BRD treatment failure: clinical and pathologic considerations

2020 ◽  
Vol 21 (2) ◽  
pp. 175-176
Author(s):  
T. L. Ollivett
Keyword(s):  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Respiratory Disease ◽  
Treatment Efficacy ◽  
Lung Ultrasound ◽  
Clinical Signs ◽  
Antibiotic Use ◽  
The Face ◽  
Pros And Cons ◽  
The Impact

AbstractIn cattle treated for respiratory disease, resolution of clinical signs has been the mainstay of determining treatment response and treatment efficacy. Through the use of calf lung ultrasound, we have found that pneumonia can persist or recur in the face of antibiotic therapy, despite improved clinical signs, leading to greater risk of clinical disease and more antibiotic use in the future. This review will discuss the pros and cons of using clinical signs to define resolution of disease and discuss how to implement lung ultrasound to improve our ability to accurately measure the impact of antibiotic therapy in cattle with respiratory disease.

Lungworms (Metastrongylus Spp.) Demonstrated in Domestic Pigs with Respiratory Disease - What was the True Relevance of that?

2021 ◽  
Author(s):  
Per Wallgren ◽  
Emelie Pettersson
Keyword(s):  
Respiratory Disease ◽  
Pasteurella Multocida ◽  
Ascaris Suum ◽  
Clinical Signs ◽  
Mycoplasma Hyopneumoniae ◽  
Disease Outbreak ◽  
Domestic Pigs ◽  
Faecal Samples ◽  
Routine Inspection ◽  
The Impact

Abstract BackgroundAn outdoor pig herd was affected by severe respiratory disease in one out of three pastures. At necropsy, Mycoplasma hyopneumoniae and Pasteurella multocida were detected in the lungs, as well as the lung worm Metastrongylus apri. The life cycle of Metastrongylus spp. includes earth worms as an intermediate host, and since domesticated pigs mainly are reared indoors lungworms has not been diagnosed in domestic pigs in Sweden for decades, not even in pigs reared outdoors. Therefore, this disease outbreak was scrutinised from the view of validating the impact of Metastrongylus spp..ResultsAt the time of the disease outbreak, neither eggs of Metastrongylus spp. nor Ascaris suum were detected in faeces of pigs aged ten weeks. In contrast, five-months-old pigs at the pasture with respiratory disease shed large amounts of eggs from Ascaris suum, whereas Ascaris suum not was demonstrated in healthy pigs aged six months at another pasture. Low numbers of eggs from Metastrongylus spp. were seen in faecal samples from both these age categories.At slaughter, seven weeks later, ten normal weighted pigs in the preceding healthy batch were compared with ten normal weighted and five small pigs from the affected batch. Healing Mycoplasma-like pneumonic lesions were seen in all groups. Small pigs had more white spot liver lesions, and all small pigs shed eggs of Ascaris suum in faeces, compared to around 50% of the pigs in the normally sized groups. Metastrongylus spp. were demonstrated in 13 of the 25 pigs (52%), %), representing all groups included.ConclusionAs Metastrongylus spp. were demonstrated regardless of health status, and in another healthy outdoor herd, the impact of Metastrongylus spp. on the outbreak of respiratory disease was depreciated. Instead, Metastrongylus spp. was suggested to be common in outdoor production, although rarely diagnosed. The reason for this is because they will escape detection at routine inspection at slaughterhouses, and that they appeared to generally not induce clinical signs of respiratory disease. Instead, a possible association with a high burden of Ascaris suum was suggested to have preceded the severe outbreak with respiratory disease.

scholarly journals Staphylococcus Aureus: Selective Reporting of Antibiogram Results and Its Impact on Antibiotic Use. Interventional Study with a Reference Group on the Effect of Switching from Non-Selective to Selective Antibiotic Reporting

2020 ◽  
Author(s):  
Franka Lestin-Bernstein ◽  
Ramona Harberg ◽  
Ingo Schumacher ◽  
Lutz Briedigkeit ◽  
Oliver Heese ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Therapy ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Selective Reporting ◽  
Care Hospital ◽  
Beta Lactams ◽  
Interventional Study ◽  
Narrow Spectrum ◽  
The Impact

Abstract Background:Antimicrobial stewardship (AMS) strategies worldwide focus on optimised antibiotic use. Selective susceptibility reporting is recommended as an effective AMS tool, although there is a lack of representative studies investigating the impact of selective susceptibility reporting on antibiotic use.The aim of this study was to investigate the impact of selective susceptibility reporting of Staphylococcus aureus (S. aureus) on antibiotic consumption. Enhancing the use of narrow-spectrum beta-lactam antibiotics such as flucloxacillin/cefazolin/cefalexin is one of the main goals in optimising antibiotic therapy of S. aureus infections.Methods:This interventional study with control group was conducted at a tertiary care hospital in Germany. During the one-year interventional period, susceptibility reports for all methicillin-sensitive S. aureus (MSSA) were restricted to flucloxacillin/cefazolin/oral cefalexin, trimethoprim-sulfamethoxazole, clindamycin, gentamicin and rifampin/fosfomycin; instead of reporting all tested antibiotics during the year before the intervention and in the reference clinic. The impact of the intervention was analysed by monitoring antibiotic consumption (recommended daily dose/100 occupied bed days: RDD/100 BD).Results:MSSA-antibiograms were reported for 2836 patients. Total use of narrow-spectrum beta-lactams more than doubled during the intervention (from 1.2 to 2.8 RDD/100 BD, P<0.001; P<0.001 compared to the reference clinic); the percentage of total antibiotic use increased from 2.6% to 6.2%. A slight, but significant increase in the use of trimethoprim-sulfamethoxazole was also observed (+ 0.37 RDD/100 BD).There was no decrease in antibiotics withdrawn from the antibiogram, probably as a consequence of their wide use for indications other than S. aureus infections.Conclusions:As narrow-spectrum beta-lactams are not widely used for other infections, there is a strong indication that selective reporting guided clinicians to optimised antibiotic therapy of S. aureus infections.As useful AMS tool, we recommend implementing selective reporting rules into the national/international standards for susceptibility reporting.

scholarly journals Understanding and Managing Sepsis in Patients With Cancer in the Era of Antimicrobial Resistance

2021 ◽  
Vol 8 ◽  
Author(s):  
Carlota Gudiol ◽  
Adaia Albasanz-Puig ◽  
Guillermo Cuervo ◽  
Jordi Carratalà
Keyword(s):  
Antimicrobial Resistance ◽  
Antibiotic Therapy ◽  
Antibiotic Use ◽  
Source Control ◽  
High Morbidity ◽  
Cell Transplant ◽  
Empirical Antibiotic Therapy ◽  
Hematopoietic Stem ◽  
Poor Outcomes ◽  
The Impact

Sepsis is a frequent complication in immunosuppressed cancer patients and hematopoietic stem cell transplant recipients that is associated with high morbidity and mortality rates. The worldwide emergence of antimicrobial resistance is of special concern in this population because any delay in starting adequate empirical antibiotic therapy can lead to poor outcomes. In this review, we aim to address: (1) the mechanisms involved in the development of sepsis and septic shock in these patients; (2) the risk factors associated with a worse prognosis; (3) the impact of adequate initial empirical antibiotic therapy given the current era of widespread antimicrobial resistance; and (4) the optimal management of sepsis, including adequate and early source control of infection, optimized antibiotic use based on the pharmacokinetic and pharmacodynamics changes in these patients, and the role of the new available antibiotics.

scholarly journals From Etest to Vitek 2: Impact of Enterococcal Linezolid Susceptibility Testing Methodology on Time to Active Therapy

2020 ◽  
Vol 64 (9) ◽  
Author(s):  
Cynthia T. Nguyen ◽  
Cindy Bethel ◽  
Natasha N. Pettit ◽  
Angella Charnot-Katsikas
Keyword(s):  
Antibiotic Therapy ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Antibiotic Use ◽  
Antimicrobial Susceptibility Testing ◽  
Active Therapy ◽  
Testing Methodology ◽  
Vitek 2 ◽  
Vancomycin Resistant ◽  
The Impact

ABSTRACT Different linezolid antimicrobial susceptibility testing (AST) methodologies yield various results. In 2018, we transitioned our linezolid AST methodology from the Etest to Vitek 2. We sought to evaluate the impact of this change on antibiotic use among 181 inpatients with vancomycin-resistant enterococcal (VRE) infections. The transition from Etest to Vitek 2 resulted in an increase in linezolid susceptibility (38% versus 96%; P < 0.001) and a reduction in time to active antibiotic therapy (3 versus 2.6 days; P = 0.007).

Clinical and Economic Consequences of Failure of Initial Antibiotic Therapy for Hospitalized Patients With Complicated Skin and Skin-Structure Infections

2008 ◽  
Vol 29 (2) ◽  
pp. 160-169 ◽  
Author(s):  
John Edelsberg ◽  
Ariel Berger ◽  
David J. Weber ◽  
Rajiv Mallick ◽  
Andreas Kuznik ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Intravenous Antibiotic ◽  
Skin Structure ◽  
Intravenous Antibiotic Therapy ◽  
Initial Antibiotic Therapy ◽  
Intravenous Antibiotics ◽  
Complicated Skin ◽  
Hospital Days ◽  
The Impact

Objective.To estimate the consequences of failure of initial antibiotic therapy for patients with complicated skin and skin-structure infections.Design.Retrospective cohort study.Setting.Large US multihospital database.Patients.We identified a total of 47,219 patients (age 18 years or older) who were admitted to the hospital for complicated skin and skin-structure infections from April 1, 2003, through March 31, 2004, and who received intravenous antibiotics during the first 2 hospital-days (ie, initial antibiotic therapy). Failure of therapy was defined as drainage, debridement, or receipt of other intravenous antibiotics at any subsequent time (except for changes to narrower-spectrum agents or any therapy change immediately before discharge). Predictors of failure of antibiotic therapy and mortality were examined using multivariate logistic regression. Analysis of covariance was used to estimate the impact of treatment failure on duration of intravenous antibiotic therapy, length of stay, and total inpatient charges.Results.For 10,782 admitted patients (22.8%), there was evidence of failure of initial antibiotic therapy. In multivariate analyses, treatment failure was associated with receipt of vasoactive medications during the first 2 hospital-days (odds ratio [OR], 1.66 [95% confidence interval {CI}, 1.19-2.31]), initiation of antibiotic therapy in the intensive care unit (OR, 1.53 [95% CI, 1.28-1.84]), and the patient's Charlson comorbidity index (OR per 1-point increase, 1.06 [95% CI, 1.04-1.08]); treatment failure was also was associated with a 3-fold increase in mortality (OR, 2.91 [95% CI, 2.34-3.62]). Compared with patients for whom initial treatment was successful, patients who experienced treatment failure received intravenous antibiotic therapy for a mean of 5.7 additional days, were hospitalized for a mean of 5.4 additional days, and incurred a mean of $5,285 (in 2003 dollars) in additional inpatient charges (all P <.01).Conclusion.Failure of initial antibiotic therapy in the treatment of complicated skin and skin-structure infections is associated with significantly worse clinical and economic outcomes.

scholarly journals Automated Feeding Behaviors Associated with Subclinical Respiratory Disease in Preweaned Dairy Calves

Animals ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 988
Author(s):  
Catie Cramer ◽  
Kathryn Proudfoot ◽  
Theresa Ollivett
Keyword(s):  
Feeding Behavior ◽  
Respiratory Disease ◽  
Lung Ultrasound ◽  
Effective Means ◽  
Clinical Signs ◽  
Dairy Calves ◽  
Feeding Behaviors ◽  
Lung Consolidation ◽  
First Case ◽  
Number Of Visits

Little is known about feeding behaviors in young dairy calves with subclinical respiratory disease (SBRD). The objective of this study was to determine if calves with their first case of SBRD exhibit different feeding behaviors during the 7 d around detection, compared to calves with their first case of clinical BRD (CBRD) or without BRD (NOBRD). Preweaned, group-housed dairy calves (n = 103; 21 ± 6 d of age) underwent twice weekly health exams (lung ultrasound and clinical respiratory score; CRS); health exams were used to classify the BRD status for each calf: SBRD (no clinical signs and lung consolidation ≥ 1cm2; n = 73), CBRD (clinical signs and lung consolidation ≥ 1cm2; n = 18), or NOBRD (never had lung consolidation ≥ 1cm2 or CRS+; n = 12). Feeding behavior data (drinking speed, number of visits, and intake volume) were collected automatically. Calves with SBRD and calves with NOBRD had similar drinking speeds (782 vs. 844 mL/min). Calves with CBRD drank slower than both calves with SBRD (688 vs. 782 mL/min) and NOBRD (688 vs. 844 mL/min). There was no effect of BRD status on any other behavior. Feeding behavior was not an effective means of identifying calves with SBRD.

scholarly journals A retrospective review on antibiotic use in acute watery diarrhea in children in a tertiary care hospital of Karachi, Pakistan

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253712
Author(s):  
Sonia Qureshi ◽  
Shahzadi Resham ◽  
Mariam Hashmi ◽  
Abdullah B. Naveed ◽  
Zoya Haq ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Hospital Stay ◽  
Retrospective Review ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Watery Diarrhea ◽  
Care Hospital ◽  
Acute Watery Diarrhea ◽  
Prolonged Hospital ◽  
The Impact

Introduction Responsible for at least one in nine pediatric deaths, diarrheal diseases are the leading, global cause of death. Further abetted by improper antibiotic use in a hospital setting, children with acute watery diarrhea can see prolonged hospital stays, and unwanted adverse effects such as antibiotic resistance. Hence, this study is aimed to identify the association between antibiotic usage for the treatment of acute watery diarrhea in children, and the impact this line of management has on the duration of their hospital stay. Methods A retrospective review was conducted at the department of Pediatric of Aga Khan University Hospital (AKUH) in Karachi. A total of 305 records of children aged 6 months to 5 years who were admitted with a diagnosis of acute watery diarrhea from June 2017 –December 2018 was screened, of which 175 fulfilled the eligibility criteria. A predesigned questionnaire was used to collect demographic information, comorbidities, and clinical features, severity of dehydration, clinical examination, treatment received, and laboratory investigations. The primary outcome of this study was the length of hospital stay measured against the number of hours a child stayed in hospital for treatment of acute watery diarrhea. The statistical analysis was carried out using STATA version 14 to reach conclusive results. Results 175 patients presented with acute watery diarrhea, out of which 106 (60.6%) did not receive antibiotics. The median (IQR) age of the group that did not receive antibiotics was 12.0 (12.0) months compared to 15.0 (12.0) months for the group that did receive antibiotics. In both groups, there were more males than females, less than 15% of the patients were severely malnourished (WHZ score -3SD) and less than 10% of the patients were severely dehydrated. The median (IQR) length of hospital stay (hours) was 32.0 (19.0) respectively for the group that did not receive antibiotic and 41.0 (32.0) for the group that did receive antibiotic therapy. The expected length of hospital stay for the group that received antibiotic therapy was 0.22 hours higher than the group that did not. Finally, as compared to females, hospital stay for males was longer by 0.25 hours. Conclusion In conclusion, antibiotic use was associated with a prolonged hospital stay in children with acute watery diarrhea as compared to children who did not receive antibiotics. Large scale robust prospective studies are needed to establish this association using this observational data.

scholarly journals Point-of-care Procalcitonin Guidance to Reduce Antibiotic Use in Critically Ill Patients: A Randomized Controlled Trial

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Wan Fadzlina Wan Muhd Shukeri ◽  
Azrina Md. Ralib ◽  
Mohd Basri Mat-Nor
Keyword(s):  
Randomized Controlled Trial ◽  
Antibiotic Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Controlled Trial ◽  
Clinical Signs ◽  
Antibiotic Use ◽  
Randomized Controlled ◽  
Prolonged Duration

Introduction: Antibiotic therapy is of great importance in sepsis but prolonged duration can add to the emergence of antibiotic resistance. We aimed to examine whether point-of-care (POC) procalcitonin (PCT) guidance can safely reduce the duration of antibiotic use in infected critically ill patients. Materials and Methods: Eighty adult patients admitted to or acquired sepsis in the intensive care unit (ICU) were enrolled in this randomized controlled trial. Patients were allocated to either POC PCT-guided intervention arm (n=40) or the control arm, in which antibiotic therapy followed local guidelines (n=40). In the PCT-guided arm, antibiotic treatment was discontinued if clinical signs of infection improved and the PCT concentration decreased by >80% of its peak value, or when it reaches a value of <0·5 g/L. Results: The mean duration of antibiotic use for PCT arm was 6.4 (SD 2.3) days compared to 9 (SD 4.3) days in the control arm (p=0.004). In the first 30 days after being assigned to a group, the proportion of patients who received a repeated course of systemic antibiotics was 33% in the PCT arm vs 38.1% in the control arm (p=0.757). Mean length of stay in the ICU was 8.4 (SD 5.3) days in the PCT arm vs 10.4 (SD 12.3) days in the control arm (p=0.404). Mortality at 30 days was 22.5% in the PCT-arm vs 25% in the control arm (p<0.0001). Conclusion: POC PCT guidance stimulates reduction of duration of antibiotic use in ICU, accompanied by a significant decrease in mortality.

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