scholarly journals Time Is of the Essence: The Impact of Delayed Antibiotic Therapy on Patient Outcomes in Hospital-Onset Enterococcal Bloodstream Infections

2016 ◽  
Vol 62 (10) ◽  
pp. 1242-1250 ◽  
Author(s):  
Evan J. Zasowski ◽  
Kimberly C. Claeys ◽  
Abdalhamid M. Lagnf ◽  
Susan L. Davis ◽  
Michael J. Rybak
Keyword(s):  
Antibiotic Therapy ◽  
Patient Outcomes ◽  
Bloodstream Infections ◽  
The Impact

Impact of Reported β-Lactam Allergy on Management of Methicillin-Sensitive Staphylococcus aureus Bloodstream Infections

2019 ◽  
Vol 33 (6) ◽  
pp. 809-814 ◽  
Author(s):  
Michael P. Veve ◽  
Spenser E. January ◽  
Rachel M. Kenney ◽  
Edward M. Zoratti ◽  
Marcus J. Zervos ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Patient Outcomes ◽  
Bloodstream Infections ◽  
Antibiotic Use ◽  
Optimal Therapy ◽  
Immune Mediated ◽  
Patient Reported ◽  
Infectious Diseases Consultation ◽  
The Impact ◽  
To Receive

Background: Antistaphylococcal β-lactams antibiotics are the preferred treatment for methicillin-sensitive Staphylococcus aureus (MSSA) infections. Patient-reported β-lactam allergies may complicate antibiotic decision-making and delay optimal therapy, with potential implications on patient outcomes. Objective: To determine the impact of reported β-lactam allergies on the receipt of optimal therapy and outcomes for MSSA bloodstream infections (BSI). Methods: Retrospective, matched cohort of MSSA BSI patients with and without a reported β-lactam allergy. The primary end point was receipt of optimal therapy, defined as an antistaphylococcal β-lactam. Results: Two hundred twelve patients were included: 53 with reported β-lactam allergy and 159 without β-lactam allergy. Commonly reported β-lactam allergies were 26 (49%) immune-mediated reaction and 8 (15%) intolerance, with 19 (36%) having no documented reaction. Optimal antibiotics were given to 135 patients without a β-lactam allergy and 37 patients with a reported β-lactam allergy (85% vs 70%, P = .015). Among reported β-lactam allergy patients, those without a documented reaction were less likely to receive optimal therapy (47% vs 79 %, P = .042). Reported β-lactam allergy was not associated with clinical response ( P = .61) or MSSA-related mortality ( P = .83). When adjusting for immunosuppression, variables independently associated with optimal therapy were β-lactam allergy (adjusted odds ratio [adjOR], 0.3; 95% confidence interval [CI], 0.1-0.6) and infectious diseases consultation (adjOR, 6.1; 95%CI, 2.7-13.9). Optimal antibiotic use was associated with decreased all-cause 90-day mortality (adjOR, 0.23; 95%CI, 0.09-0.54). Conclusions: Patients with reported β-lactam allergies, particularly those without a documented reaction, were less likely to receive optimal antibiotics for MSSA BSI. Patient outcomes may be improved with enhanced quality of allergy history and routine infectious disease consultation.

scholarly journals Stepwise Development and Yearlong Assessment of a Pharmacist-Driven Molecular Rapid Diagnostic Test Result Service for Bloodstream Infections

2021 ◽  
Vol 12 (2) ◽  
pp. 7
Author(s):  
Andrew Ticcioni ◽  
Kyle Piscitello ◽  
Matthew Bjornstad ◽  
Katie Hensley ◽  
Jim Davis ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Bloodstream Infections ◽  
Education Development ◽  
Rapid Diagnostic Test Result ◽  
Stepwise Development ◽  
System Leaders ◽  
Implementation Assessment ◽  
The Impact ◽  
Diagnostic Test Result ◽  
Test Result

Purpose: Provide a stepwise approach to the design and implementation of a service that integrates all staff pharmacists into the communication and interpretation of molecular rapid diagnostic tests (mRDT) for bloodstream infections and summarize outcomes from a 12-month post-implementation assessment. Physician and pharmacist impressions of the service are also described. Summary: mRDT have proven clinical benefit in the treatment of bacteremia. Pharmacy leadership can collaborate with other health system leaders to develop policies and a workflow that route result calls to pharmacists to maximize the impact of this technology. Pharmacist education, development of clinical resources and documentation templates allow all pharmacists to perform this antimicrobial stewardship service consistently and confidently. Physicians overwhelmingly recognize the value of this service and often accept the pharmacist’s recommendations. Antibiotic de-escalation was the most frequent outcome when changes to the antibiotic regimen were made. Conclusion: Pharmacists are well positioned to utilize results from mRDT to improve antibiotic selection. Through the use of competencies and internally-derived resources, all pharmacists, rather than just infectious diseases pharmacy specialists, can perform this important antibiotic stewardship activity and positively influence patient outcomes.

scholarly journals Delay of Active Antimicrobial Therapy and Mortality among Patients with Bacteremia: Impact of Severe Neutropenia

2008 ◽  
Vol 52 (9) ◽  
pp. 3188-3194 ◽  
Author(s):  
Michael Y. Lin ◽  
Robert A. Weinstein ◽  
Bala Hota
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Antimicrobial Therapy ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
The United States ◽  
Severe Neutropenia ◽  
Urban Hospital ◽  
The Impact

ABSTRACT Increasing bacterial antimicrobial resistance has prompted physicians to choose broad-spectrum antimicrobials in order to reduce the likelihood of inactive empirical therapy. However, for bacteremic patients already receiving supportive care, it is unclear whether delay of active antimicrobial therapy significantly impacts patient outcomes. We performed a retrospective cohort study of patients with monomicrobial bloodstream infections at a large urban hospital in the United States from 2001 to 2006. We assessed the impact of delay of active antimicrobial therapy on mortality by using multivariable logistic regression modeling with and without propensity score methodology. We evaluated 1,523 episodes of monomicrobial bacterial bloodstream infections at our institution. Nine hundred eighty-three bacteremic episodes (64.5%) were treated with an active antimicrobial agent within 24 h of the index blood culture; the remaining 540 episodes (35.5%) were considered to have delay of active antimicrobial therapy. In adjusted analysis, among patients in the non-intensive-care-unit setting with an absolute neutrophil count (ANC) of <100 cells/μl, delay was associated with increased mortality (odds ratio [OR], 18.0; 95% confidence interval [CI], 2.84 to 114.5; P < 0.01); among intensive-care-unit patients with an ANC of <100 cells/μl, the effect of delay on mortality was nearly significant (OR, 5.56; 95% CI, 0.85 to 36.3; P = 0.07). However, for patients who were nonneutropenic (ANC, >500 cells/μl) or had ANCs of 100 to 500 cells/μl, delay was not associated with increased mortality. While the delay of active antimicrobial therapy was not significantly associated with higher mortality for most patients in this cohort, patients with severe neutropenia appeared to be vulnerable.

scholarly journals Clinicians' Knowledge, Attitudes, and Practices regarding Infections with Multidrug-Resistant Gram-Negative Bacilli in Intensive Care Units

2013 ◽  
Vol 34 (3) ◽  
pp. 274-283 ◽  
Author(s):  
Juyan Julia Zhou ◽  
Sameer J. Patel ◽  
Haomiao Jia ◽  
Scott A. Weisenberg ◽  
E. Yoko Furuya ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Patient Outcomes ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Gram Negative ◽  
Attitudes And Practices ◽  
Icu Physicians ◽  
The Impact

Objective.To assess how healthcare professionals caring for patients in intensive care units (ICUs) understand and use antimicrobial susceptibility testing (AST) for multidrug-resistant gram-negative bacilli (MDR-GNB).Design.A knowledge, attitude, and practice survey assessed ICU clinicians' knowledge of antimicrobial resistance, confidence interpreting AST results, and beliefs regarding the impact of AST on patient outcomes.Setting.Sixteen ICUs affiliated with NewYork-Presbyterian Hospital.Participants.Attending physicians and subspecialty residents with primary clinical responsibilities in adult or pediatric ICUs as well as infectious diseases subspecialists and clinical pharmacists.Methods.Participants completed an anonymous electronic survey. Responses included 4-level Likert scales dichotomized for analysis. Multivariate analyses were performed using generalized estimating equation logistic regression to account for correlation of respondents from the same ICU.Results.The response rate was 51% (178 of 349 eligible participants); of the respondents, 120 (67%) were ICU physicians. Those caring for adult patients were more knowledgeable about antimicrobial activity and were more familiar with MDR-GNB infections. Only 33% and 12% of ICU physicians were familiar with standardized and specialized AST methods, respectively, but more than 95% believed that AST improved patient outcomes. After adjustment for demographic and healthcare provider characteristics, those familiar with treatment of MDR-GNB bloodstream infections, those aware of resistance mechanisms, and those aware of AST methods were more confident that they could interpret AST results and/or request additional in vitro testing.Conclusions.Our study uncovered knowledge gaps and educational needs that could serve as the foundation for future interventions. Familiarity with MDR-GNB increased overall knowledge, and familiarity with AST increased confidence interpreting the results.

scholarly journals Changing Epidemiology and Decreased Mortality Associated With Carbapenem-resistant Gram-negative Bacteria, 2000–2017

2020 ◽  
Author(s):  
Ahmed Babiker ◽  
Lloyd G Clarke ◽  
Melissa Saul ◽  
Julie A Gealey ◽  
Cornelius J Clancy ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Carbapenem Resistance ◽  
Bloodstream Infections ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Healthcare Crisis ◽  
The Impact ◽  
Over Time

Abstract Background Carbapenem-resistant gram-negative bacteria (CRGNB) continue to present a global healthcare crisis. We aimed to identify emerging trends of CRGNB over nearly 2 decades and describe the impact of CRGNB on patient outcomes. Methods Patients from whom CRGNB were isolated between 2000 and 2017 were included in the study. Carbapenem resistance was defined by the most recent breakpoints and applied across the study period. Patient demographics, clinical characteristics, and outcomes were retrieved from the electronic health record. Results A total of 94 888 isolates from 64 422 patients were identified; 9882 (10%) isolates from 4038 patients were carbapenem-resistant. Pseudomonas aeruginosa was the most common CRGNB each year. The second most common CRGNB emerged in waves over time. Carbapenem daily defined doses increased in parallel with CRGNB rates (R2 = 0.8131). The overall 30-day mortality rate was 19%, which decreased from 24% in 2000 to 17% in 2017 (P = .003; R2 = .4330). Among patients with CRGNB bloodstream infections (n = 319), overall 30- and 90-day mortality rates were 27% and 38%, respectively. Charlson score (adjusted odds ratio [aOR], 1.11 per point), intensive care unit residence (aOR, 7.32), and severe liver disease (aOR, 4.8.4) were independent predictors of 30-day mortality, while receipt of transplantation was associated with lower rates of death (aOR, 0.39). Among patients admitted between 2011 and 2017 (n = 2230), 17% died during hospitalization, 32% were transferred to long-term care facilities, and 38% were discharged home. Conclusions CRGNB emerged in waves over time, causing high rates of mortality. Despite increasing rates of CRGNB, overall patient outcomes have improved, suggesting that recognition and novel therapeutics have made a major impact.

scholarly journals The Impact of Concomitant Empiric Cefepime on Patient Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections Treated With Vancomycin

2019 ◽  
Vol 6 (4) ◽  
Author(s):  
Evan J Zasowski ◽  
Trang D Trinh ◽  
Safana M Atwan ◽  
Marina Merzlyakova ◽  
Abdalhamid M Langf ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Patient Outcomes ◽  
Primary Outcome ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bloodstream Infections ◽  
Hazard Models ◽  
Binary Outcomes ◽  
Subdistribution Hazard ◽  
Methicillin Resistant ◽  
The Impact

Abstract Background Data suggest that vancomycin + β-lactam combinations improve clearance of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs). However, it is unclear which specific β-lactams confer benefit. This analysis evaluates the impact of concomitant empiric cefepime on outcomes of MRSA BSIs treated with vancomycin. Methods Retrospective cohort study of adults with MRSA BSI from 2006 to 2017. Vancomycin + cefepime therapy was defined as ≥24 hours of cefepime during the first 72 hours of vancomycin. The primary outcome was microbiologic failure, defined as BSI duration ≥7 days and/or 60-day recurrence. Multivariable logistic regression was used to evaluate the association between vancomycin + cefepime therapy and binary outcomes. Cause-specific and subdistribution hazard models were used to evaluate the association between vancomycin + cefepime and BSI clearance. Results Three hundred fifty-eight patients were included, 129 vancomycin and 229 vancomycin + cefepime. Vancomycin + cefepime therapy was independently associated with reduced microbiologic failure (adjusted odds ratio [aOR], 0.488; 95% confidence interval [CI], 0.271–0.741). This was driven by a reduction in the incidence of BSI durations ≥7 days (vancomycin + cefepime aOR, 0.354; 95% CI, 0.202–0.621). Vancomycin + cefepime had no association with 30-day mortality (aOR, 0.952; 95% CI, 0.435–2.425). Vancomycin + cefepime was associated with faster BSI clearance in both cause-specific (HR, 1.408; 95% CI, 1.125–1.762) and subdistribution hazard models (HR, 1.264; 95% CI, 1.040–1.536). Conclusions Concomitant empiric cefepime improved MRSA BSI clearance and may be useful as the β-lactam component of synergistic vancomycin + β-lactam regimens when empiric or directed gram-negative coverage is desired.

scholarly journals Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?

2020 ◽  
Vol 9 (2) ◽  
pp. 514
Author(s):  
María Milagro Montero ◽  
Inmaculada López Montesinos ◽  
Hernando Knobel ◽  
Ema Molas ◽  
Luisa Sorlí ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
High Risk ◽  
Antibiotic Therapy ◽  
Antimicrobial Therapy ◽  
Protective Factor ◽  
Bloodstream Infections ◽  
Clinical Severity ◽  
Risk Source ◽  
The Impact

This study aimed to assess the impact of extensively drug-resistant (XDR) phenotype on mortality in Pseudomonas aeruginosa bacteremia. A retrospective cohort study was performed in a tertiary hospital from January 2000 to December 2018. All consecutive prospectively recorded P. aeruginosa bacteremia in adult patients were assessed. In this study, 382 patients were included, of which 122 (31.9%) due to XDR P. aeruginosa. Independent factors associated with 14-day mortality were as follows: high-risk source of bacteremia (hazard ratio (HR) 3.07, 95% confidence interval (CI), 1.73–5.46), septic shock (HR 1.75, 95% CI, 1.12–2.75), and higher Pitt scores (one-point increments; HR 1.25, 95% CI, 1.12–1.38). Otherwise, the appropriateness of definitive antibiotic therapy was a protective factor (HR 0.39, 95% CI, 0.24–0.62). The same variables were also associated with 30-day mortality. XDR phenotype was not associated with 14- or 30-day mortality. In a subanalysis considering only high-risk source cases, combined antimicrobial therapy was independently associated with 14-day favorable outcome (HR 0.56, 95% CI, 0.33–0.93). In conclusion, XDR phenotype was not associated with poor prognosis in patients with P. aeruginosa bacteremia in our cohort. However, source of infection, clinical severity, and inappropriate definitive antibiotic therapy were risk factors for mortality. Combined antimicrobial therapy should be considered for high-risk sources.

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