scholarly journals 2007. Impact of Combining Rapid Diagnostics with an Interpretation Guide on Vancomycin Usage for Contaminant Blood Cultures Growing Coagulase-Negative Staphylococci (CoNS)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S674-S674
Author(s):  
Simon Wu ◽  
Richard L Watson ◽  
Christopher J Graber
Keyword(s):  
Los Angeles ◽  
Antibiotic Use ◽  
Blood Cultures ◽  
Rapid Diagnostics ◽  
Coagulase Negative Staphylococci ◽  
Stewardship Program ◽  
Empiric Antibiotic ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Abstract Background Contaminant blood cultures can lead to unnecessary antibiotic use, longer admissions and increased costs. Rapid diagnostics, like the BioFire® FilmArray® Blood Culture Identification (BCID) Panel, can potentially lessen these harms. BioFire BCID was implemented at VA Greater Los Angeles in 7/2017. When providers review BCID results, they are also directed to an interpretation guide developed by our antimicrobial stewardship program. This study aimed to determine the impact of BioFire BCID with this interpretation guide on unnecessary vancomycin use for contaminant blood cultures growing CoNS. Methods This was a retrospective cohort study on adult inpatients with contaminant blood cultures positive for CoNS. We evaluated cases before BCID (April 2016–July 2017) and after BCID (July 7/2017–December 2018) implementation. Cases with patients who died or were discharged prior to preliminary results, polymicrobial cultures, no empiric vancomycin use, or where vancomycin was indicated were excluded. We defined a “case” as anytime a provider concurrently ordered blood cultures and empiric antibiotics. Our primary outcome was the duration of unnecessary vancomycin. Secondary outcomes were time to discontinuation/modification of any empiric antibiotic, length of stay (LOS), LOS in ICU and 30-day mortality. Results A total of 99 cases were included (N = 45 pre-BCID; N = 54 post-BCID). Demographics between the 2 groups were largely similar except the post-BCID group had more patients with end-stage renal disease (ESRD) (14 vs. 4, P = 0.037) and more frequent infectious disease (ID) consultation (21 vs. 8, P = 0.027). The post-BCID group had shorter mean duration of unnecessary vancomycin (53.0 hours vs. 38.1 hours, P = 0.0029). After controlling for ESRD and ID involvement, the mean duration of unnecessary vancomycin was not significantly different between the 2 groups (P = 0.30 and P = 0.49, respectively). There was no difference in time to modification/discontinuation of any empiric antibiotic (44.6 hr vs. 35.0 hr, P = 0.36). There was no difference in mean LOS, mean LOS in ICU, or 30-day mortality. Conclusion Shorter duration of unnecessary vancomycin for CoNS bacteremia after BCID implementation and provision of an interpretation guide may have been driven in part by more frequent ID consultation. Disclosures All authors: No reported disclosures.

Antibiogram Development for an Outpatient Dialysis Center

2000 ◽  
Vol 35 (3) ◽  
pp. 251-254 ◽  
Author(s):  
Harold J. Manley ◽  
George R. Bailie ◽  
Marianne Neumann
Keyword(s):  
Antibiotic Therapy ◽  
Empiric Antibiotic Therapy ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Susceptibility Data ◽  
Dialysis Center ◽  
Antimicrobial Sensitivity ◽  
Empiric Antibiotic ◽  
Stage Renal Disease ◽  
End Stage

Infection causes significant morbidity and mortality in end-stage renal disease patients. Despite recommendations to the contrary, vancomycin is often used empirically. Antibiograms may aid in the choice of empiric antibiotic therapy. We developed an antibiogram and determined the susceptibility of various microorganisms to cefazolin, gentamicin, and vancomycin. Retrospective review of culture results and susceptibility data from a 21-month time period were used to determine microorganism frequency of identification and antimicrobial sensitivity. A total of 362 microorganisms were identified and 285 cultures performed in 171 patients (144 hemodialysis; 27 peritoneal dialysis). Predominant organisms were coagulase-negative staphylococci (39.8%) and Staphylococcus aureus (24.6%). Gram-positive organisms accounted for 73.5% of isolates. Methicillin-resistant S. aureus and vancomycin-resistant Enterococcus were identified 3.8% and 2.3% of time, respectively. Gram-positive and negative microorganisms were frequently susceptible to cefazolin and gentamicin. Antibiogram interpretation indicates that cefazolin alone or in combination with gentamicin may be appropriate empiric antibiotic therapy in our outpatient dialysis center.

scholarly journals 137. Impact of Rapid Susceptibility Testing on Outcomes in Patients with Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S96-S97
Author(s):  
Oxana Megherea ◽  
Ruchi Patel ◽  
Patrick Lake ◽  
Keri Bicking ◽  
Rani Sebti
Keyword(s):  
Susceptibility Testing ◽  
Blood Cultures ◽  
Clinical Failure ◽  
Rapid Diagnostics ◽  
Post Intervention ◽  
Testing Method ◽  
Optimal Therapy ◽  
Stewardship Program ◽  
Significant Difference ◽  
The Impact

Abstract Background Early organism identification via rapid diagnostics has been shown to reduce time to effective antimicrobial therapy and improve patient outcomes in patients with bacteremia, but antimicrobial susceptibility testing is still required to optimize therapy. The objective of this study was to determine the impact of an institution-specific rapid susceptibility testing method on outcomes in patients with bacteremia. Methods This was a retrospective pre- and post-intervention study of 100 adult patients with bacteremia. Patients were excluded if they had polymicrobial infection, fungemia, blood cultures collected at outside hospitals, or if they expired prior to susceptibility results. Patients were identified through a report containing positive blood cultures from October 2017 to February 2018 (pre-intervention [PrI]) and October 2018 to February 2019 (post-intervention [PoI]). The primary endpoint was the rate of clinical failure (a composite of 28-day mortality or bacteremia persisting greater than 6 days). Secondary endpoints included microbiologic outcomes, time to effective and optimal therapy, length of stay (LOS) and therapy adjustments. Results Baseline characteristics were similar between groups; a third of the patients were immunosuppressed (Table 1). The most common sources of infection were urinary and intra-abdominal, and the most common organisms identified were E.coli and Klebsiella spp. No significant difference in the rate of clinical failure was identified between PrI and PoI (24% vs. 18%, P = 0.6242) (Table 2). In the PoI, the time to identification, susceptibility results, and effective therapy was significantly shorter with similar time to optimal therapy and LOS. In the PoI, antimicrobial stewardship program (ASP) interventions were made significantly sooner after susceptibility results. Conclusion In this small, retrospective, single-center study, the implementation of a rapid susceptibility testing method was associated with reduced time to susceptibility results and more rapid interventions by the ASP, but no difference in the rate of clinical failure or time to optimal therapy was identified. Disclosures All authors: No reported disclosures.

scholarly journals Use of Rapid Diagnostics To Manage Pediatric Bloodstream Infections? You Bet Your ASP!

2020 ◽  
Vol 58 (4) ◽  
Author(s):  
Mark D. Gonzalez ◽  
Melanie L. Yarbrough
Keyword(s):  
Clinical Microbiology ◽  
Diagnostic Testing ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Antimicrobial Stewardship Program ◽  
Rapid Diagnostics ◽  
Effective Implementation ◽  
Clinical Laboratories ◽  
Stewardship Program ◽  
The Impact

ABSTRACT Rapid diagnostic testing (RDT) can facilitate earlier optimization of the treatment of bloodstream infections, particularly in conjunction with an effective antimicrobial stewardship program (ASP). However, the effective implementation and workflow of RDTs are still a matter of debate, particularly in a pediatric setting. In this issue of the Journal of Clinical Microbiology, L. J. Juttukonda, S. Katz, J. Gillon, J. Schmitz, and R. Banerjee (J Clin Microbiol 58:e01400-19, 2020, https://doi.org/10.1128/JCM.01400-19) investigate the impact of a multiplex, molecular RDT on changes to antimicrobial therapy in an academic children’s hospital. These data reveal several factors that clinical laboratories should consider prior to the implementation of RDTs for positive blood cultures.

scholarly journals Depression among end-stage renal disease patients undergoing hemodialysis: a cross-sectional study from Palestine

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Samah W. Al-Jabi ◽  
Ansam Sous ◽  
Fatimah Jorf ◽  
Mahmoud Taqatqa ◽  
Mahdi Allan ◽  
...  
Keyword(s):  
Renal Disease ◽  
Low Income ◽  
End Stage Renal Disease ◽  
West Bank ◽  
Psychological Status ◽  
The West ◽  
Depression Prevalence ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Abstract Background The impact of end-stage renal disease on the patient’s psychological status necessitates the value of increasing depression awareness. The current study aimed to assess the depression prevalence among Palestinian hemodialyzed patients and its association with patients’ characteristics. Methods A convenience clustered sampling technique was followed. Sample was collected from ten hemodialysis centers in the West Bank, Palestine, during 3 months in 2015. We used the Beck Depression Inventory-II scale (BDI-II) to evaluate depression among participants. All data were analyzed using Statistical Package for the Social Sciences version 16.0. Results Two hundred and eighty-six hemodialyzed patients were interviewed. The mean age (± standard deviation) of the patients was 52.0 ± 14.3 years, and most participants were males 172 (60.1%). Regarding the dialysis characteristics, the median of years of dialysis was 2 years (1–4). The prevalence of depression was 73.1%. Elderly patients (p = 0.001), female (p = 0.036), living in rural areas or camp (p = 0.032), low income (p = 0.041), unemployment (p = 0.001), not doing regular exercise (p = 0.001), and having multi comorbidities (p = 0.001) were significantly associated with more depression scores. The results of binary logistic regression showed that only patients who were living in camps, patients who were previously employed, and patients who were not practicing exercise remained significantly associated with a higher depression score. Conclusions This study is the first one confirmed about depression and its prevalence among hemodialyzed patients in the West Bank, Palestine. Compared to other communities, the study found a higher depression prevalence rate. There is a need to offer psychological interviews and non-pharmacological and pharmacological interventions.

The impact of renal transplantation on survival in hepatitis C-positive end-stage renal disease patients

1997 ◽  
Vol 29 (4) ◽  
pp. 608-614 ◽  
Author(s):  
Greg A. Knoll ◽  
Martha R. Tankersley ◽  
Jeannette Y. Lee ◽  
Bruce A. Julian ◽  
John J. Curtis
Keyword(s):  
Renal Transplantation ◽  
Hepatitis C ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

scholarly journals Periodontal Disease in Patients Receiving Dialysis

2019 ◽  
Vol 20 (15) ◽  
pp. 3805
Author(s):  
Yasuyoshi Miyata ◽  
Yoko Obata ◽  
Yasushi Mochizuki ◽  
Mineaki Kitamura ◽  
Kensuke Mitsunari ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Periodontal Disease ◽  
Replacement Therapy ◽  
Healthy Individuals ◽  
Progressive Loss ◽  
Medical Instruments ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Chronic kidney disease (CKD) is characterized by kidney damage with proteinuria, hematuria, and progressive loss of kidney function. The final stage of CKD is known as end-stage renal disease, which usually indicates that approximately 90% of normal renal function is lost, and necessitates renal replacement therapy for survival. The most widespread renal replacement therapy is dialysis, which includes peritoneal dialysis (PD) and hemodialysis (HD). However, despite the development of novel medical instruments and agents, both dialysis procedures have complications and disadvantages, such as cardiovascular disease due to excessive blood fluid and infections caused by impaired immunity. Periodontal disease is chronic inflammation induced by various pathogens and its frequency and severity in patients undergoing dialysis are higher compared to those in healthy individuals. Therefore, several investigators have paid special attention to the impact of periodontal disease on inflammation-, nutrient-, and bone metabolism-related markers; the immune system; and complications in patients undergoing dialysis. Furthermore, the influence of diabetes on the prevalence and severity of manifestations of periodontal disease, and the properties of saliva in HD patients with periodontitis have been reported. Conversely, there are few reviews discussing periodontal disease in patients with dialysis. In this review, we discuss the available studies and review the pathological roles and clinical significance of periodontal disease in patients receiving PD or HD. In addition, this review underlines the importance of oral health and adequate periodontal treatment to maintain quality of life and prolong survival in these patients.

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