Faculty Opinions recommendation of Clinical Outcomes of Patients With Drug-Resistant Tuberculous Meningitis Treated With an Intensified Antituberculosis Regimen.

Abstract Background Timely effective therapy in multi-drug resistant (MDR) Pseudomonas (PsA) infections has a direct impact on patient survival. We aimed to determine the impact of diagnostic and antimicrobial stewardship (AMS) on time-to-appropriate therapy (TAP) and clinical outcomes of patients with MDR PsA infections utilizing novel beta-lactam/beta-lactamase inhibitors (BL/BLIs). Methods Retrospective cohort study of adult patients with MDR PsA infections at a 1,500-bed University-affiliated public hospital in Miami, Florida who received ≥72 hours of ceftazidime-avibactam (C/A) or ceftolozane-tazobactam (C/T). During the pre-intervention period (12/2017-12/2018), additional susceptibilities for C/A and C/T were performed upon providers’ request. In the post intervention period (01/2019 – 12/2019), we implemented automatic reflex algorithms (Figure 1) for faster identification and susceptibilities for MDR PsA, including carbapenemase producers. Results were communicated in real-time to the AMS team. Figure 1. Reflex Testing Algorithm for MDR Pseudomonas Isolates from Any Source Results Seventy-six patients were included; median age was 56 years (IQR 37.5–67.0), 40 (52.6%) were in an intensive care unit at time of culture collection; median APACHE II score was 20 (IQR 15.0 – 26.0). Three isolates were carbapenemase producers (VIM = 2; KPC = 1). The most common infections were pneumonia (56.6%) and bacteremia (18.4%). We found a significant decrease in median TAP (120.1 [IQR 82.5–164.6] vs 75.9 [IQR 51.3–101.7] hours, p = 0.003). Median time from culture collection to final susceptibility results was shorter in the post-intervention group (122.2 vs 90.5 hours; p < 0.001). Median length-of-stay after culture collection was numerically lower in the post-intervention group (26.0 [11.6–59.4] vs 19.7 [12.9–37.8] days; p = 0.33). Controlling for ICU admission, our intervention was not associated with decreased 30-day inpatient mortality (OR = 1.62, 95% CI 0.45–5.79). Conclusion Our study identified an improvement in TAP in MDR PsA infections with implementation of diagnostic and AMS initiatives. In an adequately powered study, our intervention could potentially impact patient survival through timely initiation of effective therapy with novel BL/BLIs. Disclosures All Authors: No reported disclosures

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Urinary Tract Infections Caused by Multi-Drug Resistant Proteus mirabilis: Risk Factors and Clinical Outcomes

Infection ◽

10.1007/s15010-009-8460-5 ◽

2009 ◽

Vol 38 (1) ◽

pp. 41-46 ◽

Cited By ~ 38

Author(s):

K. Cohen-Nahum ◽

L. Saidel-Odes ◽

K. Riesenberg ◽

F. Schlaeffer ◽

A. Borer

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Clinical Outcomes ◽

Urinary Tract Infections ◽

Proteus Mirabilis ◽

Drug Resistant ◽

Tract Infections

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Reply to “Dr D Dhasmana and Dr R Davidson: Multi-drug resistant tuberculous meningitis”

Journal of Infection ◽

10.1016/j.jinf.2006.06.004 ◽

2007 ◽

Vol 54 (2) ◽

pp. 206

Author(s):

Guy E. Thwaites ◽

Tran Tinh Hien ◽

Jeremy J. Farrar

Keyword(s):

Tuberculous Meningitis ◽

Drug Resistant

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Clinical outcomes of colistin in combination with either 6-g sulbactam or carbapenems for the treatment of extensively drug-resistant Acinetobacter baumannii pneumonia with high MIC to sulbactam, a prospective cohort study

10.21203/rs.2.10942/v1 ◽

2019 ◽

Author(s):

Chutchawan Ungthammakhun ◽

Vasin Vasikasin ◽

Dhitiwat Changpradub

Keyword(s):

Cohort Study ◽

Length Of Stay ◽

Acinetobacter Baumannii ◽

Clinical Outcomes ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Mortality Rates ◽

P Value ◽

Drug Resistant ◽

Extensively Drug Resistant

Abstract Background: Extensively drug-resistant Acinetobacter baumannii (XDRAB) is an important cause of nosocomial pneumonia with limited therapeutic options. Colistin based regimen is recommended treatment. Which drugs should be combined with colistin remains uncertain. The aim of this study was to investigate the clinical outcomes of patients with XDRAB pneumonia who were treated with colistin, combined with either 6-g sulbactam or carbapenems, in the setting of high MIC to sulbactam. Methods: In this prospective cohort study, hospitalized patients diagnosed with XDRAB pneumonia in Phramongkutklao Hospital were enrolled. The primary outcome was the 28-day mortality. Secondary outcomes were 7 and 14-day mortality, length of stay, ventilator days and factors associated with mortality. Results: From 1 July 2016 to 30 September 2017, 192 patients were included; 92 received colistin plus sulbactam and 90 received colistin plus carbapenems. Most of the patients were male diagnosed with ventilator associated pneumonia in medical intensive care unit. Overall mortality rates at 7, 14, 28 days were 24.2%, 37.4%, 53.3%, respectively. Mortality rates did not differ between sulbactam group and carbapenems groups at 7 days (19.6% vs. 28.9%, p-value 0.424, adjusted HR 1.277; 95% CI = 0.702-2.322), 14 days (34.8% vs. 40%, p = 0.658, adjusted HR 1.109; 95% CI = 0.703-1.749) and 28 days (51.1% vs. 55.6%, p = 0.857, adjusted HR 1.038; 95% CI = 0.690-1.562). Length of stay, ICU days and ventilator days did not differ. Complications of treatment including acute kidney injury were not statistically different. Conclusions: In XDRAB pneumonia with high MIC to sulbactam, mortality rates were not statistically significant between colistin plus 6-g sulbactam and colistin plus carbapenems. Keywords: XDR A. baumannii pneumonia, mortality rate, colistin based, sulbactam, carbapenems

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Correlation of Checkerboard Synergy Testing with Time-Kill Analysis and Clinical Outcomes of Extensively Drug-Resistant Acinetobacter baumannii Respiratory Infections

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00981-16 ◽

2016 ◽

Vol 60 (11) ◽

pp. 6892-6895 ◽

Cited By ~ 12

Author(s):

Derek N. Bremmer ◽

Karri A. Bauer ◽

Stephanie M. Pouch ◽

Keelie Thomas ◽

Debra Smith ◽

...

Keyword(s):

Acinetobacter Baumannii ◽

Clinical Outcomes ◽

Clinical Utility ◽

Respiratory Infections ◽

Drug Resistant ◽

Content Type ◽

Extensively Drug Resistant ◽

Time Kill ◽

Synergy Testing

ABSTRACTWe tested 76 extensively drug-resistant (XDR)Acinetobacter baumanniiisolates by the checkerboard method using only wells containing serum-achievable concentrations (SACs) of drugs. Checkerboard results were correlated by time-kill assay and clinical outcomes. Minocycline-colistin was the best combinationin vitro, as it inhibited growth in one or more SAC wells in all isolates. Patients who received a combination that inhibited growth in one or more SAC wells demonstrated better microbiological clearance than those who did not (88% versus 30%;P= 0.025). The checkerboard platform may have clinical utility for XDRA. baumanniiinfections.

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Environmental, pharmacological and genetic influences on the spread of drug-resistant malaria

Proceedings of The Royal Society B Biological Sciences ◽

10.1098/rspb.2010.1907 ◽

2010 ◽

Vol 278 (1712) ◽

pp. 1705-1712 ◽

Cited By ~ 22

Author(s):

Tiago Antao ◽

Ian M. Hastings

Keyword(s):

Plasmodium Falciparum ◽

Linkage Disequilibrium ◽

Malaria Transmission ◽

Clinical Outcomes ◽

Artificial Selection ◽

Genetic Interactions ◽

Genetic Influences ◽

Drug Resistant ◽

New Approach ◽

Rate Of Spread

Plasmodium falciparum malaria is subject to artificial selection from antimalarial drugs that select for drug-resistant parasites. We describe and apply a flexible new approach to investigate how epistasis, inbreeding, selection heterogeneity and multiple simultaneous drug deployments interact to influence the spread of drug-resistant malaria. This framework recognizes that different human ‘environments’ within which treatment may occur (such as semi- and non-immune humans taking full or partial drug courses) influence the genetic interactions between parasite loci involved in resistance. Our model provides an explanation for how the rate of spread varies according to different malaria transmission intensities, why resistance might stabilize at intermediate frequencies and also identifies several factors that influence the decline of resistance after a drug is removed. Results suggest that studies based on clinical outcomes might overestimate the spread of resistant parasites, especially in high-transmission areas. We show that when transmission decreases, prevalence might decrease without a corresponding change in frequency of resistance and that this relationship is heavily influenced by the extent of linkage disequilibrium between loci. This has important consequences on the interpretation of data from areas where control is being successful and suggests that reducing transmission might have less impact on the spread of resistance than previously expected.

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