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antibiotics in icu patients

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https://www.readbyqxmd.com/read/29452598/7-versus-14-days-of-antibiotic-treatment-for-critically-ill-patients-with-bloodstream-infection-a-pilot-randomized-clinical-trial
#1
Nick Daneman, Asgar H Rishu, Ruxandra Pinto, Pierre Aslanian, Sean M Bagshaw, Alex Carignan, Emmanuel Charbonney, Bryan Coburn, Deborah J Cook, Michael E Detsky, Peter Dodek, Richard Hall, Anand Kumar, Francois Lamontagne, Francois Lauzier, John C Marshall, Claudio M Martin, Lauralyn McIntyre, John Muscedere, Steven Reynolds, Wendy Sligl, Henry T Stelfox, M Elizabeth Wilcox, Robert A Fowler
BACKGROUND: Shorter-duration antibiotic treatment is sufficient for a range of bacterial infections, but has not been adequately studied for bloodstream infections. Our systematic review, survey, and observational study indicated equipoise for a trial of 7 versus 14 days of antibiotic treatment for bloodstream infections; a pilot randomized clinical trial (RCT) was a necessary next step to assess feasibility of a larger trial. METHODS: We conducted an open, pilot RCT of antibiotic treatment duration among critically ill patients with bloodstream infection across 11 intensive care units (ICUs)...
February 17, 2018: Trials
https://www.readbyqxmd.com/read/29451055/early-discontinuation-of-empirical-antibacterial-therapy-in-febrile-neutropenia-the-antibiostop-study
#2
Lenaïg Le Clech, Jean-Philippe Talarmin, Marie-Anne Couturier, Jean-Christophe Ianotto, Christophe Nicol, Ronan Le Calloch, Stéphanie Dos Santos, Pascal Hutin, Didier Tandé, Virginie Cogulet, Christian Berthou, Gaëlle Guillerm
INTRODUCTION: Immediate empirical antibiotic therapy is mandatory in febrile chemotherapy-induced neutropenia, but its optimal duration is unclear, especially in patients with fever of unknown origin (FUO). OBJECTIVES: The primary objective of this 20-month prospective observational study was to evaluate the feasibility and safety of short-term antibiotic treatment in afebrile or febrile patients exhibiting FUO, irrespective of their neutrophil count. The secondary objective was to describe the epidemiology of all episodes of febrile neutropenia...
February 16, 2018: Infectious Diseases
https://www.readbyqxmd.com/read/29451043/murepavadin-a-new-antibiotic-class-in-the-pipeline
#3
Ignacio Martin-Loeches, Glenn E Dale, Antoni Torres
With the increase in multi-drug resistant P. aeruginosa, antimicrobials with a novel mechanism of action are needed that can target these infections. Areas covered: Intravenous murepavadin is in Phase 3 development for the treatment of HABP/VABP due to P. aeruginosa. This paper summarizes the available information on the discovery, the in vitro activity, pharmacokinetic and pharmacodynamic properties and the clinical pharmacology of murepavadin to date. Expert commentary: P. aeruginosa has an intrinsic resistance to many antibiotics due to high cellular impermeability and efficient drug efflux mechanisms, and the recent increase in prevalence of multidrug-resistant P...
February 16, 2018: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/29449171/changes-in-antimicrobial-susceptibility-of-commonly-clinically-significant-isolates-before-and-after-the-interventions-on-surgical-prophylactic-antibiotics-spas-in-shanghai
#4
Su Wang, Li-Zhong Han, Yu-Xing Ni, Yi-Bo Zhang, Qun Wang, Da-Ke Shi, Wen-Hui Li, Yi-Chen Wang, Chen-Rong Mi
Surveillances and interventions on antibiotics use have been suggested to improve serious drug-resistance worldwide. Since 2007, our hospital have proposed many measures for regulating surgical prophylactic antibiotics (carbapenems, third gen. cephalosporins, vancomycin, etc.) prescribing practices, like formulary restriction or replacement for surgical prophylactic antibiotics and timely feedback. To assess the impacts on drug-resistance after interventions, we enrolled infected patients in 2006 (pre-intervention period) and 2014 (post-intervention period) in a tertiary hospital in Shanghai...
February 12, 2018: Brazilian Journal of Microbiology: [publication of the Brazilian Society for Microbiology]
https://www.readbyqxmd.com/read/29441942/risk-factors-for-the-failure-of-treatment-of-pseudomonas-aeruginosa-bacteremia-in-critically-ill-patients
#5
S Yoshida, K Suzuki, A Suzuki, H Okada, T Niwa, R Kobayashi, N Murakami, S Ogura, Y Itoh
Pseudomonas aeruginosa bacteremia is associated with high morbidity and mortality in critically ill patients. In this study, we assessed risk factors for clinical failure of first definitive therapy for P. aeruginosa bacteremia in critically ill patients. All patients with P. aeruginosa bacteremia who entered the intensive care unit in Gifu University Hospital from January 2006 to December 2015 were retrospectively identified from electronic records. Risk factors associated with clinical failure of the first definitive therapy for P...
July 3, 2017: Die Pharmazie
https://www.readbyqxmd.com/read/29438544/emergence-and-control-of-linezolid-resistant-staphylococcus-epidermidis-in-an-icu-of-a-german-hospital
#6
Christina Weßels, Birgit Strommenger, Ingo Klare, Jennifer Bender, Sabine Messler, Frauke Mattner, Michael Krakau, Guido Werner, Franziska Layer
Objectives: To investigate an outbreak of linezolid-resistant Staphylococcus epidermidis (LRSE) in an interdisciplinary ICU, linezolid consumption and infection control measures taken. Methods: Routine surveillance of nosocomial infections revealed colonization and infection with LRSE affecting 14 patients during a 15 month period. LRSE isolates were analysed with respect to their clonal relatedness, antimicrobial susceptibility, the presence of cfr and/or mutations in the 23S rRNA, rplC, rplD and rplV genes...
February 9, 2018: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29438158/intensive-care-unit-enhanced-recovery-pathway-for-patients-undergoing-orthotopic-liver-transplants-recipients-a-prospective-observational-study
#7
Adam B King, Clark D Kensinger, Yaping Shi, Matthew S Shotwell, Seth J Karp, Pratik P Pandharipande, J Kelly Wright, Liza M Weavind
BACKGROUND: Liver transplant recipients continue to have high perioperative resource utilization and prolonged length of stay despite improvements in perioperative care. Enhanced recovery pathways have been shown in other surgical populations to produce reductions in hospital resource utilization. METHODS: A prospective, observational study was performed to examine the effect of an enhanced recovery pathway for postoperative care after liver transplantation. Outcomes from patients undergoing liver transplantation from November 1, 2013, to October 31, 2014, managed by the pathway were compared to transplant recipients from the year before pathway implementation...
February 9, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29432348/trends-of-incidence-and-risk-factors-of-ventilator-associated-pneumonia-in-elderly-patients-admitted-to-french-icus-between-2007-and-2014
#8
Cédric Dananché, Philippe Vanhems, Anaïs Machut, Martine Aupée, Caroline Bervas, François L'Hériteau, Alain Lepape, Jean-Christophe Lucet, Vincent Stoeckel, Jean-François Timsit, Anne Berger-Carbonne, Anne Savey, Thomas Bénet
OBJECTIVES: To assess trends and risk factors of ventilator-associated pneumonia according to age, particularly in the elderly admitted to French ICUs between 2007 and 2014. DESIGN: Multicenter, prospective French national Healthcare-Associated Infection surveillance network of ICUs ("Réseau REA-Raisin"). SETTINGS: Two-hundred fifty six ICUs in 246 settings in France. PATIENTS: Included were all adult patients hospitalized greater than or equal to 48 hours in ICUs participating in the network...
February 9, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29430228/routine-treatment-resistant-clostridium-difficile-infection-during-recovery-from-myxedema
#9
Jan K Adamski, Björn B Jäschke, Raija S Uusitalo-Seppälä, Kalle V J Moilanen, Antti V Pehkonen, Wojciech Weigl
Development of the extreme form of hypothyroidism defined as myxedema is very rare. Acute symptoms and their management have been described in detail previously. However, not much attention has been devoted to therapeutic challenges that are faced in the recovery phase of the treatment, especially pertaining to the gastrointestinal system. The link between myxedema and the appearance of severe Clostridium difficile infection (CDI) has not been established so far. A 61-year-old woman with no significant medical record was admitted to hospital because of infected heel pressure and thyroid dysfunction...
September 2017: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/29429556/infection-with-gram-negative-bacteria-among-children-in-a-tertiary-pediatric-hospital-in-egypt
#10
John Rene Labib, Sally K Ibrahim, Marwa Rashad Salem, Meray Rene L Youssef, Basant Meligy
BACKGROUND: Patients in pediatric intensive care units (PICUs) are susceptible to infections with gram-negative bacteria (GNB). METHODS: A prospective observational study was conducted in 2 PICUs at Cairo University Hospitals to determine the incidence and outcome of GNB infections over 1 year. Variables of interest included age, gender, isolated organism, susceptibility to antibiotics, and final outcome. RESULTS: During the study period, 1420 patients were admitted to the PICU; of these, 291 developed GNB infections...
February 9, 2018: American Journal of Infection Control
https://www.readbyqxmd.com/read/29429053/program-of-gastrointestinal-rehabilitation-and-early-postoperative-enteral-nutrition-a-prospective-study
#11
Frank Daniel Martos-Benítez, Anarelys Gutiérrez-Noyola, Andrés Soto-García, Iraida González-Martínez, Ilionanys Betancourt-Plaza
Nutritional depletion is commonly observed in patients undergoing surgical treatment for a gastrointestinal malignancy. An appropriate nutritional intervention could be associated with improved postoperative outcomes. The study was aimed to determine the effect of a program of gastrointestinal rehabilitation and early postoperative enteral nutrition upon complications and clinical outcomes in patients who experienced gastrointestinal surgery for cancer. This is a prospective study (2013 January-2015 December) of 465 consecutive patients submitted to gastrointestinal surgery for cancer and admitted to an Oncological Intensive Care Unit...
February 10, 2018: Updates in Surgery
https://www.readbyqxmd.com/read/29425283/development-of-a-dosing-nomogram-for-continuous-infusion-meropenem-in-critically-ill-patients-based-on-a-validated-population-pharmacokinetic-model
#12
Iris K Minichmayr, Jason A Roberts, Otto R Frey, Anka C Roehr, Charlotte Kloft, Alexander Brinkmann
Background: Optimal antibiotic exposure is a vital but challenging prerequisite for achieving clinical success in ICU patients. Objectives: To develop and externally validate a population pharmacokinetic model for continuous-infusion meropenem in critically ill patients and to establish a nomogram based on a routinely available marker of renal function. Methods: A population pharmacokinetic model was developed in NONMEM® 7.3 based on steady-state meropenem concentrations (CSS) collected during therapeutic drug monitoring...
February 7, 2018: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29422733/quad-fever-treatment-through-lowering-of-ambient-temperature
#13
Shyam Sundar Krishnan, Pulak Nigam, Omar Bachh, Madabushi Chakravarthy Vasudevan
Hyperpyrexia is a rare and at times fatal condition seen in an Intensive Care Unit setup. We encountered a case of a 65-year-old patient with road traffic accident presenting with dorsal spine fracture at D10 level. He underwent decompression and fusion for the same. He developed hyperpyrexia of sudden onset on the 10th day of admission with no source of infection and adequate broad-spectrum antibiotic coverage with adequate thrombo-embolic prevention in place. The patient showed no response to antipyretic agents and other cooling methods...
January 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29422729/outcome-of-patients-admitted-to-a-tertiary-referral-intensive-care-unit-with-urosepsis-needing-source-control
#14
Chaitra C Rao, Pradeep Rangappa, Karthik Rao, Ipe Jacob
Introduction: Urosepsis is one of the common causes of admission to the Intensive Care Unit (ICU). It has traditionally been treated with antibiotics, but surgical management with Double J [DJ] ureteral stents is gaining popularity. This study compares patients with complicated urosepsis who underwent surgical source control by ureteral stenting with those managed medically. Materials and Methods: The study enrolled patients admitted to a tertiary adult ICU with a diagnosis of urosepsis over a period of 2 years...
January 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29421668/first-report-of-sporadic-cases-of-candida-auris-in-colombia
#15
Claudia M Parra-Giraldo, Sandra L Valderrama, Gloria Cortes-Fraile, Javier R Garzón, Beatriz E Ariza, Florent Morio, Melva Y Linares-Linares, Andrés Ceballos-Garzón, Alejandro de la Hoz, Catalina Hernandez, Carlos Alvarez-Moreno, Patrice Le Pape
BACKGROUND: Candida auris is a recently reported Candida species which is phenotypically similar to Candida haemulonii and related to hospital outbreaks. This organism can be misidentified as C. haemulonii, C. famata, C. catenulata or Rhodotorula glutinis by phenotypic approaches. MALDI-TOF MS and DNA sequence analysis using ITS rDNA barcoding provide an accurate identification. CASE PRESENTATIONS: Three cases of C. auris infection in patients with risk factors for fungal infection (Admitted to the intensive care unit, lymphoma and HIV respectively, all three with previous antibiotic use) and not epidemiologically related...
February 5, 2018: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/29416463/effect-of-extended-infusion-of-meropenem-and-nebulized-amikacin-on-gram-negative-multidrug-resistant-ventilator-associated-pneumonia
#16
Mona Ahmed Ammar, Waleed Abdalla
Background: Ventilator-associated pneumonia (VAP) due to multidrug-resistant organisms (MDROs) is associated with a significant mortality in the Intensive Care Unit (ICU). The aim of this study was to compare the efficacy and safety of extended infusion of meropenem and nebulized amikacin on VAP caused by Gram-negative MDRO versus intravenous (IV) meropenem and amikacin alone. Methodology: A randomized nonblinded controlled trial was performed on ninety patients with VAP...
January 2018: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29413218/evidence-based-practice-in-the-treatment-for-antibiotic-associated-diarrhea-in-the-intensive-care-unit
#17
REVIEW
Robin Squellati
Unit nurses provide care to patients with serious health conditions. Often antibiotics are recommended to fight infections. Sometimes patients are on proton pump inhibitors (PPI). Antibiotics and PPIs may lead to diarrhea, causing the patient more discomfort, and possibly leading to a more serious infection. One serious infection is caused by Clostridium difficile, which causes death in some cases. About 75% of patients on antibiotics may not need antibiotics. Several studies showed less diarrhea in patients on probiotics...
March 2018: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/29413014/the-need-to-reassess-dietary-fiber-requirements-in-healthy-and-critically-ill-patients
#18
REVIEW
Stephen J D O'Keefe
This article provides evidence that current dietary fiber intake levels may be insufficient to maintain colonic mucosal health and defense, and reduce inflammation and cancer risk in otherwise healthy people. Current commercial tube feeds generally overlook the metabolic needs of the colon and may predispose patients to dysbiosis, bacterial overgrowth with pathogens such as Clostridium difficile, and acute colitis. These results raise concern about the wide-scale use of prophylactic antibiotics in the intensive care unit and the use of elemental, fiber-depleted tube feeds...
March 2018: Gastroenterology Clinics of North America
https://www.readbyqxmd.com/read/29411661/novel-pharmacotherapy-for-the-treatment-of-hospital-acquired-and-ventilator-associated-pneumonia-caused-by-resistant-gram-negative-bacteria
#19
James M Kidd, Joseph L Kuti, David P Nicolau
Introduction Hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP) are among the most prevalent infections in hospitalized patients, particularly those in the intensive care unit. Importantly, the frequency of multidrug resistant (MDR) Gram-negative (GN) bacteria as the bacteriologic cause of HABP/VABP is increasing. These include MDR Pseudomonas aeruginosa, Acinetobacter baumannii, and carbapenem resistant Enterobactericeae (CRE). Few antibiotics are currently available when such MDR Gram-negatives are encountered and older agents such as polymyxin B, colistin (polymyxin E), and tigecycline have typically performed poorly in HABP/VABP...
February 7, 2018: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/29410029/sustained-multimodal-antimicrobial-stewardship-in-an-australian-tertiary-intensive-care-unit-from-2008-2015-an-interrupted-time-series-analysis
#20
Suman Adhikari, Michael Piza, Peter Taylor, Kush Deshpande, Doris Lam, Pam Konecny
The long term outcomes and sustainability of antimicrobial stewardship (AMS) in the intensive care unit (ICU) require evaluation. This study analysed the effect of a multimodal ICU AMS introduced in a 15-bed medical-surgical tertiary Australian adult ICU in November, 2008, with interrupted time-series analysis of antibiotic usage, resistance and cost from November 2005-October 2015, including national ICU average usage as a control. Overall ICU mortality, 30-day blood stream infection (BSI) mortality and length of stay (LOS) were compared over the same period...
January 30, 2018: International Journal of Antimicrobial Agents
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