Efficacy of Piperacillin-tazobactam as Empirical Antimicrobial Therapy for VAP Among ESBL-E Carriers.

2020 ◽  
Author(s):  
Keyword(s):  
Antimicrobial Therapy ◽  
Empirical Antimicrobial Therapy

Comparison of Unit-Specific and Hospital-Wide Antibiograms Potential Implications for Selection of Empirical Antimicrobial Therapy

2006 ◽  
Vol 27 (7) ◽  
pp. 682-687 ◽  
Author(s):  
Shawn Binkley ◽  
Neil O. Fishman ◽  
Lori A. LaRosa ◽  
Ann Marie Marr ◽  
Irving Nachamkin ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Medical Center ◽  
Tertiary Care ◽  
General Medicine ◽  
Bacterial Isolates ◽  
Anatomic Site ◽  
Empirical Antimicrobial Therapy ◽  
Tertiary Care Medical Center ◽  
Surgical Icu ◽  
Selection Of

Objective.To identify differences between unit-specific and hospital-wide antibiograms and to determine the potential impact of these differences on selection of empirical antimicrobial therapy.Setting.A 625-bed tertiary care medical center.Methods.Antimicrobial susceptibility results were collected for all inpatient clinical bacterial isolates recovered over a 3-year period; isolates were categorized by the hospital location of the patient at the time of sampling and by the anatomic site from which the isolate was recovered. Antibiograms from each unit were compiled for the most commonly isolated organisms and were compared to the hospital-wide antibiogram.Results.A total of 9,970 bacterial isolates were evaluated in this study, including 2,646 enterococcal isolates, 2,806 S. aureus isolates, 2,795 E. coli isolates, and 1,723 Pseudomonas aeruginosa isolates. The percentages of bacterial isolates resistant to antimicrobials were significantly higher in the medical ICU and surgical ICU than the hospital-wide antibiogram would have predicted, whereas the percentages of isolates susceptible to antimicrobials were significantly higher in the non-ICU units, compared with the hospital overall. However, on general medicine units, the prevalence of susceptibility to levofloxacin was significantly lower than that for the hospital overall.Conclusions.Unit-specific antibiograms are important for making informed decisions about empirical antimicrobial therapy, because the hospital-wide antibiogram may mask important differences in susceptibility rates across different units. These differences may have important implications for selecting the optimal empirical antimicrobial therapy.

scholarly journals Empirical antimicrobial therapy for late-onset sepsis in a neonatal unit with high prevalence of coagulase-negative Staphylococcus

2016 ◽  
Vol 92 (5) ◽  
pp. 472-478 ◽  
Author(s):  
Roberta Maia de Castro Romanelli ◽  
Lêni Márcia Anchieta ◽  
Ana Carolina Bueno e Silva ◽  
Lenize Adriana de Jesus ◽  
Viviane Rosado ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Late Onset ◽  
Neonatal Unit ◽  
Coagulase Negative Staphylococcus ◽  
Empirical Antimicrobial Therapy ◽  
Late Onset Sepsis ◽  
High Prevalence

scholarly journals 400. Comparison of Tolerance and Microbiological Efficacy of Cefepime and Piperacillin/Tazobactam in Combination with Vancomycin as Empirical Antimicrobial Therapy of Prosthetic Joint Infection: A Propensity-Matched Cohort Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S204-S205
Author(s):  
Claire Triffault-Fillit ◽  
Eugenie Mabrut ◽  
Karine Corbin ◽  
Agathe Becker ◽  
Evelyne Braun ◽  
...  
Keyword(s):  
Renal Function ◽  
Antimicrobial Therapy ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Fisher Exact Test ◽  
In Vitro Susceptibility ◽  
Empirical Antimicrobial Therapy ◽  
Prosthetic Joint ◽  
Increased Risk ◽  
Baseline Renal Function

Abstract Background The use of piperacillin/tazobactam with vancomycin as empirical antimicrobial therapy (EAT) for prosthetic joint infection (PJI) has been associated with an increased risk of acute kidney injury (AKI), leading to propose cefepime as an alternative since 2017 in our reference center. The present study compared microbiological efficacy and tolerance of these two EAT strategies. Methods All adult patients with PJI empirically treated by vancomycin-cefepime (n = 89) were enrolled in a prospective observational study, and matched with vancomycin-piperacillin/tazobactam-treated historical controls (n = 89) according to a propensity score including age, baseline renal function and concomitant use of other nephrotoxics. The two groups were compared using Kaplan–Meier curve analysis and non-parametric tests (Fisher exact test and Mann–Whitney U-test) regarding: (i) the proportion efficacious empirical regimen (i.e., at least one of the two molecules active against the identified organism(s) based on in vitro susceptibility testing); and (ii) the incidence of empirical therapy-related adverse events (AE), classified according to the Common terminology criteria for AE (CTCAE). Results Among the 146 (82.0%) documented infections, the EAT was considered as efficacious in 77 (98.7%) and 65 (98.5%) of the piperacillin–tazobactam and cefepim-treated patients, respectively (P = 1.000). The rate of AE, and in particular AKI, was significantly higher in the vancomycin–piperacillin/tazobactam (n = 27 [30.3%] and 23 [25.8%%]) compared with the vancomycin-cefepim (n = 13 [14.6%] and 6 [6.7%]) group (P = 0.019 and <0.001, respectively; figure), leading to a premature EAT discontinuation in 20 (22.5%) and 5 (5.6%) patients (P = 0.002). Of note, no significant differences were observed between the two groups regarding sex (91 males; 51.1%), median age (68-year-old; IQR, 59.3–75), main comorbidities including baseline renal function and proportion of patients receiving other nephrotoxics, and vancomycin plasmatic overload. Conclusion The empirical use of vancomycin-cefepim in PJI was as efficient as vancomycin–piperacillin/tazobactam, and was associated with a significantly lower incidence of AKI. Disclosures All authors: No reported disclosures.

scholarly journals Bloodstream Infections Due to Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae: Risk Factors for Mortality and Treatment Outcome, with Special Emphasis on Antimicrobial Therapy

2004 ◽  
Vol 48 (12) ◽  
pp. 4574-4581 ◽  
Author(s):  
Cheol-In Kang ◽  
Sung-Han Kim ◽  
Wan Beom Park ◽  
Ki-Deok Lee ◽  
Hong-Bin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Treatment Outcome ◽  
Klebsiella Pneumoniae ◽  
Antimicrobial Therapy ◽  
Bloodstream Infections ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Extended Spectrum ◽  
Empirical Antimicrobial Therapy

ABSTRACT This study was conducted to evaluate risk factors for mortality and treatment outcome of bloodstream infections due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK). ESBL production in stored K. pneumoniae and E. coli blood isolates from Jan 1998 to Dec 2002 was phenotypically determined according to NCCLS guidelines and/or the double-disk synergy test. A total of 133 patients with ESBL-EK bacteremia, including 66 patients with ESBL-producing K. pneumoniae and 67 with ESBL-producing E. coli, were enrolled. The overall 30-day mortality rate was 25.6% (34 of 133). Independent risk factors for mortality were severe sepsis, peritonitis, neutropenia, increasing Acute Physiology and Chronic Health Evaluation II score, and administration of broad-spectrum cephalosporin as definitive antimicrobial therapy (P < 0.05 for each of these risk factors). In 117 of the 133 patients, excluding 16 patients who died within 3 days after blood culture sample acquisition, the 30-day mortality rates according to definitive antibiotics were as follows: carbapenem, 12.9% (8 of 62); ciprofloxacin, 10.3% (3 of 29); and others, such as cephalosporin or an aminoglycoside, 26.9% (7 of 26). When patients who received appropriate definitive antibiotics, such as carbapenem or ciprofloxacin, were evaluated, mortality in patients receiving inappropriate empirical antimicrobial therapy was found not to be significantly higher than mortality in those receiving appropriate empirical antimicrobial therapy (18.9 versus 15.5%; P = 0.666). Carbapenem and ciprofloxacin were the most effective antibiotics in antimicrobial therapy for ESBL-EK bacteremia. A delay in appropriate definitive antimicrobial therapy was not associated with higher mortality if antimicrobial therapy was adjusted appropriately according to the susceptibility results. Our data suggest that more prudent use of carbapenem as empirical antibiotic may be reasonable.

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