scholarly journals MRSA Incidence and Antibiotic Trends in Urban Hand Infections: A 10-Year Longitudinal Study

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 449-454 ◽  
Author(s):  
Justin M. Kistler ◽  
Joseph J. Thoder ◽  
Asif M. Ilyas
Keyword(s):  
Medical Center ◽  
Antibiotic Sensitivity ◽  
Retrospective Chart Review ◽  
Empiric Antibiotic Therapy ◽  
Steady Increase ◽  
Medical Centers ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment ◽  
Culture Positive ◽  
Polymicrobial Infections

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is the most reported pathogen in hand infections at urban medical centers throughout the country. Antibiotic sensitivity trends are not well known. The purposes of this study were to examine and determine the drug resistance trends for MRSA infections of the hand and to provide recommendations for empiric antibiotic treatment based on sensitivity profiles. Methods: A 10-year longitudinal, retrospective chart review was performed on all culture-positive hand infections encountered at a single urban medical center from 2005 to 2014. The proportions of all organisms were calculated for each year and collectively. MRSA infections were additionally subanalyzed for antibiotic sensitivity. Results: A total of 815 culture-positive hand infections were identified. Overall, MRSA grew on culture in 46% of cases. A trend toward decreasing annual MRSA incidence was noted over the 10-year study period. There was a steady increase in polymicrobial infections during the same time. Resistance to clindamycin increased steadily during the 10-year study, starting at 4% in 2008 but growing to 31% by 2014. Similarly, levofloxacin resistance consistently increased throughout the study, reaching its peak at 56% in 2014. Conclusions: The annual incidence of MRSA in hand infections has declined overall but remains the most common pathogen. There has been an alternative increase in the number of polymicrobial infections. MRSA resistance to clindamycin and levofloxacin consistently increased during the study period. Empiric antibiotic therapy for hand infections should not only avoid penicillin and other beta-lactams but should also consider avoiding clindamycin and levofloxacin for empiric treatment.

scholarly journals 1521. Evaluation of the Microbiology of Intraabdominal Infections in Children and Implications for Treatment and Outcomes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S554-S554
Author(s):  
Tibisay I Villalobos-Fry ◽  
Mahlon Schaffer ◽  
Kristin H Wheatley
Keyword(s):  
Perforated Appendicitis ◽  
Retrospective Chart Review ◽  
Empiric Antibiotic Therapy ◽  
Preoperative Treatment ◽  
Oral Antibiotics ◽  
Antibiotic Regimen ◽  
Single Organism ◽  
Empiric Antibiotic ◽  
Amoxicillin Clavulanate ◽  
Fluid Collections

Abstract Background Acute appendicitis is the most common surgical emergency in pediatric medicine. Pseudomonas aeruginosa has been reported in up to 23% of intraoperative cultures though current recommendations do not specify the need for antipseudomonal coverage for preoperative treatment. Prior to transitioning the empiric antibiotic regimen used in the management of perforated appendicitis from an antipseudomonal agent to a simplified daily antibiotic regimen, we conducted a retrospective review of bacterial cultures obtained from intraabdominal fluid collections and antibiotic regimens in children that underwent surgical treatment of perforated appendicitis and/or intraabdominal abscesses. Methods A retrospective chart review of electronic medical records was conducted for pediatric patients admitted with a diagnosis of perforated appendicitis and/or intraabdominal abscess between April 1, 2016 and April 30, 2018. Results Seventy-two patients met inclusion criteria for the study with abscess identified prior to surgery in 11 patients (42.3%). Intraabdominal cultures were obtained in 48 patients (66.7%). The predominant organisms isolated were Escherichia coli, Bacteroides fragilis, and alpha-hemolytic Streptococcus. P. aeruginosa was identified in 12 (24%) cultures and never as a single organism. The majority of patients received piperacillin/tazobactam empirically (91.7%) with a median duration of 5 days (IQR 2). Forty-four patients (61.1%) received oral antibiotics to continue therapy after discharge and 75% received amoxicillin/clavulanate. Of the 12 patients with P. aeruginosa isolated, all patients received piperacillin/tazobactam empirically and 8 (66.7%) were transitioned to oral antibiotics to complete therapy, of which only two regimens retained antipseudomonal coverage. Conclusion Majority of intraabdominal cultures were polymicrobial and the isolation of P. aeruginosa did not appear to impact the choice of definitive antimicrobial therapy. The predominant organisms identified suggest that a non-antipseudomonal regimen (i.e., cephalosporin with metronidazole) may be considered for empiric antibiotic therapy for cases of perforated appendicitis. Disclosures All authors: No reported disclosures.

scholarly journals 659. Evaluation of a Rapid Diagnostic Assay for Early Detection of Bacteriuria

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S302-S302
Author(s):  
Robbie Lee Anne Christian ◽  
Curtis Donskey ◽  
Maria Navas
Keyword(s):  
Diagnostic Test ◽  
Sensitivity And Specificity ◽  
Medical Center ◽  
Traditional Culture ◽  
Urine Samples ◽  
Microbiology Laboratory ◽  
Viridans Streptococci ◽  
Colony Forming Units ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment

Abstract Background Patients with suspected urinary tract infection (UTI) are often prescribed an empiric antibiotic treatment due to delays in obtaining results of urine cultures. The BacterioScan System measures the turbidity of incubating urine specimens to provide a qualitative determination of bacteriuria at a density of >5 × 104 colony-forming units (CFU)/mL within approximately 3 hours. We examined the utility of the BacterioScan assay in predicting bacteriuria and assessed the potential impact of this test to reduce the number of urine cultures processed. Methods Urine samples received for culture in the microbiology laboratory of the Cleveland VA Medical Center were collected daily between September 2018 and December 2018. For each specimen, we performed a bacterioscan diagnostic test and compared it with the result of the traditional culture and urinalysis if available. Urinary cultures were categorized into 4 groups as defined in Figure 1. We compared the sensitivity and specificity of the bacterioscan vs. urinalysis (leukocyte esterase and/or pyuria) results. Results 120 urine samples were tested. As shown in Table 1, the BacterioScan had better sensitivity and specificity than the urinalysis for detection of positive urine cultures. The use of the BacterioScan to rule out UTI could have accurately spared 69 of 120 (57.5%) samples from traditional culture and prevented 26 of 120 (21.6%) from possible misinterpretation as infection due to reporting of growth. BacterioScan resulted in 4 of 31 (12.9%) false negatives, but all occurred when positive cultures were due to viridans streptococci or uropathogens in numbers below 100,000 CFU.ml. Conclusion The BacterioScan system is a rapid diagnostic test that provides early information on urine culture results that could help to avoid overuse of empirical antimicrobials in patients with suspected UTI and decrease the workload of the Microbiology Laboratory. Disclosures All authors: No reported disclosures.

scholarly journals 191. Appropriateness of Empiric Antibiotics for Enterobacteriaceae Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S115-S115
Author(s):  
Brandon J Smith ◽  
Abigail Kois ◽  
Nathan Gartland ◽  
Joseph Tholany ◽  
Ricardo Arbulu
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Resistance ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Academic Community ◽  
Empiric Antibiotic Therapy ◽  
In Vitro Susceptibility ◽  
Empiric Antibiotics ◽  
Empiric Antibiotic

Abstract Background Appropriate empiric antibiotic therapy is associated with decreased mortality and recurrence in patients with Enterobacteriaceae bacteremia (EB). Increasing bacterial resistance adds an additional layer to this complex clinical scenario. Swift utilization of appropriate antibiotics is crucial for improved patient outcomes. However, prolonged and excessively broad antibiotic coverage is not without its own complications. Our study aimed to review the appropriateness of empiric antibiotics for EB. Methods A retrospective chart review of all patients >18 years of age who were admitted to a single academic community hospital during 2018 EB anytime throughout their hospitalization. The primary endpoint was the appropriateness of empiric antibiotic therapy, defined as receiving active therapy prior to the return of antimicrobial sensitivities that were susceptible to the empiric agents used. Appropriateness was further adjusted for standard of care (SOC) practices. Specifically, despite in vitro susceptibility of piperacillin/tazobactam and cefepime, carbapenem therapy is preferred for ESBL infections. Results Our study identified 178 patients with EB. Most common organisms included E.coli (64.6%), K. pneumoniae (11.8%) and P. mirabilis (7.3%). Resistance patterns included 1 CRE (0.57%) and 17 ESBL (9.7%) isolates. Most common sources of infection included urinary (63.5%) and intraabdominal (13.5%). Based on the sensitivity reports of tested isolates, 83.7% of patients received appropriate empiric antibiotics. After adjustment for SOC, 11.8% of ESBL patients (2/17) and 0% of CRE (0/1) patients received appropriate therapy. Comparatively 89.0% of patients without ESBL or CRE (137/154) received appropriate care (P < 0.0001). Conclusion The results of this study demonstrate that across our patient population, over 80% of patients received appropriate empiric antibiotics for EB; however, this percentage was dramatically lower for patients with ESBL or CRE infections. This highlights room for improved rapid diagnosis and identification of risk factors predisposing to resistant organisms thereby decreasing the time to appropriate antibiotic therapy. Disclosures All authors: No reported disclosures.

scholarly journals 103. Empiric Antibiotic Susceptibility Using a Traditional vs. Syndromic Antibiogram-Implications for Antimicrobial Stewardship Programs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S65-S66
Author(s):  
Kenneth Klinker ◽  
Karri A Bauer ◽  
C Andrew DeRyke ◽  
Levita K Hidayat
Keyword(s):  
Antimicrobial Stewardship ◽  
Empiric Antibiotic Therapy ◽  
Intrinsic Variability ◽  
Gram Negative ◽  
E Coli ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment ◽  
Adequate Coverage ◽  
Gram Negative Organisms ◽  
Klebsiella Spp

Abstract Background A primary tenet of antimicrobial stewardship programs (ASPs) is to establish empiric antibiotic treatment recommendations. While traditional antibiograms are useful, intrinsic variability in susceptibility exists when stratifying by source and/or location. In contrast, a syndromic antibiogram displays the likelihood of adequate coverage for a specific infection syndrome, considering the weighted incidence of pathogens causing that syndrome. The aim of the study was to compare antibiotic susceptibilities using a traditional versus syndromic antibiogram. Methods Between 2016–2019, 20 US institutions per year submitted up to 250 consecutive targeted gram-negative pathogens from hospitalized patients as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART). MICs were determined by broth microdilution and interpreted using 2020 CLSI breakpoints, except for imipenem/relebactam (I/R) for which FDA breakpoints were used. The traditional antibiogram included the 3 most common Gram-negative pathogens from all sources and represented critical organisms considered for empiric antibiotic coverage; the syndromic antibiogram included the 3 most commonly isolated Gram-negative pathogens from a respiratory source based on patient location. Results 17,561 Gram-negative isolates, including 6,654 lower respiratory isolates were evaluated. The top 3 most common Gram-negative organisms included: E. coli (n=6095, 44%), Klebsiella spp. (n=4097, 30%), P. aeruginosa (n=3649, 26%). Cumulative susceptibilities were comparable using a traditional vs. syndromic antibiogram (Figure 1); however, cefepime (FEP), piperacillin/tazobactam (TZP), and meropenem (MEM) susceptibilities were 5 – 8% lower when stratified by patient location (Figure 2) and ≥10% for P. aeruginosa (Figure 3). Ceftolozane/tazobactam (C/T) and I/R demonstrated ≥90% susceptibility regardless of respiratory source or patient location. Figure 1. Cumulative susceptibility of E. coli, Klebsiella spp, and P. aeruginosa for traditional vs. syndromic antibiogram Figure 2. Syndromic antibiogram evaluating cumulative susceptibility of E. coli (n = 637), Klebsiella spp. (n = 1190) and P. aeruginosa (n = 1997) respiratory isolates stratified by patient location Figure 3. Syndromic antibiogram evaluating susceptibility of P. aeruginosa (n = 1997) respiratory isolates stratified by patient location Conclusion Our analysis demonstrated that susceptibilities were lower for first-line agents when stratified by ICU and P. aeruginosa. ASPs should consider syndromic antibiograms based on source and patient location to optimize empiric antibiotic therapy recommendations. Disclosures Kenneth Klinker, PharmD, Merck & Co, Inc (Employee) Karri A. Bauer, PharmD, Merck Research Laboratories (Employee) C. Andrew DeRyke, PharmD, Merck & Co., Inc. (Employee, Shareholder) Levita K. Hidayat, PharmD BCIDP, Merck & Co (Employee)

Emergency Pharmacist Impact on Health Care-Associated Pneumonia Empiric Therapy

2012 ◽  
Vol 26 (2) ◽  
pp. 125-130 ◽  
Author(s):  
Sean R. DeFrates ◽  
Kyle A. Weant ◽  
Jason P. Seamon ◽  
Alicia Shirakbari ◽  
Stephanie N. Baker
Keyword(s):  
Health Care ◽  
Treatment Group ◽  
Treatment Guidelines ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Empiric Antibiotic Therapy ◽  
Control Group ◽  
Health Care Associated Pneumonia ◽  
The Impact

Purpose: Health care-associated pneumonia (HCAP) is a serious infection dependent on proper treatment that often presents in the emergency department (ED) and deviation from treatment guidelines appears to be high. This study was conducted to evaluate the impact of emergency medicine pharmacists (EPhs) on adherence of empiric antibiotic therapy to guideline recommendations. Methods: A retrospective chart review of adult patients with HCAP who presented to an academic medical center ED from September 1, 2008 to June 30, 2010 was conducted. The control group included those patients with HCAP who presented to the ED outside of the EPhs’ hours (23:00-13:00), and the treatment group consisted of those patients who presented during the EPhs’ hours (13:00-23:00). Results: The 81 patients presenting inside the EPhs’ hours were significantly more likely to receive guideline adherent empiric antibiotics than the 70 patients presenting outside the EPhs’ hours (49.38% vs 25.7%, P = .005). Also, patients in the treatment group received antibiotics in a shorter amount of time (11.37 vs 15.56 hours, P = .272) and at more appropriate doses (85.2% vs 77.1%, P = .29) although these outcomes were not statistically significant. Conclusion: The presence of the EPh significantly increased the likelihood of at-risk patients receiving empiric antimicrobial therapy consistent with guideline recommendations.

Empiric Antibiotic Prescribing Decisions Among Medical Residents: The Role of the Antibiogram

2018 ◽  
Vol 39 (5) ◽  
pp. 578-583 ◽  
Author(s):  
Gregory B. Tallman ◽  
Rowena A. Vilches-Tran ◽  
Miriam R. Elman ◽  
David T. Bearden ◽  
Jerusha E. Taylor ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Professional Training ◽  
Medical Center ◽  
Academic Medical Center ◽  
Medical Residents ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Prescribing ◽  
Correct Identification ◽  
Clinical Vignettes ◽  
Empiric Antibiotic

OBJECTIVETo assess general medical residents’ familiarity with antibiograms using a self-administered surveyDESIGNCross-sectional, single-center surveyPARTICIPANTSResidents in internal medicine, family medicine, and pediatrics at an academic medical centerMETHODSParticipants were administered an anonymous survey at our institution during regularly scheduled educational conferences between January and May 2012. Questions collected data regarding demographics, professional training; further open-ended questions assessed knowledge and use of antibiograms regarding possible pathogens, antibiotic regimens, and prescribing resources for 2 clinical vignettes; a series of directed, closed-ended questions followed. Bivariate analyses to compare responses between residency programs were performed.RESULTSOf 122 surveys distributed, 106 residents (87%) responded; internal medicine residents accounted for 69% of responses. More than 20% of residents could not accurately identify pathogens to target with empiric therapy or select therapy with an appropriate spectrum of activity in response to the clinical vignettes; correct identification of potential pathogens was not associated with selecting appropriate therapy. Only 12% of respondents identified antibiograms as a resource when prescribing empiric antibiotic therapy for scenarios in the vignettes, with most selecting the UpToDate online clinical decision support resource or The Sanford Guide. When directly questioned, 89% reported awareness of institutional antibiograms, but only 70% felt comfortable using them and only 44% knew how to access them.CONCLUSIONSWhen selecting empiric antibiotics, many residents are not comfortable using antibiograms as part of treatment decisions. Efforts to improve antibiotic use may benefit from residents being given additional education on both infectious diseases pharmacotherapy and antibiogram utilization.Infect Control Hosp Epidemiol 2018;39:578–583

scholarly journals 1555. Evaluation of Local Pathogens and Management of Diabetic Foot Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S778-S778
Author(s):  
Jessica L Seadler ◽  
Natalie Tucker ◽  
Beth Cady ◽  
Praveen Mullangi
Keyword(s):  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Diabetic Foot ◽  
Antimicrobial Agents ◽  
Specific Treatment ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Empiric Antibiotic Therapy ◽  
Diabetic Foot Infections ◽  
Empiric Antibiotic

Abstract Background Diabetic foot infections (DFI) are a potentially devastating complication for patients with diabetes. When treating these patients, there is a need for selection of highly effective antibiotics coupled with a need to avoid excessive use of broad-spectrum antimicrobial agents that could lead to adverse patient outcomes. At this institution, it has been observed that there is a lack of compliance with consensus guideline recommendations for the choice of empiric antibiotic therapy for DFI, leading to overuse of broad-spectrum antibiotics. Methods A retrospective chart review was performed for hospitalized patients over 18 years of age that received antibiotics for DFI during the period of August 1, 2018 to July 31, 2019. Patients were excluded if they were continuing outpatient antibiotics for an existing DFI, were being treated with antibiotics for a concurrent infection, or were pregnant. The primary objective was the rate of guideline-compliant empiric antibiotic regimens as broken down by infection severity. Secondary objectives included the duration of antibiotic therapy per patient, and rates of empiric methicillin-resistant Staphylococcus aureus (MRSA) and P. aeruginosa coverage. Results A total of 114 patients were included in the analysis. A majority of patients had an infection of moderate severity (65.8%), followed by 19.3% with severe infections, and 14.9% with mild infections. In the total population, only 26.3% of patients received empiric antibiotic regimens that were guideline-compliant. A large percentage of patients received empiric anti-MRSA antibiotics (95.6%) and empiric anti-pseudomonal agents (89.5%). Use of these broad-spectrum agents did not differ by infection severity. Ninety-nine (86.8%) patients had a site culture collected. S. aureus was the most commonly isolated organism and there was a low rate of P. aeruginosa (10.1%). Conclusion There is room for improvement in the management of DFI at this institution. A specific area that has been identified is the overuse of empiric anti-pseudomonal agents in patients without risk factors for P. aeruginosa. The results of this study will be evaluated alongside consensus guidelines and used to create institution-specific treatment guidance that providers can employ to optimize the management of DFI. Disclosures All Authors: No reported disclosures

Time to Guideline-Based Empiric Antibiotic Therapy in the Treatment of Pneumonia in a Community Hospital

2016 ◽  
Vol 29 (4) ◽  
pp. 386-391 ◽  
Author(s):  
Beth L. Erwin ◽  
Jeffrey A. Kyle ◽  
Leland N. Allen
Keyword(s):  
Antibiotic Therapy ◽  
Guideline Adherence ◽  
Community Hospital ◽  
Retrospective Chart Review ◽  
Empiric Antibiotic Therapy ◽  
Adherence Rate ◽  
Record System ◽  
Empiric Antibiotic ◽  
The Mean ◽  
Mean Time

Purpose: The 2005 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines for hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and health care-associated pneumonia (HCAP) stress the importance of initiating prompt appropriate empiric antibiotic therapy. This study’s purpose was to determine the percentage of patients with HAP, VAP, and HCAP who received guideline-based empiric antibiotic therapy and to determine the average time to receipt of an appropriate empiric regimen. Methods: A retrospective chart review of adults with HAP, VAP, or HCAP was conducted at a community hospital in suburban Birmingham, Alabama. The hospital’s electronic medical record system utilized International Classification of Diseases, Ninth Revision ( ICD-9) codes to identify patients diagnosed with pneumonia. The percentage of patients who received guideline-based empiric antibiotic therapy was calculated. The mean time from suspected diagnosis of pneumonia to initial administration of the final antibiotic within the empiric regimen was calculated for patients who received guideline-based therapy. Results: Ninety-three patients met the inclusion criteria. The overall guideline adherence rate for empiric antibiotic therapy was 31.2%. The mean time to guideline-based therapy in hours:minutes was 7:47 for HAP and 28:16 for HCAP. For HAP and HCAP combined, the mean time to appropriate therapy was 21:55. Conclusion: Guideline adherence rates were lower and time to appropriate empiric therapy was greater for patients with HCAP compared to patients with HAP.

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