The impact of ﬁrst Timing of antibiotics for community acquired pneumonia in emergency department

Eligibility Criteria ◽

Antibiotic Overuse ◽

Background and objective: For patients with community-acquired pneumonia (CAP), reported associations between timing of the first dose of antibiotics and short-term mortality are inconsistent. To reduce the risks of antibiotic overuse in the emergency department, this summary of the relevant literature identified patients with CAP who benefit most from early antibiotic administration. Methods: A PubMed and Google Scholar search was performed for articles concerning the epidemiology, prognosis, diagnosis, and preliminary management of CAP. Results: Duplicate studies were eliminated and 370 citations were screened. Finally, 16 studies met the eligibility criteria. The review found that, in the presence of sepsis, antibiotics should not be delayed but administered as soon as possible. For patients with moderate-to-severe symptoms, antibiotics should be administered if a diagnosis of CAP is highly likely. For stable, non-critically ill patients with CAP, the timing of antibiotics remains unclear, but available evidence does not indicate strict requirements. For best quality of care, antibiotic timing whether rapid or delayed depends on the clinical situation. Conclusions: In suspected cases of pneumonia presenting in the emergency department, starting antibiotics early solely to conform to dogmatic guidelines within a rigid timeframe has led to unnecessary antibiotic treatment of uninfected patients, while the outcomes of patients with pneumonia have not improved. Since severity of illness is the key factor associated with poor outcomes in pneumonia, the timing of initial antibiotic treatment should be guided by the severity of symptoms.

The Impact of First Timing of Antibiotics for Community Acquired Pneumonia in Emergency Department

10.20944/preprints202009.0067.v1 ◽

2020 ◽

Author(s):

Yiwu Zhou ◽

Casey M. Clements ◽

Man Li ◽

Yanqi He ◽

Rong Yao

Keyword(s):

Quality Care ◽

Severity Of Illness ◽

Antibiotic Overuse ◽

Improved Outcomes ◽

Clinical Scenarios ◽

Key Factor ◽

Short Term Mortality ◽

Poor Outcomes ◽

Background: The reported associations between time to first antibiotic dose after hospital arrival and short-term mortality have varied in prior studies of CAP. It is unclear the benefit of early antibiotics in all patients given the risks of antibiotic overuse and misdiagnosis; Methods: A PubMed and Google Scholar search was performed to identify articles detailing the epidemiology, prognosis, diagnosis, and preliminary management of CAP; Results: In sepsis, antibiotics should not be delayed, and should be administered as soon as possible after recognition. For moderate or severe CAP patients without sepsis, antibiotics should be administered as soon as the diagnosis of CAP is highly likely. For stable, non–critically ill patients with CAP, the timing of antibiotics is not as clear and available evidence does not recommend strict requirements. Antibiotic timing – both rapid and delayed could be used as indicators of quality care in differing clinical scenarios; Results: The dogma of starting antibiotics quickly, within a rigid timeframe of expectations and guidelines has not improved outcomes in pneumonia patients, and has led to an increase in antibiotic treatment in uninfected patients. Severity of illness is the key factor associated with poor outcomes and should more significantly guide the timing of antibiotic initiation.

Emergency Department Patients with Community Acquired Pneumonia: Effect of a Change in Pneumonia Definition by Centers for Medicare and Medicaid Services on Compliance with Guidelines for Time to Antibiotic Administration

Academic Emergency Medicine ◽

10.1197/j.aem.2007.03.850 ◽

2007 ◽

Vol 14 (5 Supplement 1) ◽

pp. S56-S56

Author(s):

B. Katz ◽

J. Burton ◽

C. Lin ◽

M. McErlean

Keyword(s):

Emergency Department ◽

Emergency Department Patients

Antibiotic Treatment Drives the Diversification of the Human Gut Resistome

10.1101/537670 ◽

2019 ◽

Cited By ~ 1

Author(s):

Jun Li ◽

Elizabeth A. Rettedal ◽

Eric van der Helm ◽

Mostafa Ellabaan ◽

Gianni Panagiotou ◽

...

Keyword(s):

Gut Microbiota ◽

Antibiotic Treatment ◽

Resistance Genes ◽

Community Dynamics ◽

Antibiotic Resistance Genes ◽

Strain Level ◽

Functional Study ◽

Bacterial Community Dynamics ◽

AbstractDespite the documented antibiotic-induced disruption of the gut microbiota, the impact of antibiotic intake on strain-level dynamics, evolution of resistance genes, and factors influencing resistance dissemination potential remains poorly understood. To address this gap we analyzed public metagenomic datasets from 24 antibiotic treated subjects and controls, combined with an in-depth prospective functional study with two subjects investigating the bacterial community dynamics based on cultivation-dependent and independent methods. We observed that short-term antibiotic treatment shifted and diversified the resistome composition, increased the average copy number of antibiotic resistance genes, and altered the dominant strain genotypes in an individual-specific manner. More than 30% of the resistance genes underwent strong differentiation at the single nucleotide level during antibiotic treatment. We found that the increased potential for horizontal gene transfer, due to antibiotic administration, was ∼3-fold stronger in the differentiated resistance genes than the non-differentiated ones. This study highlights how antibiotic treatment has individualized impacts on the resistome and strain level composition, and drives the adaptive evolution of the gut microbiota.

Effect on Time to Antibiotic Administration of a Comprehensive Program for Emergency Department Patients with Community Acquired Pneumonia

Academic Emergency Medicine ◽

10.1197/j.aem.2007.03.847 ◽

2007 ◽

Vol 14 (5 Supplement 1) ◽

pp. S55-S55

Author(s):

B. Katz ◽

J. Burton ◽

C. Lin ◽

M. McErlean

Keyword(s):

Emergency Department ◽

Comprehensive Program ◽

Emergency Department Patients

Influenza and Community-acquired Pneumonia Interactions: The Impact of Order and Time of Infection on Population Patterns

American Journal of Epidemiology ◽

10.1093/aje/kwr402 ◽

2012 ◽

Vol 175 (5) ◽

pp. 363-367 ◽

Cited By ~ 11

Author(s):

Brian M. Davis ◽

Allison E. Aiello ◽

Suzanne Dawid ◽

Pejman Rohani ◽

Sourya Shrestha ◽

...

Keyword(s):

Influenza A ◽

Animal Studies ◽

Severe Disease ◽

Severity Of Illness ◽

Population Level ◽

Swine Flu ◽

1918 Influenza ◽

AbstractDiscoveries made during the 1918 influenza A pandemic and reports of severe disease associated with coinfection during the 2009 hemagglutinin type 1 and neuraminidase type 1 (commonly known as H1N1 or swine flu) pandemic have renewed interest in the role of coinfection in disease pathogenesis. The authors assessed how various timings of coinfection with influenza virus and pneumonia-causing bacteria could affect the severity of illness at multiple levels of interaction, including the biologic and population levels. Animal studies most strongly support a single pathway of coinfection with influenza inoculation occurring approximately 7 days before inoculation with Streptococcus pneumoniae, but less-examined pathways of infection also may be important for human disease. The authors discussed the implications of each pathway for disease prevention and what they would expect to see at the population level if there were sufficient data available. Lastly, the authors identified crucial gaps in the study of timing of coinfection and proposed related research questions.

Dosing of Appropriate Antibiotics and Time to Administration of First Doses in the Pediatric Emergency Department

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-20.4.309 ◽

2015 ◽

Vol 20 (4) ◽

pp. 309-315

Author(s):

Abby M. Bailey ◽

Maria Stephan ◽

Kyle A. Weant ◽

Stephanie Baker Justice

Keyword(s):

Emergency Department ◽

Complex Disease ◽

Pediatric Emergency ◽

Turnover Time ◽

Disease States ◽

Complicated Skin ◽

Timely Fashion ◽

The Impact ◽

Selection Of

OBJECTIVES: Emergency department (ED) providers are faced with the challenge of diagnosing and treating patients in a timely fashion given many obstacles including limited patient information, complex disease states, and high patient turnover. Time delays in administration or selection of appropriate drug therapies have been associated with negative outcomes in severe infections. This study was conducted to assess the impact of an emergency medicine pharmacist (EPh) on the selection of appropriate antibiotics and the timeliness of administration in pediatric patients in the ED. METHODS: Patients younger than 18 years were evaluated who were admitted through the ED and received 1 dose of intravenous antibiotic for the following conditions: community-acquired pneumonia, complicated skin and soft tissue infection (SSTI), meningitis, and sepsis. To evaluate the impact of the presence of an EPh, patients with orders placed during the EPh's hours of 1 pm and 11 pm were compared to those with an order placed between 11 pm and 1 pm. RESULTS: A total of 142 patients were included in the study. Patients seen during EPh hours received an appropriate first antibiotic 93.4% of the time (p = 0.157) and second antibiotic 96.8% of the time (p = 0.023). Time from order to verification was significantly shorter for the first 2 antimicrobials in the EPh group (10.5 minutes [p = 0.003] and 11.4 minutes [p = 0.047], respectively). The days from discharge to return to readmission to the ED were also significantly different (17.5 days vs. 62.4 days, p = 0.008). CONCLUSIONS: The available data suggest that patients are more likely to receive appropriate doses of antimicrobials, and in a more timely fashion, whenever the EPh is present. Areas for future investigation include whether the presence of EPhs at the bedside has the potential to impact areas of patient care, including readmission rates, drug costs, and medication errors.

Comparison of different antibiotic treatment in children with community acquired pneumonia: a comparative study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20183863 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2083

Author(s):

Nasima Banu ◽

Vijay Kumar Sukhani

Keyword(s):

Emergency Department ◽

Comparative Study ◽

Antibiotic Treatment ◽

Antimicrobial Agents ◽

Study Groups ◽

First Line ◽

Group 2 ◽

Considerable Concern ◽

Group 1

Background: community acquired pneumonia also known as CAP refers to pneumonia contracted by a person with little contact with the healthcare system. Narrow spectrum antibiotics are generally considered to be the first line of treatment however there is considerable concern about the emerging resistance among the usual CAP pathogens to the most commonly used antimicrobial agents. The objective of this study was comparison of different antibiotic treatment in children with community-acquired pneumonia.Method: A total of 100 paediatric patients who were admitted to the Emergency Department of medical institution with suspicion of pneumonia were included in the study. All the patients will be divided broadly into two study groups with 50 patients in each group. Group 1 patients were given intravenous amoxiclav, while Group 2 received intravenous ceftriaxone.Results: In present study subjects from, Group 1 i.e. amoxclav group 42% had fever, i.e. 24% were suffering from tachypnea and only 4% suffered from tachycardia and abnormal was found in 20/50 patients. Whereas in Group 2 -60% were suffering from fever, 16/50 i.e. 32% has tacypnea, 3/50 i.e. 6% had tachycardia and 16/50 i.e. 32 had abnormal WBC. In present study abnormal WBC was found to be more in first group.Conclusions: Ceftriaxone and amoxiclav can be used successfully in treatment of CAP.

Canine model for investigating the impact of oral enrofloxacin on commensal coliforms and colonization with multidrug-resistant Escherichia coli

Journal of Medical Microbiology ◽

10.1099/jmm.0.05473-0 ◽

2004 ◽

Vol 53 (5) ◽

pp. 439-443 ◽

Cited By ~ 23

Author(s):

Darren J. Trott ◽

Lucio J. Filippich ◽

John C. Bensink ◽

Mary T. Downs ◽

Suzanne E. McKenzie ◽

...

Keyword(s):

Escherichia Coli ◽

Gastrointestinal Tract ◽

Antibiotic Treatment ◽

Canine Model ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Faecal Coliforms ◽

A model was developed in dogs to determine the impact of oral enrofloxacin administration on the indigenous coliform population in the gastrointestinal tract and subsequent disposition to colonization by a strain of multidrug-resistant Escherichia coli (MDREC). Dogs given a daily oral dose of 5 mg enrofloxacin kg−1 for 21 consecutive days showed a significant decline in faecal coliforms to levels below detectable limits by 72 h of administration. Subsequently, faecal coliforms remained suppressed throughout the period of enrofloxacin dosing. Upon termination of antibiotic administration, the number of excreted faecal coliforms slowly returned over an 8-day period, to levels comparable to those seen prior to antibiotic treatment. Enrofloxacin-treated dogs were more effectively colonized by MDREC, evidenced by a significantly increased count of MDREC in the faeces (7.1 ± 1.5 log10 g−1) compared with non-antibiotic-treated dogs (5.2 ± 1.2; P = 0.003). Furthermore, antibiotic treatment also sustained a significantly longer period of MDREC excretion in the faeces (26.8 ± 10.5 days) compared with animals not treated with enrofloxacin (8.5 ± 5.4 days; P = 0.0215). These results confirm the importance of sustained delivery of an antimicrobial agent to maintain and expand the colonization potential of drug-resistant bacteria in vivo, achieved in part by reducing the competing commensal coliforms in the gastrointestinal tract to below detectable levels in the faeces. Without in vivo antimicrobial selection pressure, commensal coliforms dominated the gastrointestinal tract at the expense of the MDREC population. Conceivably, the model developed could be used to test the efficacy of novel non-antibiotic strategies aimed at monitoring and controlling gastrointestinal colonization by multidrug-resistant members of the Enterobacteriaceae that cause nosocomial infections.