scholarly journals 226. Evaluating the Unnecessary Use of Intravenous Broad-Spectrum Antibiotics in Patients Based on Systemic Inflammatory Response Syndrome Criteria in the Emergency Department (ED)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S114-S114
Author(s):  
Esther Y Bae ◽  
Marguerite Monogue ◽  
Tiffeny T Smith
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Bacterial Infection ◽  
Broad Spectrum ◽  
Bacterial Infections ◽  
Antibiotic Use ◽  
Systemic Inflammatory Response ◽  
Broad Spectrum Antibiotic ◽  
Suspected Sepsis ◽  
Broad Spectrum Antibiotics

Abstract Background Recognition of sepsis frequently occurs in the ED. To demonstrate the need to optimize antibiotic use for suspected sepsis and evaluate the reliability of systemic inflammatory response syndrome (SIRS) criteria in predicting bacterial infection, we quantified the rate of unnecessary intravenous (IV) broad-spectrum antibiotic use for suspected sepsis in the ED at an academic medical center. Methods Adult patients who were admitted to the ED between January 2018 and June 2018 with suspected sepsis (≥ 2 SIRS) and received ≥ 1 dose of IV broad-spectrum antibiotic were included in this retrospective study. The presence of bacterial infection was determined using Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) definitions, microbiologic, radiographic, and laboratory findings. Suspected infections lacked microbiologic data. The primary outcome was the percentage of confirmed and suspected infections. Secondary outcomes included 90-day Clostridioides difficile infection (CDI) and 90-day drug-resistant organism (DRO) infections. Results A total of 218 patients were included. The percentages of confirmed/suspected and absence of bacterial infections were 63.8% and 36.2%, respectively. Elevated SIRS (≥ 2) and Quick Sequential Organ Failure Assessment (qSOFA; ≥ 2) scores were not associated with the presence of bacterial infections. 82% of patients were discharged from the ED. Antibiotic exposure in days of therapy in the ED and/or hospital admission did not significantly vary between patients with confirmed/suspected bacterial infection and those with absence of bacterial infections. Among patients who lacked evidence of bacterial infections, 44% were prescribed outpatient antibiotics after being discharged from the ED. 90-day CDI and DRO infections were identified in 7 and 6 patients, respectively, regardless of the presence of bacterial infections. Table 1. Baseline demographics of patients admitted to the ED with suspected sepsis Conclusion A third of the patients with suspected sepsis received IV broad-spectrum antibiotics in the ED but ultimately lacked bacterial infection. Our findings suggest that identification of bacterial infection and patients with sepsis using SIRS or qSOFA lack specificity and can lead to the overuse of unnecessary antibiotics in the ED. Disclosures All Authors: No reported disclosures

Quantifying Empiric Antibiotic Use in US Children’s Hospitals

2021 ◽  
Author(s):  
Kathleen Chiotos ◽  
Lauren D’Arinzo ◽  
Eimear Kitt ◽  
Rachael Ross ◽  
Jeffrey S. Gerber
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
Level Variation ◽  
Hospital Level ◽  
Broad Spectrum Antibiotic ◽  
Children's Hospitals ◽  
Broad Spectrum Antibiotics ◽  
Children’S Hospitals ◽  
Days Of Therapy ◽  
Rule Out

OBJECTIVES Empirical broad-spectrum antibiotics are routinely administered for short durations to children with suspected bacteremia while awaiting blood culture results. Our aim for this study was to estimate the proportion of broad-spectrum antibiotic use accounted for by these “rule-outs.” METHODS The Pediatric Health Information System was used to identify children aged 3 months to 20 years hospitalized between July 2016 and June 2017 who received broad-spectrum antibiotics for suspected bacteremia. Using an electronic definition for a rule-out, we estimated the proportion of all broad-spectrum antibiotic days of therapy accounted for by this indication. Clinical and demographic characteristics, as well as antibiotic choice, are reported descriptively. RESULTS A total of 67 032 episodes of suspected bacteremia across 42 hospitals were identified. From these, 34 909 (52%) patients were classified as having received an antibiotic treatment course, and 32 123 patients (48%) underwent an antibiotic rule-out without a subsequent treatment course. Antibiotics prescribed for rule-outs accounted for 12% of all broad-spectrum antibiotic days of therapy. Third-generation cephalosporins and vancomycin were the most commonly prescribed antibiotics, and substantial hospital-level variation in vancomycin use was identified (range: 16%–58% of suspected bacteremia episodes). CONCLUSIONS Broad-spectrum intravenous antibiotic use for rule-out infections appears common across children’s hospitals, with substantial hospital-level variation in the use of vancomycin in particular. Antibiotic stewardship programs focused on intervening on antibiotics prescribed for longer durations may consider this novel opportunity to further standardize antibiotic regimens and reduce antibiotic exposure.

scholarly journals Laboratory Diagnosis of Sepsis? No SIRS, Not Just Yet

2015 ◽  
Vol 53 (8) ◽  
pp. 2404-2409 ◽  
Author(s):  
W. Michael Dunne
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Laboratory Diagnosis ◽  
Systemic Inflammatory Response ◽  
Performance Characteristics ◽  
Suspected Sepsis ◽  
Inappropriate Use ◽  
Microbiological Testing

In order to maximize the benefit of prompt antimicrobial therapy and avoid the risk associated with inappropriate use of antimicrobial agents, patients with suspected sepsis must be rapidly differentiated from patients with systemic inflammatory response syndrome (SIRS). In combination with standard microbiological testing, a number of biomarkers have been recently evaluated for this purpose, and the performance characteristics of the most promising of these are reviewed.

scholarly journals Outcomes and antibiotic use in patients with coronavirus disease 2019 (COVID-19) admitted to an intensive care unit

2022 ◽  
Vol 2 (1) ◽  
Author(s):  
Megan M. Petteys ◽  
Leigh Ann Medaris ◽  
Julie E. Williamson ◽  
Rohit S. Soman ◽  
Travis A. Denmeade ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Broad Spectrum ◽  
Bacterial Infections ◽  
Antibiotic Use ◽  
Antibiotic Overuse ◽  
Negative Culture ◽  
Broad Spectrum Antibiotics

Abstract Antibiotic overuse is high in patients hospitalized with coronavirus disease 2019 (COVID-19) despite a low documented prevalence of bacterial infections in many studies. In this study evaluating 65 COVID-19 patients in the intensive care unit, empiric broad-spectrum antibiotics were often overutilized with an inertia to de-escalate despite negative culture results.

scholarly journals Broad-spectrum antibiotic use and poor outcomes in community-onset pneumonia: a cohort study

2019 ◽  
Vol 54 (1) ◽  
pp. 1900057 ◽  
Author(s):  
Brandon J. Webb ◽  
Jeff Sorensen ◽  
Al Jephson ◽  
Ian Mecham ◽  
Nathan C. Dean
Keyword(s):  
Cohort Study ◽  
Broad Spectrum ◽  
Antibiotic Use ◽  
Average Treatment Effect ◽  
Broad Spectrum Antibiotic ◽  
Clostridioides Difficile ◽  
Broad Spectrum Antibiotics ◽  
Poor Outcomes ◽  
Healthcare Associated ◽  
Community Onset

QuestionIs broad-spectrum antibiotic use associated with poor outcomes in community-onset pneumonia after adjusting for confounders?MethodsWe performed a retrospective, observational cohort study of 1995 adults with pneumonia admitted from four US hospital emergency departments. We used multivariable regressions to investigate the effect of broad-spectrum antibiotics on 30-day mortality, length of stay, cost and Clostridioides difficile infection (CDI). To address indication bias, we developed a propensity score using multilevel (individual provider) generalised linear mixed models to perform inverse-probability of treatment weighting (IPTW) to estimate the average treatment effect in the treated. We also manually reviewed a sample of mortality cases for antibiotic-associated adverse events.Results39.7% of patients received broad-spectrum antibiotics, but drug-resistant pathogens were recovered in only 3%. Broad-spectrum antibiotics were associated with increased mortality in both the unweighted multivariable model (OR 3.8, 95% CI 2.5–5.9; p<0.001) and IPTW analysis (OR 4.6, 95% CI 2.9–7.5; p<0.001). Broad-spectrum antibiotic use by either analysis was also associated with longer hospital stay, greater cost and increased CDI. Healthcare-associated pneumonia was not associated with mortality independent of broad-spectrum antibiotic use. In manual review we identified antibiotic-associated events in 17.5% of mortality cases.ConclusionBroad-spectrum antibiotics appear to be associated with increased mortality and other poor outcomes in community-onset pneumonia.

scholarly journals Incidence, risk factors, phathophisiology and modern aspects of therapy of feline pyometra

2019 ◽  
pp. 54-60
Author(s):  
Georgy Petrovich Dyulger ◽  
Yuliya Gennadievna Sibileva ◽  
Maria Aleksandrovna Yakovleva Maria ◽  
Peter Georgievich Dyulger ◽  
Evgeniya Sergeevna Sedletskaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Early Detection ◽  
Inflammatory Response ◽  
Broad Spectrum ◽  
Clinical Manifestations ◽  
Systemic Inflammatory Response ◽  
Clinical Forms ◽  
Broad Spectrum Antibiotics ◽  
Incidence Risk

The article provides an overview of the frequency of distribution of pyometra in cats. Risk factors, clinical manifestations and clinical forms of the disease are analyzed. Current methods of pyometra diagnostics and clinical and laboratory criteria for early detection of signs of sepsis (systemic inflammatory response) in cats with pyometra are considered. The methods of pyometra therapy are analyzed. It was emphasized that the most effective and safest method of treating any form of pyometra is a total ovariohisterectomy in combination with broad-spectrum antibiotics. Encouraging results in the treatment of an open uncomplicated form of pyometers in cats were obtained using, along with antibiotics, preparations based on PgF2alfa and aglepristone.

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