scholarly journals Gram-negative bacteraemia in non-ICU patients: factors associated with inadequate antibiotic therapy and impact on outcomes

2008 ◽  
Vol 61 (6) ◽  
pp. 1376-1383 ◽  
Author(s):  
J. Marschall ◽  
D. Agniel ◽  
V. J. Fraser ◽  
J. Doherty ◽  
D. K. Warren
Keyword(s):  
Antibiotic Therapy ◽  
Icu Patients ◽  
Gram Negative ◽  
Factors Associated ◽  
Inadequate Antibiotic Therapy

Risk Factors Associated With Resistance to Ciprofloxacin in Clinical Bacterial Isolates From Intensive Care Unit Patients

2007 ◽  
Vol 28 (3) ◽  
pp. 331-336 ◽  
Author(s):  
Phillip D. Levin ◽  
Robert A. Fowler ◽  
Cameron Guest ◽  
William J. Sibbald ◽  
Alex Kiss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Prior Treatment ◽  
Bacterial Isolates ◽  
Icu Patients ◽  
Gram Negative ◽  
Factors Associated ◽  
Icu Admission ◽  
Ciprofloxacin Resistance

Objective.To determine risk factors and outcomes associated with ciprofloxacin resistance in clinical bacterial isolates from intensive care unit (ICU) patients.Design.Prospective cohort study.Setting.Twenty-bed medical-surgical ICU in a Canadian tertiary care teaching hospital.Patients.All patients admitted to the ICU with a stay of at least 72 hours between January 1 and December 31, 2003.Methods.Prospective surveillance to determine patient comorbidities, use of medical devices, nosocomial infections, use of antimicrobials, and outcomes. Characteristics of patients with a ciprofloxacin-resistant gram-negative bacterial organism were compared with characteristics of patients without these pathogens.Results.Ciprofloxacin-resistant organisms were recovered from 20 (6%) of 338 ICU patients, representing 38 (21%) of 178 nonduplicate isolates of gram-negative bacilli. Forty-nine percent ofPseudomonas aeruginosaisolates and 29% ofEscherichia coliisolates were resistant to ciprofloxacin. In a multivariate analysis, independent risk factors associated with the recovery of a ciprofloxacin-resistant organism included duration of prior treatment with ciprofloxacin (relative risk [RR], 1.15 per day [95% confidence interval {CI}, 1.08-1.23];P< .001), duration of prior treatment with levofloxacin (RR, 1.39 per day [95% CI, 1.01-1.91];P= .04), and length of hospital stay prior to ICU admission (RR, 1.02 per day [95% CI, 1.01-1.03];P= .005). Neither ICU mortality (15% of patients with a ciprofloxacin-resistant isolate vs 23% of patients with a ciprofloxacin-susceptible isolate;P= .58 ) nor in-hospital mortality (30% vs 34%;P= .81 ) were statistically significantly associated with ciprofloxacin resistance.Conclusions.ICU patients are at risk of developing infections due to ciprofloxacin-resistant organisms. Variables associated with ciprofloxacin resistance include prior use of fluoroquinolones and duration of hospitalization prior to ICU admission. Recognition of these risk factors may influence antibiotic treatment decisions.

scholarly journals Factors associated with survival of ICU patients with pneumonia caused by multidrug-resistant Gram-negative bacteria

Critical Care ◽  
2015 ◽  
Vol 19 (Suppl 1) ◽  
pp. P110
Author(s):  
M Georgiadou ◽  
E Pappa ◽  
E Papandreou ◽  
H Pavlou ◽  
M Eforakopoulou
Keyword(s):  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Icu Patients ◽  
Gram Negative ◽  
Factors Associated

scholarly journals Active Surveillance of Carbapenem-resistant Gram-negative Bacteria to guide antibiotic therapy: a single-center prospective observational study

2021 ◽  
Author(s):  
Qiqiang Liang ◽  
Juan Chen ◽  
Yongshan Xu ◽  
Yibing Chen ◽  
Man Huang
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Antibiotic Therapy ◽  
Prospective Observational Study ◽  
Gram Negative Bacteria ◽  
Empirical Antibiotic Therapy ◽  
Single Center ◽  
Gram Negative ◽  
Factors Associated ◽  
Carbapenem Resistant

Abstract Background Carbapenem-resistant Gram-negative Bacteria (CRGNB) have become a public health concern worldwide. The risk factors associated with CRGNB infection after colonization are unknown, nor is the optimal timing of antibiotic treatment, warranting further investigation. Methods A 4-year single-center prospective observational study was conducted. CRGNB-colonized patients were incorporated on admission into our observation cohort for an active surveillance culture program, and analysis of risk factors associated with infections after CRGNB colonization was performed. We divided patients into empirical antibiotic therapy groups and standard antibiotic therapy groups according to whether antibiotics were used before or after cultures yielded a result to explore the relationship between the timing of antibiotics and clinical efficacy. Results 152 out of 451 CRGNB-colonized patients in the prospective observational cohort developed CRGNB infection. The risk factors associated with CRGNB infection after colonization included CRKP (P < 0.001, OR = 3.27) and CRPA (P < 0.001, OR = 2.97) colonization, history of carbapenems use (P < 0.001, OR = 5.48), and immunocompromise (P < 0.001, OR = 7.07). There were 88 infected patients in the empirical antibiotic therapy groups and 64 in standard antibiotic therapy groups. The mortality was lower in empirical therapy groups than standard therapy groups (17.0% vs. 37.5%, P = 0.004, OR = 0.32). Conclusions CRGNB colonization increased the risk of infection, and risk factors included CRKP and CRPA colonization, immunocompromise, and prior carbapenems use. Once infection occurs in CRGNB-colonized patients, susceptibility-guided antibiotic treatment can be given according to previous susceptibility results of colonized CRGNB, reducing mortality.

scholarly journals Performance and impact of a multiplex PCR in ICU patients with ventilator-associated pneumonia or ventilated hospital-acquired pneumonia

2020 ◽  
Author(s):  
Nathan Peiffer-Smadja ◽  
Lila BOUADMA ◽  
Vincent MATHY ◽  
Kahina ALLOUCHE ◽  
Juliette PATRIER ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Multiplex Pcr ◽  
Antimicrobial Therapy ◽  
Bacterial Resistance ◽  
Clinical Samples ◽  
Gram Positive ◽  
Icu Patients ◽  
Gram Negative ◽  
Surgical Icu ◽  
Gram Positive Cocci

Abstract Background: Early appropriate antibiotic therapy reduces morbidity and mortality of severe pneumonia. However, the emergence of bacterial resistance requires the earliest use of antibiotics with the narrowest possible spectrum. The Unyvero Hospitalized Pneumonia (HPN, Curetis) test is a multiplex PCR (M-PCR) system detecting 21 bacteria and 19 resistance genes on respiratory samples within 5 hours. We assessed the performance and the potential impact of the M-PCR on the antibiotic therapy of ICU patients. Methods: In this prospective study we performed a M-PCR on bronchoalveolar lavage (BAL) or plugged telescoping catheters (PTC) samples of patients with ventilated HAP or VAP with Gram-negative bacilli or clustered Gram-positive cocci. This study was conducted in 3 ICUs in a French academic hospital; the medical and infectious diseases ICU, the surgical ICU and the cardio-surgical ICU. A multidisciplinary expert panel simulated the antibiotics changes they would have made if the M-PCR results had been available. Results We analyzed 95 clinical samples of ventilated HAP or VAP (72 BAL and 23 PTC) from 85 patients (62 males, median age 64 years). The median turnaround time of the M-PCR was 4.6 hours (IQR 4.4-5). A total of 90/112 bacteria were detected by the M-PCR system with a global sensitivity of 80% (95%CI, 73-88%) and specificity of 99% (95%CI 99-100). The sensitivity was better for Gram-negative bacteria (90%) than for Gram-positive cocci (62%) (p=0.005). Moreover, 5/8 extended-spectrum beta-lactamases (CTX-M gene) and 4/4 carbapenemases genes (3 NDM, one oxa-48) were detected. The M-PCR could have led to the earlier initiation of an effective antibiotic in 20/95 patients (21%) and to early de-escalation in 37 patients (39%) but could also have led to one (1%) inadequate antimicrobial therapy. Among 17 empiric antibiotic treatments with carbapenems, 10 could have been de-escalated in the following hours according to the M-PCR results. The M-PCR also led to 2 unexpected diagnosis of severe legionellosis confirmed by culture methods. Conclusions: Our results suggest that the use of a M-PCR system for respiratory samples of patients with VAP and ventilated HAP could improve empirical antimicrobial therapy and reduce the use of broad-spectrum antibiotics.

scholarly journals Performance and impact of a multiplex PCR in ICU patients with ventilator-associated pneumonia or ventilated hospital-acquired pneumonia

2020 ◽  
Author(s):  
Nathan Peiffer-Smadja ◽  
Lila BOUADMA ◽  
Vincent MATHY ◽  
Kahina ALLOUCHE ◽  
Juliette PATRIER ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Multiplex Pcr ◽  
Antimicrobial Therapy ◽  
Bacterial Resistance ◽  
Clinical Samples ◽  
Gram Positive ◽  
Icu Patients ◽  
Gram Negative ◽  
Surgical Icu ◽  
Gram Positive Cocci

Abstract Background: Early appropriate antibiotic therapy reduces morbidity and mortality of severe pneumonia. However, the emergence of bacterial resistance requires the earliest use of antibiotics with the narrowest possible spectrum. The Unyvero Hospitalized Pneumonia (HPN, Curetis) test is a multiplex PCR (M-PCR) system detecting 21 bacteria and 19 resistance genes on respiratory samples within 5 hours. We assessed the performance and the potential impact of the M-PCR on the antibiotic therapy of ICU patients. Methods: In this prospective study we performed a M-PCR on bronchoalveolar lavage (BAL) or plugged telescoping catheters (PTC) samples of patients with ventilated HAP or VAP with Gram-negative bacilli or clustered Gram-positive cocci. This study was conducted in 3 ICUs in a French academic hospital; the medical and infectious diseases ICU, the surgical ICU and the cardio-surgical ICU. A multidisciplinary expert panel simulated the antibiotics changes they would have made if the M-PCR results had been available. Results We analyzed 95 clinical samples of ventilated HAP or VAP (72 BAL and 23 PTC) from 85 patients (62 males, median age 64 years). The median turnaround time of the M-PCR was 4.6 hours (IQR 4.4-5). A total of 90/112 bacteria were detected by the M-PCR system with a global sensitivity of 80% (95%CI, 73-88%) and specificity of 99% (95%CI 99-100). The sensitivity was better for Gram-negative bacteria (90%) than for Gram-positive cocci (62%) (p=0.005). Moreover, 5/8 extended-spectrum beta-lactamases (CTX-M gene) and 4/4 carbapenemases genes (3 NDM, one oxa-48) were detected. The M-PCR could have led to the earlier initiation of an effective antibiotic in 20/95 patients (21%) and to early de-escalation in 37 patients (39%) but could also have led to one (1%) inadequate antimicrobial therapy. Among 17 empiric antibiotic treatments with carbapenems, 10 could have been de-escalated in the following hours according to the M-PCR results. The M-PCR also led to 2 unexpected diagnosis of severe legionellosis confirmed by culture methods. Conclusions: Our results suggest that the use of a M-PCR system for respiratory samples of patients with VAP and ventilated HAP could improve empirical antimicrobial therapy and reduce the use of broad-spectrum antibiotics.

scholarly journals Patterns of Antimicrobial Resistance Among Intensive Care Unit Patients of A Private Medical College Hospital in Dhaka

2015 ◽  
Vol 25 (2) ◽  
pp. 47-51 ◽  
Author(s):  
Quazi Tarikul Islam ◽  
Md Mahmudur Rahman Siddiqui ◽  
Farhana Raz ◽  
Mohammad Asrafuzzaman ◽  
Md Robed Amin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tracheal Aspirate ◽  
College Hospital ◽  
Icu Patients ◽  
Gram Negative ◽  
Pseudomonas Spp ◽  
Medical College ◽  
Acinetobacter Spp ◽  
Klebsiella Spp

Because of importance of Hospital acquired infections (HAIs), it is critical to conduct surveillance studies to obtain the required data about the regional microorganisms and their susceptibility to antibiotics. This study to investigate antimicrobial resistance pattern among Intensive Care Unit (ICU) patients in a private medical college hospital setup. In a cross sectional study, 100 specimens from patients admitted in the ICU who had signs or symptoms of nosocomial infection were collected from 2012 - 2013. For each patient, samples of blood, urine, tracheal aspirate, sputum, wound swab, pus, and endotracheal tubes were obtained, cultured and analyzed with antibiogram. The most common primary diagnosis were aspiration pneumonia (49%) and UTI (20%) respectively. The most common locations for infection were tracheal aspirate (54%). The most frequent gram negative microorganisms derived from samples were Acinetobacter spp (29%), Klebsiella spp (26%) and Pseudomonas spp (18%). Klebsiella spp, Acinetobacter spp and Pseudomonas spp were most common resistant organisms among all. Klebsiella spp were resistant against Ceftriaxone (84.6%), Ceftazidime (82.6%), Amikacin (46.1%), Gentamicin (66.6%) and Quinolones (65-66.6%) respectively. Acinetobacter spp were resistant against Ceftriaxone (85%), Ceftazidime (88.8%), Cefotaxime (85.7%), Meropenem (79.3%),Amikacin (86.2%), Gentamicin (84.5%) and Quinolons (86.2-89.2%) respectively. Pseudomonas spp were resistant against Ceftriaxone (70.5%), Ceftazidime (66.6%), Amikacin (68.7%), Gentamicin (58.8%), Meropenem (52.9%) and Quinolones (81.2-86.6%) respectively. Meropenem was the most sensitive antibiotic against Klebsiella spp (84.6%) but Cotrimoxazole in case of Acinetobacter spp (60%) respectively. Escherichia coli were mostly isolated from urine, which was sensitive to Amikacin (73.3%) and Meropenem (86.6%) respectively. Gram-negative pathogens obtained from ICU patients in our settings show high resistance to antibiotics. Regular monitoring of the pattern of resistance of common pathogens in the ICUs is essential to up-to-date the use of rational antibiotics regiments.Bangladesh J Medicine Jul 2014; 25 (2) : 47-51

Sign in / Sign up

Export Citation Format

Share Document