2297. Epidemiology of Antibiotic-resistant Pathogens and Empiric Treatment Patterns in Community-Onset Sepsis

Abstract Background Guidelines recommend immediate empiric broad-spectrum antibiotics for all patients with suspected sepsis. Understanding the epidemiology of antibiotic-resistant pathogens and empiric treatment patterns in sepsis could inform improvements in antibiotic utilization and outcomes. Methods We identified adults admitted during 2009–2015 to 104 US hospitals in the Cerner HealthFacts dataset who met CDC Adult Sepsis Event criteria and had positive clinical cultures within 2 days of admission. We characterized prevalence and empiric treatment rates for methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococcus (VRE), ceftriaxone-resistant Gram-negative organisms (CRO) (including P. aeruginosa), and extended-spectrum β-lactamase Gram-negative organisms (ESBL). We evaluated associations between in-hospital mortality and either inappropriate empiric therapy (antibiotics inactive against any isolated pathogen) or excessively broad therapy (empiric MRSA or VRE coverage, extended spectrum β-lactam, or carbapenem therapy when targeted organisms were absent), adjusting for baseline characteristics and severity-of-illness. Results The cohort included 17,962 patients with culture-positive sepsis; 2,965 (16.5%) died in-hospital. The most common culture-positive sites were urine (51.2%), blood (41.8%), and respiratory (16.5%). The most common pathogens were E. coli (33.0%), S. aureus (20.9%), and Streptococcus (13.2%) (Figure 1). Most (81.6%) patients received empiric antibiotics active against all isolated pathogens. Empiric therapy was directed at resistant organisms in 67.5% of cases (primarily vancomycin and extended spectrum β-lactams, Figure 2), but resistant organisms were isolated in only 25.2% (MRSA 11.5%, CRO 12.9%, VRE 2.0%, ESBL 0.8%). Both inappropriate empiric therapy and excessively broad empiric therapy were associated with higher mortality on multivariate analysis (OR 1.30, 95% CI 1.14–1.48 and OR 1.20, 95% CI 1.05–1.38, respectively). Conclusion Most patients with community-onset sepsis do not have resistant pathogens, yet empiric broad-spectrum antibiotics are frequently prescribed. Both inappropriate empiric therapy and excessively broad therapy are associated with worse outcomes. Disclosures All authors: No reported disclosures.

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Faculty Opinions recommendation of Ertapenem administered as outpatient parenteral antibiotic therapy for urinary tract infections caused by extended-spectrum-beta-lactamase-producing Gram-negative organisms.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.3274965.2960069 ◽

2010 ◽

Author(s):

Philippe Lagacé-Wiens

Keyword(s):

Urinary Tract ◽

Antibiotic Therapy ◽

Urinary Tract Infections ◽

Beta Lactamase ◽

Parenteral Antibiotic ◽

Gram Negative ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum ◽

Gram Negative Organisms ◽

Tract Infections

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Extended-spectrum cephalosporin-resistant gram-negative organisms in livestock: An emerging problem for human health?

Drug Resistance Updates ◽

10.1016/j.drup.2012.12.001 ◽

2013 ◽

Vol 16 (1-2) ◽

pp. 22-45 ◽

Cited By ~ 137

Author(s):

Salome N. Seiffert ◽

Markus Hilty ◽

Vincent Perreten ◽

Andrea Endimiani

Keyword(s):

Human Health ◽

Gram Negative ◽

Extended Spectrum ◽

Gram Negative Organisms

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Multidrug resistance in the neonatal unit and its therapeutic implications

Paediatrica Indonesiana ◽

10.14238/pi46.1.2006.25-31 ◽

2016 ◽

Vol 46 (1) ◽

pp. 25 ◽

Cited By ~ 2

Author(s):

Rinawati Rohsiswatmo

Keyword(s):

Clinical Signs ◽

Acinetobacter Calcoaceticus ◽

Neonatal Unit ◽

Antibiotic Resistant ◽

Gram Negative ◽

Therapeutic Implications ◽

Resis Tance ◽

Fungi Infection ◽

Gram Negative Organisms ◽

A Prospective Study

Background Neonatal septicemia constitutes an important causeof morbidity and mortality among neonates in Indonesia. The ex-cessive use of antibiotics may cause antibiotic resistant bacteriaand may cause neonatal fungal infection.Objective To investigate the spectrum of organisms which causeneonatal sepsis and assess their sensitivity to various groups ofdrugs in the neonatal unit.Methods A prospective study conducted on newborn babies de-livered in Cipto Mangunkusumo Hospital, Jakarta from July 2004-May 2005 who presented clinical signs of septicemia were sub-jected for blood culture. Those sensitive to antibiotics for 7 daysyet showed no clinical improvement were also cultured for fungi.Results A total of 499 blood cultures were taken, 320 were posi-tive for bacteria (positivity rate was 65.3%). There were 192 samplescultured for fungi, and the positivity rate was 64% (all for Candidasp). Acinetobacter calcoaceticus was the most common bacteriafound (35.7%), followed by Enterobacter sp (7.0%), and Staphylo-coccus sp (6.8%). Most bacteria showed high degrees of resis-tance to commonly used antibiotics (ampicillin and gentamicin).There were also high degrees of resistance to cephalosporins byboth Gram negative and Gram positive organisms. Only 61.7% ofA. calcoaceticus, and 45.7% of Enterobacter sp were sensitive toceftazidime. Gram negative organisms were also highly resistantto amikacin, but Staphylococcus sp was only moderately resis-tant. Resistance to carbapenem (meropenem and imipenem) var-ied from moderate to low. Drugs which were not used for newbornbabies (quinolones/ciprofloxacin and chloramphenicol) varied frommoderate to high resistance.Conclusion Neonatal sepsis remains one of the major causes ofmortality in our neonatal unit. Most organisms have developedmultidrug resistance, and management of patients infected withthese organisms and especially those with fungi infection are be-coming a problem in developing countries

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Nosocomial acquisition and transmission of antibiotic-resistant Gram-negative organisms in the pediatric intensive care unit

The Pediatric Infectious Disease Journal ◽

10.1097/00006454-200106000-00013 ◽

2001 ◽

Vol 20 (6) ◽

pp. 612-618 ◽

Cited By ~ 14

Author(s):

PHILIP TOLTZIS ◽

JEFFREY L. BLUMER

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Antibiotic Resistant ◽

Gram Negative ◽

Gram Negative Organisms

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Current Concepts in Antimicrobial Therapy Against Resistant Gram-Negative Organisms: Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae, Carbapenem-Resistant Enterobacteriaceae, and Multidrug-Resistant Pseudomonas aeruginosa

Mayo Clinic Proceedings ◽

10.4065/mcp.2010.0674 ◽

2011 ◽

Vol 86 (3) ◽

pp. 250-259 ◽

Cited By ~ 152

Author(s):

Souha S. Kanj ◽

Zeina A. Kanafani

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Therapy ◽

Multidrug Resistant ◽

Gram Negative ◽

Carbapenem Resistant ◽

Extended Spectrum ◽

Gram Negative Organisms ◽

Carbapenem Resistant Enterobacteriaceae

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Clinico-bacteriological profile of neonatal sepsis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20190732 ◽

2019 ◽

Vol 6 (2) ◽

pp. 796 ◽

Cited By ~ 1

Author(s):

Rashmi P. ◽

Praveen B. K.

Keyword(s):

Neonatal Sepsis ◽

Clinical Suspicion ◽

Coagulase Negative Staphylococcus ◽

Gram Positive ◽

Gram Negative ◽

Methicillin Resistant ◽

Early Onset Sepsis ◽

Sensitivity Pattern ◽

Gram Negative Organisms ◽

Culture Positive

Background: Neonatal sepsis is the commonest cause of neonatal mortality responsible for about 30-50% of total neonatal deaths in developing countries. Surveillance of causative organisms and their antibiotic sensitivity pattern promotes rational use of antibiotics and antibiotic stewardship.Methods: A retrospective study, relevant data regarding the neonates diagnosed with culture positive sepsis was obtained from the case records during the period from July 2014 to June 2017. Culture positive sepsis was defined as isolation of bacterial pathogen from blood in neonates with clinical suspicion of sepsis.Results: Of the 414 neonates with clinical suspicion of sepsis, 110 neonates had blood culture positive sepsis. Sepsis was predominant in males (64.5%). Low birth weight (47.2%) and prematurity (40.9 %) were important neonatal risk factors for sepsis. Early onset sepsis occurred in 58.1% of the cases and late onset sepsis in 41.9% of the neonates. Gram-positive cocci constituted 67.52% of all isolates and gram negative 30.76%. The most frequently isolated organism in blood was methicillin resistant coagulase negative staphylococcus(MRCONS) (32.47%). Gram positive organisms included MRCONS, methicillin resistant Staphylococci aureus (MRSA), group B Streptococci (GBS), Staphylococcus aureus and Enterococci. Among Gram-negative organisms, Acinetobacter was most frequently isolated followed by Klebsiella, Escherichia coli, Pseudomonas, Citrobacter and Burkholderia species. The mortality in the study group was 13.5%. Gram negative organisms were most resistant to ampicillin and cephalosporins. Gram positive isolates were least resistant to vancomycin and linezolid.Conclusions: Gram positive sepsis was the most common type of sepsis among the neonates, although mortality was more in gram negative sepsis.

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Frequency and Antimicrobial Susceptibility of Bacterial Agents Causing Peritoneal Dialysis-Related Peritonitis: A Two-Center Experience

International Journal of Infection ◽

10.5812/iji.104037 ◽

2020 ◽

Vol 7 (4) ◽

Author(s):

Fariba Shirvani ◽

Nakysa Hooman ◽

Abdollah Karimi ◽

Shahnaz Armin ◽

Alireza Fahimzad ◽

...

Keyword(s):

Abdominal Pain ◽

Peritoneal Dialysis ◽

Therapeutic Option ◽

Intraperitoneal Administration ◽

Clinical Manifestations ◽

Empiric Therapy ◽

Fungal Peritonitis ◽

Gram Negative ◽

Oxacillin Resistance ◽

Gram Negative Organisms

Background: Peritonitis remains a significant complication of peritoneal dialysis (PD) in children. Objectives: The current study aimed to evaluate the causative agents of PD-related peritonitis in pediatric patients treated by continuous ambulatory peritoneal dialysis (CAPD) in order to provide evidence for improving the empirical treatment of PD-related peritonitis and avoid antimicrobial resistance. Methods: The medical records of children diagnosed with PD-related peritonitis hospitalized at Mofid and Ali-Asghar Children’s Hospitals from January 2018 to December 2019 were retrospectively reviewed. Cases of relapsing peritonitis and fungal peritonitis were excluded. Data on demographics, clinical manifestations, para-clinical evaluations, peritoneal fluid culture and antibiogram, and antibiotic regimen were analyzed. Results: A total of 23 CAPD children aged 1 - 17 years were hospitalized with a confirmed diagnosis of PD-related peritonitis, accounting for a total of 27 peritonitis cases. The most frequent manifestation of peritonitis was cloudy dialysate (85.2%), followed by abdominal pain (59.3%). Gram-negative organisms were isolated in 48.1% of cases, and 4 cases had negative cultures. The frequency of antibiotic prescription within 14 days of admission was significantly higher in culture-negative cases (P = 0.002), and abdominal pain was more prevalent in Gram-negative peritonitis (P = 0.004). All Gram-negative organisms were sensitive to ceftazidime and imipenem; while 61.6% of them were sensitive to gentamycin. All Gram-positive organisms were sensitive to cefazolin, and vancomycin was effective against all Staphylococcus strains. Oxacillin resistance was reported in 50% of Staphylococcus strains. Conclusions: PD-related peritonitis should be suspected even in cases with clear dialysis effluent who present with other manifestations of peritonitis such as fever or abdominal pain. Moreover, intraperitoneal administration of a first-generation cephalosporin (cefazolin) combined with ceftazidime was an appropriate therapeutic option for empiric therapy.

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Extended Spectrum Beta-Lactamase (ESBL) Produced by Gram-Negative Bacteria in Trinidad and Tobago

International Journal of Microbiology ◽

10.1155/2021/5582755 ◽

2021 ◽

Vol 2021 ◽

pp. 1-16

Author(s):

Patrick Eberechi Akpaka ◽

Angel Vaillant ◽

Clyde Wilson ◽

Padman Jayaratne

Keyword(s):

Trinidad And Tobago ◽

Bacterial Infections ◽

High Morbidity ◽

Beta Lactamase ◽

Beta Lactam ◽

Esbl Production ◽

Gram Negative ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum ◽

Gram Negative Organisms

Gram-negative bacterial infections are a global health problem. The production of beta-lactamase is still the most vital factor leading to beta-lactam resistance. In Trinidad and Tobago, extended spectrum beta-lactamase (ESBL) production has been detected and reported mainly in the isolates of Klebsiella pneumoniae and Escherichia coli and constitutes a public health emergency that causes high morbidity and mortality in some patients. In this literature review, the authors cover vast information on ESBL frequency and laboratory detection using both conventional and molecular methods from clinical data. The aim is to make the reader reflect on how the actual knowledge can be used for rapid detection and understanding of the spread of antimicrobial resistance problems stemming from ESBL production among common Gram-negative organisms in the health care system.

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