Empiric Antibiotic Choice Overshadows Blood Cultures In Averting Pneumonia Deaths

BACKGROUND: Early empiric antibiotic exposure appears to negatively influence feeding tolerance in preterm infants. However, the effect of prolonged antibiotic treatment is unknown. The objective of this study was to investigate whether prolonged antibiotics impact the time to full enteral feed in infants less than 29 weeks of gestational age with negative blood cultures. METHODS: Retrospective data for infants less than 29 weeks gestation age were retrieved from the PEARL-Peristat perinatal registry in Qatar. Exclusion criteria were major congenital anomalies, conditions requiring surgery in the first 10 days of life, positive blood cultures in the first 48 hours of life, and death within the first week of life. Antibiotic courses were categorized as prolonged if continued more than 48 hours. The primary outcome was the duration of total parenteral nutrition. RESULTS: Of 199 study infants, 185 (92.9%) underwent antibiotic treatment for > 48 hours despite negative blood cultures. The median duration of parenteral nutrition was not significantly different between the prolonged and short antibiotic groups (25 and 22 days, respectively; p = 0.139). Infants with prolonged antibiotic courses experienced non-significantly higher levels of necrotizing enterocolitis (7.1% and 18.4%, respectively), bronchopulmonary dysplasia (28.6% and 45.4%, respectively), and retinopathy of prematurity (14.3% and 38.4%, respectively). There were no differences in the late-onset sepsis rate (78.6% and 82.1%, respectively) and the in-hospital death rate (7.1% and 7.6%, respectively). CONCLUSIONS: Prolonged antibiotic treatment in infants less than 29 weeks gestation with negative blood cultures has no significant impact on the time to full enteral feed.

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Successful Clearance of Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia with Daptomycin, Linezolid, and Meropenem Salvage Therapy

Case Reports in Infectious Diseases ◽

10.1155/2019/5623978 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Grant Shaddix ◽

Kalindi Patel ◽

Matthew Simmons ◽

Kelsie Burner

Keyword(s):

Staphylococcus Aureus ◽

Antibiotic Therapy ◽

Salvage Therapy ◽

Blood Cultures ◽

Empiric Antibiotic Therapy ◽

White Female ◽

Salvage Regimen ◽

Methicillin Resistant ◽

Staphylococcus Aureus Bacteremia ◽

Empiric Antibiotic

Staphylococcus aureus is one of the most virulent Gram-positive organisms responsible for a multitude of infections, including bacteremia. Methicillin-resistant Staphylococcus aureus (MRSA) is of special concern in patients with bacteremia. Due to its associated poor clinical outcomes, morbidity, and mortality, the superlative salvage regimen for persistent MRSA bacteremia remains uncertain. An 85-year-old white female presented with persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Empiric antibiotic therapy with linezolid was initiated prior to blood culture results. Once MRSA bacteremia was confirmed, alternative antibiotic therapy with daptomycin was initiated. Blood cultures remained positive for MRSA despite three days of daptomycin therapy after which ceftaroline was added to the antibiotic regimen. Blood cultures remained positive for MRSA despite seven days of combination therapy with daptomycin and ceftaroline. Salvage therapy was then initiated with daptomycin, linezolid, and meropenem. One day following initiation of salvage therapy, blood cultures revealed no bacterial growth for the remainder of the length of stay. This report supports the effectiveness of salvage therapy consisting of daptomycin, linezolid, and meropenem in patients with persistent MRSA bacteremia.

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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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Trends in Bacteremia Over 2 Decades in the Top End of the Northern Territory of Australia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa472 ◽

2020 ◽

Vol 7 (11) ◽

Author(s):

Nicholas M Douglas ◽

Jann N Hennessy ◽

Bart J Currie ◽

Rob W Baird

Keyword(s):

Burkholderia Pseudomallei ◽

Infection Prevention ◽

Bacterial Pathogen ◽

Northern Territory ◽

Blood Cultures ◽

International Standards ◽

Local Distribution ◽

E Coli ◽

Gram Negative Bacteremia ◽

Empiric Antibiotic

Abstract Background Information on the local distribution of bloodstream pathogens helps to guide empiric antibiotic selection and can generate hypotheses regarding the effectiveness of infection prevention practices. We assessed trends in bacterial blood culture isolates at Royal Darwin Hospital (RDH) in the Northern Territory of Australia between 1999 and 2019. Methods Species identification was extracted for all blood cultures first registered at RDH. Thirteen organisms were selected for focused analysis. Trends were examined graphically and using univariable linear regression. Results Between 1999 and 2019, 189 577 blood cultures from 65 276 patients were processed at RDH. Overall, 6.72% (12 747/189 577) of blood cultures contained a bacterial pathogen. Staphylococcus aureus was the most common cause of bacteremia during the first decade, with an estimated incidence of 96.6 episodes per 100 000 person-years (py; 95% CI, 72.2–121/100 000 py) in 1999. Since 2009, S. aureus bacteremia has declined markedly, whereas there has been an inexorable rise in Escherichia coli bacteremia (30.1 to 74.7/100 000 py between 1999 and 2019; P < .001), particularly in older adults. Since 2017, E. coli has been more common than S. aureus. Rates of Streptococcus pneumoniae bacteremia have reduced dramatically in children, while Burkholderia pseudomallei remained the fourth most common bloodstream isolate overall. Conclusions The incidence of S. aureus bacteremia, though high by international standards, is declining at RDH, possibly in part due to a sustained focus on both community and hospital infection prevention practices. Gram-negative bacteremia, particularly due to E. coli, is becoming more common, and the trend will likely continue given our aging population.

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A strange case of Malaria in a Nigerian native boy.

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2017.023 ◽

2017 ◽

Vol 9 (1) ◽

pp. e2017023

Author(s):

Paola Magro ◽

Ilaria Izzo ◽

Barbara Saccani ◽

Salvatore Casari ◽

Silvio Caligaris ◽

...

Keyword(s):

Abdominal Pain ◽

Protective Role ◽

Splenic Infarction ◽

Blood Cultures ◽

Empiric Antibiotic Therapy ◽

Radiographic Appearance ◽

Empiric Antibiotic ◽

Endemic Areas ◽

Quantiferon Test

The protective role of SCT in malaria endemic areas has been proved and prevalence of HbS gene in malaria endemic areas is high. Splenic infarction is a well-known complication of SCT, rarely associated with malaria. A Nigerian boy was admitted to our ward after returning from his country of origin, for P. falciparum malaria. He underwent abdominal US for upper right abdominal pain, showing cholecystitis and multiple splenic abscesses. Empiric antibiotic therapy was undertaken. Bartonella, Echinococcus, Entamoeba serologies, blood cultures, Quantiferon test, coproparasitologic exam were negative; endocarditis was excluded. He underwent further blood exams and abdomen MRI, confirming the presence of signal alterations areas, with radiographic appearance of recent post-infarction outcomes. Hemoglobin electrophoresis showed a percentage of HbS of 40.6% and a diagnosis of SCT was made.Splenic infarction should be taken into account in patients with malaria and localized abdominal pain. Moreover, diagnosis of SCT should be considered.

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2007. Impact of Combining Rapid Diagnostics with an Interpretation Guide on Vancomycin Usage for Contaminant Blood Cultures Growing Coagulase-Negative Staphylococci (CoNS)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1687 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S674-S674

Author(s):

Simon Wu ◽

Richard L Watson ◽

Christopher J Graber

Keyword(s):

Los Angeles ◽

Antibiotic Use ◽

Blood Cultures ◽

Rapid Diagnostics ◽

Coagulase Negative Staphylococci ◽

Stewardship Program ◽

Empiric Antibiotic ◽

Stage Renal Disease ◽

End Stage ◽

The Impact

Abstract Background Contaminant blood cultures can lead to unnecessary antibiotic use, longer admissions and increased costs. Rapid diagnostics, like the BioFire® FilmArray® Blood Culture Identification (BCID) Panel, can potentially lessen these harms. BioFire BCID was implemented at VA Greater Los Angeles in 7/2017. When providers review BCID results, they are also directed to an interpretation guide developed by our antimicrobial stewardship program. This study aimed to determine the impact of BioFire BCID with this interpretation guide on unnecessary vancomycin use for contaminant blood cultures growing CoNS. Methods This was a retrospective cohort study on adult inpatients with contaminant blood cultures positive for CoNS. We evaluated cases before BCID (April 2016–July 2017) and after BCID (July 7/2017–December 2018) implementation. Cases with patients who died or were discharged prior to preliminary results, polymicrobial cultures, no empiric vancomycin use, or where vancomycin was indicated were excluded. We defined a “case” as anytime a provider concurrently ordered blood cultures and empiric antibiotics. Our primary outcome was the duration of unnecessary vancomycin. Secondary outcomes were time to discontinuation/modification of any empiric antibiotic, length of stay (LOS), LOS in ICU and 30-day mortality. Results A total of 99 cases were included (N = 45 pre-BCID; N = 54 post-BCID). Demographics between the 2 groups were largely similar except the post-BCID group had more patients with end-stage renal disease (ESRD) (14 vs. 4, P = 0.037) and more frequent infectious disease (ID) consultation (21 vs. 8, P = 0.027). The post-BCID group had shorter mean duration of unnecessary vancomycin (53.0 hours vs. 38.1 hours, P = 0.0029). After controlling for ESRD and ID involvement, the mean duration of unnecessary vancomycin was not significantly different between the 2 groups (P = 0.30 and P = 0.49, respectively). There was no difference in time to modification/discontinuation of any empiric antibiotic (44.6 hr vs. 35.0 hr, P = 0.36). There was no difference in mean LOS, mean LOS in ICU, or 30-day mortality. Conclusion Shorter duration of unnecessary vancomycin for CoNS bacteremia after BCID implementation and provision of an interpretation guide may have been driven in part by more frequent ID consultation. Disclosures All authors: No reported disclosures.

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Erythema Nodosum Associated with Staphylococcus Species Infection in a Child

Serbian Journal of Experimental and Clinical Research ◽

10.2478/sjecr-2020-0017 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Knezevic Sanja ◽

Prodanovic Tijana ◽

Radovanovic Marija ◽

Prodanovic Nikola ◽

Kostic Gordana

Keyword(s):

Antibiotic Therapy ◽

Erythema Nodosum ◽

Blood Cultures ◽

Empiric Antibiotic Therapy ◽

Coagulase Negative Staphylococcus ◽

Proteus Vulgaris ◽

Cutaneous Lesions ◽

Skin Changes ◽

Erythrocyte Sedimentation ◽

Empiric Antibiotic

AbstractErythema nodosum (EN) is a poly-etiological disease with an acute flow that is characterized by symmetric emergence of painful nodules often in pretibial areas.A twenty-month-old male child was admitted to hospital for evaluation of the eruptive skin changes in the lower extremities and forearms. The disease began 10 days before getting febricity and loose stools. The laboratory analysis showed an elevated erythrocyte sedimentation rate and leukocytosis. Blood cultures demonstrated the presence of coagulase-negative Staphylococcus, while Proteus vulgaris was isolated in urine cultures. After initiation of the empiric antibiotic therapy and then, the targeted antibiotic therapy according to the antibiogram, there was a significant improvement in a general condition and regression of cutaneous lesions.Erythema nodosum in the present case, is the result of staphylococcal bacteremia although Proteus vulgaris cannot be excluded as a cause.

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Shortened Time to IdentifyStaphylococcusSpecies from Blood Cultures and Methicillin Resistance Testing Using CHROMAgar

International Journal of Microbiology ◽

10.1155/2009/636502 ◽

2009 ◽

Vol 2009 ◽

pp. 1-3 ◽

Cited By ~ 4

Author(s):

Shingo Chihara ◽

Mary K. Hayden ◽

Eileen Minogue-Corbett ◽

Kamaljit Singh

Keyword(s):

Methicillin Resistance ◽

Rapid Identification ◽

Blood Cultures ◽

Resistance Testing ◽

Coagulase Negative Staphylococcus ◽

Becton Dickinson ◽

Antibiotic Selection ◽

Empiric Antibiotic ◽

Positive Results ◽

Gram Positive Cocci

The ability to rapidly differentiate coagulase-negative staphylococcus (CoNS) fromStaphylococcus aureusand to determine methicillin resistance is important as it affects the decision to treat empiric antibiotic selection. The objective of this study was to evaluate CHROMagarS. aureusand CHROMagar MRSA (Becton Dickinson) for rapid identification ofStaphylococcusspp. directly from blood cultures. Consecutive blood culture bottles (BacT Alert 3D SA and SN, bioMérieux) growing gram-positive cocci in clusters were evaluated. An aliquot was plated onto CHROMagar MRSA (C-MRSA) and CHROMagarS. aureus(C-SA) plates, which were read at 12 to 16 hours. C-SA correctly identified 147/147S. aureus(100% sensitivity); 2 CoNS were misidentified asS. aureus(98% specificity). C-MRSA correctly identified 74/77 MRSA (96% sensitivity). None of the MSSA isolates grew on C-MRSA (100% specificity). In conclusion, CHROMagar is a rapid and sensitive method to distinguish MRSA, MSSA, and coagulase-negativeStaphylococcusand may decrease time of reporting positive results.

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135 Time to positivity of neonatal blood cultures: Is it time to question the 48-hour empiric antibiotic rule?

Paediatrics & Child Health ◽

10.1093/pch/pxz066.134 ◽

2019 ◽

Vol 24 (Supplement_2) ◽

pp. e53-e53 ◽

Cited By ~ 1

Author(s):

Karlee Jones ◽

Souvik Mitra ◽

Michael O’Dea ◽

Beth McDougall ◽

Kathryn Slayter ◽

...

Keyword(s):

Blood Cultures ◽

Time To Positivity ◽

Empiric Antibiotic ◽

Neonatal Blood

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Rapid demonstration of septic or infectious arthritis due to Gram-negative bacteria

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100123830 ◽

1992 ◽

Vol 50 (1) ◽

pp. 686-687

Author(s):

Jacob S. Hanker ◽

Paul R. Gross ◽

Beverly L. Giammara

Keyword(s):

Chronic Arthritis ◽

Blood Cultures ◽

Gram Negative Bacteria ◽

Infectious Arthritis ◽

Bacterial Arthritis ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria

Blood cultures are positive in approximately only 50 per cent of the patients with nongonococcal bacterial infectious arthritis and about 20 per cent of those with gonococcal arthritis. But the concept that gram-negative bacteria could be involved even in chronic arthritis is well-supported. Gram stains are more definitive in staphylococcal arthritis caused by gram-positive bacteria than in bacterial arthritis due to gram-negative bacteria. In the latter situation where gram-negative bacilli are the problem, Gram stains are helpful for 50% of the patients; they are only helpful for 25% of the patients, however, where gram-negative gonococci are the problem. In arthritis due to gram-positive Staphylococci. Gramstained smears are positive for 75% of the patients.

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