scholarly journals Practice Patterns of Infectious Diseases Physicians in Transitioning From Intravenous to Oral Therapy in Patients With Bacteremia

2019 ◽  
Vol 7 (12) ◽  
Author(s):  
Duane R Hospenthal ◽  
C Dustin Waters ◽  
Susan E Beekmann ◽  
Philip M Polgreen
Keyword(s):  
Infectious Diseases ◽  
Oral Therapy ◽  
Source Control ◽  
Oral Antibiotics ◽  
Emerging Infections ◽  
Gram Positive ◽  
Gram Negative ◽  
Oral Agents ◽  
Gram Negative Bacteremia ◽  
Rapid Transition

Abstract Background Bacteremia in adult patients has traditionally been treated with extended courses of intravenous antibiotics. Data on the use of (or rapid transition to) oral therapy are limited. Methods Adult infectious disease physicians participating in the Infectious Diseases Society of America Emerging Infections Network (EIN) were surveyed regarding their use of oral antibiotics in patients with bacteremia. Respondents were asked to assume that patients were hemodynamically stable, recovered bacteria were susceptible to potential antibiotics, adequate source control had been achieved, and patients had adequate gastrointestinal absorption. Variables of specific bacteria, oral agent, and associated infection were included. Results A total of 655 (50%) of 1321 EIN participants responded. Under certain conditions, 88% would transition patients with Gram-negative bacteremia to complete a course of therapy with oral antibiotics; 71% would transition patients with Gram-positive bacteremia to oral agents. Only 78 (12%) respondents would not treat any bacteremic patient with oral agents. Most respondents (≥75%) were comfortable treating infections secondary to Enterobacteriaceae, Salmonella, Pseudomonas, Stenotrophomonas, Streptococcus pneumoniae, and β-hemolytic streptococci with oral agents. Fewer than 20% endorsed use of oral antibiotics for Staphylococcus aureus or in cases of endocarditis. Fluoroquinolones and trimethoprim-sulfamethoxazole were the preferred agents in Gram-negative bacteremia; linezolid and β-lactams were the preferred agents in Gram-positive bacteremia. Conclusions In select circumstances, the majority of respondents would transition patients to oral antibiotics, in both Gram-negative and Gram-positive bacteremia. Most agreed with the use of oral agents in Gram-negative bacteremia caused by Enterobacteriaceae, but they would not use oral agents for Gram-positive bacteremia caused by S aureus or in endocarditis.

scholarly journals The Changing Landscape of Uncomplicated Gram-Negative Bacteremia: A Narrative Review to Guide Inpatient Management

2020 ◽  
Vol 15 (12) ◽  
pp. 746-753 ◽  
Author(s):  
Jeannie D Chan ◽  
Chloe Bryson-Cahn ◽  
Zahra Kassamali-Escobar ◽  
John B Lynch ◽  
Anneliese M Schleyer
Keyword(s):  
Cost Effective ◽  
Hospital Length ◽  
Antimicrobial Treatment ◽  
Blood Cultures ◽  
Hospital Length Of Stay ◽  
Source Control ◽  
Gram Negative ◽  
Oral Agents ◽  
Gram Negative Bacteremia

Gram-negative bacteremia secondary to focal infection such as skin and soft-tissue infection, pneumonia, pyelonephritis, or urinary tract infection is commonly encountered in hospital care. Current practice guidelines lack sufficient detail to inform evidence-based practices. Specifically, antimicrobial duration, criteria to transition from intravenous to oral step-down therapy, choice of oral antimicrobials, and reassessment of follow-up blood cultures are not addressed. The presence of bacteremia is often used as a justification for a prolonged course of antimicrobial therapy regardless of infection source or clinical response. Antimicrobials are lifesaving but not benign. Prolonged antimicrobial exposure is associated with adverse effects, increased rates of Clostridioides difficile infection, antimicrobial resistance, and longer hospital length of stay. Emerging evidence supports shorter overall duration of antimicrobial treatment and earlier transition to oral agents among patients with uncomplicated Enterobacteriaceae bacteremia who have achieved adequate source control and demonstrated clinical stability and improvement. After appropriate initial treatment with an intravenous antimicrobial, transition to highly bioavailable oral agents should be considered for total treatment duration of 7 days. Routine follow-up blood cultures are not cost-effective and may result in unnecessary healthcare resource utilization and inappropriate use of antimicrobials. Clinicians should incorporate these principles into the management of gram-negative bacteremia in the hospital.

scholarly journals PATIENTS' MICROFLORA COMPARATIVE CHARACTERISTICS OF DIFFERENT DEPARTMENTS AT THE NATIONAL HOSPITAL OF PEDIATRICS IN HANOI, VIETNAM

2019 ◽  
pp. 43-48
Author(s):  
L.V. Kataeva ◽  
A.P. Rebeshchenko ◽  
T.F. Stepanova ◽  
O.V. Posoiuznykh ◽  
Le Thanh Hai ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infectious Diseases ◽  
Hospital Environment ◽  
Clinical Samples ◽  
Gram Negative Bacteria ◽  
National Hospital ◽  
Statistical Research ◽  
Gram Positive ◽  
Gram Negative

We studied the microflora structure and resistance gathered from the biomaterial of patients and the environment objects of various departments at the National hospital of Pediatrics in Hanoi. 140 clinical samples of biomaterials from 74 patients treated in the intensive care unit, the infectious diseases and the gastroenterology departments were studied. A systematic approach including microbiological, epidemiological and statistical research methods was used in carrying out the study. Bacteria of the Enterobacteriaceae family (38.5 per cent) prevailed in the biomaterial of intensive care unit patients. Nonfermentative Gram-negative bacteria (46.5 per cent) occupied the leading positions in the infectious diseases department and Gram-positive bacteria (39.3 per cent) were in the gastroenterology department. Gram-positive flora (60.2 per cent in the intensive care unit and 50.7 per cent in the infectious diseases department) prevailed in the microflora structure gathered from hospital environment objects. We identified the prevalence of bacteria of the genus Enterobacteriaceae and non-fermentative Gram-negative bacteria with a wide spectrum of resistance in the departments of the National Hospital of Pediatrics.

scholarly journals Susceptibility of Multidrug-Resistant Gram-Negative Urine Isolates to Oral Antibiotics

2016 ◽  
Vol 60 (5) ◽  
pp. 3138-3140 ◽  
Author(s):  
Elizabeth B. Hirsch ◽  
Paola C. Zucchi ◽  
Alice Chen ◽  
Brian R. Raux ◽  
James E. Kirby ◽  
...  
Keyword(s):  
Emergency Department ◽  
Treatment Options ◽  
Multidrug Resistant ◽  
Hospitalized Patients ◽  
Oral Antibiotics ◽  
Gram Negative ◽  
Susceptibility Data ◽  
Oral Agents ◽  
High Prevalence

ABSTRACTIncreasing resistance among Gram-negative uropathogens limits treatment options, and susceptibility data for multidrug-resistant isolates are limited. We assessed the activity of five oral agents against 91 multidrug-resistant Gram-negative urine isolates that were collected from emergency department/hospitalized patients. Fosfomycin and nitrofurantoin were most active (>75% susceptibility). Susceptibilities to sulfamethoxazole-trimethoprim, ciprofloxacin, and ampicillin were ≤40%; empirical use of these agents likely provides inadequate coverage in areas with a high prevalence of multidrug-resistant uropathogens.

scholarly journals The number of circulating endothelial progenitor cells from septic patients are associated with different infectious organisms

2020 ◽  
Author(s):  
Yingying Zhu ◽  
Nana Yang ◽  
Jing Zhu ◽  
Chao Fu ◽  
Xinghan Tian ◽  
...  
Keyword(s):  
Blood Culture ◽  
Progenitor Cells ◽  
Endothelial Progenitor Cells ◽  
Healthy Controls ◽  
Negative Blood Culture ◽  
Endothelial Progenitor ◽  
Gram Positive ◽  
Survival Group ◽  
Gram Negative ◽  
Gram Negative Bacteremia

Abstract Background Endothelial progenitor cells (EPCs) can affect the repairment of endothelial injury by improving the process of re-endothelialization and angiogenesis in sepsis patients. However, the markers of EPCs have not been standardized nowadays, and the changes of EPCs are still unclear in patients with different infectious organisms. This study explored the relationship between the number of EPCs and different infectious organisms in patients with sepsis. Materials and Methods 39 septic patients and 20 healthy controls were enrolled in this study. The number of CD34+/KDR+, CD133+/KDR+, CD34+/CD133+/KDR+, CD34+, CD133+, and KDR+ cells were all analyzed through flow cytometry. Analysis of adhesion function of EPCs were also performed by counting the number of adherent cells in different cultured time points (4 days, 14 days, and 21 days). Results The number of EPCs in peripheral blood of septic patients were higher than that of healthy controls, but there were no significant differences between sepsis group and septic shock group, also between the survival group and the non-survival group. Additionally, the percentages of CD34+/CD133+/KDR+ cells in Gram-positive bacteremia group was significantly higher than the Gram-negative bacteremia group and negative blood culture group; the percentage of KDR+ cells in both Gram-positive bacteremia group and Gram-negative bacteremia group were significantly higher than the negative blood culture group. Furthermore, the adhesion function of EPCs in healthy controls was significantly higher than in septic patients. Conclusions The number of circulating EPCs and the adhesion function of EPCs in patients with sepsis are associated with different infectious organisms.

scholarly journals Procalcitonin levels in patients with suspected sepsis

2021 ◽  
Vol 12 (11) ◽  
pp. 108-112
Author(s):  
Tribeni Goswami ◽  
Renu Mathew ◽  
Marina Thomas ◽  
Reena Anie Jose ◽  
Anjali Jacob ◽  
...  
Keyword(s):  
Early Recognition ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Care Hospital ◽  
Gram Positive ◽  
Suspected Sepsis ◽  
Gram Negative ◽  
Culture Positivity ◽  
Blood Culture Positivity ◽  
Gram Negative Bacteremia

Background: Procalcitonin (PCT) was found to be a valuable and reliable biomarker for sepsis, especially in critical care patients for whom early recognition and prompt treatment could reduce mortality. Aims and Objectives: This study was aimed at correlating the levels of PCT as diagnostic marker for sepsis in relation to the culture positivity of various samples from blood, respiratory, urine, and exudates from patients admitted in a tertiary care hospital. Materials and Methods: Results of PCT level along with bacterial culture results of blood, respiratory, urine, and exudates were analyzed from 780 patients for a period of 1 year. Results: High PCT values ranging from 0.52 to 200 ng/ml were found in 331 patients admitted with suspected sepsis. Out of 135 cases of sepsis, 85 had blood culture positivity alone and 50 had culture positivity in blood and in other sites with the same organism. Among the 85 cases of bloodstream infections, in which no localized infections were identified, the median PCT was 33 for Gram-negative bacteremia, which was significantly higher as compared with a median of 16 for Gram-positive cocci. In UTI with bacteremia, the median PCT was 45.34 and in UTI without bacteremia, it was 5. Conclusion: From this study, we concluded that PCT values may be useful to distinguish Gram-negative and Gram-positive bacteremia, and furthermore, a high PCT value for patients with UTI may be helpful in predicting bacteremia.

scholarly journals Gram-negative bacteremia induces greater magnitude of inflammatory response than Gram-positive bacteremia

Critical Care ◽  
2010 ◽  
Vol 14 (2) ◽  
pp. R27 ◽  
Author(s):  
Ryuzo Abe ◽  
Shigeto Oda ◽  
Tomohito Sadahiro ◽  
Masataka Nakamura ◽  
Yo Hirayama ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Negative Bacteremia

scholarly journals Diagnostic values of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and procalcitonin in early diagnosis of bacteremia

2019 ◽  
Vol 45 (1) ◽  
pp. 57-64
Author(s):  
Ayfer Colak ◽  
Merve Zeytinli Aksit ◽  
Burak Toprak ◽  
Nisel Yılmaz
Keyword(s):  
Complete Blood Count ◽  
Gram Positive ◽  
Distribution Width ◽  
Gram Negative ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Platelet Lymphocyte Ratio ◽  
Hematological Analysis ◽  
Gram Negative Bacteremia ◽  
Diagnostic Values

Abstract Objective The aim of this study is to investigate the diagnostic accuracy of complete blood count (CBC), C-reactive protein (CRP), and procalcitonin (PCT) levels, which can be used as a cultural alternative for the diagnosis of infection faster. Methods The patients were divided into two groups as bacteremia (n = 220) and nonbacteremia group (n = 812). The bacteremia group was divided into two subgroups as Gram-positive bacteria (n = 167) and Gram-negative bacteria (n = 53). Results PCT, CRP, red blood cell distribution width (RDW), platelet distribution width (PDW), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) levels were significantly higher in patients with positive blood culture than non-patients. The serum PCT levels were 3.80 (0.83–37.68) and 0.43 (0.16–2.61) ng/mL, respectively (p < 0.001) in the patients with Gram-negative and Gram-positive bacterium. PCT at a cut-off value of 0.45 ng/mL for Gram-negative bacterium; sensitivity of 90% and specificity of 64%. Conclusions It is important that RDW, PDW, NLR, PLR, MPV values can be measured quickly, easily and cheaply by automatic hematological analysis. However, among the markers tested, PCT has the best diagnostic performance for Gram-negative bacteremia.

scholarly journals Predictive scoring models for persistent gram-negative bacteremia that reduce the need for follow-up blood cultures: a retrospective observational cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jongtak Jung ◽  
Kyoung-Ho Song ◽  
Kang Il. Jun ◽  
Chang Kyoung Kang ◽  
Nak-Hyun Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Response ◽  
Blood Cultures ◽  
Source Control ◽  
Care Hospital ◽  
Gram Negative ◽  
Scoring Model ◽  
Source Of Infection ◽  
Gram Negative Bacteremia

Abstract Background Although the risk factors for positive follow-up blood cultures (FUBCs) in gram-negative bacteremia (GNB) have not been investigated extensively, FUBC has been routinely carried out in many acute care hospitals. We attempted to identify the risk factors and develop a predictive scoring model for positive FUBC in GNB cases. Methods All adults with GNB in a tertiary care hospital were retrospectively identified during a 2-year period, and GNB cases were assigned to eradicable and non-eradicable groups based on whether removal of the source of infection was possible. We performed multivariate logistic analyses to identify risk factors for positive FUBC and built predictive scoring models accordingly. Results Out of 1473 GNB cases, FUBCs were carried out in 1268 cases, and the results were positive in 122 cases. In case of eradicable source of infection, we assigned points according to the coefficients from the multivariate logistic regression analysis: Extended spectrum beta-lactamase-producing microorganism (+ 1 point), catheter-related bloodstream infection (+ 1), unfavorable treatment response (+ 1), quick sequential organ failure assessment score of 2 points or more (+ 1), administration of effective antibiotics (− 1), and adequate source control (− 2). In case of non-eradicable source of infection, the assigned points were end-stage renal disease on hemodialysis (+ 1), unfavorable treatment response (+ 1), and the administration of effective antibiotics (− 2). The areas under the curves were 0.861 (95% confidence interval [95CI] 0.806–0.916) and 0.792 (95CI, 0.724–0.861), respectively. When we applied a cut-off of 0, the specificities and negative predictive values (NPVs) in the eradicable and non-eradicable sources of infection groups were 95.6/92.6% and 95.5/95.0%, respectively. Conclusions FUBC is commonly carried out in GNB cases, but the rate of positive results is less than 10%. In our simple predictive scoring model, zero scores—which were easily achieved following the administration of effective antibiotics and/or adequate source control in both groups—had high NPVs. We expect that the model reported herein will reduce the necessity for FUBCs in GNB cases.

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