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De-escalation carbapenems

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https://www.readbyqxmd.com/read/28249572/efficacy-and-safety-of-de-escalation-therapy-to-ertapenem-for-treatment-of-infections-caused-by-extended-spectrum-%C3%AE-lactamase-producing-enterobacteriaceae-an-open-label-randomized-controlled-trial
#1
Pinyo Rattanaumpawan, Peerawong Werarak, Anupop Jitmuang, Pattarachai Kiratisin, Visanu Thamlikitkul
BACKGROUND: Carbapenem antibiotics are considered the treatment of choice for serious extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria (GNB) infections. The study objectives were to evaluate efficacy and safety of de-escalation therapy to ertapenem for treatment of infections caused by extended-spectrum-β-lactamase-producing Enterobacteriaceae. METHODS: We conducted a randomized controlled trial of adult patients with documented ESBL-producing Enterobacteriaceae infections who had received any group 2 carbapenem for less than 96 h...
March 1, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28222811/recurring-septic-shock-in-a-patient-with-blunt-abdominal-and-pelvic-trauma-how-mandatory-is-source-control-surgery-a-case-report
#2
Antonella Frattari, Giustino Parruti, Rocco Erasmo, Luigi Guerra, Ennio Polilli, Rosamaria Zocaro, Giuliano Iervese, Paolo Fazii, Tullio Spina
BACKGROUND: In critically ill patients with colonization/infection of multidrug-resistant organisms, source control surgery is one of the major determinants of clinical success. In more complex cases, the use of different tools for sepsis management may allow survival until complete source control. CASE PRESENTATION: A 42-year-old white man presented with traumatic hemorrhagic shock. Unstable pelvic fractures led to emergency stabilization surgery. Fever ensued with diarrhea, followed by septic shock...
February 22, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28108091/implementation-of-a-simple-innovative-system-for-postprescription-antibiotic-review-based-on-computerized-tools-with-shared-access
#3
F Bouchand, A Dinh, A L Roux, B Davido, H Michelon, M Lepainteur, B Legendre, F El Sayed, I Pierre, J Salomon, C Lawrence, C Perronne, M Villart, A-C Crémieux
BACKGROUND: Controlling antibiotic use in healthcare establishments limits their consumption and the emergence of bacterial resistance. AIM: To evaluate the efficiency of an innovative antibiotic stewardship strategy implemented over three years in a university hospital. METHODS: An antimicrobial multi-disciplinary team (AMT) [pharmacist, microbiologist and infectious disease specialist (IDS)] conducted a postprescription review. Specific coding of targeted antibiotics (including broad-spectrum β-lactams, glycopeptides, lipopeptides, fluoroquinolones and carbapenems) in the computerized physician order entry allowed recording of all new prescriptions...
March 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/27898208/-design-and-implementation-of-an-outpatient-parenteral-antimicrobial-therapy-program-in-primary-care-the-experience-at-a-second-level-hospital
#4
M Ruiz-Campuzano, E García-Vázquez, J J Hernández-Roca, J Gómez-Gómez, M Canteras-Jordana, E Mené-Fenor, A Hernández-Torres, A Peláez-Ballesta
OBJECTIVE: Outpatient parenteral antimicrobial therapy (OPAT) programs are a good assistance option in a wide variety of infectious diseases. Our aim was to design and implement an OPAT program in the area of influence of a second-level hospital, with no Home Hospitalization Service available, being necessary close collaboration between hospitalization and Primary Care teams, describe our cohort, analyse the antimicrobial treatment indicated and evaluate the prognostic and risk factors associated with readmission and mortality...
November 28, 2016: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
https://www.readbyqxmd.com/read/27686471/targeted-de-escalation-rounds-may-effectively-and-safely-reduce-meropenem-use
#5
U Ni Riain, M Tierney, C Doyle, A Vellinga, C Fleming, M Cormican
OBJECTIVE: Use of meropenem in our hospital has doubled in recent years. An audit in 2013 showed that although initiation of therapy with meropenem was generally appropriate, therapy was rarely subsequently reviewed and de-escalated where appropriate. Therefore, a structured stewardship initiative focussed on meropenem de-escalation was developed. METHODS: A local guideline for review and de-escalation of meropenem was developed and approved by the Antimicrobial Stewardship Team...
September 29, 2016: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/27544545/the-challenges-of-multi-drug-resistance-in-hepatology
#6
REVIEW
Javier Fernández, Frédéric Bert, Marie-Hélène Nicolas-Chanoine
Antimicrobial resistance has become a major global public health security problem that needs coordinated approaches at regional, national and international levels. Antibiotic overuse and the failure of control measures to prevent the spread of resistant bacteria in the healthcare environment have led to an alarming increase in the number of infections caused by resistant bacteria, organisms that resist many (multi-drug and extensively drug-resistant strains), if not all (pan-drug-resistant bacteria) currently available antibiotics...
November 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/27453168/antimicrobial-stewardship-in-a-gastroenterology-department-impact-on-antimicrobial-consumption-antimicrobial-resistance-and-clinical-outcome
#7
Andrea Bedini, Nicola De Maria, Mariagrazia Del Buono, Marcello Bianchini, Mauro Mancini, Cecilia Binda, Andrea Brasacchio, Gabriella Orlando, Erica Franceschini, Marianna Meschiari, Alessandro Sartini, Stefano Zona, Serena Paioli, Erica Villa, Inge C Gyssens, Cristina Mussini
BACKGROUND: A major cause of the increase in antimicrobial resistance is the inappropriate use of antimicrobials. AIMS: To evaluate the impact on antimicrobial consumption and clinical outcome of an antimicrobial stewardship program in an Italian Gastroenterology Department. METHODS: Between October 2014 and September 2015 (period B), a specialist in infectious diseases (ID) controlled all antimicrobial prescriptions and decided about the therapy in agreement with gastroenterologists...
October 2016: Digestive and Liver Disease
https://www.readbyqxmd.com/read/27196948/multidrug-resistant-bacteria-in-hematology-patients-emerging-threats
#8
Paola Tatarelli, Malgorzata Mikulska
Multidrug-resistant (MDR) bacteria, particularly Gram negatives, such as Enterobacteriaceae resistant to third-generation cephalosporins or carbapenems and MDR Pseudomonas aeruginosa, are increasingly frequent in hematology patients. The prevalence of different resistant species varies significantly between centers. Thus, the knowledge of local epidemiology is mandatory for deciding the most appr-opriate management protocols. In the era of increasing antibiotic resistance, empirical therapy of febrile neutropenia should be individualized...
June 2016: Future Microbiology
https://www.readbyqxmd.com/read/27052675/characteristics-and-outcomes-of-anti-infective-de-escalation-during-health-care-associated-intra-abdominal-infections
#9
Philippe Montravers, Pascal Augustin, Nathalie Grall, Mathieu Desmard, Nicolas Allou, Jean-Pierre Marmuse, Jean Guglielminotti
BACKGROUND: De-escalation is strongly recommended for antibiotic stewardship. No studies have addressed this issue in the context of health care-associated intra-abdominal infections (HCIAI). We analyzed the factors that could interfere with this process and their clinical consequences in intensive care unit (ICU) patients with HCIAI. METHODS: All consecutive patients admitted for the management of HCIAI who survived more than 3 days following their diagnosis, who remained in the ICU for more than 3 days, and who did not undergo early reoperation during the first 3 days were analyzed prospectively in an observational, single-center study in a tertiary care university hospital...
April 7, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27002635/bloodstream-infections-in-neutropenic-cancer-patients-a-practical-update
#10
Giulia Gustinetti, Malgorzata Mikulska
Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective...
April 2, 2016: Virulence
https://www.readbyqxmd.com/read/26874673/compliance-with-carbapenem-guidelines-in-a-university-hospital
#11
M Van Hollebeke, C Chapuis, S Bernard, L Foroni, J P Stahl, P Bedouch, P Pavese
OBJECTIVE: We aimed to evaluate carbapenem prescription compliance with guidelines for nosocomial and community-acquired infections. PATIENTS AND METHODS: We conducted a prospective study over a four-month period at our university hospital. We included all adult and pediatric hospitalized patients who had received at least one dose of carbapenem. Data was collected from patients' medical records (hard copy and computerized data; CristalLink software). Compliance with guidelines was assessed by two infectious disease specialists...
March 2016: Médecine et Maladies Infectieuses
https://www.readbyqxmd.com/read/26707079/association-of-risk-factors-antimicrobial-resistance-trends-and-occurrence-of-blatem-bla-shv-and-blactx-m-in-escherichia-coli-causing-bacteremia
#12
Richa Sinha, Sphurti Kamath, Suchitra M Shenoy
PURPOSE: Escherichia coli are the most frequent cause of gram negative bloodstream infection. This study was done to evaluate the association of risk factors, antimicrobial susceptibility pattern and detection of TEM, SHV and CTX M genes in the extended spectrum beta lactamase (ESBL) producing E.coli. MATERIALS AND METHODS: 11,133 blood samples were processed in BacT/Alert bottles. Bacteria grown were identified and antibiotic susceptibility patterns were studied using VITEK2 system...
2016: Infectious Disorders Drug Targets
https://www.readbyqxmd.com/read/26698014/proper-use-of-carbapenems-role-of-the-infectious-disease-specialist
#13
COMPARATIVE STUDY
N Issa, S Pedeboscq, F Le Quellec, E Bessède, M Vandenhende, F Bonnet, P Morlat, F Camou
OBJECTIVE: One of the objectives of the French national plan on antibiotics is to preserve antibiotic effectiveness. A group of infectious disease specialists of the University hospital of Bordeaux aimed to monitor the prescriptions of broad-spectrum antibiotics. Particular attention was paid to carbapenem (CBP) prescriptions given the increase in betalactamase- and carbapenemase-producing bacteria. PATIENTS AND METHODS: We carried out a three-step Professional Practice Evaluation (PPE): evaluation of CBP prescriptions made at the hospital between January and June 2013; CBP prescription training for prescribers; and another evaluation of CBP prescriptions between January and June 2014...
February 2016: Médecine et Maladies Infectieuses
https://www.readbyqxmd.com/read/26688375/a-de-escalation-protocol-for-febrile-neutropenia-cases-and-its-impact-on-carbapenem-resistance-a-retrospective-quasi-experimental-single-center-study
#14
Abeer Alshukairi, Haleema Alserehi, Aiman El-Saed, Mouhammed Kelta, Jalil U Rehman, Farrukh A Khan, Hanadi Alsalmi, Majda Alattas, Muhammad Aslam
Our objective was to evaluate the impact of using an imipenem de-escalation protocol for empiric febrile neutropenia on the development of carbapenem resistance. A pre-post intervention design was used. The intervention was adopting the imipenem de-escalation approach, which began on January 1, 2012. A retrospective chart review of cases of febrile neutropenia bacteremia was performed one year before and one year after the intervention. We compared the development of carbapenem resistance between the two study periods...
July 2016: Journal of Infection and Public Health
https://www.readbyqxmd.com/read/26630548/empiric-antibiotic-therapy-for-severe-sepsis-and-septic-shock
#15
Taku Oshima, Yoshiyuki Kodama, Waka Takahashi, Yosuke Hayashi, Shinya Iwase, Takeo Kurita, Daiki Saito, Yoshihiro Yamaji, Shigeto Oda
BACKGROUND: A retrospective study was conducted to investigate the validity and the effectiveness of early empiric antibiotic and de-escalation therapy for the treatment of severe sepsis and septic shock patients in the intensive care unit (ICU). METHODS: Patients admitted to the ICU at Chiba University Hospital from January 1, 2010, to December 31, 2012, for the treatment of severe sepsis or septic shock were selected for analysis. RESULTS: One-hundred and ten patients were enrolled for the analysis...
April 2016: Surgical Infections
https://www.readbyqxmd.com/read/26508585/carbapenem-use-in-french-hospitals-a-nationwide-survey-at-the-patient-level
#16
Rémy Gauzit, Yves Pean, Serge Alfandari, Jean-Pierre Bru, Jean-Pierre Bedos, Christian Rabaud, Jérôme Robert
The objective of this study was to evaluate the characteristics of carbapenem use in French healthcare settings in order to guide future actions. Healthcare facilities voluntarily participated in a nationwide cross-sectional survey in 2011. Medical data and reasons for carbapenem treatment (CPR) and discontinuation were recorded for all patients treated with carbapenems. A total of 2338 patients were recorded by 207 facilities. The median duration of CPR was 8 days, and 31.4% of patients received CPR for >10 days...
December 2015: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/26465070/new-antibiotic-strategies-in-patients-with-cirrhosis-and-bacterial-infection
#17
REVIEW
Javier Fernández, Juan Acevedo
Early diagnosis and adequate empirical antibiotic treatment of bacterial infections in advanced cirrhosis is essential to improve outcomes given the high risk of developing severe sepsis, multiple organ failure and death. β-lactams and quinolones are nowadays frequently ineffective in nosocomial and healthcare associated infections, due to the increasing prevalence of multidrug resistant (MDR) bacteria reported across different geographical areas. Recent antibiotic exposure also increases the risk of developing MDR bacterial infections...
2015: Expert Review of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/26327124/extended-spectrum-beta-lactamase-producing-enterobacteriaceae-esbl-pe-infections-are-carbapenem-alternatives-achievable-in-daily-practice
#18
B Pilmis, T Delory, M Groh, E Weiss, A Emirian, H Lecuyer, P Lesprit, J-R Zahar
OBJECTIVES: To avoid the use of carbapenems, alternatives such as cephamycin, piperacillin-tazobactam, and others are suggested for the treatment of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) infections. The aim of this study was to evaluate the frequency and the feasibility of antimicrobial de-escalation for ESBL-PE-related infections. METHODS: A prospective observational, bi centric cohort study was conducted. All patients with ESBL-PE infections were included...
October 2015: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/25784248/targeting-antimicrobial-resistant-bacterial-respiratory-tract-pathogens-it-is-time-to-get-smart
#19
REVIEW
Boeun Lee, Helen W Boucher
PURPOSE OF REVIEW: Pathogen-directed therapy targeting multidrug-resistant bacteria in pneumonia can be a challenge. We reviewed the recent literature on bacterial resistance, diagnostic methods, and treatment strategies to guide pathogen-directed therapy of respiratory infections. RECENT FINDINGS: Antibiotic resistance is a growing problem in both community and nosocomial settings. Macrolide resistance in Streptococcus pneumoniae varies geographically, ranging from 45 to 88%, and has been associated with prior antibiotic use...
May 2015: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/25706258/how-to-manage-infections-caused-by-antibiotic-resistant-gram-negative-bacteria-ebmt-educational-meeting-from-the-severe-aplastic-anaemia-and-infectious-diseases-working-parties-naples-italy-2014
#20
Małgorzata Mikulska
Multidrug resistant (MDR) Gram-negative bacteria are increasingly frequent in hematopoietic stem cell transplant (HSCT) recipients, yet their prevalence is highly variable among transplant centres. Thus, the knowledge of local epidemiology is mandatory for deciding the most appropriate management protocols. Empirical therapy of febrile neutropenia should be individualized. Either escalation or de-escalation strategy could be chosen, based on local epidemiology, individual risk factors for infection due to resistant strains, such as previous infection or colonization with a resistant pathogen, and clinical presentation...
February 23, 2015: Current Drug Targets
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