scholarly journals Clinical Outcomes and Healthcare Utilization Related to Multidrug-Resistant Gram-Negative Infections in Community Hospitals

2016 ◽  
Vol 38 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Kristen V. Dicks ◽  
Deverick J. Anderson ◽  
Arthur W. Baker ◽  
Daniel J. Sexton ◽  
Sarah S. Lewis
Keyword(s):  
Bacterial Infections ◽  
Multidrug Resistant ◽  
Healthcare Resource Utilization ◽  
Community Hospitals ◽  
Readmission Rates ◽  
Gram Negative ◽  
Mortality Difference ◽  
Tract Infections ◽  
Multivariable Regression Models ◽  
The Impact

OBJECTIVETo evaluate the impact of multidrug-resistant gram-negative rod (MDR-GNR) infections on mortality and healthcare resource utilization in community hospitals.DESIGNTwo matched case-control analyses.SETTINGSix community hospitals participating in the Duke Infection Control Outreach Network from January 1, 2010, through December 31, 2012.PARTICIPANTSAdult patients admitted to study hospitals during the study period.METHODSPatients with MDR-GNR bloodstream and urinary tract infections were compared with 2 groups: (1) patients with infections due to nonMDR-GNR and (2) control patients representative of the nonpsychiatric, non-obstetric hospitalized population. Four outcomes were assessed: mortality, direct cost of hospitalization, length of stay, and 30-day readmission rates. Multivariable regression models were created to estimate the effect of MDR status on each outcome measure.RESULTSNo mortality difference was seen in either analysis. Patients with MDR-GNR infections had 2.03 higher odds of 30-day readmission compared with patients with nonMDR-GNR infections (95% CI, 1.04–3.97, P=.04). There was no difference in hospital direct costs between patients with MDR-GNR infections and patients with nonMDR-GNR infections. Hospitalizations for patients with MDR-GNR infections cost $5,320.03 more (95% CI, $2,366.02–$8,274.05, P<.001) and resulted in 3.40 extra hospital days (95% CI, 1.41–5.40, P<.001) than hospitalizations for control patients.CONCLUSIONSOur study provides novel data regarding the clinical and financial impact of MDR gram-negative bacterial infections in community hospitals. There was no difference in mortality between patients with MDR-GNR infections and patients with nonMDR-GNR infections or control patients.Infect Control Hosp Epidemiol 2016;1–8

scholarly journals 1575. Predictors of Negative Clinical Outcomes among Patients treated with Meropenem-Vaborbactam for Serious Gram-Negative Bacterial Infections: Impact of Delayed Appropriate Antibiotic Selection

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S786-S786
Author(s):  
Sara Alosaimy ◽  
Abdalhamid M Lagnf ◽  
Sarah Jorgensen ◽  
Travis J Carlson ◽  
Jinhee Jo ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Bacterial Infections ◽  
The United States ◽  
Research Support ◽  
Gram Negative ◽  
Appropriate Therapy ◽  
Tract Infections ◽  
The Impact

Abstract Background Numerous number of studies have found a positive correlation between delayed appropriate antibiotic therapy and negative clinical outcomes (NCO) in Gram-negative bacterial infections (GNBI). The combination of meropenem with vaborbactam (MVB) received Food and Drug Administration approval for the treatment of complicated urinary tract infections and acute pyelonephritis caused by susceptible organisms in August 2017. We sought to determine the impact of delayed appropriate therapy with MVB on NCO among patients with GNBI. Methods Multi-center, retrospective cohort study from October 2017 to March 2020. We included adult patients treated with MVB for &gt;72 hours. We excluded patients who received alternative appropriate antibiotics for GNB prior to MVB and patients with unknown dates for index culture. NCO were defined as 30-day mortality and/or microbiological recurrence. All outcomes were measured from MVB start date. Classification and regression tree analysis (CART) was used to identify the time breakpoint (BP) that delineates the risk of NCO. Multivariable logistic regression analysis (MLR) was used to examine the independent association between the CART-derived-BP and NCO. Variables were retained in the model if P&lt; 0.2 and removed in a backward stepwise approach. Results A total of 86 patients were included from 13 institutions in the United States: median(IQR) age 55 (37-67) years, 67% male, and 48% Caucasian. Median(IQR) APACHE II and Charlson Comorbidity index scores were 18(11-26) and 4(2-6), respectively. Common sources of infection were respiratory (37%) and intra-abdominal (21%). The most common pathogens were carbapenem-resistant Enterobacterales (83%). CART-derived BP between early and delayed treatment was 48 hours, where NCO was increased (36% vs.7%; P=0.04). Delayed MVB initiation was independently associated with NCO in the MLR (aOR=7.4, P=0.02). Results of Regression Analysis of Variables Associated With Negative Clinical Outcomes and Delayed Appropriate Therapy with Meropenem-vaborbactam Conclusion Our results suggest that delaying appropriate antibiotic therapy with MVB for &gt;48 hours significantly increases the risk of NCO in patients with GNBI. Clinicians must ensure timely administration of MVB to assure best outcomes in patients with GNBI. Disclosures Kevin W. Garey, PharMD, MS, FASHP, Merck & Co. (Grant/Research Support, Scientific Research Study Investigator) Michael J. Rybak, PharmD, MPH, PhD, Paratek (Grant/Research Support)

scholarly journals Evaluation of the Impact of Consciousness Energy Healing Treatment on the Isotopic Abundance Ratios (PM+1/PM and PM+2/PM) of Ofloxacin

2019 ◽  
Vol 2 (3) ◽  
pp. 49-58
Author(s):  
Dahryn Trivedi ◽  
Mahendra Kumar Trivedi ◽  
Alice Branton ◽  
Gopal Nayak ◽  
Snehasis Jana
Keyword(s):  
Bacterial Infections ◽  
Control Sample ◽  
Pharmaceutical Formulations ◽  
Multidrug Resistant ◽  
Abundance Ratio ◽  
The Body ◽  
Isotopic Abundance ◽  
Energy Healing ◽  
Tract Infections ◽  
The Impact

Ofloxacin is a class of fluorinated quinolone antibiotics, useful against most of the Gram-positive and Gram-negative bacterial infections. This study was designed to investigate the impact of the Trivedi Effect®-Consciousness Energy Healing Treatment on the structural properties and the isotopic abundance ratio of ofloxacin using LC-MS and GC-MS spectroscopy. Ofloxacin sample was divided into control and treated parts. The control ofloxacin did not receive the Consciousness Energy Healing Treatment, while the treated ofloxacin receives the Consciousness Energy Healing Treatment remotely by a renowned Biofield Energy Healer, Dahryn Trivedi. The LC-ESI-MS spectra of both the samples of ofloxacin at the retention time 3.05 minutes exhibited the mass of the protonated molecular ion peak at m/z 362.17 M+H+ (calculated for C18H21FN3O4+, 362.15). The LC-MS based isotopic abundance ratio of PM+1/PM in the treated ofloxacin was significantly increased by 56.57% compared with the control sample. Thus,2H, 15N, 13C, and17O contributions from (C18H21FN3O4)+ to m/z 363.17 in the treated ofloxacin were considerably increased compared with the control sample. The GC-MS based isotopic abundance ratios of PM+1/PM and PM+2/PM in the treated ofloxacin was significantly increased by 9.53% and 12.94%, respectively compared with the control sample. Hence,2H, 15N, 13C, 17O, and 18O contributions from (C18H21FN3O4)+ to m/z 318 and 319 in the treated ofloxacin were significantly increased compared with the control sample. The LC-MS and GC-MS based isotopic abundance ratios of PM+1/PM (2H/1H or 15N/14N or 13C/12C or 17O/16O), and PM+2/PM (18O/16O) in the treated ofloxacin were considerably improved compared to the control sample. The increased isotopic abundance ratio of the treated ofloxacin would increase the chemical bond strength and increase the stability in the body. The new form of treated ofloxacin would be more stable compared to the control sample and would be very useful to design improved pharmaceutical formulations that might offer better therapeutic response against infections of the urethra and cervix, infectious diarrhoea, urinary tract infections, cellulitis, chronic bronchitis, pneumonia, prostatitis, multidrug-resistant tuberculosis, plague, otitis media, etc.

scholarly journals Three-Year Trend in Escherichia coli Antimicrobial Resistance among Children’s Urine Cultures in an Italian Metropolitan Area

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 597
Author(s):  
Luca Pierantoni ◽  
Laura Andreozzi ◽  
Simone Ambretti ◽  
Arianna Dondi ◽  
Carlotta Biagi ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Metropolitan Area ◽  
Bacterial Infections ◽  
Asymptomatic Bacteriuria ◽  
Multidrug Resistant ◽  
Resistance Rate ◽  
First Line ◽  
E Coli ◽  
First Line Therapy ◽  
Tract Infections

Urinary tract infections (UTIs) are among the most common bacterial infections in children, and Escherichia coli is the main pathogen responsible. Several guidelines, including the recently updated Italian guidelines, recommend amoxicillin-clavulanic acid (AMC) as a first-line antibiotic therapy in children with febrile UTIs. Given the current increasing rates of antibiotic resistance worldwide, this study aimed to investigate the three-year trend in the resistance rate of E. coli isolated from pediatric urine cultures (UCs) in a metropolitan area of northern Italy. We conducted a retrospective review of E. coli-positive, non-repetitive UCs collected in children aged from 1 month to 14 years, regardless of a diagnosis of UTI, catheter colonization, urine contamination, or asymptomatic bacteriuria. During the study period, the rate of resistance to AMC significantly increased from 17.6% to 40.2% (p < 0.001). Ciprofloxacin doubled its resistance rate from 9.1% to 16.3% (p = 0.007). The prevalence of multidrug-resistant E. coli rose from 3.9% to 9.2% (p = 0.015). The rate of resistance to other considered antibiotics remained stable, as did the prevalence of extended spectrum beta-lactamases and extensively resistant E. coli among isolates. These findings call into question the use of AMC as a first-line therapy for pediatric UTIs in our population, despite the indications of recent Italian guidelines.

scholarly journals Low Immunogenicity of Intravesical Phage Therapy for Urogenitary Tract Infections

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 627
Author(s):  
Sławomir Letkiewicz ◽  
Marzanna Łusiak-Szelachowska ◽  
Ryszard Międzybrodzki ◽  
Maciej Żaczek ◽  
Beata Weber-Dąbrowska ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Bacterial Infections ◽  
Phage Therapy ◽  
Serum Antibody ◽  
Multidrug Resistant ◽  
Antibody Responses ◽  
Urogenital Infections ◽  
Reliable Model ◽  
Tract Infections ◽  
Antibody Levels

Patients with chronic urinary and urogenital multidrug resistant bacterial infections received phage therapy (PT) using intravesical or intravesical and intravaginal phage administration. A single course of PT did not induce significant serum antibody responses against administered phage. Whilst the second cycle of PT caused a significant increase in antibody levels, they nevertheless remained quite low. These data combined with good therapy results achieved in some patients suggest that this mode of PT may be an efficient means of therapy for urogenital infections and a reliable model for a clinical trial of PT.

scholarly journals Characterisation of Plasmids in Multidrug Resistant Uropathogenic Gram-negative Bacterial Isolates

2021 ◽  
Author(s):  
Manish Ranjan ◽  
Mahadevan Kumar ◽  
Sourav Sen ◽  
Parijat Das ◽  
Kunal Kanti Lahiri
Keyword(s):  
Acquired Resistance ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Bacterial Isolates ◽  
Cross Sectional ◽  
Gram Negative ◽  
Hospital Stays ◽  
Tract Infections ◽  
Almost All ◽  
Prolonged Hospital

Introduction: Urinary Tract Infections (UTI) are one of the commonest conditions for which people seek medical care with an estimated 150 million episodes per annum worldwide. An unprecedented upsurge in the rate of development of antimicrobial resistance has reduced the therapeutic options leading to increased morbidity, prolonged hospital stays, development of complications. Majority of these infections are attributable to Gram negative bacteria which have now acquired resistance to almost all classes of antibiotics. Aim: To analyse the plasmid-mediated drug resistance and characterise the major plasmid families that are in circulation. Materials and Methods: A cross-sectional study comprising of a total of 95 non consecutive multidrug-resistant gram-negative bacterial isolates were subjected to Plasmid based replicon typing from January 2017 to June 2018. The 18 major replicons were divided in five multiplex and three uniplex Polymerase Chain Reaction (PCR) formats and the samples were subjected for plasmid characterisation and further sequencing of the plasmid Deoxyribonucleic Acid (DNA). The data obtained was analysed by Microsoft Excel software. Results: Escherichia coli, accounted for maximum n=51 (53.7%), Klebsiella pneumoniae n=19 (20%), Citrobacter sp n=11 (11.6%), miscellaneous gram negative n=14 (14.7%) The isolates exhibited a high degree of resistance to almost all tested antibiotics, sparing a few like Fosfomycin, Chloramphenicol, Imipenem, Amikacin. A total of 154 different plasmid families were detected from the 95 isolates. FIB replicon (24%), FIA (21%), F, W (20%), FIC, B/O (14%), Y (12%), I1 replicon (10.5%) were the major plasmid families detected in the present study. Conclusion: Many isolates exhibited the presence of more than one Incompatibility (Inc.) group plasmids, conferring multidrug resistance to the isolates. The study highlights the need for further research to study the association between plasmid families and their respective antibiotic resistance profiles for a given geographical niche and the need to devise further methods to target these epidemic plasmids.

scholarly journals The Odilorhabdin Antibiotic Biosynthetic Cluster and Acetyltransferase Self-Resistance Locus Are Niche and Species Specific

mBio ◽  
2022 ◽  
Author(s):  
Anne Lanois-Nouri ◽  
Lucile Pantel ◽  
Jun Fu ◽  
Jessica Houard ◽  
Jean-Claude Ogier ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Multidrug Resistant ◽  
Small Subunit ◽  
Cationic Peptides ◽  
Resistance Locus ◽  
Gram Negative ◽  
Species Specific ◽  
Bacterial Translation

Odilorhabdins (ODLs) constitute a novel antibiotic family with promising properties for treating problematic multidrug-resistant Gram-negative bacterial infections. ODLs are 10-mer linear cationic peptides inhibiting bacterial translation by binding to the small subunit of the ribosome.

scholarly journals Polymyxins Nebulization over Intravenous Injection: Pharmacokinetics and Pharmacodynamics-Based Therapeutic Evaluation

2019 ◽  
pp. 1-10
Author(s):  
Md. Jahidul Hasan
Keyword(s):  
Respiratory Tract ◽  
Adverse Drug Reactions ◽  
Intravenous Administration ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Drug Reactions ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Gram Negative ◽  
Tract Infections

Polymyxins are the last line potential antibiotics against multi-drug resistant gram-negative bacteria and consist of two sister antibiotics: Polymyxin B and colistin (polymyxin E). Intravenous use of polymyxins was started from a long ago in the treatment of serious gram-negative infections and once their uses were restricted due to potential adverse drug reactions, such as nephrotoxicity and neurotoxicity. Lack of in vivo clinical studies on polymyxins mostly, in human body makes the pharmacokinetics and pharmacodynamics of polymyxin B and colistin unclear in many aspects, such as the distribution of polymyxins in different compartments of lung. The nebulization of polymyxins is practicing very limitedly and lack of clinical evidence has not justified this administration technique yet properly to date. The main objective of this review study was to evaluate the pharmacokinetic and pharmacodynamic properties of intravenous and nebulized polymyxins and the related therapeutic potentialities. Aerosolized polymyxins directly administered to the respiratory tract was found with higher drug concentration in different subcompartments of lungs than the intravenous administration and sustainably meets the minimum inhibitory concentration locally with superior bactericidal properties in respiratory tract infections. In contrast, intravenous administration of polymyxins shows similar anti-infective superiority in other organs, such as blood, urinary tract etc. So, during this alarming situation of rapidly emerging multidrug-resistant organisms in human communities, therapeutic administration techniques of last resort polymyxins should be clinically evidence-based for achieving optimum therapeutic outcomes with minimum chance of adverse drug reactions.  

Assessment of symptoms on patients with urinary tract infections and adherence to medications

2021 ◽  
Vol 12 (3) ◽  
pp. 1740-1744
Author(s):  
Eva Lorel Kouassi ◽  
Abdul Wahid Ishaque ◽  
Amulya P. Shetty ◽  
Rimpa Devi ◽  
Sheethal Kuriakose ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bacterial Infections ◽  
Developed Countries ◽  
P Value ◽  
Strong Positive Correlation ◽  
Early Assessment ◽  
Tract Infections ◽  
Outpatient Settings ◽  
The Impact

Although urinary tract infections (UTIs) are considered to be the most common bacterial infections worldwide, their assessment remains a big clinical challenge, because they are not reportable diseases in developed countries like United States and any other parts of the world including India. This situation is further complicated by the fact that accurate diagnosis depends on both the presence of symptoms and a positive urine culture, although in most outpatient settings this diagnosis is made without the benefit of culture. Our study aimed to appraise the impact of urinary tract infections symptoms on selected patients and comprehend their adherence to medications despite the challenges of antimicrobial susceptibility and resistance observed. One hundred and twenty patients with confirmed cases of urinary tract infections were recruited for the study. The mean age of females and males patients was found to be 59.86±2.37and 52.27±3 years respectively. Pertinent descriptive and inferential statistics were performed. Spearman correlation test revealed a strong positive correlation between overall UTIs’ symptoms and their impact on patients at baseline (0.84) and at follow up (0.799) with p value =0.5. On the other hand the majority of patients were found to be adherent to the medications after discharge. The current study revealed that Urinary tract infections if left untreated can negatively impact the lives of patients suffering from it and hinder their adherence to medications. Consequently, accurate and early assessment of UTIs’ symptoms in clinics and hospitals becomes a necessity.

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