Implementation of a Simplified Pediatric Peri-Appendectomy Antibiotic Regimen

A simplified peri-appendectomy antibiotic regimen was as effective with fewer nursing resources and treatment costs

Evaluation of the Therapeutic Outcomes of Antibiotic Regimen Against Carbapenemase-Producing Klebsiella pneumoniae: A Systematic Review and Meta-Analysis

Background: Carbapenemase-producing Klebsiella pneumoniae (CpKP) has been implicated as an increasing threat to public health. CpKP is a ubiquitous, opportunistic pathogen that causes both hospital and community acquired infections. This organism hydrolyzes carbapenems and other β-lactams and thus, leading to multiple resistance to these antibiotics. Despite the difficult to treat nature of infections caused by CpKP, little has been discussed on the mortality, clinical response and microbiological success rates associated with various antibiotic regimen against CpKP. This meta-analysis was designed to fill the paucity of information on the clinical impact of various antibiotic therapeutic regimens among patients infected with CpKP.Materials and Methods: Literature in most English databases such as Medline through PubMed, Google Scholar, Web of Science, Cochrane Library and EMBASE, were searched for most studies published between the years 2015–2020. Data were analyzed using the R studio 2.15.2 statistical software program (metaphor and meta Package, Version 2) by random-effects (DerSimonian and Laird) model.Results: Twenty-one (21) studies including 2841 patients who had been infected with CpKP were analysed. The overall mortality rate was 32.2% (95%CI = 26.23–38.87; I2 = 89%; p-value ≤ 0.01, Number of patients = 2716). Pooled clinical and microbiological success rates were 67.6% (95%CI = 58.35–75.64, I2 = 22%, p-value = 0.25, Number of patients = 171) and 74.9% (95%CI = 59.02–86.09, I2 = 53%, p-value = 0.05, Number of patients = 121), respectively. CpKP infected patients treated with combination therapy are less likely to die as compared to those treated with monotherapy (OR = 0.55, 95%CI = 0.35–0.87, p-value = 0.01, Number of patients = 1,475). No significant difference existed between the mortality rate among 60years and above patients vs below 60years (OR = 0.84, 95%CI = 0.28–2.57, p-value = 0.76, 6 studies, Number of patients = 1,688), and among patients treated with triple therapy vs. double therapy (OR = 0.50, 95%CI = 0.21–1.22, p-value = 0.13, 2 studies, Number of patients = 102). When compared with aminoglycoside-sparing therapies, aminoglycoside-containing therapies had positive significant outcomes on both mortality and microbiological success rates.Conclusion: New effective therapies are urgently needed to help fight infections caused by this organism. The effective use of various therapeutic options and the strict implementation of infection control measures are of utmost importance in order to prevent infections caused by CpKP. Strict national or international implementation of infection control measures and treatment guidelines will help improve healthcare, and equip governments and communities to respond to and prevent the spread of infectious diseases caused by CpKP.

141. A Blind Spot for Antibiotic Stewardship Programs: Misadministration of Perioperative Antibiotics

Background Hospitalized patients requiring intravenous antibiotics frequently undergo surgical intervention. These surgeries involve multiple transitions of care that may lead to antibiotic delay, additional unnecessary doses, omission, or substitution. While many studies examine the use of antibiotics for surgical site infection prophylaxis, there are no studies investigating antibiotic use in the perioperative period for inpatients already on an IV antibiotic regimen. This study examined the incidence and nature of antibiotic misadministration in the perioperative period among inpatients. Methods We conducted a retrospective cross-sectional study at a Veterans Affairs Medical Center involving all inpatients who underwent surgery in 2019. Patients 18 years or older who were on an IV antibacterial regimen prior to surgery were included. Patients undergoing cardiac surgery and patients only receiving surgical infection prophylaxis were excluded. Through manual chart review, we collected information on the prescribed IV antibiotic regimen and timing of antibiotic doses in the perioperative period. Errors were classified as administration of additional unnecessary IV antibiotics and missed, delayed, and additional doses of prescribed IV antibiotics. Results There were 168 inpatients on an IV antibiotic regimen who underwent surgery in 2019. Complete data was available for 158 patients. Errors in antibiotic administration in the perioperative period were identified in 64 (41%) patients. Missed, delayed, additional unnecessary antibiotics, and additional doses of prescribed IV antibiotics were identified in 21 patients (13%), 14 patients (9%), 13 patients (8%), and 7 patients (4%), respectively (Figure 1). Conclusion We found errors in antibiotic administration for inpatients undergoing surgery to be common, with the most frequent error being a missed dose of a prescribed IV antibiotic. This illustrates an area for quality improvement in inpatient antibiotic stewardship in our hospital and we suspect in other hospitals as well. Future work will incorporate more centers and examine how these errors affect outcomes for inpatients undergoing surgery, particularly in patients with sepsis or those requiring surgery for infection source control. Disclosures All Authors: No reported disclosures

Lactococcus lactis bacteraemia in a patient on probiotic supplementation therapy

A 59-year-old woman presented with fever and malaise and was found to have Lactococcus lactis bacteraemia. L. lactis infection is rare in humans with few reported cases, with most associated with dairy food product ingestion. The patient reported use of a multistrain over-the-counter probiotic supplement. After isolation of L. lactis from blood culture, the patient was treated empirically with ertapenem and amoxicillin and displayed clinical improvement. She remained well after completion of antibiotic regimen and discontinued probiotic supplementation use. We review the clinical presentation of L. lactis infection including diagnosis, identification and treatment.

A Case Report of Mycetoma and Cranial Osteomyelitis by Nocardia nova

Mycetoma is a chronic, localized, slowly progressive, granulomatous infection of the skin that may progress to subcutaneous tissue, muscle and bone. It is an infrequent manifestation of Nocardia infection that predominantly occurs on the lower extremities.A previously healthy, 17-year-old boy presented with a 3-month history of scalp abscesses. On physical examination he had numerous, large left parietal and occipital inflammatory nodules on the scalp covered by alopecic skin and several sinuses discharging a purulent and serosanguinous material. He underwent a CT-scan and an MRI of the skull that revealed signs of cranial osteomyelitis and epidural empyema. Polymerase chain reaction assay of the purulent exudate was performed and identified Nocardia nova. The patient was discharged from the hospital after 8 weeks of antibiotherapy with meropenem and TMP-SMX with clinical, laboratorial and imaging improvement. He completed 12 months of outpatient oral therapy with TMP-SMX, after which cranial CT-scan showed a significant reduction of soft tissue thickening and bone reconstitution, with no relapses after stopping the treatment.The best antibiotic regimen and length of treatment are not established for the management of nocardiosis. This is an unusual and severe presentation of infection by Nocardia nova with extent to the bone and epidural space, with full recovery under standard antibiotic therapy. This case shows that a good outcome may be achieved with prolonged antimicrobial treatment in an immunocompetent patient.

THE REASONABLENESS OF USING DRUGS TO TREAT PNEUMONIA

Objective: To investigate the reasonableness of using drugs to treat pneumonia at Can Tho Children’s Hospital. Subjects and methods: a retrospective-descriptive study on 384 inpatient medical records at Can Tho Children’s Hospital from January 2019 to December 2019 was diagnosed pneumonia. Results: The percentage of the initial treatment regimen that was not reasonable with the recommended antibiotic regimen was relatively high at 84.11%. The proportion of antibiotics with inappropriate dose was only 1.71% of the total number of surveyed cases. The appropriate rate of antibiotic dose was 98.29%. The proportion of adjuvants with high appropriate doses such as Salbutamol, Hydrocortison and Prednisolon accounted for 100%. The rate of taking antibiotics in accordance with recommendations accounted for 94.67%. The rate of adjuvanvt drug delivery was very high, there were only a few cases that did not comply with recommendations such as Ibuprofen with 14 cases, accounting for 37.84%, Acetylcysteine ​​and Hydrocortison accounted for 14.58% with 7 cases, and Prednisolon and Budesonid accounted for the very low percentage. Conclusion: The proportion of the initial treatment regimen that was not compatible with the antibiotic regimen was relatively high. The appropriate rate of antibiotic dose was high. The proportion of adjuvants with suitable doses was high such as Salbutamol, Hydrocortison and Prednisolon. The antibiotic delivery rate was consistent with recommendations. The rate of adjuvant delivery was very high.

SITUATION OF DRUGS FOR TREATMENT INTESTINAL INFECTION

Objective: To survey the use of drugs to treat intestinal infection at Can Tho Children’s Hospital. Objects and methods: Cross-sectional retrospective descriptive study on 400 medical records of pediatric patients diagnosed with intestinal infection in Can Tho City Children’s Hospital in 2019. Result: There were 353 pediatric patients using rehydration and electrolytes measeurement, ORS with the highest frequency was 38.66%. The antibiotic with the highest frequency of use was the beta-lactam 3rd group. In which, Cefotaxim had the most use frequency. Single regimen of cefotaxim used the most with a frequency of 70.06%. Meanwhile, the antibiotic regimen cefotaxime combined with tobramycin was the highest in the combined regimen with 57.14%. Up to 70 cases changed the regimen due to ineffective results and 22 cases changed the regimen due to its effectiveness, reducing the amount of antibiotics. The first regimen with the highest frequency of change was the cefotaxim regimen with 33 cases. The 2nd regimens changed with the highest frequency were cefotaxim regimen and regimen of cefotaxim combined with tobramycin with 5 cases. The third change of regimen was mostly from combination antibiotic regimen to single regimen. Conclusion: Rehydration and electrolyte measures were mainly ORS. Antibiotics used mainly in the beta-lactam 3rd group, Cefotaxim had the highest frequency of use. Cefotaxim was used the most frequency in a single regimen. The antibiotic combined regimen between cefotaxime and tobramycin was the highest use in all combined regimens. Changing treatment regimen was mainly due to the ineffective effect.