scholarly journals 1148. Duration of Antibiotic Therapy in the Treatment of Bacterial Meningitis in Young Infants: A Systematic Review and Narrative Synthesis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S665-S666
Author(s):  
Maite Van Hentenryck ◽  
Alan Schroeder ◽  
Russell McCulloh ◽  
Christopher D Stave ◽  
Marie E Wang
Keyword(s):  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Treatment Duration ◽  
Small Sample ◽  
Cochrane Central Register ◽  
Narrative Synthesis ◽  
Parenteral Therapy ◽  
Parenteral Treatment ◽  
Duration Of Therapy ◽  
Days Of Therapy

Abstract Background IDSA recommendations of 14-21 days of parenteral therapy for bacterial meningitis are based predominantly on expert consensus. Parenteral durations consistent with these recommendations are sometimes provided even when meningitis is suspected but not confirmed. We aimed to systematically review the literature on duration of parenteral antibiotic therapy and outcomes in bacterial meningitis in infants < 3 months of age. Methods We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for publications up until May 11, 2021. Eligible studies were published in English and included infants < 3 months of age with bacterial meningitis for which route and duration of antibiotic therapy and outcomes were reported. We excluded case reports and infants with birth weight < 1500g, major congenital malformations, or neurosurgical conditions. We assessed bias using published tools specific to study type. A meta-analysis was not conducted due to insufficient data on outcomes by duration of therapy. PROSPERO registration: CRD42020201667. Results A total of 2195 studies were identified; 280 were selected for full text review and 32 were included for narrative synthesis. There was 1 randomized-controlled trial (RCT), 25 cohort studies, and 6 case series. The RCT found no difference in treatment failure rates between 10 and 14 days of therapy, but only included 2 cerebrospinal fluid (CSF) culture-positive cases. A single cohort study including only CSF culture-negative cases presented outcomes by duration of therapy and concluded that courses >21 days had no impact on prognosis. Twenty-one studies had data on duration of therapy and outcomes by patient, most with small samples (median 4 patients). No conclusions on efficacy of shortened antibiotic courses could be drawn due to small sample sizes and lack of stratification of outcomes by short versus long courses. Conclusion Data on parenteral treatment duration in bacterial meningitis in infants < 3 months are primarily observational, and larger studies rarely report outcomes by duration of therapy. Given the associated risks and costs of prolonged parenteral therapy, there is a pressing need for comparative effectiveness research to determine the optimal parenteral treatment duration. Disclosures All Authors: No reported disclosures

scholarly journals 1302. Duration of Antibiotic Therapy for Pneumonia Among Patients with Advanced Cancer: An Opportunity for Antibiotic Stewardship

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S739-S739
Author(s):  
Jemma Benson ◽  
Rupak Datta ◽  
Vincent Quagliarello ◽  
Manisha Juthani-Mehta
Keyword(s):  
Older Adults ◽  
Antibiotic Therapy ◽  
Advanced Cancer ◽  
Antibiotic Stewardship ◽  
Palliative Chemotherapy ◽  
Total Duration ◽  
Index Admission ◽  
Post Discharge ◽  
Duration Of Therapy ◽  
Days Of Therapy

Abstract Background Antibiotic therapy is common for hospitalized older adults (≥65 years) with advanced cancer.1 Pneumonia is prevalent, but data conflict about the benefits and harms of antibiotics in palliative care settings. To inform antibiotic stewardship protocols, we assessed the duration of therapy for non-ventilator-associated pneumonia (non-VAP) in older adults who received palliative chemotherapy for advanced cancer. Methods We identified older adults who received palliative chemotherapy from 1/1/2016 through 9/30/2017 at Yale New Haven Hospital and subsequently developed non-VAP during their index admission following receipt of palliative chemotherapy. Non-VAPs were defined per standardized criteria; 2 complicated pneumonias including those associated with abscess, bacteremia, subsequent VAP, necrotizing and fungal pneumonia, and organizing pneumonia were excluded. We determined the total duration of antibiotics, including both inpatient and post-discharge days of therapy, for each initial episode of non-VAP. Patients were then stratified by total duration of therapy ( >7 days versus ≤ 7 days). Results We identified a total of 118 older adults who developed non-VAP during their index admission following receipt of palliative chemotherapy (Figure). Median age was 77.6 (range, 65.2 to 92.5), 37.2% were female sex, and the most common malignancies included lung (n=42/118; 35.5%), hematologic (n=28/118; 23.7%), gastrointestinal (n=17/118; 14.4%), and genitourinary (n=17/118; 14.4%) tumors. Overall, 83.0% (n=98/118) were prescribed >7 days of therapy. Figure. Duration of therapy for non-VAP Conclusion 83.0% of older adults who developed non-VAP during the index hospitalization following receipt of palliative chemotherapy received a duration of antibiotics that exceeded guideline recommendations. This finding provides an opportunity for intervention to improve patient care and antibiotic stewardship in patients receiving palliative chemotherapy. Future studies are needed in larger cohorts to evaluate the implications of guideline-discordant therapy on readmissions and mortality. References 1. Marra et al. Antibiotic use during end-of-life care: A systematic literature review and meta-analysis. ICHE 2021;42:523-9. 2. CDC NHSN Patient Safety Component Manual, 2021. Disclosures All Authors: No reported disclosures

Effects of an automatic discontinuation of antibiotics policy: A novel approach to antimicrobial stewardship

2019 ◽  
Vol 76 (Supplement_3) ◽  
pp. S85-S90 ◽  
Author(s):  
Bailey C Bolten ◽  
J Lacie Bradford ◽  
Brittany N White ◽  
Gregory W Heath ◽  
James M Sizemore ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Antibiotic Usage ◽  
Duration Of Therapy ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Before And After ◽  
The Mean

Abstract Purpose A novel automatic discontinuation policy implemented within an antimicrobial stewardship program (ASP) is described, and results of an evaluation of the policy’s effects on antibiotic usage are reported. Methods A retrospective, before-and-after study was conducted at an 800-bed, tertiary care, academic teaching hospital to evaluate selected antibiotic usage outcomes in both intensive care unit (ICU) and non-ICU adult patients targeted for ASP interventions before and after implementation of an automatic discontinuation of antibiotics policy (ADAP) authorizing the ASP team to automatically halt antibiotic therapy in cases involving inappropriate duplicate antimicrobial coverage or excess duration of therapy. The primary outcome was total days of antibiotic therapy. Secondary outcomes included excess days of therapy and rates of 30-day readmission, Clostridioides difficile infection, and multidrug-resistant infection. Results There were no statistically significant differences in group demographics or clinical characteristics. The most common indication for antibiotics was hospital-acquired pneumonia, and the most common reason for ASP intervention was excess duration of therapy. The mean total number of antibiotic days per patient was reduced from 7.6 days in the pre-ADAP group to 6.6 days in the post-ADAP group (p < 0.05). The mean number of excess days of antibiotics was similarly reduced, from 2.3 days to 1.5 days, after implementation of the ADAP (p < 0.05). Conclusion Adoption of an ADAP—a more active approach to ASP interventions—was effective in reducing overall antibiotic usage and improving the efficiency of the ASP.

scholarly journals ADD it up: an evaluation of Antibiotic Duration at hospital Discharge at a community hospital

2021 ◽  
Author(s):  
Morgan Conner ◽  
William H Harris ◽  
John P Bomkamp
Keyword(s):  
Antibiotic Therapy ◽  
Hospital Discharge ◽  
Median Duration ◽  
Unmet Need ◽  
Community Acquired Pneumonia ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Duration Of Therapy ◽  
Days Of Therapy ◽  
Antibiotic Duration

Abstract Purpose According to the CDC, patients admitted to the hospital are commonly discharged on antibiotic therapy with prolonged courses of therapy, which contributes to excessive antibiotic exposure and adverse events. The purpose of this study was to evaluate total antibiotic duration of therapy at hospital discharge at Indiana University (IU) Health Arnett, White Memorial, and Frankfort Hospitals. Methods A multicenter, retrospective electronic health record review was conducted from January 1, 2019, to June 30, 2019. Patients were included if they were at least 18 years of age, began antibiotic therapy while admitted, and continued antibiotic therapy at hospital discharge for one of the following indications: skin/soft tissue infection (SSTI), urinary tract infection (UTI), community-acquired pneumonia (CAP) or acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The days-of-therapy (DOT) of each inpatient and outpatient antibiotic prescribed were collected to calculate the total DOT, which was utilized to determine the appropriateness of the duration of therapy. Results Of the 547 patients included, 233 patients (42.6%) had CAP, 120 (21.9%) had UTI, 101 (18.5%) had SSTI, and 93 (17%) had AECOPD. The median duration of antibiotic therapy across all indications was 9 days (IQR 7-11). Median duration for CAP was 9 days (IQR 7-10), AECOPD was 7 days (IQR 5-9), UTI was 8 days (IQR 6-10), and SSTI was 12 days (IQR 10-14). Conclusions Excess antimicrobial duration at hospital discharge represents an unmet need of antimicrobial stewardship programs.

scholarly journals The TOPAZ study: a home-based trial of zoledronic acid to prevent fractures in neurodegenerative parkinsonism

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Caroline M. Tanner ◽  
Steven R. Cummings ◽  
Michael A. Schwarzschild ◽  
Ethan G. Brown ◽  
E. Ray Dorsey ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Zoledronic Acid ◽  
Support Groups ◽  
Movement Disorders ◽  
Fracture Prevention ◽  
Parenteral Therapy ◽  
Controlled Clinical Trials ◽  
Multiple Sources ◽  
Parenteral Treatment ◽  
Home Based

AbstractThe Trial of Parkinson’s And Zoledronic acid (TOPAZ, https://clinicaltrials.gov/ct2/show/NCT03924414) is a unique collaboration between experts in movement disorders and osteoporosis to test the efficacy of zoledronic acid, an FDA-approved parenteral treatment for osteoporosis, for fracture prevention in people with neurodegenerative parkinsonism. Aiming to enroll 3,500 participants age 65 years or older, TOPAZ is one of the largest randomized, placebo-controlled clinical trials ever attempted in parkinsonism. The feasibility of TOPAZ is enhanced by its design as a U.S.- wide home-based trial without geographical limits. Participants receive information from multiple sources, including specialty practices, support groups and websites. Conducting TOPAZ in participants’ homes takes advantage of online consent technology, the capacity to confirm diagnosis using telemedicine and the availability of research nursing to provide screening and parenteral therapy in homes. Home-based clinical research may provide an efficient, convenient, less expensive method that opens participation in clinical trials to almost anyone with parkinsonism.

scholarly journals DIAGNOSIS OF ENDOCRINE DISEASE: The diagnostic performance of adrenal biopsy: a systematic review and meta-analysis

2016 ◽  
Vol 175 (2) ◽  
pp. R65-R80 ◽  
Author(s):  
Irina Bancos ◽  
Shrikant Tamhane ◽  
Muhammad Shah ◽  
Danae A Delivanis ◽  
Fares Alahdab ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Performance ◽  
Small Sample Size ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Small Sample ◽  
Cochrane Central Register ◽  
Moderate Risk ◽  
Adrenal Biopsy ◽  
Adrenocortical Carcinomas

ObjectiveTo perform a systematic review of published literature on adrenal biopsy and to assess its performance in diagnosing adrenal malignancy.MethodsMedline In-Process and Other Non-Indexed Citations, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trial were searched from inception to February 2016. Reviewers extracted data and assessed methodological quality in duplicate.ResultsWe included 32 observational studies reporting on 2174 patients (39.4% women, mean age 59.8 years) undergoing 2190 adrenal mass biopsy procedures. Pathology was described in 1621/2190 adrenal lesions (689 metastases, 68 adrenocortical carcinomas, 64 other malignancies, 464 adenomas, 226 other benign, 36 pheochromocytomas, and 74 others). The pooled non-diagnostic rate (30 studies, 2013 adrenal biopsies) was 8.7% (95%CI: 6–11%). The pooled complication rate (25 studies, 1339 biopsies) was 2.5% (95%CI: 1.5–3.4%). Studies were at a moderate risk for bias. Most limitations related to patient selection, assessment of outcome, and adequacy of follow-up. Only eight studies (240 patients) could be included in the diagnostic performance analysis with a sensitivity and specificity of 87 and 100% for malignancy, 70 and 98% for adrenocortical carcinoma, and 87 and 96% for metastasis respectively.ConclusionsEvidence based on small sample size and moderate risk of bias suggests that adrenal biopsy appears to be most useful in the diagnosis of adrenal metastasis in patients with a history of extra-adrenal malignancy. Adrenal biopsy should only be performed if the expected findings are likely to alter the management of the individual patient and after biochemical exclusion of catecholamine-producing tumors to help prevent potentially life-threatening complications.

The Frequency of Pericardial Effusions in Bacterial Meningitis

PEDIATRICS ◽  
1979 ◽  
Vol 63 (5) ◽  
pp. 764-770
Author(s):  
W. Pennock Laird ◽  
John D. Nelson ◽  
F. Douglas Huffines
Keyword(s):  
Risk Factors ◽  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Significant Risk ◽  
Literature Survey ◽  
The Other ◽  
Purulent Pericarditis ◽  
Pericardial Effusions ◽  
In Series ◽  
A Prospective Study

Because of our experience with four cases of purulent pericarditis complicating bacterial meningitis during a 13-month period, we performed a prospective study to determine the frequency of this complication. Echocardiograms were done on 100 patients with bacterial meningitis. Small or moderate pericardial effusions were detected in 19 patients, but none had symptoms or signs related to the effusion. Pericardiocentesis was done in one infant; all the other effusions resolved spontaneously. Patients with effusion were significantly younger than those without this complication, but no other significant risk factors were identified. A literature survey indicated that symptomatic pericarditis occurs in fewer than 1% of patients with meningitis. Conversely, in series of cases of purulent pericarditis, associated meningitis was reported in 12% of patients. We concluded that pericardial infection is common in patients with meningitis but that it is usually of no clinical significance and resolves with antibiotic therapy.

Antibiotic Treatment—Much Better than Nothing

2019 ◽  
pp. 135-154
Author(s):  
Janet R. Gilsdorf
Keyword(s):  
Clinical Trials ◽  
Bacterial Meningitis ◽  
Antibiotic Treatment ◽  
Animal Experiments ◽  
Effective Management ◽  
Basic Principles ◽  
Duration Of Therapy ◽  
The Past ◽  
Drug Doses ◽  
Better Than

Over the past five decades, many animal experiments as well as clinical trials of antibiotics in humans treated for meningitis have defined the levels of antibiotics that are present in infected meninges and in the blood, thus informing the drug doses necessary to successfully treat the infection. In spite of the different kinds of bacteria that cause meningitis and the availability of various antibiotics to treat it, several basic principles of effective management for all common forms of bacterial meningitis have emerged from the decades of research. As a result of these studies, most children with meningitis in America receive appropriate antibiotic treatment (the correct antibiotic and the correct dose for the correct duration of therapy), and their outcomes are much, much better than the disastrous outcomes of earlier eras.

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