Antibiotic therapy in patients with surgical sepsis and pulmonary-broncho-pulmonary complications

In 152 patients with pulmonary-broncho-pleural complications (PBLS) developing against the background of surgical sepsis, rational antibiotic therapy was administered. Before laboratory microflora examination, 2 antibiotics were prescribed, and 3 antibiotics were prescribed for anaerobic sepsis, based on the clinical assumption of the pathogen type. Broad-spectrum antibiotics (claforan, amikacin, gentamicin, metronidazole, etc.) were used. After laboratory investigation, according to the bacteriogram data, targeted antibiotic therapy was switched to.

Pseudomonal breast infection

Annals of The Royal College of Surgeons of England ◽

10.1308/147870810x12659688851591 ◽

2010 ◽

Vol 92 (3) ◽

pp. e20-e22 ◽

Cited By ~ 4

Author(s):

DP Harji ◽

S Rastall ◽

C Catchpole ◽

R Bright-Thomas ◽

S Thrush

Keyword(s):

Septic Shock ◽

Pseudomonas Aeruginosa ◽

Antibiotic Therapy ◽

Broad Spectrum ◽

Abscess Formation ◽

Causative Organism ◽

Breast Infection ◽

Breast infection and breast sepsis secondary to Pseudomonas aeruginosa is uncommon. We report two cases of pseudomonal breast infection leading to septic shock and abscess formation in women with non-responding breast infection. The management of breast infection is broad-spectrum antibiotics and ultrasound with aspiration of any collection. To treat breast infection effectively, the causative organism must be isolated to enable appropriate antibiotic therapy.

Mycobacterium fortuitum abdominal wall abscesses following liposuction

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699229 ◽

2008 ◽

Vol 41 (01) ◽

pp. 58-61

Author(s):

Hussam Al Soub ◽

Eman Al-Maslamani ◽

Mona Al-Maslamani

Keyword(s):

Antibiotic Therapy ◽

Abdominal Wall ◽

Broad Spectrum ◽

Mycobacterium Fortuitum ◽

Surgical Drainage ◽

Abdominal Abscesses ◽

ABSTRACTwe describe here a case of abdominal abscesses due to mycobacterium fortuitum following liposuction. the abscesses developed three months after the procedure and diagnosis was delayed for five months. the clues for diagnosis were persistent pus discharge in spite of broad spectrum antibiotics and failure to grow any organisms on routine culture. this condition has been rarely reported; however, the increasing number of liposuction procedures done and awareness among physicians will probably result in the identification of more cases. combination antibiotic therapy with surgical drainage in more extensive diseases is essential for cure.

A Decision Tree Using Patient Characteristics to Predict Resistance to Commonly Used Broad-Spectrum Antibiotics in Children With Gram-Negative Bloodstream Infections

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piy137 ◽

2019 ◽

Vol 9 (2) ◽

pp. 142-149 ◽

Cited By ~ 2

Author(s):

Anna C Sick-Samuels ◽

Katherine E Goodman ◽

Glenn Rapsinski ◽

Elizabeth Colantouni ◽

Aaron M Milstone ◽

...

Keyword(s):

High Risk ◽

Decision Tree ◽

Antibiotic Therapy ◽

Broad Spectrum ◽

Tertiary Care ◽

Bloodstream Infections ◽

Intestinal Transplantation ◽

Empiric Antibiotic Therapy ◽

Gram Negative ◽

Abstract Background As rates of multidrug-resistant gram-negative infections rise, it is critical to recognize children at high risk of bloodstream infections with organisms resistant to commonly used empiric broad-spectrum antibiotics. The objective of the current study was to develop a user-friendly clinical decision aid to predict the risk of resistance to commonly prescribed broad-spectrum empiric antibiotics for children with gram-negative bloodstream infections. Methods This was a longitudinal retrospective cohort study of children with gram-negative bacteria cared for at a tertiary care pediatric hospital from June 2009 to June 2015. The primary outcome was a bloodstream infection due to bacteria resistant to broad-spectrum antibiotics (ie, cefepime, piperacillin-tazobactam, meropenem, or imipenem-cilastatin). Recursive partitioning was used to develop the decision tree. Results Of 689 episodes of gram-negative bloodstream infections included, 31% were resistant to broad-spectrum antibiotics. The decision tree stratified patients into high- or low-risk groups based on prior carbapenem treatment, a previous culture with a broad-spectrum antibiotic resistant gram-negative organism in the preceding 6 months, intestinal transplantation, age ≥3 years, and ≥7 prior episodes of gram-negative bloodstream infections. The sensitivity for classifying high-risk patients was 46%, and the specificity was 91%. Conclusion A decision tree offers a novel approach to individualize patients’ risk of gram-negative bloodstream infections resistant to broad-spectrum antibiotics, distinguishing children who may warrant even broader antibiotic therapy (eg, combination therapy, newer β-lactam agents) from those for whom standard empiric antibiotic therapy is appropriate. The constructed tree needs to be validated more widely before incorporation into clinical practice.

Rate of broad-spectrum antibiotic overuse in patients receiving outpatient parenteral antibiotic therapy (OPAT)

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.204 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Jessa R. Brenon ◽

Stephanie E. Shulder ◽

Sonal S. Munsiff ◽

Colleen M. Burgoyne ◽

Angela K. Nagel ◽

...

Keyword(s):

Antibiotic Therapy ◽

Broad Spectrum ◽

Broad Spectrum Antibiotic ◽

Parenteral Antibiotic ◽

Once Daily ◽

Antibiotic Overuse ◽

Outpatient Parenteral Antibiotic Therapy

Abstract Broad-spectrum antibiotics with once-daily dosing are often chosen for outpatient parenteral antibiotic therapy (OPAT) due to convenience even when narrower-spectrum antibiotics are appropriate. At our institution, up to 50% of select broad-spectrum OPAT regimens had potential to be narrowed, highlighting the need to re-evaluate regimens for de-escalation prior to discharge.

Multistep antimicrobial stewardship intervention on antibiotic prescriptions and treatment duration in children with pneumonia

PLoS ONE ◽

10.1371/journal.pone.0257993 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0257993

Author(s):

Sara Rossin ◽

Elisa Barbieri ◽

Anna Cantarutti ◽

Francesco Martinolli ◽

Carlo Giaquinto ◽

...

Keyword(s):

Antibiotic Therapy ◽

Broad Spectrum ◽

Antibiotic Stewardship ◽

Clinical Pathways ◽

Community Acquired Pneumonia ◽

Outpatient Group ◽

Before And After ◽

Tract Infections ◽

The Impact

Introduction The Italian antimicrobial prescription rate is one of the highest in Europe, and antibiotic resistance has become a serious problem with high costs and severe consequences, including prolonged illnesses, the increased period of hospitalization and mortality. Inadequate antibiotic prescriptions have been frequently reported, especially for lower respiratory tract infections (LRTI); many patients receive antibiotics for viral pneumonia or bronchiolitis or broad-spectrum antibiotics for not complicated community-acquired pneumonia. For this reason, healthcare organizations need to implement strategies to raise physicians’ awareness about this kind of drug and their overall effect on the population. The implementation of antibiotic stewardship programs and the use of Clinical Pathways (CPs) are excellent solutions because they have proven to be effective tools at diagnostic and therapeutic levels. Aims This study evaluates the impact of CPs implementation in a Pediatric Emergency Department (PED), analyzing antibiotic prescriptions before and after the publication in 2015 and 2019. The CP developed in 2019 represents an update of the previous one with the introduction of serum procalcitonin. The study aims to evaluate the antibiotic prescriptions in patients with community-acquired pneumonia (CAP) before and after both CPs (2015 and 2019). Methods The periods analyzed are seven semesters (one before CP-2015 called PRE period, five post CP-2015 called POST 1–5 and 1 post CP-2019 called POST6). The patients have been split into two groups: (i) children admitted to the Pediatric Acute Care Unit (INPATIENTS), and (ii) patients evaluated in the PED and sent back home (OUTPATIENTS). We have analyzed all descriptive diagnosis of CAP (the assessment of episodes with a descriptive diagnosis were conducted independently by two pediatricians) and CAP with ICD9 classification. All antibiotic prescriptions for pediatric patients with CAP were analyzed. Results A drastic reduction of broad-spectrum antibiotics prescription for inpatients has been noticed; from 100.0% in the PRE-period to 66.7% in POST1, and up to 38.5% in POST6. Simultaneously, an increase in amoxicillin use from 33.3% in the PRE-period to 76.1% in POST1 (p-value 0.078 and 0.018) has been seen. The outpatients’ group’s broad-spectrum antibiotics prescriptions decreased from 54.6% PRE to 17.4% in POST6. Both for outpatients and inpatients, there was a decrease of macrolides. The inpatient group’s antibiotic therapy duration decreased from 13.5 days (PRE-period) to 7.0 days in the POST6. Antibiotic therapy duration in the outpatient group decreased from 9.0 days (PRE) to 7.0 days (POST1), maintaining the same value in subsequent periods. Overlapping results were seen in the ICD9 group for both inpatients and outpatients. Conclusions This study shows that CPs are effective tools for an antibiotic stewardship program. Indeed, broad-spectrum antibiotics usage has dropped and amoxicillin prescriptions have increased after implementing the CAP CP-2015 and the 2019 update.

Infectious Esophagitis in Romanian Children: From Etiology and Risk Factors to Clinical Characteristics and Endoscopic Features

Journal of Clinical Medicine ◽

10.3390/jcm9040939 ◽

2020 ◽

Vol 9 (4) ◽

pp. 939

Author(s):

Mădălina Adriana Bordea ◽

Alexandru Pîrvan ◽

Dan Gheban ◽

Ciprian Silaghi ◽

Iulia Lupan ◽

...

Keyword(s):

Risk Factors ◽

Gastrointestinal Tract ◽

Antibiotic Therapy ◽

Broad Spectrum ◽

Clinical Characteristics ◽

Clinical Manifestations ◽

Post Mortem ◽

Appetite Loss ◽

Prolonged Antibiotic Therapy

Objectives. The aim of this study is to provide information about prevalence, etiology, risk factors, clinical characteristics and endoscopic features of various types of infectious esophagitis in children. Methods. We performed a total of 520 upper gastrointestinal tract endoscopies in Pediatric Clinic II, Emergency Hospital for Children, Cluj-Napoca. Indications for endoscopy in our cohort were gastrointestinal tract symptoms such as dysphagia, heartburn, or appetite loss. Results. The prevalence of infectious esophagitis in the study population was 2.11% (11 patients). Candida albicans (C. albicans) was the most frequent cause. Our data illustrates that herpes simplex virus (HSV)-induced esophagitis is common in immunocompromised patients and should be systematically suspected in cases of severe dysphagia, heartburn, or hematemesis. In the present study, all cytomegalovirus (CMV) esophagitis patients were immunocompromised. Immunodeficiency (81.8%) and prolonged antibiotic therapy with broad-spectrum antibiotics were by far the most important risk factors involved in the pathogenicity of the disease. Dysphagia, appetite loss, heartburn, epigastralgia, and hematemesis were the main clinical manifestations. Infectious esophagitis was associated with significant mortality. In four patients, endoscopy during life showed signs of infectious esophagitis; however, the precise etiology was only established post-mortem, in the pathological anatomy laboratory department. A risk factor involved in pathogenesis of post-mortem diagnosed infectious esophagitis is the DiGeorge syndrome for CMV and HSV patients. Conclusions. The study illustrates that infectious esophagitis should be considered in immunocompromised infants with prolonged antibiotic therapy with broad-spectrum antibiotics.

Pencegahan Kejadian Ventilator-Associated Pneumonia (VAP) dengan Kepatuhan Pelaksanaan Bundle: Literature Review

HOLISTIK JURNAL KESEHATAN ◽

10.33024/hjk.v14i3.2661 ◽

2020 ◽

Vol 14 (3) ◽

pp. 354-368

Author(s):

Solikin Solikin ◽

Matius Sakundarno Adi ◽

Septo Pawelas Arso

Keyword(s):

Literature Review ◽

Antibiotic Therapy ◽

Broad Spectrum ◽

Early Treatment ◽

Review Literature ◽

Ventilator Associated Pneumonia ◽

Increased Risk ◽

Detection And Diagnosis ◽

The Right

Prevention of Ventilator-Associated Pneumonia (VAP) Events with Compliance with Bundle Implementation: Literature Review Background: Patients who experience critical illness and use a mechanical ventilator in the ICU have an increased risk of experiencing ventilator associated pneumonia (VAP) which is a major cause of morbidity and mortality in the ICU and causes lengthening the length of stay and an increase in hospital costs.Purpose: To conduct a recent literature review with regard to VAP primarily related to causes, risk factors, pathogenesis, prevention, early detection and diagnosis, and administration of antibiotics to patients with VAP. At the end of this article conclusions will be presented that can be used by practitioners as a clinical guide.Method: The design used was literature review, articles were collected using a search engine, including (Clinicalkey) 27 articles, (Cochrane) 25 articles, (Medline) 17 articles and (Pubmed) 19 articles. From the predetermined article inclusion criteria, we found 7 articles out of 88 that were suitable for different interventionsResults: Prevention of VAP incidents in hospitals using multimodal interventions, one of which is the application of a VAP prevention bundle, can effectively reduce the incidence of VAP in hospitals. Examination of the lower respiratory tract culture should be carried out for all patients before administering antibiotic therapy provided that it should not delay giving antibiotic therapy to critical patients. Early treatment of broad-spectrum antibiotics with the right dosage can maximize the efficacy of antibiotics and the outcome of VAP patients in the ICU. Antibiotic combinations must be used wisely to treat VAP because certain pathogens increase the life expectancy of patients with severe infections especially those with septic shock. Negative culture results can also be used to stop antibiotic therapy in patients undergoing culture without antibiotic changes within the last 72 hours. The health team must consider the need for antibiotic de-escalation based on the culture results and the clinical response of the patient.Conclusion: VAP prevention bundles that implement multimodal interventions effectively reduce the incidence of VAP in hospitals. An examination of airway culture must be carried out for all patients before administering antibiotic therapy. Early treatment of broad-spectrum antibiotics can maximize the efficacy of antibiotics and the outcome of VAP patients in the ICU.Keywords: VAP; ICU; Patients; Morbidity; Mortality; BundlePendahuluan: Pasien yang mengalami penyakit kritis dan menggunakan ventilator mekanik di ICU mempunyai peningkatan resiko untuk mengalami ventilator associated pneumonia (VAP) yang merupakan penyebab utama morbiditas dan mortalitas di ICU serta menyebabkan pemanjangan lenght of stay dan peningkatan biaya rumah sakit.Tujuan: Untuk melakukan review literature terkini sehubungan dengan VAP terutama terkait dengan penyebab, faktor resiko, pathogenesis, pencegahan, deteksi dini dan diagnosis, serta pemberian antibiotik pada pasien dengan VAP. Di ahir artikel ini akan disampaikan kesimpulan yang dapat digunakan praktisi sebagai panduan di klinis.Metode: Desain yang digunakan adalah literature review, artikel dikumpulkan menggunakan mesin pencarian antara lain (Clinicalkey) 27 artikel, (Cochrane) 25 artikel, (Medline) 17 artikel dan (Pubmed) 19 artikel. Dari kriteria inklusi artikel yang telah ditentukan, ditemukan 7 artikel dari 88 yang sesuai dengan intervensi yang berbeda.Hasil: Pencegahan kejadian VAP di rumah sakit menggunakan intervensi multimodal, yang mana salah satunya berupa penerapan bundle pencegahan VAP, dapat dengan efektif menurunkan kejadian VAP di rumah sakit. Pemeriksasan kultur saluran nafas bawah perlu dilakukan kepada semua pasien sebelum pemberian terapi antibiotik dengan catatan tidak boleh menunda pemberian terapi antibiotik pada pasien kritis. Terapi dini antibiotik spektum luas dengan dosis yang tepat dapat memaksimalkan kemanjuran antibiotik dan luaran pasien VAP di ICU. Kombinasi antibiotik harus digunakan dengan bijaksana untuk mengobati VAP karena pathogen tertentu untuk meningkatkan harapan hidup pasien dengan infeksi berat terutama yang mengalami shok sepsis. Hasil kultur yang negatif juga dapat digunakan untuk menghentikan terapi antibiotik pada pasien yang dilakukan kultur tanpa perubahan antibiotik dalam 72 jam terahir. Tim kesehatan harus mempertimbangkan perlunya deeskalasi antibiotik berdasarkan hasil kultur dan respon klinik pasien.Simpulan: Bundle pencegahan VAP yang menerapkan intervensi multimodal efektif menurunkan kejadian VAP di rumah sakit. Pemeriksasan kultur saluran nafas harus dilakukan kepada semua pasien sebelum pemberian terapi antibiotik. Terapi dini antibiotik spektum luas dapat memaksimalkan kemanjuran antibiotik dan luaran pasien VAP di ICU.