scholarly journals 345. Early Oral Therapy for Streptococcus anginosus Purulent Brain Infections: A Single Center Experience

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S242-S242
Author(s):  
Daniel S Dodson ◽  
Heather R Heizer ◽  
James Gaensbauer
Keyword(s):  
Oral Therapy ◽  
Fluid Collection ◽  
Positive Culture ◽  
Central Line ◽  
Oral Antibiotic ◽  
Inclusion Criteria ◽  
Exact Test ◽  
Streptococcus Anginosus ◽  
Days Of Therapy ◽  
Antibiotic Failure

Abstract Background Pediatric Streptococcus anginosus intracranial pyogenic are commonly treated with prolonged intravenous (IV) antibiotics, exposing patients to risks of a long-term central catheter. Antibiotics with high oral bioavailability, such as levofloxacin, may allow early oral transition. Methods To characterize patients with S. anginosus intracranial infections transitioned to oral therapy, we performed a retrospective review at Children’s Hospital Colorado from 1/2004 to 2/2019. Inclusion criteria were radiologic evidence of an infected parenchymal, subdural, or epidural fluid collection AND a positive culture for S. anginosus from an intracranial source, specific extracranial sources (sinus, scalp, orbit), or blood. The primary endpoint was oral antibiotic failure defined as worsening infection on oral therapy. Comparisons were done using Fisher’s exact test. Results 94 patients met inclusion criteria, 57 of whom were transitioned to oral therapy during treatment. Oral levofloxacin was used in 54 of the 57. 12% of oral transitions occurred in the first 14 days of therapy (range 3–8 days), and 35% in the first 28 days. Patients transitioned in the first 28 days were more likely to have an epidural collection (p:< 0.01), and less likely to have a subdural collection (p: 0.03) or brain abscess (p:< 0.01). Of the 57, none had oral antibiotic failure. Contributing reasons for oral transition included central line complications (18%), IV medication reaction (18%), hematologic abnormality presumed secondary to IV antibiotics (33%), and provider judgement (56%). Two patients required re-introduction of IV therapy for reasons other than clinical failure (one for medication non-adherence and one for adverse reaction to levofloxacin). Conclusion We observed success and tolerance of levofloxacin-based oral therapy for pediatric pyogenic intracranial S. anginosus brain infections and confirmed the frequent occurrence of adverse events associated with IV treatment. Transition to oral therapy should be considered, particularly if complications of IV therapy arise in treatment of an epidural infection. A subset of patients in our study transitioned within the first 14 days of therapy; prospective studies are needed to characterize the safety of such very early transition. Disclosures All Authors: No reported disclosures

scholarly journals 308. Re-purposing Beta-lactam Antibiotics as Fluoroquinolone Sparing Stepdown Therapy for the Treatment of Enterobacteriales Bloodstream Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S151-S152
Author(s):  
Matthew Davis ◽  
Dayna McManus ◽  
Michael Ruggero ◽  
Jeffrey E Topal
Keyword(s):  
Positive Culture ◽  
Retrospective Chart Review ◽  
Bloodstream Infections ◽  
Central Line ◽  
Cost Of Care ◽  
Cns Infection ◽  
Oral Antibiotic ◽  
Beta Lactam ◽  
Clostridioides Difficile ◽  
Secondary Outcomes

Abstract Background Oral antimicrobial therapy for Enterobacteriales bloodstream infection (EB-BSI) is advantageous to reduce the risk of central line complications, cost of care, and length of stay. Fluoroquinolones (FQ) given their high bioavailability have been utilized as the standard for stepdown therapy (SDT) for EB-BSI. Given the recent increased warnings around FQ use including Clostridioides difficile infection (CDI) and the increasing FQ resistance alternative oral options for treatment are warranted. Recent literature has suggested beta-lactams (BLM) may be an option for EB-BSI. To enhance the antimicrobial stewardship goal of reducing FQ use, our team began recommending de-escalation to a BLM for EB-BSI and the objective of this study is to evaluate the outcomes of this approach. Methods This study was a retrospective chart review of patients with EB-BSI due to ceftriaxone sensitive monomicrobial E. coli, Klebsiella spp., or P. mirabilis who received a BLM or a FQ as SDT. Patients were excluded if < 18 years of age; pregnant; ANC < 1000 cells/µL; had endocarditis, a bone/joint, or a CNS infection; discharged to hospice or expired prior to discharge; anaphylactic BLM allergy; or prior kidney transplant. SDT was defined as a switch to a definitive oral antibiotic after empiric IV therapy. The primary outcome was clinical cure defined as completion of therapy without signs of infection (increase in WBC > 2000 cells/mL if WBC was ≥ 12,000 cells/mL, fever (>38°C), or change in antibiotic due to failure). Secondary outcomes included 30 day re-admission rates, reinfection rate defined as positive culture within 30 days of completion of therapy, antibiotic associated adverse events defined as side effects leading to discontinuation and/or CDI within 90 days from start of treatment. Results A total of 159 patients were included in the study (Figure 1). The BLM patients had a higher median age (78 vs 72, p=0.008), higher median PITT bacteremia score (2 vs 1, p=0.037), were less likely to be immunosuppressed (9% vs 25%, p=0.045), and had shorter median duration of therapy (13 vs 14, p=0.034). There was no difference in the primary or secondary outcomes (Table 2). Conclusion BLM may enhance stewardship efforts as a FQ sparing option for treatment of EB-BSI; however, prospective studies in this area are warranted. Disclosures All Authors: No reported disclosures

HUBUNGAN KEPATUHAN DIET RENDAH PURIN DENGAN ASAM URAT DI PUSKESMAS WARA KOTA PALOPO TAHUN 2016

2018 ◽  
Vol 6 (08) ◽  
pp. 31-37
Author(s):  
Abdullah Sappe Ampin Maja
Keyword(s):  
Uric Acid ◽  
Sampling Technique ◽  
Statistical Test ◽  
Health Clinic ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Dietary Compliance ◽  
Exact Test ◽  
Purposive Sampling ◽  
Food Consumed

The research of this research to analysis dietary compliance of low purine diet in uric acid patients in Wara Health Clinic Year 2016. Type of this research that was used cross sectional approach and use a sampling technique was purposive sampling. The sample of the research was a portion of gout patients enrolled in Wara Health Clinic that fulfilled the inclusion criteria were 42 people.Based on the analysis by using statistical test Fisher's exact test, the value p = 0468 (p> 0.05%), it can be concluded that the hypothesis "there is no correlation between dietary compliance low purine with uric acid in Puskesmas Wara Palopo".Based on the result of research purpose recommendations were provide clearly information about the low purine diet and provide support in the form of motivation for pay attention of type food consumed so as to prevent the increasing of uric acid. Keywords : Compliance, Diet Low Purin, Uric Acid

scholarly journals 284. Evaluation of Oral Step-Down Therapy for Enterobacteriaceae Bloodstream Infection

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S143-S143
Author(s):  
Sara Utley ◽  
Dawn Bouknight ◽  
Radha Patel ◽  
Kent Stock
Keyword(s):  
Bloodstream Infection ◽  
Oral Therapy ◽  
Common Source ◽  
Oral Antibiotic ◽  
Beta Lactam ◽  
Hospital System ◽  
Source Of Infection ◽  
Complete Treatment ◽  
Antibiotic Duration ◽  
Alternate Source

Abstract Background Oral antibiotic stepdown therapy for Gram-negative (GN) bloodstream infection (BSI) appears to be a safe option, though high bioavailability drugs like fluoroquinolones (FQ) and trimethoprim-sulfamethoxazole are often recommended without clear evidence demonstrating superiority. Due to increasing concerns of FQ resistance and collateral damage with an increasing community C. difficile rate, our organization sought to reduce overall FQ use and a shift toward oral beta-lactams (BL) was observed. A review was conducted to assess the outcomes of this shift. Methods This retrospective cohort included all patients within our 3-hospital system who had a positive GN blood culture and were transitioned to oral therapy to complete treatment outpatient for bacteremia between Jan 2017-Sept 2019. The primary outcome was recurrent BSI within 30 days of completing initial treatment. Secondary outcomes included 30-day mortality, 30-day recurrence of organism at an alternate source, 30-day readmission, and 90-day BSI relapse. Results Of 191 GN BSIs, 77 patients were transitioned to oral therapy. The mean age was 68 years, 60% were female. The most common source of infection was described as urine (39/77), intra-abdominal (16/77), unknown (13/77). Mean total antibiotic duration (IV plus PO) was 14 days (range 7–33). Patients received an average of 5 days IV prior to transitioning to PO therapy. The most common PO class was a 1st gen cephalosporin (29/77), followed by BL/BL inhibitor (16/77), and a FQ (13/77). There were no 30-day relapse BSIs observed in this cohort. There was 1 patient discharged to inpatient hospice, and no other 30-day mortality observed. There were 4 recurrent UTIs observed within 30 days, none of which required readmission. Of the twelve 30-day readmissions, 1 was considered by the investigators to be related to the initial infection. Conclusion An opportunity for education regarding duration of therapy was identified. Oral beta lactam use in our limited population appears to be a reasonable option to facilitate discharge. Results should be confirmed in additional, larger studies. Disclosures All Authors: No reported disclosures

863 Peri-Implant Fluid Collection in Breast Reconstruction and Aesthetic Surgery

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Karagiannidis ◽  
E Mallidis
Keyword(s):  
Reconstructive Surgery ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Fluid Collection ◽  
Aesthetic Surgery ◽  
Large Cell ◽  
Inclusion Criteria ◽  
Electronic Data Collection ◽  
Fluid Collections ◽  
Mean Time

Abstract Introduction Peri-implant fluid more than 6 months from surgery is a known complication of breast surgery.Differential diagnosis includes infection, inflammation,implant rupture and haematoma.Other than infection raised no concern until the identification of Breast Implant Associated Anaplastic Large Cell Lymphoma(BIA-ALCL). Method Retrospective electronic data collection for women 18 years or older who met the following inclusion criteria:(a)oncoplastic and/or cosmetic reconstructive surgery with placement of implant(b)peri-implant fluid collection after 6-36 months. Results In total,17 women with implants with a mean age of 56 years were included in the study.The mean time between reconstructive surgery and the peri-implant fluid collection was 23 months.The median peri-implant fluid collection size was 143 ml.14 of the 17 peri-implant fluid collections were benign.12 of 14 had polyurethane-coated textured implants.4 of the 17 were BIA-ALCL. Conclusions The current literature suggests that late peri-implant seromas arise from friction as the implant moves within the cavity and that this friction is increased with textured rather than smooth implants.In our unit 12/14 of the benign collections appeared in reconstructions with polyurethane implants.Furthermore,BIA-ALCL should always be considered in this situation and aspirate should be sent for cytology.Is this change in polyurethane implants a new entity?

Short Oral Antibiotic Treatment of Osteomyelitis Questioned

1980 ◽  
Vol 2 (1) ◽  
pp. 18-18
Keyword(s):  
Antimicrobial Therapy ◽  
Oral Therapy ◽  
Initial Period ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Oral Route ◽  
Antimicrobial Treatment ◽  
Blood Levels ◽  
Oral Antibiotic ◽  
Cortical Destruction

Dr. Rothman of Haverhill, MA questioned the short duration of antimicrobial treatment and use of oral route for the patient with osteomyelitis presented by Bennett in PIR 1:153, November 1979. He noted that the traditional regimen for osteomyelitis calls for six weeks of intravenous antimicrobial therapy. Dr. Bennett quotes from Telzlaff et al (J Pediatr 92:485, 1978). In this report good results were found when antimicrobial regimens for patients with osteomyelitis and suppurative arthritis consisted of a brief initial period of parenteral therapy of only one to seven days followed by oral antimicrobial therapy begun when there was a definitive decrease in clinical signs of inflammation and continued for three weeks or longer. It is important to note that surgical drainage of pus was carried out, that antimicrobial blood levels were obtained after initiation of oral therapy to ensure adequate levels, that therapy was continued until all signs and symptoms had subsided, that there was no evidence of cortical destruction or sequestrum formation on roentgenogram, and the erythrocyte sedimentation rate was less than 20 mg/hr. When these conditions are met it is clear that oral therapy can be an adequate substitute for prolonged intravenous therapy for osteomyelitis in children.

scholarly journals SELULITIS DENGAN ULKUS VARIKOSUM

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Andravita F. Mitaart ◽  
Herry E. J. Pandaleke
Keyword(s):  
Subcutaneous Tissue ◽  
Topical Therapy ◽  
Venous Blood ◽  
Clinical Signs ◽  
Lower Limbs ◽  
Body Region ◽  
Venous Blood Flow ◽  
Oral Antibiotic ◽  
Varicose Ulcer ◽  
Days Of Therapy

Abstract: Cellulitis is an acute bacterial infection of dermis and subcutaneous tissue which manifests as an erythematous lesion with an undefined border accompanied with inflammatory signs. It is mainly found in the elderly; more frequently in females than males; with a history of malaise, fever, and pain as the prodromal signs, and enlargement of local lymph nodes. Cellulitis can occur in any body region, most commonly on the lower limbs, followed by the arms, head, and, neck. It tends to occur in sites with prior lesions such as dermatitis, static ulcers (including varicose ulcers), animal bites, or trauma. A varicose ulcer is an ulcer located on the lower limb caused by a disturbance in the venous blood flow. We reported an 80-year-old woman, presented with cellulitis and varicose ulcers. The diagnosis was based on history, clinical signs, and laboratory findings. The therapy consisted of limb elevation; oral antibiotic clindamycin (300 mg), mefenamic acid (500 mg), and mebhydroline napadisilate (50 mg), each three times daily; and a topical therapy that was comprised of a wound dressing using NaCl 0.9% for 30 minutes three times daily and an application of sodium fusidate cream twice daily. After ten days of therapy, there were clinical improvements with wound healing without any sign of cellulitis.Keywords: cellulitis, varicose ulcer  Abstrak: Selulitis merupakan infeksi bakteri akut pada dermis dan jaringan subkutan yang ditandai lesi kemerahan berbatas tidak jelas dan disertai tanda-tanda radang. Umumnya selulitis ditemukan pada usia lanjut, perempuan lebih sering daripada laki-laki, dengan riwayat lesu, demam, dan rasa nyeri sebagai gejala prodromal, disertai pembesaran kelenjar getah bening setempat. Selulitis dapat terjadi pada bagian tubuh manapun dengan predileksi pada tungkai bawah diikuti lengan, kepala, dan leher. Selain itu, selulitis biasanya timbul pada lokasi dengan lesi yang telah ada sebelummya, yaitu dermatitis, ulkus stasis (termasuk ulkus varikosum), luka tusuk, gigitan binatang, atau trauma. Ulkus varikosum ialah ulkus pada tungkai bawah yang disebabkan gangguan aliran darah venosa. Kami melaporkan kasus seorang perempuan berusia 80 tahun dengan selulitis dan ulkus varikosum. Diagnosis ditegakkan berdasarkan anamnesis, gejala klinis, dan pemeriksaan penunjang. Penatalaksanaannya ialah elevasi tungkai; antibiotik oral klindamisin 300 mg, asam mefenamat 500 mg, dan mebhidrolin napadisilat 50 mg, masing-masing 3 kali sehari; kompres solusio NaCl 0,9% selama 30 menit 3 kali sehari, dan natrium fusidat krim dioleskan 2 kali sehari. Setelah 10 hari paska terapi, terdapat perbaikan klinis berupa luka yang mulai mengering tanpa disertai tanda-tanda selulitis.Kata kunci: selulitis, ulkus varikosum

scholarly journals 452. Antibiotic Duration, but Not Size, Impacts Clinical Cure of Limited Skin and Soft-Tissue Infection After Incision and Drainage

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S222-S223
Author(s):  
Jason G Lake ◽  
Stephanie Fritz
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Clinical Cure ◽  
Day Treatment ◽  
Treatment Protocol ◽  
Chi Square ◽  
Incision And Drainage ◽  
Exact Test ◽  
Days Of Therapy ◽  
Antibiotic Duration

Abstract Background Incision and drainage (I&D) is the most common treatment for skin abscesses. A recent randomized clinical trial (RCT) of outpatients with limited (≤5 cm) skin abscesses demonstrated antibiotic therapy with clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) was superior to I&D alone. We performed a subgroup analysis to measure the effect of antibiotic duration and abscess size on clinical cure at 7–10 days after antibiotic completion. Methods Participants with complete data regarding adherence to the 10-day treatment were included. Demographic and baseline clinical features were compared using t-test, Pearson’s chi-square or Fisher’s exact test, or a non-parametric equivalent where appropriate. Largest abscess dimension (cm) was dichotomized by median size. The effect of antibiotic duration, abscess size (≤ median vs. >median) and covariates on clinical cure were measured using logistic regression. Breslow-Day Test for Homogeneity was used to assess the interaction between treatment and abscess size. Results Of 786 participants in the intention-to-treat analysis, complete adherence data were available for 680 (87%) participants. Of these, 463 (68%) received either antibiotic: 421 (91%) completed 10 days of therapy, 29 (6.3%) ≤7 days and 20 (4.3%) ≤5 days. Only antibiotic treatment duration was associated with clinical cure (table). Odds of clinical cure were 1.7 (95% CI: 1.5, 2.0) times higher for each additional day of treatment. Median abscess size was 2.5 cm (range: 0.2–5); 364 participants had abscesses ≤ median vs. 316 >median. Assessed continuously, abscess size was not associated with cure within antibiotic groups (table) or between placebo and treatment groups (OR 0.94, 95% CI: 0.58–1.5). Stratifying on size, no significant interaction was observed with antibiotic treatment (Breslow-Day P = 0.13). Conclusion Adherence to the treatment protocol was high. These data suggest that longer courses of antibiotic therapy in conjunction with I&D are associated with successful treatment of limited skin abscesses. Size was not associated with clinical cure. Prospective RCTs to determine the optimal length of treatment are needed. Disclosures All authors: No reported disclosures.

scholarly journals Out of Sight—Out of Mind: Impact of Cascade Reporting on Antimicrobial Usage

2020 ◽  
Vol 7 (2) ◽  
Author(s):  
Siyun Liao ◽  
Judith Rhodes ◽  
Roman Jandarov ◽  
Zachary DeVore ◽  
Madhuri M Sopirala
Keyword(s):  
Relative Risk ◽  
Positive Culture ◽  
Baseline Period ◽  
Adjusted Relative Risk ◽  
Test Results ◽  
Antibiotic Susceptibilities ◽  
Days Of Therapy ◽  
All Cause Mortality ◽  
Study Population ◽  
The Impact

Abstract Background There is a paucity of data evaluating the strategy of suppressing broader-spectrum antibiotic susceptibilities on utilization. Cascade reporting (CR) is a strategy of reporting antimicrobial susceptibility test results in which secondary (eg, broader-spectrum, costlier) agents may only be reported if an organism is resistant to primary agents within a particular drug class. Our objective was to evaluate the impact of ceftriaxone-based cascade reporting on utilization of cefepime and clinical outcomes in patients with ceftriaxone-susceptible Escherichia and Klebsiella clinical cultures. Methods We compared post-CR (July 2014–June 2015) with baseline (July 2013–June 2014), evaluating utilization of cefepime, cefazolin, ceftriaxone, ampicillin derivatives, fluoroquinolones, piperacillin/tazobactam, ertapenem, and meropenem; new Clostridium difficile infection; and length of stay (LOS) after the positive culture, 30-day readmission, and in-hospital all-cause mortality. Results Mean days of therapy (DOT) among patients who received any antibiotic for cefepime decreased from 1.229 days during the baseline period to 0.813 days post-CR (adjusted relative risk, 0.668; P < .0001). Mean DOT of ceftriaxone increased from 0.864 days to 0.962 days, with an adjusted relative risk of 1.113 (P = .004). No significant differences were detected in other antibiotics including ertapenem and meropenem, demonstrating the direct association of the decrease in cefepime utilization with CR based on ceftriaxone susceptibility. Average LOS in the study population decreased from 14.139 days to 10.882 days from baseline to post-CR and was found to be statistically significant (P < .0001). Conclusions In conclusion, we demonstrated significant association of decreased cefepime utilization with the implementation of a CR based on ceftriaxone susceptibility. We demonstrated the safety of deescalation, with LOS being significantly lower during the post-CR period than in the baseline period, with no change in in-hospital mortality.

Comparison of oral antibiotic failure rates in post-Roux-en-Y gastric bypass patients versus controls

2017 ◽  
Vol 13 (9) ◽  
pp. 1524-1529 ◽  
Author(s):  
David J. Roy ◽  
Diana R. Langworthy ◽  
Kristina M. Thurber ◽  
Paul A. Lorentz ◽  
Ross A. Dierkhising ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Oral Antibiotic ◽  
Failure Rates ◽  
Antibiotic Failure

scholarly journals Electronic Surveillance for Healthcare-Associated Central Line—Associated Bloodstream Infections Outside the Intensive Care Unit

2011 ◽  
Vol 32 (11) ◽  
pp. 1086-1090 ◽  
Author(s):  
Keith F. Woeltje ◽  
Kathleen M. McMullen ◽  
Anne M. Butler ◽  
Ashleigh J. Goris ◽  
Joshua A. Doherty
Keyword(s):  
Intensive Care ◽  
Blood Culture ◽  
Predictive Value ◽  
Chart Review ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Central Line ◽  
Electronic Surveillance ◽  
Predictive Values ◽  
Best Fit

Background.Manual surveillance for central line-associated bloodstream infections (CLABSIs) by infection prevention practitioners is time-consuming and often limited to intensive care units (ICUs). An automated surveillance system using existing databases with patient-level variables and microbiology data was investigated.Methods.Patients with a positive blood culture in 4 non-ICU wards at Barnes-Jewish Hospital between July 1, 2005, and December 31, 2006, were evaluated. CLABSI determination for these patients was made via 2 sources; a manual chart review and an automated review from electronically available data. Agreement between these 2 sources was used to develop the best-fit electronic algorithm that used a set of rules to identify a CLABSI. Sensitivity, specificity, predictive values, and Pearson's correlation were calculated for the various rule sets, using manual chart review as the reference standard.Results.During the study period, 391 positive blood cultures from 331 patients were evaluated. Eighty-five (22%) of these were confirmed to be CLABSI by manual chart review. The best-fit model included presence of a catheter, blood culture positive for known pathogen or blood culture with a common skin contaminant confirmed by a second positive culture and the presence of fever, and no positive cultures with the same organism from another sterile site. The best-performing rule set had an overall sensitivity of 95.2%, specificity of 97.5%, positive predictive value of 90%, and negative predictive value of 99.2% compared with intensive manual surveillance.Conclusions.Although CLABSIs were slightly overpredicted by electronic surveillance compared with manual chart review, the method offers the possibility of performing acceptably good surveillance in areas where resources do not allow for traditional manual surveillance.

Sign in / Sign up

Export Citation Format

Share Document