scholarly journals Vancomycin Dosage and Its Association with Clinical Outcomes in Pediatric Patients with Gram-Positive Bacterial Infections

2020 ◽  
Vol Volume 13 ◽  
pp. 685-695
Author(s):  
Sooyoung Shin ◽  
Hyun Joo Jung ◽  
Sang-Min Jeon ◽  
Young-Joon Park ◽  
Jung-Woo Chae ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Bacterial Infections ◽  
Pediatric Patients ◽  
Gram Positive ◽  
Vancomycin Dosage

scholarly journals Prevalence and effect of bacterial co-infections on clinical outcomes in hospitalized COVID-19 patients at a tertiary care centre of India

2021 ◽  
Author(s):  
Ashutosh Pathak ◽  
Sweta Singh ◽  
Sanjay Singh ◽  
Sangram Singh Patel ◽  
Nida Fatima ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Bacterial Infections ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Antibiotic Sensitivity ◽  
Tertiary Care Centre ◽  
Gram Positive ◽  
Gram Negative ◽  
Systematic Testing ◽  
Sensitivity Pattern

Abstract Background: Bacterial co-infections are a leading cause of morbidity and mortality during viral infections including COVID-19. Systematic testing of COVID-19 patients having bacterial co-infections is essential to select the correct antibiotic for treatment in order to reduce mortality and also prevent spread of antimicrobial resistance (AMR). The present study aims to evaluate the prevalence, demographic parameters, antibiotic sensitivity patterns and outcomes in hospitalized COVID-19 patients with bacterial co-infections. Methods: A total of 1019 COVID-19 patients were selected for the study. We analyzed the prevalence, antibiotic sensitivity pattern and clinical outcomes in COVID-19 patients having bacterial co-infections. Results: Out of a total 1019 COVID-19 patients screened, 5.2% of patients demonstrated clinical signs of bacterial co-infection. Bacteremia was found in majority of the patients followed by respiratory and urinary infections. Escherichia coli, Pseudomonas aeruginosa and Klebsiella spp. were most common isolates among the Gram-negative and Coagulase-negative Staphylococci (CONS) and Staphylococcus aureus among the Gram-positive bacterial infections. Antibiotic sensitivity profiling revealed that colistin, imipenem and fosfomycin were the most effective drugs against the Gram-negative isolates while vancomycin, teicoplanin and doxycycline against the Gram-positive isolates. Analysis of clinical outcomes revealed that the mortality rate was higher (39%) among the patients with bacterial co-infections as compared to the group without co-infection (17%). Conclusions: This study reveals that the rate of bacterial co-infections is significantly increasing among COVID-19 patients and leading to increase in mortality. Systematic testing of bacterial co-infections is therefore essential in COVID-19 patients for better clinical outcomes and to reduce AMR.

scholarly journals Modeling Approach to Optimizing Dose Regimen of Vancomycin for Chinese Pediatric Patients with Gram-Positive Bacterial Infections

2021 ◽  
Vol 12 ◽  
Author(s):  
Kai Shen ◽  
Yaxin Fan ◽  
Minjie Yang ◽  
Yuancheng Chen ◽  
Jinhao Tao ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Clinical Efficacy ◽  
Dose Regimen ◽  
Bacterial Infections ◽  
Pediatric Patients ◽  
Adult Population ◽  
Area Under The Curve ◽  
Gram Positive ◽  
Target Value ◽  
Population Pk

The aim of this study was to establish the population pharmacokinetics (PK) model of Vancomycin for Chinese pediatric patients which can extrapolate to whole age periods by bridging the published adult population PK model and the established pediatric population PK model. The final consolidated population PK model was used to explore the correlation of pharmacokinetics/pharmacodynamics (PK/PD) indices and efficacy of vancomycin and to provide evidence for the optimized regimen of vancomycin in Chinese pediatric patients with Gram-positive bacterial infection. 108 pediatric patients with Gram-positive infections from 2 pediatric hospitals in China in the first period of the prospective multi-center vancomycin clinical observational study were enrolled to establish the population PK model. A one-compartment population PK model was established and validated. The correlation between vancomycin PK/PD indices [trough concentration (Cmin), peak concentration (Cmax), 0–24 h area under the curve (AUC0–24) and the area under the curve to minimum inhibitory concentration ratio (AUC0–24/MIC)] and the overall clinical outcomes (clinical efficacy and microbiological efficacy) in Chinese pediatric patients were evaluated. There is no significant correlation between PK/PD indices and clinical efficacy or microbiological efficacy. Considering the high clinical effective rate (>90%) and median AUC0–24/MIC values of 200–300, Chinese pediatric patients with Gram-positive bacterial infection may be suitable for lower AUC0–24/MIC target value compared to the target value of 400–600 recommended by IDSA guideline. Different optimal dose regimen of vancomycin for Chinese pediatric patients should be considered. Further evaluation in more prospective studies will be needed.

scholarly journals 1758. Impact of Accelerate Pheno™ Rapid Blood Culture Detection System on Laboratory and Clinical Outcomes in Bacteremic Patients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S61-S61 ◽  
Author(s):  
Ryan Dare ◽  
Kelsey McCain ◽  
Katherine Lusardi ◽  
Kay Daniels ◽  
Jacob Painter ◽  
...  
Keyword(s):  
Blood Culture ◽  
Clinical Outcomes ◽  
Bacterial Infections ◽  
Detection System ◽  
Positive Culture ◽  
Retrospective Chart Review ◽  
Improve Patient Care ◽  
Standard Of Care ◽  
Historical Cohort ◽  
Stewardship Program

Abstract Background Molecular-based automated systems for the rapid diagnosis of bacterial infections have potential to improve patient care. The Accelerate Pheno™ blood culture detection system (ACCEL) is an FDA approved platform that allows for identification (ID) and antimicrobial susceptibility testing (AST) 8 hours following growth in routine culture. Methods This is a single-center retrospective chart review of bacteremic adult inpatients before and after implementation of ACCEL. Laboratory and clinical data were collected February–March 2018 (intervention) and compared with a January–April 2017 historical cohort (standard of care). Standard of care ID and AST were performed using VITEK® MS (MALDI-TOF MS) and VITEK®2, respectively. An active antimicrobial stewardship program was in place during both study periods. Patients with polymicrobial cultures, off-panel isolates, previous positive culture, or who were discharged prior to final AST report were excluded. Primary outcome was length of stay (LOS). Secondary outcomes were inpatient antibiotic duration of therapy (DOT) and time to optimal therapy (TTOT). Nonparametric unadjusted analyses were performed due to non-normal distributions. Statistics were performed using SAS 9.4. Results Of the 143 positive cultures performed on ACCEL during intervention, 118 (83%) were identified as on-panel organisms. Seventy-five (64%) of these 118 cultures and 79 (70%) of 113 reviewed standard of care cultures met inclusion criteria. Patient comorbidities (P = NS), MEWS severity score (P = 0.10), source of bacteremia (P = NS), and pathogen detected (P = 0.30) were similar between cohorts. Time from collection to ID (28.2 ± 12.7 hours vs. 53.8 ± 20.9 hours; P < 0.001) and AST (31.9 ± 11 hours vs. 71.8 ± 20 hours; P < 0.001) were shorter in the intervention arm. Conclusion Compared with standard of care, ACCEL shortens laboratory turn-around-time and improves clinical outcomes. The use of this system has resulted in decreased mean antibiotic DOT, TTOT, and LOS. Further studies are needed to verify these findings. Disclosures All authors: No reported disclosures.

scholarly journals 688 Pediatric Obstructive Sleep Apnea (OSA) and COVID-19-Related Adverse Clinical Outcomes

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A269-A269
Author(s):  
Vaishal Shah ◽  
Nancy Foldvary-Schaefer ◽  
Lu Wang ◽  
Lara Jehi ◽  
Cynthia Pena Obrea ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Pediatric Patients ◽  
Control Design ◽  
Supplemental Oxygen ◽  
Case Control ◽  
World Health ◽  
Invasive Ventilation ◽  
High Flow Oxygen

Abstract Introduction The relationship of OSA and human coronavirus (COVID-19) in the pediatric population is unknown. We postulate that OSA is associated with SARS-CoV-2 positivity and with adverse COVID-19 outcomes in children. Methods A retrospective review of 120 consecutive patients (<18 years) with prior polysomnogram (PSG) and COVID-19 testing from the Cleveland Clinic COVID-19 registry was conducted. Using a case control design of SARS-CoV-2 positive and negative pediatric patients, we examined COVID-19 and pre-existing OSA (dichotomized AHI≥1) using logistic (OR,95%CI) regression and as continuous measures: AHI, oxygen(SpO2) nadir, %time SpO2<90%) using linear regression(beta+/-SE). In those positive for SARS-CoV-2(cases only), we assessed the association of OSA and World Health Organization(WHO) COVID-19 clinical outcome composite score (hospitalization, requiring supplemental oxygen, non-invasive ventilation/high-flow oxygen, invasive ventilation/ECMO or death) using Wilcoxon rank sum test for ordinal data. Results Cases (n=36) were 11.8±4.4 years, 61% male, 27.8% black and 88.9% with OSA, while 85.7% of controls (n=84) had OSA. OSA was not associated with increased SARS-CoV-2 positivity: OR=1.33(0.40, 4.45,p=0.64). No significant difference between cases and controls for mean AHI 3.7(1.5,6.0) vs 3.5(1.5,7.1),p=0.91,SpO2 nadir 88.6±5.4 vs 89.1±4.4,p=0.58,%time SpO2<90% 0.05[0.00,1.00) vs 0.10 (0.00,1.00, p=0.65) respectively was noted. WHO-7 COVID-19 clinical outcome did not meet statistical significance in relation to OSA due to the low event frequency (p=0.49). Of note, those with OSA vs without OSA had a higher WHO-7 outcome score of 2 vs 0 and prevalence of hospitalization: 12.5 vs 0% respectively. Of hospitalized patients, the following was observed: 23% had moderate/severe OSA vs 4.3% mild OSA, 50% required supplemental oxygen and 25% required intubation/invasive ventilation. No deaths or readmissions were reported. High risk conditions included: 75% obesity, 50% asthma, 25% sickle cell disease and 25% hypoplastic left heart. Conclusion In this first report of which we are aware focused on COVID-19 in pediatric OSA, we use a case control design leveraging COVID-19 and sleep laboratory registries. Albeit not statistically significant, pediatric patients with OSA had a higher percentage of worse clinical outcomes. Larger network studies are needed to clarify whether poorer COVID-19 outcomes may be attributable to OSA or modulated via high risk health conditions. Support (if any):

Fusogenic porous silicon nanoparticles as a broad-spectrum immunotherapy against bacterial infections

2021 ◽  
Author(s):  
Byungji Kim ◽  
Qinglin Yang ◽  
Leslie W. Chan ◽  
Sangeeta N. Bhatia ◽  
Erkki Ruoslahti ◽  
...  
Keyword(s):  
Porous Silicon ◽  
Broad Spectrum ◽  
Therapeutic Efficacy ◽  
Bacterial Infections ◽  
Silicon Nanoparticles ◽  
First Line ◽  
Gram Positive ◽  
Gram Negative ◽  
Porous Silicon Nanoparticles

RNAi-mediated immunotherapy provided by fusogenic porous silicon nanoparticles demonstrates superior therapeutic efficacy against both Gram-positive and Gram-negative bacterial infections compared with first-line antibiotics.

scholarly journals Differential effects of gram-positive and gram-negative bacterial products on morphine induced inhibition of phagocytosis

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Jana Ninkovic ◽  
Vidhu Anand ◽  
Raini Dutta ◽  
Li Zhang ◽  
Anuj Saluja ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Drug Abusers ◽  
Bacterial Clearance ◽  
Chronic Morphine ◽  
Gram Positive ◽  
Bacterial Killing ◽  
Differential Effects ◽  
Secondary Infections ◽  
First Time ◽  
Dependent Signaling Pathway

Abstract Opioid drug abusers have a greater susceptibility to gram positive (Gram (+)) bacterial infections. However, the mechanism underlying opioid modulation of Gram (+) versus Gram (−) bacterial clearance has not been investigated. In this study, we show that opioid treatment resulted in reduced phagocytosis of Gram (+), when compared to Gram (−) bacteria. We further established that LPS priming of chronic morphine treated macrophages leads to potentiated phagocytosis and killing of both Gram (+) and Gram (−) bacteria in a P-38 MAP kinase dependent signaling pathway. In contrast, LTA priming lead to inhibition of both phagocytosis and bacterial killing. This study demonstrates for the first time the differential effects of TLR4 and TLR2 agonists on morphine induced inhibition of phagocytosis. Our results suggest that the incidence and severity of secondary infections with Gram (+) bacteria would be higher in opioid abusers.

scholarly journals Ceftazidime as initial therapy for suspected bacterial infections in hospitalized pediatric patients.

1984 ◽  
Vol 26 (3) ◽  
pp. 318-321 ◽  
Author(s):  
M D Reed ◽  
C A O'Brien ◽  
S C Aronoff ◽  
J D Klinger ◽  
J L Blumer
Keyword(s):  
Bacterial Infections ◽  
Pediatric Patients ◽  
Initial Therapy

The diagnostic value of apolipoprotein E in pediatric patients with invasive bacterial infections

2012 ◽  
Vol 45 (3) ◽  
pp. 215-218 ◽  
Author(s):  
Chuanqing Wang ◽  
Yi Wang ◽  
Aimin Wang ◽  
Pan Fu ◽  
Yi Yang
Keyword(s):  
Apolipoprotein E ◽  
Bacterial Infections ◽  
Pediatric Patients ◽  
Diagnostic Value
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