Inapropriate Use of Antibiotics Effective Against Gram Positive Microorganism in Under Restrictive Antibiotic Policies in ICU; A Prospective Observational Study

Abstract Background Gram-positive spectrum antibiotics such as vancomycin, teicoplanin, daptomycin ,and linezolid are frequently used in empirical treatment combinations in critically ill patients Although they are included in the national antibiotic restriction program, thought to be inappropriate, unnecessary and suboptimal use is high due to their widespread use. In our study, in addition to their widespread use, gram-positive spectrum antibiotics were evaluated due to their use in more limited and clear clinical indications. This study aims to determine the frequency of inappropriate uses of gram-positive spectrum antibiotics and risk factors for inappropriate use according to different quality parameters. Methods This clinical study was conducted prospectively between 01.10.2018 and 01.10.2019 in the medical and surgical ICUs of Gazi University Faculty of Medicine Hospital with a total bed capacity of 55. Patients older than 18 years of age onset of gram-positive spectrum antibiotics (vancomycin, teicoplanin, linezolid ,and daptomycin) were included. Patients under the age of eighteen or immunosuppressed (neutropenic, HIV-infected patients with hematologic or solid organ malignancies) were not included in the study. The demographic and clinical features of the patients were recorded. The treatment was also evaluated and recorded by 2 infectious diseases specialists and 2 clinical pharmacists except for the clinical staff at 24-hour intervals from the first day to the last day of treatment. SPSS software for Windows, version 17 (IBM, Armonk, NY) was used to analyze the data. Categorical variables are presented as number and percentage, and non-categorical variables are presented as mean ± standard deviation. Results In the use of antibiotics, the incidence of non-compliance with at least one of the determined quality parameters was 83%. Multivariate analysis was performed to evaluate risk factors for inappropriate antibiotic use, and creatine values were found to increase the risk of inappropriate antibiotic use. Conclusions In spite of the restricted antibiotic program, inappropriate antibiotic use in ICUs is quite common. In particular, it is necessary to establish local guidelines in collaboration with different disciplines for the determination and follow-up of de-escalation and optimal treatment doses

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Inapropriate Use of Antibiotics Effective Against Gram Positive Microorganism in Under Restrictive Antibiotic Policies in ICU; A Prospective Observational Study

10.21203/rs.2.21842/v1 ◽

2020 ◽

Author(s):

Hasan Selçuk Özger ◽

Dolunay Merve Fakıoğlu ◽

Kübra Erbay ◽

ASLINUR ALBAYRAK ◽

Kenan Hızel

Keyword(s):

Risk Factors ◽

Antibiotic Use ◽

Quality Parameters ◽

Categorical Variables ◽

Solid Organ ◽

Gram Positive ◽

Inappropriate Use ◽

Positive Spectrum ◽

Surgical Icus ◽

Bed Capacity

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Inapropriate Use of Antibiotics Effective Against Gram Positive Microorganisms Despite Restrictive Antibiotic Policies in ICUs: A Prospective Observational Study

10.21203/rs.2.21842/v3 ◽

2020 ◽

Author(s):

Hasan Selçuk Özger ◽

Dolunay Merve Fakıoğlu ◽

Kübra Erbay ◽

ASLINUR ALBAYRAK ◽

Kenan Hızel

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Evaluation Criteria ◽

Antibiotic Use ◽

Quality Parameters ◽

Categorical Variables ◽

Solid Organ ◽

Gram Positive ◽

Positive Spectrum ◽

Immunosuppressed Patients

Abstract Background: Gram-positive spectrum antibiotics such as vancomycin, teicoplanin, daptomycin, and linezolid are frequently used in empirical treatment combinations in critically ill patients. Such inappropriate and unnecessary widespread use, leads to sub-optimal utilisation. However they are covered by the antibiotics restriction programme. This prospective observational study, evaluates gram-positive anti-bacterial utilisations in intensive care units (ICUs) with various evaluation criteria, to determine the frequency of inappropriate usage and the intervention targets required to ensure optimum use. Methods: This clinical study was conducted prospectively between 01.10.2018 and 01.10.2019 in the medical and surgical ICUs of Gazi University Faculty of Medicine Hospital, Turkey. The total bed capacity was 55. Patients older than 18 years and who were prescribed gram-positive spectrum antibiotics (vancomycin, teicoplanin, linezolid, and daptomycin) were included. Patients under this age or immunosuppressed patients (neutropenic,- HIV-infected patients with hematologic or solid organ malignancies) were not included in the study. During the study period, 200 treatments were evaluated in 169 patients. The demographic and clinical features of the patients were recorded. Besides observations by the clinical staff, the treatments were recorded and evaluated by two infectious diseases specialists and two clinical pharmacists at 24-h intervals from the first day to the last day of treatment. SPSS software for Windows, (version 17, IBM, Armonk, NY) was used to analyse the data. Categorical variables were presented as number and percentage, and non-categorical variables were presented as mean ± standard deviation. Results: It was found that inappropriate gram-positive antibiotic use in ICUs was as high as 83% in terms of non-compliance with the selected quality parameters. Multivariate analysis was performed to evaluate the factors associated with inappropriate antibiotic use, increased creatinine levels were found to increase the risk of such use. Conclusions: In spite of the restricted antibiotics programme, inappropriate antibiotic use in ICUs is quite common. Thus, it is necessary to establish local guidelines in collaboration with different disciplines for the determination and follow-up of de-escalation of such use and optimal treatment doses. Keywords: Antibiotic stewardship, rational antibiotic use, antibiotic resistance, gram positive microorganisms, inappropriate antibiotic use

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Risk factors and outcomes for multidrug-resistant Gram-negative bacilli bacteremia

Therapeutic Advances in Infectious Disease ◽

10.1177/2049936117727497 ◽

2017 ◽

Vol 5 (1) ◽

pp. 11-18 ◽

Cited By ~ 5

Author(s):

Swati Patolia ◽

Getahun Abate ◽

Nirav Patel ◽

Setu Patolia ◽

Sharon Frey

Keyword(s):

Risk Factors ◽

Urinary Catheter ◽

Medical Center ◽

Demographic Data ◽

Significant Risk ◽

Antibiotic Use ◽

Multidrug Resistant ◽

Solid Organ ◽

Gram Negative ◽

Source Of Infection

Background: The incidence of multidrug-resistant (MDR) organisms is increasing along with mortality. Identifying risk factors for the development of MDR Gram-negative bacilli (GNB) bacteremia could greatly impact patient care and management. Methods: Data from the electronic health record of patients with GNB over 13-month period were collected at a single university medical center. Baseline demographic data, risk factor, microbiological data, recurrence of bacteremia, and mortality were recorded. Results: A total of 177 patients were included in the analysis. MDR GNB occurred in 46 patients (26%). The mortality rate in the MDR group was 34.8% compared to 13.7% in non-MDR group ( p = 0.002). In multivariate analysis, diabetes mellitus [DM; odds ratio (OR): 2.8, 95% confidence interval (CI): 1–4.88], previous antibiotic use (OR: 2.93, 95% CI: 1.25–6.87), and urinary catheter as a source of infection (OR 5.96, 95% CI: 1.78–19.94) were significant risk factors for the development of MDR GNB. In addition, end-stage liver disease (OR: 3.64, 95% CI: 1.07–12.3), solid organ malignancy (OR: 3.64, 95% CI: 1.25–10.56), intra-abdominal source of infection (OR: 3.66, 95% CI: 1.14–11.73), inappropriate empiric antibiotics (OR 7.59, 95% CI: 1.68–34.34) and urinary catheter as a source of infection (OR 5.68, 95% CI: 1.37–23.5) were significant factors for mortality in patients with MDR GNB. Conclusion: Our study provides important information about the risk factors for the development of MDR GNB bacteremia and helps prognosticate patient with MDR GNB.

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90. Incidence and Risk Factors for Inappropriate Use of Non-culture Based Fungal Assays: Implication for Diagnostic Stewardship

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.400 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S176-S176

Author(s):

Hiroshi Ito ◽

Koh Okamoto ◽

Marie Yamashita ◽

Shinya Yamamoto ◽

Yoshiaki Kanno ◽

...

Keyword(s):

Risk Factors ◽

Fungal Infections ◽

Multivariate Logistic Regression Analysis ◽

Solid Organ ◽

Hematopoietic Stem ◽

Factors Associated ◽

Inappropriate Use ◽

Transplant Patients ◽

Galactomannan Antigen ◽

Low Sensitivity

Abstract Background Culture-based diagnostic tests are the gold standard for diagnosing invasive fungal diseases (IFDs). Because these tests have low sensitivity, non-culture-based fungal assays (NCBFAs) have been used increasingly to help diagnose IFDs. However, little is known about inappropriate use of NCBFAs. We aimed to investigate inappropriate use of NCBFAs in a tertiary academic hospital in Tokyo, Japan. Methods This retrospective cohort study included all patients who underwent testing with beta-D glucan (BDG) between January and March 2018, or galactomannan antigen (GMA) or cryptococcal antigen (CRAG) between January and June 2018. Patients who had received hematopoietic stem cell or solid organ transplantations were excluded. Appropriateness was assessed according to the previously published study. We compared patients with appropriate and inappropriate use of NCBFAs. Risk factors for inappropriate use were evaluated using multivariate logistic regression analysis. Results Of 1,140 patients (BDG, 1,009; GMA 273; CRAG, 310) who underwent tests, 470 patients (BDG, 394; GMA, 138; CRAG, 164) were included in this study. Four hundred thirty-eight patients (93.2%) were aged 18 or older. About 80% of NCBFAs (BDG, 334 patients [74.8%]; GMA, 117 patients [74.8%]; CRAG, 146 patients [89.0%]) were deemed inappropriate. The factors associated with inappropriate NCBFAs use included specialties of ordering physicians, risk factors for fungal infections, and recommendation from infectious disease physicians (Table). Sixty-four patients (13.6%) underwent three inappropriate NCBFAs simultaneously. Furthermore, during the study period, 408 patients (35.8%) with inappropriate NCBFAs underwent the same assays repeatedly during the study period; 643 times for BDG, 163 times for GMA, and 192 times for CRAG. The Factors Associated with Inappropriate Use of Non-Culture Based Fungal Assays Conclusion We found a large proportion of NCBFAs were deemed inappropriate and it was mostly driven by ordering physicians who generally care for transplant patients. Because inappropriate use of NCBFAs could lead to additional inappropriate tests and treatment with substantial costs to patients and health systems, diagnostic stewardship targeting NCBFAs is urgently needed. Disclosures All Authors: No reported disclosures

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Clinical and epidemiological differences and risk factors for death among solid organ transplant recipients with Gram-positive and Gram-negative bloodstream infections

Safety in Health ◽

10.1186/s40886-015-0007-0 ◽

2015 ◽

Vol 1 (1) ◽

Author(s):

Thiago Zinsly Sampaio Camargo ◽

M. Silva Jr ◽

A. R. Marra ◽

L. F. A. Camargo

Keyword(s):

Risk Factors ◽

Organ Transplant ◽

Bloodstream Infections ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Recipients ◽

Gram Positive ◽

Gram Negative ◽

Organ Transplant Recipients ◽

Solid Organ Transplant Recipients

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Mortality and Risk Factors for Bacteremia in Patients with Cutaneous T-Cell Lymphoma (CTCL) at Emory University

Blood ◽

10.1182/blood-2019-131626 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4043-4043

Author(s):

Pamela Allen ◽

Esther Kim ◽

Amy Ayers ◽

Mary Jo Lechowicz

Keyword(s):

Risk Factors ◽

Systemic Therapy ◽

Early Stage ◽

Antibiotic Use ◽

Outpatient Setting ◽

Prophylactic Antibiotics ◽

Cutaneous Lymphoma ◽

Categorical Variables ◽

Advanced Stage ◽

Emory University

Introduction: Patients (pts) with CTCL have disruption in their skin barrier and are at increased risk for cutaneous infections. In particular, staphylococcal infections are common in pts with CTCL and are associated with pathogenesis of the lymphoma. Previous studies have identified extra-cutaneous involvement of lymphoma as the most important independent risk factor for recurrent skin infection, bacteremia, and death from infection. However, the risk of mortality with bacteremia and risk factors for developing bacteremia in CTCL have not been fully elucidated. We aimed to explore risk factors for bacteremia and subsequent mortality in pts with CTCL at Emory University. Methods: We conducted a single center retrospective analysis at the Winship Cancer Institute of Emory University analyzing CTCL pts from 01/01/1990 - 06/01/2019. We selected pts from an existing cutaneous lymphoma database and separated them by presence or absence of bacteremia at any point following diagnosis. Bacteremia was defined as identification of at least one microbe in the bloodstream on culture. The primary objective was to assess 90-day mortality among pts with CTCL with bacteremia. Secondary objectives included assessing patterns of care in bacteremic pts, identifying risk factors for bacteremia incidence and for poor outcomes following bacteremia (defined as a composite outcome of intensive care unit stay, mortality at 90 days, or re-current hospitalization within 90 days). Additionally, we explored patterns of oral antibiotic use in the outpatient setting and their association with bacteremia incidence and outcomes. Prophylactic skin antibiotics were defined in the notes as "prophylactic" i.e. not being used to treat active cellulitis or other infections. Categorical variables were analyzed with chi-squared tests. Results: 184 of 549 pts identified from our cutaneous lymphoma database were included in our analysis. Patients were excluded for lack of follow up or missing data. The median age was 57. Most pts had mycosis fungoides (n=137), followed by Sézary syndrome (n=20), CTCL, NOS (n=12), and CD30+ variants (n=6). 85 pts were early stage, and 87 were advanced stage (stage 2B n=41; 3 n=16; 4 n= 30) at diagnosis. 37 of 184 pts (20.1%) developed bacteremia. 95 pts used intermittent skin prophylactic antibiotics in the outpatient setting, 84 did not, and 5 were unknown. A total of 101 bacteremic episodes were noted (range of 1-10 per pt). The most common organisms were Staphylococcus species (sp) (MRSA n=21, MSSA n=10, other staph n=10). Other organisms included Corynebacterium sp., Enterococcus sp., Acinetobacter sp., Pseudomonas sp., and Escherichia-coli. Polymicrobial bacteremias were noted in 23 pts (28.8%). 42 (40%) had concurrent positive skin/wound . 69 pts (86.3%) were taking oral at the time of bacteremia. 71 pts were hospitalized for bacteremia (88.8%), and 41 pts (51.3%) had a recurrent admission within 90 days of discharge. 45 pts (56.3%) had invasive lines prior to bacteremia, and 44 of these had them removed following bacteremia. 71 (88.8%) cases were treated with appropriate antibiotic coverage. 56 pts were receiving active disease therapy at the time of bacteremia (70%), including 33 who were receiving systemic therapy. Intermittent prophylactic antibiotic use was highly associated with development of bacteremia (p < 0.001, table 1), as was advanced stage (12.8% early stage patients developed bacteremia compared to 29.9% of advanced stage, p=0.005). Prior systemic therapy, and in particular chemotherapy was associated with increased incidence of bacteremia (31 of 106 (29.2%) patients treated with chemotherapy developed bacteremia, p=0.0003) Extra-cutaneous disease was not associated with bacteremia in our analysis. The 90-day mortality among CTCL pts developing bacteremia was 11.25%. Conclusions This is the largest study assessing outcomes and risk factors for bacteremia in CTCL in the modern era. We confirmed that bacteremia is associated with high rates of re-admission, recurrent infection, and 90-day mortality, and identified advanced stage and use of chemotherapy as risk factors associated with bacteremia. The positive association of prophylactic antibiotics with bacteremia likely represents increased prescribing of skin prophylaxis among those at higher risk for bacteremia. Uni-variate, multivariate, and survival analyses will be updated at the time of the presentation. Disclosures Lechowicz: Kyowa: Consultancy.

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Risk Factors for Incisional Hernia Recurrence and Surgical Site Infection in Solid Organ Transplant Population - Single Center Experience

10.29011/2575-9760.001344 ◽

2020 ◽

Keyword(s):

Risk Factors ◽

Incisional Hernia ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Hernia Recurrence ◽

Solid Organ ◽

Site Infection ◽

Single Center ◽

Single Center Experience ◽

Incisional Hernia Recurrence

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Mortality and Conversion Rate to Below Knee or Above Knee Amputation Following Transmetatarsal Amputation

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00112 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0011

Author(s):

D. Anthony Barcel ◽

Susan M. Odum ◽

Taylor Rowe ◽

Jefferson B. Sabatini ◽

Samuel E. Ford ◽

...

Keyword(s):

Risk Factors ◽

Conversion Rate ◽

Significant Risk ◽

High Rate ◽

Administrative Database ◽

Categorical Variables ◽

Diabetic Patients ◽

Knee Amputation ◽

History Of ◽

Transmetatarsal Amputation

Category: Midfoot/Forefoot; Diabetes; Other Introduction/Purpose: Non-traumatic lower extremity amputations (LEA), especially those performed in dysvascular and diabetic patients, are known to have poor long-term prognosis. Perioperative mortality has been reported at between 4 and 10%, and the 1 and 5 year mortality rates range between 22-33% and 39-69%, respectively. While poor outcomes in these patients have been described, there is no consensus as to the predictors of mortality. The purpose of the study is to determine the percentage of patients who had a complication following transmetatarsal amputation (TMA) and identify associated risk factors for complications and mortality. Methods: We queried our institution’s administrative database to identify 247 TMA procedures performed in 229 patients between January, 2002 and December, 2016. Electronic health records were reviewed to document complications defined as reoperation, amputation and mortality. Mortality was also verified using the National Death Index. Additionally, we recorded risk factors including diabetes, A1c level, end stage renal disease (ESRD), cardiovascular disease (CVD), peripheral vascular disease (PVD), history of revascularization, contralateral amputation, and neuropathy. The majority of the study patients were males (157, 69%) and the average age was 57 years (range 24-91). The median BMI was 28 (range 16-58) and 29% of the study patients were obese with a BMI ≥ 30. Fishers Exact tests were used to compare categorical variables. Kruskal-Wallis and Independent T-tests were used to compare numeric data. All data were analyzed using SAS/STAT software version 9.4 (Carey, NC) and a 0.05 level of significance was defined apriori. Results: The conversion rate to below (BKA) or above knee amputation (AKA) was 26% (64 of 247). Males (p=.0274), diabetics (p=.0139), patients in ESRD (p=.019), and patients with a history of CVD (p=.0247) or perioperative revascularization (p=.022) were more likely to undergo further amputation following an index TMA. BMI was significantly higher in patients requiring BKA/AKA (p=.0305). There were no significant differences in age (p=.2723) or A1c levels (p=.4219). The overall mortality rate was 35% (84 of 229). Diabetes (p=.0272), ESRD (p=.0031), history of CVD (p<.0001) or PVD (p=.0179) were all significantly associated with mortality. Patients who died were significantly older (p=.0006) and had significantly higher A1c levels (p=.0373). BMI was not significantly associated with mortality. Twenty-two patients who had 23 further amputations subsequently died. Conclusion: In our series of patients undergoing TMA, 26% underwent further amputation and 35% of patients died. Conversion rate to BKA or AKA occurred at a high rate regardless of preoperative revascularization or the use of tendo-achilles or gastrocnemius lengthening procedures. Male sex, diabetes, ESRD, history of CVD or revascularization are significant risk factors for further amputation. ESRD, diabetes, history of CVD or PVD, older age and higher A1c levels are significant risk factors for mortality. These data provide useful insight into risk factors to be emphasized when counseling patients and their families to establish realistic postoperative expectations.

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Educational Video Improves Knowledge about Outpatients’ Usage of Antibiotics in Two Public Hospitals in Indonesia

Antibiotics ◽

10.3390/antibiotics10050606 ◽

2021 ◽

Vol 10 (5) ◽

pp. 606

Author(s):

Fauna Herawati ◽

Rika Yulia ◽

Bustanul Arifin ◽

Ikhwan Frasetyo ◽

Setiasih ◽

...

Keyword(s):

Antibiotic Resistance ◽

General Hospital ◽

Sampling Technique ◽

Knowledge Score ◽

Antibiotic Use ◽

Public Hospitals ◽

Educational Video ◽

Inappropriate Use ◽

Quasi Experimental ◽

The Difference

The inappropriate use or misuse of antibiotics, particularly by outpatients, increases antibiotic resistance. A lack of public knowledge about “Responsible use of antibiotics” and “How to obtain antibiotics” is a major cause of this. This study aimed to assess the effectiveness of an educational video about antibiotics and antibiotic use to increase outpatients’ knowledge shown in two public hospitals in East Java, Indonesia. A quasi-experimental research setting was used with a one-group pre-test—post-test design, carried out from November 2018 to January 2019. The study population consisted of outpatients to whom antibiotics were prescribed. Participants were selected using a purposive sampling technique; 98 outpatients at MZ General Hospital in the S regency and 96 at SG General Hospital in the L regency were included. A questionnaire was used to measure the respondents’ knowledge, and consisted of five domains, i.e., the definition of infections and antibiotics, obtaining the antibiotics, directions for use, storage instructions, and antibiotic resistance. The knowledge test score was the total score of the Guttman scale (a dichotomous “yes” or “no” answer). To determine the significance of the difference in knowledge before and after providing the educational video and in the knowledge score between hospitals, the (paired) Student’s t-test was applied. The educational videos significantly improved outpatients’ knowledge, which increased by 41% in MZ General Hospital, and by 42% in SG General Hospital. It was concluded that an educational video provides a useful method to improve the knowledge of the outpatients regarding antibiotics.

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947. Stroke demographics and risk factor profile in HIV infected individuals in Florida

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1133 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S506-S506

Author(s):

Folusakin Ayoade ◽

Dushyantha Jayaweera

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Clinical Research ◽

Stroke Risk ◽

Research Network ◽

Categorical Variables ◽

People Living With Hiv ◽

Risk Factor Profile ◽

Stroke Risk Factors ◽

Living With Hiv

Abstract Background The risk of ischemic stroke (IS) is known to be higher in people living with HIV (PLWH) than uninfected controls. However, information about the demographics and risk factors for hemorrhagic stroke (HS) in PLWH is scant. Specifically, very little is known about the differences in the stroke risk factors between HS and IS in PLWH. The goal of this study was to determine the demographics and risk factor differences between HS and IS in PLWH. Methods We retrospectively analyzed the demographic and clinical data of PLWH in OneFlorida (1FL) Clinical Research Consortium from October 2015 to December 2018. 1FL is a large statewide clinical research network and database which contains health information of over 15 million patients, 1240 clinical practices, and 22 hospitals. We compared HS and IS based on documented ICD 9 and 10 diagnostic codes and extracted information about sociodemographic data, traditional stroke risk factors, Charlson comorbidity scores, habits, HIV factors, diagnostic modalities and medications. Statistical significance was determined using 2-sample T-test for continuous variables and adjusted Pearson chi square for categorical variables. Odds ratio (OR) and 95% confidence intervals (CI) between groups were compared. Results Overall, from 1FL sample of 13986 people living with HIV, 574 subjects had strokes during the study period. The rate of any stroke was 18.2/1000 person-years (PYRS). The rate of IS was 10.8/1000 PYRS while the rate of HS was 3.7/1000 PYRS, corresponding to 25.4% HS of all strokes in the study. Table 1 summarizes the pertinent demographic and risk factors for HS and IS in PLWH in the study. Table 1: Summary of pertinent demographic and risk factors for hemorrhagic and ischemic strokes in people living with HIV from One Florida database Conclusion In this large Floridian health database, demographics and risk factor profile differs between HS and IS in PLWH. Younger age group is associated with HS than IS. However, hypertension, hyperlipidemia and coronary artery disease are more likely to contribute to IS than HS in PLWH. Further research is needed to better understand the interplay between known and yet unidentified risk factors that may be contributing to HS and IS in PLWH. Disclosures All Authors: No reported disclosures

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