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 HoSPITAL ACQuIReD PneuMonIA onSeT DAN BAKTEREMIA

2016 ◽  
Vol 20 (3) ◽  
pp. 233
Author(s):  
Bellya Affan Roes ◽  
Dewi Kartika ◽  
Basti Andriyoko
Keyword(s):  
Klebsiella Pneumoniae ◽  
Early Onset ◽  
Late Onset ◽  
Clinical Pathology ◽  
Clinical Microbiology Laboratory ◽  
Patient Morbidity ◽  
Common Etiology ◽  
Hospital Acquired Pneumonia ◽  
Patient Prognosis ◽  
Hospital Acquired

Hospital acquired pneumonia (HAP) is significantly impact the patient morbidity and mortality that cause etiologic identification becomes a microbiological emergency in HAP. The etiologic identification based on the onset of pneumonia is important to determine the specific pathogens, that impact patient prognosis and prevent bacteremia. The aim of the study is to know the bacterial profile and antibiotic susceptibility pattern of early onset HAP by determination, late onset HAP and HAP with bacteriaemia in the intensive care setting. The design of this study was retrospective descriptive. The data was collected from the Clinical Microbiology Laboratory, Department of Clinical Pathology and the medical record from Dr. Hasan Sadikin hospital Bandung, from April 2013–March 2013. From the 61 episodes of HAP, 18 were early onset HAP and 43 were late onset HAP, including five (5) related to (8.2%) HAP with bacteriaemia. Klebsiella pneumoniae is the most common etiology of the early onset HAP (22.2%), with the highest susceptibility (75%) to amikacin, meropenem, and tigecyclin. Acinetobacter baumannii is the most common etiology of the late onset HAP (27.9%), with the highest susceptibility (75%) to amikacin and cotrymoxazole. The most common etiology of HAP with bacteriaemia is Klebsiella pneumoniae confirmed ESBL (40%) with the highest susceptibility to amikacin and meropenem (100%). Based on this study, it can be concluded that the most common bacterial profile of the early onset HAP is K. pneumoniae, while for the late onset HAP is A. baumannii, and HAP with bacteriaemia is K. pneumoniae confirmed ESBL. All of them have the highest susceptibility to amikacin.

scholarly journals Characterization of Neonatal Infections by Gram-Negative Bacilli and Associated Risk Factors, Havana, Cuba

2021 ◽  
Vol 13 (1) ◽  
pp. 219-229
Author(s):  
Arlenis Oliva ◽  
Yenisel Carmona ◽  
Elizabeth de La C. López ◽  
Roberto Álvarez ◽  
Meiji Soe Aung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Late Onset ◽  
Empirical Therapy ◽  
Antibiotic Use ◽  
Neonatal Infections ◽  
Cross Sectional ◽  
Prolonged Stay ◽  
Gram Negative ◽  
Associated Risk Factors ◽  
Resistance Rates

Infections represent an important problem in neonates because of the high mortality. An increase in neonatal infections has been found in Cuban hospitals in recent years. The aim of this study was to provide evidence on the clinical and microbiological behavior of Gram-negative bacilli that cause neonatal infections in hospitals of Havana, Cuba. It was carried out as a descriptive cross-sectional investigation from September 2017 to July 2018 in The Tropical Medicine Institute “Pedro Kouri” (IPK). Sixty-one Gram-negative bacilli isolated from neonates with infections in six Gyneco-Obstetric and Pediatric Hospitals of Havana were analyzed for their species and antimicrobial susceptibility. Late-onset infections were more common than early-onset ones and included urinary tract infection in the community (87%) and sepsis in hospitals (63.3%). Catheter use (47%) and prolonged stay (38%) were the most frequent risk factors. Species of major pathogens were Escherichia coli (47%) and Klebsiella spp. (26%). The isolated Gram-negative bacilli showed high resistance rates to third-generation cephalosporins, ciprofloxacin and gentamicin, while being more susceptible to carbapenems, fosfomycin, colistin and amikacin. The present study revealed the clinical impact of Gram-negative bacilli in neonatology units in hospitals of Havana. Evaluation of antimicrobial susceptibilities to the isolates from neonates is necessary for selection of appropriate empirical therapy and promotion of the rational antibiotic use.

Pulmonary Infections

Chest Imaging ◽  
2019 ◽  
pp. 187-189
Author(s):  
Santiago Martínez-Jiménez
Keyword(s):  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Clinical Response ◽  
Chest Radiography ◽  
Community Acquired Pneumonia ◽  
Clinical Perspective ◽  
Immunosuppressed Patients ◽  
Hospital Acquired Pneumonia ◽  
Healthcare Associated ◽  
Hospital Acquired

Pneumonia can be classified as: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), healthcare-associated pneumonia (HCAP), and pneumonia in immunosuppressed patients. Although the above are similar pathologically, they are very different from a clinical perspective. Chest radiography is often performed to support the diagnosis and to determine the extent of involvement prior to the onset of therapy. Radiography should not be performed in the short term in patients who are improving clinically as it can lead to the misdiagnosis of treatment failure. Chest radiography in patients treated for pneumonia should only be obtained before 4-6 weeks after the onset of therapy if there is a failure of clinical response or if complications of pneumonia are clinically suspected. The majority of pneumonias will resolve after 6 weeks of appropriate antibiotic therapy.

scholarly journals 1181. Significant Reduction of Non-Ventilator Hospital-Acquired Pneumonia (HAP) with a Prevention Bundle and Clinical and Leadership Feedback in a Large Integrated Healthcare System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S423-S423
Author(s):  
Sejal Naik ◽  
Cristine Lacerna ◽  
Yulia Kevorkova ◽  
Jessica Galin ◽  
Donna Patey ◽  
...  
Keyword(s):  
Healthcare System ◽  
Oral Care ◽  
Antibiotic Use ◽  
Altered Mental Status ◽  
Feeding Tube ◽  
Healthcare Associated Infection ◽  
Integrated Healthcare ◽  
Benzodiazepine Use ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstract Background Non-Ventilator Hospital-acquired Pneumonia (HAP) is a prevalent healthcare-associated infection with mortality of 21%. HAP prevention literature is scant. We developed a definition enabling accurate surveillance to support this effort and implemented a prevention bundle based on available literature and characteristics of our high-performing centers. Methods Kaiser Permanente Northern California is an integrated healthcare system providing care for 4.4 million patients at 21 medical centers. Discharge diagnoses of HAP cases were reviewed for accuracy and factors permitting programmatic confirmation. A natural language extraction program identified new and persisting imaging findings, providing specificity. No other surveillance factors added specificity. Surgery, altered mental status, sedation, albumin <3 g/dl and tube feedings were identified as predictive risks. Seven interventions became part of a new pneumonia prevention order set for automatically identified high-risk patients: aggressive mobilization, upright posture for meals, swallowing evaluation before feeding, sedation restriction, elevated head of bed, oral care and feeding tube care. The project was fully implemented in 2015. Results Results were reported by 1,000 admissions and by 100,000 members served, to address a rapidly growing population. HAP decreased from 5.92 to 1.79/1000 admissions and 24.57 to 6.49/100,000 members and HAP case mortality remained stable (18–19%) while overall HAP mortality decreased from 1.05 to 0.34/1000 admissions (4.37 to 1.24 /100,000 members) (Figure 1 and 2). Carbapenem, quinolone, aminoglycoside and vancomycin use all decreased significantly (Figure 3). Benzodiazepine use decreased from 10.4% of all inpatient-days in 2014 to 8.8% of inpatient-days in 2016. Conclusion HAP rates, mortality and broad-spectrum antibiotic use were all reduced significantly, despite the absence of clinical practice guidelines or strong supportive literature for guidance. Some interventions had limited support, but most augmented basic nursing care. None had risks of adverse consequences. This supports the need to examine practices to improve care despite absent literature and even more so supports a need to study these difficult nebulous areas of care. Disclosures All authors: No reported disclosures.

scholarly journals Neonatal and young infant sepsis by Group B Streptococci and Escherichia coli: a single-center retrospective analysis in Germany—GBS screening implementation gaps and reduction in antibiotic resistance

2020 ◽  
Vol 179 (11) ◽  
pp. 1769-1777
Author(s):  
Maren Doenhardt ◽  
Barbara Seipolt ◽  
Lars Mense ◽  
Jennifer Lucia Winkler ◽  
Alexander Thürmer ◽  
...  
Keyword(s):  
Early Onset ◽  
Late Onset ◽  
Young Infant ◽  
Antibiotic Use ◽  
Group B Streptococci ◽  
E Coli ◽  
Antimicrobial Substances ◽  
Intrapartum Antibiotic ◽  
Group B ◽  
Implementation Gaps

Abstract The last nationwide surveillance study on neonatal and young infant sepsis due to Group B Streptococci (GBS) and Escherichia coli in Germany was conducted between 2009 and 2010. The aim of this study is to provide longitudinal epidemiological data on neonatal and young infant sepsis caused by GBS and E. coli to reevaluate existing data and to inform clinical decision-making. Every positive blood culture for GBS and E. coli within the first 90 days of life that occurred at our center from 2008 until 2018 was identified. The epidemiological, clinical, laboratory, and microbiological data of all affected patients were analyzed through retrospective chart review, along with the pathogen’s antimicrobial susceptibility results. In total, 106 episodes of neonatal sepsis were described; 31% (n = 33) being caused by GBS and 69% (n = 73) by E. coli; 87% of GBS early-onset disease (EOD) cases did not receive intrapartum antibiotic prophylaxis (IAP). Contrary to general trends, the proportion of resistant E. coli isolates decreased for all tested antibiotics over time. Coincidentally, antenatal antibiotic use beyond IAP during that period decreased significantly in our center. Conclusions: (1) Data at our center suggests at least a regional implementation gap in GBS screening and IAP. (2) The decline in the resistance rate of E. coli for all antimicrobial substances might indicate that the reduction of prenatal antibiotics use is beneficial and that neonatal antibiotic stewardship programs should include pregnant women as well. What is Known:• GBS screening and intrapartum antibiotic prophylaxis led to a 32%-reduction in GBS disease in Germany with a 0.75 (92:122) ratio of early-onset disease to late-onset disease in 2009–2010.• Prenatal antibiotic use might increase the risk of E. coli early-onset disease and antibiotic resistances. What is New:• The GBS early-onset disease rates were twice as high as those of late-onset disease, the ratio was 1.75 (21:12) in 2008–2018 at our institution. This suggests that there are at least regional implementation gaps in the antenatal GBS screening in Germany.• We found a decline in E. coli resistance rates over time for all antimicrobial substances. Reduction in use of prenatal antibiotics might be an explanation.

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 &lt; 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.

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