scholarly journals Is There a Difference in Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Fracture-Related Infection and Periprosthetic Joint Infection? A Retrospective Comparative Study

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 921
Author(s):  
Markus Rupp ◽  
Susanne Baertl ◽  
Nike Walter ◽  
Florian Hitzenbichler ◽  
Martin Ehrenschwender ◽  
...  
Keyword(s):  
Statistical Difference ◽  
Joint Infection ◽  
Empiric Therapy ◽  
Empiric Antibiotic Therapy ◽  
Joint Infections ◽  
Empiric Antibiotic ◽  
Retrospective Comparative Study ◽  
Resistance Rates ◽  
Susceptibility Profiles ◽  
Common Infection

This study aims to investigate (1) microbial patterns in fracture-related infections (FRIs) in comparison to microbiological patterns of periprosthetic joint infections (PJIs), (2) the identification of effective empiric antibiotic therapy for FRIs and PJIs and (3) analysis of difficult-to-treat (DTT) pathogens. Patients treated for FRIs or PJIs from 2017 to 2020 were evaluated for pathogens detected during treatment. Antibiotic susceptibility profiles were examined with respect to broadly used antibiotics and antibiotic combinations. Resistance rates to rifampicin or fluoroquinolone were determined. A total of 81 patients with PJI and 86 with FRI were included in the study. For FRIs Staphylococcus aureus was the most common infection-causing pathogen (37.4% vs. 27.9% for PJI). Overall, there was no statistical difference in pathogen distribution (p = 0.254). For FRIs, combinations of gentamicin + vancomycin (93.2%), co-amoxiclav + glycopeptide and meropenem + vancomycin (91.9% each) would have been effective for empiric therapy, similar to PJIs. Difficult to treat pathogens were more frequently detectable in PJIs (11.6% vs. 2.3%). Empiric therapy combinations such as gentamicin + vancomycin, co-amoxiclav + glycopeptide or meropenem + vancomycin, are effective antibiotic strategies for both FRI and PJI patients. More DTT pathogens were detectable in PJIs compared to FRIs.

scholarly journals Delayed Rifampin Administration in the Antibiotic Treatment of Periprosthetic Joint Infections Significantly Reduces the Emergence of Rifampin Resistance

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1139
Author(s):  
Ali Darwich ◽  
Franz-Joseph Dally ◽  
Mohamad Bdeir ◽  
Katharina Kehr ◽  
Thomas Miethke ◽  
...  
Keyword(s):  
Pathogen Detection ◽  
Joint Infection ◽  
Empiric Antibiotic Therapy ◽  
Resistant Organism ◽  
Joint Infections ◽  
Treatment Failure Rate ◽  
Empiric Antibiotic ◽  
Rifampin Resistance ◽  
Group 2 ◽  
Group 1

Rifampin is one of the most important biofilm-active antibiotics in the treatment of periprosthetic joint infection (PJI), and antibiotic regimens not involving rifampin were shown to have higher failure rates. Therefore, an emerging rifampin resistance can have a devastating effect on the outcome of PJI. The aim of this study was to compare the incidence of rifampin resistance between two groups of patients with a PJI treated with antibiotic regimens involving either immediate or delayed additional rifampin administration and to evaluate the effect of this resistance on the outcome. In this retrospective analysis of routinely collected data, all patients who presented with an acute/chronic PJI between 2018 and 2020 were recorded in the context of a single-center comparative cohort study. Two groups were formed: Group 1 included 25 patients with a PJI presenting in 2018–2019. These patients received additional rifampin only after pathogen detection in the intraoperative specimens. Group 2 included 37 patients presenting in 2019–2020. These patients were treated directly postoperatively with an empiric antibiotic therapy including rifampin. In all, 62 patients (32 females) with a mean age of 68 years and 322 operations were included. We found a rifampin-resistant organism in 16% of cases. Rifampin resistance increased significantly from 12% in Group 1 to 19% in Group 2 (p < 0.05). The treatment failure rate was 16% in Group 1 and 16.2% in Group 2 (p = 0.83). The most commonly isolated rifampin-resistant pathogen was Staphylococcus epidermidis (86%) (p < 0.05). The present study shows a significant association between the immediate start of rifampin after surgical revision in the treatment of PJI and the emergence of rifampin resistance, however with no significant effect on outcome.

Case of flexor tenosynovitis caused by Mycobacterium arupense

2021 ◽  
Vol 14 (10) ◽  
pp. e245130
Author(s):  
Kushali Patel ◽  
John Flaherty
Keyword(s):  
Drinking Water ◽  
Case Report ◽  
Water Systems ◽  
The Other ◽  
Empiric Antibiotic Therapy ◽  
Joint Infections ◽  
Empiric Antibiotic ◽  
Environmental Pathogens ◽  
Fish Tanks ◽  
Flexor Tenosynovitis

Mycobacterium arupense is a member of the Mycobacterium terrae complex (MTC) that is implicated in bone and joint infections, among others. This group of environmental pathogens can be found in soil, reclaimed and drinking water systems, rodents, fish tanks and bioaerosols in duck houses. Interestingly, while M. arupense is genotypically closely related to the other agents in the MTC, antibiotic susceptibility of these mycobacteria can vary widely and empiric antibiotic therapy is controversial. Our case report contributes to the very limited literature on M. arupense tenosynovitis—as only six cases have been reported since 2008—and sheds light on different courses of treatment. While previous cases have been successfully treated, a streamlined course of therapy for M. arupense tenosynovitis is still needed.

Antibiotic Prescribing Evaluation in an Outpatient Hemodialysis Clinic

2002 ◽  
Vol 18 (3) ◽  
pp. 128-132 ◽  
Author(s):  
Harold J Manley ◽  
Michael A Huke ◽  
Mark A Dykstra ◽  
Angela V Bedenbaugh
Keyword(s):  
Antibiotic Therapy ◽  
Empiric Therapy ◽  
Prescribing Patterns ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Prescribing ◽  
Gram Positive ◽  
Hospital Infection Control ◽  
Empiric Antibiotic ◽  
Control And Prevention ◽  
Gram Negative Organisms

Background Empiric vancomycin treatment is frequently used in hemodialysis (HD) patients because of ease of administration when methicillin-resistant Staphylococcus aureus (MRSA) infection is suspected. Differing rates of MRSA indicate that empiric antibiotic treatment should be based on a center-specific antibiogram. Objective To develop a center-specific antibiogram, evaluate antibiotic prescribing patterns, and determine areas of improvement in infection treatment. Methods The antibiogram was constructed from culture and susceptibility (C&S) data from January through December 1999. Evaluation of prescribing habits was based on 3 criteria: (1) Hospital Infection Control Practices Advisory Committee and Centers for Disease Control and Prevention guidelines; (2) vancomycin for 1 dose followed by appropriate antibiotic based on C&S results; and (3) C&S obtained with more than 1 dose of antibiotic. Results HD was provided to 161 patients during the study period. Antibiotics were empirically prescribed 104 times in 62 different patients. Cultures were obtained 122 times, and 67 different isolates were identified. Gram-positive organisms and gram-negative organisms accounted for 77.6% and 22.4% of isolates, respectively. Gram-positive organisms were identified as Staphylococcus spp. (53.8%); 17.9% of the staphylococcal isolates were MRSA strains. No isolates of vancomycin-resistant enterococcus were identified. Based on the antibiogram, empiric antibiotic therapy within our center should be 1 dose each of vancomycin and an aminoglycoside. Empiric vancomycin was used 71 times. When criterion I is used, 12 prescriptions (16.9%) were considered appropriate. When criterion II and adjustment for MRSA reported for our center were used, 46 (64.8%) vancomycin prescriptions were considered appropriate. Forty-one patients had more than 1 dose of antibiotic therapy, and 18 (43.9%) of those patients did not have C&S data obtained as prescribed by criterion III. Areas of prescribing improvement include obtaining a C&S in all suspected infections prior to empiric therapy and a more aggressive antibiotic switch based on C&S results. Conclusions Antibiograms can be used to determine appropriate empric antibiotic therapy and identify areas of improvement.

scholarly journals Empiric antibiotic therapy in a child with cancer and suspected septicemia

2012 ◽  
Vol 4 (1) ◽  
pp. 2 ◽  
Author(s):  
Desiree Caselli ◽  
Olivia Paolicchi
Keyword(s):  
Antibiotic Therapy ◽  
Supportive Therapy ◽  
Empiric Therapy ◽  
Infectious Complications ◽  
Empiric Antibiotic Therapy ◽  
Beta Lactam ◽  
Blood Tests ◽  
Empiric Antibiotic ◽  
Lactam Antibiotic ◽  
Life Threatening

Improved outcome in the treatment of in childhood cancer results not only from more aggressive and tailored cancer-directed therapy, but also from improved supportive therapy and treatment of life-threatening infectious complications. Prompt and aggressive intervention with empiric antibiotics has reduced the mortality in this group of patients. Physical examination, blood tests, and blood cultures must be performed, and antibiotic therapy must be administered as soon as possible. Beta-lactam monotherapy, such as piperacillin-tazobactam or cefepime, may be an appropriate empiric therapy of choice for all clinically stable patients with neutropenic fever. An anti-pseudomonal beta-lactam antibiotic plus gentamicin is recommended for patients with systemic compromise.

scholarly journals Feasibility of informing syndrome-level empiric antibiotic recommendations using publicly available antibiotic resistance datasets

2020 ◽  
Vol 4 ◽  
pp. 140
Author(s):  
Quentin J. Leclerc ◽  
Nichola R. Naylor ◽  
Alexander M. Aiken ◽  
Francesc Coll ◽  
Gwenan M. Knight
Keyword(s):  
Antibiotic Resistance ◽  
Open Access ◽  
Bloodstream Infection ◽  
National Level ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Prescribing ◽  
Current Form ◽  
Bacterial Aetiology ◽  
Empiric Antibiotic ◽  
Common Infection

Background: Antibiotics are often prescribed empirically to treat infection syndromes before causative bacteria and their susceptibility to antibiotics are identified. Guidelines on empiric antibiotic prescribing are key to effective treatment of infection syndromes, and need to be informed by likely bacterial aetiology and antibiotic resistance patterns. We aimed to create a clinically-relevant composite index of antibiotic resistance for common infection syndromes to inform recommendations at the national level. Methods: To create our index, we used open-access antimicrobial resistance (AMR) surveillance datasets, including the ECDC Surveillance Atlas, CDDEP ResistanceMap, WHO GLASS and the newly-available Pfizer ATLAS dataset. We integrated these with data on aetiology of common infection syndromes, existing empiric prescribing guidelines, and pricing and availability of antibiotics. Results:  The ATLAS dataset covered many more bacterial species (287) and antibiotics (52) than other datasets (ranges = 8-11 and 16-32 respectively), but had a similar number of samples per country per year. Using these data, we were able to make empiric prescribing recommendations for bloodstream infection, pneumonia and cellulitis/skin abscess in up to 44 countries. There was insufficient data to make national-level recommendations for the other six syndromes investigated. Results are presented in an interactive web app, where users can visualise underlying resistance proportions to first-line empiric antibiotics for infection syndromes and countries of interest. Conclusions: We found that whilst the creation of a composite resistance index for empiric antibiotic therapy was technically feasible, the ATLAS dataset in its current form can only inform on a limited number of infection syndromes. Other open-access AMR surveillance datasets are largely limited to bloodstream infection specimens and cannot directly inform treatment of other syndromes. With improving availability of international AMR data and better understanding of infection aetiology, this approach may prove useful for informing empiric prescribing decisions in settings with limited local AMR surveillance data

scholarly journals Using the Association Between Antibiotic Susceptibility and Genetic Relatedness to Rescue Old Drugs for Empiric Use

2019 ◽  
Author(s):  
Derek R MacFadden ◽  
Bryan Coburn ◽  
Karel Břinda ◽  
Antoine Corbeil ◽  
Nick Daneman ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Susceptibility ◽  
Genetic Relatedness ◽  
Model Performance ◽  
Empiric Therapy ◽  
Empiric Antibiotic Therapy ◽  
Phenotypic Data ◽  
Oral Agents ◽  
Empiric Antibiotic ◽  
Treatment Adequacy

AbstractBackgroundRising rates of antibiotic resistance have led to the use of broader spectrum antibiotics and increasingly compromise empiric therapy. Knowing the antibiotic susceptibility of a pathogen’s close genetic relative(s) may improve empiric antibiotic selection.MethodsUsing genomic and phenotypic data from three separate clinically-derived databases of Escherichia coli isolates, we evaluated multiple genomic methods and statistical models for predicting antibiotic susceptibility, focusing on potentially rapidly available information such as lineage or genetic distance from archived isolates. We applied these methods to derive and validate prediction of antibiotic susceptibility to common antibiotics.ResultsWe evaluated 968 separate episodes of suspected and confirmed infection with Escherichia coli from three geographically and temporally separated databases in Ontario, Canada, from 2010-2018. The most common sequence type (ST) was ST131 (30%). Antibiotic susceptibility to ciprofloxacin and trimethoprim-sulfamethoxazole were lowest (<=72%). Across all approaches, model performance (AUC) ranges for predicting antibiotic susceptibility were greatest for ciprofloxacin (0.76-0.97), and lowest for trimethoprim-sulfamethoxazole (0.51-0.80). When a model predicted a susceptible isolate, the resulting (post-test) probabilities of susceptibility were sufficient to warrant empiric therapy for most antibiotics (mean 92%). An approach combining multiple models could permit the use of narrower spectrum oral agents in 2 out of every 3 patients while maintaining high treatment adequacy (∼90%).ConclusionsMethods based on genetic relatedness to archived samples in E. coli could be used to rescue older and typically unsuitable agents for use as empiric antibiotic therapy, as well as improve decisions to select newer broader spectrum agents.SummaryRapid genomic approaches that capitalize on the association between genetic relatedness and phenotype can improve our selection of antibiotics, allowing us to rescue older drugs for empiric use and better select newer and broader spectrum agents.

scholarly journals Use of a Precision Antibiotic Therapy (PAT) Prediction Model to Identify Multidrug-Resistant (MDR) Enterobacteriaceae

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S328-S328 ◽  
Author(s):  
Alexandra Varga ◽  
Leigh Cressman ◽  
Ebbing Lautenbach ◽  
Valerie Cluzet ◽  
Pam Tolomeo ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Susceptibility ◽  
Area Under The Curve ◽  
Empiric Therapy ◽  
Multidrug Resistant ◽  
Empiric Antibiotic Therapy ◽  
Brier Score ◽  
First Line ◽  
Roc Curve Analysis ◽  
Empiric Antibiotic

Abstract Background Emergence of multidrug-resistant (MDR) Enterobacteriaceae complicates the selection of empiric antibiotic therapy. Software called Precision Antibiotic Therapy (PAT) (Teqqa, LLC; Jackson, WY) operationalizes a predictive model using patient factors to make real-time, personalized predictions of antibiotic susceptibility for each antibiotic, allowing prescribers to choose empiric therapy for patients at risk for resistant infections. The purpose of this study was to determine the performance of PAT software in identifying MDR Enterobacteriaceaebloodstream infections (BSI) as well as to determine optimal thresholds of predicted antibiotic susceptibility to choose a broader-spectrum antibiotic. Methods We conducted a retrospective cohort study including 475 unique patients with BSIs caused by Enterobacteriaceaefrom January 1, 2016 through December 31, 2016. First-line antibiotic therapy for BSI was defined as cefepime, piperacillin-tazobactam, levofloxacin, or aztreonam. Susceptibilities predicted by PAT were compared with known susceptibilities determined by routine laboratory testing. PAT thresholds for broadening antibiotics were assessed when predicted susceptibilities were 80%, 85%, 90%, and 95% using receiver-operating characteristic (ROC) curves. Performance characteristics were calculated for each threshold. Brier score calculations were then used to compare the accuracy of PAT predictions using the optimized predicted susceptibility threshold, to that of aggregate institutional susceptibility data. Results ROC curve analysis demonstrated an area under the curve of 0.82 for the 95% threshold. The sensitivity for the PAT prediction utilizing the 95% threshold was 91.7% with a specificity of 74.3%. The Brier score for the 2016 antibiogram to determine antibiotic therapy was 0.085, whereas the Brier score using PAT software was 0.071, representing a 16% improvement in accuracy. Conclusion PAT software demonstrated excellent capability to discriminate between Enterobacteriaceae BSIs resistant and susceptible to first-line therapy. A predicted susceptibility threshold of 95% should be used to indicate a need for escalation of empiric antibiotic therapy using PAT. Disclosures All authors: No reported disclosures.

Infection in Solid Organ Transplantation: Prophylactic Regimens, Clinical Manifestations, and Empiric Therapy

1997 ◽  
Vol 10 (2) ◽  
pp. 90-100
Author(s):  
Joanna K. Maudlin
Keyword(s):  
Organ Transplantation ◽  
Immunocompromised Patient ◽  
Solid Organ Transplantation ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Empiric Therapy ◽  
Empiric Antibiotic Therapy ◽  
Solid Organ ◽  
Protective Measures ◽  
Empiric Antibiotic

Solid organ transplantation has become an established practice for end-organ disease. Transplantation has inherent risks for infection which can be minimized by appropriate prophylactic, preemptive, and empiric antibiotic regimens. Proper vaccination and appropriate perioperative antibiotic use are of utmost importance in an immunocompromised patient. When immunosuppression is high, further prophylactic regimens against some pathogens, such as cytomegalovirus, are necessary. Empiric antibiotic therapy should be targeted to the most likely pathogens. However, certain antimicrobials may interact with immunosuppressant agents resulting in enhanced toxicity or decreasing immunosuppression. Appropriate monitoring parameters and protective measures should be taken.

scholarly journals Ceftazidime as an empiric therapy for neonatal sepsis

2021 ◽  
Vol 61 (4) ◽  
pp. 198-204
Author(s):  
Indrayady Indrayady ◽  
Afifa Ramadanti ◽  
Yulia Iriani ◽  
Herka Pratama Putra
Keyword(s):  
Neonatal Sepsis ◽  
Empiric Therapy ◽  
Empiric Antibiotic Therapy ◽  
Blood Cell Count ◽  
Gram Positive Bacteria ◽  
Significant Difference ◽  
Before And After ◽  
Post Test ◽  
Empiric Antibiotic ◽  
Neonatal Ward

Background Sepsis is still the leading cause of death in neonates in developing countries. Proper administration of antibiotics is important for managing neonatal sepsis. The microorganisms that cause neonatal sepsis, as well as their sensitivity patterns, change over time and differ from one place to another. Since 2001, ceftazidime has been used as an empirical antibiotic for managing neonatal sepsis at Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera, but its effectiveness is questionable. Objective To evaluate the effectiveness of ceftazidime as an empiric therapy for neonatal sepsis. Methods This study was pre-experimental, for one group, pre- and post-test, was conducted in 49 neonates with neonatal sepsis in the Neonatal Ward at Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera, from April to September 2019. The effectiveness of ceftazidime was determined based on clinical and laboratory improvements 72 hours after ceftazidime administration. Results Of 49 neonates, 28 experienced clinical and laboratory improvement, while 21  experienced improvement in only one parameter, either clinical or laboratory. Gram positive bacteria were found in 22/49 subjects. Conclusion There is a significant difference on white blood cell count and CRP level between before and after ceftazidime administration but overall ceftazidime is no longer effective as empiric antibiotic therapy in neonatal sepsis.  

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