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.

Antibiotic Prescribing Evaluation in an Outpatient Hemodialysis Clinic

2002 ◽  
Vol 18 (3) ◽  
pp. 128-132 ◽  
Author(s):  
Harold J Manley ◽  
Michael A Huke ◽  
Mark A Dykstra ◽  
Angela V Bedenbaugh
Keyword(s):  
Antibiotic Therapy ◽  
Empiric Therapy ◽  
Prescribing Patterns ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Prescribing ◽  
Gram Positive ◽  
Hospital Infection Control ◽  
Empiric Antibiotic ◽  
Control And Prevention ◽  
Gram Negative Organisms

Background Empiric vancomycin treatment is frequently used in hemodialysis (HD) patients because of ease of administration when methicillin-resistant Staphylococcus aureus (MRSA) infection is suspected. Differing rates of MRSA indicate that empiric antibiotic treatment should be based on a center-specific antibiogram. Objective To develop a center-specific antibiogram, evaluate antibiotic prescribing patterns, and determine areas of improvement in infection treatment. Methods The antibiogram was constructed from culture and susceptibility (C&S) data from January through December 1999. Evaluation of prescribing habits was based on 3 criteria: (1) Hospital Infection Control Practices Advisory Committee and Centers for Disease Control and Prevention guidelines; (2) vancomycin for 1 dose followed by appropriate antibiotic based on C&S results; and (3) C&S obtained with more than 1 dose of antibiotic. Results HD was provided to 161 patients during the study period. Antibiotics were empirically prescribed 104 times in 62 different patients. Cultures were obtained 122 times, and 67 different isolates were identified. Gram-positive organisms and gram-negative organisms accounted for 77.6% and 22.4% of isolates, respectively. Gram-positive organisms were identified as Staphylococcus spp. (53.8%); 17.9% of the staphylococcal isolates were MRSA strains. No isolates of vancomycin-resistant enterococcus were identified. Based on the antibiogram, empiric antibiotic therapy within our center should be 1 dose each of vancomycin and an aminoglycoside. Empiric vancomycin was used 71 times. When criterion I is used, 12 prescriptions (16.9%) were considered appropriate. When criterion II and adjustment for MRSA reported for our center were used, 46 (64.8%) vancomycin prescriptions were considered appropriate. Forty-one patients had more than 1 dose of antibiotic therapy, and 18 (43.9%) of those patients did not have C&S data obtained as prescribed by criterion III. Areas of prescribing improvement include obtaining a C&S in all suspected infections prior to empiric therapy and a more aggressive antibiotic switch based on C&S results. Conclusions Antibiograms can be used to determine appropriate empric antibiotic therapy and identify areas of improvement.

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.

Compliance With ATS-IDSA Guideline Recommendations for Empiric Antibiotic Therapy in Pneumonia

CHEST Journal ◽  
2010 ◽  
Vol 138 (4) ◽  
pp. 856A
Author(s):  
Kyle W. Bierman ◽  
Lee E. Morrow ◽  
Joshua D. Holweger ◽  
John T. Ratelle ◽  
Mark A. Malesker
Keyword(s):  
Antibiotic Therapy ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic

The effect of empiric antibiotic therapy on mortality in debilitated patients with dementia

2011 ◽  
Vol 30 (6) ◽  
pp. 813-818 ◽  
Author(s):  
S. Reisfeld ◽  
M. Paul ◽  
B. S. Gottesman ◽  
P. Shitrit ◽  
L. Leibovici ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic

P39 Start smart: improving the quality of empiric antimicrobial prescribing at a tertiary paediatric hospital

2018 ◽  
Vol 103 (2) ◽  
pp. e2.43-e2
Author(s):  
Michelle Kirrane ◽  
Rob Cunney ◽  
Roisin McNamara ◽  
Ike Okafor
Keyword(s):  
Antibiotic Therapy ◽  
Drug Effects ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Prescribing ◽  
Monday Morning ◽  
Paediatric Hospital ◽  
Antimicrobial Prescribing ◽  
National Quality ◽  
Empiric Antibiotic

Appropriate choice of empiric antibiotic therapy, in line with local guidelines, improves outcome for children with infection, while reducing adverse drug effects, cost, and selection of antimicrobial resistance. Data from national point prevalence surveys showed compliance with local prescribing guidelines at our hospital was suboptimal. A team with representatives from the pharmacy, microbiology and emergency departments collaborated with prescribers to improve the quality of empiric antibiotic prescribing. The project aim was, using the ‘Model for Improvement’, to ensure ≥90% of children admitted via the Emergency Department (ED) and commenced on antibiotic therapy, have a documented indication and a choice of therapy in line with local antimicrobial guidelines.MethodResults of weekly audits of the first ten children admitted via ED and started on antibiotics were fed back to prescribers. Front line ownership techniques were used to develop ideas for change, including; regular antibiotic prescribing discussion at Monday morning handover meeting, antibiotic ‘spot quiz’ for prescribers, updates to prescribing guidelines (along with improved access and promotion of prescribing app), printed ID badge guideline summary cards, reminders and guideline summaries at point of prescribing in ED.Collection of audit data initially proved challenging, but was resolved through a series of rapid PDSA cycles. Initial support from ED consultants and other ED staff facilitated establishment of the project. Presentation of weekly run charts to prescribers fostered considerable support among consultants and non-consultant doctors (NCHDs). We saw a shift in perspective from ‘how is your project going?’ to ‘How are we doing?’.ResultsDocumentation of indication and guideline compliance increased from a median of 30% in December 2014/January 2015 to 100% consistently from February 2015 to the present. It is felt that a change in approach to antimicrobial prescribing is now embedded in our hospital culture as this improvement has remained constant through three NCHD changeovers. A comparison of 2014 Antimicrobial expenditure to 2015 figures shows a reduction in expenditure of €101,078.44.ConclusionThis project has inspired other departments to develop local QIPs and has encouraged the surgical teams to lead their own audits in antimicrobial stewardship. An improvement in other areas of antimicrobial prescribing has also been noted e.g. documentation of review date.The initiative has been shared with other hospitals throughout Ireland via presentations at the National Patient Safety Conference, Antimicrobial Awareness day and the Irish Antimicrobial Pharmacist’s Group meeting. It has also been shared at both European and international conferences. The project was a shortlisted finalist for a national healthcare excellence award and has been rolled out as part of a national quality improvement collaborative.

scholarly journals Local audit of empiric antibiotic therapy in bacteremia: A retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248817
Author(s):  
Anthony D. Bai ◽  
Neal Irfan ◽  
Cheryl Main ◽  
Philippe El-Helou ◽  
Dominik Mertz
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Blood Culture ◽  
Antibiotic Therapy ◽  
Retrospective Cohort Study ◽  
Clinical Pathway ◽  
Retrospective Cohort ◽  
Negative Likelihood Ratio ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic

Background It is unclear if a local audit would be useful in providing guidance on how to improve local practice of empiric antibiotic therapy. We performed an audit of antibiotic therapy in bacteremia to evaluate the proportion and risk factors for inadequate empiric antibiotic coverage. Methods This retrospective cohort study included patients with positive blood cultures across 3 hospitals in Hamilton, Ontario, Canada during October of 2019. Antibiotic therapy was considered empiric if it was administered within 24 hours after blood culture collection. Adequate coverage was defined as when the isolate from blood culture was tested to be susceptible to the empiric antibiotic. A multivariable logistic regression model was used to predict inadequate empiric coverage. Diagnostic accuracy of a clinical pathway based on patient risk factors was compared to clinician’s decision in predicting which bacteria to empirically cover. Results Of 201 bacteremia cases, empiric coverage was inadequate in 56 (27.9%) cases. Risk factors for inadequate empiric coverage included unknown source at initiation of antibiotic therapy (adjusted odds ratio (aOR) of 2.76 95% CI 1.27–6.01, P = 0.010) and prior antibiotic therapy within 90 days (aOR of 2.46 95% CI 1.30–4.74, P = 0.006). A clinical pathway that considered community-associated infection as low risk for Pseudomonas was better at ruling out Pseudomonas bacteremia with a negative likelihood ratio of 0.17 (95% CI 0.03–1.10) compared to clinician’s decision with negative likelihood ratio of 0.34 (95% CI 0.10–1.22). Conclusions An audit of antibiotic therapy in bacteremia is feasible and may provide useful feedback on how to locally improve empiric antibiotic therapy.

Peritoneal dialysis-associated peritonitis caused by Enterococcus avium

2021 ◽  
Vol 14 (3) ◽  
pp. e240272
Author(s):  
Rita Calça ◽  
Francisca Gomes da Silva ◽  
Ana Rita Martins ◽  
Patrícia Quadros Branco
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Antibiotic Therapy ◽  
Rare Case ◽  
Clinical Course ◽  
Catheter Removal ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Laboratory Findings ◽  
Microbial Agents

Peritonitis remains a common and serious complication of peritoneal dialysis. Peritonitis caused by gram-positive organisms includes coagulase-negative staphylococci, Streptococcus spp and Enterococcus spp. We present a rare case of peritoneal dialysis-associated peritonitis, where persisting abdominal pain and worsening laboratory findings despite antibiotic therapy led to the identification of Enterococcus avium, requiring Tenckoff catheter removal and temporary transfer to haemodialysis. The available literature reports only few cases where peritonitis is caused by this agent, underlining the need to consider atypical microbial agents when heterogeneous clinical course is presented.

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