scholarly journals Effect of Inadequate Empiric Antibacterial Therapy on Hospital Outcomes in SARS-CoV-2-positive and -negative US Patients with a Positive Bacterial Culture: a Multicenter Evaluation from March to November 2020

2021 ◽  
Author(s):  
Laura Puzniak ◽  
Karri A Bauer ◽  
Kalvin C Yu ◽  
Pamela Moise ◽  
Lyn Finelli ◽  
...  
Keyword(s):  
Antibacterial Therapy ◽  
Antimicrobial Therapy ◽  
Bacterial Culture ◽  
Bacterial Pathogens ◽  
Empiric Therapy ◽  
Research Database ◽  
Gram Positive ◽  
Hospital Outcomes ◽  
Gram Negative ◽  
Positive Bacterial Culture

Abstract Background Increased utilization of antimicrobial therapy has been observed during the coronavirus disease 2019 pandemic. We evaluated hospital outcomes based on the adequacy of antibacterial therapy for bacterial pathogens in US patients. Methods This multicenter retrospective study included patients with ≥24 hours of inpatient admission, ≥24 hours of antibiotic therapy, and discharge/death from March-November 2020 at 201 US hospitals in the BD Insights Research Database. Included patients had a test for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and a positive bacterial culture (gram-positive or gram-negative). We used generalized linear mixed models to evaluate the impact of inadequate empiric therapy (IET), defined as therapy not active against the identified bacteria or no antimicrobial therapy in the 48 hours following culture, on in-hospital mortality and hospital and intensive care unit (ICU) length of stay (LOS). Results Of 438,888 SARS-CoV-2 tested patients, 39,203 (8.9%) had positive bacterial cultures. Among patients with positive cultures, 9.4% were SARS-CoV-2 positive, 74.4% had a gram-negative pathogen, 25.6% had a gram-positive pathogen, and 44.1% received IET for the bacterial infection. The odds of mortality were 21% higher for IET (odds ratio 1.21 [95% confidence interval (CI), 1.10–1.33]; P<.001) compared with adequate empiric therapy. IET was also associated with increased hospital LOS(16.1 [95% CI, 15.5–16.7] vs 14.5 [95% CI 13.9–15.1] days; (P<.001). Both mortality and hospital LOS findings remained consistent for SARS-CoV-2-positive and -negative patients. Conclusions Bacterial pathogens continue to play an important role in hospital outcomes during the pandemic. Adequate and timely therapeutic management may help ensure better outcomes.

scholarly journals 890. Incidence and Microbiology of Surgical Site Infection (SSI) after Breast Surgery

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S479-S479
Author(s):  
Farah Tanveer ◽  
Dima Youssef ◽  
Mamta Youssef ◽  
Susanna Szpunar ◽  
Michelle Flood
Keyword(s):  
Surgical Site Infection ◽  
Breast Surgery ◽  
Tissue Expander ◽  
Empiric Therapy ◽  
Site Infection ◽  
Gram Positive ◽  
Historical Cohort ◽  
Gram Negative ◽  
Tissue Expanders ◽  
Student’S T

Abstract Background Surgical site infection (SSI) after breast surgery is much more common than expected after a clean surgical procedure. Although breast SSIs are primarily Gram-positive; recent literature shows an increase in Gram-negative infections. We assessed the risk factors and microbiology of SSI following breast surgery at our institution. Methods We conducted a historical cohort study of all (³ 18 y) females who had surgery from 1/1/2014-3/31/2019 and subsequent SSI within 90 days of the procedure. Two controls, matched for surgery type, were selected per case. Data were collected on demographic and clinical characteristics, surgery type, microbiology and antibiotics. Data were analyzed using the χ 2 test, Student’s t-test and multivariable logistic regression with a forward likelihood ratio algorithm. Results After excluding patients with limited data, we reviewed 284 charts: 95 of 132 cases and 189 controls. The 90-day incidence of SSI was 3.5 % (132/3755). Cases were younger than controls: 53.9 ± 12.4 years vs. 58.3± 13.7 years, respectively, p=0.02. Controls had more comorbidities: 1.8 ± 1.3 vs. 1.4 ± 0.7,respectively, p=0.001. Tissue expanders were placed in 65 (70%) cases versus 11 (5.8%) controls (p < 0.0001). After controlling for age, BMI, comorbidities and post-operative antibiotics, only tissue expanders were associated with infection (OR=35.1, p< 0.0001, 95% CI: 16.6, 74.0). Microbiological data were available for 84 cases. Gram-positive organisms accounted for 45 (53.6%) infections and Gram-negative organisms accounted for 39 (46.4%) infections. Over 72% of African Americans (p= 0.014), 76.5% of patients with diabetes (p=0.005) and 57.1 % with tissue expanders (p= 0.02) had Gram-negative infections. The table shows the multivariable predictors of Gram-negative infection. Tissue expander removal was required in 61.5% of patients with Gram-negative infections compared to 39% with Gram-positive infections. Predictors of Gram-negative SSI after breast surgery Conclusion Patients with tissue expanders had a higher incidence of SSI after breast surgery; removal was often required in Gram-negative infections. Diabetes and post-operative antibiotics were significant predictors of Gram-negative infection. Knowledge of local epidemiology is a key factor in deciding empiric therapy for SSI. Disclosures All Authors: No reported disclosures

scholarly journals Microbiology of Vertebral Osteomyelitis and Implications on Empiric Therapy

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S6-S6
Author(s):  
Abbye Clark ◽  
Neha Sharma ◽  
Sharon Weissman ◽  
Majdi N Al-Hasan ◽  
Caroline Derrick ◽  
...  
Keyword(s):  
South Carolina ◽  
Antimicrobial Therapy ◽  
Vertebral Osteomyelitis ◽  
Case Series ◽  
Empiric Therapy ◽  
Empiric Antibiotic Therapy ◽  
Retrospective Case ◽  
Gram Negative ◽  
Male Predominance ◽  
Case Series Study

Abstract Background The management of vertebral osteomyelitis (VO) includes empiric antibiotic therapy while clinical cultures are being processed. Optimal antimicrobial therapy for VO, particularly when Gram-negative (GN) organisms are involved, is an area of ongoing debate. Narrow spectrum and oral antimicrobial therapy are preferred. The objective of this study was to identify characteristics of local pathogens and to formulate an institution-specific antibiotic protocol for empiric treatment of VO. Methods We conducted a retrospective case series study of adults diagnosed with VO from August 1, 2010 to August 31, 2015 at Palmetto Health Hospitals in Columbia, South Carolina. Cases identified by ICD-9 codes were included in the analysis if they met clinical, imaging and microbiology, criteria. Results Analysis is based on 150 cases of VO with a mean age of 61 years, a male predominance (91; 61%), and an average body mass index of 29kg/m2. Comorbidities included diabetes mellitus (69; 46%), tobacco use (33; 22%), and hemodialysis (20; 13%). Thirty-seven (25%) cases had recent related injury or vertebral surgery, and 14 (9%) had prior hardware. Bone, disc, or adjacent tissue cultures were obtained in 129 (86%) of cases; 60 (40%) of these had >1 sample taken. The remaining 14% had blood cultures alone. Thirty-six cases (24%) had culture negative VO. In the remaining 114 cases, 132 organisms were isolated. A total of 111 (84%) organisms were Gram-positive cocci (GPC). Of those, the majority was Staphylococcus aureus. (66; 59%) (26/66 were methicillin-resistant), coagulase-negative staphylococci (20; 18%) and Streptococcus spp. (17; 15%). Enterobacteriaceae accounted for 13/17 Gram-negative bacilli (GNB), with only one isolate of Pseudomonas aeruginosa. Of the GNB, 11/17 were susceptible to either ceftriaxone or ciprofloxacin. Conclusion There was a predominance of VO due to GPC suggesting that intravenous vancomycin monotherapy may be reasonable for empiric therapy in noncritically ill patients while awaiting Gram stain and clinical culture results. Addition of either ceftriaxone or ciprofloxacin to vancomycin would increase cumulative antimicrobial coverage from 84 to 92%. Disclosures All authors: No reported disclosures.

scholarly journals Different Modes of Action of Naphthyridones in Gram-Positive and Gram-Negative Bacteria

2006 ◽  
Vol 50 (1) ◽  
pp. 385-387 ◽  
Author(s):  
Ed T. Buurman ◽  
Kenneth D. Johnson ◽  
Roxanne K. Kelly ◽  
Kathy MacCormack
Keyword(s):  
Escherichia Coli ◽  
Haemophilus Influenzae ◽  
Mode Of Action ◽  
Bacterial Pathogens ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Modes Of Action

ABSTRACT Naphthyridones that were recently described as a class of translation inhibitors in gram-positive bacteria mediate their mode of action via GyrA in Haemophilus influenzae and Escherichia coli. These are the first examples of compounds in which modes of action in different bacterial pathogens are mediated through widely different targets.

A strategy of antimicrobial therapy of pelvic inflammatory diseases at antibiotic resistance of microbial pathogens

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (1) ◽  
pp. 60-63
Author(s):  
Tatiana Yu Pestrikova ◽  
Elena A Yurasova ◽  
Igor V Yurasov
Keyword(s):  
Antibiotic Resistance ◽  
Antimicrobial Therapy ◽  
Inflammatory Diseases ◽  
Combined Therapy ◽  
Treatment Options ◽  
Anaerobic Bacteria ◽  
Microbial Flora ◽  
Microbial Pathogens ◽  
Gram Positive ◽  
Gram Negative

Relevance. Antibiotic resistance of microbial pathogens is an interdisciplinary and interstate problem of major medical and socio-economic importance. If multiresistant microbial flora is detected in patients with acute or chronic forms of pelvic inflammatory diseases alternative antimicrobial combined therapy an advisability should be considered. Current trends of an increase in multiresistant gram-negative infections along with limited range of alternative treatment options dictate a need for further research. Study of alternative antibiotics effectiveness in pelvic inflammatory diseases treatment is necessary for a further development of optimal treatment regimens. Aim. To search for adequate combinations of antimicrobial therapy aimed at antibiotic-resistant pathogens. Materials and methods. To write this review a search for domestic and foreign publications in Russian and international search systems (PubMed, eLibrary, etc.) for the last 2-12 years was conducted. The review includes articles from peer-reviewed literature. Results. Fosfomycin possesses a broad spectrum of antibacterial effects including gram-positive and gram-negative aerobic bacteria. The drug is highly effective against Pseudomonas aeruginosa and Escherichia coli, anaerobic bacteria (Proteus mirabilis and Klebsiella pneumoniae) as well as against gram- positive bacteria (Staphylococcus spp., including S. aureus, S. epidermidis; Streptococcus spp., including Enterococcus faecalis). Conclusions. When multiresistant microbial flora is detected in patients with acute or chronic forms of pelvic inflammatory diseases an advisability of fosfomycin administration should be considered.

Combination Therapy for Bacterial Pathogens: Naturally Derived Antimicrobial Drugs Augmented with Ulva lactuca Extract

2021 ◽  
Vol 21 ◽  
Author(s):  
Nilushi Indika Bamunuarachchi ◽  
Fazlurrahman Khan ◽  
Young-Mog Kim
Keyword(s):  
Antibacterial Activity ◽  
Pathogenic Bacteria ◽  
Inhibitory Concentration ◽  
Bacterial Pathogens ◽  
Dilution Method ◽  
Gram Positive ◽  
Antimicrobial Drugs ◽  
Gram Negative ◽  
Hexane Extracts ◽  
Conventional Antibiotics

Background: With the growing incidence of microbial pathogenesis, several alternative strategies have been developed. The number of treatments using naturally (e.g., plants, algae, fungi, bacteria, and animals) derived compounds has increased. Importantly, marine-derived products have become a promising and effective approach to combat the antibiotic resistance properties developed by bacterial pathogens. Furthermore, augmenting the sub-inhibitory concentration of the naturally-derived antimicrobial compounds (e.g., hydroxycinnamic acids, terpenes, marine-derived polysaccharides, phenolic compounds) into the naturally derived extracts as a combination therapy to treat the bacterial infection has not been well studied. Objective: The present study was aimed to prepare green algae Ulva lactuca extract and evaluate its antibacterial activity towards Gram-positive and Gram-negative human pathogenic bacteria. Also, revitalize the antibacterial efficiency of the naturally-derived antimicrobial drugs and conventional antibiotics by augmenting their sub-MIC to the U. lactuca extracts. Methods: Extraction was done using a different organic solvent, and its antibacterial activity was tested towards Gram-positive and Gram-negative pathogens. The minimum inhibitory concentration (MIC) of U. lactuca extracts has been determined towards pathogenic bacteria using the micro broth dilution method. The viable cell counting method was used to determine the minimum bactericidal concentration (MBC). The fractional inhibitory concentration (FIC) assay was utilized to examine the combinatorial impact of sub-MIC of two antibacterial drugs using the micro broth dilution method. The chemical components of the extract were analyzed by GC-MS analysis. Results: Among all the extracts, n-hexane extract was found to show effective antibacterial activity towards tested pathogens with the lowest MIC and MBC value. Furthermore, the n-hexane extracts have also been used to enhance the efficacy of the naturally-derived (derived from plants and marine organisms) compounds and conventional antibiotics at their sub-inhibitory concentrations. Most of the tested antibiotics and natural drugs at their sub-MIC were found to exhibit synergistic and additive antibacterial activity towards the tested bacterial pathogens. Conclusions: The augmenting of U. lactuca n-hexane extracts resulted in synergistic and additive bactericidal effects on Gram-positive and Gram-negative human pathogenic bacteria. The present study shows a new alternative strategy to revitalize the antimicrobial activity of naturally derived compounds for treating human bacterial pathogens.

Silica Supported Synthesis and Quorum Quenching Ability of Isoxazolones Against Both Gram Positive and Gram Negative Bacterial Pathogens

2021 ◽  
Vol 6 (42) ◽  
pp. 11718-11728
Author(s):  
Hari K. Kadam ◽  
Komal Salkar ◽  
Akshata P. Naik ◽  
Milind M. Naik ◽  
Lalitprabha N. Salgaonkar ◽  
...  
Keyword(s):  
Bacterial Pathogens ◽  
Quorum Quenching ◽  
Gram Positive ◽  
Gram Negative

scholarly journals In VitroActivity of Plazomicin against Gram-Negative and Gram-Positive Bacterial Pathogens Isolated from Patients in Canadian Hospitals from 2013 to 2017 as Part of the CANWARD Surveillance Study

2018 ◽  
Vol 63 (1) ◽  
Author(s):  
Andrew Walkty ◽  
James A. Karlowsky ◽  
Melanie R. Baxter ◽  
Heather J. Adam ◽  
George G. Zhanel
Keyword(s):  
Antimicrobial Agents ◽  
Bacterial Pathogens ◽  
Multidrug Resistant ◽  
Surveillance Study ◽  
Gram Positive ◽  
Gram Negative ◽  
Content Type ◽  
Microdilution Method ◽  
Broth Microdilution Method

ABSTRACTThe Clinical and Laboratory Standards Institute (CLSI) broth microdilution method was used to evaluate thein vitroactivities of plazomicin and comparator antimicrobial agents against 7,712 Gram-negative and 4,481 Gram-positive bacterial pathogens obtained from 2013 to 2017 from patients in Canadian hospitals as part of the CANWARD Surveillance Study. Plazomicin demonstrated potentin vitroactivity againstEnterobacteriaceae(MIC90≤ 1 µg/ml for all species tested exceptProteus mirabilisandMorganella morganii), including aminoglycoside-nonsusceptible, extended-spectrum β-lactamase (ESBL)-positive, and multidrug-resistant (MDR) isolates. Plazomicin was equally active against methicillin-susceptible and methicillin-resistant isolates ofStaphylococcus aureus.

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