scholarly journals Blood Cultures Versus Respiratory Cultures: 2 Different Views of Pneumonia

2019 ◽  
Vol 71 (7) ◽  
pp. 1604-1612 ◽  
Author(s):  
Sarah Haessler ◽  
Peter K Lindenauer ◽  
Marya D Zilberberg ◽  
Peter B Imrey ◽  
Pei-Chun Yu ◽  
...  
Keyword(s):  
Case Fatality ◽  
Empiric Therapy ◽  
Respiratory Arrest ◽  
Community Acquired Pneumonia ◽  
Blood Cultures ◽  
First Line ◽  
First Line Therapy ◽  
Lengths Of Stay ◽  
Resistance Patterns ◽  
Source Models

Abstract Background Choice of empiric therapy for pneumonia depends on risk for antimicrobial resistance. Models to predict resistance are derived from blood and respiratory culture results. We compared these results to understand if organisms and resistance patterns differed by site. We also compared characteristics and outcomes of patients with positive cultures by site. Methods We studied adult patients discharged from 177 US hospitals from July 2010 through June 2015, with principal diagnoses of pneumonia, or principal diagnoses of respiratory failure, acute respiratory distress syndrome, respiratory arrest, or sepsis with a secondary diagnosis of pneumonia, and who had blood or respiratory cultures performed. Demographics, treatment, microbiologic results, and outcomes were examined. Results Among 138 561 hospitalizations of patients with pneumonia who had blood or respiratory cultures obtained at admission, 12 888 (9.3%) yielded positive cultures: 6438 respiratory cultures, 5992 blood cultures, and 458 both respiratory and blood cultures. Forty-two percent had isolates resistant to first-line therapy for community-acquired pneumonia. Isolates from respiratory samples were more often resistant than were isolates from blood (54.2% vs 26.6%; P < .001). Patients with both culture sites positive had higher case-fatality, longer lengths of stay, and higher costs than patients who had only blood or respiratory cultures positive. Among respiratory cultures, the most common pathogens were Staphylococcus aureus (34%) and Pseudomonas aeruginosa (17%), whereas blood cultures most commonly grew Streptococcus pneumoniae (33%), followed by S. aureus (22%). Conclusions Patients with positive respiratory tract cultures are clinically different from those with positive blood cultures, and resistance patterns differ by source. Models of antibiotic resistance should account for culture source.

scholarly journals Routine blood cultures in the management of community acquired pneumonia; is it necessary?

2013 ◽  
Vol 1 (2) ◽  
pp. 54-57
Author(s):  
TM Ibrahim
Keyword(s):  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Cost Effective ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Blood Cultures ◽  
True Positive ◽  
It Use ◽  
The Cost

INTRODUCTION: The role of blood cultures (BCs) in the management of community acquired pneumonia (CAP) has generated a lot of controversy among clinicians in recent times. The main objectives of this audit were to determine if BC results impact the choice of antibiotics, and hospital outcomes in CAP. MATERIALS AND METHODS: This was a retrospective study of adults with CAP treated in the ED of Goulbourn Valley Base Hospital, Shepparton in Australia from November 2010 to November 2011. RESULTS: Two hundred and twenty five patients were treated for CAP during the period in review with a mean age of 67.09±19.82 yrs and male:female of 1.5:1. 277 sets of BCs were performed and only 2.2% of the cases had true positive BCs .87% of the total cost of performing these BCs was spent on those with negative cultres.15.1% of the cases had their antibiotics changed during their hospitalization but the results of the BCs had no impact on the antibiotic change. Even though not statistically significant true positive BCs was associated with prolong length of hospital stay (7.6 ± 9.39 days vs 4.89 ± 3.24 days, p=0.44), and duration of IV antibiotic use (4.8±3.27 days vs 3.58±1.97 days, p=0.39). But the case fatality rate was much lower in those with positive BCs, (0 vs 5.7%,p< 0.05). Tachycardia (>120.4±12.46 bpm), neutrophilia (15.0± 8.16 /ul), and high CRP (326.4±146.32 ug/l) were predictors of true positive BCs. CONCLUSIONS: Routine BCs in the management of CAP is not cost-effective with large portion of the cost spent on cultures that returned negative result .Therefore it use show be limited to those likely to return positive cultures. DOI: http://dx.doi.org/10.3126/ijim.v1i2.7408 Int J Infect Microbiol 2012;1(1):54-57

scholarly journals Effectiveness of oral moxifloxacin in standard first-line therapy in community-acquired pneumonia

2003 ◽  
Vol 21 (1) ◽  
pp. 135-143 ◽  
Author(s):  
A. Torres ◽  
J-F. Muir ◽  
P. Corris ◽  
R. Kubin ◽  
I. Duprat-Lomon ◽  
...  
Keyword(s):  
Community Acquired Pneumonia ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy

Peritonitis as the First Presentation of Disseminated Listeriosis in a Patient on Peritoneal Dialysis—a Case Report

2017 ◽  
Vol 37 (2) ◽  
pp. 239-240 ◽  
Author(s):  
Weiwei Beckerleg ◽  
Vaibhav Keskar ◽  
Jolanta Karpinski
Keyword(s):  
Peritoneal Dialysis ◽  
Case Report ◽  
Listeria Monocytogenes ◽  
Empiric Therapy ◽  
Second Line ◽  
First Line ◽  
Systemic Involvement ◽  
First Line Therapy ◽  
Line Therapy ◽  
High Index Of Suspicion

Infections with Listeria monocytogenes are uncommon but serious, with mortality rate approaching 30% in cases of systemic involvement despite first-line therapy. They are usually caused by ingestion of contaminated foods, but spontaneous infections have also been described. Listeria monocytogenes is a rare cause of peritonitis, and most of the published cases are in patients with cirrhosis and ascites. There are a few reported cases of Listeria peritonitis associated with peritoneal dialysis (PD), primarily isolated peritonitis. If detected early, Listeria peritonitis can be successfully treated with ampicillin, alone or in combination with gentamicin. Vancomycin has been listed as a second-line agent. However, it has been associated with treatment failure. In this case report, we present a patient who developed disseminated listeriosis, with peritonitis as the first manifestation of disseminated infection. This case illustrates the importance of having a high index of suspicion for L. monocytogenes if patients deteriorate despite empiric therapy for PD-associated peritonitis and serves as a further example demonstrating the inadequate coverage of vancomycin for L. monocytogenes.

scholarly journals Use of Tedizolid for the Treatment of Staphylococcus aureus Bacteremia – An off Labelled Indication

2019 ◽  
pp. 1-4
Author(s):  
L. W. Loo ◽  
Andrea L. Kwa ◽  
Jenny G. Low ◽  
Jaime Chien
Keyword(s):  
Staphylococcus Aureus ◽  
Drug Allergy ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Blood Cultures ◽  
First Line ◽  
Vancomycin Therapy ◽  
Staphylococcus Aureus Bacteremia ◽  
First Line Therapy ◽  
Line Therapy ◽  
End Stage

Aims: We aim to share our experience in the successful use of tedizolid for the treatment of Staphylococcus aureus bacteremia in two of our patients. Presentation of Cases: Our first patient had methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. The MRSA isolated was sensitive to linezolid and vancomycin (MIC=2), resistant to daptomycin (MIC=2). In view of the documented drug allergy to ceftriaxone and drug interaction with daptomycin, the patient was initially initiated on intravenous vancomycin but developed a breakthrough fever with rising inflammatory markers. However, upon initiation of tedizolid, fever lysed and the patient improved clinically. Our second patient has end–stage renal failure on hemodialysis. The patient has methicillin-susceptible Staphylococcus aureus (MSSA) catheter-related bloodstream infection. The MSSA isolated was sensitive to vancomycin (MIC=2) and ceftaroline (MIC=0.50), but resistant to daptomycin (MIC=2). Vancomycin was initiated in view of documented drug allergy to ceftriaxone but repeated blood cultures showed the persistence of MSSA. Antibiotics were switched to linezolid for 3 days before switching to tedizolid due to previous neutropenia with linezolid. Blood cultures had documented clearance with tedizolid. Discussion and Conclusion: In both our patients, tedizolid was introduced after a few days of vancomycin therapy. Hence, the efficacy of tedizolid as the first-line therapy for the treatment of staphylococcus bacteremia remains unknown. Nevertheless, in both patients, there was no relapse of staphylococcus bacteremia when tedizolid was used to complete the antibiotic therapy. The optimal treatment duration of staphylococcus bacteremia with tedizolid also remains unknown.

scholarly journals Spontaneous Bacterial Peritonitis Caused byListeria monocytogenesAssociated with Ascitic Fluid Lymphocytosis: A Case Report and Review of Current Empiric Therapy

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Todd Yecies ◽  
Sanae Inagami
Keyword(s):  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Alcoholic Cirrhosis ◽  
Malignant Ascites ◽  
Empiric Therapy ◽  
First Line ◽  
Bacterial Peritonitis ◽  
First Line Therapy ◽  
Line Therapy ◽  
Unusual Finding

Spontaneous bacterial peritonitis (SBP) is a potentially deadly complication of ascites. We describe a case of SBP caused byListeria monocytogenesin a patient with alcoholic cirrhosis. This was associated with the unusual finding of ascitic fluid lymphocytosis, which previously had only been associated with tuberculoid or malignant ascites. Given increasing rates of cefotaxime-resistant SBP alongside the possibility of Listeriosis, the use of cefotaxime as first-line therapy in SBP should be reevaluated.

scholarly journals COMPARISON OF ANTIMICROBIAL SENSITIVITY TO OLDER AND NEWER QUINOLONES VERSUS PIPERACILLIN-TAZOBACTAM, CEFEPIME AND MEROPENEM IN FEBRILE PATIENTS WITH CANCER IN TWO REFERRAL PEDIATRIC CENTERS IN TEHRAN, IRAN

2014 ◽  
Vol 6 (1) ◽  
pp. e2014045 ◽  
Author(s):  
Ali Nateghian ◽  
Joan Robinson ◽  
P. Vosough ◽  
M. Navidinia ◽  
M. Malekanl ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Pediatric Oncology ◽  
Empiric Therapy ◽  
Blood Cultures ◽  
Oncology Patients ◽  
Patients With Cancer ◽  
Antimicrobial Sensitivity ◽  
Pediatric Cancer Patients ◽  
Resistance Patterns ◽  
Antimicrobial Sensitivity Test

Infection in pediatric cancer patients has become a concerning problem due to increasing antimicrobial resistance. The goal of this study was to determine the antimicrobial resistance patterns of blood isolates from pediatric oncology patients in Iran to determine if quinolones are appropriate for empiric therapy. Methods Children with cancer who were admitted with or developed fever during admission to Aliasghar Children’s Hospital or Mahak Hospitals July 2009 through June 2011 were eligible for enrollment. Two blood cultures were obtained.  Antimicrobial sensitivity test was performed for ciprofloxacin, moxifloxacin, gatifloxacin, meropenem, cefepime, and piperacillin-tazobactam on isolates from children who were bacteremic. Results Blood cultures were positive for 39 episodes in 169 enrolled children but 9 episodes were excluded as blood cultures were thought to be contaminated,  yielding a bacteremia rate of 29/160 (18%). The mean age of children and the stage of malignancy did not differ between those with and without bacteremia. Meropenem was the most likely antibiotic to cover isolates (97%) with cefepime having the lowest coverage rate (21%). Quinolone coverage ranged from 63%  to 76%. Conclusion Quinolones are not suitable for use as empiric therapy in febrile pediatric oncology patients in Iran.

scholarly journals Implementation and evaluation of a nurse-driven noninvasive ventilation weaning protocol in infants with severe bronchiolitis

2021 ◽  
Author(s):  
Julie Cassibba ◽  
Marie Chevallier ◽  
ISABELLE PIN ◽  
Aurélie Alexandre ◽  
Alice Fumagalli ◽  
...  
Keyword(s):  
Noninvasive Ventilation ◽  
Ventilatory Support ◽  
First Line ◽  
First Line Therapy ◽  
Lengths Of Stay ◽  
Single Center Study ◽  
Weaning Failure ◽  
Tertiary Center ◽  
Ventilation Weaning ◽  
Homogenous Population

Rationale: Noninvasive ventilation (NIV) is the first-line therapy in infants with bronchiolitis-related acute respiratory failure. However, there is a lack of data regarding weaning from NIV in this setting. Working hypothesis: This study aims to evaluate a nurse-driven weaning protocol in this homogenous population. Study design: A retrospective single-center study with pre-versus-post comparative design in a tertiary center. Methodology: Data from all infants aged ≤ 6 months admitted to the PICU during 2 seasons with a clinical diagnosis of bronchiolitis and requiring any type of noninvasive ventilatory support on admission, were analyzed. Main results: In total, 187 infants (95 with standard and 92 with nurse-driven protocols) were included; the median age was 47 (IQR 24-75) and 31 days (19-58) in patients at baseline and after the protocol implementation, respectively. There was no difference in terms of weaning failure between the two periods (11 (12%) versus 14 (15%), p=0.46). At baseline, the ventilatory support duration was 70 hours (IQR 54-104) versus 56 hours (IQR 29-83) during the nurse-driven protocol period (p=0.29). The PICU and hospital lengths of stay did not differ between the two periods. No complication related to NIV occurred in the two periods. Conclusions: In patients with bronchiolitis supported by NIV, the nurse-driven weaning management - as opposed to physician-driven - was not associated with a significantly higher proportion of weaning failure cases.

scholarly journals 1147. Sentinel Surveillance of Bacterial Pneumonia in Children Under 5 years Treated in HOMI - Fundación Hospital pediatrico la Misericordia in Bogotá, Colombia 2016-2020

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S665-S665
Author(s):  
German Camacho Moreno ◽  
Carolina Duarte Valderrama ◽  
Jacqueline Palacios ◽  
Luz Angela Calvo ◽  
Ivy Talavera ◽  
...  
Keyword(s):  
Disease Surveillance ◽  
Bacterial Pneumonia ◽  
Case Fatality ◽  
Community Acquired Pneumonia ◽  
Blood Cultures ◽  
Sentinel Surveillance ◽  
Surveillance Network ◽  
Probable Case ◽  
The Impact ◽  
Children Under 5

Abstract Background Pneumonia is one of the leading causes of hospitalization and death in children under 5y. The main causes of bacterial pneumonia (BP) are Streptococcus pneumoniae (Spn) and Haemophilus influenzae (Hi). Colombia implemented the Hib vaccine in 1997 with a 3 + 0 scheme and the PCV10 vaccine in 2012, using a 2 + 1 scheme. Sentinel surveillance of BP is carried out at HOMI - Fundación Hospital Pediátrico La Misericordia, which is part of the invasive bacterial vaccine preventable disease surveillance network. Methods A daily active search for cases that met the definitions established in the protocol of the Pan American Health Organization was carried out. All hospitalized patients under 5 years of age with a diagnosis of community acquired pneumonia (ICD10 J10 to J22) were classified as suspected cases, while all suspected cases in which chest X-ray showed a radiological pattern compatible with bacterial pneumonia were considered a probable case. Blood cultures were taken from probable cases; if results were positive (Spn, Hi), the samples were sent to the district and national reference laboratories for confirmation and serotyping. The data obtained in the period January 2016 to December 2020 were analyzed. Results 5272 suspected cases of bacterial pneumonia were found, of which 60% were &lt; 2 y. The highest incidence occurred from March to June (Figure 1). Blood cultures were performed in 2223 (92%) of the 2432 (46.1%) probable cases, confirming 127 (5.2%) cases. Spn, Hi, and other bacteria were found in 55, 27, and 28 cases, respectively (Table 1). Serotyping was performed in 85.4% of the Spn isolates and 77.7% of Hi isolates. The most frequent Spn serotypes were Spn19A in 19 cases (40.4%), Spn3 in 12 cases (25.5%), and Spn14 in 4 cases (8.5%). The presence of Spn19A has increased over time (Figure 2). The most frequent Hi was non-typeable in 13 patients (61.9%), followed by serotype b 6 (28.5%) and serotype a 2 (9.5%). The rate of hospitalization for BP was 9/1000 children &lt; 5 years, and 43 patients died. Case fatality rate was 1.7% among probable cases. Graph 1. Trend of suspected bacterial pneumonia cases in children under 5 years old. HOMI. 2016-2020 Table 1. Bacterial pneumonia isolates. HOMI. 2016 - 2020 Graph 2. Bacterial pneumonia serotypes. HOMI. January 2016 - December 2020 Conclusion BP mainly occurs in 2-year-old children. Spn 19A is the most common bacteria. Although the most frequent Hi is non-typeable, cases of Hib are still observed. Sentinel surveillance allows measuring the impact of public health interventions on this disease. Disclosures German Camacho Moreno, n/a, Pfizer and MSD (Research Grant or Support, Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses)

Sign in / Sign up

Export Citation Format

Share Document