P473 BACTERIAL INFECTIONS IN CIRRHOTIC PATIENTS: RISK FACTORS AND RATE OF FAILURE OF THE EMPIRICAL ANTIBIOTIC THERAPY

Bacterial infections are a major problem in the management of liver cirrhosis. They represent the first precipitating cause of death since patients with cirrhosis carry an increased risk of sepsis, sepsis-induced organ failure and death. Although the clinical presentation is often misleading, the presence of bacterial infection should always be actively searched and ruled out with certainty whenever a cirrhotic patient is admitted to the hospital with an acute clinical deterioration. Major changes in the epidemiology of bacterial infections have also occurred in the last decade making the choice of empirical antibiotic therapy a challenge. We report a paradigmatic case of a 54-year old man with hepatitis C-related cirrhosis admitted to the hospital for worsening of his ascites and onset of hepatic encephalopathy, an excellent example for the difficulties of management of sepsis in cirrhosis and the limits of current knowledge.

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Low prevalence of bloodstream infection and high blood culture contamination rates in patients with COVID-19

PLoS ONE ◽

10.1371/journal.pone.0242533 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242533

Author(s):

David Yu ◽

Karolina Ininbergs ◽

Karolina Hedman ◽

Christian G. Giske ◽

Kristoffer Strålin ◽

...

Keyword(s):

Blood Culture ◽

Antibiotic Therapy ◽

Bacterial Infections ◽

Tertiary Care ◽

Control Group ◽

Contamination Rate ◽

Empirical Antibiotic Therapy ◽

Cohort Study Design ◽

Low Prevalence ◽

Tertiary Care Hospitals

Purpose In the management of COVID-19, knowledge is lacking on the frequency of secondary bacterial infections and on how empirical antibiotic therapy should be used. In the present study, we aimed to compare blood culture (BC) results of a COVID-19 patient cohort with two cohorts of patients without detected COVID-19. Methods Using a retrospective cohort study design of patients subjected to BC in six tertiary care hospitals, SARS-CoV-2 positive patients from March 1 to April 30 in 2020 (COVID-19 group) were compared to patients without confirmed SARS-CoV-2 during the same period (control group-2020) and with patients sampled March 1 to April 30 in 2019 (control group-2019). The outcomes studied were proportion of BC positivity, clinically relevant growth, and contaminant growth. Results In total 15,103 patients and 17,865 BC episodes were studied. Clinically relevant growth was detected in 197/3,027 (6.5%) BC episodes in the COVID-19 group compared to 717/6,663 (10.8%) in control group-2020 (p<0.0001) and 850/8,175 (10.4%) in control group-2019 (p<0.0001). Contamination was present in 255/3,027 (8.4%) BC episodes in the COVID-19 group compared to 330/6,663 (5.0%) in control group-2020 (p<0.0001) and 354/8,175 (4.3%) in control group-2019 (p<0.0001). Conclusion In COVID-19 patients, the prevalence of bloodstream bacterial infection is low and the contamination rate of BC is high. This knowledge should influence guidelines regarding blood culture sampling and empirical antibiotic therapy in COVID-19 patients.

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Fever without a focus in children 0-36 months of age

Medicinski pregled ◽

10.2298/mpns0604187k ◽

2006 ◽

Vol 59 (3-4) ◽

pp. 187-191 ◽

Cited By ~ 2

Author(s):

Svetlana Kuzmanovic ◽

Nevenka Roncevic ◽

Aleksandra Stojadinovic

Keyword(s):

Antibiotic Therapy ◽

Bacterial Infection ◽

Medical Care ◽

Bacterial Infections ◽

Clinical Presentation ◽

Febrile Illness ◽

Empirical Antibiotic Therapy ◽

Focus Of Infection ◽

Serious Bacterial Infections ◽

Yale Observation Scale

Introduction. About 20% of fevers in childhood have no apparent cause. A small, but significant number of these children may have a seroius bacterial infection. Fever without a focus of infection is an acute febrile illness with rectal temperature of 38?C or higher in children younger than 36 months, without localizing signs or symptoms. Practice Guidelines for Medical Care. In this article, practical recommendations for medical care of febrile children 0-36 months of age are given, bearing in mind children's age, clinical presentation (toxic manifestations) and risk for serious bacterial infection (sepsis, meningitis, pneumonia, urinary tract infection...). Toxic appearance is a clinical presentation characterized by lethargy, poor perfusion, marked hypo/hyperventilation and cyanosis. All febrile children under 36 months of age, who are appearing toxic, require hospitalization, evaluation for sepsis and administration of empirical antibiotic therapy. All febrile neonates, however, must be hospitalized: cultures of blood, urine and spinal fluid should be taken and empirical antibiotic therapy administered immediately. Febrile infants, 28 to 90 days of age, need to be evaluated in order to determine whether they are in the low-risk group for serious bacterial infections (Rochester Criteria). Yale Observation Scale is recommended to assess febrile children aged 3-36 months, and the risk of occult bacteriemia. Febrile children, 3-36 months of age who appear well, with temperature of less than 39?C without focus, should be closely followed up without laboratory tests and antibiotics and 2-3 days later reexamined. In febrile children, 3-36 months old, with temperature of 39?C and above, without toxic manifestations, blood culture should be taken and ceftriaxone 50 mg/kg/in a single dose should be given, if leukocyte count is 15000/mm? or absolute neutrophil count is over 10.000/mm? .

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Review Article: Presepsin: New Biomaker to Evaluate Empirical Antibiotic Therapy Outcome in Septic Condition

Folia Medica Indonesiana ◽

10.20473/fmi.v56i2.21236 ◽

2020 ◽

Vol 56 (2) ◽

pp. 148

Author(s):

Aldita Cahyani Puspitasari ◽

Ayu Mawari

Keyword(s):

Clinical Trials ◽

Antibiotic Therapy ◽

Bacterial Infections ◽

Experimental Studies ◽

Research Field ◽

Review Article ◽

Therapy Outcome ◽

Empirical Antibiotic Therapy ◽

New Biomarkers ◽

Septic Condition

This review presents key publications from the research field of new biomarker of sepsis and other relevant journals during 2009-2015. The results of these experimental studies and clinical trials are discussed in the context of biomarker for sepsis and the accuracy of presepsin for optimising antibiotic therapy. The discussion highlights and summarises articles on three main topics: diagnostic and prognostic biomarkers, presepsin as new biomarkers, and outcome studies. According to the review, presepsin is specific biomarker for bacterial infections compare with CRP and PCT. It may be useful to evaluate the empirical antibiotic outcome in sepsis condition.

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Risk factors for multidrug resistant bacteria and optimization of empirical antibiotic therapy in postoperative peritonitis

Critical Care ◽

10.1186/cc8877 ◽

2010 ◽

Vol 14 (1) ◽

pp. R20 ◽

Cited By ~ 58

Author(s):

Pascal Augustin ◽

Nathalie Kermarrec ◽

Claudette Muller-Serieys ◽

Sigismond Lasocki ◽

Denis Chosidow ◽

...

Keyword(s):

Risk Factors ◽

Antibiotic Therapy ◽

Multidrug Resistant ◽

Postoperative Peritonitis ◽

Resistant Bacteria ◽

Empirical Antibiotic Therapy ◽

Multidrug Resistant Bacteria

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Risk Factors for Bacterial Infections in Cirrhotic Patients

The American Journal of Gastroenterology ◽

10.14309/00000434-200509001-00270 ◽

2005 ◽

Vol 100 ◽

pp. S112

Author(s):

Jeong Wook Kim ◽

Jae Hyuk Do ◽

Dae Won Kim ◽

Hyung Joon Kim ◽

Jae Gyu Kim ◽

...

Keyword(s):

Risk Factors ◽

Bacterial Infections ◽

Cirrhotic Patients

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Risk Factors for Mortality in Patients with NosocomialStenotrophomonas maltophiliaPneumonia

Infection Control and Hospital Epidemiology ◽

10.1086/648455 ◽

2009 ◽

Vol 30 (12) ◽

pp. 1193-1202 ◽

Cited By ~ 23

Author(s):

Chia-Cheng Tseng ◽

Wen-Feng Fang ◽

Kuo-Tung Huang ◽

Pei-Wen Chang ◽

Mei-Lien Tu ◽

...

Keyword(s):

Risk Factors ◽

Standard Deviation ◽

Mortality Rate ◽

Antibiotic Therapy ◽

Chang Gung Memorial Hospital ◽

Empirical Antibiotic Therapy ◽

Tertiary Teaching ◽

Potential Risk Factors ◽

Tertiary Teaching Hospital ◽

Southern Taiwan

Objective.The aim of this study was to determine potential risk factors for mortality in patients with nosocomialStenotrophomonas maltophiliapneumonia.Design.A retrospective, single-center, observational study.Setting.A 2400-bed tertiary teaching hospital in southern Taiwan.Patients and Methods.This retrospective study evaluated patients (age, at least 18 years) with nosocomial pneumonia (S. maltophiliaisolated from respiratory culture) who were seen at Kaohsiung Chang Gung Memorial Hospital over a 3-year period. A total of 406 patients (64% male, mean age ± standard deviation, 69.6 ± 14.93 years; mean duration of hospital stay ± standard deviation, 57.5 ± 39.47 days) were included.Results.Most index isolates (53.9%) were from the first sample cultured. Polymicrobial isolates were cultured from samples from 177 (43.6%) of the 406 study patients. The most common copathogen wasPseudomonas aeruginosa(53.11% of isolates). The all-cause hospital mortality rate was 42.6% (173 deaths among 406 patients). Survivors had a shorter time from admission to a positive index culture result than did nonsurvivors (26.1 vs 31.7 days;P= .04). Mortality was significantly higher among patients with malignancy (adjusted odds ratio [AOR], 2.48; 95% confidence interval [CI], 1.52–4.07;P< .001 ), renal disease (AOR, 2.6; 95% CI, 1.51–4.47;P= .001), intensive care unit stay (AOR, 1.72; 95% CI, 1.1–2.7;P= .018), and inadequate initial empirical antibiotic therapy (AOR, 2.17; 95% CI, 1.4–3.38;P= .001).Conclusions.S. maltophiliapneumonia is associated with a high mortality rate and is commonly associated with concomitant polymicrobial colonization or infection. Underlying comorbidities and inadequate initial empirical antibiotic therapy substantially account for increased mortality rates.

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A comparative study of three methods to evaluate an intervention to improve empirical antibiotic therapy for acute bacterial infections in hospitalized patients

Scandinavian Journal of Infectious Diseases ◽

10.3109/00365548.2010.544326 ◽

2010 ◽

Vol 43 (4) ◽

pp. 251-257 ◽

Cited By ~ 6

Author(s):

Thomas Schön ◽

Lisa Labbé Sandelin ◽

Jonas Bonnedahl ◽

Fredrika Hedebäck ◽

Annika Wistedt ◽

...

Keyword(s):

Antibiotic Therapy ◽

Comparative Study ◽

Bacterial Infections ◽

Hospitalized Patients ◽

Empirical Antibiotic Therapy ◽

Acute Bacterial Infections

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Identification of Risk Factors For Mortality and Delayed Oral Dietary Intake In Patients With Open Drainage Due To Deep Neck Infections: A Nationwide Study Using A Japanese Inpatient Database

10.21203/rs.3.rs-94379/v1 ◽

2020 ◽

Author(s):

Hiroshi Hidaka ◽

Kunio Tarasawa ◽

Kenji Fujimori ◽

Taku Obara ◽

Kiyohide Fushimi ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Logistic Regression ◽

Regression Analysis ◽

Antibiotic Therapy ◽

Dietary Intake ◽

Subgroup Analysis ◽

Oral Intake ◽

Empirical Antibiotic Therapy ◽

Inpatient Database

Abstract Backgrounds: Data on risk factors for deep neck infection (DNI) including descending necrotizing mediastinitis (DNM) have been limited. Using a nationwide database, the aim was to identify the factors related to patient death and delay in recovering oral intake.Methods: We retrospective reviewed a Japanese inpatient database between 2012 and 2017, and data of 4,949 patients with DNM and DNI were extracted. The main outcome was survival at discharge. In a subgroup analysis of the 4,791 patients with survival at discharge, the second outcome was delay in the interval between admission and full recovery of oral intake. In both of the setting, logistic regression analyses were conducted to determine the risk factors.Results: Regarding survival at discharge, logistic regression analysis showed that age (≥75 years), comorbid diabetes mellitus, sepsis, receiving mechanical ventilation, and duration of empirical antibiotic therapy were significantly associated with mortality [adjusted-odds ratios (ORs) (95% confidence intervals (CIs)] as follows: 5.57 (2.80-11.1), 2.47 (1.69-3.62), 3.32 (2.29-4.82), 3.96 (2.51-6.23), and 1.00 (1.00-1.02), respectively. In a subgroup analysis of the 4,791 patients with survival at discharge, logistic regression analysis showed the following factors to be significantly associated with delayed oral dietary intake (>9 days), as follows [adjusted OR (95% CIs)]: age ≥75 years 1.89 (1.48-2.41); body mass index (BMI) <18.5 kg/m2 1.39 (1.13-1.71); DNM 1.41 (1.04-1.92); repeated surgical interventions 1.70 (1.16-2.48); tracheotomy 1.70 (1.44-2.00); mechanical ventilation 1.92 (1.53-2.41); intensive care unit (ICU) admission 1.54 (1.22-1.93); rehabilitation for oral dietary intake 2.05 (1.44-2.92); and duration of empirical antibiotic therapy 1.18 (1.17-1.20).Conclusions: In this study, a few factors (advanced age, ventilation) were associated with both mortality and delayed oral dietary intake. Conversely, several factors including DNM and repeated surgery were significantly related only to delayed oral dietary intake. Although DNM was not necessarily related to mortality, patients with DNM should receive postoperative care with careful attention to avoid delayed oral dietary intake.

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