scholarly journals 74. Empiric Antibiotic Therapy and Community-onset Bacterial Co-infection in Patients Hospitalized with COVID-19: A Multi-hospital Cohort Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S167-S168
Author(s):  
Valerie Vaughn ◽  
Tejal N Gandhi ◽  
Lindsay A Petty ◽  
Payal K Patel ◽  
Hallie Prescott ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antibiotic Therapy ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic ◽  
To Receive ◽  
Community Onset ◽  
Blue Shield ◽  
Research Grant

Abstract Background Antibiotic therapy has no known benefit against COVID-19, but is often initiated out of concern for concomitant bacterial infection. We sought to determine how common early empiric antibiotic therapy and community-onset bacterial co-infections are in hospitalized patients with COVID-19. Methods In this multi-center cohort study of hospitalized patients with COVID-19 discharged from 32 Michigan hospitals during the COVID-19 Michigan surge, we describe the use of early empiric antibiotic therapy (within the first two days) and prevalence of community-onset bacterial co-infection. Additionally, we assessed patient and hospital predictors of early empiric antibiotic using poison generalized estimating equation models. Results Between 3/10/2020 and 5/10/2020, data were collected on 951 COVID-19 PCR positive patients. Patient characteristics are described in Table 1. Nearly two thirds (62.4%, 593/951) of COVID-19 positive patients were prescribed early empiric antibiotic therapy, most of which (66.2%, 393/593) was directed at community-acquired pathogens. Across hospitals, the proportion of COVID-19 patients prescribed early empiric antibiotics varied from 40% to 90% (Figure 1). On multivariable analysis, patients were more likely to receive early empiric antibiotic therapy if they were older (adjusted rate ratio [ARR]: 1.01 [1.00–1.01] per year), required respiratory support (e.g., low flow oxygen, ARR: 1.16 [1.04–1.29]), had signs of a bacterial infection (e.g., lobar infiltrate, ARR: 1.17 [1.02–1.34]), or were admitted to a for-profit hospital (ARR: 1.27 [1.11–1.45]); patients admitted later were less likely to receive empiric antibiotics (April vs. March, ARR: 0.72 [0.62–0.84], Table 2). Community-onset bacterial co-infections were identified in 4.5% (43/951) of COVID-19 positive patients (2.4% [23/951] positive blood culture; 1.9% [18/951] positive respiratory culture). Conclusion Despite low prevalence of community-onset bacterial co-infections, patients hospitalized with COVID-19 often received early empiric antibiotic therapy. Given the potential harms from unnecessary antibiotic use, including additional personal protective equipment to administer antibiotics, judicious antibiotic use is key in hospitalized patients with COVID-19. Disclosures Tejal N. Gandhi, MD, Blue Cross Blue Shield of Michigan (Grant/Research Support) Scott A. Flanders, MD, Agency for Healthcare Research and Quality (Research Grant or Support)Blue Cross Blue Shield of Michigan (Research Grant or Support)

scholarly journals Local audit of empiric antibiotic therapy in bacteremia: A retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248817
Author(s):  
Anthony D. Bai ◽  
Neal Irfan ◽  
Cheryl Main ◽  
Philippe El-Helou ◽  
Dominik Mertz
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Blood Culture ◽  
Antibiotic Therapy ◽  
Retrospective Cohort Study ◽  
Clinical Pathway ◽  
Retrospective Cohort ◽  
Negative Likelihood Ratio ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic

Background It is unclear if a local audit would be useful in providing guidance on how to improve local practice of empiric antibiotic therapy. We performed an audit of antibiotic therapy in bacteremia to evaluate the proportion and risk factors for inadequate empiric antibiotic coverage. Methods This retrospective cohort study included patients with positive blood cultures across 3 hospitals in Hamilton, Ontario, Canada during October of 2019. Antibiotic therapy was considered empiric if it was administered within 24 hours after blood culture collection. Adequate coverage was defined as when the isolate from blood culture was tested to be susceptible to the empiric antibiotic. A multivariable logistic regression model was used to predict inadequate empiric coverage. Diagnostic accuracy of a clinical pathway based on patient risk factors was compared to clinician’s decision in predicting which bacteria to empirically cover. Results Of 201 bacteremia cases, empiric coverage was inadequate in 56 (27.9%) cases. Risk factors for inadequate empiric coverage included unknown source at initiation of antibiotic therapy (adjusted odds ratio (aOR) of 2.76 95% CI 1.27–6.01, P = 0.010) and prior antibiotic therapy within 90 days (aOR of 2.46 95% CI 1.30–4.74, P = 0.006). A clinical pathway that considered community-associated infection as low risk for Pseudomonas was better at ruling out Pseudomonas bacteremia with a negative likelihood ratio of 0.17 (95% CI 0.03–1.10) compared to clinician’s decision with negative likelihood ratio of 0.34 (95% CI 0.10–1.22). Conclusions An audit of antibiotic therapy in bacteremia is feasible and may provide useful feedback on how to locally improve empiric antibiotic therapy.

Factors associated with suitability of empiric antibiotic therapy in hospitalized patients with bloodstream infections

2016 ◽  
Vol 29 (3) ◽  
pp. 159-163 ◽  
Author(s):  
Chagai Grossman ◽  
Nathan Keller ◽  
Gil Bornstein ◽  
Ilan Ben-Zvi ◽  
Nira Koren-Morag ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Bloodstream Infections ◽  
Hospitalized Patients ◽  
Empiric Antibiotic Therapy ◽  
Factors Associated ◽  
Empiric Antibiotic

scholarly journals Prolonged antibiotic use induces intestinal injury in mice that is repaired after removing antibiotic pressure: implications for empiric antibiotic therapy

Metabolomics ◽  
2013 ◽  
Vol 10 (1) ◽  
pp. 8-20 ◽  
Author(s):  
Lindsey E. Romick-Rosendale ◽  
Anne Legomarcino ◽  
Neil B. Patel ◽  
Ardythe L. Morrow ◽  
Michael A. Kennedy
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Use ◽  
Intestinal Injury ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic

scholarly journals Population-Level Burden of Delayed or In Vitro Discordant Empiric Antibiotics Among Bacteremic Patients at US Hospitals

2020 ◽  
Vol 41 (S1) ◽  
pp. s44-s45
Author(s):  
Sameer Kadri ◽  
Yi Ling Lai ◽  
Sarah Warner ◽  
Jeffrey R. Strich ◽  
Ahmed Babiker ◽  
...  
Keyword(s):  
Septic Shock ◽  
Antibiotic Therapy ◽  
Population Level ◽  
Empiric Antibiotic Therapy ◽  
Teaching Hospitals ◽  
Antibiotic Resistant ◽  
Empiric Antibiotic ◽  
Resistance Patterns ◽  
To Receive

Background: Delayed or in vitro inactive empiric antibiotic therapy may be detrimental to survival in patients with bloodstream infections (BSIs). Understanding the landscape of delayed or discordant empiric antibiotic therapy (DDEAT) across different patient, pathogen, and hospital types, as well as by their baseline resistance milieu, may enable providers, antimicrobial stewardship programs, and policy makers to optimize empiric prescribing. Methods: Inpatients with clinically suspected serious infection (based on sampling of blood cultures and receiving systemic antibiotic therapy on the same or next day) found to have BSI were identified in the Cerner Healthfacts EHR database. Patients were considered to have received DDEAT when, on culture sampling day, they received either no antibiotic(s) or none that displayed in vitro activity against the pathogenic bloodstream isolate. Antibiotic-resistant phenotypes were defined by in vitro resistance to taxon-specific prototype antibiotics (eg, methicillin/oxacillin resistance in S. aureus) and were used to estimate baseline resistance prevalence encountered by the hospital. The probability of DDEAT was examined by bacterial taxon, by time of BSI onset, and by presence versus absence of antibiotic-resistance phenotypes, sepsis or septic shock, hospital type, and baseline resistance. Results: Of 26,036 assessable patients with a BSI at 131 US hospitals between 2005 and 2014, 14,658 (56%) had sepsis, 3,623 (14%) had septic shock, 5,084 (20%) had antibiotic-resistant phenotypes, and 8,593 (33%) received DDEAT. Also, 4,428 (52%) recipients of DDEAT received no antibiotics on culture sampling day, whereas the remaining 4,165 (48%) received in vitro discordant therapy. DDEAT occurred most often in S. maltophilia (87%) and E. faecium (80%) BSIs; however, 75% of DDEAT cases and 76% of deaths among recipients of DDEAT collectively occurred among patients with S. aureus and Enterobacteriales BSIs. For every 8 bacteremic patients presenting with septic shock, 1 patient did not receive any antibiotics on culture day (Fig. 1A). Patients with BSIs of hospital (vs community) onset were twice as likely to receive no antibiotics on culture day, whereas those with bloodstream pathogens displaying antibiotic-resistant (vs susceptible) phenotypes were 3 times as likely to receive in vitro discordant therapy (Fig. 1B). The median proportion of DDEAT ranged between 25% (14, 37%) in eight <300-bed teaching hospitals in the lowest baseline resistance quartile and 40% (31, 50%) at five ≥300-bed teaching hospitals in the third baseline resistance quartile (Fig. 2). Conclusions: Delayed or in vitro discordant empiric antibiotic therapy is common among patients with BSI in US hospitals regardless of hospital size, teaching status, or local resistance patterns. Prompt empiric antibiotic therapy in septic shock and hospital-onset BSI needs more support. Reliable detection of S. aureus and Enterobacteriales bloodstream pathogens and their resistance patterns earlier with rapid point-of-care diagnostics may mitigate the population-level impact of DDEAT in BSI.Funding: This study was funded in part by the National Institutes of Health Clinical Center, National Institutes of Allergy and Infectious Diseases, National Cancer Institute (NCI contract no. HHSN261200800001E) and the Agency for Healthcare Research and Quality.Disclosures: None

Targeted empiric antibiotic therapy for children with non-oncological comorbidities and community-onset invasive bacterial infections

2015 ◽  
Vol 71 (3) ◽  
pp. 294-301 ◽  
Author(s):  
Rosy Wells ◽  
Kirsty Le Doare ◽  
Mike Sharland ◽  
Paul Heath ◽  
Shamez N. Ladhani ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Infections ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic ◽  
Community Onset

Management of infants born to mothers with chorioamnionitis: A retrospective comparison of the three approaches recommended by the committee on fetus and newborn

2020 ◽  
pp. 1-8
Author(s):  
A.J. Sloane ◽  
D.L. Carola ◽  
M.A. Lafferty ◽  
C. Edwards ◽  
J. Greenspan ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Antibiotic Therapy ◽  
Clinical Condition ◽  
Vital Signs ◽  
Antibiotic Use ◽  
Risk Assessments ◽  
Empiric Antibiotic Therapy ◽  
Early Onset Sepsis ◽  
Increased Risk ◽  
Empiric Antibiotic

BACKGROUND: Based on the most recently published recommendations from the Committee on the Fetus and Newborn (COFN), three approaches currently exist for the use of risk factors to identify infants who are at increased risk of early-onset sepsis (EOS). Categorical risk factor assessments recommend laboratory testing and empiric antibiotic therapy for all infants born to mothers with a clinical diagnosis of chorioamnionitis. Risk assessments based on clinical condition recommend frequent examinations and close vital sign monitoring for infants born to mothers with chorioamnionitis. The Kaiser Permanente EOS risk calculator (SRC) is an example of the third approach, multivariate risk assessments. The aim of our study was to compare the three risk stratification approaches recommended by the COFN for management of chorioamnionitis-exposed infants. METHODS: Retrospective study of 1,521 infants born ≥35 weeks to mothers with chorioamnionitis. Management recommendations of the SRC were compared to the recommendations of categorical risk assessment and risk assessment based on clinical condition (CCA). RESULTS: Hypothetical application of SRC and CCA resulted in 79.6% and 76.8–85.1% respectively fewer infants allocated empiric antibiotic therapy. While CCA recommended enhanced observation for all chorioamnionitis-exposed infants, SRC recommended routine care without enhanced observation in 44.3% infants. For the six infants (0.39%) with EOS, SRC and CCA recommended empiric antibiotics only for three symptomatic infants. CONCLUSION: The SRC and CCA can reduce antibiotic use but potentially delay antibiotic treatment. The SRC does not recommend enhanced observation with frequent and prolonged vital signs for >44% of chorioamnionitis-exposed infants.

scholarly journals Discontinuation of Glycopeptides in Patients with Culture Negative Severe Sepsis or Septic Shock: A Propensity-Matched Retrospective Cohort Study

Antibiotics ◽  
2020 ◽  
Vol 9 (5) ◽  
pp. 250
Author(s):  
Yong Chan Kim ◽  
Jung Ho Kim ◽  
Jin Young Ahn ◽  
Su Jin Jeong ◽  
Nam Su Ku ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Cohort Study ◽  
Antibiotic Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic ◽  
The Impact ◽  
Culture Negative

Implementation of antibiotic stewardship is difficult in patients with sepsis because of severity of disease. We evaluated the impact of glycopeptide discontinuation (GD) in patients with culture negative severe sepsis or septic shock who received glycopeptides as initial empiric antibiotic therapy at admission. We conducted a single center retrospective cohort study between January 2010 and March 2018. GD was defined as discontinuation of initial empiric glycopeptides on availability of culture results, revealing the absence of identified pathogens. In 92 included patients, the leading causes of sepsis were pneumonia (34.8%) and intra-abdominal infection (23.9%); 28-day mortality and overall mortality were 14% and 21%, respectively. Glycopeptides were discontinued in 42/92 patients. After propensity score matching, baseline characteristics were not significantly different between the GD and non-GD (GND) groups. GND was associated with development of acute kidney injury (OR 5.54, 95% CI 1.49–20.6, P = 0.011). GD did not increase the 7-day, 14-day, and 28-day mortality compared with GND. The length of hospital stay was shorter in the GD group than in GND group (16.33 ± 17.11 vs. 25.05 ± 14.37, P = 0.082), though not statistically significant. GD may be safe and reduce adverse events of prolonged antibiotic use in patients with culture negative severe sepsis or septic shock receiving glycopeptides as initial empiric antibiotic therapy.

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