scholarly journals Development of the first edition of African treatment guidelines for common bacterial infections and syndromes

2022 ◽  
Vol 12 (2) ◽  
Author(s):  
Jessica Craig ◽  
Isabel Frost ◽  
Aditi Sriram ◽  
James Nuttall ◽  
Geetanjali Kapoor ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Bacterial Infections ◽  
Treatment Guidelines ◽  
Clinical Care ◽  
Treatment Recommendations ◽  
Antimicrobial Treatment ◽  
Empiric Antibiotic Therapy ◽  
Member States ◽  
Clinical Syndromes ◽  
Empiric Antibiotic

Standard treatment guidelines (STGs) are an important tool for ensuring high quality clinical care and prudent antimicrobial use (AMU) and stewardship (AMS). In 2018, African Union (AU) member state representatives recognized the lack of STGs as a barrier to AMS at national and facility levels. Previous research reported that only 17 of 55 (31%) member states had STGs that provided disease- or pathogen-specific antimicrobial treatment recommendations, excluding those that covered only treatment of HIV, malaria, and tuberculosis). The Africa Centres for Disease Control and Prevention convened expert panels to develop first edition antibiotic treatment guidelines for priority infectious diseases and clinical syndromes for pediatric and adult patient populations in Africa. The purpose of the guidelines is to provide healthcare workers with treatment guidance by harmonising existing national STGs, filling gaps where existing STGs are not available, and serving as a model for future guidelines. Two expert panels of 28 total clinicians, pharmacists, and other relevant stakeholders from 14 AU member states representing each continental region convened to develop consensus treatment recommendations for select priority bacterial infections and clinical syndromes. In developing recommendations, the panels considered treatment recommendations from existing STGs, drug availability, clinical experience, and available antimicrobial resistance data. The guidelines underwent an external review process where clinical stakeholders who did not serve on either panel were invited to submit feedback prior to their publication. The guidelines provide empiric antibiotic therapy guidelines – including drug selection, route of administration, formulation, dosage, and therapy duration – and principles of stewardship for 28 bacterial infections or clinical syndromes. The first edition guidelines for the treatment of common infectious diseases and clinical syndromes in Africa aims to improve clinical treatment and antimicrobial stewardship and will serve as a template for future regional guidelines.

scholarly journals Urinary Tract Infection Caused By Enterococcus Spp: Risk Factors And Mortality. An Observational Study.

2020 ◽  
Author(s):  
Elisa Alvarez-Artero ◽  
Amaia Campo Nuñez ◽  
Inmaculada Garcia Garcia ◽  
Moises Garcia Bravo ◽  
Olia Cores ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Antimicrobial Treatment ◽  
Empiric Antibiotic Therapy ◽  
Enterococcus Spp ◽  
Empiric Antibiotic ◽  
Patients At Risk ◽  
Severe Comorbidity ◽  
Predictive Risk ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are frequently caused by Enterococcus spp. We aim to define the risk factors involved in UTIs caused by Enterococcus. Determine the overall mortality and predictive risk factors. Methods A retrospective in-patients study was conducted with bacteriemic UTIs caused by Enterococcus spp. We compared bacteriemic UTIs caused by Enterococcus spp. vs. a random sample of 100 in-patients with bacteriemic UTIs caused by others enterobacteria. Results We found 106 in-patients with UTIs caused by Enterococcus spp., 51 of whom had concomitant positive blood cultures. Distribution by species was: 83% E. faecalis and 17% E. faecium, with a Charlson comorbidity index of 5.9 ± 2.9. When we compared bacteriemic UTIs caused by Enterococcus spp. vs. bacteriemic UTIs caused by others enterobacteria we found the following independent predictors of bacteriemic UTI by Enterococcus: male sex with an OR of 6.1 (95%CI 2.3–16.1), uropathy with an OR of 4.1 (1.6–10.1), nosocomial infection with an OR of 3.8 (1.4–10.3), urinary cancer with an OR of 6.4 (1.3–30.3) and previous antimicrobial treatment with an OR of 18 (5.2–62.1). Overall, in-patient mortality was 16.5%, which was associated with a higher Sequential Organ Failure Assessment (SOFA) score (> 4), severe comorbidity such as immunosuppression, malignant hemopathy and nephrostomy, or Enterococcus faecium species and its pattern or resistance to ampicillin or vancomycin (p < 0.05). Appropriate empiric antibiotic therapy was not associated with a better prognosis (p > 0.05). Conclusions Enterococcus spp. is a frequent cause of complicated UTI by a profile of risk factors. High mortality secondary to a severe clinical setting and high comorbidity may be sufficient reasons for implementing empiric treatment of patients at risk, although we did not show a higher survival rate in patients with this treatment strategy.

scholarly journals Identification of volatile compounds from bacteria by spectrometric methods in medicine diagnostic and other areas: current state and perspectives

2021 ◽  
Vol 105 (16-17) ◽  
pp. 6245-6255
Author(s):  
Nils Kunze-Szikszay ◽  
Maximilian Euler ◽  
Thorsten Perl
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Infections ◽  
Point Of Care ◽  
Empiric Antibiotic Therapy ◽  
Current State ◽  
Point Of Care Diagnostics ◽  
Microbiological Methods ◽  
Empiric Antibiotic ◽  
Delayed Initiation ◽  
Species Specific

Abstract Diagnosis of bacterial infections until today mostly relies on conventional microbiological methods. The resulting long turnaround times can lead to delayed initiation of adequate antibiotic therapy and prolonged periods of empiric antibiotic therapy (e.g., in intensive care medicine). Therewith, they contribute to the mortality of bacterial infections and the induction of multidrug resistances. The detection of species specific volatile organic compounds (VOCs) emitted by bacteria has been proposed as a possible diagnostic approach with the potential to serve as an innovative point-of-care diagnostic tool with very short turnaround times. A range of spectrometric methods are available which allow the detection and quantification of bacterial VOCs down to a range of part per trillion. This narrative review introduces the application of spectrometric analytical methods for the purpose of detecting VOCs of bacterial origin and their clinical use for diagnosing different infectious conditions over the last decade. Key Points • Detection of VOCs enables bacterial differentiation in various medical conditions. • Spectrometric methods may function as point-of-care diagnostics in near future.

scholarly journals A rapid review of the overuse of antibiotics during the COVID-19 pandemic: lessons learned and recommendations for the future

2021 ◽  
Vol 3 ◽  
pp. 17
Author(s):  
Will Cherry ◽  
Marielle Brown ◽  
Colin Garner
Keyword(s):  
Antimicrobial Resistance ◽  
Bacterial Infections ◽  
Treatment Guidelines ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
Healthcare Systems ◽  
Antimicrobial Treatment ◽  
Lessons Learned ◽  
Rapid Review ◽  
Causative Agents

The coronavirus disease 2019 (COVID-19) pandemic has had severe implications on healthcare systems and the patients affected by this infectious disease. To improve outcomes for patients with COVID-19 and limit future antimicrobial resistance, there is continued urgency to improve our understanding of the rates and causative agents of secondary bacterial infections in patients with COVID‑19, and recognise whether antibiotics are being overused in patients prior to and following COVID-19 diagnosis. This article presents the results of a rapid review comparing reported rates of secondary bacterial infections with rates of antibiotic use in patients with COVID-19 predominantly in a hospital setting, within the context of treatment guidelines and recommendations. The review revealed rates of antibiotic use in patients with COVID-19 of 37–100%, far outweighing rates of secondary bacterial infections which were typically below 20%. There was a lack of consistent reporting of causative microorganisms of secondary infections, and the distinction between bacterially- and virally-induced sepsis was rarely made. Early in the pandemic, healthcare agencies published treatment guidelines recognising the importance of antimicrobial stewardship. However, many are yet to provide updated guidance detailing the most appropriate antibiotics to treat patients with concurrent COVID-19 and secondary bacterial infections in a way which limits the emergence of drug-resistant infections and does not negatively impact patient outcomes. Without significant improvements to the testing and reporting of causative organisms and corresponding updates to antimicrobial treatment guidelines, there is a risk of worsened clinical outcomes and increased burden on healthcare systems from antimicrobial resistance during the remainder of the COVID-19 pandemic and beyond.

scholarly journals Constructing Unit-Specific Empiric Treatment Guidelines for Catheter-Related and Primary Bacteremia by Determining the Likelihood of Inadequate Therapy

2012 ◽  
Vol 33 (4) ◽  
pp. 416-420 ◽  
Author(s):  
Megan E. Davis ◽  
Deverick J. Anderson ◽  
Michelle Sharpe ◽  
Luke F. Chen ◽  
Richard H. Drew
Keyword(s):  
Antibiotic Therapy ◽  
Treatment Guidelines ◽  
Bloodstream Infections ◽  
Empiric Antibiotic Therapy ◽  
In Vitro Susceptibility ◽  
Empiric Treatment ◽  
Inadequate Therapy ◽  
Empiric Antibiotic

This study aimed to determine the feasibility of using likelihood of inadequate therapy (LIT), a parameter calculated by using pathogen frequency and in vitro susceptibility for determination of appropriate empiric antibiotic therapy for primary bloodstream infections. Our study demonstrates that LIT may reveal differences in traditional antibiograms.

scholarly journals Change of antibiotic-resistant nosocomial microflora: Results of implementation of the strategy for control of antimicrobial treatment in multi speciality in-patient hospital

2015 ◽  
Vol 20 (5) ◽  
pp. 11-18 ◽  
Author(s):  
V. G Gusarov ◽  
E. E Nesterova ◽  
N. N Lashenkova ◽  
N. V Petrova ◽  
N. A Silaeva ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Resistance Index ◽  
Antimicrobial Treatment ◽  
Empiric Antibiotic Therapy ◽  
Beta Lactamases ◽  
Stewardship Program ◽  
Empiric Antibiotic ◽  
Extended Spectrum Beta Lactamases ◽  
The One ◽  
Staphylococcus Spp

The unreasonable use of antimicrobial preparations is the one of leading causes of the increase of microbial resistance to antibiotics in in-patient departments. With the aim of containment of the resistance of nosocomial flora in multi-disciplinary in-patient hospital during two years there is used Antimicrobial Stewardship Program (ASP) with the involvement of a team of specialists in appropriate antibiotic therapy, protocols of perioperative antibiotic prophylaxis and empiric antibiotic therapy (EAT), educational programs for personal and measures for the assessment of the efficacy of ASP. The efficacy was evaluated with the use of such indices as the change of the pattern of nosocomial germs, incidence of methicillin-resistant Staphylococcus spp., vancomycin-resistant strains of Enterococcus faecium (VRE), incidence of extended-spectrum beta-lactamases(ESBL)-producing microorganisms, prevalence of carbapenem-resistant gram-negatives, drug resistance index (DRI). Implementation of ASP allowed to properly change the structure of nosocomial germs, to attain the real decline of the incidence of methicillinresistant Staphylococcus aureus (MRSA) from 16,2% (95%CI: 12-20,4) to 10,4% (95%CI: 7-13,8), p

Immunoadjunctive Therapy against Bacterial Infections Using Herbal Medicines Based on Th17 Cell-mediated Protective Immunity

2021 ◽  
Vol 27 ◽  
Author(s):  
Haruaki Tomioka ◽  
Yutaka Tatano ◽  
Toshiaki Shimizu ◽  
Chiaki Sano
Keyword(s):  
Infectious Diseases ◽  
Th17 Cell ◽  
Bacterial Infections ◽  
Herbal Medicines ◽  
Antimicrobial Treatment ◽  
Clinical Treatment ◽  
Current Status ◽  
Health Concerns ◽  
Host Immune Responses ◽  
The World

: One of the major health concerns in the world is the global increase in intractable bacterial infectious diseases due to the emergence of multi- and extensively drug-resistant bacterial pathogens as well as an increase in compromised hosts around the world. Particularly, in the case of mycobacteriosis, the high incidence of tuberculosis in developing countries, resurgence of tuberculosis in industrialized countries, and increase in the prevalence of Mycobacterium avium complex infections are important worldwide health concerns. However, the development of novel antimycobacterial drugs is currently making slow progress. Therefore, it is considered that devising improved administration protocols for clinical treatment against refractory mycobacteriosis using existing chemotherapeutics is more practical than awaiting the development of new antimycobacterial drugs. The regulation of host immune responses using immunoadjunctive agents may increase the efficacy of antimicrobial treatment against mycobacteriosis. The same situations also exist in cases of intractable infectious diseases due to common bacteria other than mycobacteria. The mild and long-term up-regulation of host immune reactions in hosts with intractable chronic bacterial infections, using herbal medicines and medicinal plants, may be beneficial for such immunoadjunctive therapy. This review describes the current status regarding basic and clinical studies on therapeutic regimens using herbal medicines, useful for the clinical treatment of patients with intractable bacterial infections. In particular, we focus on immunoadjunctive effects of herbal medicines on the establishment and manifestation of host antibacterial immunity related to the immunological roles of Th17 cell lineages.

Urinary tract infection caused by enterococcus spp: risk factors and mortality.

2019 ◽  
Author(s):  
Elisa Alvarez Artero ◽  
Amaia Campo ◽  
Inmaculada Garcia Garcia ◽  
Moises Garcia Bravo ◽  
Olaia Cores ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Antimicrobial Treatment ◽  
Empiric Antibiotic Therapy ◽  
Enterococcus Spp ◽  
Empiric Antibiotic ◽  
Patients At Risk ◽  
Severe Comorbidity ◽  
Predictive Risk ◽  
Tract Infections

Abstract Purpose: Complicated urinary tract infections (UTIs) are frequently caused by Enterococcus spp. We aim to define the risk factors involved in UTIs caused by Enterococcus. Determine the overall mortality and predictive risk factors.Methods: A retrospective study was conducted. We compared the results with those of a random sample of patients with complicated UTIs infection caused by Escherichia coli.Results: We found 106 in-patients with UTIs caused by Enterococcus spp., 56 of whom had positive blood cultures. Distribution by species: 83% E. faecalis and 17% E. faecium, with a Charlson comorbidity index of 5.9±2.9. Only male sex with an OR of 2.8 (95%CI 1.2-6.4), nosocomial infection with an OR of 2.8 (95%CI 1.1-7), urinary catheter with an OR of 4.5 (95%CI 1.8-11.3), urinary cancer with an OR of 6.4 (2.1-19.4), and previous antimicrobial treatment with an OR of 4.3 (1.8-10.2) were independent predictors of Enterococcus infection. Overall, in-patient mortality was 16.5%, which was associated with a higher Sequential Organ Failure Assessment (SOFA) score (>4), severe comorbidity such as immunosuppression, malignant hemopathy and nephrostomy, or Enterococcus faecium species and its pattern or resistance to ampicillin or vancomycin (p<0.05). Appropriate empiric antibiotic therapy was not associated with a better prognosis (p >0.05).Conclusions: Enterococcus spp. is a frequent cause of complicated UTI by a profile of risk factors. High mortality secondary to a severe clinical setting and high comorbidity may be sufficient reasons for implementing empiric treatment of patients at risk, although we did not show a higher survival rate in patients with this treatment strategy.

Targeted empiric antibiotic therapy for children with non-oncological comorbidities and community-onset invasive bacterial infections

2015 ◽  
Vol 71 (3) ◽  
pp. 294-301 ◽  
Author(s):  
Rosy Wells ◽  
Kirsty Le Doare ◽  
Mike Sharland ◽  
Paul Heath ◽  
Shamez N. Ladhani ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Infections ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic ◽  
Community Onset

Evaluation of Susceptibility Patterns in Uropathogens and Empiric Antibiotic Therapy in the Emergency Department

2020 ◽  
pp. 001857872095796
Author(s):  
Mira Koro ◽  
Samuel Borgert ◽  
Andrew Abbott ◽  
Veena Venugopalan
Keyword(s):  
Escherichia Coli ◽  
Emergency Department ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bacterial Infections ◽  
Empiric Antibiotic Therapy ◽  
In Vitro Susceptibility ◽  
Empiric Antibiotic ◽  
Tract Infections ◽  
Susceptibility Patterns

Objectives: Urinary Tract Infections (UTIs) are the most common bacterial infections encountered in the Emergency Department (ED). Objectives of this study are to describe the urological pathogens associated with UTIs in the ED, report antibiotic susceptibilities, and assess empiric antibiotic treatment. Methods: A retrospective chart review of 154 patients with positive urine cultures from January to June 2016 were reviewed for inclusion in the study. Patients were excluded if less than 18 years of age, hospitalized, discharged from the ED without antibiotics or diagnosed with pyelonephritis. Patient demographics, uropathogens isolated, in-vitro susceptibility to commonly prescribed oral antibiotics (nitrofurantoin, ciprofloxacin, and sulfamethoxazole/trimethoprim), and antibiotics selected for treatment were recorded. Results: One hundred patients were included in the final analysis. Of the 106 bacterial isolates, Escherichia coli, Klebsiella pneumoniae, and Group B Streptococcus accounted for 62.5%, 8%, and 8% of pathogens, respectively. Overall susceptibilities were 88.1%, 87.9%, 85.4%, and 70.6% for nitrofurantoin, cefazolin, ciprofloxacin, and sulfamethoxazole/trimethoprim, respectively. Escherichia coli was most susceptible to nitrofurantoin at 96.9% followed by cefazolin at 94%. Ciprofloxacin was the most prescribed antibiotic followed by cephalexin, nitrofurantoin and sulfamethoxazole/trimethoprim. Conclusions: Based on bacterial susceptibility patterns, nitrofurantoin and cephalexin are reasonable first line agents in the empiric treatment of urinary tract infections identified in the emergency department. The most frequently prescribed antibiotic was ciprofloxacin, highlighting the importance of implementing antimicrobial stewardship initiatives and designing specific tools and educational programs for the emergency department targeted at minimizing fluoroquinolone use.

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