The impact of national recommendations on antibiotic treatment of community acquired pneumonia. Do pediatricians follow the national guidelines?

2017 ◽  
Author(s):  
Grażyna Kraj ◽  
Katarzyna Krenke ◽  
Joanna Peradzyńska ◽  
Julita Chądzyńska ◽  
Krystian Wołoszyn ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Community Acquired Pneumonia ◽  
National Guidelines ◽  
The Impact

The impact of first Timing of antibiotics for community acquired pneumonia in emergency department

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Antibiotic Treatment ◽  
Relevant Literature ◽  
Severity Of Illness ◽  
Clinical Situation ◽  
Community Acquired Pneumonia ◽  
Antibiotic Administration ◽  
Eligibility Criteria ◽  
Antibiotic Overuse ◽  
The Impact

Background and objective: For patients with community-acquired pneumonia (CAP), reported associations between timing of the first dose of antibiotics and short-term mortality are inconsistent. To reduce the risks of antibiotic overuse in the emergency department, this summary of the relevant literature identified patients with CAP who benefit most from early antibiotic administration. Methods: A PubMed and Google Scholar search was performed for articles concerning the epidemiology, prognosis, diagnosis, and preliminary management of CAP. Results: Duplicate studies were eliminated and 370 citations were screened. Finally, 16 studies met the eligibility criteria. The review found that, in the presence of sepsis, antibiotics should not be delayed but administered as soon as possible. For patients with moderate-to-severe symptoms, antibiotics should be administered if a diagnosis of CAP is highly likely. For stable, non-critically ill patients with CAP, the timing of antibiotics remains unclear, but available evidence does not indicate strict requirements. For best quality of care, antibiotic timing whether rapid or delayed depends on the clinical situation. Conclusions: In suspected cases of pneumonia presenting in the emergency department, starting antibiotics early solely to conform to dogmatic guidelines within a rigid timeframe has led to unnecessary antibiotic treatment of uninfected patients, while the outcomes of patients with pneumonia have not improved. Since severity of illness is the key factor associated with poor outcomes in pneumonia, the timing of initial antibiotic treatment should be guided by the severity of symptoms.

scholarly journals Comprehensive Description of Pathogens and Antibiotic Treatment Guidance in Children With Community-Acquired Pneumonia Using Combined Mass Spectrometry Methods

2021 ◽  
Vol 11 ◽  
Author(s):  
Liying Sun ◽  
Chi Zhang ◽  
Shuhua An ◽  
Xiangpeng Chen ◽  
Yamei Li ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Community Acquired Pneumonia ◽  
Molecular Testing ◽  
Respiratory Pathogens ◽  
National Guidelines ◽  
Culture Methods ◽  
Identification Rate ◽  
Infection Pattern

The objective of this study was to evaluate the value of molecular methods in the management of community-acquired pneumonia (CAP) in children. Previously developed mass spectrometry (MS)-based methods combined with quantitative real-time PCR (combined-MS methods) were used to describe the aetiology and evaluate antibiotic therapy in the enrolled children. Sputum collected from 302 children hospitalized with CAP were analyzed using the combined-MS methods, which can detect 19 viruses and 12 bacteria related to CAP. Based on the results, appropriate antibiotics were determined using national guidelines and compared with the initial empirical therapies. Respiratory pathogens were identified in 84.4% of the patients (255/302). Co-infection was the predominant infection pattern (51.7%, 156/302) and was primarily a bacterial-viral mixed infection (36.8%, 111/302). Compared with that using culture-based methods, the identification rate for bacteria using the combined-MS methods (61.8%, 126/204) increased by 28.5% (p <0.001). Based on the results of the combined-MS methods, the initial antibiotic treatment of 235 patients was not optimal, which mostly required switching to β-lactam/β-lactamase inhibitor combinations or reducing unnecessary macrolide treatments. Moreover, using the combined-MS methods to guide antibiotic therapy showed potential to decrease the length of stay in children with severe CAP. For children with CAP, quantitative molecular testing on sputum can serve as an important complement to traditional culture methods. Early aetiology elucidated using molecular testing can help guide the antibiotic therapy.

scholarly journals Impact of reducing the duration of antibiotic treatment on the long-term prognosis of community acquired pneumonia

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ane Uranga MD ◽  
Amaia Artaraz MD ◽  
Amaia Bilbao MD ◽  
Jose María Quintana MD ◽  
Ignacio Arriaga MD ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Intervention Group ◽  
Cardiovascular Complications ◽  
Community Acquired Pneumonia ◽  
Control Group ◽  
Reactive Protein ◽  
Long Term Prognosis ◽  
The Impact ◽  
Clinical Stability

Abstract Background The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) is not well established. The aim of this study was to assess the impact of reducing the duration of antibiotic treatment on long-term prognosis in patients hospitalized with CAP. Methods This was a multicenter study assessing complications developed during 1 year of patients previously hospitalized with CAP who had been included in a randomized clinical trial concerning the duration of antibiotic treatment. Mortality at 90 days, at 180 days and at 1 year was analyzed, as well as new admissions and cardiovascular complications. A subanalysis was carried out in one of the hospitals by measuring C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM) at admission, at day 5 and at day 30. Results A total of 312 patients were included, 150 in the control group and 162 in the intervention group. Ninety day, 180 day and 1-year mortality in the per-protocol analysis were 8 (2.57%), 10 (3.22%) and 14 (4.50%), respectively. There were no significant differences between both groups in terms of 1-year mortality (p = 0.94), new admissions (p = 0.84) or cardiovascular events (p = 0.33). No differences were observed between biomarker level differences from day 5 to day 30 (CRP p = 0.29; PCT p = 0.44; proADM p = 0.52). Conclusions Reducing antibiotic treatment in hospitalized patients with CAP based on clinical stability criteria is safe, without leading to a greater number of long-term complications.

scholarly journals Adherence to SATS antibiotic recommendations in patients with community acquired pneumonia in Johannesburg, South Africa

2016 ◽  
Vol 10 (04) ◽  
pp. 347-353 ◽  
Author(s):  
Murimisi Mukansi ◽  
Anastacia Chetty ◽  
Charles Feldman
Keyword(s):  
South Africa ◽  
Antibiotic Treatment ◽  
Patient Outcomes ◽  
Guideline Adherence ◽  
Length Of Hospital Stay ◽  
Community Acquired Pneumonia ◽  
Significant Difference ◽  
Empiric Antibiotic ◽  
High Level ◽  
The Impact

Introduction: Antibiotic guidelines have been published by various societies indicating the optimal empiric antibiotic treatment of patients with community acquired pneumonia (CAP); however, no studies have been undertaken in South Africa investigating whether the most recent South African Thoracic Society (SATS) antibiotic CAP guideline, published in 2007, is being adhered to, or whether adherence is associated with improved patient outcomes. Methodology: This was a retrospective record review over a one-year period undertaken to document levels of adherence to the 2007 SATS guideline for CAP management in adults at an academic teaching hospital. Results: A total of 181 patients with CAP were included in the study, of whom 101 were female, and 109 were known to be HIV-seropositive. The majority (66%) of the patients received antibiotic treatment that was guideline-adherent. In those patients who received treatment that was non-adherent to the guideline recommendations, rather than receiving inadequate cover, they actually had received treatment that was in excess of what was recommended.  There was no significant difference in the length of hospital stay among the two patient groups; however, a significantly longer time to clinical stability was found in patients who had received guideline-adherent treatment.  Only one CAP patient died and therefore it was not possible to determine the impact of guideline adherence on patient mortality. Conclusion: Results of this study indicated a relatively high level of SATS guideline adherence. Guideline adherence was not associated with improved patient outcomes.

scholarly journals Community-acquired pneumonia: selection of empirical treatment and sequential therapy. SARS-CoV-2 implications Juan González del Castillo, Agustín Julián Jiménez, Francisco Javier Candel

2021 ◽  
Author(s):  
Juan González del Castillo ◽  
◽  
Agustín Julián-Jiménez ◽  
Francisco Javier Candel
Keyword(s):  
Decision Making ◽  
Antibiotic Treatment ◽  
Ecological Impact ◽  
Sequential Therapy ◽  
Developed Countries ◽  
Community Acquired Pneumonia ◽  
Beta Lactams ◽  
The One ◽  
The Impact ◽  
Selection Of

Pneumonia is a major cause of global mortality in developed countries. The adequacy of the antibiotic treatment is essential for the good evolution of the patients. When selecting the antimicrobial, the severity of the patient, the characteristics of the antibiotics, and the profile of the patient to be treated should be considered. Recommendations for the selection of antibiotic treatment may differ between the patient who requires admission and the one who can be treated as outpatient. Beta-lactams, fluoroquinolones, and macrolides are the most widely used antimicrobials in this last circumstance. However, not all are the same in terms of efficacy, safety and ecological impact. This review delves into the aforementioned aspects to improve decision-making and offers concrete recommendations for the selection of antibiotic treatment. Likewise, it includes recommendations for performing sequential therapy. Finally, a brief review is made about the impact of SARS-CoV-2 infection on this pathology.

scholarly journals Severe community-acquired pneumonia in general medical wards: outcomes and impact of initial antibiotic selection

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Phunsup Wongsurakiat ◽  
Napat Chitwarakorn
Keyword(s):  
Antibiotic Treatment ◽  
Empirical Therapy ◽  
Community Acquired Pneumonia ◽  
Unfavorable Outcome ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Antibiotic Selection ◽  
Severe Community Acquired Pneumonia ◽  
General Wards ◽  
The Impact

Abstract Background Most international guidelines recommend empirical therapy for community-acquired pneumonia (CAP) to be based on site of care. Some patients with severe CAP are managed in general wards because of limited intensive care unit (ICU) bed or because of unrecognition of the pneumonia severity. Appropriate initial antibiotic treatment for severe CAP outside ICU has not yet been established. This study aimed to determine the prevalence and the impact of initial antibiotic selection on the outcomes of patients with severe CAP who were admitted and managing in general wards. Methods This prospective observational study included consecutive patients hospitalized for presumed CAP in general wards over a 1-year period. Severe CAP was identified using the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) criteria. Initial antibiotic treatment in the first 24 h were collected. The primary outcome was the rate of unfavorable outcome (composite outcome of treatment failure and in-hospital death). The secondary outcome was the number of hospital-free days assessed 30 days after enrollment into the study. Results There were 94 patients hospitalized with CAP of which 50 (53.2%) patients were compatible with severe CAP. An etiologic diagnosis was found in 43 (45.8%) patients. The most common pathogens identified in patients with severe CAP were Staphylococcus aureus (28.6%) and Klebsiella pneumoniae (28.6%), followed by Pseudomonas aeruginosa (17.9%). Patients with severe CAP had significantly more positive blood culture than patients with non-severe CAP (24% VS 4.5%; p = .008). Initial antibiotic treatment were discordant with the IDSA/ATS guidelines in 42% of all patients hospitalized with CAP, and 52% of patients with severe CAP. Multivariate analysis revealed that age (OR 1.1, 95% CI 1.01–1.1) and initial antibiotic treatment discordant to guidelines for severe CAP in ICU (OR 4.6, 95% CI 1.3–17.1) were independent risk factors of the unfavorable outcome of patients with severe CAP. Patients with unfavorable outcome had lower number of hospital-free days than patients with favorable outcome (5.2 ± 8 days VS 18 ± 7.1 days; p < .001). Conclusions Patients with severe CAP outside ICU should be recognized for appropriate initial antibiotic selection to improve outcomes.

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value &lt; 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P &lt; 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P &lt; 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P &lt; 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

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