Influence of Selective Bowel Decontamination on the Organisms Recovered During Bacteremia in Neutropenic Patients

2004 ◽  
Vol 25 (8) ◽  
pp. 685-689 ◽  
Author(s):  
Florian Daxboeck ◽  
Werner Rabitsch ◽  
Alexander Blacky ◽  
Maria Stadler ◽  
Paul A. Kyrle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Bone Marrow ◽  
Anaerobic Bacteria ◽  
Blood Cultures ◽  
University Teaching ◽  
Coagulase Negative Staphylococci ◽  
Gram Negative ◽  
Neutropenic Patients ◽  
Care Ward

AbstractObjective:To assess the influence of prophylactic selective bowel decontamination (SBD) on the spectrum of microbes causing bloodstream infection (BSI).Design:The microbes causing BSI in neutropenic patients of a hematologic ward (HW) and a bone marrow transplantation unit (BMTU), respectively, were compared by retrospective analysis of blood culture results from January 1996 to June 2003.Setting:A 30-bed HW (no SBD) and a BMTU including a 7-bed normal care ward and an 8-bed intensive care unit (SBD used) of a 2,200-bed university teaching hospital.Results:The overall incidences of bacteremia in the HW and the BMTU were similar (72.6 vs 70.6 episodes per 1,000 admissions; P = .8). Two hundred twenty episodes of BSI were recorded in 164 neutropenic patients of the HW and 153 episodes in 127 neutropenic patients of the BMTU. Enterobacteriaceae (OR, 3.14; CI95, 1.67–5.97; P = .0002) and Streptococcus species (OR, 2.04; CI95, 1.14–3.70; P = .015) were observed more frequently in HW patients and coagulase-negative staphylococci more frequently in BMTU patients (OR, 0.15; CI95, 0.09–0.26; P< .00001). No statistically significant differences were found for gram-negative nonfermentative bacilli (P = .53), Staphylococcus aureus (P = .21), Enterococcus species (P = .48), anaerobic bacteria (P = .1), or fungi (P = .50).Conclusions:SBD did not lead to a significant reduction in the incidence of bacteremia, but significant changes in microbes recovered from blood cultures were observed. SBD should be considered when empiric antimicrobial therapy is prescribed for suspected BSI.

Pathophysiology and management of neutropenia in the critically ill

2016 ◽  
Author(s):  
Benoit Champigneulle ◽  
Frédéric Pène
Keyword(s):  
Intensive Care Unit ◽  
Bone Marrow ◽  
Severe Sepsis ◽  
Fungal Infections ◽  
Broad Spectrum Antibiotic ◽  
Icu Admission ◽  
Organ Failures ◽  
Neutropenic Patients ◽  
Epidemiological Trends ◽  
Bone Marrow Disorders

Neutropenia is defined by an absolute neutrophil count <500 per mm3. Chemotherapy-induced myelosuppression represents the main mechanism accounting for neutropenia, although various bone marrow disorders might also result in impaired granulopoiesis. Neutropenia, especially when profound and prolonged, is a major risk factor for severe bacterial and fungal infections. Early initiation of empirical broad-spectrum antibiotic therapy represents the cornerstone of the treatment of febrile neutropenia. A number of infected neutropenic patients may exhibit organ failures, such as acute respiratory failures and/or severe sepsis requiring intensive care unit (ICU) admission. This chapter discusses the particularities in the management of neutropenic patients in the ICU, including outcome and criteria for ICU admission, management of antimicrobials with respect to the current epidemiological trends, and other measures specific to this subgroup of patients.

scholarly journals Antimicrobial Sensitivity Pattern in the Mixed Intensive Care Unit in a Tertiary Care Hospital of Eastern Nepal

2020 ◽  
Vol 2 (2) ◽  
pp. 9-15
Author(s):  
Niraj Kumar Keyal ◽  
Mahendra Shrestha ◽  
Partima Sigdel Ghimire
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Polymyxin B ◽  
Clinical Samples ◽  
Care Hospital ◽  
Gram Negative ◽  
Sensitivity Pattern

 Background: Empirical antibiotics are used in the intensive care unit based on developing countries’ guidelines due to a lack of a bacteriological profile of individual ICU and institution policy. Therefore, this study was conducted to know the antibiogram of the intensive care unit and to make institution policy for antibiotic use in ICU. Materials and methods: It was a prospective descriptive cross-sectional study conducted in the mixed surgical and medical intensive care unit of a tertiary care hospital for one year in 625 patients. Various clinical samples were collected aseptically and organisms were identified by the cultural characteristics, morphology, gram stain, and different biochemical test. Antimicrobial susceptibility was done with a disc diffusion test. Data collection was done in a preformed sheet that included all tested antibiotic and demographic variables. Statistical analysis was done by using statistical package for the social sciences. The result was presented as frequency and percentage. Results: Out of 625 samples, 135(22%) showed growth in culture. Among them, 96(71%) and 39(29%) were gram-negative bacilli and gram-positive cocci respectively. The tracheal aspirate was the most common type of specimen which comprised 49(36.29%) isolates. The most common organism was Staphylococcus aureus which accounts for 27(20%) isolates, followed by Acinetobacter baumanni 25(18.51%), Klebsiella pneumoniae 22(16.29%) and Pseudomonas aeurignosa 21(15.55%). The incidence of multidrug-resistant and extended drug resistance was 44(32.5%) and 45(33%) respectively. Meanwhile, the incidence of methicillin-resistant staphylococcus aureus was 70%. However, in the case of Acinetobacter baumannii and Enterobacteriaceae, all were sensitive to polymyxin B and meropenem. Conclusion:Antibiotics should be prescribed based on the antibiogram of individual intensive care units that can decrease antibiotic resistance. Polymyxin B and meropenem can be prescribed for gram-negative bacilli and vancomycin for Staphylococcus aureus.

scholarly journals 1013. If Blood Cultures Were Not Done Before Starting Antibiotics, Is It of Any Value to Obtain Them Later?

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S301-S302 ◽  
Author(s):  
Kenneth Rand ◽  
Stacy Beal ◽  
Brandon Allen ◽  
Thomas Payton ◽  
Gloria Lipori ◽  
...  
Keyword(s):  
Blood Cultures ◽  
Time Stamp ◽  
Surviving Sepsis Campaign ◽  
Coagulase Negative Staphylococci ◽  
Gram Negative ◽  
Hourly Rate ◽  
Before And After ◽  
Patient Groups ◽  
The Relationship ◽  
Antibiotic Dose

Abstract Background Obtaining blood cultures before starting antibiotics is one of the pillars of the Surviving Sepsis Campaign (SSC), and delay in obtaining blood cultures (BC) after starting antibiotics is associated with increased mortality (Levy M 2015, Pruinelli L 2018), but we were unable to find data on the relationship between such a delay and a reduction in percentage of positive cultures. Methods All adult patients (&gt;18) admitted from the UFHealth Shands Emergency Department (ED) between August 2012 and December 2016 were included in the study (N = 30,743), excluding hospital-hospital transfers. BC were done with BacTec aerobic, anaerobic, and pediatric resin bottles, incubated for 5 days. We calculated the hourly rate of positive BC obtained before and after the start of IV antibiotics by subtracting the time stamp in the electronic medical record (Epic) between the first BC collection time and the start of the first IV antibiotic dose. We considered S. aureus, all Gram-negative rods, β-hemolytic Streptococci and Enterococci as significant pathogens and coagulase negative Staphylococci, S. viridans, Propionibacterium sp., Micrococcus sp. and Bacillus sp. as contaminants hospital ransfers. Results The percentage of BC with significant growth was unchanged during the first hour after starting IV antibiotics, but declined significantly in the period 1–12 hours after IV antibiotics were started. The overall positivity rate before starting IV antibiotics was 1,646/20,867 (7.9%) of patients and declined to 112/3,490 (3.2%), P &lt; 0.0001, in the 1–12 hour period afterwards, but did not decline to 0. Septic patients averaged 1,143/4,923 (23.2%) positive and declined to 65/728 (8.9%), P &lt; 0.0001, while nonseptic patients averaged 503/15,944 (3.15%) positive before antibiotics and declined to 47/2,762 (1.7%) P &lt; 0.0001, 1–12 hours after. It should be pointed out that these are group averages from different patient groups at each hourly time, rather than individual patients with blood cultures drawn serially. Conclusion We conclude that IV antibiotics dramatically reduce the likelihood of getting a positive blood culture, but not during the first hour of administration; however, the residual positivity rate remains high enough that blood cultures are still clinically worthwhile. Disclosures All authors: No reported disclosures.

Increased Antimicrobial Resistance of Pathogenic Coagulase-Negative Staphylococci From Blood Cultures (1961–1981)

1984 ◽  
Vol 5 (3) ◽  
pp. 142-143 ◽  
Author(s):  
D.J. Flournoy
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Prosthetic Heart Valve ◽  
Bacterial Endocarditis ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococci ◽  
Difficult Decision ◽  
Antimicrobial Susceptibilities ◽  
Cons Isolate ◽  
Intravenous Catheters

Coagulase-negative staphylococci (CONS) have only recently gained notoriety as pathogens. Several reports have established their pathogenicity in bacterial endocarditis, prosthetic heart valve endocarditis, intraventricular shunts for treatment of hydrocephalus and intravenous catheters. One difficult decision for physicians is determining whether a particular CONS isolate is pathogenic or contaminant. The differentiation of pathogenic and contaminant CONS has recently been noted, but further studies are needed to aid in this differentiation. Data on antimicrobial susceptibilities of positive blood culture isolates were recently compiled at this institution. This report compares antimicrobial susceptibilities of pathogenic and contaminant CONS and Staphylococcus aureus blood culture isolates from 1961-1981 at this institution.

scholarly journals Anaerobic Spondylodiscitis due toFusobacteriumSpecies: A Case Report Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Tiffany N. Latta ◽  
Aimee L. Mandapat ◽  
Joseph P. Myers
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Case Report ◽  
Epidural Abscess ◽  
Vertebral Osteomyelitis ◽  
Review Of The Literature ◽  
Coagulase Negative Staphylococci ◽  
Gram Negative

Spondylodiscitis caused byFusobacteriumspecies is rare. Most cases of spontaneous spondylodiscitis are caused byStaphylococcus aureusand most postoperative cases are caused byStaphylococcus aureusor coagulase-negative staphylococci.Escherichia coliis the most common Gram-negative organism causing spondylodiscitis.Fusobacteriumspecies are unusual causes for anaerobic spondylodiscitis. We report the case of a patient with spontaneous L2-L3 spondylodiscitis, vertebral osteomyelitis, and epidural abscess caused byFusobacteriumspecies and review the literature for patients withFusobacteriumspondylodiscitis.

scholarly journals A Fatal Bloodstream Infection byStaphylococcus pettenkoferiin an Intensive Care Unit Patient

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Caterina Mammina ◽  
Celestino Bonura ◽  
Maria Stella Verde ◽  
Teresa Fasciana ◽  
Daniela Maria Palma
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Patient ◽  
Bloodstream Infection ◽  
Intensive Care Units ◽  
Fatal Case ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococci

Coagulase negative staphylococci are increasingly recognized as leading pathogens in bacteremia, with incidence peaking in intensive care units. Interpretation of blood cultures that are positive for CoNS is often doubtful. We describe a fatal case of bacteremia by a newly recognized species of CoNS,Staphylococcus pettenkoferi, in an ICU patient.

Point: Fluoroquinolone-Based Antibacterial Chemoprophylaxis in Neutropenic Cancer Patients Works for Defined Outcomes in Defined Populations, but Must Be Used Wisely

2004 ◽  
Vol 2 (5) ◽  
pp. 433-444 ◽  
Author(s):  
Eric J. Bow
Keyword(s):  
Viridans Streptococci ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Gram Negative ◽  
Prescribing Behavior ◽  
Phase Ii Clinical Trials ◽  
Empirical Antibacterial Therapy ◽  
Invasive Infections ◽  
Neutropenic Patients ◽  
Related Mortality

Fluoroquinolone-based antibacterial chemoprophylaxis administered in situations in which the prevalence of fluoroquinolone-resistant Escherichia coli is low (<3% to 5%) can reliably reduce the risk for invasive gram-negative bacillary infection, and, if supplemented by gram-positive agents such as rifampin, penicillin, or macrolides, can reduce the risk of developing invasive infections caused by gram-positive microorganisms, including Viridans streptococci and coagulase-negative staphylococci. In the published literature, fluoroquinolone-based chemoprophylaxis does not reliably reduce the incidence of febrile neutropenic episodes, neutropenic episode-related mortality, or physician-initiated systemic antimicrobial prescribing behavior. Prophylaxis should only be prescribed in defined patient populations from the first day of cytotoxic therapy until neutrophil regeneration in environments in which the prevalence of gram-negative bacillary resistance to the prophylaxis strategy is low. Small phase II clinical trials suggest that empirical antibacterial therapy of unexplained fevers in neutropenic patients receiving effective fluoroquinolone-based prophylaxis under defined epidemiologic circumstances may be safely discontinued early. Better discriminators of infection in febrile neutropenic patients are needed.

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