empirical treatment
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2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Hui Liu ◽  
Suishan Qiu ◽  
Minghao Chen ◽  
Jun Lyu ◽  
Guangchao Yu ◽  
...  

Abstract Background Prevalence of extended-spectrum beta-lactamase-producing-Enterobacteriaceae (ESBL-E) has risen in patients with urinary tract infections. The objective of this study was to determine explore the risk factors of ESBL-E infection in hospitalized patients and establish a predictive model. Methods This retrospective study included all patients with an Enterobacteriaceae-positive urine sample at the first affiliated hospital of Jinan university from January 2018 to December 2019. Antimicrobial susceptibility patterns of ESBL-E were analyzed, and multivariate analysis of related factors was performed. From these, a nomogram was established to predict the possibility of ESBL-E infection. Simultaneously, susceptibility testing of a broad array of carbapenem antibiotics was performed on ESBL-E cultures to explore possible alternative treatment options. Results Of the total 874 patients with urinary tract infections (UTIs), 272 (31.1%) were ESBL-E positive. In the predictive analysis, five variables were identified as independent risk factors for ESBL-E infection: male gender (OR = 1.607, 95% CI 1.066–2.416), older age (OR = 4.100, 95% CI 1.678–12.343), a hospital stay in preceding 3 months (OR = 1.872, 95% CI 1.141–3.067), invasive urological procedure (OR = 1.810, 95% CI 1.197–2.729), and antibiotic use within the previous 3 months (OR = 1.833, 95% CI 1.055–3.188). In multivariate analysis, the data set was divided into a training set of 611 patients and a validation set of 263 patients The model developed to predict ESBL-E infection was effective, with the AuROC of 0.650 (95% CI 0.577–0.725). Among the antibiotics tested, several showed very high effectiveness against ESBL-E: amikacin (85.7%), carbapenems (83.8%), tigecycline (97.1%) and polymyxin (98.2%). Conclusions The nomogram is useful for estimating a UTI patient’s likelihood of infection with ESBL-E. It could improve clinical decision making and enable more efficient empirical treatment. Empirical treatment may be informed by the results of the antibiotic susceptibility testing.


2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Yuzhu Dong ◽  
Dan Sun ◽  
Yan Wang ◽  
Qian Du ◽  
Ying Zhang ◽  
...  

Abstract Background Bacterial infections are common complications in patients with cirrhosis or liver failure and are correlated with high mortality. Clinical practice guideline (CPG) is a reference used to help clinicians make decisions. This systematic appraisal aimed to evaluate the methodological quality and summarize the recommendations of reported CPGs in these patients. Methods We systematically searched CPGs published from 2008 to 2019. The methodological quality of the included CPGs was assessed using the AGREE II instrument. We extracted and compared recommendations for prophylactic and empirical treatment strategies. Results Fourteen CPGs with a median overall score of 56.3% were included. The highest domain score was Clarity of Presentation (domain 4, 85.4%), and the lowest was for Stakeholder Involvement (domain 2, 31.3%). Three CPGs had an overall score above 80%, and 6 CPGs had a score above 90% in domain 4. Prophylaxis should be strictly limited to patients with varicose bleeding, low ascites protein levels and a history of spontaneous bacterial peritonitis. Fluoroquinolones (norfloxacin and ciprofloxacin), third-generation cephalosporins (G3) (ceftriaxone and cefotaxime) and trimethoprim–sulfamethoxazole (SXT) are recommended for preventing infections in patients with cirrhosis or liver failure. G3, β-lactam/β-lactamase inhibitor combinations (BLBLIs) and carbapenems are recommended as the first choice in empirical treatment according to local epidemiology of bacterial resistance. Conclusions The methodological quality of CPGs focused on patients with cirrhosis or liver failure evaluated by the AGREE II instrument is generally poor. Three CPGs that were considered applicable without modification and 6 CPGs that scored above 90% in domain 4 should also be paid more attention to by healthcare practitioners. Regarding recommendations, norfloxacin, ciprofloxacin, ceftriaxone, cefotaxime, and SXT are recommended for prophylactic treatment appropriately. G3, BLBLIs, and carbapenems are recommended for use in empirical treatment strategies.


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Joyce F. Braam ◽  
Alje P. van Dam ◽  
Sylvia M. Bruisten ◽  
Martijn S. van Rooijen ◽  
Henry J.C. de Vries ◽  
...  

2021 ◽  
Vol 11 (1) ◽  
pp. 32
Author(s):  
Suzanne Béra ◽  
Yvan Jamilloux ◽  
Mathieu Gerfaud-Valentin ◽  
Stéphane Durupt ◽  
Raphaèle Nove-Josserand ◽  
...  

(1) Background: there are few studies on the inflammation of unknown origin (IUO). We sought to determine the etiologies and prognosis of IUO, as well as the contribution of complementary examinations. (2) Methods: this retrospective study analyzed patients meeting the Vanderschueren’s criteria in the Hospices Civils de Lyon from 2005 to 2020. (3) Results: a total of 57 patients (mean age: 67 years; interquartile range: 55–79) were included. Final diagnoses were made for 26 (46%) patients. Non-infectious inflammatory diseases were the most common diagnoses (13/26, 50%), followed by neoplasms (10/26, 38%; 8/10 hematological malignancies), infections (2/26, 8%), and miscellaneous causes (1/26, 4%). Moreover, 18-FDG-PET/CT was contributory in 12/42 cases. Anti-neutrophil cytoplasmic antibodies, serology, temporal biopsies, and bone marrow aspirates were contributory in 3/41, 1/57, 5/23, and 3/19 cases, respectively. At last follow-up (mean follow-up duration: 48 months), 8/31 undiagnosed patients were cured (five received an empirical treatment), and 5/31 died (one death was related to the empirical treatment). (4) Conclusion: more than half of the IUO remained undiagnosed. Non-infectious inflammatory diseases and hematological malignancies were the most common etiologies. Moreover, 18-FDG-PET/CT had the highest diagnostic value. Most IUO without final diagnosis persisted. The role of empirical treatments remains to be explored.


2021 ◽  
Author(s):  
Alfredo Tagarro ◽  
Cinta Moraleda ◽  
Sara Dominguez ◽  
Pui-Ying Iroh Tam ◽  
Christopher William Buck ◽  
...  

Abstract Background Pneumonia is the primary cause of death among HIV-infected children in Africa, with mortality rates as high as 35-40% in infants hospitalized with severe pneumonia. Bacterial pathogens and Pneumocystis jirovecii are well known causes of pneumonia-related death, but other important causes such as cytomegalovirus (CMV) and tuberculosis (TB) remain under-recognized and under-treated.The immune response elicited by CMV may be associated with the risk of developing TB and TB disease progression, and CMV may accelerate disease caused both by HIV and TB. Minimally invasive autopsies confirm that CMV and TB are unrecognized causes of death in children wit HIV. CMV and TB may also co-infect the same child. The aim of this study is to compare the impact on 15-day and 1-year mortality of empirical treatment against TB and CMV plus standard of care (SoC) versus SoC in HIV-infected infants with severe pneumonia. Methods This is a Phase II-III, open-label randomized factorial (2x2) clinical trial, conducted in six African countries. The trial has four arms. Infants from 28 to 365 days of age HIV-infected and hospitalized with severe pneumonia will be randomized (1:1:1:1) to i) SoC, ii) valganciclovir iii) TB-T and iv) TB-T plus valganciclovir. The primary endpoint of the study is all-cause mortality, focusing on the short term (up to 15-days) and long-term (up to 1-year) mortality. Secondary endpoints include repeat hospitalization, duration of oxygen therapy during initial admission, severe and notable adverse events, adverse reactions, CMV and TB prevalence at enrolment, TB incidence, CMV viral load reduction, and evaluation of diagnostic tests such as GeneXpert Ultra on fecal and nasopharyngeal aspirate samples and urine TB-LAM.Discussion Given the challenges in diagnosing CMV and TB in children and results from previous autopsy studies that show high rates of poly-infection in HIV-infected infants with respiratory disease, , this study aims to evaluate a new approach including empirical treatment of CMV and TB for this patient population. The potential downsides of empirical treatment of these conditions including toxicity, and medication interactions, which will be evaluated with pharmacokinetics substudies. Trial Registration: ClinicalTrials.gov, NCT03915366, Universal Trial Number U111-1231-4736, Pan African Clinical Trial Registry PACTR201994797961340.


2021 ◽  
Author(s):  
Alexandre Sacchetti Bezerra ◽  
◽  
Flavia Altheman Loureiro ◽  
Carla Maria Pasquareli Vazquez ◽  
Afonso Cesar Polimanti ◽  
...  

Background: Despite being treated with antibiotics of broad spectrum recommended by International Consensus, severe diabetic patients with lower limb infection do not present a positive clinical evolution during empirical treatment. This study’s bacterial profile was analysed and compared with other worldwide hospital centers. Objective: To confirm the need of an individualized empirical treatment for severe diabetic patients with foot infection. Methods: Retrospective analysis of cultures and antibiograms of severe diabetic patients admitted by foot infection. Results: The results were consistent with the socioeconomic realities of developing countries. Gram-negative bacteria (52,11%) were present in most bone cultures. Results presented a high incidence of Enterococcus faecalis in both gram-positive (21,2%) and polymicrobial (34,7%) samples. Bacterial resistance with the use of ordinary antibiotics in the statistical analysis was high. Conclusion: The community infections should undergo broad spectrum empirical therapy combining amikacin (80,43%) or meropenem (72,00%) with gram-negative and vancomycin (100%) or teicoplanin (90,00%) or linezolid (74,19%) with gram-positive.


Author(s):  
Mykola Yasynetskyi ◽  
Oleg Banyra ◽  
Oleg Nikitin ◽  
Iryna Ventskivska ◽  
Vadym Kozlov ◽  
...  

Background: Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) and Ureaplasma urealyticum (UU) are common sexually transmitted infections (STIs) that are diagnosed in infertile couples (cps). In cases with their simultaneous presence in a patient (mixed STI, MSTIs), treatment is complicated by the different sensitivity of microorganisms to antibacterial drugs. Moreover, in cases of complicated infections, the empirical treatment should be started before obtaining the results of drug susceptibilities. Objective: The objective of the current study is to find the effective and well-tolerated combination of drugs for the empirical antibacterial treatment of mixed STIs presented by TV, MG and UU in infertile couples. We also aimed to establish the influence of mixed STIs on semen quality. Method: Our prospective study included 154 infertile couples (308 patients) with confirmed symptomatic MSTIs in one of the couples caused by the simultaneous presence of TV, MG and UU. All couples were randomized on three groups for empirical treatment: Group 1 (n=49 cps, 98 pts) who were treated by initial prescribing of anti-trichomoniasis drug Secnidazole, 2.0 g po followed by Azythromycin 500 mg on day 1 continuing by 250 mg on days 2-7; Group 2 (n=52 cps, 104 pts: Secnidazole, 2.0 g po followed by Josamycin 1000 mg bid for 12 days); Group 3 (n=53 cps, 106 pts: Secnidazole, 2.0 g po followed by Moxifloxacin 400 mg once daily for 12 days). The endpoints were clinical and microbiological cure rates as well as the frequency of side-effects in analyzed groups. We determined the basic parameters of the spermogram and Deoxyribonucleic acid (DNA) fragmentation levels in 59 patients with MSTIs before and at the 3rd, 6th and 9th month after pathogens eradication comparing them with results in 63 healthy sperm donors. Result: After the treatment, clinical cure rates in analyzed groups were 82.6% (Group 1) vs 96.1% (Group 2) vs 92.3% (Group 3). Microbiological cure rates (UU+MG) were 73.9 % vs 97.1 % vs 84.5% correspondingly (p<0.05). TV microbiological cure rates were 97.8% vs 98.0% vs 96.1% (p>0.05). Side-effects were registered in 28.6% vs 12.5% vs 18.9% cases correspondingly (p<0.05). In MSTIs patients, we registered the increasing DNA fragmentation rates, leucocytes count and decreasing semen volume, motility, vitality, sperm concentration, total spermatozoa number and number of spermatozoa with normal morphology. At the 6th month after complete pathogens eradication, these parameters approached normal values. Conclusion: At the present time, the combination of Secnidazole+Josamycin can be considered the most effective and well-tolerated for the empirical treatment in patients with MSTIs presented by TV, MG and UU. Complete eradication of these MSTIs in males improves their semen parameters.


2021 ◽  
Vol 1 ◽  
pp. 61
Author(s):  
Rashmi Sarkar ◽  
Sushil Tahiliani ◽  
Amit Madan ◽  
Anil Abraham ◽  
Anil Ganjoo ◽  
...  

Dermatologists often come across cases of skin and soft-tissue infections (SSTIs) which have diverse clinical presentations. Various local, systemic, and environmental risk factors predispose an individual to develop SSTIs. Topical antimicrobial agents are frequently used in superficial uncomplicated SSTIs, whereas systemic therapy is generally reserved for use in severe cases. However, emergence of resistance to these agents is becoming a common problem in clinical practice. This necessitates the use of other classes of antimicrobials for the effective treatment of SSTIs. Nadifloxacin, a potential drug belonging to the fluoroquinolone group, has various advantages such as binding to bacterial DNA gyrase and topoisomerase IV enzymes, inhibition of nor-A efflux pump, survival in acidic pH, anti-MRSA activity, and biofilms penetration. It has also shown least development of resistance since its introduction. Although its topical formulation has shown superior efficacy as an anti-acne agent, there are no specific guidelines for its appropriate use in SSTIs. Hence, a panel of experts was formed, under whose guidance an extensive literature search was performed in MEDLINE, Cochrane Library, and Science Direct databases. Using the modified Delphi technique, the available evidence was reviewed and corresponding recommendations were given for the use of topical Nadifloxacin as an empirical treatment in SSTIs.


2021 ◽  
Vol 15 (10) ◽  
pp. 2721-2723
Author(s):  
Suada Usmani ◽  
Javaid Munir ◽  
Zulfiqar Ali Buzdar ◽  
Tariq Abassi ◽  
Zia ul Haq ◽  
...  

Background: Fires and burns incidence are on constant rise. Efforts had been made since very ancient times to curb such debilitating injuries resulting from domestic violence, vitriol incidences, accidents and mishaps. Treating the burns always had been an intricate matter of concern. Since primitive times the treatment modalities had been changed over and over in the search of best available options. Aim: To compare the efficacy of empirical treatment with that of advanced medical care among the victims of burns. Methods: The study comprised of 300 cases of burns presented from January to December 2020 in Accidents and Emergency Department of the Jannah Hospital Lahore for empirical treatment and those managed in the Burn Center of Jannah Hospital Lahore for advanced medical care of burns. Those who have been referred from periphery and could not get advanced medical care or had their wound healed when brought to above set-up were considered as treated as empirically managed burn victims. Results: The comparative analysis of empirical therapy and advanced medical care revealed significant difference when observed among the literacy level and medium of burns with 0.000 value of p. While no significance difference was observed when analysis was carried out for age and gender with a p value of 0.187 and 0.496 respectively. Keywords: Empirical, Advanced Medical Care, Burns, Age, Gender, Literacy level, Medium of Burns


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