of 158 patients with complicated skin and soft tissue infections were analyzed and the microbiology culture specimens and the isolates were also examined. Results and conclusions: The results show that penicillin is the first choice for the treatment of erysipelas. However, the complicated skin and soft tissue infections require broad-spectrum antibiotics. Orv. Hetil., 2011, 152, 252–258.

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Vancomycin and Ciprofloxacin: Systemic Antibiotic Administration for Peritoneal Dialysis-Associated Peritonitis

Peritoneal Dialysis International ◽

10.1177/089686080402400507 ◽

2004 ◽

Vol 24 (5) ◽

pp. 433-439 ◽

Cited By ~ 25

Author(s):

Eric Goffin ◽

Laurence Herbiet ◽

Dominique Pouthier ◽

Jean-Michel Pochet ◽

Jean-Jacques Lafontaine ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Antibiotic Therapy ◽

First Generation ◽

Close Monitoring ◽

First Line ◽

Coagulase Negative Staphylococci ◽

Gram Positive ◽

Gram Negative ◽

Oral Ciprofloxacin ◽

Susceptibility Rate

Objectives Peritonitis due to peritoneal dialysis (PD) is best treated empirically while waiting for the results of the dialysate culture. Thus, antibiotic therapy must cover both gram-positive and gram-negative micro-organisms. First, over a period of 9 years in a multicenter study we evaluated the efficiency of a vancomycin and ciprofloxacin combination given as the first-line treatment protocol for PD peritonitis. Second, we evaluated whether a systemic route of administration of the antibiotics could be an interesting alternative to the usual cumbersome intraperitoneal drug administration. Methods Vancomycin 15 mg/kg body weight, intravenous, and oral ciprofloxacin 250 mg two times per day (500 mg twice per day if residual creatinine clearance was above 3 mL/minute) were prescribed at diagnosis of peritonitis. Vancomycin injections were repeated (when blood trough level was expected to be below 12 μg/mL) in cases of gram-positive organisms for a total duration of 3 weeks. Ciprofloxacin was given for a total of 3 weeks in cases of gram-negative and a total of 10 days for susceptible gram-positive infections. Results A total of 129 episodes of peritonitis occurred; 28 of them were not included in the study because of protocol violation ( n = 15) or fungal ( n = 7) or fecal ( n = 6) peritonitis, leaving 101 peritonitis episodes for analysis. 52 (51.5%) gram-positive and 28 (27.7%) gram-negative organisms were grown; 38 gram-positive organisms were coagulase-negative staphylococci. No organism was identified in 8 peritonitis episodes, whereas 13 peritonitis episodes were caused by more than 1 organism. 35% of the coagulase-negative staphylococci were resistant to first-generation cephalosporin and methicillin, whereas all were susceptible to vancomycin. For gram-negative bacilli, the susceptibility rate was 96% and 95% for ciprofloxacin and ceftazidime respectively. The overall treatment success rate was 77.2% (78 of the 101 peritonitis episodes): 61.4% at first intention and 15.8% after optimization of the antibiotic therapy (second intention). The protocol failed in 22.8% of the peritonitis episodes. Hospitalization was required in 52% of the peritonitis episodes; average hospitalization was 11 (range 1 – 45) days. Conclusion Systemic vancomycin and ciprofloxacin administration is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis. In our opinion, vancomycin should still be used for gram-positive infections because of its high susceptibility rate compared with first-generation cephalosporins, providing a close monitoring of the local epidemiology. Oral ciprofloxacin provides satisfactory results in gram-negative infections, comparable to those obtained with intraperitoneal ceftazidime or aminoglycosides.

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Inflammatory markers in hospitalized patients with bacterial pneumonia: comparison of Gram-positive versus Gram-negative etiology and admission versus discharge findings

Archives of Medical Science ◽

10.5114/aoms.2020.95051 ◽

2020 ◽

Author(s):

Hatice Turker ◽

Armagan Hazar ◽

Birsen Ocakli

Keyword(s):

Inflammatory Markers ◽

Bacterial Pneumonia ◽

Hospitalized Patients ◽

Gram Positive ◽

Gram Negative

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The relationship between clinical outcomes and empirical antibiotic therapy in patients with community-onset Gram-negative bloodstream infections: a cohort study from a large teaching hospital

Epidemiology and Infection ◽

10.1017/s0950268820002083 ◽

2020 ◽

Vol 148 ◽

Author(s):

A. Aryee ◽

P. Rockenschaub ◽

M. J. Gill ◽

A. Hayward ◽

L. Shallcross

Keyword(s):

Cohort Study ◽

Antibiotic Therapy ◽

Clinical Outcomes ◽

Teaching Hospital ◽

Severe Illness ◽

Hospital Death ◽

Empirical Antibiotic Therapy ◽

Gram Negative ◽

The Relationship ◽

Community Onset

Abstract Antibiotic-resistant Gram-negative bacteraemias (GNB) are increasing in incidence. We aimed to investigate the impact of empirical antibiotic therapy on clinical outcomes by carrying out an observational 6-year cohort study of patients at a teaching hospital with community-onset Escherichia coli bacteraemia (ECB), Klebsiella pneumoniae bacteraemia (KPB) and Pseudomonas aeruginosa bacteraemia (PsAB). Antibiotic therapy was considered concordant if the organism was sensitive in vitro and discordant if resistant. We estimated the association between concordant vs. discordant empirical antibiotic therapy on odds of in-hospital death and ICU admission for KPB and ECB. Of 1380 patients, 1103 (79.9%) had ECB, 189 (13.7%) KPB and 88 (6.4%) PsAB. Discordant therapy was not associated with increased odds of either outcome. For ECB, severe illness and non-urinary source were associated with increased odds of both outcomes (OR of in-hospital death for non-urinary source 3.21, 95% CI 1.73–5.97). For KPB, discordant therapy was associated with in-hospital death on univariable but not multivariable analysis. Illness severity was associated with increased odds of both outcomes. These findings suggest broadening of therapy for low-risk patients with community-onset GNB is not warranted. Future research should focus on the relationship between patient outcomes, clinical factors, infection focus and causative organism and resistance profile.

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