Duration of Antibiotic Therapy in VLBW Infants with Exposure to Chorioamnionitis and Negative Blood Culture: Their Outcomes

2017 ◽  
Author(s):  
Chibuzor Nonye Opara ◽  
John H Stroger
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Negative Blood Culture ◽  
Vlbw Infants

Neisseria meningitidis Bacteremia in Children: Quantitation of Bacteremia and Spontaneous Clinical Recovery Without Antibiotic Therapy

PEDIATRICS ◽  
1987 ◽  
Vol 80 (1) ◽  
pp. 63-67 ◽  
Author(s):  
T. Dennis Sullivan ◽  
Leonard J. LaScolea
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Neisseria Meningitidis ◽  
Invasive Disease ◽  
Blood Cultures ◽  
Negative Blood Culture ◽  
Clinical Recovery ◽  
Oral Amoxicillin ◽  
Occult Bacteremia ◽  
The Relationship

The relationship between the magnitude of bacteremia due to Neisseria meningitidis and the clinical diagnosis was determined for 43 children who had fever in the presence or absence of focal signs of infection. Bacteremia was quantitated by the previously described procedure using heparinized blood (0.2 to 1.0 mL). Additionally, blood was cultured by means of the radiometric Bactec technique. Seventeen patients had meningitis, 12 had meningococcemia, 13 had unsuspected or "occult" bacteremia, and five had other diagnoses. "Occult" bactermia was diagnosed initially in four patients, but subsequently meningitis was diagnosed. All 13 patients with 500 or more organisms per milliliter had meningitis or meningococcemia in contrast to 12 (55%) of 22 patients with less than 500 organisms per milliliter (P ≤ .0035). Only 18 (42%) of these patients bacteremic with N meningitidis presented with petechiae or purpura. All 13 children with occult bacteremia were sent home after blood cultures were obtained; six of the 13 received a regimen of oral amoxicillin for otitis media. At reexamination (interval 16 to 119 hours) four had meningitis, seven were clinically improved (afebrile, negative blood culture, without invasive disease), and two were still mildly febrile with negative blood culture. Three of these bacteremic children experienced spontaneous clinical and bacteriologic resolution without antibiotic treatment. This has not been previously reported.

Impact of Pharmacist Involvement on the Utility of a Gram-Negative Blood Culture Identification Panel on Antimicrobial Usage

2021 ◽  
pp. 875512252110466
Author(s):  
Caitlin Bowman ◽  
Melissa Holloway ◽  
Lisa Scott ◽  
Carmen Russell ◽  
Sonia Lott ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Intervention Group ◽  
Pharmacist Intervention ◽  
Small Sample ◽  
Molecular Diagnostic ◽  
Negative Blood Culture ◽  
Gram Negative ◽  
Significant Difference ◽  
The Impact

Background: A rapid molecular diagnostic test (MDT) is a test used to identify several different species of gram-negative bacteria and their genetic resistance markers. However, the impact of rapid MDT has not been established when combined with pharmacist involvement. Objective: To determine the impact of pharmacy involvement on patient outcomes when using rapid MDT. The primary outcome is the time from gram stain result to the first dose of the targeted antibiotic. Methods: This is a single-center, quasi-experimental, 1-group pretest-posttest design study of patients with gram-negative bacteremia in a community hospital. Hospitalized patients 18 years or older were included if they had a gram-negative blood culture. Patients were excluded if they were discharged or expired prior to culture results. Outcomes were compared between patients prior to and after implementation of the automated MDT. This research was determined to be exempt from institutional review board oversight consistent with West Florida Healthcare and in accordance with institutional policy. Results: The use of rapid MDT combined with pharmacist intervention resulted in a statistically significant decrease in the time to targeted antibiotic therapy (pre-intervention group, n = 77, 44.8 ± 17.8 hours versus post-intervention group, n= 80, 4.4 ± 5.8 hours; P ≤.001). There was no significant difference found between secondary outcomes. Limitations included small sample size as well as inconsistent documentation. Conclusions: The use of rapid MDT combined with pharmacist intervention resulted in a statistically significant decrease in the time to targeted antibiotic therapy.

scholarly journals Rapid Testing Using the Verigene Gram-Negative Blood Culture Nucleic Acid Test in Combination with Antimicrobial Stewardship Intervention against Gram-Negative Bacteremia

2014 ◽  
Vol 59 (3) ◽  
pp. 1588-1595 ◽  
Author(s):  
Jacqueline T. Bork ◽  
Surbhi Leekha ◽  
Emily L. Heil ◽  
LiCheng Zhao ◽  
Rilwan Badamas ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Blood Culture ◽  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Clinical Isolates ◽  
Molecular Diagnostic ◽  
Negative Blood Culture ◽  
Gram Negative ◽  
Nucleic Acid Test ◽  
Acid Test

ABSTRACTRapid identification of microorganisms and antimicrobial resistance is paramount for targeted treatment in serious bloodstream infections (BSI). The Verigene Gram-negative blood culture nucleic acid test (BC-GN) is a multiplex, automated molecular diagnostic test for identification of eight Gram-negative (GN) organisms and resistance markers from blood culture with a turnaround time of approximately 2 h. Clinical isolates from adult patients at the University Maryland Medical Center with GN bacteremia from 1 January 2012 to 30 June 2012 were included in this study. Blood culture bottles were spiked with clinical isolates, allowed to incubate, and processed by BC-GN. A diagnostic evaluation was performed. In addition, a theoretical evaluation of time to effective and optimal antibiotic was performed, comparing actual antibiotic administration times from chart review (“control”) to theoretical administration times based on BC-GN reporting and antimicrobial stewardship team (AST) review (“intervention”). For organisms detected by the assay, BC-GN correctly identified 95.6% (131/137), with a sensitivity of 97.1% (95% confidence interval [CI], 90.7 to 98.4%) and a specificity of 99.5% (95% CI, 98.8 to 99.8%). CTX-M and OXA resistance determinants were both detected. Allowing 12 h from Gram stain for antibiotic implementation, the intervention group had a significantly shorter duration to both effective (3.3 versus 7.0 h;P< 0.01) and optimal (23.5 versus 41.8 h;P< 0.01) antibiotic therapy. BC-GN with AST intervention can potentially decrease time to both effective and optimal antibiotic therapy in GN BSI.

Clinical consequences of contaminated blood cultures in adult hospitalized patients at an institution utilizing a rapid blood-culture identification system

2020 ◽  
pp. 1-7
Author(s):  
Sidra Liaquat ◽  
Lorena Baccaglini ◽  
Gleb Haynatzki ◽  
Sharon J. Medcalf ◽  
Mark E. Rupp
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Blood Cultures ◽  
Hospitalized Patients ◽  
Identification System ◽  
Negative Blood Culture ◽  
Culture Identification ◽  
Contaminated Blood

Abstract Objective: To assess the clinical impact of contaminated blood cultures in hospitalized patients during a period when rapid diagnostic testing using a FilmArray Blood Culture Identification (BCID) panel was in use. Design: Retrospective cohort study. Setting: Single academic medical center. Participants: Patients who had blood culture(s) performed during an admission between June 2014 and December 2016. Methods: Length of hospital stay and days of antibiotic therapy were assessed in relation to blood-culture contamination using generalized linear models with univariable and multivariable analyses. Results: Among 11,474 patients who had blood cultures performed, the adjusted mean length of hospital stay for patients with contaminated blood-culture episodes (N = 464) was 12.3 days (95% confidence interval [CI], 11.4–13.2) compared to 11.5 days (95% CI, 11.0–11.9) for patients (N = 11,010) with negative blood-culture episodes (P = .032). The adjusted mean durations of antibiotic therapy for patients with contaminated and negative blood-culture episodes were 6.0 days (95% CI, 5.3–6.7) and 5.2 days (95% CI, 4.9–5.4), respectively (P = .011). Conclusions: Despite the use of molecular-based, rapid blood-culture identification, contamination of blood cultures continues to result in prolonged hospital stay and unnecessary antibiotic therapy in hospitalized patients.

The Association between Prolonged Antibiotic Use in Culture Negative Infants and Length of Hospital Stay and Total Hospital Costs

2021 ◽  
Author(s):  
Wesam Sourour ◽  
Valeria Sanchez ◽  
Michel Sourour ◽  
Jordan Burdine ◽  
Elizabeth Rodriguez Lien ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Multivariate Linear Regression Analysis ◽  
Negative Blood Culture ◽  
Total Cost

Objective This study aimed to determine if prolonged antibiotic use at birth in neonates with a negative blood culture increases the total cost of hospital stay. Study design This was a retrospective study performed at a 60-bed level IV neonatal intensive care unit. Neonates born <30 weeks of gestation or <1,500 g between 2016 and 2018 who received antibiotics were included. A multivariate linear regression analysis was conducted to determine if clinical factors contributed to increased hospital cost or length of stay. Results In total, 190 patients met inclusion criteria with 94 infants in the prolonged antibiotic group and 96 in the control group. Prolonged antibiotic use was associated with an increase length of hospital stay of approximately 31.87 days, resulting in a $69,946 increase in total cost of hospitalization. Conclusion Prolonged antibiotics in neonates with negative blood culture were associated with significantly longer hospital length of stay and increased total cost of hospitalization. Key Points

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.

scholarly journals [18F]FDG hypermetabolisms of the spleen and/or bone marrow: indirect signs of bacteremia

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
R Zanca ◽  
F Bartoli ◽  
E Lazzeri ◽  
M Sollini ◽  
RHJA Slart ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Test Procedure ◽  
Lumbar Vertebrae ◽  
Final Diagnosis ◽  
Negative Blood Culture ◽  
Suspected Infection ◽  
Significant Difference ◽  
18F Fdg

Abstract Funding Acknowledgements Type of funding sources: None. Aim Recently hypermetabolisms of the spleen and/or bone marrow has been proposed as an indirect sign of infective endocarditis (IE), useful to reinforce the suspicion of IE in the absence of any other infectious, inflammatory, or malignant disease. The purpose of this study is to determine whether hypermetabolisms of the spleen and/or bone marrow are indirect signs of bacteremia rather than of IE, specifically. Materials and Method In this work we retrospectively evaluated a series 240 patients who performed between January 2015 to December 2020 [18F]FDG PET/CT (Discovery 710 GE) for suspected infection. In particular, 80 pts had infections from different origin and a positive blood culture (PBC), 80 pts presented localized infection, but negative blood culture (IDBCN) and 80 pts were classified as definite IE (IED) according to the 2015 ESCcriteria. [18F]FDG SUVmax SUVmean in bone marrow, spleen and liver were measured drawind a 14 cm3 regions of interest (ROIs) positioned close to the centers of the spleen and of the right liver lobe, but excluding abscess and/or ischemic lesions., as previously described (Caroline Boursier et al. ; Jordy P.Pijl et al.). BM SUVmax and SUVmean was obtained from ROIs placed on the bodies of each of the five lumbar vertebrae, excluding any damaged vertebra. BM to liver SUV ratios (BLR) and spleen to liver SUV ratios (SLR) were calculated. Kruskal-Wallis tests and the Dunn’s test procedure for multiple comparison were performed using JMP Statistical Discoverytm. Results No significant difference among the three groups of SUVmax/mean or in SLR were found. Nevertheless, by grouping patients for the presence of positive blood culture (142 pts) or negative blood culture (98 pts), irrespectively from the final diagnosis a significant associations of SLR was found (p = 0.0070). No significant associations were found with BLR. Conclusions Based on our data SLR in seems to represent an indirect signs of bacteremia, rather than IE.

Sepsis and septic shock

2018 ◽  
pp. 161-168
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Septic Shock ◽  
Mortality Rate ◽  
Blood Culture ◽  
Antibiotic Therapy ◽  
Fluid Resuscitation ◽  
High Flow ◽  
Empirical Antibiotic Therapy ◽  
Goal Directed Therapy ◽  
Reduce Mortality Rate ◽  
Sepsis And Septic Shock

Sepsis is very common; however, goal–directed therapy significantly helps to reduce mortality rate following septic shock. Sepsis Six should be delivered within one hour of initial diagnosis of sepsis. The sepsis resuscitation and management bundle includes delivery of high flow O2, blood culture, measurement of lactate, empirical antibiotic therapy, and IV fluid resuscitation and renal support.

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