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https://www.readbyqxmd.com/read/28733718/antimicrobial-resistance-in-the-next-30%C3%A2-years-humankind-bugs-and-drugs-a-visionary-approach
#1
REVIEW
Matteo Bassetti, Garyphallia Poulakou, Etienne Ruppe, Emilio Bouza, Sebastian J Van Hal, Adrian Brink
PURPOSE: To describe the current standards of care and major recent advances with regard to antimicrobial resistance (AMR) and to give a prospective overview for the next 30 years in this field. METHODS: Review of medical literature and expert opinion were used in the development of this review. RESULTS: There is undoubtedly a large clinical and public health burden associated with AMR in ICU, but it is challenging to quantify the associated excess morbidity and mortality...
July 21, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28732822/atypical-coverage-in-community-acquired-pneumonia-after-outpatient-beta-lactam-monotherapy
#2
Cornelis H van Werkhoven, Ewoudt M W van de Garde, Jan Jelrik Oosterheert, Douwe F Postma, Marc J M Bonten
INTRODUCTION: In adults hospitalized with community-acquired pneumonia (CAP) after >48 h of outpatient beta-lactam monotherapy, coverage of atypical pathogens is recommended based on expert opinion. METHODS: In a post-hoc analysis of a large study of CAP treatment we included patients who received beta-lactam monotherapy for >48 h before hospitalization. Length of hospital stay (LOS), 30-day mortality, and number of treatment escalations were compared for those that continued beta-lactam monotherapy and those that received atypical coverage at admission...
August 2017: Respiratory Medicine
https://www.readbyqxmd.com/read/28732563/risk-factors-and-outcomes-for-the-acquisition-of-carbapenem-resistant-gram-negative-bacillus-bacteremia-a-retrospective-propensity-matched-case-control-study
#3
Shih-Wen Ting, Chen-Hsiang Lee, Jien-Wei Liu
BACKGROUND/PURPOSE: A substantial number of carbapenem-resistant Gram-negative bacilli (CR GNB) have been identified among the etiologic multidrug-resistant GNB in healthcare-associated infections. For achieving a better therapeutic outcome by minimizing inappropriate empirical antibiotic treatment before blood culture and susceptibility testing results are available, it is very important to identify patients who are at risk for the development of CR GNB bacteremia. METHODS: Retrospective analysis of propensity-score matched (PSM) adult patients with CR GNB bacteremia (PSM-group 1 [n = 95]) and those with non-CR GNB bacteremia (PSM-group 2 [n = 190])...
June 23, 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
https://www.readbyqxmd.com/read/28717037/impact-of-a-carbapenem-antimicrobial-stewardship-program-on-patient-outcomes
#4
Valerie Xue Fen Seah, Rina Yue Ling Ong, Ashley Shi Yuan Lim, Chia Yin Chong, Natalie Woon Hui Tan, Koh Cheng Thoon
Antimicrobial stewardship programs (ASPs) aim to improve appropriate antimicrobials use. However, concerns of the negative consequences from accepting ASP interventions exist, particularly when de-escalation or discontinuation of broad-spectrum antibiotics are recommended. Hence, we sought to evaluate the impact on clinical outcomes when ASP interventions for inappropriate carbapenem use were accepted or rejected by primary providers.We retrospectively reviewed all carbapenem prescriptions deemed inappropriate according to institutional guidelines with ASP interventions between July 2011 and December 2014...
July 17, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28709439/enhanced-antimicrobial-de-escalation-for-pneumonia-in-mechanically-ventilated-patients-a-cross-over-study
#5
Tracy Trupka, Kristen Fisher, Scott T Micek, Paul Juang, Marin H Kollef
BACKGROUND: Antibiotics are commonly administered to hospitalized patients with infiltrates for possible bacterial pneumonia, often leading to unnecessary treatment and increasing the risk for resistance emergence. Therefore, we performed a study to determine if an enhanced antibiotic de-escalation practice could improve antibiotic utilization in mechanically ventilated patients with suspected pneumonia cared for in an academic closed intensive care unit (ICU). METHODS: This was a prospective cross-over trial comparing routine antibiotic management (RAM) and enhanced antimicrobial de-escalation (EAD) performed within two medical ICUs (total 34 beds) at Barnes-Jewish Hospital, an academic referral center...
July 15, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28705675/use-of-evidence-based-recommendations-in-an-antibiotic-care-bundle-for-the-intensive-care-unit
#6
Nico T Mutters, Giulia De Angelis, Giovanni Restuccia, Francesca Di Muzio, Jeroen Schouten, Marlies Hulscher, Massimo Antonelli, Evelina Tacconelli
PURPOSE: To drive decisions on antibiotic therapy in the intensive care unit (ICU), we developed an antibiotic care bundle (ABC-Bundle) with evidence-based recommendations (EBRs) for antibiotic prescriptions. METHODS: We conducted a 3-step prospective study. First, a systematic review of the literature reporting EBRs for antibiotic usage in the ICU was performed. Second, we developed an ABC-Bundle through a 2-round, RAND-modified Delphi method with an international expert panel, including the most relevant EBRs on a 9-point Likert scale...
July 10, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28694235/clinical-benefits-of-antimicrobial-de-escalation-in-adults-with-community-onset-monomicrobial-escherichia-coli-klebsiella-species-and-proteus-mirabilis-bacteremia
#7
Ching-Chi Lee, Jiun-Ling Wang, Chung-Hsun Lee, Yuan-Pin Hung, Ming-Yuan Hong, Hung-Jen Tang, Wen-Chien Ko
The clinical benefits of an antimicrobial de-escalation strategy were compared with those of a no-switch strategy in bacteremic patients. Adults with community-onset monomicrobial Escherichia coli, Klebsiella species and Proteus mirabilis bacteremia treated empirically using broad-spectrum beta-lactams, including third-generation cephalosporins (GCs), fourth-GC or carbapenems, were treated definitively with first- or second-GCs (de-escalation group), the same regimens as empirical antibiotics (no-switch group), or antibiotics with a broader-spectrum than empirical antibiotics (escalation group)...
July 7, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28693625/a-role-for-antimicrobial-stewardship-in-clinical-sepsis-pathways-a-prospective-interventional-study
#8
John Burston, Suman Adhikari, Andrew Hayen, Heather Doolan, Melissa L Kelly, Kathy Fu, Tomas O Jensen, Pamela Konecny
OBJECTIVE To evaluate the impact of early infectious diseases (ID) antimicrobial stewardship (AMS) intervention on inpatient sepsis antibiotic management. DESIGN Interventional, nonrandomized, controlled study. SETTING Tertiary-care referral hospital, Sydney, Australia. PATIENTS Consecutive, adult, non-intensive care unit (non-ICU) inpatients triggering an institutional clinical sepsis pathway from May to August 2015. INTERVENTION All patients reviewed by an ID Fellow within 24 hours of sepsis pathway trigger underwent case review and clinic file documentation of recommendations...
July 11, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28685393/side-effects-of-long-term-continuous-intra-arterial-nimodipine-infusion-in-patients-with-severe-refractory-cerebral-vasospasm-after-subarachnoid-hemorrhage
#9
Martin Kieninger, Julia Flessa, Nicole Lindenberg, Sylvia Bele, Andreas Redel, André Schneiker, Gerhard Schuierer, Christina Wendl, Bernhard Graf, Vera Silbereisen
BACKGROUND: Long-term continuous intra-arterial nimodipine infusion (CIAN) is a rescue therapy option in cases of severe refractory cerebral vasospasm (CV) following acute non-traumatic subarachnoid hemorrhage (SAH). However, CIAN therapy can be associated with relevant side effects. Available studies focus on intracerebral complications, whereas extracerebral side effects are rarely examined. Aim of the present study was to generate descriptive data on the clinical course during CIAN therapy and expectable extracerebral side effects...
July 6, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28679083/antimicrobial-resistance-in-escherichia-coli-and-salmonella-spp-isolates-from-fresh-produce-and-the-impact-to-food-safety
#10
Pierangeli G Vital, Marie Bernadine D Caballes, Windell L Rivera
Foodborne diseases associated with fresh produce consumption have escalated worldwide, causing microbial safety of produce of critical importance. Bacteria that have increasingly been detected in fresh produce are Escherichia coli and Salmonella spp., both of which have been shown to progressively display antimicrobial resistance. The study focused on the assessment of antimicrobial resistance of these enteric bacteria from different kinds of fresh produce from various open air markets and supermarkets in the Philippines...
July 5, 2017: Journal of Environmental Science and Health. Part. B, Pesticides, Food Contaminants, and Agricultural Wastes
https://www.readbyqxmd.com/read/28666580/current-trends-and-challenges-in-the-postoperative-medical-management-of-crohn-s-disease-a-systematic-review
#11
REVIEW
Andrew T Schlussel, Nicole B Cherng, Karim Alavi
BACKGROUND: Crohn's disease is an aggressive chronic inflammatory disorder, and despite medical advances no cure exists. There is a great risk of requiring an operative intervention, with evidence of recurrence developing in up to 80-90% of cases. Therefore, we sought to systematically review the current status in the postoperative medical management of Crohn's disease. DATA SOURCES: A systematic literature review of medications administered following respective therapy for Crohn's disease was performed from 1979 through 2016...
June 6, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28655352/evaluation-of-early-antimicrobial-therapy-adaptation-guided-by-the-betalacta%C3%A2-test-a-case-control-study
#12
Marc Garnier, Sacha Rozencwajg, Tài Pham, Sophie Vimont, Clarisse Blayau, Mehdi Hafiani, Jean-Pierre Fulgencio, Francis Bonnet, Jean-Luc Mainardi, Guillaume Arlet, Muriel Fartoukh, Salah Gallah, Christophe Quesnel
BACKGROUND: Rapid diagnostic tests detecting microbial resistance are needed for limiting the duration of inappropriateness of empirical antimicrobial therapy (EAT) in intensive care unit patients, besides reducing the use of broad-spectrum antibiotics. We hypothesized that the betaLACTA® test (BLT) could lead to early increase in the adequacy of antimicrobial therapy. METHODS: This was a case-control study. Sixty-one patients with BLT-guided adaptation of EAT were prospectively included, and then matched with 61 "controls" having similar infection characteristics (community or hospital-acquired, and source of infection), in whom EAT was conventionally adapted to antibiogram results...
June 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28643112/a-retrospective-study-of-antibiotic-de-escalation-in-patients-with-ventilator-associated-pneumonia-in-malaysia
#13
Rahela Ambaras Khan, Zoriah Aziz
Background Antibiotic de-escalation is an important strategy to conserve the effectiveness of broad-spectrum antibiotics. However, the outcome of this strategy for the treatment of ventilator-associated pneumonia (VAP) has not been widely studied in developing countries. Objectives To evaluate the outcome on intensive care unit (ICU) mortality, 28 days mortality, and length of ICU stay among VAP patients who receive de-escalation therapy. Setting This study was conducted in an ICU of a Malaysian public hospital...
June 22, 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28630239/an-unusual-case-of-escherichia-coli-o157-h7-infection-with-pseudomembranous-colitis-like-lesions-associated-with-haemolytic-uraemic-syndrome-and-neurological-sequelae
#14
James Kennedy, Lauren Simmonds, Robert Orme, Warren Doherty
A 75-year-old man was admitted with abdominal pain and fresh rectal bleeding. Significantly, he had no risk factors for Clostridium difficile infection. An abdominal CT demonstrated colonic thickening, and flexible sigmoidoscopy identified pseudomembranous colitis-like lesions. After initial treatment as C. difficile colitis, a stool sample revealed Escherichia coli O157:H7 infection. Antibiotic therapy was stopped due to the risk of lysis-mediated toxin release, but unfortunately, the patient continued to deteriorate...
June 18, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28627952/clinical-efficacy-of-piperacillin-tazobactam-in-the-treatment-of-complicated-skin-and-soft-tissue-infections
#15
Kohei Takimoto, Qianzhi Wang, Daisuke Suzuki, Mitsuya Katayama, Yoshiro Hayashi
Complicated skin and soft tissue infections (cSSTIs) are skin and soft tissue infections (SSTIs) that involve deep soft tissue. cSSTIs often require surgical intervention and/or hospitalization. cSSTIs are associated with significant mortality and morbidity, and carry a significant burden on health care systems. Piperacillin/tazobactam has been regarded as a standard treatment for cSSTIs because of its antibiotic spectrum, safety and clinical efficacy. Several antibiotics, as compared to piperacillin/tazobactam, have been evaluated in the treatment of cSSTIs...
July 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/28601833/targeted-simplification-versus-antipseudomonal-broad-spectrum-beta-lactams-in-patients-with-bloodstream-infections-due-to-enterobacteriaceae-simplify-a-study-protocol-for-a-multicentre-open-label-phase-iii-randomised-controlled-non-inferiority-clinical-trial
#16
Luis Eduardo López-Cortés, Clara Rosso-Fernández, María Núñez-Núñez, Lucía Lavín-Alconero, José Bravo-Ferrer, Ángel Barriga, Mercedes Delgado, Carmen Lupión, Pilar Retamar, Jesús Rodríguez-Baño
INTRODUCTION: Within the context of antimicrobial stewardship programmes, de-escalation of antimicrobial therapy is one of the proposed strategies for reducing the unnecessary use of broad-spectrum antibiotics (BSA). The empirical treatment of nosocomial and some healthcare-associated bloodstream infections (BSI) frequently includes a beta-lactam with antipseudomonal activity as monotherapy or in combination with other drugs, so there is a great opportunity to optimise the empirical therapy based on microbiological data...
June 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28584140/safety-tolerability-systemic-exposure-and-metabolism-of-crs3123-a-methionyl-trna-synthetase-inhibitor-developed-for-treatment-of-clostridium-difficile-infections-in-a-phase-i-study
#17
Seema U Nayak, J McLeod Griffiss, Jeffrey Blumer, Mary Ann O'Riordan, Wesley Gray, Robin McKenzie, Robert A Jurao, Amanda T An, Melissa Le, Stacie J Bell, Urs A Ochsner, Thale C Jarvis, Nebojsa Janjic, Jonathan M Zenilman
Clostridium difficile causes antibiotic associated diarrhea and is a major public health concern. Current therapies disrupt the protective intestinal flora, do not reliably prevent recurrent infections and will be decreasingly effective should less susceptible strains emerge. CRS3123 is an oral agent that inhibits bacterial methionyl-tRNA synthetase, has potent activity against C. difficile and aerobic Gram positive bacteria, but little activity against Gram negative bacteria, including anaerobes. This first-in-human, double-blind, placebo-controlled, dose-escalation study evaluated the safety and systemic exposure of CRS3123 after a single oral dose in healthy adults...
June 5, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28578555/infections-due-to-acinetobacter-baumannii-in-the-icu-treatment-options
#18
Joseph P Lynch, George G Zhanel, Nina M Clark
Bacteria within the genus Acinetobacter (principally A. baumannii-calcoaceticus complex [ABC]) are gram-negative coccobacilli that may cause nosocomial infections in critically ill or debilitated patients (particularly ventilator-associated pneumonia and infections of the bloodstream, urinary tract, and wounds). Treatment of Acinetobacter infections is difficult, as Acinetobacter spp. are intrinsically resistant to multiple antimicrobial agents, and have a remarkable ability to acquire new resistance determinants via mechanisms that include plasmids, transposons, integrons, and resistance islands...
June 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28578550/ventilator-associated-pneumonia-the-role-of-emerging-diagnostic-technologies
#19
Marin H Kollef, Carey-Ann D Burnham
Antibiotic resistance has emerged as a key determinant of outcome in patients with serious infections along with the virulence of the underlying pathogen. Within the intensive care unit (ICU) setting, ventilator-associated pneumonia (VAP) is a common nosocomial infection that is frequently caused by multidrug-resistant bacteria. Antimicrobial resistance is a growing challenge in the care of critically ill patients. Escalating rates of antibiotic resistance add substantially to the morbidity, mortality, and cost related to infection in the ICU...
June 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28573366/-antibiotic-stewardship%C3%A2-2-0-individualization-of-therapy
#20
REVIEW
M W Pletz, E Tacconelli, T Welte
Antibiotic resistance is a part of bacterial evolution and therefore unavoidable. In the context of missing novel treatment options, the restrictive use of available antibiotics in order to decelerate the spread of resistance is of high importance. This is the aim of Antibiotic Stewardship (ABS). ABS consists of two sides: a structural one and an individual one. The former deals with the formation of ABS teams, the analysis of antibiotic usage and resistance development, and the implementation of certain measures to improve antibiotic use; the latter is reflected by concrete bedside decisions: How can (broad) spectrum antibiotics be spared without harming the patient? This can be achieved, for example, by de-escalation, limiting duration of treatment, and avoiding nonindicated use...
July 2017: Der Internist
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