Combination Antimicrobial Therapy for Gram-Negative Infections: What Is the Evidence?

2007 ◽  
pp. 433-459
Author(s):  
Nasia Safdar ◽  
Cybele L. Abad
Keyword(s):  
Antimicrobial Therapy ◽  
Gram Negative

scholarly journals Cumulative Effect of an Antimicrobial Stewardship and Rapid Diagnostic Testing Bundle on Early Streamlining of Antimicrobial Therapy in Gram-Negative Bloodstream Infections

2017 ◽  
Vol 61 (9) ◽  
Author(s):  
P. B. Bookstaver ◽  
E. B. Nimmich ◽  
T. J. Smith ◽  
J. A. Justo ◽  
J. Kohn ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Phase 1 ◽  
Bloodstream Infections ◽  
Antimicrobial Stewardship Program ◽  
Phase 2 ◽  
Beta Lactams ◽  
Gram Negative ◽  
Stewardship Program ◽  
Tof Ms

ABSTRACT The use of rapid diagnostic tests (RDTs) enhances antimicrobial stewardship program (ASP) interventions in optimization of antimicrobial therapy. This quasi-experimental cohort study evaluated the combined impact of an ASP/RDT bundle on the appropriateness of empirical antimicrobial therapy (EAT) and time to de-escalation of broad-spectrum antimicrobial agents (BSAA) in Gram-negative bloodstream infections (GNBSI). The ASP/RDT bundle consisted of system-wide GNBSI treatment guidelines, prospective stewardship monitoring, and sequential introduction of two RDTs, matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) and the FilmArray blood culture identification (BCID) panel. The preintervention period was January 2010 through December 2013, and the postintervention period followed from January 2014 through June 2015. The postintervention period was conducted in two phases; phase 1 followed the introduction of MALDI-TOF MS, and phase 2 followed the introduction of the FilmArray BCID panel. The interventions resulted in significantly improved appropriateness of EAT (95% versus 91%; P = 0.02). Significant reductions in median time to de-escalation from combination antimicrobial therapy (2.8 versus 1.5 days), antipseudomonal beta-lactams (4.0 versus 2.5 days), and carbapenems (4.0 versus 2.5 days) were observed in the postintervention compared to the preintervention period (P < 0.001 for all). The reduction in median time to de-escalation from combination therapy (1.0 versus 2.0 days; P = 0.03) and antipseudomonal beta-lactams (2.2 versus 2.7 days; P = 0.04) was further augmented during phase 2 compared to phase 1 of the postintervention period. Implementation of an antimicrobial stewardship program and RDT intervention bundle in a multihospital health care system is associated with improved appropriateness of EAT for GNBSI and decreased utilization of BSAA through early de-escalation.

Reply to comments: duration of antimicrobial therapy for Gram-negative bacteremia secondary to urinary source of infection

Infection ◽  
2018 ◽  
Vol 46 (2) ◽  
pp. 283-284 ◽  
Author(s):  
Majdi N. Al-Hasan ◽  
Avery N. Nelson ◽  
Julie Ann Justo ◽  
Helmut Albrecht ◽  
Joseph Kohn ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Gram Negative ◽  
Source Of Infection ◽  
Gram Negative Bacteremia

Polymyxin B-modified conjugated oligomer nanoparticle for targeted identification and enhanced photodynamic antimicrobial therapy

2021 ◽  
Author(s):  
Qi Jiang ◽  
Xinrong Yan ◽  
Dan Jiao ◽  
Jiangyan Zhang ◽  
Yonggang Wu ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Antimicrobial Therapy ◽  
Polymyxin B ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Photodynamic Antimicrobial Therapy

We report a photosensitive polymyxin B-modified conjugated oligomer nanoparticle that integrates the targeted identification and synergistic photodynamic therapy in one treatment against resistant gram-negative bacteria. The study expands the application...

Neisseria gonorrhoeae

2020 ◽  
pp. 1025-1032
Author(s):  
Jackie Sherrard ◽  
Magnus Unemo
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Sexual Activity ◽  
Antimicrobial Therapy ◽  
Genital Tract ◽  
Systemic Disease ◽  
Gonococcal Infection ◽  
Gram Negative ◽  
Lower Genital Tract ◽  
Direct Inoculation ◽  
Sex With Men

Neisseria gonorrhoeae is a Gram-negative, intracellular diplococcus that is transmitted by direct inoculation of infected secretion from one mucosa to another. It primarily colonizes the columnar epithelium of lower genital tract, only occasionally spreading to the upper genital tract or causing systemic disease. Oropharyngeal and rectal infections are common in men who have sex with men but also occur in women. N. gonorrhoeae is almost exclusively transmitted by sexual activity. Oropharyngeal and rectal infections usually produce no symptoms; disseminated gonococcal infection is a comparatively benign bacteraemia affecting joints (particularly shoulder and knee) and skin; traditionally more common in women than men. The gonococcus has adapted rapidly to prevalent antimicrobial usage, leading to resistance to all antibiotics used for treatment, notably penicillins, fluoroquinolones, macrolides, tetracycline, and cephalosporins. This development has resulted in major concerns internationally and the introduction of international and national action/response plans as well as dual antimicrobial therapy.

scholarly journals Shorter-course Antimicrobial Therapy for Uncomplicated Gram-negative Bacteremia: Is It Generalizable?

2019 ◽  
Vol 69 (7) ◽  
pp. 1263-1263
Author(s):  
Scott J C Pallett ◽  
Stephen Hughes ◽  
Muhammed U Ebrahimsa ◽  
Nabeela Mughal ◽  
Luke S P Moore
Keyword(s):  
Antimicrobial Therapy ◽  
Gram Negative ◽  
Gram Negative Bacteremia

scholarly journals Microbiology of Vertebral Osteomyelitis and Implications on Empiric Therapy

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S6-S6
Author(s):  
Abbye Clark ◽  
Neha Sharma ◽  
Sharon Weissman ◽  
Majdi N Al-Hasan ◽  
Caroline Derrick ◽  
...  
Keyword(s):  
South Carolina ◽  
Antimicrobial Therapy ◽  
Vertebral Osteomyelitis ◽  
Case Series ◽  
Empiric Therapy ◽  
Empiric Antibiotic Therapy ◽  
Retrospective Case ◽  
Gram Negative ◽  
Male Predominance ◽  
Case Series Study

Abstract Background The management of vertebral osteomyelitis (VO) includes empiric antibiotic therapy while clinical cultures are being processed. Optimal antimicrobial therapy for VO, particularly when Gram-negative (GN) organisms are involved, is an area of ongoing debate. Narrow spectrum and oral antimicrobial therapy are preferred. The objective of this study was to identify characteristics of local pathogens and to formulate an institution-specific antibiotic protocol for empiric treatment of VO. Methods We conducted a retrospective case series study of adults diagnosed with VO from August 1, 2010 to August 31, 2015 at Palmetto Health Hospitals in Columbia, South Carolina. Cases identified by ICD-9 codes were included in the analysis if they met clinical, imaging and microbiology, criteria. Results Analysis is based on 150 cases of VO with a mean age of 61 years, a male predominance (91; 61%), and an average body mass index of 29kg/m2. Comorbidities included diabetes mellitus (69; 46%), tobacco use (33; 22%), and hemodialysis (20; 13%). Thirty-seven (25%) cases had recent related injury or vertebral surgery, and 14 (9%) had prior hardware. Bone, disc, or adjacent tissue cultures were obtained in 129 (86%) of cases; 60 (40%) of these had &gt;1 sample taken. The remaining 14% had blood cultures alone. Thirty-six cases (24%) had culture negative VO. In the remaining 114 cases, 132 organisms were isolated. A total of 111 (84%) organisms were Gram-positive cocci (GPC). Of those, the majority was Staphylococcus aureus. (66; 59%) (26/66 were methicillin-resistant), coagulase-negative staphylococci (20; 18%) and Streptococcus spp. (17; 15%). Enterobacteriaceae accounted for 13/17 Gram-negative bacilli (GNB), with only one isolate of Pseudomonas aeruginosa. Of the GNB, 11/17 were susceptible to either ceftriaxone or ciprofloxacin. Conclusion There was a predominance of VO due to GPC suggesting that intravenous vancomycin monotherapy may be reasonable for empiric therapy in noncritically ill patients while awaiting Gram stain and clinical culture results. Addition of either ceftriaxone or ciprofloxacin to vancomycin would increase cumulative antimicrobial coverage from 84 to 92%. Disclosures All authors: No reported disclosures.

scholarly journals Bloodstream Infections Caused by Antibiotic-Resistant Gram-Negative Bacilli: Risk Factors for Mortality and Impact of Inappropriate Initial Antimicrobial Therapy on Outcome

2005 ◽  
Vol 49 (2) ◽  
pp. 760-766 ◽  
Author(s):  
Cheol-In Kang ◽  
Sung-Han Kim ◽  
Wan Beom Park ◽  
Ki-Deok Lee ◽  
Hong-Bin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Mortality Rate ◽  
Antimicrobial Therapy ◽  
Treated Group ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Initial Antimicrobial Therapy ◽  
Risk Source

ABSTRACT The marked increase in the incidence of infections due to antibiotic-resistant gram-negative bacilli in recent years is of great concern, as patients infected by those isolates might initially receive antibiotics that are inactive against the responsible pathogens. To evaluate the effect of inappropriate initial antimicrobial therapy on survival, a total of 286 patients with antibiotic-resistant gram-negative bacteremia, 61 patients with Escherichia coli bacteremia, 65 with Klebsiella pneumoniae bacteremia, 74 with Pseudomonas aeruginosa bacteremia, and 86 with Enterobacter bacteremia, were analyzed retrospectively. If a patient received at least one antimicrobial agent to which the causative microorganisms were susceptible within 24 h of blood culture collection, the initial antimicrobial therapy was considered to have been appropriate. High-risk sources of bacteremia were defined as the lung, peritoneum, or an unknown source. The main outcome measure was 30-day mortality. Of the 286 patients, 135 (47.2%) received appropriate initial empirical antimicrobial therapy, and the remaining 151 (52.8%) patients received inappropriate therapy. The adequately treated group had a 27.4% mortality rate, whereas the inadequately treated group had a 38.4% mortality rate (P = 0.049). Multivariate analysis showed that the significant independent risk factors of mortality were presentation with septic shock, a high-risk source of bacteremia, P. aeruginosa infection, and an increasing APACHE II score. In the subgroup of patients (n = 132) with a high-risk source of bacteremia, inappropriate initial antimicrobial therapy was independently associated with increased mortality (odds ratio, 3.64; 95% confidence interval, 1.13 to 11.72; P = 0.030). Our data suggest that inappropriate initial antimicrobial therapy is associated with adverse outcome in antibiotic-resistant gram-negative bacteremia, particularly in patients with a high-risk source of bacteremia.

scholarly journals AKURASI TES BACTIDENT AMINOPEPTIDA SE UNTUK MENGIDENTIFIKASI BAKTERI GRAM NEGATIF

2018 ◽  
Vol 16 (1) ◽  
pp. 29
Author(s):  
Ramla Tongko ◽  
Tenri Esa ◽  
Hardjoeno .
Keyword(s):  
Diagnostic Test ◽  
Antimicrobial Therapy ◽  
Public Hospital ◽  
High Sensitivity ◽  
Gram Stain ◽  
Antimicrobial Drugs ◽  
Gram Negative ◽  
Culture Test

The information about Gram stain of a bactery can help the clinicians to choose good antimicrobial therapy because many of antimicrobial drugs have activity to positive or negative Gram bacterial selective. So it needed to have a method to early identificationGram stain of bactery, which can be faster, cheaper and more practice. Identification of Gram stain we can do with BactidentBactident aminopeptidase test, Gram stain test and culture test. The aimed of this study is to know the accuracy of bactident aminopeptidase test, Gram stain test and culture test. The aimed of this study is to know the accuracy of bactident aminopeptidase test with culture test in identify Gram negative bactery. A diagnostic test was done among 60 samples (pus and sputum) at Sub UnitInfection Disease Dr.Wahidin Sudirohusodo public Hospital of Makasar from March to July 2008. Bactident aminopeptidase test, Gramstain test and culture test were done to each sample. The data was analysed with 2 × 2 table. Accuracy of Bactident aminopeptidaseBactident aminopeptidase test on culture test were high sensitivity 61.11%, specificity 100.00%, positive predivtive value (PPV) 100.00% and negative predictivevalue (NPV) 63.16%. Sensitivity of Bactident aminopeptidase test on culture test were lower than sensitivity of Gram stain test onBactident aminopeptidase test on culture test were lower than sensitivity of Gram stain test on test on culture test were lower than sensitivity of Gram stain test on culture test (61.11% vs 83.33%). Specificity of Bactident aminopeptidase test on culture test were higher than specificity of Gram stainBactident aminopeptidase test on culture test were higher than specificity of Gram stain test on culture test were higher than specificity of Gram stain test on culture test (100.00% vs 79.19%). Accuracy of Bactident aminopeptidase test on Gram stain and culture test is high enough,Bactident aminopeptidase test on Gram stain and culture test is high enough, test on Gram stain and culture test is high enough, it can lead us conclude that Bactident aminopeptidase test can be usefull to the clinician for using the antimicrobial before culture testBactident aminopeptidase test can be usefull to the clinician for using the antimicrobial before culture test test can be usefull to the clinician for using the antimicrobial before culture test was provided.

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