scholarly journals Predicting peritoneal contamination with enterobacteria producing extendedspectrum beta-lactamases and choosing empirical antibacterial therapy for postoperative peritonitis in cancer patients

2021 ◽  
Vol 60 (2) ◽  
pp. 4-8
Author(s):  
I. F. Shishlo ◽  
S. A. Krasny ◽  
Yu. N. Dolgina
Keyword(s):  
Risk Factors ◽  
Antibacterial Therapy ◽  
Predictive Accuracy ◽  
Postoperative Peritonitis ◽  
Empiric Antibiotic Therapy ◽  
Beta Lactamases ◽  
Peritoneal Contamination ◽  
Empirical Antibacterial Therapy ◽  
Empiric Antibiotic ◽  
Extended Spectrum Beta Lactamases

Enterobacteriaceae family microorganisms, specifically E. coli and K. pneumoniae isolates, are the most common activators of postoperative peritonitis in oncology. Many of these microorganisms produce extended-spectrum beta-lactamases (ESBL). The deemed resistance of ESBL-producing enterobacteria to all β-lactam antibiotics, except for carbapenems, leads to ineffectiveness of empiric antibiotic therapy. Purpose of the study: To define the risk factors of peritoneal contamination with ESBL-producing enterobacteria for choosing optimal empirical antibacterial therapy on the example of a specific cancer patient with postoperative peritonitis. Results: Independent risk factors of peritoneal contamination with ESBL-producing enterobacteria included “the administration of antibiotics for more than three days” (OR 106, 95% CI 21.0-537, p<0.001), “two or more relaparotomies” (OR 2.66, 95% CI 1.32-5.34, p =0.006), and “postoperative preventive antibiotic treatment” (OR 0.17, 95% CI 0.04-0.75, p =0.02). The obtained prognostic model allowed predicting the infection with ESBL-producing enterobacteria before establishing the postoperative peritonitis microbial etiology. The model sensitivity was 94.7%, overall predictive accuracy was 73.1. Conclusion: Prolonged administration of antibiotics (3rd-generation cephalosporins and/or fluoroquinolones) after cancer surgery to prevent surgical infections is the main independent risk factor of peritoneal contamination with ESBL- producing enterobacteria.

scholarly journals Predicting peritoneal contamination with enterobacteria producing extended-spectrum beta-lactamases and choosing empirical antibacterial therapy for postoperative peritonitis in cancer patients

2021 ◽  
Vol 60 (2) ◽  
pp. 4-8
Author(s):  
I. F. Shishlo ◽  
S. A. Krasny ◽  
Yu. N. Dolgina
Keyword(s):  
Risk Factors ◽  
Antibacterial Therapy ◽  
Predictive Accuracy ◽  
Postoperative Peritonitis ◽  
Empiric Antibiotic Therapy ◽  
Beta Lactamases ◽  
Extended Spectrum ◽  
Peritoneal Contamination ◽  
Empirical Antibacterial Therapy ◽  
Extended Spectrum Beta Lactamases

Relevance: Enterobacteriaceae family microorganisms, specifically E. coli and K. pneumoniae isolates, are the most common activators of postoperative peritonitis in oncology. Many of these microorganisms produce extended-spectrum beta-lactamases (ESBL). The deemed resistance of ESBL-producing enterobacteria to all β-lactam antibiotics, except for carbapenems, leads to the ineffectiveness of empiric antibiotic therapy. The purpose of the study was to define the risk factors of peritoneal contamination with ESBL-producing enterobacteria for choosing optimal empirical antibacterial therapy on the example of a specific cancer patient with postoperative peritonitis. Results: Independent risk factors of peritoneal contamination with ESBL-producing enterobacteria included “the administration of antibiotics for more than three days” (OR 106, 95% CI 21.0-537, p<0.001), “two or more repeated laparotomies” (OR 2.66, 95% CI 1.32-5.34, p=0.006), and “postoperative preventive antibiotic treatment” (OR 0.17, 95% CI 0.04-0.75, p=0.02). The obtained prognostic model allowed predicting the infection with ESBL-producing enterobacteria before establishing the postoperative peritonitis microbial etiology. The model sensitivity was 94.7%, overall predictive accuracy was 73.1. Conclusion: Prolonged administration of antibiotics (3rd-generation cephalosporins and/or fluoroquinolones) after cancer surgery to prevent surgical infections is the main independent risk factor of peritoneal contamination with ESBL- producing enterobacteria.

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

scholarly journals Local audit of empiric antibiotic therapy in bacteremia: A retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248817
Author(s):  
Anthony D. Bai ◽  
Neal Irfan ◽  
Cheryl Main ◽  
Philippe El-Helou ◽  
Dominik Mertz
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Blood Culture ◽  
Antibiotic Therapy ◽  
Retrospective Cohort Study ◽  
Clinical Pathway ◽  
Retrospective Cohort ◽  
Negative Likelihood Ratio ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic

Background It is unclear if a local audit would be useful in providing guidance on how to improve local practice of empiric antibiotic therapy. We performed an audit of antibiotic therapy in bacteremia to evaluate the proportion and risk factors for inadequate empiric antibiotic coverage. Methods This retrospective cohort study included patients with positive blood cultures across 3 hospitals in Hamilton, Ontario, Canada during October of 2019. Antibiotic therapy was considered empiric if it was administered within 24 hours after blood culture collection. Adequate coverage was defined as when the isolate from blood culture was tested to be susceptible to the empiric antibiotic. A multivariable logistic regression model was used to predict inadequate empiric coverage. Diagnostic accuracy of a clinical pathway based on patient risk factors was compared to clinician’s decision in predicting which bacteria to empirically cover. Results Of 201 bacteremia cases, empiric coverage was inadequate in 56 (27.9%) cases. Risk factors for inadequate empiric coverage included unknown source at initiation of antibiotic therapy (adjusted odds ratio (aOR) of 2.76 95% CI 1.27–6.01, P = 0.010) and prior antibiotic therapy within 90 days (aOR of 2.46 95% CI 1.30–4.74, P = 0.006). A clinical pathway that considered community-associated infection as low risk for Pseudomonas was better at ruling out Pseudomonas bacteremia with a negative likelihood ratio of 0.17 (95% CI 0.03–1.10) compared to clinician’s decision with negative likelihood ratio of 0.34 (95% CI 0.10–1.22). Conclusions An audit of antibiotic therapy in bacteremia is feasible and may provide useful feedback on how to locally improve empiric antibiotic therapy.

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 The higher prevalence of extended spectrum beta-lactamases among Escherichia coli ST131 in Southeast Asia is driven by expansion of a single, locally prevalent subclone

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Swaine L. Chen ◽  
Ying Ding ◽  
Anucha Apisarnthanarak ◽  
Shirin Kalimuddin ◽  
Sophia Archuleta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
South America ◽  
Southeast Asia ◽  
Sequence Type ◽  
Beta Lactamases ◽  
Extended Spectrum Beta Lactamases ◽  
Mlst Type ◽  
Excess Resistance

Abstract The ST131 multilocus sequence type (MLST) of Escherichia coli is a globally successful pathogen whose dissemination is increasing rates of antibiotic resistance. Numerous global surveys have demonstrated the pervasiveness of this clone; in some regions ST131 accounts for up to 30% of all E. coli isolates. However, many regions are underrepresented in these published surveys, including Africa, South America, and Asia. We collected consecutive bloodstream E. coli isolates from three countries in Southeast Asia; ST131 was the most common MLST type. As in other studies, the C2/H30Rx clade accounted for the majority of ST131 strains. Clinical risk factors were similar to other reported studies. However, we found that nearly all of the C2 strains in this study were closely related, forming what we denote the SEA-C2 clone. The SEA-C2 clone is enriched for strains from Asia, particularly Southeast Asia and Singapore. The SEA-C2 clone accounts for all of the excess resistance and virulence of ST131 relative to non-ST131 E. coli. The SEA-C2 strains appear to be locally circulating and dominant in Southeast Asia, despite the intuition that high international connectivity and travel would enable frequent opportunities for other strains to establish themselves.

scholarly journals Epidemiology of Inappropriate Empiric Antibiotic Therapy for Bacteremia Based on Discordant In vitro Susceptibilities: Risk factors and Taxon-level Variation in Burden and Outcome in 156 US hospitals, 2000–2014

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S13-S14
Author(s):  
Sameer S Kadri ◽  
Yi Ling Lai ◽  
Emily Ricotta ◽  
Jeffrey Strich ◽  
Ahmed Babiker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Therapy ◽  
Empiric Antibiotic Therapy ◽  
In Vitro Susceptibility ◽  
Gram Negative ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Empiric Antibiotic

Abstract Background Discordance between in vitro susceptibility and empiric antibiotic therapy is inextricably linked to antibiotic resistance and decreased survival in bloodstream infections (BSI). However, its prevalence, patient- and hospital-level risk factors, and impact on outcome in a large cohort and across different pathogens remain unclear. Methods We examined in vitro susceptibility interpretations for bacterial BSI and corresponding antibiotic therapy among inpatient encounters across 156 hospitals from 2000 to 2014 in the Cerner Healthfacts database. Discordance was defined as nonsusceptibility to initial therapy administered from 2 days before pathogen isolation to 1 day before final susceptibility reporting. Discordance prevalence was compared across taxa; risk factors and its association with in-hospital mortality were evaluated by logistic regression. Adjusted odds ratios (aOR) were estimated for pathogen-, patient- and facility-level factors. Results Of 33,161 unique encounters with BSIs, 4,219 (13%) at 123 hospitals met criteria for discordant antibiotic therapy, ranging from 3% for pneumococci to 55% for E. faecium. Discordance was higher in recent years (2010–2014 vs. 2005–2009) and was associated with older age, lower baseline SOFA score, urinary (vs. abdominal) source and hospital-onset BSI, as well as ≥500-bed, Midwestern, non-teaching, and rural hospitals. Discordant antibiotic therapy increased the risk of death [aOR = 1.3 [95% CI 1.1–1.4]). Among Gram-negative taxa, discordant therapy increased risk of mortality associated with Enterobacteriaceae (aOR = 1.3 [1.0–1.6]) and non-fermenters (aOR = 1.7 [1.1–2.5]). Among Gram-positive taxa, risk of mortality from discordant therapy was significantly higher for S. aureus (aOR = 1.3 [1.1–1.6]) but unchanged for streptococcal or enterococcal BSIs. Conclusion The prevalence of discordant antibiotic therapy displayed extensive taxon-level variability and was associated with patient and institutional factors. Discordance detrimentally impacted survival in Gram-negative and S. aureus BSIs. Understanding reasons behind observed differences in discordance risk and their impact on outcomes could inform stewardship efforts and guidelines for empiric therapy in sepsis. Disclosures All authors: No reported disclosures.

Nosocomial Bacterial Pneumonia in HIV-Infected Patients: Risk Factors for Adverse Outcome and Implications for Rational Empiric Antibiotic Therapy

Infection ◽  
2006 ◽  
Vol 34 (1) ◽  
pp. 9-16 ◽  
Author(s):  
F. Franzetti ◽  
A. Grassini ◽  
M. Piazza ◽  
M. Degl’Innocenti ◽  
A. Bandera ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Therapy ◽  
Bacterial Pneumonia ◽  
Adverse Outcome ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic

scholarly journals Carriage of Enterobacteria Producing Extended-Spectrum β-Lactamases and Composition of the Gut Microbiota in an Amerindian Community

2015 ◽  
Vol 60 (1) ◽  
pp. 507-514 ◽  
Author(s):  
María José Gosalbes ◽  
Jorge F. Vázquez-Castellanos ◽  
Cécile Angebault ◽  
Paul-Louis Woerther ◽  
Etienne Ruppé ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gut Microbiota ◽  
Individual Risk ◽  
Content Type ◽  
Beta Lactamases ◽  
Extended Spectrum ◽  
Extended Spectrum Beta Lactamases ◽  
Individual Risk Factors

ABSTRACTEpidemiological and individual risk factors for colonization by enterobacteria producing extended-spectrum beta-lactamases (E-ESBL) have been studied extensively, but whether such colonization is associated with significant changes in the composition of the rest of the microbiota is still unknown. To address this issue, we assessed in an isolated Amerindian Guianese community whether intestinal carriage of E-ESBL was associated with specificities in gut microbiota using metagenomic and metatranscriptomic approaches. While the richness of taxa of the active microbiota of carriers was similar to that of noncarriers, the taxa were less homogeneous. In addition, species of four genera,Desulfovibrio,Oscillospira,Parabacteroides, andCoprococcus, were significantly more abundant in the active microbiota of noncarriers than in the active microbiota of carriers, whereas such was the case only for species ofDesulfovibrioandOscillospirain the total microbiota. Differential genera in noncarrier microbiota could either be associated with resistance to colonization or be the consequence of the colonization by E-ESBL.

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