Efficacy of temocillin against MDR Enterobacterales: a retrospective cohort study

2020 ◽  
Author(s):  
Kévin Alexandre ◽  
François Leysour de Rohello ◽  
Sandrine Dahyot ◽  
Manuel Etienne ◽  
Isabelle Tiret ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Primary Outcome ◽  
Klebsiella Aerogenes ◽  
Clinical Failure ◽  
Monomicrobial Infection ◽  
Tract Infections ◽  
Klebsiella Spp ◽  
Esbl Producers ◽  
Urinary Isolates ◽  
Susceptibility Breakpoint

Abstract Objectives EUCAST recently advised against temocillin use, except for non-serious urinary tract infections (UTI) caused by Escherichia coli, Klebsiella spp. (except Klebsiella aerogenes) and Proteus mirabilis (EKP) treated with a dose of 2 g q8h. We aimed to analyse our practice in the context of a larger temocillin use in France. Patients and methods All ≥3 day temocillin prescriptions from 2016 to 2019 were reviewed, with reference to French recommendations and a susceptibility breakpoint of 8 mg/L. The primary outcome was early clinical failure (antibiotic switch, relapse or death within 10 days after the completion of antibiotic treatment). Results Overall, 153 cases were analysed: 123 cases of UTI (80.4%) and 133 cases of monomicrobial infection with Enterobacterales (86.9%). A total of 160 Enterobacterales were isolated, comprising 108 (67.5%) ESBL producers and 30 (20.7%) non-EKP species. The rate of early clinical failure was 9.2% and was significantly lower for UTI compared with non-UTI (4.9% versus 26.7%, P = 0.001) and for sepsis compared with severe sepsis or septic shock (6.2% versus 25%, P = 0.011). It was not different between 2 g q12h and 2 g q8h doses (10% versus 7.4%, P = 0.81) and between EKP and other Enterobacterales (8.7% versus 14.3%, P = 0.41). Conclusions EUCAST recommendations on urinary isolates seem to be too restrictive. Our data support the efficacy of temocillin at a dose of 2 g q12h to treat patients with non-severe complicated UTI caused by MDR Enterobacterales with an MIC of ≤8 mg/L, whatever the species.

Incidence of ESBL-Producing Gram Negative Bacteria of Lower Respiratory Tract Infection in Bharatpur Hospital, Nepal

2020 ◽  
Vol 18 ◽  
Author(s):  
Asmita Lamichhane ◽  
Sanjeep Sapkota ◽  
Sujan Khadka ◽  
Sanjib Adhikari ◽  
Alina Thapa ◽  
...  
Keyword(s):  
Multidrug Resistance ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Esbl Production ◽  
Lower Respiratory Tract Infections ◽  
Gram Negative ◽  
Tract Infections ◽  
Klebsiella Spp ◽  
Esbl Producers

Background: Antimicrobial resistance is a global threat in the medical society. Extended-Spectrum β-lactamase (ESBL) producing bacteria are increasing worldwide including Nepal and causing more severe infections because of their continuous mutation and multidrug resistance (MDR) nature. Objective: The objective of this study was to assess Gram-negative bacterial etiology of lower respiratory tract infections (LRTIs) and determine their antibiotic susceptibility pattern with a special focus on MDR including ESBL production. Methods: A total of 109 sputum specimens were analyzed. The bacterial isolates were identified by standard microbiological procedures including Analytical Profile Index (API) 20E test panels for Enterobacteriaceae and subjected to antimicrobial susceptibility testing. Screening of ESBL producers among Gram-negative isolates was done by using third generation cephalosporins (ceftazidime and cefotaxime) and confirmed by the combined disk method as recommended by CLSI (2019). Results: Out of 109 sputum specimens, Gram-negative bacterial etiology was determined in 31(28.4%) cases. The age-wise distribution of LRTIs patient was found to be statistically significant with bacterial incidence (p < 0.05). Altogether, 15(46.9%) isolates were multidrugresistant. ESBL producers were observed only among Klebsiella spp. and Escherichia coli isolates. On the ESBL screening test of 9 isolates (3 of E. coli and 6 of Klebsiella spp.,) 5(55.6%) gave a positive result, and only 3(33.3%) of them were further confirmed as ESBL producers. The majority of ESBL producers were Klebsiella spp. 2(66.7%). Conclusion: The present study revealed that multidrug resistance is prevalent among Gramnegative bacterial pathogens isolated from the patients with lower respiratory tract infections, requiring routine laboratory testing for MDR and ESBL production in clinical isolates for better prophylaxis and reducing the risk of ESBL transmission.

scholarly journals Prevalence of Extended Spectrum b-Lactamases (ESBLs) Producers Among Gram-Negative Bacilli in Urinary Tract Infections

2015 ◽  
Vol 14 (2) ◽  
pp. 17-20 ◽  
Author(s):  
Abu Hena Md Saiful Karim Chowdhury ◽  
Md Anwar Husain ◽  
Nasima Akter ◽  
Md Abdul Mazed ◽  
Shakeel Ahmed ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Gram Negative Bacteria ◽  
Bacterial Strains ◽  
Gram Negative ◽  
Extended Spectrum ◽  
Important Challenge ◽  
Severe Infections ◽  
Tract Infections ◽  
Klebsiella Spp ◽  
Esbl Producers

Background: Antimicrobial resistance is now proclaimed as the most important challenge worldwide being faced by humanity in its fight against infectious diseases. Extended Spectrum b-Lactamases (ESBLs) producing organisms are increasing in number and causing more severe infections because of their continuous mutation and multidrug resistance property which make its treatment difficult.Aims: The present study was undertaken to detect the prevalence of the ESBLs producing bacteria in urinary tract infection.Methods: Isolated gram-negative bacteria initially screened by Minimum Inhibitory Concentration (MIC) ESBLs breakpoints. Then suspected ESBLs producers were confirmed by phenotypic confirmatory test.Results: 71 (59.17%) bacterial strains were isolated from 120 urine samples of patients of suspected urinary tract infection of which 66(92.96%) were gram-negative and 05(07.04%) were gram-positive. Among the isolated gram-negative bacteria 63(95.45%) were found suspected ESBLs producers of which 35(55.56%) were found as confirmed ESBL producers. The prevalence of ESBLs producing organisms in the present study were found to be 53.03% and Klebsiella spp. as most prevalent ESBLs producers.Conclusion: It is essential to report ESBL production along with routine sensitivity reporting, which will help the clinician in prescribing the proper antibiotics.Chatt Maa Shi Hosp Med Coll J; Vol.14 (2); Jul 2015; Page 17-20

scholarly journals Impact of Antibiotic Prescribing Patterns on Susceptibilities of Uropathogens in Children below 24 Months Old

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 915
Author(s):  
Ji Young Park ◽  
Hyun Mi Kang ◽  
Eun Min Kwak ◽  
Jung-Woo Rhim ◽  
Yo Han Ahn ◽  
...  
Keyword(s):  
Prescribing Patterns ◽  
First Episode ◽  
Data Repository ◽  
Antibiotic Prescribing ◽  
E Coli ◽  
Factors Associated ◽  
Increased Risk ◽  
Tract Infections ◽  
Klebsiella Spp ◽  
Esbl Producers

Monitoring regional antibiotic resistance patterns of uropathogens are important for deciding suitable empirical antibiotics for urinary tract infections (UTIs) in children. This study aimed to investigate regional differences in antimicrobial susceptibility patterns of E. coli and Klebsiella spp. in children below 24 months old, diagnosed with their first episode of UTI, and to find factors associated with an increased risk for UTI caused by extended-spectrum β-lactamase (ESBL)-producing uropathogens. This was a retrospective cohort study of children diagnosed between 2011 and 2017 in four different hospitals located in four different regions of South Korea; regions A, B, C, and D. The government’s big data repository was used to acquire data on regional antibiotic prescriptions. The pooled antimicrobial susceptibilities of E. coli and Klebsiella spp. (n = 2044) were as follows: ampicillin–sulbactam (61.0%), 3rd generation cephalosporin (3C) (82.8%), and trimethoprim–sulfamethoxazole (72.0%). Multivariate analysis showed that children diagnosed at hospital A (OR, 1.8; 95% confidence interval [CI], 1.2–2.6; P = 0.002) and every year that increased in the study period (OR, 1.1; 95% CI, 1.1–1.2; P < 0.001) were factors associated with an increased risk for UTIs with ESBL-producers. Regions A and B had significantly higher amounts of oral 3Cs prescribed compared to regions C and D (P = 0.009), which correlate with hospitals in the regions that had higher proportions of UTIs with ESBL-producing uropathogens (A and B vs. C and D, P < 0.001). Therefore, children in certain regions are at a higher risk for UTIs caused by ESBL-producers compared to other regions, which correlate with regions that had higher amounts of oral 3Cs prescribed.

Effect of Vasopressin Dose on Hemodynamic Response in Obese Patients With Septic Shock: A Retrospective Observational Study

2021 ◽  
pp. 106002802110072
Author(s):  
Casey A. Dubrawka ◽  
Kevin D. Betthauser ◽  
Hannah E. Pope ◽  
Gabrielle A. Gibson
Keyword(s):  
Septic Shock ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Standard Dose ◽  
Hemodynamic Response ◽  
Percentage Change ◽  
High Dose ◽  
Obese Patients ◽  
Improved Outcomes ◽  
Higher Doses

Background No clear association between standard vasopressin doses and body mass index exists, despite potential pharmacokinetic and pharmacodynamic variability among patients with septic shock. It is unknown if higher doses may alter hemodynamic response. Objective The purpose of this study was to evaluate the effect of vasopressin dose on hemodynamic response in obese patients with septic shock. Methods A single-center, retrospective cohort study was conducted in adult, obese patients with septic shock receiving catecholamine vasopressors and vasopressin. Patients were analyzed according to vasopressin dose received: standard dose (≤0.04 U/min) and high dose (>0.04 U/min). The primary outcome was percentage change in norepinephrine equivalent (NEQ) dose. Results A total of 182 patients were included in the analysis, with 136 in the standard-dose vasopressin group and 46 in the high-dose vasopressin group. There was no difference in percentage change in NEQ dose at 6 hours after standard- or high-dose vasopressin attainment (−28.6% vs −19.1%; P = 0.166). A greater increase in mean arterial pressure (MAP) at 6 hours was observed with receipt of high-dose vasopressin (23.3% vs 15.3%; P = 0.023). Duration of shock and length of stay were significantly longer in patients who received high-dose vasopressin, with no difference in in-hospital mortality. Conclusion and Relevance This represents the first analysis comparing standard and higher doses of vasopressin in obese patients with septic shock. Receipt of high-dose vasopressin was not associated with a difference in catecholamine requirement or improved outcomes. Further studies are warranted to provide guidance on the use of high-dose vasopressin in septic shock.

The effects of propofol on extracorporeal membrane oxygenation oxygenator exchange

2021 ◽  
pp. 039139882110160
Author(s):  
Kelsey L Browder ◽  
Ayesha Ather ◽  
Komal A Pandya
Keyword(s):  
Cohort Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Cumulative Dose ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Ecmo Support ◽  
Single Center ◽  
Membrane Oxygenation ◽  
Vv Ecmo

The objective of this study was to determine if propofol administration to veno-venous (VV) extracorporeal membrane oxygenation (ECMO) patients was associated with more incidents of oxygenator failure when compared to patients who did not receive propofol. This was a single center, retrospective cohort study. The primary outcome of the study is oxygenator exchanges per ECMO day in patients who received propofol versus those who did not receive propofol. Patients were 18 years or older on VV-ECMO support between January 1, 2015 and January 31, 2018. Patients were excluded if they required ECMO support for less than 48 h or greater than 21 days. There were five patients in the propofol arm that required oxygenator exchanges and seven patients in the control arm. The total number of oxygenator exchanges per ECMO day was not significantly different between groups ( p = 0.50). When comparing those who required an oxygenator exchange and those who did not, there was no difference in the cumulative dose of propofol received per ECMO hour (0.64 mg/kg/h vs 0.96 mg/kg/h; p = 0.16). Propofol use in patients on VV-ECMO does not appear to increase the number of oxygenator exchanges.

#39: Streptococcus anginosus Group Infections in Children: A Retrospective Cohort Study, 2015–2019

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S6-S6
Author(s):  
O Amin ◽  
O Smith ◽  
F Berkowitz ◽  
T Lyon ◽  
C Kao ◽  
...  
Keyword(s):  
Antibiotic Susceptibility ◽  
Retrospective Cohort ◽  
Management Strategies ◽  
Upper Respiratory Tract ◽  
Streptococcus Anginosus ◽  
Streptococcus Constellatus ◽  
Clinical Presentations ◽  
Inflammatory Bowel ◽  
Tract Infections ◽  
Polymicrobial Infections

Abstract Background Infections attributed to the Streptococcus anginosus group (SAG), which includes Streptococcus anginosus, Streptococcus constellatus, and Streptococcus intermedius, have varying clinical presentations. SAG infections are difficult to identify initially, and members of the group may require different management strategies. Methods A retrospective review of SAG-positive cultures from January 2015, to September 2019, was conducted to describe the demographic, clinical, and laboratory features including the site of infection, antibiotic susceptibility, management, and clinical outcome. Results We identified 561 patients [median age 11.3, interquartile range (IQR) 7.1–14.9 years, male:female ratio 3:2, non-Hispanic–non-Latino 454 (81%), White 279 (49%)]. Thirty-nine (7%) had at least one underlying condition. Of these, inflammatory bowel disease 15 (39%), diabetes 7 (18%), immunodeficiency 5 (13%). SAG was found in exudate, fluid, or aspirate (537/561, 96%), blood (11/561, 2%), and tissue (11/561, 2%) samples; 388 (69%) were polymicrobial infections. The most common site of infection was intra-abdominal (175, 31%), followed by neck/odontogenic (114. 20%) and genitourinary tract (66, 12%). The median length of stay was 6 days (IQR 3–10 days) and was statistically significantly longer for patients with blood, central nervous system, and pulmonary infections compared with soft tissue and upper respiratory tract infections (P &lt; 0.001). Beta-lactams were the most commonly used antibiotics (38%), followed by clindamycin (30 %) (see Figure for antibiotic susceptibility results) and 33 (56%) patients received combination therapy. We did not observe any SAG attributed to mortality. Conclusions In our retrospective cohort, SAG infections were more commonly identified in males, were associated with abscess formation, and presented as polymicrobial infections. Children with underlying comorbidities are more likely to present with systemic SAG infections. SAG-associated infections can be variable in presentation site and severity and should be considered as pathogens when managing patients.

Atrial Fibrillation and Mortality in the Oldest Old after Surgery for Hip Fractures

Gerontology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Amit Frenkel ◽  
Vladimir Zeldetz ◽  
Roni Gat ◽  
Yair Binyamin ◽  
Asaf Acker ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Hip Fractures ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Oldest Old ◽  
Postoperative Mortality ◽  
Patient Characteristics ◽  
One Year

Introduction: One-year mortality following hip fractures increases steeply with age, from 2% in the 60- to 69-year-old population up to 28% in the oldest old (older than 90 years). Of the various factors that contribute to hip fractures, atrial fibrillation (AF) is an independent risk factor at any age. Objective: The objective of this study was to assess the association of AF with mortality among the oldest old with hip fractures. Method: This is a retrospective cohort study of 701 persons above age 90 years who underwent orthopedic repair for a hip fracture during 2000–2018. Of them, 218 (31%) had AF at hospital admission. The primary outcome was survival following surgery. We compared patient characteristics and 30-day, 180-day, 1-year, and 3-year survival between patients with and without AF. Results: The adjusted odds ratio for 30-day postoperative mortality for those with AF versus without AF group was 1.03 (95% confidence interval [CI] 0.63–1.66). Survival estimates were higher among those without AF than with AF at 180 days postoperative: 0.85 (95% CI 0.82–0.89) versus 0.68 (95% CI 0.61–0.74), p < 0.001; at 1 year postoperative: 0.68 (95% CI 0.63–0.72) versus 0.48 (95% CI 0.42–0.55), p < 0.001; and at 3 years postoperative: 0.47 (95% CI 0.42–0.52) versus 0.28 (95% CI 0.27–0.34), p < 0.001. Conclusions: Among individuals aged >90 years, operated for hip fractures, mortality was similar for those with and without AF at 30 days postoperative. However, the survival curves diverged sharply after 180 days. Our findings suggest that AF is not an immediate surgical risk factor, but rather confers increased long-term risk in this population.

Isolation and Identification of Multidrug-Resistant Isolates of Uropathogenic Klebsiella spp in Dogs

2021 ◽  
Vol 3 (1) ◽  
pp. 6-12
Author(s):  
M Mustapha ◽  
P Goel
Keyword(s):  
Antimicrobial Agents ◽  
Bacterial Species ◽  
Multidrug Resistant ◽  
Urine Samples ◽  
Penicillin G ◽  
Isolation And Identification ◽  
Sensitivity Testing ◽  
Bacterial Organism ◽  
Tract Infections ◽  
Klebsiella Spp

The most widespread ailments in dogs are urinary tract infections (UTIs) caused by bacterial species. It is necessary to recognize the prevailing bacterial pathogens and their susceptibility to antimicrobial agents to effectively treat UTIs. The present study aimed to classify the bacterial organism that causes UTIs in dogs and their patterns of antimicrobial resistance. A total of 141 urine samples were collected from diseased dogs in Veterinary Clinical Complex LUVAS in Hisar, India. Culture, biochemical and sensitivity testing were performed for each of the urine samples based on standard method. Of the total 141 urine samples from dogs, 21 (14.9%) isolates were identified as Klebsiella spp. The isolates were found to be highly resistant to ampicillin (100%), penicillin G (100%), oxytetracycline (100%), enrofloxacin (85.7%), chloramphenicol (80.6%), ceftriaxone (76.2%) and cloxacillin (71.4%), while susceptibility was observed against gentamicin (100%), amikacin (100%) and neomycin (90.5%). In the current study, 19 out of 21 identified isolates were found to be multidrug-resistant. This study indicates that dogs in the study area are found to harbor highly resistant Klebsiella spp. Therefore, when deciding on the antibiotic regimen for UTIs cases, Vets should consider resistance profile of chosen antibacterial agents before usage in order to discourage dissemination of resistant organisms in the study area.

scholarly journals Fosfomycin versus Ertapenem for Outpatient Treatment of Complicated Urinary Tract Infections: A Multicenter, Retrospective Cohort Study

2021 ◽  
Author(s):  
Noah Wald-Dickler ◽  
Todd C Lee ◽  
Soodtida Tangpraphaphorn ◽  
Susan M Butler-Wu ◽  
Nina Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Urinary Tract ◽  
Los Angeles ◽  
Urinary Tract Infections ◽  
Retrospective Cohort Study ◽  
Outpatient Treatment ◽  
Retrospective Cohort ◽  
Clinical Success ◽  
Public Hospitals ◽  
Tract Infections

Abstract Objectives We sought to determine the comparative efficacy of fosfomycin vs. ertapenem for outpatient treatment of complicated urinary tract infections (cUTI). Methods We conducted a multi-centered, retrospective cohort study involving patients with cUTI treated with outpatient oral fosfomycin vs. intravenous ertapenem at three public hospitals in Los Angeles County between January 2018 and September 2020. The primary outcome was resolution of clinical symptoms 30 days after diagnosis. Results We identified 322 patients with cUTI treated with fosfomycin (n = 110) or ertapenem (n = 212) meeting study criteria. Study arms had similar demographics, although patients treated with ertapenem more frequently had pyelonephritis or bacteremia while fosfomycin-treated patients had more retained catheters, nephrolithiasis, or urinary obstruction. Most infections were due to extended-spectrum β-lactamase-producing E. coli and Klebsiella pneumoniae; 80-90% of which were resistant to other oral options. Adjusted odds ratios for clinical success at 30 days, clinical success at last follow up, and relapse were 1.21 (0.68 to 2.16), 0.84 (0.46 to 1.52), and 0.94 (0.52 to 1.70), for fosfomycin vs. ertapenem, respectively. Patients treated with fosfomycin had significant reductions in length of hospital stay and length of antimicrobial therapy, and fewer adverse events (1 vs. 10). Fosfomycin outcomes were similar irrespective of duration of lead-in IV therapy or fosfomycin dosing interval (daily, every other day, every third day). Conclusion These results would support the conduct of a randomized controlled trial to verify efficacy. In the meantime, they suggest fosfomycin may be a reasonable stepdown from IV antibiotics for cUTI.

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