Estimation of efficiency of empirical antibiotic therapy of catheter-associated infection in a urological hospital

2020 ◽  
Vol 10 (2) ◽  
pp. 157-162
Author(s):  
Andrey V. Kuzmenko ◽  
Timur A. Gyaurgiev ◽  
Alexander E. Halchenko ◽  
Yaroslav M. Vorkel
Keyword(s):  
Antibiotic Therapy ◽  
High Frequency ◽  
Empirical Therapy ◽  
Empirical Antibiotic Therapy ◽  
Bacteriological Examination ◽  
Case Histories ◽  
Antibacterial Drugs ◽  
Tract Infections ◽  
Klebsiella Spp ◽  
Clinical Emergency

An analysis of case histories of 119 patients who underwent treatment in the urology department of the Voronezh City Clinical Emergency Hospital No. 10 was performed. All patients were drained with a urethral catheter, a bacteriological examination of the urine was performed, and empirical antibiotic therapy was prescribed. Microflora growth was detected in the urine of 30 (25.2%) patients, most often revealed Klebsiella spp. and Enterococcus faecalis. A high frequency of resistance of uropathogens to antibacterial drugs prescribed as empirical therapy was noted. 66% were resistant to ceftriaxone, and 70% of the isolated microorganism strains to ciprofloxacin. Significantly lower resistance was noted for amikacin and doxycycline. To increase the effectiveness of empirical antibiotic therapy in patients with catheter-associated urinary tract infections, it is necessary to select antibacterial drugs based on the results of monitoring the sensitivity of hospital strains, followed by treatment correction in accordance with the results of urine bacteriological studies.

scholarly journals Prolonged empirical antibiotic therapy is correlated with bloodstream infections and increased mortality in a tertiary care hospital in Ethiopia: bacteriology testing matters

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Makeda Semret ◽  
Workeabeba Abebe ◽  
Ling Yuan Kong ◽  
Tinsae Alemayehu ◽  
Temesgen Beyene ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Tertiary Care ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
Care Hospital ◽  
Empirical Antibiotic Therapy ◽  
Middle Income ◽  
Risk Of Death ◽  
Days Of Therapy

Abstract Background Hospital-associated infection (HAI) and antimicrobial resistance (AMR) are major health threats in low- and middle-income countries (LMICs). Because diagnostic capacity is lacking throughout most of Africa, patients are commonly managed with prolonged empirical antibiotic therapy. Our goal was to assess mortality in relation to HAI and empirical therapy in Ethiopia’s largest referral hospital. Methods Cohort study of patients with suspected HAI at Tikur Anbessa Specialized Hospital from October 2016 to October 2018. Blood culture testing was performed on an automated platform. Primary outcomes were proportion of patients with bloodstream infection (BSI), antibiotic resistance patterns and 14 day mortality. We also assessed days of therapy (DOT) pre- and post-blood culture testing. Results Of 978 enrolled patients, 777 had blood culture testing; 237 (30%) had a BSI. Enterobacteriaceae were isolated in 49%; 81% of these were cephalosporin resistant and 23% were also carbapenem resistant. Mortality at 14 days was 31% and 21% in those with and without BSI, respectively. Ceftriaxone resistance was strongly correlated with mortality. Patients with BSI had longer DOT pre-blood culture testing compared with those without BSI (median DOT 12 versus 3 days, respectively, P < 0.0001). After testing, DOT were comparable between the two groups (20 versus 18 days, respectively). Conclusions BSI are frequent and fatal among patients with suspected HAI in Ethiopia. Highly resistant blood isolates are alarmingly common. This study provides evidence that investing in systematic blood culture testing in LMICs identifies patients at highest risk of death and that empirical management is frequently inappropriate. Major investments in laboratory development are critical to achieve better outcomes.

scholarly journals Optimization of starting empirical antibacterial therapy in patients with HIV infection – specialized hospital patients

2019 ◽  
Vol 11 (2) ◽  
pp. 97-106
Author(s):  
S. I. Dvorak ◽  
D. A. Gusev ◽  
T. N. Suborova ◽  
N. G. Zakharova ◽  
N. V. Sizova ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Antibiotic Therapy ◽  
Antibacterial Therapy ◽  
Empirical Therapy ◽  
Risk Groups ◽  
Infectious Complications ◽  
Empirical Antibiotic Therapy ◽  
Multiresistant Pathogens ◽  
Specialized Hospital ◽  
Empirical Antibacterial Therapy

Objective: to analyze the adequacy of the scheme of empirical antibiotic therapy in patients with complicated forms of HIV infection in a specialized hospital and propose a set of measures for its optimization.Materials and methods: Clinical and demographic characteristics, results of bacteriological studies, risk factors of infection with resistant and multiresistant pathogens were studied in patients with HIV infection at the stage of progression with infectious complications of bacterial etiology, and the adequacy of empirical antibiotic therapy was evaluated. Results: The analysis of bacterial infectious complications in 21 HIV-infected patients with advanced stages of the disease was carried out. It was established that the profiles of the starting ABT only in 47% of cases coincide with the results of the antibiogram. To increase the effectiveness of empirical antibacterial therapy, stratification of risk groups for the detection of multiresistant bacterial pathogens has been developed. The basis of stratification: the severity of immunodeficiency, the presence of previously conducted antibacterial therapy, the period and place of detection of infectious complications, the localization of the infectious process.Conclusion: the use in clinical practice of a differentiated approach to the appointment of antibacterial drugs for starting empirical therapy in patients with HIV infection can improve the quality of treatment of infectious complications in patients with immunosuppression.

Empirical antibiotic therapy of complicated skin and soft tissue infections in dermatological practice

2011 ◽  
Vol 152 (7) ◽  
pp. 252-258
Author(s):  
Andrea Magyar ◽  
Edina Garaczi ◽  
Edit Hajdú ◽  
Lajos Kemény
Keyword(s):  
Soft Tissue ◽  
Antibiotic Therapy ◽  
Streptococcus Pyogenes ◽  
Anaerobic Bacteria ◽  
Empirical Therapy ◽  
Soft Tissue Infections ◽  
Empirical Antibiotic Therapy ◽  
Gram Negative ◽  
First Choice ◽  
Complicated Skin

Erysipelas is an acute bacterial infection of the skin predominantly caused by Streptococcus pyogenes. According to the international classification complicated erysipelas belongs to the complicated skin and soft tissue infections. Complicated infections are defined as severe skin involvement or when the infection occurs in compromised hosts. These infections frequently involve Gram-negative bacilli and anaerobic bacteria. Aims: The aim of this study was to compare the efficacy of the empirical antibiotic therapy for the patients who were admitted to the Department of Dermatology and Allergology, University of Szeged. Methods: The empirical therapy was started according to a previously determined protocol. The data of 158 patients with complicated skin and soft tissue infections were analyzed and the microbiology culture specimens and the isolates were also examined. Results and conclusions: The results show that penicillin is the first choice for the treatment of erysipelas. However, the complicated skin and soft tissue infections require broad-spectrum antibiotics. Orv. Hetil., 2011, 152, 252–258.

scholarly journals Changes in Bacterial Resistance Patterns of Pediatric Urinary Tract Infections and Rationale for Empirical Antibiotic Therapy

2017 ◽  
Vol 34 (5) ◽  
pp. 432-435 ◽  
Author(s):  
İbrahim Gökçe ◽  
Neslihan Çiçek ◽  
Serçin Güven ◽  
Ülger Altuntaş ◽  
Neşe Bıyıklı ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Urinary Tract Infections ◽  
Bacterial Resistance ◽  
Empirical Antibiotic Therapy ◽  
Resistance Patterns ◽  
Tract Infections

A PROSPECTIVE STUDY OF THE IMPACT OF MICROBIOLOGICAL CULTURES ON ANTIBIOTIC PRESCRIBING PATTERN IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 26-29
Author(s):  
PARTH VACHHANI ◽  
ANIL SINGH
Keyword(s):  
Antibiotic Therapy ◽  
Hospital Stay ◽  
Antibiotic Prescribing ◽  
Microbiological Analysis ◽  
Empirical Antibiotic Therapy ◽  
Prescribing Pattern ◽  
Duration Of Hospital Stay ◽  
Microbiological Culture ◽  
Tract Infections ◽  
The Impact

Objective: Antibiotics are frequently prescribed because of clinical suspicion of infection, while the results of the microbiological analysis are still awaited. This study was undertaken to assess the impact of microbiological culture results on the antibiotic prescribing pattern. Methods: This prospective observational study was conducted on 400 patients of either sex and any age with positive microbiological culture results. Empirical antibiotic therapy details were recorded and change in empirical antibiotic therapy after positive culture results was also recorded. Assessment of sensitivity resistance pattern of microorganisms was also performed. Results: In the study, male: female ratio was 1.01:1. The majority of patients i.e. 94 (24.50%) were in the 46 y to 60 y of age group. Definitive antibiotic therapy was initiated in 103 patients (25.75%) out of 400 patients. The highest number of changes in antibiotic therapy was done in urinary tract infections (63.95%) and septicemia (32.61%) cases. Klebsiella (34.25%), E. coli (32%) and Staphylococcus aureus (14.75%) were commonly isolated microorganisms. Cephalosporins (77.75%) and aminoglycosides (47%) were commonly used in empirical antibiotic therapy, while nitrofurantoin (47.57%) and penicillins (22.33%) were commonly used in definitive antibiotic therapy. Definitive antibiotic therapy was associated with a reduced duration of hospital stay as compared to empirical antibiotic therapy (p<0.0001). Conclusion: Antibiotic prescribing is infrequently influenced by microbiological culture results. Adjustment of the antimicrobial therapy according to microbiological culture results can decrease the duration of hospital stay as well as can decrease the spread of antimicrobial resistance.

EVALUATION OF THE EFFECTIVENESS OF EMPIRICAL ANTIBIOTIC THERAPY IN PATIENS WITH CHRONIC CALCULOUS PYELONEPHRITIS

2020 ◽  
pp. 111-115
Author(s):  
Андрей Владимирович Кузьменко ◽  
Владимир Васильевич Кузьменко ◽  
Тимур Асланбекович Гяургиев ◽  
Иван Иванович Баранников
Keyword(s):  
Urine Culture ◽  
Antibiotic Sensitivity ◽  
Empirical Therapy ◽  
Bacteriological Examination ◽  
Antibacterial Drugs ◽  
Wide Availability ◽  
The Moment ◽  
Almost All ◽  
Near Future

На сегодняшний день проблема возросшей антибиотикорезистентности патогенных микроорганизмов существенно возросла и является одной из самых обсуждаемых в научном сообществе. Это связано с частобесконтрольным назначением антибиотиков врачами, а такжеширокой доступностью практически всех видов существующих антибактериальных препаратов для пациентов, что дает им возможность самостоятельно приобрести и принимать их, без соответствующего контроля специалиста.На настоящий момент на фармацевтическом рынке отсутствуют существенно новые антибактериальные препараты с принципиально новым механизмом действия и появления их в ближайшем будущем не предвидится. В связи с тем, что пациенты, имеющие заболевания вызванные микроорганизмами нуждаются в назначении антибиотиков с первого дня начала болезни, а бактериальный посев мочи с определением чувствительности микроорганизмов к антибактериальным препаратам занимает от 3 до 7 дней, проблема эмпирической терапии становится ещё более актуальной. Постоянно меняющийся спектр антибиотикочувствительности микроорганизмов обуславливает необходимость постоянного его мониторинга и регулярной оценки эффективности проводимой эмпирической терапии. Целью данной работы стало изучение соответствия чувствительности микроорганизмов, выявляемых при бактериологическом исследовании мочи у больных уролитиазом, осложненным пиелонефритом, антибиотикам, назначаемым пациентам в качестве эмпирической терапии To date, the problem of increased antibiotic resistance of pathogens has increased significantly and is one of the most discussed in the scientific community. This is due to the often uncontrolled prescribing of antibiotics by doctors, as well as the wide availability of almost all types of existing antibacterial drugs for patients, which gives them the opportunity to independently purchase and take them, without the appropriate supervision of a specialist. At the moment, there are no significantly new antibacterial drugs with a fundamentally new mechanism of action on the pharmaceutical market, and their appearance is not expected in the near future. Due to the fact that patients with diseases caused by microorganisms need to prescribe antibiotics from the first day of the onset of the disease, and bacterial urine culture with the determination of the sensitivity of microorganisms to antibacterial drugs takes from 3 to 7 days, the problem of empirical therapy becomes even more urgent. The constantly changing spectrum of antibiotic sensitivity of microorganisms requires constant monitoring and regular evaluation of the effectiveness of empirical therapy. The aim of this work was to study the compliance of the sensitivity of microorganisms detected during bacteriological examination of urine in patients with urolithiasis complicated by pyelonephritis with antibiotics prescribed to patients as an empirical therapy

Empirical Antimicrobial Therapy for Bloodstream Infection Due to Methicillin-Resistant Staphylococcus aureus: No Better than a Coin Toss

2009 ◽  
Vol 30 (11) ◽  
pp. 1057-1061 ◽  
Author(s):  
Carrie A. Herzke ◽  
Luke F. Chen ◽  
Deverick J. Anderson ◽  
Yong Choi ◽  
Daniel J. Sexton ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Central Venous Catheter ◽  
Antibiotic Therapy ◽  
Empirical Therapy ◽  
Venous Catheter ◽  
Empirical Antibiotic Therapy ◽  
Central Venous ◽  
Factors Associated ◽  
Mrsa Infection ◽  
Appropriate Therapy

Background.Despite the high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection in the hospital, the proportion of patients with MRSA bacteremia who receive appropriate empirical therapy remains suboptimal.Objective.To investigate the proportion of patients with MRSA bloodstream infection (BSI) who received appropriate empirical antibiotic therapy and to identify risk factors associated with receipt of appropriate empirical therapy.Methods.We studied a cohort of patients from 10 hospitals. The primary outcome was the proportion of patients who received appropriate empirical antibiotic therapy for MRSA BSI. Appropriate therapy was defined as receipt of daptomycin, linezolid, quinupristin-dalfopristin, or vancomycin within 1 calendar day after the first blood culture result positive for S. aureus (ie, before antimicrobial susceptibilities were known). Multivariable logistic regression was used to determine variables associated with receipt of appropriate empirical therapy.Results.The study included 562 patients with MRSA BSI. The mean (± standard deviation) age of the patients was 64 ± 16 years, and 288 (51.2%) were male. Only 291 (51.8%) patients received appropriate empirical therapy. Patients were more likely to receive appropriate therapy if they required hemodialysis (odds ratio [OR], 1.36 [95% confidence interval {CI}, 1.00–1.85]), had undergone knee or hip arthroplasty (OR, 3.04 [95% CI, 1.21–7.6]), had a central venous catheter at admission (OR, 1.72 [95% CI, 1.01–2.93]), or had a McCabe score of 1 at admission (OR, 1.83 [95% CI, 1.16–2.83]). Bowel incontinence (OR, 0.41 [95% CI, 0.19–0.92]) and BSIs categorized as primary (OR, 0.41 [95% CI, 0.27–0.63]) were associated with a decreased likelihood of receiving appropriate empirical therapy.Conclusions.Only half of patients with MRSA BSI received appropriate empirical therapy. Factors associated with receiving appropriate empirical antibiotics included the presence of a central venous catheter at admission and a history of joint arthroplasty. Surprisingly, prior MRSA infection was not predictive of receipt of appropriate antimicrobial therapy.

scholarly journals Antibiotic resistance – a new challenge of modern urology

2020 ◽  
Vol 13 (5) ◽  
pp. 113-119
Author(s):  
S.V. Kotov ◽  
◽  
S.A. Pulbere ◽  
S.V. Belomyttsev ◽  
R.A. Perov ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Therapy ◽  
Bacterial Resistance ◽  
Diffusion Method ◽  
Klebsiella Pneumonia ◽  
Disk Diffusion Method ◽  
Antibacterial Drugs ◽  
Clinical Hospital ◽  
Resistant Strains ◽  
Tract Infections

Introduction. Analyze of the incidence and resistance to antibacterial drugs to microorganisms isolated in urine cultures of patients with urinary tract infections (UTI) from 2012 to 2019. Materials and methods. In the clinic of urology clinical hospital № 1 named after N.I. Pirogov and in the city clinical hospital № 29 named after N.E. Bauman was analyzed the results of 6083 urine cultures in 5027 patients. The traditional standardized inoculation was carried out with a 10 μl loop on the following nutrient media: agar with the addition of 5% sheep blood (Pronadisa, Spain), Levin agar (Pronadisa, Spain), Biggie agar (BD, USA), followed by incubation at 37°C for 18-24 hours. Next, a visual colony count was performed. The sensitivity of the isolated microorganisms to antibiotics was evaluated using a Phoenix bacteriological analyzer (BD, USA) and a disk diffusion method production discs (BD, USA). ESBL producers and carbapenemases were evaluated using a Phoenix bacteriological analyzer (BD, USA) using the double disc method, by the method of inactivation of carbapenems. Results. A high level of resistance among Enterococcus faecalis strains to fluoroquinolones (> 20%) and aminoglycosides (> 35%) was revealed. Among the strains of Escherichia coli, an increase in resistance to the antibacterial group of penicillins (> 80%) was noted, at the same time, an increase in resistance to drugs of the cephalosporins group (> 60%), fluoroquinolones (> 50%) was observed. The appearance of carbapenem-resistant strains is noted. Among the strains of Klebsiella pneumonia, high resistance to fluoroquinolones (> 50%) and cephalosporins (> 45%) was found. A sharp increase in resistance to all used antibacterial drugs is noted. Separately, increase in resistance to carbapenems (27,1%) can be noted. Discussion. According to the results of our study, it can be argued that the most common causative agents of complicated UTI in 2019 were representatives of the Enterococcaceae and Enterobacteriaceaes, there is an increase in the number of strains resistant to certain groups of antibacterial drugs. When comparing the results obtained with the data of the Internet platform «Map of antibiotic resistance. AMR map» shows comparable data on the occurrence and resistance of microorganisms. Of particular concern is the high frequency of bacterial resistance to drugs of the fluoroquinolone group and, therefore, these drugs cannot be used as empirical therapy for patients with complicated UTI. Conclusions. Adhering to the strategy of rational antibiotic therapy, further studying of the problem of antibiotic resistance, identification of resistant strains, monitoring of the of antibacterial drugs prescription at the outpatient stage and in the hospital are necessary. It is necessary to study the epidemiological data and the results of susceptibility to antibiotics in a particular region, this will help us to more accurately select antibiotic therapy and introduce accelerated laboratory diagnosis of bacteria resistance markers into practice.

scholarly journals Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia

2015 ◽  
Vol 53 (200) ◽  
pp. 240-243
Author(s):  
Santosh Dahal ◽  
Basista Prasad Rijal ◽  
Karbir Nath Yogi ◽  
Jeevan Bahadur Sherchand ◽  
Keshab Parajuli ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Early Onset ◽  
Late Onset ◽  
Empirical Therapy ◽  
Antibiotic Use ◽  
Empirical Antibiotic Therapy ◽  
Hospital Acquired Pneumonia ◽  
Empirical Antibiotics ◽  
Microsoft Office ◽  
Hospital Acquired

Introduction: Inadequate empirical antibiotic therapy for HAP is a common phenomena and one of the indicators of the poor stewardship. This study intended to analyze the efficacy of empirical antibiotics in the light of microbiological data in HAP cases. Methods: Suspected cases of HAP were followed for clinico-bacterial evidence, antimicrobial resistance and pre and post culture antibiotic use. The study was taken from February,2014 to July, 2014 in department of Microbiology and department of Respiratory medicine prospectively. Data was analyzed by Microsoft Office Excel 2007. Results: Out of 758 cases investigated, 77(10 %) cases were HAP, 65(84%) of them were culture positive and 48(74 %) were late in onset. In early onset cases, isolates were Acinetobacter 10(42%), Escherichia coli 5(21%), S.aureus 4(17%), Klebsiella 1(4%) and Pseudomonas 1(4%). From the late onset cases Acinetobacter 15(28%), Klebsiella 17(32%) and Pseudomonas 13(24%) were isolated. All Acinetobacter, 78% Klebsiella and 36% Pseudomonas isolates were multi drug resistant. Empirical therapies were inadequate in 12(70%) of early onset cases and 44(92%) of late onset type. Cephalosporins were used in 7(41%) of early onset infections but found to be adequate only in 2(12%) cases. Polymyxins were avoided empirically but after cultures were used in 9(19%) cases. Conclusions: Empirical antibiotics were vastly inadequate, more frequently so in late onset infections. Use of cephalosporins empirically in early onset infections and avoiding empirical use of polymyxin antibiotics in late onset infections contributed largely to the findings. Inadequate empirical regimen is a real time feedback for a practitioner to update his knowledge on the local microbiological trends. Keywords: empirical therapy; hospital acquired pneumonia.

scholarly journals Extended Spectrum β-Lactamases among Gram-negative bacteria from an Egyptian pediatric hospital: a two-year experience

2007 ◽  
Vol 1 (03) ◽  
pp. 269-274 ◽  
Author(s):  
Maysaa El Sayed Zaki
Keyword(s):  
Antibiotic Therapy ◽  
Burkholderia Cepacia ◽  
Empirical Therapy ◽  
Empirical Antibiotic Therapy ◽  
Pediatric Hospital ◽  
Klebsiella Species ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Extended Spectrum ◽  
Resistant Strains

Background Knowledge of the anti-microbial susceptibility pattern of common pathogens in a given area helps to inform the choice of empirical antibiotic therapy. The aim of this study was to determine the existence and to describe the characteristics of extended spectrum β-lactamase (ESBLs) in a pediatric hospital in Mansoura University, Egypt, to aid in the choice of empirical antibiotic therapy. Method: Between January 2005 and December 2006, blood samples were collected from children suspected to have nosocomial infections in a pediatric hospital in Mansoura. The gram negative isolates were identified, tested for antimicrobial susceptibility and analyzed for presence of ESBL. Results: A total of 1,600 children with suspected septicemia were studied. Gram negative septicemia was identified in 816 cases (45%). The commonest isolated gram negative bacilli was Klebsiella species (38.2%) followed by Enterobacter species (32.4), Serratia species (16.2%) and Burkholderia cepacia (10.3%). The highest susceptibility was for imipenem (74.3%) followed by gentamicin (70.8%), cefoperazone (64.5%) and cefotaxime (63.2%). The highest resistant rate was for cefazolin and ampicillin/sulbactam (75.5% for each), followed by cefuroxime 70.3% and ceftriaxone (63.5%). The ESBL was found in 44.5% for cefotaxime and 50% for ceftazidime by double discs method. Conclusion: This study highlights the emergence of antibiotic resistant gram negative bacilli in a pediatric hospital with special emphasis on extended β-lactamase resistant strains. Our results show that the most appropriate antibiotics to be used for empirical therapy are amikacin and gentamicin.

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