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antibiotics in icu patients

Ekamjeet Randhawa, John Woytanowski, Kedesha Sibliss, Ian Sheffer
Streptococcus pyogenes is a Gram-positive beta-hemolytic bacteria, also known as group A streptococci, that causes a range of infections. The most common presentation is acute pharyngitis; however, it is also implicated in skin and soft tissue infections, and less commonly bacteremia, osteomyelitis, pneumonia, otitis media and sinusitis. Group A streptococci infections of the central nervous system are exceedingly rare in the antibiotic era. The mechanism of infection is typically contiguous spread from existing infection or via direct inoculation...
2018: SAGE Open Medical Case Reports
A Rezaei, H Fazeli, M Halaji, M Moghadampour, J Faghri
INTRODUCTION: The emergence of Metallo-beta-lactamase (MBL)-producing Acinetobacter baumannii has become a global concern in nosocomial infections. The aim of this study is to determine the prevalence of MBL producing genes among clinical isolates of A. baumannii from hospitalized patients. METHODS: This study was performed from October 2015 to October 2016 at three teaching hospitals located in Isfahan, Iran. Totally, 100 A-baumannii isolates were collected from clinical specimens and identified as A-baumannii using standard microbiological methods...
July 2018: Annali di Igiene: Medicina Preventiva e di Comunità
Richard Y Kim, Alex M Ng, Annuradha K Persaud, Stephen P Furmanek, Yash N Kothari, John D Price, Timothy L Wiemken, Mohamed A Saad, Juan J Guardiola, Rodrigo S Cavallazzi
BACKGROUND: We evaluated the effect of time spent in the emergency department (ED) and process of care on mortality and length of hospital stay in patients with sepsis or septic shock. METHODS: An observational cohort study was conducted on 117 patients who came through the University of Louisville Hospital ED and subsequently were directly admitted to the intensive care unit (ICU). Variables of interest were time in the ED from triage to physical transport to the ICU, from triage to antibiotic(s) ordered, and from triage to antibiotic(s) administered...
June 2018: American Journal of the Medical Sciences
Wenjun Sui, Haijian Zhou, Pengcheng Du, Lijun Wang, Tian Qin, Mei Wang, Hongyu Ren, Yanfei Huang, Jing Hou, Chen Chen, Xinxin Lu
Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a major cause of nosocomial infections worldwide. The transmission route of CRKP isolates within an outbreak is rarely described. This study aimed to reveal the molecular characteristics and transmission route of CRKP isolates within an outbreak of nosocomial infection. Methods: Collecting case information, active screening and targeted environmental monitoring were carried out. The antibiotic susceptibility, drug-resistant genes, molecular subtype and whole genome sequence of CRKP strains were analyzed...
2018: Antimicrobial Resistance and Infection Control
Christian S Scheer, Christian Fuchs, Matthias Gründling, Marcus Vollmer, Juliane Bast, Jürgen A Bohnert, Kathrin Zimmermann, Klaus Hahnenkamp, Sebastian Rehberg, Sven-Olaf Kuhn
OBJECTIVES: Sepsis guidelines recommend obtaining blood cultures before starting anti-infective therapy in patients with sepsis. However, little is known how antibiotic treatment prior to sampling affects bacterial growth. The aim of this study was to compare the results of blood cultures drawn prior to and under antibiotic therapy. METHODS: Prospective clinical cohort study of septic patients. Adult ICU patients with 2 or 3 blood culture (BC) sets at the beginning of sepsis between 2010 and 2017 were included...
June 4, 2018: Clinical Microbiology and Infection
Michele Bartoletti, Massimo Antonelli, Francesco Arturo Bruno Blasi, Ivo Casagranda, Arturo Chieregato, Roberto Fumagalli, Massimo Girardis, Filippo Pieralli, Mario Plebani, Gian Maria Rossolini, Massimo Sartelli, Bruno Viaggi, Pierluigi Viale, Claudio Viscoli, Federico Pea
BACKGROUND: Procalcitonin (PCT) is a useful biomarker of bacterial infection and its use is associated to reduced duration of antibiotic therapy in the setting of intensive care medicine. To address the need of practical guidance for the use of PCT in various clinical settings, a group of experts was invited to participate at a consensus process with the aims of defining the rationale for appropriate use of PCT and for improving the management of critically ill patients with sepsis. METHODS: A group of 14 experts from anesthesiology and critical care, infectious diseases, internal medicine, pulmonology, clinical microbiology, laboratory medicine, clinical pharmacology and methodology provided expert opinion through a modified Delphi process, after a comprehensive literature review...
June 6, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
Raymond L Bonds
Current evidence reveals that surgical patients are more prone to adverse events when compared to any other population in the acute care setting. In a military training hospital, handoff communication between surgical intensive care unit (SICU) nurses, physicians, and anesthesia providers (certified registered nurse anesthetists and anesthesiologists) about patients being prepared for surgery was identified as a problem by an initial inquiry of the staff. This article discusses an evidence-based project (EBP) that utilized a standardized multidisciplinary Situation, Background, Assessment, Recommendation (SBAR) tool to improve communication, teamwork, and the perception of a patient safety culture between the SICU nurses and physicians and the anesthesia providers in preparation for surgery...
May 1, 2018: Creative Nursing
Lingling Yang, Tianzhou Wu, Jiang Li, Jun Li
Acute-on-chronic liver failure (ACLF) is a newly recognized clinical syndrome characterized by preexisting chronic liver disease or cirrhosis with organ failure and high 28-day mortality (50-90%). Bacterial infections (BIs) play pivotal roles in the development and progression of ACLF either as a main precipitating event or a specific complication. The main organisms isolated as triggering ACLF are Gram-positive bacteria, followed by Gram-negative bacteria. Spontaneous bacterial peritonitis, pneumonia, urinary tract infections, and skin infections are prevalent infections that trigger and complicate ACLF...
May 2018: Seminars in Liver Disease
Yuri van der Does, Maarten Limper, Kim E Jie, Stephanie C E Schuit, Henry Jansen, Niki Pernot, Joost van Rosmalen, Marten J Poley, Christian Ramakers, Peter Patka, Eric C M van Gorp, Pleunie P M Rood
OBJECTIVES: Overuse of broad-spectrum antibiotics in emergency departments(EDs) results in antibiotic resistance. We determined if procalcitonin(PCT)-guided therapy can be used to reduce antibiotic regimens in EDs by investigating efficacy, safety and accuracy. METHODS: This was a noninferiority multicenter randomized clinical trial, performed in two Dutch hospitals. Adult patients with fever ≥38.2°C(100.8°F) in triage were randomized between standard diagnostic workup(control group) and PCT-guided therapy, defined as standard workup with addition of one single PCT measurement...
June 2, 2018: Clinical Microbiology and Infection
Andreas Hohn, Nina Balfer, Bernhard Heising, Sabine Hertel, Jan C Wiemer, Marcel Hochreiter, Stefan Schröder
BACKGROUND: In randomised controlled trials, procalcitonin (PCT)-guided antibiotic treatment has been proven to significantly reduce length of antibiotic therapy in intensive care unit (ICU) patients. However, concern was raised on low protocol adherence and high rates of overruling, and thus the value of PCT-guided treatment in real clinical life outside study conditions remains unclear. In this study, adherence to a PCT protocol to guide antibiotic treatment in patients with severe sepsis and septic shock was analysed...
June 4, 2018: Annals of Intensive Care
Amy C Weintrob, Clinton K Murray, Jiahong Xu, Margot Krauss, William Bradley, Tyler E Warkentien, Bradley A Lloyd, David R Tribble
BACKGROUND: During the conflicts in Iraq and Afghanistan, more than 52,000 U.S. military members were wounded in action. The battlefield mortality rate was lower than in past conflicts, however, those surviving often had complex soft tissue and bone injuries requiring multiple surgeries. This report describes the rates, types, and risks of infections complicating the care of combat casualties. PATIENTS AND METHODS: Infection and microbiology data obtained from the Trauma Infectious Disease Outcomes Study (TIDOS), a prospective observational study of infections complicating deployment-related injuries, were used to determine the proportion of infection, types, and associated organisms...
April 2018: Surgical Infections
Huseyin Bilgin, Murat Haliloglu, Ali Yaman, Pinar Ay, Beliz Bilgili, Mustafa Kemal Arslantas, Filiz Ture Ozdemir, Goncagul Haklar, Ismail Cinel, Lutfiye Mulazimoglu
Purpose: The main purpose of this study was to investigate the dynamics of pentraxin 3 (PTX3) compared with procalcitonin (PCT) and C-reactive protein (CRP) in patients with suspicion of ventilator-associated pneumonia (VAP). Materials and Methods: We designed a nested case-control study. This study was performed in the Surgical Intensive Care Unit of a tertiary care academic university and teaching hospital. Ninety-one adults who were mechanically ventilated for >48 hours were enrolled in the study...
2018: Canadian Journal of Infectious Diseases & Medical Microbiology
Camille Hua, Romain Bosc, Emilie Sbidian, Nicolas De Prost, Carolyn Hughes, Patricia Jabre, Olivier Chosidow, Laurence Le Cleach
BACKGROUND: Necrotizing soft tissue infections (NSTIs) are severe and rapidly spreading soft tissue infections of the subcutaneous tissue, fascia, or muscle, which are mostly caused by bacteria. Associated rates of mortality and morbidity are high, with the former estimated at around 23%, and disability, sequelae, and limb loss occurring in 15% of patients. Standard management includes intravenous empiric antimicrobial therapy, early surgical debridement of necrotic tissues, intensive care support, and adjuvant therapies such as intravenous immunoglobulin (IVIG)...
May 31, 2018: Cochrane Database of Systematic Reviews
Sindhura Bandaru, Sukesh Manthri, Vidya Sundareshan, Vidhya Prakash
Empyema necessitans (EN) is a rare phenomenon that refers to an insidious extension of the empyema through parietal pleura and subsequent dissection into subcutaneous tissue of the chest wall. A 29-year-old man presented to the hospital with fever and chills a few days after an inadvertent needle stick while injecting heroin. His left forearm was warm with an area of fluctuance. He underwent incision and drainage of the left forearm abscess with fluid submitted for Gram stain and culture. His condition rapidly deteriorated due to sepsis, and he required transfer to the intensive care unit...
2018: Case Reports in Infectious Diseases
Maria Corazon Astorga, Kyle J Piscitello, Nina Menda, Ann M Ebert, Steven C Ebert, Michael A Porte, Pamela J Kling
Background: Meeting antibiotic stewardship goals in the neonatal intensive care unit (NICU) is challenging because of the unique nature of newborns and the lack of specificity of clinical signs of sepsis. Antibiotics are commonly continued for 48 hours pending culture results and clinical status. The goal of this study was to examine if the implementation of a 48-hour automatic stop (autostop) order during NICU admissions would decrease antibiotic use at UnityPoint Health-Meriter. Methods: An observational double-cohort study was performed in a level 3 NICU...
May 28, 2018: Journal of the Pediatric Infectious Diseases Society
Nayani Prasangika Weerasinghe, Dhammika Vidanagama, Bilesha Perera, Herath Mudiyanselage Meththananda Herath, Ajith De Silva Nagahawatte
OBJECTIVE: To identify the validity of surveillance cultures in predicting causative organism(s) of late onset neonatal sepsis. RESULTS: Prospective analytical study was conducted from January to April 2011 at the Neonatal Intensive Care Unit, Teaching Hospital, Karapitiya, Galle, Sri Lanka. Fifty neonates were screened on admission and weekly thereafter for colonization with potential pathogens. On suspicion of infection, relevant samples were cultured and tested for antibiotic sensitivity...
May 29, 2018: BMC Research Notes
Catalina Sánchez-Ramírez, Silvia Hípola-Escalada, Miriam Cabrera-Santana, María Adela Hernández-Viera, Liliana Caipe-Balcázar, Pedro Saavedra, Fernando Artiles-Campelo, Nayra Sangil-Monroy, Carlos Federico Lübbe-Vázquez, Sergio Ruiz-Santana
BACKGROUND: We examined whether long-term use of selective digestive tract decontamination (SDD) was effective in reducing intensive care unit (ICU)-acquired infection and antibiotic consumption while decreasing colistin-, tobramycin-, and most of the antibiotic-resistant colonization rates in a mixed ICU with a high endemic level of multidrug-resistant bacteria (MDRB). METHODS: In this cohort study, which was conducted in a 30-bed medical-surgical ICU, clinical outcomes before (1 year, non-SDD group) and after (4 years) implementation of SDD were compared...
May 30, 2018: Critical Care: the Official Journal of the Critical Care Forum
Xuan Han, Dana P Edelson, Ashley Snyder, Natasha Pettit, Sarah Sokol, Carmen Barc, Michael D Howell, Matthew M Churpek
BACKGROUND: Sepsis remains a significant cause of morbidity and mortality in the United States, leading to the implementation of the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1). SEP-1 identifies patients with "severe sepsis" via clinical and laboratory criteria and mandates interventions, including lactate draws and antibiotics, within a specific time window. We sought to characterize the patients affected and to study the implications of SEP-1 on patient care and outcomes...
May 19, 2018: Chest
Peter Daley, David Garcia, Raheel Inayatullah, Carla Penney, Sarah Boyd
DESIGNWe conducted a randomized, parallel, unblinded, superiority trial of a laboratory reporting intervention designed to reduce antibiotic treatment of asymptomatic bacteriuria (ASB).METHODSResults of positive urine cultures from 110 consecutive inpatients at 2 urban acute-care hospitals were randomized to standard report (control) or modified report (intervention). The standard report included bacterial count, bacterial identification, and antibiotic susceptibility information including drug dosage and cost...
May 28, 2018: Infection Control and Hospital Epidemiology
Yuto Haruki, Hideharu Hagiya, Mai Haruki, Tetsuhiro Sugiyama
The number of patients infected with extended-spectrum beta-lactamase (ESBL)-producing organisms has increased dramatically worldwide, and high mortality rates are seen in severely ill patients. This study retrospectively compared the clinical characteristics and outcomes of critically ill patients in an intensive care unit (ICU) at the Tsuyama Chuo Hospital (Okayama, Japan) who were hospitalized for bacteremia caused by ESBL-producing Escherichia coli (ESBL-EC) or non-ESBL-producing E. coli (non-ESBL-EC) between January 2006 and December 2016 (11 years)...
May 24, 2018: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
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