Read by QxMD icon Read

Empiric antibiotic treatment of sepsis

Maureen Campion, Gail Scully
Appropriate antimicrobial therapy is essential to ensuring positive patient outcomes. Inappropriate or suboptimal utilization of antibiotics can lead to increased length of stay, multidrug-resistant infections, and mortality. Critically ill intensive care patients, particularly those with severe sepsis and septic shock, are at risk of antibiotic failure and secondary infections associated with incorrect antibiotic use. Through the initiation of active empiric antibiotic therapy based upon local susceptibilities, daily evaluation of signs and symptoms of infection and narrowing of antibiotic therapy when feasible, providers can streamline the treatment of common intensive care unit (ICU) infections...
January 1, 2018: Journal of Intensive Care Medicine
Alexander R Levine, Midori Tran, Jonathan Shepherd, Edgar Naut
BACKGROUND: Urinary tract infections (UTIs) are one of the most common reasons women seek treatment in the emergency department (ED). The biomarker procalcitonin (PCT) has gained popularity over the last decade to improve the diagnosis of bacterial infections and reduce unnecessary exposure to antibiotics. PCT has been extensively studied in patients with pneumonia and sepsis and may have additional role in UTI. METHODS: A retrospective study of patients who presented to the ED in which a urinalysis test and a PCT level was obtained within the first 24h of presentation...
March 3, 2018: American Journal of Emergency Medicine
Pan Hu, Zhi Mao, Chao Liu, Xin Hu, Hongjun Kang, Feihu Zhou
Malignant atrophic papulosis (MAP) is a rare type of obliterating vasculopathy that can present as pure cutaneous lesions or a systemic entity affecting multiple organs. Systemic disease, such as gastrointestinal or central nervous system involvement, may predispose the patients to poorer or even fatal outcomes. We present a 30-year-old female patient with systemic manifestation of MAP 10 days after delivery of a full-term pregnancy who subsequently developed motor aphasia and intestinal perforation. The patient was administrated empirical treatment with an antiplatelet, anticoagulant, methylprednisolone sodium succinate and alprostadil...
March 8, 2018: Journal of Dermatology
Tobias Strunk, Ashok Buchiboyina, Mary Sharp, Elizabeth Nathan, Dorota Doherty, Sanjay Patole
BACKGROUND: Early-onset sepsis (EOS) is a potentially fatal condition that affects about 0.3-0.8/1,000 infants born at ≥35 weeks' gestation in developed countries. Current EOS management algorithms result in 8-15% of infants receiving antibiotics for suspected sepsis. The Neonatal Sepsis Calculator provides evidence-based estimates of individual sepsis risk, but data on its clinical application is limited. OBJECTIVES: To evaluate the feasibility, safety, and effect on the newborn infants that were investigated and that received antibiotic treatment for suspected EOS following the introduction of the Neonatal Sepsis Calculator...
March 7, 2018: Neonatology
Ejaz Ahmed, Abdur Rehman, Muhammad Asghar Ali
Objective: To evaluate the adequacy of serum C-reactive protein (CRP) in diagnosing neonatal sepsis and role of CRP in determining the duration of antibiotic treatment in neonatal sepsis. Methods: In this validation study, we included 135 neonates with suspected diagnosis of sepsis within duration of nine months from September 2016 to May2017 in Children Hospital Multan. Blood samples were drawn from every neonate for culture sensitivity and measurement of serum C-reactive proteins...
November 2017: Pakistan Journal of Medical Sciences Quarterly
Niek B Achten, J Wendelien Dorigo-Zetsma, Paul D van der Linden, Monique van Brakel, Frans B Plötz
Significant overtreatment with antibiotics for suspected early onset sepsis (EOS) constitutes a persisting clinical problem, generating unnecessary risks, harms, and costs for many newborns. We aimed to study feasibility and impact of a sepsis calculator to help guide antibiotic for suspected EOS in a European setting. In this single-center study, the sepsis calculator was implemented as an addition to and in accordance with existing protocols. One thousand eight hundred seventy-seven newborns ≥ 35 weeks of gestational age were prospectively evaluated; an analogous retrospective control group (n = 2076) was used for impact analysis...
February 18, 2018: European Journal of Pediatrics
Fortress Yayra Aku, Patricia Akweongo, Kofi Nyarko, Samuel Sackey, Fredrick Wurapa, Edwin Andrew Afari, Donne Kofi Ameme, Ernest Kenu
Background: Globally, 4 million neonates die annually, with one-third of such deaths occurring as a result of infections. In 2011, there were 7.2million deaths in children below 5 years globally, and a proportion of 40% of these deaths occurred in neonates. Sepsis was reported to account for one-third of these deaths. Presently, multidrug antibiotic resistance is rapidly increasing in Neonatal Intensive Care Units (NICUs), particularly in developing countries and poses a threat to public health...
2018: Maternal Health, Neonatology and Perinatology
Amar H Kelkar, Kavitha S Jacob, Eman B Yousif, John J Farrell
RATIONALE: Herein, we present a case of seemingly unprovoked portal vein thrombosis (PVT) occurring in the context of an acute cytomegalovirus (CMV) infection and prolonged debilitating fatigue. PATIENT CONCERNS: A 46-year-old male airline pilot presented with a 2 week history of abdominal pain, nausea, vomiting, watery diarrhea, and daily recurrent fevers. This was in the context of progressive, debilitating fatigue for 3 months forcing the patient to leave his job...
December 2017: Medicine (Baltimore)
Po-Hsiung Chang, Chin-Ming Jeng, Der-Fang Chen, Lung-Huang Lin
RATIONALE: Sigmoid volvulus (SV) is an exceptionally rare but potentially life-threatening condition in children. CHIEF COMPLAINT: Abdominal distention for 1 week. DIAGNOSES: Sigmoid volvulus. PATIENT CONCERNS: We present a case of a 12-year-old boy with mechanical ileus who was finally confirmed to have SV with the combination of abdominal plain film, sonography, and computed tomography (CT) with the finding of mesenteric artery rotation...
December 2017: Medicine (Baltimore)
Alejandra Ugarte-Torres, Mark R Gillrie, Thomas P Griener, Deirdre L Church
Background: Eggerthella lenta is a non-sporulating anaerobic gram-positive bacilli associated with polymicrobial intra-abdominal infections. Recently, E. lenta has been recognized as an important cause of anaerobic blood-stream infections (BSI) associated with high mortality. E. lenta has been reported to have high minimal inhibitory concentrations (MICs) to piperacillin-tazobactam (TZP), a broad-spectrum antibiotic with anaerobic coverage commonly used in multiple centers for empiric treatment of abdominal sepsis...
January 24, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Asher Weisberg, Pauline Park, Jill R Cherry-Bukowiec
The use of early goal-directed therapy (EGDT) for the management of severe sepsis and septic shock, a practice put forth by Dr. Rivers et al. in 2001, ushered in a new era of targeted sepsis therapy. After its publication, several further studies helped validate the protocolized approach to sepsis management, ultimately leading to its incorporation into the Surviving Sepsis Campaign guidelines. Since that time, however, a trio of large multi-center randomized controlled trials have taken place to evaluate the efficacy of EGDT when compared with usual care and have demonstrated that strict adherence to the entirety of the original EGDT protocol is unnecessary for improved outcomes...
January 22, 2018: Surgical Infections
Philip Robinson, Surjo Kiran De
Diagnosing bacterial infection in the unwell or febrile child is a common challenge faced by all paediatricians. Despite the advent of novel molecular techniques, there is ongoing need for diagnostic assays with adequate performance and turnaround time to facilitate safe clinical decision-making when bacterial sepsis is suspected, such as whether to commence empirical treatment with antibiotics. Procalcitonin is an established marker of infection that has a potential role in the diagnosis and exclusion of serious or invasive bacterial infection in neonates and children...
January 17, 2018: Archives of Disease in Childhood. Education and Practice Edition
Sara A Buckman, Isaiah R Turnbull, John E Mazuski
BACKGROUND: Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Early recognition and treatment are the cornerstones of management. METHODS: Review of the English-language literature. RESULTS: For both sepsis and septic shock "antimicrobials [should be] be initiated as soon as possible and within one hour" (Surviving Sepsis Campaign). The risk of progression from severe sepsis to septic shock increases 8% for each hour before antibiotics are started...
January 17, 2018: Surgical Infections
Nicholas J Mercuro, Patricia Stogsdill, Minkey Wungwattana
Enterobacteriaceae bloodstream infections (EB-BSI) are a common manifestation of Gram-negative sepsis, and are initially managed with empiric intravenous (IV) antibiotics. Upon stabilization and source control, patients are often transitioned to an oral agent. The fluoroquinolone (FQ) class plays a prominent role in stepdown therapy for severe infections due to favorable pharmacokinetic parameters; however, serious adverse effects have been documented with their use. Two hundred and twenty-four adults with EB-BSI initiated on empiric IV antibiotics with stepdown to oral beta-lactam (BLM) (n= 84) or FQ (n= 140) were included to compare clinical success and identify risk factors for treatment failure...
December 25, 2017: International Journal of Antimicrobial Agents
David Carola, Mansi Vasconcellos, Amy Sloane, Dorothy McElwee, Caroline Edwards, Jay Greenspan, Zubair H Aghai
OBJECTIVES: To evaluate the performance of the early-onset sepsis (EOS) risk calculator in a cohort of neonates born to mothers with clinical chorioamnionitis, and to compare the diagnostic utility of the EOS calculator, clinical signs, and laboratory evaluations for correctly identifying EOS in this cohort. STUDY DESIGN: This was a retrospective study of neonates born at ≥35 weeks of gestation to mothers with chorioamnionitis. The risk and management categories for all neonates were calculated using the EOS calculator, and these results were analyzed and compared with laboratory data and clinical signs...
December 22, 2017: Journal of Pediatrics
Marya D Zilberberg, Brian H Nathanson, Kate Sulham, Weihong Fan, Andrew F Shorr
Background: Enterobacteriaceae are common pathogens in pneumonia, sepsis and urinary tract infection (UTI). Though rare, carbapenem resistance (CRE) among these organisms complicates efforts to ensure adequate empiric antimicrobial therapy. In turn this negatively impacts such outcomes as mortality and hospital costs. We explored proportion of total costs represented by antibiotics, 30-day readmission rates, and per-day costs of inadequate antimicrobial coverage among patients with Enterobacteriaceae pneumonia, sepsis and/or UTI in the context of inappropriate (IET) vs...
2017: Antimicrobial Resistance and Infection Control
Øyvind Andreas Fladberg, Silje Bakken Jørgensen, Hege Vangstein Aamot
Background: Cephalosporin resistance in clinical E. coli isolates is increasing internationally. The increase has been caused by virulent and often multidrug-resistant clones, especially the extended spectrum β-lactamase (ESBL) producing E. coli clone O25b-ST131. Methods: In Norway, recommended empirical treatment of sepsis consists of gentamicin and penicillin combined, or a broad-spectrum cephalosporin. To investigate if increased gentamicin and cephalosporins resistance rates in our hospital could be caused by specific clones, we conducted a retrospective study on E...
2017: Antimicrobial Resistance and Infection Control
İlyas Dökmetaş, Aziz Ahmad Hamidi, Mehmet Emin Bulut, Sinan Çetin, Ahsen Öncül, Nuray Uzun
Objective: It has been shown in previous studies that inadequate empirical treatment is associated with mortality in a variety of infections caused by Gram-negative bacteria. In this study, the clinical effect of discordance in empirical treatment was investigated in patients with urinary tract infection (UTI) accompanied by bacteremia. Material and methods: We retrospectively reviewed the files of adult (>18 years old) patients who were diagnosed with UTI in our clinic between January 2014 and December 2015...
December 2017: Turkish Journal of Urology
Charlotte Aillet, Didier Jammes, Agnès Fribourg, Sophie Léotard, Olivier Pellat, Patricia Etienne, Dominique Néri, Djamel Lameche, Olivier Pantaloni, Serge Tournoud, Pierre-Marie Roger
Patients with bacteraemia constitute an useful population for an audit of antibiotic treatments. Empirical antibiotic therapy (EAT) and its reassessment must take into account clinical data and microbiological results. Our aim was to determine the impact of these sequential steps of the therapy on survival. This was a retrospective multicentre study which included patients admitted to emergency departments (ED) for whom blood cultures were positive over a 4-month period. Microbial results were compiled from the database of the laboratories...
February 2018: European Journal of Clinical Microbiology & Infectious Diseases
Scott T Micek, Nicholas Hampton, Marin Kollef
Sepsis and septic shock remain serious consequences of infections, with reported mortality rates in excess of 40 percent. Timely antibiotic therapy in cases of sepsis and septic shock is recognized as an important determinant of outcome. However, the administration of ineffective empirical treatment (IET) (an initial antibiotic regimen that is not active against the identified pathogen[s] based on in vitro susceptibility testing results) is associated with excess mortality compared to effective empirical treatment (EET)...
January 2018: Antimicrobial Agents and Chemotherapy
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"