scholarly journals Clinical Impact of Two Different Multiplex Respiratory Panel Assays on Management of Hospitalized Children Aged ≤24 months

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S32-S33 ◽  
Author(s):  
Ferdaus Hassan ◽  
Brian Lee ◽  
Jennifer Goldman ◽  
Mary Anne Jackson ◽  
Rangaraj Selvarangan
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Impact ◽  
Empiric Antibiotic Therapy ◽  
Suppressive Therapy ◽  
Hospitalized Children ◽  
Respiratory Pathogens ◽  
Test Results ◽  
Molecular Assays ◽  
The Impact ◽  
Research Grant

Abstract Background Highly multiplexed molecular assays are popular in clinical laboratories due their high sensitivity, specificity and relatively rapid turn-around time (TAT) for results. Luminex™ respiratory viral panel (RVP) detects 12 respiratory viruses, while BioFire™ respiratory panel (RP) detects 20 respiratory pathogens (17 viruses, 3 bacteria). The aim of the current study was to compare the impact of RVP and RP assay on management of hospitalized children aged ≤24 months. Methods Retrospective data were collected to compare the clinical impact from two multiplex molecular assays (RVP, December 2008–May 2012; RP August 2012–June 2015) on management and outcomes of hospitalized patients. Patients aged ≤24 months and positive for at least one respiratory virus were included. Patients who were (1) receiving immune suppressive therapy, (2) neonates requiring intensive care, or (3) hospitalized for >7 days were excluded. Results A total of 810 patients in RVP and 2,095 patients in RP group were included. The median TAT for RVP and RP assay were 29 hours (IQR 26–58 hours) and 4 hours (IQR 2–8 hours), respectively (P < 0.001). Significantly higher number of children in RVP group (44%, 357/810) received empiric antibiotic therapy compared with RP group (28%, 595/2095) (P < 0.001). Following PCR test reporting, the rate of antibiotic discontinuation was higher in the RP group (23%, 135/595) vs. RVP group (16%, 56/357) (P < 0.001). Antibiotics were discontinued more often in older children aged 6–24 months (23%, 113/492) compared with children aged < 60 days (11%, 34/297) (P < 0.001). Following positive influenza test results, more children received timely oseltamivir in the RP group (85%, 48/56) compared with the RVP group (17%, 7/41) (P < 0.001). The median length of hospitalization (LOH) was shorter in the RP group (48 hours, IQR 32–76 hours) than in the RVP group (54 hours, IQR 39–89 hours) (P < 0.001). Conclusion Rapid availability of test results from RP assay was associated with reduced antibiotic use, timely antiviral therapy and decreased LOH. The implementation of a more comprehensive respiratory multiplex molecular assay with rapid reporting of test results has the potential to improve management of hospitalized children, decrease unnecessary antibiotic therapy and reduce overall costs. Disclosures R. Selvarangan, BioFire Diagnostics: Board Member and Investigator, Consulting fee and Research grant; Luminex Diagnostics: Investigator, Research grant

scholarly journals Comparison of 11 respiratory pathogens among hospitalized children before and during the COVID-19 epidemic in Shenzhen, China

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Li Li ◽  
Heping Wang ◽  
Ailiang Liu ◽  
Rongjun Wang ◽  
Tingting Zhi ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Multiplex Pcr ◽  
Detection Rate ◽  
Human Metapneumovirus ◽  
Human Respiratory Syncytial Virus ◽  
Hospitalized Children ◽  
Respiratory Pathogens ◽  
Detection Rates ◽  
Syncytial Virus ◽  
The Impact

Abstract Background The effect of SARS-CoV-2 on existing respiratory pathogens in circulation remains uncertain. This study aimed to assess the impact of SARS-CoV-2 on the prevalence of respiratory pathogens among hospitalized children. Methods This study enrolled hospitalized children with acute respiratory infections in Shenzhen Children’s Hospital from September to December 2019 (before the COVID-19 epidemic) and those from September to December 2020 (during the COVID-19 epidemic). Nasopharyngeal swabs were collected, and respiratory pathogens were detected using multiplex PCR. The absolute case number and detection rates of 11 pathogens were collected and analyzed. Results A total of 5696 children with respiratory tract infection received multiplex PCR examination for respiratory pathogens: 2298 from September to December 2019 and 3398 from September to December 2020. At least one pathogen was detected in 1850 (80.5%) patients in 2019, and in 2380 (70.0%) patients in 2020; the detection rate in 2020 was significantly lower than that in 2019.The Influenza A (InfA) detection rate was 5.6% in 2019, but 0% in 2020. The detection rates of Mycoplasma pneumoniae, Human adenovirus, and Human rhinovirus also decreased from 20% (460), 8.9% (206), and 41.8% (961) in 2019 to 1.0% (37), 2.1% (77), and 25.6% (873) in 2020, respectively. In contrast, the detection rates of Human respiratory syncytial virus, Human parainfluenza virus, and Human metapneumovirus increased from 6.6% (153), 9.9% (229), and 0.5% (12) in 2019 to 25.6% (873), 15.5% (530), and 7.2% (247) in 2020, respectively (p < 0.0001). Conclusions Successful containment of seasonal influenza as a result of COVID-19 control measures will ensure we are better equipped to deal with future outbreaks of both influenza and COVID-19.Caused by virus competition, the detection rates of Human respiratory syncytial virus, Human parainfluenza virus, and Human metapneumovirus increased in Shenzhen,that reminds us we need to take further monitoring and preventive measures in the next epidemic season.

scholarly journals Impact of a multiplex polymerase chain reaction panel on duration of empiric antibiotic therapy in suspected bacterial meningitis

2021 ◽  
Author(s):  
Justin J Choi ◽  
Lars F Westblade ◽  
Lee S Gottesdiener ◽  
Kyle Liang ◽  
Han A Li ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Multiplex Pcr ◽  
Hospital Length ◽  
Clinical Impact ◽  
Hospital Length Of Stay ◽  
Empiric Antibiotic Therapy ◽  
Chain Reaction ◽  
Empiric Antibiotic ◽  
Polymerase Chain

Abstract Background Multiplex polymerase chain reaction (PCR) panels allow for rapid detection or exclusion of pathogens causing meningitis and encephalitis (ME). The clinical impact of rapid multiplex PCR ME panel results on the duration of empiric antibiotic therapy is not well characterized. Methods We performed a retrospective pre-post study at our institution that evaluated the clinical impact of a multiplex PCR ME panel among adults with suspected bacterial meningitis who received empiric antibiotic therapy and underwent lumbar puncture in the emergency department. The primary outcome was the duration of empiric antibiotic therapy. Results The positive pathogen detection rates were similar between pre- and post-multiplex PCR ME panel periods (17.5%, 24 of 137, vs. 20.3%, 14 of 69, respectively). The median duration of empiric antibiotic therapy was significantly reduced in the post-multiplex PCR ME panel period compared to the pre-multiplex PCR ME panel period (34.7 h vs. 12.3 h, P=0.01). At any point in time, 46% more patients in the post-multiplex PCR ME panel period had empiric antibiotic therapy discontinued or de-escalated compared to the pre-multiplex PCR ME panel period (sex- and immunosuppressant use-adjusted HR 1.46, P=0.01). The median hospital length of stay was shorter in the post-multiplex PCR ME panel period (3 d vs. 4 d, P=0.03). Conclusions The implementation of the multiplex PCR ME panel for bacterial meningitis reduced the duration of empiric antibiotic therapy and possibly hospital length of stay compared to traditional microbiological testing methods.

scholarly journals A Multicenter Stewardship Initiative to Decrease Excessive Duration of Antibiotic Therapy for the Treatment of Community-Acquired Pneumonia (CAP)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S63-S64
Author(s):  
Farnaz Foolad ◽  
Angela Huang ◽  
Cynthia Nguyen ◽  
Lindsay Colyer ◽  
Megan Lim ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Total Duration ◽  
Audit And Feedback ◽  
Patient Specific ◽  
Control Group ◽  
Duration Of Therapy ◽  
The Impact ◽  
Research Grant

Abstract Background Hospitals have implemented multifaceted approaches to quickly identify CAP, start timely therapy, and reduce hospital readmission, yet there has been minimal focus on providing appropriate duration of therapy. The IDSA CAP guidelines recommend 5 days of antibiotic therapy for patients that are clinically stable and quickly defervesce. However, previous publications suggest duration of therapy for CAP may be unnecessarily prolonged. Methods The objective of this multicenter, quasi-experimental study of hospitalized patients with CAP was to assess the impact of a prospective 6-month stewardship intervention on total duration of antibiotic therapy and associated clinical outcomes. All centers updated institutional CAP guidelines to promote IDSA-concordant durations of therapy and provided education to pharmacists and prescribers. Daily patient-specific prospective audit and feedback was provided by infectious diseases stewardship pharmacists to optimize compliance with guideline recommendations. Results A total of 600 patients were included (307 in the historic control group and 293 in the stewardship intervention group). The stewardship intervention led to significantly increased rates of compliance with IDSA duration of therapy recommendations (5.6% vs. 41.4%, P&lt; &lt; 0.01) and significantly reduced the duration of therapy for CAP (9 vs. 6 days, P &lt; 0.01). Inappropriate days of antibiotic therapy was reduced in the intervention group (4 vs. 1.6 days, P &lt; 0.01), and total avoidance of 720 excessive days of antibiotic therapy. Clinical outcomes, including mortality, length of hospitalization, readmission to hospital with pneumonia, presentation to the ER/clinic with pneumonia within 30 days of discharge, and incidence of C. difficilecolitis, were not different between groups. Conclusion This multicenter evaluation of a prospective stewardship intervention in hospitalized CAP patients reduced the total duration of antibiotic therapy and increased compliance with guideline-concordant duration of therapy without adversely affecting patient outcomes. This project was funded through a competitive stewardship grant provided by Merck & Co. Disclosures A. Huang, Merck: Grant Investigator, Research grant; C. Nguyen, Merck: Grant Investigator, Research grant; J. Grieger, Merck: Grant Investigator, Research grant; S. Revolinski, Merck: Grant Investigator, Research grant; J. Li, Merck: Grant Investigator, Research grant; M. Mack, Merck: Grant Investigator, Research grant; J. N. Wainaina, Merck: Grant Investigator, Research grant; G. Eschenauer, Merck: Grant Investigator, Research grant; T. Patel, Merck: Grant Investigator, Research grant; V. Marshall, Merck: Grant Investigator, Research grant; J. Nagel, Merck: Grant Investigator, Research grant

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 1019. Clinical Impact of a Rapid Cerebrospinal Fluid Diagnostic Stewardship Program for Suspected Central Nervous System Infections in Children

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S600-S602
Author(s):  
Kevin Messacar ◽  
Claire Palmer ◽  
LiseAnne Gregoire ◽  
Audrey Elliott ◽  
Elizabeth Ackley ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Hospital Admissions ◽  
Clinical Impact ◽  
High Yield ◽  
Cns Infection ◽  
Research Support ◽  
Detection Rates ◽  
Stewardship Program ◽  
The Impact ◽  
Research Grant

Abstract Background Despite widespread use, the optimal implementation and clinical impact of FilmArray Meningitis Encephalitis Panel (MEP; Table 1) multiplex PCR testing of cerebrospinal fluid (CSF) in children with suspected (CNS) infections is unknown. Table 1: FilmArray Meningitis Encephalitis Panel Test Characteristics Methods A pre-post quasi-experimental cohort study to investigate the impact of implementing MEP using a rapid CSF diagnostic stewardship program was conducted at Children’s Hospital Colorado (CHCO). MEP was implemented with EMR indication selection to guide testing to children meeting approved use criteria: i. infants &lt; 2mo, ii. immunocompromised, iii. encephalitis, iv. &gt; 5 WBCs in CSF. Positive results were communicated with antimicrobial stewardship real-time decision support (Fig 1). All cases with CSF obtained by lumbar puncture (LP) sent to the CHCO microbiology laboratory meeting any of the 4 criteria above were included with pre-implementation controls (2015-2016) compared to post-implementation cases (2017-2018). Primary outcome was time-to-optimal antimicrobials (time from LP to 1st dose of antimicrobials targeted to identified pathogen, or cessation when no treatable pathogen identified). Figure 1: Rapid Cerebrospinal Fluid Diagnostic Stewardship Program Intervention Design Results Post-implementation (n=1127) and pre-implementation (n=1124) group characteristics are in Table 2. Following implementation, MEP was sent in 72% of cases, largely replacing pathogen-specific singleplex CSF testing (Table 3). Time-to-optimal antimicrobials decreased by 10 hours (p&lt; 0.0001; Fig 2). There were no differences in time-to-effective antimicrobials, hospital admissions, antimicrobial starts or length of stay. Time-to-positive CSF results was faster (4.8 vs. 9.6 hrs, p&lt; 0.0001), IV antimicrobial duration was shorter (24 vs 36 hrs, p=0.004) with infectious neurologic diagnoses more frequently identified (15% vs. 10%, p=0.03). Overall, 3% had bacterial and 9% viral CNS infection identified. Enterovirus (n=128) was most common, then HSV (n=28) and parechovirus (n=17) with similar detection rates between groups Conclusion Implementation of MEP with a rapid CNS diagnostic stewardship program improved antimicrobial use with faster results shortening empiric therapy. Routine MEP testing in high-yield cases rapidly detects common viral causes and rules out bacterial targets to enable antimicrobial optimization Disclosures Samuel R. Dominguez, MD, PhD, BioFire Diagnostics (Consultant, Research Grant or Support)DiaSorin Molecular (Consultant)Pfizer (Grant/Research Support) Samuel R. Dominguez, MD, PhD, BioFire (Individual(s) Involved: Self): Consultant, Research Grant or Support; DiaSorin Molecular (Individual(s) Involved: Self): Consultant; Pfizer (Individual(s) Involved: Self): Grant/Research Support

scholarly journals Comparison of 11 Respiratory Pathogens Among Hospitalized Children Before and After the COVID-19 Epidemic in Shenzhen, China

2021 ◽  
Author(s):  
Li Li ◽  
Heping Wang ◽  
Ailiang Liu ◽  
Rongjun Wang ◽  
Tingting Zhi ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Multiplex Pcr ◽  
Mycoplasma Pneumoniae ◽  
Detection Rate ◽  
Human Metapneumovirus ◽  
Hospitalized Children ◽  
Respiratory Pathogens ◽  
Detection Rates ◽  
Syncytial Virus ◽  
The Impact

Abstract Background: The effect of SARS-CoV-2 on existing respiratory pathogens in circulation remains uncertain. This study aimed to assess the impact of SARS-CoV-2 on the prevalence of respiratory pathogens among hospitalized children.Methods: This study enrolled hospitalized children with acute respiratory infections in Shenzhen Children’s Hospital from September to December 2019 (before the COVID-19 epidemic) and those from September to December 2020 (after the COVID-19 epidemic). Nasopharyngeal swabs were collected, and respiratory pathogens were detected using multiplex PCR. The absolute case number and detection rates of 11 pathogens were collected and analyzed.Results: A total of 5696 children with respiratory tract infection received multiplex PCR examination for respiratory pathogens: 2298 from September to December 2019 and 3398 from September to December 2020. At least one pathogen was detected in 1850 (80.5%) patients in 2019, and in 2380 (70.0%) patients in 2020; the detection rate in 2020 was significantly lower than that in 2019. The detection rates reflected changes in these pathogens when the COVID-19 epidemic was well controlled. The Influenza A (InfA) detection rate was 5.6% in 2019, but 0% in 2020. The detection rates of Mycoplasma pneumoniae, Human adenovirus, and Human rhinovirus also decreased from 20% (460), 8.9% (206), and 41.8% (961) in 2019 to 1.0% (37), 2.1% (77), and 25.6% (873) in 2020, respectively. In contrast, the detection rates of Human respiratory syncytial virus, Human parainfluenza virus, and Human metapneumovirus increased from 6.6% (153), 9.9% (229), and 0.5% (12) in 2019 to 25.6% (873), 15.5% (530), and 7.2% (247) in 2020, respectively (p < 0.0001).Conclusions: The emergence of SARS-CoV-2 was associated with the substantial reduction in the circulation of respiratory pathogens including influenza virus, rhinovirus, adenovirus, and Mycoplasma pneumoniae, as well as with the increase in respiratory syncytial virus, parainfluenza, and human metapneumovirus in Shenzhen. The reasons for this phenomenon require further studies.

scholarly journals Reducing the use of empiric antibiotic therapy in COVID-19 on hospital admission

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Natasha N. Pettit ◽  
Cynthia T. Nguyen ◽  
Alison K. Lew ◽  
Palak H. Bhagat ◽  
Allison Nelson ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Empiric Antibiotics ◽  
Empiric Antibiotic ◽  
The Impact ◽  
Post Intervention Group

Abstract Background Empiric antibiotics for community acquired bacterial pneumonia (CABP) are often prescribed to patients with COVID-19, despite a low reported incidence of co-infections. Stewardship interventions targeted at facilitating appropriate antibiotic prescribing for CABP among COVID-19 patients are needed. We developed a guideline for antibiotic initiation and discontinuation for CABP in COVID-19 patients. The purpose of this study was to assess the impact of this intervention on the duration of empiric CABP antibiotic therapy among patients with COVID-19. Methods This was a single-center, retrospective, quasi-experimental study of adult patients admitted between 3/1/2020 to 4/25/2020 with COVID-19 pneumonia, who were initiated on empiric CABP antibiotics. Patients were excluded if they were initiated on antibiotics > 48 h following admission or if another source of infection was identified. The primary outcome was the duration of antibiotic therapy (DOT) prior to the guideline (March 1 to March27, 2020) and after guideline implementation (March 28 to April 25, 2020). We also evaluated the clinical outcomes (mortality, readmissions, length of stay) among those initiated on empiric CABP antibiotics. Results A total of 506 patients with COVID-19 were evaluated, 102 pre-intervention and 404 post-intervention. Prior to the intervention, 74.5% (n = 76) of patients with COVID-19 received empiric antibiotics compared to only 42% of patients post-intervention (n = 170), p < 0.001. The median DOT in the post-intervention group was 1.3 days shorter (p < 0.001) than the pre-intervention group, and antibiotics directed at atypical bacteria DOT was reduced by 2.8 days (p < 0.001). More patients in the post-intervention group were initiated on antibiotics based on criteria consistent with our guideline (68% versus 87%, p = 0.001). There were no differences between groups in terms of clinical outcomes. Conclusion Following the implementation of a guideline outlining recommendations for initiating and discontinuing antibiotics for CABP among COVID-19 inpatients, we observed a reduction in antibiotic prescribing and DOT. The guideline also resulted in a significant increase in the rate of guideline-congruent empiric antibiotic initiation.

scholarly journals Reducing the use of empiric antibiotic therapy in patients on admission to the hospital with COVID-19

2020 ◽  
Author(s):  
Natasha N. Pettit ◽  
Cynthia T. Nguyen ◽  
Alison Lew ◽  
Palak Bhagat ◽  
Allison Nelson ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Empiric Antibiotics ◽  
Empiric Antibiotic ◽  
The Impact ◽  
Post Intervention Group

Abstract Background: Empiric antibiotics for community acquired bacterial pneumonia (CABP) are often prescribed to patients with COVID-19, despite a low reported incidence of co-infections. Stewardship interventions targeted at facilitating appropriate antibiotic prescribing for CABP among COVID-19 patients are needed. We developed a guideline for antibiotic initiation and discontinuation for CABP in COVID-19 patients. The purpose of this study was to assess the impact of this intervention on the duration of empiric CABP antibiotic therapy among patients with COVID-19. Methods: This was a single-center, retrospective, quasi-experimental study of adult patients admitted between 3/1/2020 to 4/25/2020 with COVID-19 pneumonia, who were initiated on empiric CABP antibiotics. Patients were excluded if they were initiated on antibiotics >48hours following admission or if another infection was identified. The primary outcome was the duration of antibiotic therapy (DOT) prior to the guideline (March 1 to March27, 2020) and after guideline implementation (March 28 to April 25, 2020). We also evaluated the clinical outcomes (mortality, readmissions, length of stay) among those initiated on empiric CABP antibiotics. Results: A total of 506 patients with COVID-19 were evaluated, 102 pre-intervention and 404 post-intervention. Prior to the intervention, 74.5% (n=76) of patients with COVID-19 received empiric antibiotics compared to only 42% of patients post-intervention (n=170), p<0.001. The median DOT in the post-intervention group was 1.3 days shorter (p<0.001) than the pre-intervention group, and atypical antibiotic DOT was reduced by 2.8 days (p<0.001). More patients in the post-intervention group were initiated on antibiotics based on criteria consistent with our guideline (68% versus 87%, p=0.001). There were no differences between groups in terms of clinical outcomes. Conclusion: Following the implementation of a guideline outlining recommendations for initiating and discontinuing antibiotics for CABP among COVID-19 inpatients, we observed a reduction in antibiotic prescribing and DOT. The guideline also resulted in a significant increase in the rate of guideline-congruent empiric antibiotic initiation.

scholarly journals 2292. Incidence of Acute Kidney Injury Associated with Duration of Vancomycin and Piperacillin/tazobactam Combination Therapy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S785-S786
Author(s):  
Lisanne McMullen ◽  
Rachael Craft ◽  
Mackenzie Tenkku
Keyword(s):  
Acute Kidney Injury ◽  
Combination Therapy ◽  
Antibiotic Therapy ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Empiric Antibiotic Therapy ◽  
Steady Increase ◽  
Event Analysis ◽  
Duration Of Therapy ◽  
The Impact

Abstract Background Empiric antibiotic therapy for serious and healthcare-acquired infections often requires coverage for resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. These regimens commonly consist of vancomycin plus an antipseudomonal β-lactam. Recent studies have reported increased acute kidney injury (AKI) risk associated with concomitant vancomycin and piperacillin/tazobactam therapy compared with each agent alone. The objective of this study was to determine whether vancomycin with piperacillin/tazobactam had an increased AKI incidence compared with vancomycin plus cefepime or meropenem. Furthermore, data were analyzed to determine whether a specific duration was associated with an increased AKI incidence. Methods A retrospective cohort study was conducted analyzing patients who received vancomycin in combination with piperacillin/tazobactam (V+PT), cefepime (V+C), or meropenem (V+M) between January 1, 2018 through June 30, 2018. Adult patients with normal baseline renal function and receipt of at least 48 hours of combination therapy, with the two antibiotics initiated within 24 hours of one another, were included. AKI events, evaluated using the Acute Kidney Injury Network (AKIN) criteria, during antibiotic therapy and up to 72 hours after antibiotic discontinuation were recorded. This data were used to calculate the AKI incidence with each regimen and AKI incidence associated with each day of therapy. Results A total of 181 patients were included in the study. The incidence of AKI in the V+PT group was 22.8% vs. 5.6% and 16.7% in the V+C and V+M groups, respectively (P = 0.237). Median duration of therapy when AKI occurred was 3 days for V+PT, 4 days for V+C, and 2 days for V+M (P = 0.015). Patients in the V+M group received more nephrotoxic agents compared with V+PT and V+C (P = 0.004). Statistical analysis did not find a specific day of V+PT therapy predictive of AKI. However, a time to event analysis demonstrated a steady increase in AKI risk with V+PT from day 2 through 6. Conclusion Although not statistically significant, V+PT therapy was associated with a higher incidence of AKI compared with V+C or V+M. Future studies are needed to further assess the impact of duration of therapy on AKI incidence. Disclosures All authors: No reported disclosures.

scholarly journals Assessment of the Usefulness of Multiplex Real-Time PCR Tests in the Diagnostic and Therapeutic Process of Pneumonia in Hospitalized Children: A Single-Center Experience

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Ewelina Gowin ◽  
Alicja Bartkowska-Śniatkowska ◽  
Katarzyna Jończyk-Potoczna ◽  
Joanna Wysocka-Leszczyńska ◽  
Waldemar Bobkowski ◽  
...  
Keyword(s):  
Real Time ◽  
Real Time Pcr ◽  
Therapeutic Process ◽  
Hospitalized Children ◽  
Respiratory Pathogens ◽  
Test Results ◽  
Single Center Experience ◽  
Lung Infections ◽  
Positive Results ◽  
Severe Lung

The aim of the study was assessment of the usefulness of multiplex real-time PCR tests in the diagnostic and therapeutic process in children hospitalized due to pneumonia and burdened with comorbidities.Methods. The study group included 97 children hospitalized due to pneumonia at the Karol Jonscher Teaching Hospital in Poznań, in whom multiplex real-time PCR tests (FTD respiratory pathogens 33; fast-track diagnostics) were used.Results. Positive test results of the test were achieved in 74 patients (76.3%). The average age in the group was 56 months. Viruses were detected in 61 samples (82% of all positive results); bacterial factors were found in 29 samples (39% of all positive results). The presence of comorbidities was established in 90 children (92.78%). On the basis of the obtained results, 5 groups of patients were established: viral etiology of infection, 34 patients; bacterial etiology, 7 patients; mixed etiology, 23 patients; pneumocystis, 9 patients; and no etiology diagnosed, 24 patients.Conclusions. Our analysis demonstrated that the participation of viruses in causing severe lung infections is significant in children with comorbidities. Multiplex real-time PCR tests proved to be more useful in establishing the etiology of pneumonia in hospitalized children than the traditional microbiological examinations.

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