Etiology of Bacterial Sepsis in Nephrotic Children 1963-1967

PEDIATRICS ◽  
1968 ◽  
Vol 42 (5) ◽  
pp. 840-843
Author(s):  
Catherine M. Katz ◽  
Samuel L. Katz
Keyword(s):  
Retrospective Study ◽  
Antibiotic Therapy ◽  
Medical Center ◽  
Bacterial Sepsis ◽  
Gram Negative ◽  
E Coli ◽  
Enterobacter Species ◽  
Nephrotic Patient ◽  
Nephrotic Children ◽  
Selection Of

A retrospective study of 280 nephrotic admissions from 1963 through 1967 at Children's Hospital Medical Center in Boston revealed that gram-negative bacilli have caused the majority of infections in hospitalized nephrotic children. The organisms isolated during this period included pneumococci, E. coli, proteus, klebsiella-enterobacter species, pseudomonas, and Serratia marcescens. This information is recorded to aid physicians in the selection of initial antibiotic therapy in the septic nephrotic patient.

scholarly journals 1005. The Antibiotic Optimization DOOR: Refining Assessment of Antibiotic Therapy with Desirability of Outcome Ranking

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S354-S354
Author(s):  
Steven Smoke ◽  
Vishal Patel ◽  
Nicole Leonida ◽  
Maria DeVivo
Keyword(s):  
Retrospective Study ◽  
Antibiotic Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Treatment Success ◽  
Molecular Diagnostic ◽  
Single Measure ◽  
Optimal Therapy ◽  
Desirable Outcome ◽  
The Impact

Abstract Background Desirability of outcome ranking (DOOR) is a novel methodology for incorporating multiple outcomes into a single value to more comprehensively compare therapeutic strategies. Its primary application has been limited to antibiotic clinical trials, incorporating treatment success and antibiotic toxicity into a single measure. We describe the application of DOOR methodology to a retrospective study evaluating antibiotic optimization. Methods This was a single-center, retrospective quasi-experimental study conducted at an academic medical center evaluating the impact of prospective pharmacist review of rapid molecular diagnostic testing (RDT) of blood cultures on antibiotic optimization. Two 8-week time periods were evaluated, corresponding to RDT implementation prior to prospective pharmacist review (RDT-only) and RDT with prospective pharmacist review (RDT-PPR). Patients with a positive blood culture who were not on optimal therapy at the time of gram stain were included in the study. Outcomes included the percentage of patients who received optimal therapy, time to optimal antibiotic therapy, and percentage of patients who had therapy de-escalated. An antibiotic optimization DOOR was created with 3 ordinal ranks. The most desirable outcome, rank one, was patients receiving optimal therapy with no missed de-escalation opportunities. Rank two was patients receiving optimal therapy with a missed de-escalation opportunity. The least desirable outcome, rank three, consisted of patients not receiving optimal antibiotic therapy. Time to optimal therapy was used as a tiebreaker for patients in ranks one and two. Results A total of 19 and 29 patients were included in the pre and post-intervention periods, respectively. The percentage of patients reaching optimal therapy was 84% (16/19) and 97% ([28/29], P = 0.16). Median time to optimal therapy was 30:28:26 and 22:40:17 (P = 0.32), respectively. DOOR analysis indicated that the probability of a better outcome for the RDT-PPR group than the RDT-only group was 58% (95% CI 54–62). Conclusion In this small retrospective study, the use of a novel composite methodology identified the benefit of an intervention that was not detected by standard comparison of individual outcomes. Disclosures All authors: No reported disclosures.

Hematogenous Septic Arthritis in the Dog: Results of Five Patients Treated Nonsurgically With Antibiotics

2003 ◽  
Vol 39 (6) ◽  
pp. 563-566 ◽  
Author(s):  
Randall B. Fitch ◽  
Tara C. Hogan ◽  
Simon T. Kudnig
Keyword(s):  
Retrospective Study ◽  
Synovial Fluid ◽  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Pasteurella Multocida ◽  
Bacterial Species ◽  
Clinical Report ◽  
Clinical Resolution ◽  
Staphylococcus Intermedius ◽  
Selection Of

This retrospective study evaluates the effectiveness of nonsurgical treatment using antibiotics to treat hematogenous septic arthritis in five dogs. Giant-breed dogs were over-represented, with all dogs <1 year of age. Synovial fluid cultures were positive in all cases, with common bacterial species isolated that included Streptococcus B-haemolytic spp., Pasteurella multocida, and Staphylococcus intermedius. Dogs treated with appropriate duration and selection of antibiotics had clinical resolution with no residual deficits. This report and a previous clinical report demonstrate that hematogenous septic arthritis can be successfully treated nonsurgically with antibiotic therapy.

scholarly journals Improvement of gram-negative susceptibility to fluoroquinolones after implementation of a pre-authorization policy for fluoroquinolone use: A decade-long experience

2018 ◽  
Vol 39 (12) ◽  
pp. 1419-1424 ◽  
Author(s):  
Rachael A. Lee ◽  
Morgan C. Scully ◽  
Bernard C. Camins ◽  
Russell L. Griffin ◽  
Danielle F. Kunz ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Rate Of Change ◽  
Gram Negative ◽  
E Coli ◽  
Stewardship Program ◽  
Restriction Policy ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Gram Negative Organisms

AbstractObjectiveDue to concerns over increasing fluoroquinolone (FQ) resistance among gram-negative organisms, our stewardship program implemented a preauthorization use policy. The goal of this study was to assess the relationship between hospital FQ use and antibiotic resistance.DesignRetrospective cohort.SettingLarge academic medical center.MethodsWe performed a retrospective analysis of FQ susceptibility of hospital isolates for 5 common gram-negative bacteria: Acinetobacter spp., Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Primary endpoint was the change of FQ susceptibility. A Poisson regression model was used to calculate the rate of change between the preintervention period (1998–2005) and the postimplementation period (2006–2016).ResultsLarge rates of decline of FQ susceptibility began in 1998, particularly among P. aeruginosa, Acinetobacter spp., and E. cloacae. Our FQ restriction policy improved FQ use from 173 days of therapy (DOT) per 1,000 patient days to <60 DOT per 1,000 patient days. Fluoroquinolone susceptibility increased for Acinetobacter spp. (rate ratio [RR], 1.038; 95% confidence interval [CI], 1.005–1.072), E. cloacae (RR, 1.028; 95% CI, 1.013–1.044), and P. aeruginosa (RR, 1.013; 95% CI, 1.006–1.020). No significant change in susceptibility was detected for K. pneumoniae (RR, 1.002; 95% CI, 0.996–1.008), and the susceptibility for E. coli continued to decline, although the decline was not as steep (RR, 0.981; 95% CI, 0.975–0.987).ConclusionsA stewardship-driven FQ restriction program stopped overall declining FQ susceptibility rates for all species except E. coli. For 3 species (ie, Acinetobacter spp, E. cloacae, and P. aeruginosa), susceptibility rates improved after implementation, and this improvement has been sustained over a 10-year period.

Peritonitis in Children With Nephrotic Syndrome

PEDIATRICS ◽  
1988 ◽  
Vol 81 (6) ◽  
pp. 849-856
Author(s):  
Margaret J. Gorensek ◽  
Marc H. Lebel ◽  
John D. Nelson
Keyword(s):  
Nephrotic Syndrome ◽  
Abdominal Pain ◽  
Recent Trend ◽  
Medical Center ◽  
Gram Negative ◽  
Rebound Tenderness ◽  
Primary Peritonitis ◽  
Negative Culture ◽  
Gram Negative Organisms ◽  
Nephrotic Children

In a retrospective review of 214 children with nephrotic syndrome seen at Children's Medical Center and Parkland Memorial Hospital in Dallas throughout the 20-year period from 1967 to 1986, 62 cases of primary peritonitis were identified in 37 patients (17.3% rate). Streptococcus pneumoniae was the major pathogen, accounting for 38% of the cases. An additional 27% of patients had negative culture results but were clinically responsive to penicillin. Gram-negative organisms were cultured from only 3% of patients; 5% were caused by α-streptococci and 2% each by enterococcus and anaerobes. In 23% of cases the cause was unknown. Our findings differ from the recent trend in the literature in which Gram-negative organisms associated with these infections are increasingly implicated. The incidence and bacteriology of peritonitis do not appear to have changed significantly during the 20-year period. Clinically, peritonitis was characterized by abdominal pain (98%), fever (95%), rebound tenderness (85%), and nausea and vomiting (71%). A total of 79% of patients were either in relapse or receiving steroid therapy at the time peritonitis was diagnosed; 13% had infiltrates visible on their chest radiographs. Based on our data, it seems reasonable to initiate antimicrobial therapy in nephrotic children with suspected peritonitis using a combination of penicillin plus either an aminoglycoside or a cephalosporin. This regimen should continue until culture results are available, unless Gram-positive diplococci are identified in a Gram-stained specimen of peritoneal fluid, in which case penicillin alone should suffice.

scholarly journals Risk factors of initial inappropriate antibiotic therapy and the impacts on outcomes of neonates with gram-negative bacteremia

2019 ◽  
Author(s):  
Shih-Ming Chu ◽  
Jen-Fu Hsu ◽  
Mei-Yin Lai ◽  
Hsuan-Rong Huang ◽  
Ming-Chou Chiang ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Tertiary Care ◽  
Generation Cephalosporin ◽  
Resistant Bacteria ◽  
Empirical Antibiotic Therapy ◽  
Gram Negative ◽  
Tertiary Care Medical Center ◽  
Gram Negative Bacteremia

Abstract Background Timely appropriate empirical antibiotic plays an important role in critically ill patients with gram-negative bacteremia. However, the relevant data and significant impacts have not been well studied in the neonatal intensive care unit (NICU).Methods An 8-year (1 January 2007-31 December 2014) cohort study of all NICU patients with gram-negative bacteremia in a tertiary-care medical center was performed. Inadequate empirical antibiotic therapy was defined when a patient didn’t receive any antimicrobial agent to which the causative microorganisms were susceptible within 24 hour of blood culture sampling.Results Among 376 episodes of Gram-negative bacteremia, 75 (19.9%) received inadequate empirical antibiotic therapy. The cause of inadequate treatment was mostly due to the pathogen resistant to prescribed antibiotics (88.0%), and Pseudomonas aeruginosa (Odds ratio [OR]: 20.8, P < 0.001) and ESBL-producing bacteria (OR: 18.4, P < 0.001) had the highest risk. Previous exposure with 3rd generation cephalosporin was identified as the only independent risk factor (OR: 2.52, 95% CI: 1.18-5.37, P = 0.018). Empirically inadequately treated bacteremias were significantly more likely to have worse outcomes than those with adequate therapy, including more prolonged illness, higher rate of infectious complications (25.3% versus 9.3%, P < 0.001) and overall mortality (22.7% versus 11.0%, P = 0.013).Conclusions Inadequate empirical antibiotic therapy occurs in one-fifth of Gram-negative bacteremias in the NICU, and is associated with worse outcomes. Further effort to decrease emergence of antibiotic resistance and highly suspicion of infection by drug-resistant bacteria clinically is important to reduce rates of inadequacy.

scholarly journals Microbial Predominance and Antimicrobial Resistance in a Tertiary Hospital in Northwest China: A Six-Year Retrospective Study of Outpatients and Patients Visiting the Emergency Department

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Caifeng Wang ◽  
Wen Li ◽  
Juanjuan Gao ◽  
Dancheng Zhang ◽  
Yali Li ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Antimicrobial Resistance ◽  
Northwest China ◽  
Tertiary Hospital ◽  
Diffusion Method ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Local Healthcare

Background. With the wide use of antibiotics, antimicrobial resistance becomes a serious issue. Timely understanding of microbial pathogen profiles and the change of antimicrobial resistance provide an important guidance for effective and optimized use of antibiotics in local healthcare systems. The aim was to investigate the characteristics of microbial species and their antimicrobial resistances in a tertiary hospital with an Emergency Department and outpatient clinics for a period of six years. Methodology. A retrospective study was conducted using the HIS database of a tertiary hospital between 2013 and 2018. Antimicrobial susceptibility was tested by automated systems and/or the Kirby–Bauer disc diffusion method. The data were analyzed using the WHONET 5.6 software. The Cochran-Armitage test was used to study the trends over the period of research. Results. In a total of 19,028 specimens submitted for microbial tests during the period from 49 units of the hospital, only the samples from the Emergency Department and Kidney Transplantation Clinic showed an annually significant increase ( P < 0.001 ). More than 200 species with 46.4% gram-positive cocci and 45.3% gram-negative bacilli were identified in the 3,849 nonrepetitive isolates. The methicillin-resistant S. aureus and S. epidermidis rates were 25.1% and 74.6%, respectively. 60.9% E. coli and 33.5% K. pneumonia samples carried extended-spectrum-β-lactamase. All Staphylococci and Enterococci samples were not resistant to linezolid, vancomycin, and tigecycline. In addition, only 0.01% E. coli, 1.1% K. pneumonia, and 18.7% P. aeruginosa isolates showed resistance to carbapenems. Conclusions. Vancomycin, linezolid and tigecycline were the most effective antibiotics for outpatients with gram-positive infection. Carbapenems were the most effective antibiotics for gram-negative infection. There was no significant annual increase of common multidrug resistances.

scholarly journals Microbial Predominance and Antimicrobial Resistance in a Tertiary Hospital: A Six-year Retrospective study from Outpatients and Patients Visiting the Emergency Department

2020 ◽  
Author(s):  
CaiFeng Wang ◽  
Wen Li ◽  
Juanjuan Gao ◽  
Dancheng Zhang ◽  
Yali Li ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Antimicrobial Resistance ◽  
Tertiary Hospital ◽  
Diffusion Method ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Antimicrobial Susceptibility Tests ◽  
Susceptibility Tests

Abstract Objective: To assessing the characteristics of of microbial species and the antimicrobial resistance in a Tertiary Hospital with 49 outpatient clinics and emergency department in Northwestern China, of six years. Methods: A retrospective study was conducted using HIS database of a tertiary hospital between the full-year period of 2013 and 2018. Antimicrobial susceptibility tests were conducted by automated systems and/or the Kary-Bauer disc diffusion method. Data were analyzed using the WHONET 5.6 software. The Cochran–Armitage test was used to study the trends over the period. Results: A total of 19,028 specimens were submitted for the laboratory tests of microbiology. Among 49 units, only Emergency Department and Kidney Transplantation Clinic with the number of submission showed a significant increase annually (P<0.001). A total of 3,849 non-repetitive isolates were identified, covering more than 200 species, of which gram-positive cocci accounted for 46.4% and gram-negative bacilli 45.3%. The methicillin-resistant rates of S. aureus and S. epidermidis were 25.1% and 74.6%, respectively. The isolates of 60.9% of E. coli and 33.5% of K. pneumonia contained extended spectrum β lactamases. Moreover, there were no Staphylococci and Enterococci resistant to linezolid, vancomycin and tigecycline. In addition, the percentages of E. coli, K. pneumonia and P. aeruginosa isolates resistant to carbapenems were low (0.0%, 1.1% and 18.7%, respectively). Conclusion: Vancomycin, linezolid and tigecycline are among the most effective treatment for outpatients with gram-positive infection. Carbapenems are among the most effective for gram-negative infection. There is no significant annual increase of common multidrug resistances.

scholarly journals Duration of Antibiotic Therapy in Neonatal Gram-negative Bacterial Sepsis—10 Days versus 14 Days

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Anurag Fursule ◽  
Anup Thakur ◽  
Pankaj Garg ◽  
Neelam Kler
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Sepsis ◽  
Gram Negative

scholarly journals Antimicrobial agents active against carbapenem-resistant Escherichia coli and Klebsiella pneumoniae isolates in Lebanon

2018 ◽  
Vol 12 (03) ◽  
pp. 164-170 ◽  
Author(s):  
George Farah Araj ◽  
Aline Z Avedissian ◽  
Lina Y Itani ◽  
Jowana A Obeid
Keyword(s):  
Escherichia Coli ◽  
Retrospective Study ◽  
Klebsiella Pneumoniae ◽  
Antimicrobial Agents ◽  
Medical Center ◽  
In Vitro Activity ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Promising Treatment

Introduction: It is not yet clear which antimicrobial agents should be used to treat the ominously increasing infections with carbapenem-resistant (CR) bacteria. We therefore investigated the activity of different antimicrobial agents against CR Escherichia coli and Klebsiella pneumoniae in Lebanon. Methodology: This retrospective study assessed the minimum inhibitory concentrations (MICs) of three carbapenems (by Etest), as well as the in vitro activity of eight other antimicrobials (by disk diffusion) against CR E. coli (n = 300) and K. pneumoniae (n = 232) isolates recovered at a major University Medical Center in Lebanon. Results: Higher percentages of isolates showing carbapenem MICs of ≤ 8 µg/mL were noted among the CR E. coli compared to the CR K. pneumoniae for ertapenem (48% vs 27%), imipenem (74 % vs 58%) and meropenem (82% vs 63%). Among the eight other antimicrobials, activity was generally higher when the MICs for the three carbapenems were ≤ 8 µg/mL. Regardless of the MIC level of the three carbapenems, very low susceptibility rates (≤ 33%) were noted for ciprofloxacin, trimethoprim-sulfamethoxazole and aztreonam against both E. coli and K. pneumoniae isolates. With Amikacin, higher susceptibility rates were seen against E. coli isolates (81%-97%) than against K. pneumoniae isolates (55%-86%), also reflecting higher activity than gentamicin (44%-54%). The best activity (66%-100%) was observed for tigecycline, colistin and fosfomycin against both CR species. Conclusions: Based on the in vitro findings in this study, the combination of a carbapenem showing an MIC of ≤ 8 µg/mL together with an active colistin, tigecycline, or fosfomycin, would offer a promising treatment option for patients infected with CR E. coli or K. pneumoniae.

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