Bifidobacterium longum BB536 and Changes in Septicemia Markers Associated with Antibiotic Use in Critically Ill Patients

2018 ◽  
Vol 07 (02) ◽  
Author(s):  
Takao Arai ◽  
Shiro Mishima ◽  
Shoichi Ohta ◽  
Tetsuo Yukioka ◽  
Tetsuya Matsumoto
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Bifidobacterium Longum ◽  
Antibiotic Use

scholarly journals 325. Empiric Antibiotics for COVID-19 and the Utility of Procalcitonin

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S267-S268
Author(s):  
Adrienne D Desens ◽  
Kiya D Mohadjer ◽  
Jessica Thompson
Keyword(s):  
Critically Ill ◽  
Median Time ◽  
Critically Ill Patients ◽  
Antibiotic Use ◽  
Secondary Outcome ◽  
Clinical Resolution ◽  
Procalcitonin Level ◽  
Empiric Antibiotics ◽  
Bacterial Coinfection ◽  
The Impact

Abstract Background Bacterial coinfection in COVID-19 is infrequent, yet empiric antibiotic use is common. The objectives of this study were to investigate the effect of empiric antibiotics on time to resolution of COVID-19 pneumonia, elucidate the impact of COVID-19 on procalcitonin levels, and determine the incidence of respiratory bacterial coinfection. Methods This was a retrospective study of adult patients hospitalized with COVID-19 between June 1, 2020 and September 30, 2020. Patients were included if they had at least one procalcitonin level. They were excluded if admitted to an intensive care unit within 24 hours of presentation or received antibiotics for an indication besides pneumonia. Patients were stratified into 4 groups based on procalcitonin level and receipt of antibiotics. The primary outcome was time to clinical resolution of pneumonia. A key secondary outcome was incidence of confirmed respiratory bacterial coinfection. Results A total of 199 patients were included. Patients with a procalcitonin greater than 0.25 ng/mL who received antibiotics had a longer median time to clinical resolution of pneumonia, 8 days (95% CI, 4 to 11 days) vs. 3 or 4 days in other groups (P< 0.001). Additionally, this same group required greater baseline oxygen supplementation, had more comorbidities, and increased mortality compared to all other groups. Median time to clinical resolution of pneumonia was also longer in patients who received antibiotics compared to those who did not (5 vs. 4 days, P=0.017) and in those with a procalcitonin greater than 0.25 ng/mL compared to those with PCT less than or equal to 0.25 ng/mL (7 vs. 4 days, P< 0.001). Renal dysfunction was more prevalent in patients with an elevated procalcitonin (45% vs. 17.5%). The overall incidence of confirmed respiratory bacterial coinfection was 1.5%. Conclusion Irrespective of procalcitonin level, empiric antibiotics were not associated with a shorter time to resolution of COVID-19 pneumonia in non-critically ill patients. Elevated procalcitonin is likely a reflection of the severity of COVID-19 disease and baseline renal function rather than bacterial infection. Additionally, the overall incidence of confirmed bacterial coinfection in non-critically ill patients hospitalized with COVID-19 was low. Disclosures Kiya D. Mohadjer, PharmD, BCPS, BCIDP, Eli Lilly and Company (Shareholder)Gilead Sciences (Shareholder)

How Could We Reduce Antibiotic Use in Critically Ill Patients?

2011 ◽  
Vol 11 (4) ◽  
pp. 376-383 ◽  
Author(s):  
Giulia De Angelis ◽  
Giovanni Restuccia ◽  
Roberto Cauda ◽  
Evelina Tacconelli
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antibiotic Use

scholarly journals Antibiotic Use and Fatal Outcomes among Critically Ill Patients with COVID-19 in Tacna, Peru

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 959
Author(s):  
Cesar Copaja-Corzo ◽  
Miguel Hueda-Zavaleta ◽  
Vicente A. Benites-Zapata ◽  
Alfonso J. Rodriguez-Morales
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antibiotic Use ◽  
Resistant Bacteria ◽  
Healthcare Associated Infection ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Healthcare Associated ◽  
Selection Of

Overuse of antibiotics during the Coronavirus Disease 2019 (COVID-19) pandemic could increase the selection of extensively resistant bacteria (XDR). However, it is unknown what impact they could have on the evolution of patients, particularly critically ill patients. This study aimed to evaluate the characteristics and impact of ICU-acquired infections in patients with COVID-19. A retrospective cohort study was conducted, evaluating all patients with critical COVID-19 admitted to the intensive care unit (ICU) of a hospital in Southern Peru from 28 March 2020 to 1 March 2021. Of the 124 patients evaluated, 50 (40.32%) developed a healthcare-associated infection (HAI), which occurred at a median of 8 days (IQR 6–17) after ICU admission. The proportion of patients with HAI that required ceftriaxone was significantly higher; the same was true for the use of dexamethasone. Forty bacteria isolations (80%) were classified as XDR to antibiotics, with the most common organisms being Acinetobacter baumannii (54%) and Pseudomonas aeruginosa (22%); 33% (41/124) died at the ICU during the follow-up. In the adjusted analysis, healthcare-associated infection was associated with an increased risk of mortality (aHR= 2.7; 95% CI: 1.33–5.60) and of developing acute renal failure (aRR = 3.1; 95% CI: 1.42–6.72). The incidence of healthcare infection mainly by XDR pathogens is high in critically ill patients with COVID-19 and is associated with an increased risk of complications or death.

scholarly journals Is a Single Initial Procalcitonin Test Sufficient in Septic, Critically Ill Patients to Minimize Antibiotic Use?

CHEST Journal ◽  
2017 ◽  
Vol 152 (1) ◽  
pp. 218-219 ◽  
Author(s):  
Jos A.H. van Oers ◽  
Evelien de Jong ◽  
Albertus B. Beishuizen ◽  
Maarten W. Nijsten ◽  
Armand R. Girbes ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antibiotic Use

scholarly journals Using Procalcitonin to Guide Antibiotic Therapy

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Chanu Rhee
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Respiratory Infections ◽  
Optimal Strategies ◽  
Antibiotic Use ◽  
Future Research ◽  
Suspected Sepsis ◽  
Clinical Scenarios ◽  
Risk Patients ◽  
Guidance Study

Abstract Procalcitonin levels rise in response to systemic inflammation, especially of bacterial origin. Multiple randomized controlled trials have demonstrated that procalcitonin-based algorithms can safely reduce antibiotic use in 2 clinical scenarios. First, in stable, low-risk patients with respiratory infections, procalcitonin levels of <0.25 µg/L can guide the decision to withhold antibiotics or stop therapy early. Second, in critically ill patients with suspected sepsis, clinicians should not initially withhold antibiotics, but procalcitonin levels of <0.5 µg/L or levels that decrease by ≥80% from peak can guide discontinuation once patients stabilize. The recent stop antibiotics on procalcitonin guidance study (SAPS), the largest procalcitonin trial to date, demonstrated reduction in both antibiotic exposure and mortality in critically ill patients. Although procalcitonin is ready for routine use, future research should examine optimal strategies for implementation in hospitals, its real-world impact on clinical outcomes and costs, its applicability to immunocompromised patients, and the generalizability of trials to the US population.

scholarly journals ICU Patients’ Antibiotic Exposure and Triazole-Resistance in Invasive Candidiasis: Parallel Analysis of Aggregated and Individual Data

2021 ◽  
Vol 12 ◽  
Author(s):  
Yan Wang ◽  
Ying Zhang ◽  
Treasure M. McGuire ◽  
Samantha A. Hollingworth ◽  
Mieke L. Van Driel ◽  
...  
Keyword(s):  
Critically Ill ◽  
Invasive Candidiasis ◽  
Critically Ill Patients ◽  
Time Lag ◽  
Antibiotic Use ◽  
Cross Resistance ◽  
Group Level ◽  
Individual Patient Level ◽  
Patient Level ◽  
The Individual

Background: The relationship between antibiotic use and the incidence of triazole-resistant phenotypes of invasive candidiasis (IC) in critically ill patients is unclear. Different methodologies on determining this relationship may yield different results.Methods: A retrospective multicenter observational analysis was conducted to investigate exposure to antibiotics and the incidence of non-duplicate clinical isolates of Candida spp. resistant to fluconazole, voriconazole, or both during November 2013 to April 2018, using two different methodologies: group-level (time-series analysis) and individual-patient-level (regression analysis and propensity-score adjusting).Results: Of 393 identified Candida spp. from 388 critically ill patients, there were three phenotypes of IC identified: fluconazole-resistance (FR, 63, 16.0%); voriconazole-resistance (VR, 46, 11.7%); and cross-resistance between fluconazole and voriconazole (CR, 32, 8.1%). Exposure to several antibacterial agents with activity against the anaerobic gastrointestinal flora, especially third-generation cefalosporins (mainly cefoperazone/sulbactam and ceftriaxone), but not triazoles, have an immediate effect (time lag = 0) on subsequent ICU-acquired triazole-resistant IC in the group-level (p < 0.05). When the same patient database was analyzed at the individual-patient-level, we found that exposure to many antifungal agents was significantly associated with triazole-resistance (fluconazole [adjusted odds ratio (aOR) = 2.73] or caspofungin [aOR = 11.32] on FR, voriconazole [aOR = 2.87] on CR). Compared to the mono-triazole-resistant phenotype, CR IC has worse clinical outcomes (14-days mortality) and a higher level of resistance.Conclusion: Group-level and individual-patient-level analyses of antibiotic-use-versus-resistance relations yielded distinct but valuable results. Antibacterials with antianaerobic activity and antifungals might have “indirect” and “direct” effect on triazole-resistant IC, respectively.

scholarly journals Point-of-care Procalcitonin Guidance to Reduce Antibiotic Use in Critically Ill Patients: A Randomized Controlled Trial

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Wan Fadzlina Wan Muhd Shukeri ◽  
Azrina Md. Ralib ◽  
Mohd Basri Mat-Nor
Keyword(s):  
Randomized Controlled Trial ◽  
Antibiotic Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Controlled Trial ◽  
Clinical Signs ◽  
Antibiotic Use ◽  
Randomized Controlled ◽  
Prolonged Duration

Introduction: Antibiotic therapy is of great importance in sepsis but prolonged duration can add to the emergence of antibiotic resistance. We aimed to examine whether point-of-care (POC) procalcitonin (PCT) guidance can safely reduce the duration of antibiotic use in infected critically ill patients. Materials and Methods: Eighty adult patients admitted to or acquired sepsis in the intensive care unit (ICU) were enrolled in this randomized controlled trial. Patients were allocated to either POC PCT-guided intervention arm (n=40) or the control arm, in which antibiotic therapy followed local guidelines (n=40). In the PCT-guided arm, antibiotic treatment was discontinued if clinical signs of infection improved and the PCT concentration decreased by >80% of its peak value, or when it reaches a value of <0·5 g/L. Results: The mean duration of antibiotic use for PCT arm was 6.4 (SD 2.3) days compared to 9 (SD 4.3) days in the control arm (p=0.004). In the first 30 days after being assigned to a group, the proportion of patients who received a repeated course of systemic antibiotics was 33% in the PCT arm vs 38.1% in the control arm (p=0.757). Mean length of stay in the ICU was 8.4 (SD 5.3) days in the PCT arm vs 10.4 (SD 12.3) days in the control arm (p=0.404). Mortality at 30 days was 22.5% in the PCT-arm vs 25% in the control arm (p<0.0001). Conclusion: POC PCT guidance stimulates reduction of duration of antibiotic use in ICU, accompanied by a significant decrease in mortality.

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