Empiric Antibiotic Treatment
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Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 182
Bernardo A. Martinez-Guerra ◽  
Maria F. Gonzalez-Lara ◽  
Nereyda A. de-Leon-Cividanes ◽  
Karla M. Tamez-Torres ◽  
Carla M. Roman-Montes ◽  

Objective: To describe empirical antimicrobial prescription on admission in patients with severe COVID-19, the prevalence of Hospital-Acquired Infections, and the susceptibility patterns of the causing organisms. Methods: In this prospective cohort study in a tertiary care center in Mexico City, we included consecutive patients admitted with severe COVID-19 between March 20th and June 10th and evaluated empirical antimicrobial prescription and the occurrence of HAI. Results: 794 patients with severe COVID-19 were admitted during the study period. Empiric antibiotic treatment was started in 92% of patients (731/794); the most frequent regimes were amoxicillin-clavulanate plus atypical coverage in 341 (46.6%) and ceftriaxone plus atypical coverage in 213 (29.1%). We identified 110 HAI episodes in 74/656 patients (11.3%). Ventilator-associated pneumonia (VAP) was the most frequent HAI, in 56/110 (50.9%), followed by bloodstream infections (BSI), in 32/110 (29.1%). The most frequent cause of VAP were Enterobacteriaceae in 48/69 (69.6%), followed by non-fermenter gram-negative bacilli in 18/69 (26.1%). The most frequent cause of BSI was coagulase negative staphylococci, in 14/35 (40.0%), followed by Enterobacter complex in 7/35 (20%). Death occurred in 30/74 (40.5%) patients with one or more HAI episodes and in 193/584 (33.0%) patients without any HAI episode (p < 0.05). Conclusion: A high frequency of empiric antibiotic treatment in patients admitted with COVID-19 was seen. VAP and BSI were the most frequent hospital-acquired infections, due to Enterobacteriaceae and coagulase negative staphylococci, respectively.

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S751-S751
Saeed Shoar ◽  
Daniel Musher

Abstract Background Background: Recent guidelines recommend immediate empiric antibiotic treatment for patients (pts) with community-acquired pneumonia (CAP). Concerns about treatment recommendations and antibiotic stewardship motivated a systematic literature review of the etiology of CAP. Methods We reviewed English-language literature using PRISMA guidelines. Data were stratified into diagnostic categories according to the microbiologic studies that were done (Table1). Fig.1. Flowchart of systematic literature review and study selection Table 1. Characteristics of studies reporting the etiology of community-acquired pneumonia Results 146 articles with 82,674 CAP pts met criteria for inclusion; 63,938 (77.3%) were inpatients, 16,532 (20.0%) were in- or outpatients, and 2,204 (2.7%) were outpatients. Pneumococcus was the most common cause of CAP without regard to which microbiological techniques were used (33-50% of all cases). The proportion due to this organism declined with time, much more strikingly in the US than in Europe. Haemophilus influenzae was the second most common cause (7-16% of cases), followed by Staphylococcus aureus and Enterobacteriaceae each in 4–10%. Pseudomonas (0.8-4.5%) and Moraxella (1.2-3.5%) were less common; all other bacteria were isolated far less frequently. Mycoplasma caused 4-11% of CAP, Legionella 3-8%, Chlamydophila 2-7%, and Coxiella &lt; 2%; some studies showed a much higher frequency of Mycoplasma. With routine use of viral PCR, a virus was identified in 30-40% of pts; bacterial/viral coinfection was found in 25-35% of these cases. In a separate study of CAP pts in whom viral PCR was positive, 40% had bacterial coinfection. Influenza viruses were identified in 6.2-13.7% of cases and rhinoviruses in 4.1-11.5%. RSV and human metapneumovirus were less common (0.4-4.7%), followed more distantly by other viruses. Even with the use of the most sophisticated diagnostic techniques, no etiologic agent for CAP was identified in &gt; 50% of cases. Trends of identification of S. pneumoniae and H. influenzae as the etiology of CAP (above); and the proportion of S. pneumoniae as the causes of CAP in different geographic regions (below). Conclusion Our results justify current guidelines for initial empiric antibiotic treatment of all pts with CAP. With pneumococcus and Haemophilus continuing to predominate, efforts at antibiotic stewardship might be enhanced by greater attention to routine use of sputum Gram stain and culture. Because viral/bacterial coinfection is relatively common, the identification of a virus by PCR does not, by itself, permit the non-use of an antibiotic. Disclosures All Authors: No reported disclosures

2020 ◽  
Vol 109 (12) ◽  
pp. 2549-2551
Bo M. Weijden ◽  
Niek B. Achten ◽  
Jolita Bekhof ◽  
Esther E. Evers ◽  
Oviedo Dongen ◽  

2020 ◽  
Vol 179 (5) ◽  
pp. 727-734 ◽  
Niek B. Achten ◽  
Douwe H. Visser ◽  
Ellen Tromp ◽  
Wim Groot ◽  
Johannes B. van Goudoever ◽  

AbstractThe neonatal early onset sepsis (EOS) calculator is a novel tool for antibiotic stewardship in newborns, associated with a reduction of empiric antibiotic treatment for suspected EOS. We studied if implementation of the EOS calculator results in less healthcare utilization and lower financial costs of suspected EOS. For this, we compared two single-year cohorts of hospitalizations within 3 days after birth in a Dutch nonacademic teaching hospital, before and after implementation of the EOS calculator. All admitted newborns born at or after 35 weeks of gestation were eligible for inclusion. We analyzed data from 881 newborns pre-implementation and 827 newborns post-implementation. We found significant reductions in EOS-related laboratory tests performed and antibiotic days, associated with implementation of the EOS calculator. Mean length of hospital stay was shorter, and EOS-related financial costs were lower after implementation among term, but not among preterm newborns.Conclusion: In addition to the well-known positive impact on antibiotic stewardship, implementation of the EOS calculator is also clearly associated with reductions in healthcare utilization related to suspected EOS in late preterm and term newborns and with a reduction in associated financial costs among those born term.What is Known:• The early-onset sepsis (EOS) calculator is a novel tool for antibiotic stewardship in newborns, associated with a reduction in empiric antibiotic treatment for suspected EOS.What is New:• In newborns at risk for EOS, EOS calculator implementation is associated with a significant reduction in laboratory investigations related to suspected EOS and significantly shorter stay in those born term.• EOS calculator implementation in term newborns is associated with a mean reduction of €207 in costs for EOS-related care per admitted newborn.

2018 ◽  
pp. 257-262
Temima Waltuch

This case reviews the workup and management of febrile infants less than 3 months of age. These infants are a unique population as their immune systems are immature, placing them at increased risk for serious bacterial infections. Most febrile infants have self-limited viral illnesses; however, it is important to identify those that have a coexisting or isolated bacterial illness. Febrile infants <28 days require a full sepsis workup and admission to the hospital for monitoring and parenteral empiric antibiotic treatment. Workup and management of febrile infants between 29 and 90 days present more of a controversy in the literature. At minimum, infants 1 to 2 months of age will have blood and urine cultures performed, while the lumbar puncture is dependent on their individual risk stratification. Workup for infants 2 to 3 months of age will be completely dependent on risk stratification.

2018 ◽  
Vol 113 (Supplement) ◽  
pp. S94-S95
Merjona Saliaj ◽  
Mark Aloysius ◽  
Mariam Saad ◽  
Muneer Khan ◽  
Julie Singh ◽  

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