Interplay between Rapid Diagnostic Tests and Antimicrobial Stewardship Programs among Patients with Bloodstream and Other Severe Infections

2019 ◽  
Vol 3 (4) ◽  
pp. 601-616 ◽  
Author(s):  
Maya Beganovic ◽  
Erin K McCreary ◽  
Monica V Mahoney ◽  
Brandon Dionne ◽  
Daniel A Green ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Antimicrobial Stewardship ◽  
Diagnostic Tests ◽  
Susceptibility Testing ◽  
Rapid Diagnostic Tests ◽  
Clinical Value ◽  
Gastrointestinal Infections ◽  
Genotypic Resistance ◽  
Phenotypic Susceptibility

Abstract Background Antimicrobial stewardship programs (ASPs) aim to provide optimal antimicrobial therapy to patients quickly to improve the likelihood of overcoming infection while reducing the risk of adverse effects. Rapid diagnostic tests (RDTs) for infectious diseases have become an integral tool for ASPs to achieve these aims. Content This review explored the demonstrated clinical value of longer-standing technologies and implications of newer RDTs from an antimicrobial stewardship perspective. Based on available literature, the focus was on the use of RDTs in bloodstream infections (BSIs), particularly those that perform organism identification and genotypic resistance detection, phenotypic susceptibility testing, and direct specimen testing. Clinical implications of rapid testing among respiratory, central nervous system, and gastrointestinal infections are also reviewed. Summary Coupling RDTs with ASPs facilitates the appropriate and timely use of test results, translating into improved patient outcomes through optimization of antimicrobial use. These benefits are best demonstrated in the use of RDT in BSIs. Rapid phenotypic susceptibility testing offers the potential for early pharmacokinetic/pharmacodynamic optimization, and direct specimen testing on blood may allow ASPs to initiate appropriate therapy and/or tailor empiric therapy even sooner than other RDTs. RDTs for respiratory, central nervous system, and gastrointestinal illnesses have also shown significant promise, although more outcome studies are needed to evaluate their full impact.

scholarly journals Predictors of Time to Effective and Optimal Antimicrobial Therapy in Patients With Positive Blood Cultures Identified via Molecular Rapid Diagnostic Testing

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Maya Beganovic ◽  
Tristan T Timbrook ◽  
Sarah M Wieczorkiewicz
Keyword(s):  
Patient Outcomes ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Diagnostic Tests ◽  
Diagnostic Testing ◽  
Rapid Diagnostic Tests ◽  
Blood Cultures ◽  
Effective Therapy ◽  
Rapid Diagnostic Testing ◽  
Optimal Therapy

Abstract Antimicrobial stewardship (AMS) programs integrated with rapid diagnostic tests optimize patient outcomes and reduce time to effective therapy (TTET) and time to optimal therapy (TTOT). This study identifies predictors of TTET and TTOT among patients with positive blood cultures and identifies limitations to current TTOT definitions and outcomes.

Treatment of Cluster Headache with Topiramate: Effects and Side-Effects in Five Patients

Cephalalgia ◽  
2002 ◽  
Vol 22 (3) ◽  
pp. 186-187 ◽  
Author(s):  
S Förderreuther ◽  
M Mayer ◽  
A Straube
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Side Effects ◽  
Cluster Headache ◽  
Clinical Experience ◽  
Prophylactic Treatment ◽  
Clinical Value ◽  
Epilepsy Therapy ◽  
Headache Patients

We report on clinical experience with topiramate in the prophylactic treatment of three patients with chronic and two patients with episodic, otherwise therapy-resistant, cluster headache. Patients were treated with daily doses of 75-200 mg topiramate. Topiramate was effective in three patients but proved ineffective and also caused intolerable side-effects in two patients. Topiramate may have prophylactic properties for treating cluster headache at lower doses than needed in epilepsy therapy, but its clinical value is limited due to central nervous system side-effects.

Diagnostic Tests

2018 ◽  
pp. 42-62
Author(s):  
Andrea C. Adams
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Magnetic Resonance ◽  
Diagnostic Tests ◽  
Csf Analysis ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri

The diagnostic tests used most often to evaluate patients who have disease of the central nervous system (CNS) include cerebrospinal fluid (CSF) analysis, electroencephalography (EEG), evoked potentials, electromyography (EMG), computed tomography (CT), and magnetic resonance imaging (MRI). These tests should be used to supplement or to extend the clinical examination.

scholarly journals Diagnosis of Central Nervous System Lupus

1988 ◽  
Vol 15 (3) ◽  
pp. 257-260 ◽  
Author(s):  
Paul O'Connor
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Lupus Erythematosus ◽  
Diagnostic Tests ◽  
Foreseeable Future ◽  
Systemic Lupus ◽  
Cns Involvement ◽  
Cns Lupus ◽  
Patient Morbidity ◽  
Central Nervous System Lupus

ABSTRACT:Central nervous system (CNS) involvement in systemic lupus erythematosus is a major source of patient morbidity and mortality. The recognition of nervous system lupus is hampered by the diagnostic insensitivity and non-specificity of the various testing modalities that are currently available. A review of the effectiveness of diagnostic tests for CNS lupus is presented. Areas of current research in this area are examined. Because of the diversity of neurologic manifestations in this disorder and their complex pathogenesis, no single test is sufficient to establish the diagnosis rapidly and accurately in all cases, now or for the foreseeable future.

scholarly journals Central and peripheral demyelination

2014 ◽  
Vol 5 (01) ◽  
pp. 84-86 ◽  
Author(s):  
Man Mohan Mehndiratta ◽  
Natasha Singh Gulati
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Diagnostic Tests ◽  
Demyelinating Diseases ◽  
Demyelinating Disorders

ABSTRACTSeveral conditions cause damage to the inherently normal myelin of central nervous system, perepheral nervous system or both central and perepheral nervous system and hence termed as central demyelinating diseases, perepheral demyelinating diseases and combined central and perepheral demyelinating diseases respectively. Here we analysed and foccused on the etiology, prevalance, incidence and age of these demyelinating disorders. Clinical attention and various diagnostic tests are needed to adequately assess all these possibilities.

scholarly journals New Insight of Circular RNAs' Roles in Central Nervous System Post-Traumatic Injury

2021 ◽  
Vol 15 ◽  
Author(s):  
Lvwan Xu ◽  
Xin Ye ◽  
Jinjie Zhong ◽  
Ying-ying Chen ◽  
Lin-lin Wang
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Traumatic Injury ◽  
Circular Rnas ◽  
Clinical Value ◽  
Cord Injury ◽  
Second Generation Sequencing ◽  
The Central Nervous System ◽  
Post Traumatic ◽  
Generation Sequencing

The central nervous system (CNS) post-traumatic injury can cause severe nerve damage with devastating consequences. However, its pathophysiological mechanisms remain vague. There is still an urgent need for more effective treatments. Circular RNAs (circRNAs) are non-coding RNAs that can form covalently closed RNA circles. Through second-generation sequencing technology, microarray analysis, bioinformatics, and other technologies, recent studies have shown that a number of circRNAs are differentially expressed after traumatic brain injury (TBI) or spinal cord injury (SCI). These circRNAs play important roles in the proliferation, inflammation, and apoptosis in CNS post-traumatic injury. In this review, we summarize the expression and functions of circRNAs in CNS in recent studies, as well as the circRNA–miRNA–mRNA interaction networks. The potential clinical value of circRNAs as a therapeutic target is also discussed.

scholarly journals Central nervous system infections in patients with systemic lupus erythematosus: a systematic review and meta-analysis

2022 ◽  
Vol 9 (1) ◽  
pp. e000560
Author(s):  
Kasra Molooghi ◽  
Fereshte Sheybani ◽  
Hamidreza Naderi ◽  
Zahra Mirfeizi ◽  
Negar Morovatdar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Central Nervous System ◽  
Nervous System ◽  
Lupus Erythematosus ◽  
Diagnostic Tests ◽  
Activity Index ◽  
Meta Analysis ◽  
Cns Infection ◽  
Cns Infections ◽  
Systemic Corticosteroids

We aimed to conduct a systematic review and meta-analysis of studies on central nervous system (CNS) infections in patients with SLE, in order to describe their clinical and microbiological characteristics, and outcomes. A systematic search of PubMed/Medline and Embase electronic databases was performed (March 2021) to identify all published studies on CNS infections and their characteristics in patients with SLE. A random-effects model was adopted and findings were reported with 95% CI. Overall, 6 studies involving 17 751 patients with SLE and 209 SLE cases with CNS infection were included in our meta-analysis. The frequency rate of CNS infections in patients with SLE was 0.012 (95% CI: 0.008 to 0.018). Meningitis was the most common clinical syndrome (93.5%, n=109/114, 95% CI: 82.6% to 97.8%) and Cryptococcus neoformans (35.9%, n=55, 95% CI: 27.2% to 45.7%) and Mycobacterium tuberculosis (27.1%, n=43, 95% CI: 14.6% to 44.8%) were the most common causative pathogens. Our patient-pool showed a mean SLE Disease Activity Index (SLEDAI) score of 7.9 (95% CI: 6.1 to 9.6), while 92.4% (n=72/76, 95% CI: 83.0% to 96.8%) of cases were on oral systemic corticosteroids, with a prednisone equivalent mean daily dose of 30.9 mg/day (95% CI: 18.0 to 43.7). Our meta-analysis revealed a mortality rate of 29.0% (95% CI: 15.0% to 48.6%). Clinicians should maintain a high index of suspicion for cryptococcal and tuberculosis (TB) meningitis in patients with SLE with suspected CNS infection, particularly in those with higher SLEDAI and on higher doses of systemic corticosteroids. In conclusion, initiation of empiric antituberculous treatment for patients with SLE who are highly suspected to have CNS TB is warranted while awaiting the results of diagnostic tests. Antifungals might also be potentially useful empirically in patients with SLE who are suspected to have fungal CNS infections. However, with respect to side effects such as toxicity and high cost of antifungals, decision regarding early antifungal therapy should be guided by early and less time-consuming fungal diagnostic tests.

Sign in / Sign up

Export Citation Format

Share Document