scholarly journals Antibiotic Therapy for Pseudomonas aeruginosa Bloodstream Infections: How Long Is Long Enough?

2019 ◽  
Vol 69 (11) ◽  
pp. 2011-2014 ◽  
Author(s):  
Valeria Fabre ◽  
Joe Amoah ◽  
Sara E Cosgrove ◽  
Pranita D Tamma
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Propensity Score ◽  
Antibiotic Therapy ◽  
Recurrent Infection ◽  
Bloodstream Infections ◽  
Interquartile Range ◽  
Short Course

Abstract In a multicenter, observational, propensity-score–weighted cohort of 249 adults with uncomplicated Pseudomonas aeruginosa bacteremia, patients receiving short-course (median, 9 days; interquartile range [IQR], 8–10) therapy had a similar odds of recurrent infection or death within 30 days as those receiving longer courses (median, 16 days; IQR, 14–17).

scholarly journals 212. Outcomes of Adults with Uncomplicated Staphylococcus aureus Bacteremia Receiving Short-Course Vs. Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score–Matched Cohort

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S125-S126
Author(s):  
Louise Thorlacius-Ussing ◽  
Jette Nissen ◽  
Jon J Rasmussen ◽  
Robert Skov ◽  
Magnus Arpi ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Propensity Score ◽  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Nearest Neighbor ◽  
Bloodstream Infections ◽  
Staphylococcus Aureus Bacteremia ◽  
Short Course ◽  
Short Courses

Abstract Background The recommended duration of antibiotic treatment for uncomplicated Staphylococcus aureus bloodstream infections is 14 days. We compared the outcomes of patients receiving short-course (6–10 days) vs. prolonged-course (11–16 days) antibiotic therapy for S. aureus bacteremia (SAB). Methods 30-day outcome of patients with penicillin (PSSAB, n = 202)) or methicillin-susceptible SAB (MSSAB, n = 203) treated with in vitro active therapy in the range of 6–16 days was analyzed using pooled data from two previously published, observational studies. Individuals were matched 1:1 by nearest neighbor propensity score matching without replacement. Regression analysis was performed to estimate the risk of all-cause mortality within 30 days after the end of antibiotic treatment. Eligible individuals had to have >1 day of follow-up after discontinuation of antimicrobials. Individuals with a diagnosis of endocarditis, bone infection, meningitis or pneumonia were excluded. Results There were 107 well-balanced matched pairs; 58 in the PSSAB and 39 in the MSSAB cohort. For PSSAB, the median duration of therapy was 8 (interquartile range [IQR], 7–10) in the short-course group and 12 days (IQR, 10–13) in the prolonged-course group. For the MSSAB cohort, these numbers were 9 days (IQR, 7–10) and 14 days (IQR, 13–16 days), respectively. No difference in mortality between short-course and prolonged-course treatment was observed (adjusted hazard ratio [aHR], 0.74; 95% confidence interval [CI], .23–2.41) and 1.14; 95% CI, 0.31–4.20), respectively for PSSAB and MSSAB. Conclusion Short courses of antibiotic therapy yielded similar clinical outcomes as prolonged courses of antibiotic therapy for S. aureus bacteremia. The findings warrant a randomized clinical trial to study the safety and efficacy of shortened antimicrobial therapy for the treatment of uncomplicated SAB. Disclosures All authors: No reported disclosures.

scholarly journals 195. Duration of Therapy for Streptococcal Bacteremia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S205-S205
Author(s):  
John M Boulos ◽  
Valeria Fabre ◽  
Kate Dzintars ◽  
Kate Dzintars ◽  
George Jones ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Hospital Readmission ◽  
Primary Outcome ◽  
Bloodstream Infections ◽  
Multivariable Logistic Regression Analysis ◽  
Eligibility Criteria ◽  
Short Course ◽  
All Cause Mortality ◽  
Long Course

Abstract Background Shorter durations have shown similar clinical outcomes as longer durations for uncomplicated (source-controlled) Gram-negative bloodstream infections (BSI). There is limited data on the outcomes of patients with non-pneumococcal streptococcal BSI receiving shorter durations of therapy compared to usual durations. Methods This was a retrospective, multicenter study of adults hospitalized between January 2018 and March 2019 with ≥ 1 blood culture positive for Streptococcus spp. Exposed patients were those who received ≤ 10 days of antibiotics (i.e., short course therapy) and unexposed patients were those who received 11-21 days of antibiotics (i.e., prolonged course therapy). Patients were excluded if they had S. pneumoniae BSI, suspected contamination, did not receive or complete therapy, or treated for > 21 days. The primary outcome was a composite of recurrent bacteremia with the same pathogen, hospital readmission, or all-cause mortality, all within 30 days from completing therapy. The odds of achieving the primary outcome was compared between exposed and unexposed patients using multivariable logistic regression analysis. Results A total of 176 patients met eligibility criteria. 35 (20%) received a short course (median 8 days) and 141 (80%) received a prolonged course (median 15 days) of antibiotic therapy. Baseline characteristics were similar between short and long course groups. The most common pathogens were viridans group streptococci (22%) and S. agalactiae (23%). The most common BSI source was skin and soft tissue infection (SSTI) (40%). The primary outcome occurred in 26% (9/35) and 23% (33/141) of patients in the short course and prolonged course groups, respectively (p = 0.774). The proportion of patients in the short course and prolonged course groups who experienced recurrent BSI, hospital readmission, or all-cause mortality were also non-significant. After adjusting for receipt of an infectious diseases consult, Pitt bacteremia score, and SSTI source, the adjusted odds of meeting the composite outcome remained unchanged (aOR 1.41, 95% CI 0.55 – 3.61, p = 0.466). Table 1. Cohort Characteristics Table 2. Source/Microbiology Table 3. Outcomes Conclusion Approximately a week of antibiotic therapy may be associated with similar clinical outcomes as longer antibiotics courses in patients with uncomplicated streptococcal BSI. Disclosures Kate Dzintars, PharmD, Nothing to disclose Sara E. Cosgrove, MD, MS, Basilea (Individual(s) Involved: Self): Consultant Pranita Tamma, MD, MHS, Nothing to disclose

scholarly journals Comparing the Outcomes of Adults With Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score–Matched Cohort

2017 ◽  
Vol 66 (2) ◽  
pp. 172-177 ◽  
Author(s):  
Darunee Chotiprasitsakul ◽  
Jennifer H Han ◽  
Sara E Cosgrove ◽  
Anthony D Harris ◽  
Ebbing Lautenbach ◽  
...  
Keyword(s):  
Propensity Score ◽  
Antibiotic Therapy ◽  
Matched Cohort ◽  
Short Course

scholarly journals Predictors of 30-Day Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: Impact of Delayed Appropriate Antibiotic Selection

2007 ◽  
Vol 51 (10) ◽  
pp. 3510-3515 ◽  
Author(s):  
Thomas P. Lodise ◽  
Nimish Patel ◽  
Andrea Kwa ◽  
Jeffrey Graves ◽  
Jon P. Furuno ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Treatment Group ◽  
Antibiotic Therapy ◽  
Bloodstream Infections ◽  
Classification And Regression Tree ◽  
Temporal Association ◽  
Chronic Obstructive ◽  
Delayed Treatment ◽  
Increased Risk ◽  
Appropriate Therapy

ABSTRACT Although a growing number of studies have found a relationship between delayed appropriate antibiotic therapy and mortality, few have attempted to quantify the temporal association between delayed appropriate antibiotic therapy and mortality. This study was designed to measure the elapsed time associated with an increased risk of 30-day mortality among patients with Pseudomonas aeruginosa bacteremia. The retrospective cohort study was conducted among immunocompetent, adult patients with P. aeruginosa bacteremia onset at least 2 days after hospital admission between 1 January 2001 and 30 September 2006. Classification and regression tree analysis (CART) was used to identify the delay in appropriate antibiotic therapy that was associated with an increased risk of 30-day mortality. During the study period, 100 patients met the inclusion criteria. The CART-derived breakpoint between early and delayed treatment was 52 h. The delayed treatment group experienced a >2-fold significant increase in 30-day mortality compared to the early treatment group (44 and 19%, respectively, P = 0.008). Delayed appropriate therapy of >52 h (odds ratio [OR] = 4.1; 95% confidence interval [CI] 1.2 to 13.9, P = 0.03) was independently associated with 30-day mortality in the multivariate analysis. Antibiotic resistance ≥3 classes (adjusted OR [AOR] = 4.6; 95% CI = 1.9 to 11.2, P = 0.001) and chronic obstructive pulmonary disease (AOR = 5.4; 95% CI = 1.5 to 19.7, P = 0.01) were independently associated with delayed appropriate therapy of >52 h. The data strongly suggest that delaying appropriate therapy for approximately 2 days significantly increases the risk of 30-day mortality in patients with P. aeruginosa bloodstream infections.

scholarly journals Impairment of Validity of Comparison Between Short-Course and Prolonged-Course Antibiotic Therapy Using Propensity Score Matching

2018 ◽  
Vol 66 (12) ◽  
pp. 1978-1978 ◽  
Author(s):  
Kentaro Tochitani ◽  
Tatsuyoshi Ikenoue ◽  
Shungo Yamamoto ◽  
Yosuke Yamamoto
Keyword(s):  
Propensity Score ◽  
Antibiotic Therapy ◽  
Propensity Score Matching ◽  
Short Course

scholarly journals Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?

2020 ◽  
Vol 9 (2) ◽  
pp. 514
Author(s):  
María Milagro Montero ◽  
Inmaculada López Montesinos ◽  
Hernando Knobel ◽  
Ema Molas ◽  
Luisa Sorlí ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
High Risk ◽  
Antibiotic Therapy ◽  
Antimicrobial Therapy ◽  
Protective Factor ◽  
Bloodstream Infections ◽  
Clinical Severity ◽  
Risk Source ◽  
The Impact

This study aimed to assess the impact of extensively drug-resistant (XDR) phenotype on mortality in Pseudomonas aeruginosa bacteremia. A retrospective cohort study was performed in a tertiary hospital from January 2000 to December 2018. All consecutive prospectively recorded P. aeruginosa bacteremia in adult patients were assessed. In this study, 382 patients were included, of which 122 (31.9%) due to XDR P. aeruginosa. Independent factors associated with 14-day mortality were as follows: high-risk source of bacteremia (hazard ratio (HR) 3.07, 95% confidence interval (CI), 1.73–5.46), septic shock (HR 1.75, 95% CI, 1.12–2.75), and higher Pitt scores (one-point increments; HR 1.25, 95% CI, 1.12–1.38). Otherwise, the appropriateness of definitive antibiotic therapy was a protective factor (HR 0.39, 95% CI, 0.24–0.62). The same variables were also associated with 30-day mortality. XDR phenotype was not associated with 14- or 30-day mortality. In a subanalysis considering only high-risk source cases, combined antimicrobial therapy was independently associated with 14-day favorable outcome (HR 0.56, 95% CI, 0.33–0.93). In conclusion, XDR phenotype was not associated with poor prognosis in patients with P. aeruginosa bacteremia in our cohort. However, source of infection, clinical severity, and inappropriate definitive antibiotic therapy were risk factors for mortality. Combined antimicrobial therapy should be considered for high-risk sources.

Recurrent infection with Pseudomonas aeruginosa in a chronic venous leg ulcer

Infectio ro ◽  
2017 ◽  
Vol 3 (51) ◽  
Author(s):  
Mădălina Irina Mitran ◽  
Cristina Iulia Mitran ◽  
Mircea Tampa ◽  
Maria Isabela Sârbu ◽  
Alexandra Mihaela Popa ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Recurrent Infection ◽  
Leg Ulcer ◽  
Venous Leg Ulcer

scholarly journals Colour Me Blue: The History and the Biotechnological Potential of Pyocyanin

Molecules ◽  
2021 ◽  
Vol 26 (4) ◽  
pp. 927
Author(s):  
Thiago Gonçalves ◽  
Ulrich Vasconcelos
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Antibiotic Therapy ◽  
Electric Current ◽  
Antimicrobial Therapy ◽  
Blue Colour ◽  
Current Generation ◽  
Biotechnological Potential ◽  
Avant Garde ◽  
New Horizons ◽  
The Subject

Pyocyanin was the first natural phenazine described. The molecule is synthesized by about 95% of the strains of Pseudomonas aeruginosa. From discovery up to now, pyocyanin has been characterised by a very rich and avant-garde history, which includes its use in antimicrobial therapy, even before the discovery of penicillin opened the era of antibiotic therapy, as well as its use in electric current generation. Exhibiting an exuberant blue colour and being easy to obtain, this pigment is the subject of the present review, aiming to narrate its history as well as to unveil its mechanisms and suggest new horizons for applications in different areas of engineering, biology and biotechnology.

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