Intervention to Discontinue Parenteral Antimicrobial Therapy in Hospitalized Patients with Urinary Tract Infection, Skin and Soft Tissue Infection, or No Evident Infection

1993 ◽  
Vol 14 (9) ◽  
pp. 517-522 ◽  
Author(s):  
N. Joel Ehrenkranz ◽  
Debra E. Nerenberg ◽  
Kenneth C. Slater ◽  
James M. Shultz
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Soft Tissue ◽  
Tract Infection ◽  
Soft Tissue Infection ◽  
Antimicrobial Therapy ◽  
Hospitalized Patients ◽  
Tissue Infection

Antibiotic overuse after discharge from medical short-stay units

2021 ◽  
pp. 1-4
Author(s):  
Nathaniel S. Soper ◽  
Abhinav J. Appukutty ◽  
David Paje ◽  
Lindsay A. Petty ◽  
Scott A. Flanders ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Soft Tissue ◽  
Tract Infection ◽  
Soft Tissue Infection ◽  
Tissue Infection ◽  
Short Stay ◽  
Antibiotic Overuse

Abstract Of 100 patients discharged from short-stay units (SSUs) with antibiotics, 47 had a skin and soft-tissue infection, 22 had pneumonia, and 21 had a urinary tract infection. Among all discharge antibiotic prescriptions, 78% involved antibiotic overuse, most commonly excess duration (54 of 100) and guideline discordant selection (44 of 100).

Intervention to Discontinue Parenteral Antimicrobial Therapy in Hospitalized Patients with Urinary Tract Infection, Skin and Soft Tissue Infection, or No Evident Infection

1993 ◽  
Vol 14 (9) ◽  
pp. 517-522 ◽  
Author(s):  
N. Joel Ehrenkranz ◽  
Debra E. Nerenberg ◽  
Kenneth C. Slater ◽  
James M. Shultz
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Soft Tissue ◽  
Tract Infection ◽  
Adverse Events ◽  
Soft Tissue Infection ◽  
Hospital Length ◽  
Tissue Infection ◽  
Hospital Length Of Stay ◽  
Continuous Use

AbstractObjectives:In a previous study, we found that unsolicited recommendations to physicians of medically stable patients with pneumonia to suspend parenteral antimicrobials shortened hospital length of stay (LOS) significantly. In this study, we made similar recommendations to physicians treating patients with different indications for parenteral antimicrobials, to examine the effect on LOS.Methods:A nurse-interventionist presented randomly assigned physicians with nonconfrontational suggestions to discontinue parenteral antimicrobials by substituting comparable oral antimicrobials or stopping treatment. Patients were being treated for urinary tract infection, skin infection, or no evident infection. Blinded observers evaluated in-hospital and 30-day postdischarge patient courses. Methodologies were identical to the previous study.Results:There were 70 physician-patient episodes (49 intervened episodes, 21 control episodes). In 44 episodes (90%), compliant physicians discontinued parenteral antimicrobials. Compared to a median postrandomization LOS of 2.5 days (range, 0 to 40.5) for 21 patients of control physicians, the corresponding LOS for 44 patients of compliant physicians was two days (range, 0 to 8; P= 1.0), and for five patients of noncompliant physicians, five days (range, 3 to 11; P= 0.04).The combined occurrence of all adverse events detected in this and the previous study was 11% for patients of control physicians, compared to 14% for patients of compliant physicians (P= 0.2), and 19% for patients of noncompliant physicians (P<0.05).Conclusions:For patients of compliant physicians hospitalized with urinary tract infection, skin and soft tissue infection, or no evident infection, cessation of parenteral antimicrobials did not significantly shorten LOS, due to brief LOS of patients of control physicians. Patients of noncompliant physicians experienced more adverse events and prolonged LOS. The appropriateness of routine continuous use of parenteral antimicrobials in medically stable inpatients is questioned.

scholarly journals Infections caused by Klebsiella ozaenae: a changing disease spectrum

1978 ◽  
Vol 8 (4) ◽  
pp. 413-418
Author(s):  
E J Goldstein ◽  
R P Lewis ◽  
W J Martin ◽  
P H Edelstein
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Soft Tissue ◽  
Tract Infection ◽  
Mixed Culture ◽  
Soft Tissue Infection ◽  
Atrophic Rhinitis ◽  
Nasal Discharge ◽  
Disease Spectrum ◽  
Time Period

A total of 64 isolates of Klebsiella ozaenae were recovered from 36 patients during a 40-month period. Over 7,500 isolates of K. pneumoniae were isolated during the same time period. Before this decade, K. ozaenae was considered to be only a colonizer of the nasopharynx or a putative cause of ozena (atrophic rhinitis). K. ozaenae was recovered most frequently from sputum in mixed culture but was associated with infection in 12 patients (2 with bacteremia, 3 with urinary tract infection, 1 with soft tissue infection, and 6 with mucopurulent nasal discharge). The spectrum of disease caused by this organism is more extensive than has been appreciated previously.

scholarly journals Clinical impact of multidrug-resistant bacteria in older hospitalized patients with community-acquired urinary tract infection

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Manuel Madrazo ◽  
Ana Esparcia ◽  
Ian López-Cruz ◽  
Juan Alberola ◽  
Laura Piles ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract Infection ◽  
Nursing Home ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Therapy ◽  
Multidrug Resistant ◽  
Clinical Impact ◽  
Hospitalized Patients ◽  
Independent Risk Factors

Abstract Introduction Previous studies have described some risk factors for multidrug-resistant (MDR) bacteria in urinary tract infection (UTI). However, the clinical impact of MDR bacteria on older hospitalized patients with community-acquired UTI has not been broadly analyzed. We conducted a study in older adults with community-acquired UTI in order to identify risk factors for MDR bacteria and to know their clinical impact. Methods Cohort prospective observational study of patients of 65 years or older, consecutively admitted to a university hospital, diagnosed with community-acquired UTI. We compared epidemiological and clinical variables and outcomes, from UTI due to MDR and non-MDR bacteria. Independent risk factors for MDR bacteria were analyzed using logistic regression. Results 348 patients were included, 41.4% of them with UTI due to MDR bacteria. Median age was 81 years. Hospital mortality was 8.6%, with no difference between the MDR and non-MDR bacteria groups. Median length of stay was 5 [4–8] days, with a longer stay in the MDR group (6 [4–8] vs. 5 [4–7] days, p = 0.029). Inadequate empirical antimicrobial therapy (IEAT) was 23.3%, with statistically significant differences between groups (33.3% vs. 16.2%, p < 0.001). Healthcare-associated UTI variables, in particular previous antimicrobial therapy and residence in a nursing home, were found to be independent risk factors for MDR bacteria. Conclusions The clinical impact of MDR bacteria was moderate. MDR bacteria cases had higher IEAT and longer hospital stay, although mortality was not higher. Previous antimicrobial therapy and residence in a nursing home were independent risk factors for MDR bacteria.

Ultrasonography in the Radiologic Evaluation of Children With Urinary Tract Infection

PEDIATRICS ◽  
1986 ◽  
Vol 78 (1) ◽  
pp. 58-64 ◽  
Author(s):  
Uri Alon ◽  
Menucha Pery ◽  
Giora Davidai ◽  
Moshe Berant
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Hospitalized Patients ◽  
Voiding Cystourethrography ◽  
Urinary System ◽  
Intravenous Pyelography ◽  
Early Screening ◽  
Radiologic Evaluation ◽  
Radiologic Workup

A prospective blind study comparing the findings of ultrasonography, intravenous pyelography, and voiding cystourethrography was conducted on 81 patients to examine the place of ultrasonography in the initial radiologic evaluation of children with urinary tract infection. The patients' mean age was 4.8 years; 15 were male. Forty-eight were inpatients (mean age, 3.2 years) and 33 were outpatients (mean age, 7.2 years). In 29 patients (35.8%) abnormality of the urinary system was detected by one or more of the three imaging procedures; 21 were inpatients and eight were outpatients. The most frequent finding was vesicoureteral reflux, occurring in 62.1% of the pathologic cases. The findings at ultrasonography correlated well with those of intravenous pyelography in 73 of the 81 studies (90.1%), but they failed to demonstrate double collecting systems and several of the minor changes. However, ultrasonography in combination with cystourethrography identified all patients who had abnormal urinary systems, except for two children with negligible findings. Moreover, ultrasonography and cystourethrography together identified all 11 patients, nine of them inpatients, in whom surgical treatment was indicated. It is concluded that ultrasonography can successfully replace intravenous pyelography as a screening imaging procedure for the urinary system, but because of the superiority of intravenous pyelography in the detection of some types of lesions, intravenous pyelography will be required whenever ultrasonography or cystourethrography results are abnormal. Accordingly, and in view of the differences in the frequency and severity of pathologic findings between outpatients and hospitalized patients, the following protocol is suggested for the radiologic evaluation of children with urinary tract infection: For outpatients, cystourethrography can be performed 4 to 6 weeks after cessation of antibiotic therapy. If the study is normal, ultrasonography can be done; if this is also normal, no further radiologic workup is needed. Only when cystourethrography or ultrasonography findings are abnormal is intravenous pyelography also indicated. For hospitalized patients, especially young children, ultrasonography can be used as the early screening procedure, within two to four days after the diagnosis of urinary tract infection. If the results are normal, cystourethrography can follow after 4 to 6 weeks; if abnormal, cystourethrography can be performed after ten to 14 days. Here, too, intravenous pyelography is needed only when ultrasonography and/or cystourethrography results are abnormal.

Sign in / Sign up

Export Citation Format

Share Document