scholarly journals Extended Perioperative Antibiotic Coverage in Conjunction with Intraoperative Bile Cultures Decreases Infectious Complications after Pancreaticoduodenectomy

HPB Surgery ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Amir H. Fathi ◽  
Terence Jackson ◽  
Mehdi Barati ◽  
Babak Eghbalieh ◽  
Kelly A. Siegel ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Fungal Infections ◽  
Medical Center ◽  
Surgical Site Infections ◽  
Infectious Complications ◽  
Broad Spectrum Antibiotic ◽  
Matching Method ◽  
Short Term ◽  
Perioperative Antibiotics ◽  
Antibiotic Coverage

Background. Bile contamination from the digestive tract is a well-known risk factor for postoperative complications. Despite the literature concerning prevalence of bacterobilia and fungobilia in patients with biliary pathologies, there are no specific recommendations for perioperative antimicrobial coverage for biliary/pancreatic procedures. We evaluated the effect of at least 72 hours of perioperative broad spectrum antibiotic coverage on outcomes of pancreaticoduodenectomy (PD). Materials and Methods. A retrospective review of all patients at Case Medical Center of Case Western Reserve University undergoing PD procedure, from 2006 to 2011, was performed (n=122). Perioperative data including demographics, comorbidities, biliary instrumentation, antibiotic coverage, culture results, and postoperative outcomes were analyzed. Propensity score matching method was used to match the patients according to duration of antibiotic coverage into two groups: 72 hours (A72) and 24 hours (A24). Results. Longer broad spectrum antibiotic coverage in group A72 resulted in significantly less surgical site infections after PD, compared to routine 24 hours of perioperative antibiotics in group A24. This study did not reveal a statistically significant decrease in postoperative fungal infections in patients receiving preoperative antifungals. Conclusion. Prolonged perioperative antibiotic therapy in conjunction with intraoperative bile cultures decreases the short-term infectious complications of PD, with no significant increase in Clostridium difficile colitis incidence.

Antifungal Treatment with Caspofungin: A Single Centre Experience.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5386-5386
Author(s):  
Alessandro Bonini ◽  
Alessia Tieghi ◽  
Luigi Gugliotta
Keyword(s):  
Adverse Events ◽  
Antibiotic Therapy ◽  
Fungal Infection ◽  
Broad Spectrum ◽  
Fungal Infections ◽  
The Other ◽  
Broad Spectrum Antibiotic ◽  
Persistent Fever ◽  
Neutropenic Patients ◽  
The Mean

Abstract Infections are the main complication for patients with hematologic diseases and severe neutropenia and among them fungal infections are the most diffucult to treat and a major cause of mortality for these patients. Now we have a new antifungal class, Echinocandins which work with a new and different mechanism of action regarding azoles and amphotericin B, so we wanted to verify the tolerability and efficacy of Caspofungin (Caspo). From January 2004 until now we have treated 15 consecutive oncohemopatic and neutropenic patients admitted at our Institution. The schedule of treatment was: in case of persistent fever (at least 4 days) during broad spectrum antibiotic therapy a high-resolution CT-scan of the lungs, an abdomen US-scan, swabs from pharynx, nose and rectum and blood cultures were performed. In case of positivity of one or more of these findings suggesting for invasive fungal disease, Caspofungin was administered at the dosage of 70 mg i.v. on the first day and 50 mg i.v. from the second day; the infusion time was 1 hour. The patients were 10 males and 5 females, the mean age was 46 yrs (range 19–60 yrs). The diagnoses were: acute myeloid leukemia 8, acute lymphoblastic leukemia 3, lymphoma 4; the disease’s phases were: onset 3, first remission 3, remission>I 2, partial remission 5, relapse 1, resistant 1. Two patients received an allogeneic BMT, 1 an autologous BMT, the other patients an induction or consolidation or rescue chemotherapy course. In four cases Caspo was administered as secondary prophylaxis of a previous invasive fungal infection while for the other patients Caspo was administered for persistent fever and at least one lesion of the lungs or other organs with no evidence of bacterial or viral infection. The mean time of treatment was 18 days (range 6–21 days); the treatment was not discontinued for anyone of them because of adverse events; the dosage of Caspo was not changed for anyone. For the 2 allogeneic BMT Cyclosporine A administration was not changed and we did not found any renal or liver alterations. All the patients received a concomitant broad spectrum antibiotic therapy (association of Tazobactam/Piperacilline, Amikacine and Vancomycin) and for none of them we registered any liver or renal disfunction. No adverse events during the infusion of Caspo were seen and it was not necessary to administer any drug before the infusion. We did not seen breakthrough fungal infections. In 2 patients a proven fungal infection (Aspergillus fumigatus and Aspergillus spp) was demonstrated so the other cases remained probable or possible infections. No progression of the infection was seen. All the infections, except one, resolved; one patient died after 6 days of antifungal treatment for leukemia progression. Five patients died: 4 for leukemia and 1 for bacterial infection (Pseudomonas aeruginosa) after the fungal infection. In conclusion now we have a new treatment option for fungal infections in neutropenic patients and this option is safe, it does not preclude any other treatment (such as CsA), it is well tolerated and the resolution rate of the infections is very high, probably because of the new mechanism of action of the drug. Moreover the cost of the drug is lower than other antifungal treatments. According to these preliminary data we have decided to continue this experience to verify them in a larger cohort of patients.

Infectious Complications In 96 Matched-Related Bone Marrow Transplants Performed Without Positive Pressure Room Or Centralized Hepa Filtration In Lower Middle Income Countries

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1731-1731
Author(s):  
Mohamed El Missiry ◽  
Sadaf Khaled ◽  
Naila Yaqub ◽  
Priya Marwa ◽  
Rajpreet Soni ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Blood Culture ◽  
Infection Control ◽  
Positive Blood Culture ◽  
Broad Spectrum ◽  
Infectious Complications ◽  
Broad Spectrum Antibiotic ◽  
Middle Income ◽  
Persistent Fever ◽  
Middle Income Countries

Abstract Background There is general perception that bone marrow transplant (BMT) centers need complex and costly infection control engineering standards, even more in developing countries where a greater infection-related transplant risk is often assumed in spite of lack of scientific evidence. We aim to investigate incidence of BMT-associated infectious complications in patients admitted to BMT units with no centralized air control systems in lower middle income countries (Pakistan and India). Methods A total of 96 consecutive patients (87 cases with thalassemia major (TM), 4 fanconi and 4 severe aplastic anemia (SAA); and 1 acute lymphoblastic leukemia (ALL); median age 3.8 years (range; 0.9 - 15.3)) transplanted in 3 centers in Pakistan (86 patients) and 1 in India (10 patients), with at least 100 days follow up from BMT where included in this analysis. All patients where admitted to single rooms with split air conditioning but no central HEPA filtration. Evidence-based infection control measures such as hand washing and daily cleaning/drying and disinfection where implemented. Mebendazole, fluconazole, and acyclovir were used as anti-infection prophylaxis. Broad-spectrum antibiotic therapy was used empirically for fever and neutropenia but not as prophylaxis. Voriconazole was used empirically for persistent fever (> 3 days) on broad spectrum antibiotic coverage and/or clinical suspicion of fungal infection. Results Among the 96 transplanted patients; 8 cases suffered from infections with ECOG scoring grade over 2 (i.e. ranging from severe systemic infections up to septicemia) of which 3 had clinical sepsis (one with a positive blood culture for Pseudomonas Aeruginosa and two with negative cultures). In three cases a fungal infection was suspected: One had a positive β-D-Glucan (Fungitell Assay), one had a paranasal sinusitis responding to voriconazole and one a positive blood culture for Candida, neutropenia duration (<500 neutrophils/µL) was 18, 30 and 13 days respectively. Median neutropenic days (<500 neutrophils/µL) of all 96 patients was 16 (range; 9-30). A total of 7 patients received voriconazole empirical therapy for persistent fever not responding to broad spectrum antibiotics. CMV reactivation (PCR +ve) was observed in 18 patients; of which 10 were in subclinical form (without symptoms or signs of CMV disease). A total of 3 infection-related deaths were reported: sepsis (2; one with a positive blood culture for Pseudomonas Aeruginosaand one with negative culture) and 1 CMV intersitital pneumonia. Conclusions Incidence and type of infection in these low-risk BMTs did not seem to be higher compared to published reports from stringent air-controlled BMT units. This may have important implications to simplify and increase access to low-risk HLA-compatible BMT in limited-resources settings. Disclosures: El Missiry: Cure2Children Foundation: Employment. Khaled:Cure2Children Foundation: Employment; PIDSA: Research Funding. Cornelio:Cure2Children Foundation: Employment. Faulkner:Cure2Children Foundation: Employment.

scholarly journals Acute Iatrogenic Agranulocytosis: A Rare and Dire Case of an Adverse Drug Reaction to Be Aware

2020 ◽  
Vol 2020 ◽  
pp. 1-2 ◽  
Author(s):  
Diogo André ◽  
Mónica Caldeira ◽  
Fabiana Gouveia ◽  
Rafael Nascimento ◽  
António Chaves ◽  
...  
Keyword(s):  
Adverse Drug Reaction ◽  
Adverse Event ◽  
Drug Reaction ◽  
Growth Factors ◽  
Neutrophil Count ◽  
Broad Spectrum ◽  
Infectious Complications ◽  
Hematopoietic Growth Factors ◽  
Broad Spectrum Antibiotic

Background. Iatrogenic agranulocytosis (IA), by nonchemotherapeutic drugs, is a rare adverse event, resulting in a neutrophil count under 0.5 × 109 cells/L with fever or other suggestive signs of infection. Methods. This paper discusses the possible mechanisms responsible for agranulocytosis induced by nonchemotherapeutic drugs. It also describes three cases as well as potential ways to handle such iatrogenic situations. Conclusion. Neutropenia under 0.1 × 109 cells/L predispose patients to potentially fatal infections. Empiric broad-spectrum antibiotic and hematopoietic growth factors may be helpful in shortening hospitalization and prevent further infectious complications. Not all drugs associated with IA require frequent hematological monitoring, except medications such as clozapine, ticlopidine, and antithyroids.

scholarly journals A study on comparison of short term three dose antibiotic prophylaxis with conventional prolonged postoperative antibiotic coverage in development of surgical site infections

2018 ◽  
Vol 5 (6) ◽  
pp. 2114
Author(s):  
M. V. Saila Suman Konidala ◽  
Padmaja Rani Gopalam ◽  
Jithendra Kandati
Keyword(s):  
Risk Factors ◽  
Antibiotic Prophylaxis ◽  
Wound Infection ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Short Term ◽  
Group A ◽  
Group B ◽  
Associated Risk Factors ◽  
Antibiotic Coverage

Background: Surgical site infections are still an increasing threat to the surgeons despite advances in techniques of surgery, patient care and sterilization practices. Most of the studies state that pre-operative antibiotic prophylaxis is effective in reducing the risk of wound infection in surgical procedures and has been a standard practice followed in many surgeries. Prolonged administration of prophylactic antibiotic has been associated with development of resistant bacterial strains and predisposes the patient in development of wound infection. The aim of the present study is to study the effectiveness of short term antibiotic coverage during decisive period in prevention of post-operative infection in surgical procedures.Methods: A prospective randomized and comparative study was done for one year with 100 cases divided into two groups A and B. Group A received prophylactic Ceftriaxone three doses intravenously, 12 h before surgery 1st dose, 1h before surgery 2nd dose and third 10h after surgery. Group B received Ceftriaxone twice daily for 5 days after surgery. The two groups were compared for development of SSI and associated risk factors.Results: The mean age of the total study group was 37.11± 12.12 years with 60% of males and 40% females. Overall incidence of SSI in study was 24% with Group A 10% and 14% in group B. Anemia, associated drain, increased BMI and undernourishment was associated risk factors and a statistically significant association was found with these risk factors in present study. Pseudomonas and Methicillin resistant staphylococcus aureus were the isolates in the study.Conclusions: Present study strongly recommends the use of antibiotics during surgery than administration after surgery. More care and proper management of the cases are required with associated risk factors like increased BMI, presence of drain and low Hb%. Large multicentric studies are further required to establish further associated risk factors and to identify the local pathogens and their resistance pattern. Appropriate use of antibiotics can substantially reduce the emergence of resistant pathogens and limit the cost of treatment.

scholarly journals Invasive Candida Infection after Upper Gastrointestinal Tract Surgery for Gastric Cancer

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Evgeni Brotfain ◽  
Gilbert Sebbag ◽  
Michael Friger ◽  
Boris Kirshtein ◽  
Abraham Borer ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastrointestinal Tract ◽  
Fungal Infections ◽  
Medical Center ◽  
Gastroesophageal Junction ◽  
Clinical Importance ◽  
Infectious Complications ◽  
Upper Gastrointestinal Tract ◽  
Oncologic Patients ◽  
Upper Gastrointestinal

Upper gastrointestinal tract (GIT) surgical procedures are more likely to cause nosocomial Candida peritonitis than lower GIT procedures and they thus constitute an independent risk factor for mortality. Because of the severity of postsurgical fungal infections complications, intensivists and surgeons need to be extremely aware of their clinical importance in critically ill postsurgical intensive care unit (ICU) patients. We analyzed the clinical and microbiological data of 149 oncologic patients who were hospitalized in the ICU at Soroka Medical Center between January 2010 and January 2015 after undergoing upper GIT surgery for gastric cancer. Invasive fungal infections related to secondary peritonitis following oncologic upper GIT surgery had a higher mortality rate than patients with nonfungal postoperative infectious complications. The presence of gastroesophageal junction leakage and advanced age were found to be independent risk factors for invasive fungal infection after oncologic upper GIT surgery.

scholarly journals 109. Develop and Implement a Novel Pediatric Antimicrobial Stewardship Program in a Non-Freestanding Children’s Hospital Located in an Adult-Centered Community Hospital in San Joaquin Valley, California

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S168-S169
Author(s):  
Tsung-Chi Lien ◽  
Laurie Covarrubias ◽  
Alice Ip ◽  
Harlan Husted ◽  
Emi Suzuki ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Medical Center ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Broad Spectrum Antibiotic ◽  
Children's Hospital ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Children’S Hospital

Abstract Background A pediatric-specific antimicrobial stewardship program (Ped ASP) has been shown to optimize antimicrobial use, improve patient outcomes, and reduce healthcare expenditures in this population. Opportunities and challenges exist when developing a Ped ASP for a children’s hospital within an adult-centered medical center primarily due to mixed infrastructure. The objective of this study is to provide process and outcome data of a new Ped ASP in a non-freestanding children’s hospital within an adult-centered tertiary hospital. Methods A pediatric infectious disease physician and four pediatric pharmacists designed a Ped ASP utilizing direct and indirect patient care activities to optimize pediatric antimicrobial use in 21 bed-pediatric services within a 685-bed, adult-centered medical center. Implemented in 2020, Ped ASP activities include thrice weekly chart reviews followed by handshake rounds and quarterly reviews of documented interventions. The Ped ASP team also developed policies, education, and other resources to further guide appropriate antimicrobial use, in collaboration with the adult team. Results Ped ASP was initiated on general pediatric (PED) and pediatric intensive care (PICU) units. In 2020, a total of 286 charts were reviewed with 199 antibiotic interventions provided, including optimization of antimicrobial selection (23%), IV-to-PO conversion (15%), and antimicrobial dosage adjustment (13%). Annual average antibiotic length and days of therapy per 1000 patient-days were 241 and 290 respectively in PED, and 388 and 432 in PICU. The overall trend from 2020 to 2021 decreased in PED but increased in PICU (Fig. 1). The ratio of narrow to broad spectrum antibiotic use increased for both PED and PICU (Fig. 2). Simultaneously, a pediatric-specific antibiogram, extended-infusion protocol of beta-lactams, and neonatal sepsis treatment algorithm were developed and implemented. Antibiotic Days of Therapy per 1000 Patient Days Ratio of Narrow: Broad Spectrum Antibiotic Usage Conclusion A Ped ASP was successfully developed in a non-freestanding children’s hospital. Continual metrics served as an important tool to identify areas for improvement. Future goals include expansion of Ped ASP to other service lines, enhanced ASP education and development of additional pediatric antimicrobial treatment pathways. Disclosures All Authors: No reported disclosures

scholarly journals AIR-FLUID LEVEL IN SPLEEN: A RARE CASE OF SPLENIC ABSCESS CAUSED BY GAS FORMING ORGANISMS

2020 ◽  
pp. 57-58
Author(s):  
Tapan Patel ◽  
Shivani Patel ◽  
Shreya Dholakia
Keyword(s):  
Broad Spectrum ◽  
Rare Case ◽  
Splenic Abscess ◽  
High Morbidity ◽  
Rare Entity ◽  
Fluid Level ◽  
Broad Spectrum Antibiotic ◽  
History Of ◽  
Antibiotic Coverage ◽  
Prompt Diagnosis

Splenic abscess is a rare entity. Delay in its diagnosis and treatment can lead to high morbidity and mortality. Here, we describe a case of a female patient with air-uid level in the parenchyma of the spleen caused by a gas forming bacterial infection. There was no preceding history of trauma or instrumentation in our case. This case was managed by prompt diagnosis followed by percutaneous drainage under broad spectrum antibiotic coverage. Agas forming infection of the spleen without manipulation or trauma is extremely rare, with only 3 reported cases in the literature

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