scholarly journals Influence of Antibiotic Susceptibility Testing on Antibiotic Choice in Hospital-Acquired and Ventilator-Associated Pneumonia

2020 ◽  
Vol 41 (S1) ◽  
pp. s520-s521
Author(s):  
Taissa Zappernick ◽  
Robbie Christian ◽  
Sharanie Sims ◽  
Brigid Wilson ◽  
Federico Perez ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Susceptibility ◽  
Susceptibility Testing ◽  
Empiric Antibiotic Therapy ◽  
Ventilator Associated Pneumonia ◽  
Antibiotic Susceptibility Testing ◽  
Bacterial Identification ◽  
Respiratory Sample ◽  
Empiric Antibiotic ◽  
Hospital Acquired

Background: The survival of patients with hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) is largely determined by the timely administration of effective antibiotic therapy. Guidelines for the treatment HAP and VAP recommend empiric treatment with broad-spectrum antibiotics and tailoring of antibiotic therapy once results of microbiological testing are available. Objective: We examined the influence of bacterial identification and antibiotic susceptibility testing on antibiotic therapy for patients with HAP or VAP. Methods: We used the US Veterans’ Health Administration (VHA) database to identify a retrospective cohort of patients diagnosed with HAP or VAP between fiscal year 2015 and 2018. We further analyzed patients who were started on empiric antibiotic therapy, for whom microbiological test results from a respiratory sample were available within 7 days and who were alive within 48 hours of sample collection. We used the antibiotic spectrum index (ASI) to compare antibiotics prescribed the day before and the day after availability of bacterial identification and antibiotic susceptibility testing results. Results: We identified 4,669 cases of HAP and VAP in 4,555 VHA patients. The median time from respiratory sample receipt in the laboratory to final result of bacterial identification and antibiotic susceptibility testing was 2.22 days (IQR, 1.31–3.38 days). The most common pathogen was Staphylococcus aureus (n = 994), with methicillin resistance in 58% of those isolates tested. The next most common pathogen was Pseudomonas spp (n = 946 isolates). The susceptibility of antipseudomonal antibiotics, when tested, was as follows: 64% to carbapenems, 74% to cephalosporins, 75% to β-lactam/β-lactamase inhibitors, 69% to fluoroquinolones, and 95% to amikacin. Lactose-fermenting gram-negative bacteria (296 Escherichia coli and 360 Klebsiella pneumoniae) were also common. Among the 3,094 cases who received empiric antibiotic therapy, 607 (20%) had antibiotics stopped the day after antibiotic susceptibility results became available, 920 (30%) had a decrease in ASI, 1,075 (35%) had no change in ASI, and 492 (16%) had an increase in ASI (Fig. 1). Among the 1,098 patients who were not started on empiric antibiotic therapy, only 154 (14%) were started on antibiotic therapy the day after antibiotic susceptibility results became available. Conclusions: Changes in antibiotic therapy occurred in at least two-thirds of cases the day after bacterial identification and antibiotic susceptibility results became available. These results highlight how respiratory cultures can inform the treatment and improve antibiotic stewardship for patients with HAP/VAP.Funding: This study was supported by Accelerate Diagnostics.Disclosures: None

scholarly journals Emerging Microtechnologies and Automated Systems for Rapid Bacterial Identification and Antibiotic Susceptibility Testing

2017 ◽  
Vol 22 (6) ◽  
pp. 585-608 ◽  
Author(s):  
Yiyan Li ◽  
Xing Yang ◽  
Weian Zhao
Keyword(s):  
Antibiotic Susceptibility ◽  
Susceptibility Testing ◽  
Point Of Care ◽  
Single Cells ◽  
Turnaround Time ◽  
Resistant Bacteria ◽  
Representative Point ◽  
Antibiotic Susceptibility Testing ◽  
Bacterial Identification ◽  
Automated Systems

Rapid bacterial identification (ID) and antibiotic susceptibility testing (AST) are in great demand due to the rise of drug-resistant bacteria. Conventional culture-based AST methods suffer from a long turnaround time. By necessity, physicians often have to treat patients empirically with antibiotics, which has led to an inappropriate use of antibiotics, an elevated mortality rate and healthcare costs, and antibiotic resistance. Recent advances in miniaturization and automation provide promising solutions for rapid bacterial ID/AST profiling, which will potentially make a significant impact in the clinical management of infectious diseases and antibiotic stewardship in the coming years. In this review, we summarize and analyze representative emerging micro- and nanotechnologies, as well as automated systems for bacterial ID/AST, including both phenotypic (e.g., microfluidic-based bacterial culture, and digital imaging of single cells) and molecular (e.g., multiplex PCR, hybridization probes, nanoparticles, synthetic biology tools, mass spectrometry, and sequencing technologies) methods. We also discuss representative point-of-care (POC) systems that integrate sample processing, fluid handling, and detection for rapid bacterial ID/AST. Finally, we highlight major remaining challenges and discuss potential future endeavors toward improving clinical outcomes with rapid bacterial ID/AST technologies.

Reduction in Inadequate Empiric Antibiotic Therapy for Ventilator-Associated Pneumonia: Impact of a Unit-Specific Treatment Pathway

2008 ◽  
Vol 74 (6) ◽  
pp. 516-523 ◽  
Author(s):  
Louis J. Magnotti ◽  
Thomas J. Schroeppel ◽  
Timothy C. Fabian ◽  
L. Paige Clement ◽  
Joseph M. Swanson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antibiotic Therapy ◽  
Injury Severity ◽  
Specific Treatment ◽  
Empiric Antibiotic Therapy ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Empiric Antibiotic ◽  
Specific Pathway

Empiric antibiotic therapy is routinely initiated for patients with presumed ventilator-associated pneumonia (VAP). Reported mortality rates for inadequate empiric antibiotic therapy (IEAT) for VAP range from 45 to 91 per cent. The purpose of this study was to determine the effect of a unit-specific pathway for the empiric management of VAP on reducing IEAT episodes and improving outcomes in trauma patients. Patients admitted with VAP over 36-months were identified and stratified by gender, age, severity of shock, and injury severity. Outcomes included number of IEAT episodes, ventilator days, intensive care unit days, hospital days, and mortality. Three hundred and ninety-three patients with 668 VAP episodes were identified. There were 144 (22%) IEAT episodes: significantly reduced compared with our previous study (39%) ( P < 0.001). Patients were classified by number of IEAT episodes: 0 (n = 271), 1 (n = 98) and ≥ 2 (n = 24). Mortality was 12 per cent, 13 per cent, and 38 per cent ( P < 0.001), respectively. Multivariable logistic regression identified multiple IEAT episodes as an independent predictor of mortality (odds ratio = 4.7; 95% confidence interval: 1.684–13.162). Multiple IEAT episodes were also associated with prolonged mechanical ventilation and intensive care unit stay ( P < 0.001). Trauma patients with multiple IEAT episodes for VAP have increased morbidity and mortality. Adherence to a unit-specific pathway for the empiric management of VAP reduces multiple IEAT episodes. By limiting IEAT episodes, resource utilization and hospital mortality are significantly decreased.

scholarly journals A simple blood-culture bacterial pellet preparation for faster accurate direct bacterial identification and antibiotic susceptibility testing with the VITEK 2 system

2013 ◽  
Vol 62 (5) ◽  
pp. 773-777 ◽  
Author(s):  
Guy Prod’hom ◽  
Christian Durussel ◽  
Gilbert Greub
Keyword(s):  
Ammonium Chloride ◽  
Antibiotic Susceptibility ◽  
Susceptibility Testing ◽  
Blood Cultures ◽  
Correct Identification ◽  
Antibiotic Susceptibility Testing ◽  
Bacterial Identification ◽  
Lower Accuracy ◽  
Direct Inoculation ◽  
Vitek 2

An ammonium chloride procedure was used to prepare a bacterial pellet from positive blood cultures, which was used for direct inoculation of VITEK 2 cards. Correct identification reached 99 % for Enterobacteriaceae and 74 % for staphylococci. For antibiotic susceptibility testing, very major and major errors were 0.1 and 0.3 % for Enterobacteriaceae, and 0.7 and 0.1 % for staphylococci, respectively. Thus, bacterial pellets prepared with ammonium chloride allow direct inoculation of VITEK cards with excellent accuracy for Enterobacteriaceae and a lower accuracy for staphylococci.

The adequacy of timely empiric antibiotic therapy for ventilator-associated pneumonia: An important determinant of outcome

2012 ◽  
Vol 27 (3) ◽  
pp. 322.e7-322.e14 ◽  
Author(s):  
John G. Muscedere ◽  
Andrew F. Shorr ◽  
Xuran Jiang ◽  
Andrew Day ◽  
Daren K. Heyland
Keyword(s):  
Antibiotic Therapy ◽  
Important Determinant ◽  
Empiric Antibiotic Therapy ◽  
Ventilator Associated Pneumonia ◽  
Empiric Antibiotic

INADEQUATE EMPIRIC ANTIBIOTIC THERAPY AND ITS INFLUENCE ON MORTALITY OF PATIENTS WITH VENTILATOR ASSOCIATED PNEUMONIA.

2006 ◽  
Vol 34 ◽  
pp. A93
Author(s):  
Shiry Attie ◽  
Ignacio Bonelli ◽  
Luis Mazzuoccolo ◽  
Martin Stryjewski ◽  
Ricardo Valentini
Keyword(s):  
Antibiotic Therapy ◽  
Empiric Antibiotic Therapy ◽  
Ventilator Associated Pneumonia ◽  
Empiric Antibiotic

scholarly journals Use of a Precision Antibiotic Therapy (PAT) Prediction Model to Identify Multidrug-Resistant (MDR) Enterobacteriaceae

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S328-S328 ◽  
Author(s):  
Alexandra Varga ◽  
Leigh Cressman ◽  
Ebbing Lautenbach ◽  
Valerie Cluzet ◽  
Pam Tolomeo ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Susceptibility ◽  
Area Under The Curve ◽  
Empiric Therapy ◽  
Multidrug Resistant ◽  
Empiric Antibiotic Therapy ◽  
Brier Score ◽  
First Line ◽  
Roc Curve Analysis ◽  
Empiric Antibiotic

Abstract Background Emergence of multidrug-resistant (MDR) Enterobacteriaceae complicates the selection of empiric antibiotic therapy. Software called Precision Antibiotic Therapy (PAT) (Teqqa, LLC; Jackson, WY) operationalizes a predictive model using patient factors to make real-time, personalized predictions of antibiotic susceptibility for each antibiotic, allowing prescribers to choose empiric therapy for patients at risk for resistant infections. The purpose of this study was to determine the performance of PAT software in identifying MDR Enterobacteriaceaebloodstream infections (BSI) as well as to determine optimal thresholds of predicted antibiotic susceptibility to choose a broader-spectrum antibiotic. Methods We conducted a retrospective cohort study including 475 unique patients with BSIs caused by Enterobacteriaceaefrom January 1, 2016 through December 31, 2016. First-line antibiotic therapy for BSI was defined as cefepime, piperacillin-tazobactam, levofloxacin, or aztreonam. Susceptibilities predicted by PAT were compared with known susceptibilities determined by routine laboratory testing. PAT thresholds for broadening antibiotics were assessed when predicted susceptibilities were 80%, 85%, 90%, and 95% using receiver-operating characteristic (ROC) curves. Performance characteristics were calculated for each threshold. Brier score calculations were then used to compare the accuracy of PAT predictions using the optimized predicted susceptibility threshold, to that of aggregate institutional susceptibility data. Results ROC curve analysis demonstrated an area under the curve of 0.82 for the 95% threshold. The sensitivity for the PAT prediction utilizing the 95% threshold was 91.7% with a specificity of 74.3%. The Brier score for the 2016 antibiogram to determine antibiotic therapy was 0.085, whereas the Brier score using PAT software was 0.071, representing a 16% improvement in accuracy. Conclusion PAT software demonstrated excellent capability to discriminate between Enterobacteriaceae BSIs resistant and susceptible to first-line therapy. A predicted susceptibility threshold of 95% should be used to indicate a need for escalation of empiric antibiotic therapy using PAT. Disclosures All authors: No reported disclosures.

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