Short-Course Antimicrobial Therapy Does Not Increase Treatment Failure Rate in Patients with Intra-Abdominal Infection Involving Fungal Organisms

2018 ◽  
Vol 19 (4) ◽  
pp. 376-381 ◽  
Author(s):  
Nathan R. Elwood ◽  
Christopher A. Guidry ◽  
Therese M. Duane ◽  
Joseph Cuschieri ◽  
Charles H. Cook ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Failure Rate ◽  
Antimicrobial Therapy ◽  
Abdominal Infection ◽  
Short Course ◽  
Treatment Failure Rate ◽  
Fungal Organisms ◽  
Intra Abdominal Infection

Risk Factors for and Clinical Outcomes of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-ProducingKlebsiella pneumoniae

2004 ◽  
Vol 25 (10) ◽  
pp. 860-867 ◽  
Author(s):  
Cheol-In Kang ◽  
Sung-Han Kim ◽  
Dong Min Kim ◽  
Wan Beom Park ◽  
Ki-Deok Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Treatment Failure ◽  
Failure Rate ◽  
Antimicrobial Therapy ◽  
Statistical Power ◽  
Bloodstream Infections ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Treatment Failure Rate

AbstractObjective:To evaluate risk factors and treatment outcomes of bloodstream infections caused by extended-spectrum beta-lactamase-producingKlebsiella pneumoniae(ESBL-KP).Design:Retrospective case-control study. Stored blood isolates ofK. pneumoniaewere tested for ESBL production by NCCLS guidelines, double-disk synergy test, or both.Setting:A 1,500-bed, tertiary-care university hospital and referral center.Patients:Sixty case-patients with bacteremia due to ESBL-KP were compared with 60 matched control-patients with non-ESBL-KP.Results:There were no significant differences in age, gender, APACHE II score, or underlying diseases between the groups. Independent risk factors for infections caused by ESBL-KP were urinary catheterization, invasive procedure within the previous 72 hours, and an increasing number of antibiotics administered within the previous 30 days. Complete response rate, evaluated 72 hours after initial antimicrobial therapy, was higher among control-patients (13.3% vs 36.7%;P= .003). Treatment failure rate was higher among case-patients (35.0% vs 15%;P= .011). Overall 30-day mortality rate was 30% for case-patients and 28.3% for control-patients (P= .841). Case-patients who received imipenem or ciprofloxacin as a definitive antibiotic had 10.5% mortality. The mortality rate for initially ineffective therapy was no higher than that for initially effective therapy (9.1% vs 11.1%;P= 1.000), but statistical power was low for evaluating mortality in the absence of septic shock.Conclusion:ForK. pneumoniaebacteremia, patients with ESBL-KP had a higher initial treatment failure rate but did not have higher mortality if antimicrobial therapy was appropriately adjusted in this study with limited statistical power.

Patients with Risk Factors for Complications Do Not Require Longer Antimicrobial Therapy for Complicated Intra-Abdominal Infection

2016 ◽  
Vol 82 (9) ◽  
pp. 860-866 ◽  
Author(s):  
Rishi Rattan ◽  
Casey J. Allen ◽  
Robert G. Sawyer ◽  
John Mazuski ◽  
Therese M. Duane ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Surgical Site Infection ◽  
Chronic Health Evaluation ◽  
Health Evaluation ◽  
Site Infection ◽  
Chronic Health ◽  
Abdominal Infection ◽  
Short Course ◽  
Intra Abdominal Infection

A prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-abdominal infection resulted in similar outcomes when compared with a longer duration. We hypothesized that patients with specific risk factors for complications also had similar outcomes. Short-course patients with obesity, diabetes, or Acute Physiology and Chronic Health Evaluation II ≥15 from the STOP-IT trial were compared with longer duration patients. Outcomes included incidence of and days to infectious complications, mortality, and length of stay. Obese and diabetic patients had similar incidences of and days to surgical site infection, recurrent intra-abdominal infection, extra-abdominal infection, and Clostridium difficile infection. Short- and long-course patients had similar incidences of complications among patients with Acute Physiology and Chronic Health Evaluation II ≥15. However, there were fewer days to the diagnosis of surgical site infection (9.5 ± 3.4 vs 21.6 ± 6.2, P = 0.010) and extra-abdominal infection (12.4 ± 6.9 vs 21.8 ± 6.1, P = 0.029) in the short-course group. Mortality and length of stay was similar for all groups. A short course of antibiotics in complicated intraabdominal infection with source control seems to have similar outcomes to a longer course in patients with diabetes, obesity, or increased severity of illness.

Guideline-Concordant Versus Discordant Antimicrobial Therapy in Patients With Community-Onset Complicated Intra-abdominal Infections

2016 ◽  
Vol 37 (7) ◽  
pp. 855-858 ◽  
Author(s):  
Lori L. Huang ◽  
Trevor C. Van Schooneveld ◽  
Robert D. Huang ◽  
Keith M. Olsen ◽  
Mark E. Rupp ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Empiric Therapy ◽  
Infect Control Hosp ◽  
Active Therapy ◽  
Abdominal Infection ◽  
Guideline Compliance ◽  
Improved Outcomes ◽  
Intra Abdominal Infection ◽  
Abdominal Infections ◽  
Community Onset

Overall IDSA/SIS intra-abdominal infection guideline compliance was not associated with improved outcomes; however, there was a longer time to active therapy (P=.024) and higher mortality (P=.077) if empiric therapy was too narrow per guidelines. These findings support the need for the implementation of customized institutional guidelines adapted from the IDSA/SIS guidelines.Infect Control Hosp Epidemiol 2016;37:855–858

scholarly journals Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention

2020 ◽  
Author(s):  
Bruno Alves Rudelli ◽  
Pedro Nogueira Giglio ◽  
Vladimir Cordeiro Carvalho ◽  
Jose Ricardo Pecora ◽  
Henrique Melo Campos Gurgel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Failure Rate ◽  
Multidrug Resistant ◽  
The Other ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Treatment Failure Rate ◽  
Drug Resistance Profile ◽  
Implant Retention

Abstract BACKGROUND: debridement, antibiotics and implant retention (DAIR) with the exchange of modular components is the most widely used option for the treatment of acute periprosthetic joint infections. The objective of this study is to evaluate the effect of bacteria drug resistance profile on the success rates of DAIR. METHODS: All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics.RESULTS: Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistant Staphylococcus aureus (MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p<0.05) in the treatment failure rate among the three groups: 8.3% for the MSB group, 18.2% for the MRSA group and 55.6% for the MRB group (p=0.005). Among the other risk factors for treatment failure, the presence of inflammatory arthritis presented a failure rate of 45.1 (p<0.05).CONCLUSION: DAIR showed a good success rate in cases of early acute infection by multidrug-sensitive bacteria. In the presence of infection by multidrug-resistant bacteria or association with rheumatic diseases the treatment failure rate was higher and other surgical options should be considered in this specific population. The MRSA group showed intermediate results between MSB and MRB and should be carefully evaluated.

A Comparison of Intraperitoneal and Intravenous/Oral Antibiotics in CAPD Peritonitis

1987 ◽  
Vol 7 (1) ◽  
pp. 31-33 ◽  
Author(s):  
David Bennett-Jones ◽  
Val Wass Penny ◽  
Mawson David Taube ◽  
Guy Neild Chisholm ◽  
Ogg J Stewart Cameron ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Failure Rate ◽  
Oral Antibiotics ◽  
Gram Positive ◽  
Intraperitoneal Route ◽  
Bacterial Peritonitis ◽  
Treatment Failure Rate ◽  
Culture And Sensitivity ◽  
To Receive

Eighty patients with CAPD peritonitis were randomised to receive either intraperitoneal (IP) vancomycin and tobramycin, or intravenous (IV) van-comycin and tobramycin followed by oral antibiotics, depending on the results of culture and sensitivity. Five patients were withdrawn, and, of the remaining patients, 39 were in the IP group and 36 in the IV group. When all episodes of bacterial peritonitis are considered, the treatment failure rate was higher in the IV group (34.1%), than in the IP group (10.3%) (p < 0.02). This was also the case when gram-positive organisms resistant to tobramycin were considered separately (p < 0.05), but not for vancoinycin-resistant organisms. We conclude that vancomycin should be administered by the intraperitoneal route: the case for intraperitoneal tobramycin is “not proven”.

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