Reply to Casalini et al., “Bacterial Coinfections in COVID-19 Patients without a Positive Microbiologic Result: a Word of Caution”

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02332-21 ◽

2022 ◽

Author(s):

Jonathan Baghdadi ◽

Sarah Bejo ◽

Anthony Harris

Keyword(s):

Bacterial Infection ◽

Antibiotic Use ◽

Hospitalized Patients ◽

Letter To The Editor ◽

Microbiologic Result

We thank Casalini et al. for their letter to the editor and interest in our recent publication, Antibiotic use and bacterial infection among inpatients in the first wave of covid-19 ,(1) and appreciate the opportunity to extend the conversation related to antibiotic use among hospitalized patients with COVID-19.…

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Procalcitonin Testingreduce Unnecessary Antibiotic Use in Bacterial Infection

Asian Pacific Journal of Environment and Cancer ◽

10.31557/apjec.2019.2.1.1-3 ◽

2019 ◽

Vol 2 (1) ◽

pp. 1-3

Author(s):

Attabak Toofani Milani ◽

Mahshid Mohammadian ◽

Sadegh Rostaminasab ◽

Roghayeh Paribananaem ◽

Zohre Ahmadi ◽

...

Keyword(s):

Antibiotic Therapy ◽

Bacterial Infection ◽

Diagnostic Test ◽

Bacterial Infections ◽

Intervention Studies ◽

Antibiotic Use ◽

Clinical Suspicion ◽

Diagnostic Biomarker ◽

Clinical Routine ◽

Initial Rise

Conventional diagnostic test have limitations to deferential diagnosis in clinical suspicion ofbacterial infection cases, that in some cases lead to inappropriate antibiotic therapy and increases antibiotic resistance. A new diagnostic insight is procalcitonin (PCT) test to improve diagnosis of bacterial infections and to guide antibiotic therapy. Serum PCT levels are of useful test as a biomarker in patients with bacterial infections for several reasons. Initial rise of PCT levels due to bacterial infection, subsequent sequential PCT levels can be used to assess the effectiveness and duration of antibiotic therapy. Based on clinical researches results, in bacterial infections, promising good results obtained when use of PCT used as differential diagnostic test. But further intervention studies are needed before use of PCT in clinical routine tests. The goal of this review is to study the PCT reliability as infections diagnostic biomarker.

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Reply to Letter to the Editor - in response to: Cardiac injury prediction and lymphocyte immunity and inflammation analysis in hospitalized patients with coronavirus disease 2019 (COVID-19)

International Journal of Cardiology ◽

10.1016/j.ijcard.2021.01.014 ◽

2021 ◽

Author(s):

Wenqian Zhou ◽

Yushi Wang ◽

Yang Zheng

Keyword(s):

Cardiac Injury ◽

Hospitalized Patients ◽

Injury Prediction ◽

Letter To The Editor ◽

Lymphocyte Immunity

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The host transcriptional response to Candidemia is dominated by neutrophil activation and heme biosynthesis and supports novel diagnostic approaches

Genome Medicine ◽

10.1186/s13073-021-00924-9 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Julie M. Steinbrink ◽

Rachel A. Myers ◽

Kaiyuan Hua ◽

Melissa D. Johnson ◽

Jessica L. Seidelman ◽

...

Keyword(s):

Immune Response ◽

Bacterial Infection ◽

Viral Infection ◽

Fungal Infection ◽

Host Response ◽

Hospitalized Patients ◽

Neutrophil Activation ◽

Heme Biosynthesis ◽

Transcriptional Analysis ◽

Diagnostic Approaches

Abstract Background Candidemia is one of the most common nosocomial bloodstream infections in the United States, causing significant morbidity and mortality in hospitalized patients, but the breadth of the host response to Candida infections in human patients remains poorly defined. Methods In order to better define the host response to Candida infection at the transcriptional level, we performed RNA sequencing on serial peripheral blood samples from 48 hospitalized patients with blood cultures positive for Candida species and compared them to patients with other acute viral, bacterial, and non-infectious illnesses. Regularized multinomial regression was utilized to develop pathogen class-specific gene expression classifiers. Results Candidemia triggers a unique, robust, and conserved transcriptomic response in human hosts with 1641 genes differentially upregulated compared to healthy controls. Many of these genes corresponded to components of the immune response to fungal infection, heavily weighted toward neutrophil activation, heme biosynthesis, and T cell signaling. We developed pathogen class-specific classifiers from these unique signals capable of identifying and differentiating candidemia, viral, or bacterial infection across a variety of hosts with a high degree of accuracy (auROC 0.98 for candidemia, 0.99 for viral and bacterial infection). This classifier was validated on two separate human cohorts (auROC 0.88 for viral infection and 0.87 for bacterial infection in one cohort; auROC 0.97 in another cohort) and an in vitro model (auROC 0.94 for fungal infection, 0.96 for bacterial, and 0.90 for viral infection). Conclusions Transcriptional analysis of circulating leukocytes in patients with acute Candida infections defines novel aspects of the breadth of the human immune response during candidemia and suggests promising diagnostic approaches for simultaneously differentiating multiple types of clinical illnesses in at-risk, acutely ill patients.

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Assessment of Testing and Treatment of Asymptomatic Bacteriuria Initiated in the Emergency Department

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa537 ◽

2020 ◽

Vol 7 (12) ◽

Author(s):

Lindsay A Petty ◽

Valerie M Vaughn ◽

Scott A Flanders ◽

Twisha Patel ◽

Anurag N Malani ◽

...

Keyword(s):

Emergency Department ◽

Antibiotic Treatment ◽

Asymptomatic Bacteriuria ◽

Antibiotic Use ◽

Altered Mental Status ◽

Estimating Equation ◽

Hospitalized Patients ◽

Clostridioides Difficile ◽

Cord Injury ◽

Clostridioides Difficile Infection

Abstract Background Reducing antibiotic use in patients with asymptomatic bacteriuria (ASB) has been inpatient focused. However, testing and treatment is often started in the emergency department (ED). Thus, for hospitalized patients with ASB, we sought to identify patterns of testing and treatment initiated by emergency medicine (EM) clinicians and the association of treatment with outcomes. Methods We conducted a 43-hospital, cohort study of adults admitted through the ED with ASB (February 2018–February 2020). Using generalized estimating equation models, we assessed for (1) factors associated with antibiotic treatment by EM clinicians and, after inverse probability of treatment weighting, (2) the effect of treatment on outcomes. Results Of 2461 patients with ASB, 74.4% (N = 1830) received antibiotics. The EM clinicians ordered urine cultures in 80.0% (N = 1970) of patients and initiated treatment in 68.5% (1253 of 1830). Predictors of EM clinician treatment of ASB versus no treatment included dementia, spinal cord injury, incontinence, urinary catheter, altered mental status, leukocytosis, and abnormal urinalysis. Once initiated by EM clinicians, 79% (993 of 1253) of patients remained on antibiotics for at least 3 days. Antibiotic treatment was associated with a longer length of hospitalization (mean 5.1 vs 4.2 days; relative risk = 1.16; 95% confidence interval, 1.08–1.23) and Clostridioides difficile infection (CDI) (0.9% [N = 11] vs 0% [N = 0]; P = .02). Conclusions Among hospitalized patients ultimately diagnosed with ASB, EM clinicians commonly initiated testing and treatment; most antibiotics were continued by inpatient clinicians. Antibiotic treatment was not associated with improved outcomes, whereas it was associated with prolonged hospitalization and CDI. For best impact, stewardship interventions must expand to the ED.

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Reply to a letter to the editor regarding “Chronic low back pain, bacterial infection and treatment with antibiotics”

The Spine Journal ◽

10.1016/j.spinee.2021.03.036 ◽

2021 ◽

Vol 21 (7) ◽

pp. 1231-1232

Author(s):

Christopher J. Gilligan ◽

Steven P. Cohen ◽

Vincent A. Fischetti ◽

Joshua A. Hirsch ◽

Lloyd G. Czaplewski

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Bacterial Infection ◽

Chronic Low Back Pain ◽

Low Back ◽

Letter To The Editor

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Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piy113 ◽

2018 ◽

Vol 9 (1) ◽

pp. 36-43 ◽

Cited By ~ 2

Author(s):

Kevin J Downes ◽

Julie C Fitzgerald ◽

Emily Schriver ◽

Craig L K Boge ◽

Michael E Russo ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Bacterial Infection ◽

Pediatric Intensive Care Unit ◽

Bacterial Infections ◽

Pediatric Intensive Care ◽

Antibiotic Use ◽

Antibiotic Administration ◽

Period 2 ◽

Rate Ratios

Abstract Background Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection. Methods We tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections (uninfected) in our pediatric intensive care unit (PICU). The algorithm suggested that PICU clinicians stop antibiotics if (1) C-reactive protein <4 mg/dL and procalcitonin <1 ng/mL at SIRS onset and (2) no evidence of bacterial infection by exam/testing by 48 hours. We evaluated excess broad-spectrum antibiotic use, defined as administration on days 3–9 after SIRS onset in uninfected children. Incidence rate ratios (IRRs) compared unadjusted excess length of therapy (LOT) in the 34 months before (Period 1) and 12 months after (Period 2) implementation of this algorithm, stratified by biomarker values. Segmented linear regression evaluated excess LOT among all uninfected episodes over time and between the periods. Results We identified 457 eligible SIRS episodes without bacterial infection, 333 in Period 1 and 124 in Period 2. When both biomarkers were below the algorithm’s cut-points (n = 48 Period 1, n = 31 Period 2), unadjusted excess LOT was lower in Period 2 (IRR, 0.53; 95% confidence interval, 0.30–0.93). Among all 457 uninfected episodes, there were no significant differences in LOT (coefficient 0.9, P = .99) between the periods on segmented regression. Conclusions Implementation of a biomarker-based algorithm did not decrease overall antibiotic exposure among all uninfected patients in our PICU, although exposures were reduced in the subset of SIRS episodes where biomarkers were low.

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Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

Journal of Laboratory Physicians ◽

10.4103/0974-2727.163123 ◽

2015 ◽

Vol 7 (02) ◽

pp. 108-111 ◽

Cited By ~ 1

Author(s):

Tuhina Banerjee ◽

Shampa Anupurba ◽

Joel Filgona ◽

Dinesh K Singh

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Tertiary Care ◽

Significant Risk ◽

Antibiotic Use ◽

Antibiotic Usage ◽

Hospitalized Patients ◽

University Hospital ◽

North India ◽

Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

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