scholarly journals Antibiotics in General Surgical Practice

JMS SKIMS ◽  
2018 ◽  
Vol 21 (1) ◽  
pp. 54-60
Author(s):  
Javid Ahmad Bhat ◽  
Ajaz Ahmad Malik ◽  
Nadiem Nazir Bhat
Keyword(s):  
Antifungal Therapy ◽  
Broad Spectrum ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Postoperative Mortality ◽  
Source Control ◽  
Individual Risk ◽  
Apache Ii Score ◽  
Short Period ◽  
Risk Patients

Introduction: Worldwide antibiotic prescription in surgical practices are inappropriate quite often, reasons being inappropriate indication, inappropriate antibiotic prophylaxis, continuation of empiric therapy despite negative cultures in a stable patient, and a lack of awareness of susceptibility patterns of common pathogens. Extended-spectrum b-lactamase, Carbapenemase resistant and multidrug-resistant strains of organisms causing intrabdominal infections, have developed. The occurrence of MRSA surgical site infection (SSI) has a significant impact on clinical and economic outcomes, notably an increase in postoperative mortality. Opportunities: There is an array of web of factors which affect the occurrence of SSI and antibiotics should not be answer or replacement to any of those factors. Narrow spectrum antibiotic active against the most probable pathogen to be encountered during operation, for a short period of time in adequate doses should be utilized. Broad-spectrum antimicrobial agents don’t result in lower rates of postoperative SSI compared to narrower spectrum. Elective laparoscopic cholecystectomy, parotidectomy, chest tube insertion and other clean procedures don’t warrant use of prophylaxis. For most patients who have had their wounds opened and adequately drained, antibiotic therapy is unnecessary. Antibiotics should be discontinued at time of incision closure (exceptions include implant-based breast reconstruction, joint arthroplasty, and cardiac procedures and liver transplantation. Hospital-specific antibiograms are important to guide the usage of diverse antibiotic agents to decrease resistance among pathogens. In intrabdominal infections source control is still integral and most important to the treatment of most patients. Routine use of antimicrobial therapy is not appropriate for all patients with intra-abdominal infections e.g. Patients with uncomplicated diverticulitis. In uncomplicated IAIs, when the focus of infection is treated effectively, the administration of antibiotics is unnecessary beyond prophylaxis e.g. Acute unperforated appendicitis removed surgically. In case of intraabdominal infections selection of empirical antimicrobial therapy depends on various factors which include probable contaminating pathogen/s, individual risk assessment and possibility of resistant pathogens. Higher risk patients are those, with severe sepsis/septic shock, elevated APACHE II score (>10), multiple medical comorbidities, problematic or delayed source control. The possibility of resistant pathogens is low in community acquired infections (CAI) in contrast to healthcare or hospital-associated infection (HAI). In Lower risk patients with community-acquired IAI, narrower-spectrum therapy ( coli, Bacteroides) is recommended and there is no need for anti-enterococcal or antifungal therapy. In Higher risk patients with community-acquired IAI, broader-spectrum therapy is recommended with selective use of anti-enterococcal and antifungal therapy. In Patients with healthcare/hospital-associated IAI, broader-spectrum therapy is recommended with additional agents for resistant pathogens. Do not use clindamycin as an anti-anaerobic agent in combination regimens for the empiric treatment in adults and children unless metronidazole cannot be used. Duration of antimicrobial therapy can be significantly shortened to 4-7 days under most of the circumstances. Routine addition of an aminoglycoside to other agents having broad spectrum gram negative coverage provides no additional benefit in intrabdominal infections. Conclusion: Antibiotics are a treasure but not unlimited. Appropriate use is the need of the hour to save our present and future generations from the menace of antimicrobial resistance. JMS 2018;21(1):54-60  

Polymicrobial bloodstream infections (PBI): An under-realized complication in patients with cancer (2005–2006)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19590-19590
Author(s):  
A. Safdar ◽  
G. H. Rodriguez ◽  
D. S. Raval ◽  
G. P. Bodey ◽  
K. V. Rolston
Keyword(s):  
Cancer Patients ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Hematologic Malignancy ◽  
Bacterial Load ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Response To Treatment ◽  
Apache Ii Score ◽  
Solid Organ

19590 Background: Little attention has been directed to PBI in cancer patients. Methods: Fifty-four PBI episodes were evaluated retrospectively in 51 patients after obtaining IRB approval. PBI was defined as ≥ 2 organisms isolated from a single blood culture or sample(s) obtained within 72 hrs after the initial positive culture. All values are given as median ± s.d. Results: The age was 57 ± 16 years. Thirty-four patients had hematologic malignancy of whom, 73% had acute leukemia. Nearly half (47%) of the patients had refractory or relapsed cancer. Thirty-two (63%) were neutropenic (ANC 0 ± 144 cells/UL) and 31 patients (61%) had lymphocytopenia (ALC 0 ± 86 cells/UL). At the time of infection diagnosis, APACHE II score was 16 ± 5 and 5 (10%) patients were receiving systemic corticosteroids (> 600 mg prednisone equivalent dose). Thirty-one PBI episodes (57%) occurred while patients were receiving systemic antimicrobial agents for prophylaxis or treatment. In 83% of PBI episodes, positive specimens were collected from central venous catheter (CVC). Catheter-related infection necessitating CVC removal occurred in nearly half of these cases (24/45). Twenty-two (41%) PBI episodes were associated with high bacterial load (> 100 CFU/ml). The overall response to treatment was 86%. In 39 of 42 episodes (77%) treated with concordant antimicrobial therapy infection resolved. Whereas, in only 5 episodes (9%) treated with discordant antimicrobial therapy, infection resolution occurred (P = 0.07). There were no differences in PBI outcomes in patients with hematologic malignancies vs. solid-organ cancers, patients > 50 years vs. < 50 years of age or among neutropenic patients who had recovery of neutropenia during infection episode vs. patients in whom neutropenia persisted. Conclusions: The overall high response of concordant antimicrobial therapy for even high-risk cancer patients with PBI looks encouraging. No significant financial relationships to disclose. [Table: see text]

scholarly journals Emergence of Antibiotic Resistance during Therapy for Infections Caused by Enterobacteriaceae Producing AmpC β-Lactamase: Implications for Antibiotic Use

2007 ◽  
Vol 52 (3) ◽  
pp. 995-1000 ◽  
Author(s):  
Sang-Ho Choi ◽  
Jung Eun Lee ◽  
Su Jin Park ◽  
Seong-Ho Choi ◽  
Sang-Oh Lee ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Medical Center ◽  
Antibiotic Use ◽  
Significance Level ◽  
Risk Of Mortality ◽  
Asan Medical ◽  
Bile Duct Invasion ◽  
Emergence Of Resistance

ABSTRACT Enterobacter spp., Serratia marcescens, Citrobacter freundii, and Morganella morganii are characterized by chromosomally encoded AmpC β-lactamases and possess the ability to develop resistance upon exposure to broad-spectrum cephalosporins. To determine the incidences of the emergence of resistance during antimicrobial therapy for infections caused by these organisms and the effect of the emergence of resistance on patient outcomes, all patients who were admitted to the Asan Medical Center (Seoul, Republic of Korea) from January 2005 to June 2006 and whose clinical specimens yielded Enterobacter spp., S. marcescens, C. freundii, or M. morganii were monitored prospectively. The main end point was the emergence of resistance during antimicrobial therapy. A total of 732 patients with infections were included for analysis. The overall incidence of the emergence of antimicrobial resistance during antimicrobial therapy was 1.9% (14/732). Resistance to broad-spectrum cephalosporins, cefepime, extended-spectrum penicillin, carbapenem, fluoroquinolones, and aminoglycosides emerged during treatment in 5.0% (11/218), 0% (0/20), 2.0% (2/100), 0% (0/226), 0% (0/153), and 1.1% (1/89) of patients, respectively. The emergence of resistance to broad-spectrum cephalosporins occurred more often in Enterobacter spp. (8.3%, 10/121) than in C. freundii (2.6%, 1/39), S. marcescens (0%, 0/37), or M. morganii (0%, 0/21). Biliary tract infection associated with malignant bile duct invasion was significantly associated with the emergence of resistance to broad-spectrum cephalosporins (P = 0.024 at a significance level of 0.042, by use of the Bonferroni correction). Only 1 of the 14 patients whose isolates developed resistance during antimicrobial therapy died. The emergence of resistance was more frequently associated with broad-spectrum cephalosporins than with the other antimicrobial agents tested, especially in Enterobacter spp. However, the emergence of resistance was associated with a low risk of mortality.

Preliminary in Vitro Investigations on The Inhibitory Activity of The Original Dietary Supplement Oxidal® on Pathogenic Bacterial Strains

2020 ◽  
Vol 11 ◽  
pp. 37-43
Author(s):  
Prof. Teodora P. Popova ◽  
Toshka Petrova ◽  
Ignat Ignatov ◽  
Stoil Karadzhov
Keyword(s):  
Dietary Supplement ◽  
Broad Spectrum ◽  
Pathogenic Bacteria ◽  
Antimicrobial Agents ◽  
Clinical Effectiveness ◽  
Inhibitory Effect ◽  
Diffusion Method ◽  
Bacterial Strains ◽  
Microbial Strains

The antimicrobial action of the dietary supplement Oxidal® was tested using the classic Bauer and Kirby agar-gel diffusion method. Clinical and reference strains of Staphylococcus aureus and Escherichia coli were used in the studies. The tested dietary supplement showed a well-pronounced inhibitory effect against the microbial strains commensurable with that of the broad-spectrum chemotherapeutic agent Enrofloxacin and showed even higher activity than the broad spectrum antibiotic Thiamphenicol. The proven inhibitory effect of the tested dietary supplement against the examined pathogenic bacteria is in accordance with the established clinical effectiveness standards for antimicrobial agents.

scholarly journals 216. Are Automatic Antimicrobial Stop Orders an Effective Stewardship Tool for Urinary Tract and Intra-Abdominal Infections?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S110-S110
Author(s):  
Christina Maguire ◽  
Dusten T Rose ◽  
Theresa Jaso
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Therapy ◽  
Source Control ◽  
Clostridioides Difficile ◽  
Days Of Therapy ◽  
Before And After ◽  
The Difference ◽  
Tract Infections ◽  
Length Of Therapy ◽  
The Impact

Abstract Background Automatic antimicrobial stop orders (ASOs) are a stewardship initiative used to decrease days of therapy, prevent resistance, and reduce drug costs. Limited evidence outside of the perioperative setting exists on the effects of ASOs on broad spectrum antimicrobial use, discharge prescription duration, and effects of missed doses. This study aims to evaluate the impact of an ASO policy across a health system of adult academic and community hospitals for treatment of intra-abdominal (IAI) and urinary tract infections (UTI). ASO Outcome Definitions ASO Outcomes Methods This multicenter retrospective cohort study compared patients with IAI and UTI treated before and after implementation of an ASO. Patients over the age of 18 with a diagnosis of UTI or IAI and 48 hours of intravenous (IV) antimicrobial administration were included. Patients unable to achieve IAI source control within 48 hours or those with a concomitant infection were excluded. The primary outcome was the difference in sum length of antimicrobial therapy (LOT). Secondary endpoints include length and days of antimicrobial therapy (DOT) at multiple timepoints, all cause in hospital mortality and readmission, and adverse events such as rates of Clostridioides difficile infection. Outcomes were also evaluated by type of infection, hospital site, and presence of infectious diseases (ID) pharmacist on site. Results This study included 119 patients in the pre-ASO group and 121 patients in the post-ASO group. ASO shortened sum length of therapy (LOT) (12 days vs 11 days respectively; p=0.0364) and sum DOT (15 days vs 12 days respectively; p=0.022). This finding appears to be driven by a decrease in outpatient LOT (p=0.0017) and outpatient DOT (p=0.0034). Conversely, ASO extended empiric IV LOT (p=0.005). All other secondary outcomes were not significant. Ten patients missed doses of antimicrobials due to ASO. Subgroup analyses suggested that one hospital may have influenced outcomes and reduction in LOT was observed primarily in sites without an ID pharmacist on site (p=0.018). Conclusion While implementation of ASO decreases sum length of inpatient and outpatient therapy, it may not influence inpatient length of therapy alone. Moreover, ASOs prolong use of empiric intravenous therapy. Hospitals without an ID pharmacist may benefit most from ASO protocols. Disclosures All Authors: No reported disclosures

scholarly journals A predictive nomogram for mortality of cancer patients with invasive candidiasis: a 10-year study in a cancer center of North China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ding Li ◽  
Tianjiao Li ◽  
Changsen Bai ◽  
Qing Zhang ◽  
Zheng Li ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Invasive Candidiasis ◽  
Multivariate Logistic Regression Analysis ◽  
Bloodstream Infections ◽  
Mortality Prediction ◽  
Source Control ◽  
Cancer Center ◽  
Net Benefit ◽  
Opt Out ◽  
Risk Patients

Abstract Background Invasive candidiasis is the most common fungal disease among hospitalized patients and continues to be a major cause of mortality. Risk factors for mortality have been studied previously but rarely developed into a predictive nomogram, especially for cancer patients. We constructed a nomogram for mortality prediction based on a retrospective review of 10 years of data for cancer patients with invasive candidiasis. Methods Clinical data for cancer patients with invasive candidiasis during the period of 2010–2019 were studied; the cases were randomly divided into training and validation cohorts. Variables in the training cohort were subjected to a predictive nomogram based on multivariate logistic regression analysis and a stepwise algorithm. We assessed the performance of the nomogram through the area under the receiver operating characteristic (ROC) curve (AUC) and decision curve analysis (DCA) in both the training and validation cohorts. Results A total of 207 cases of invasive candidiasis were examined, and the crude 30-day mortality was 28.0%. Candida albicans (48.3%) was the predominant species responsible for infection, followed by the Candida glabrata complex (24.2%) and Candida tropicalis (10.1%). The training and validation cohorts contained 147 and 60 cases, respectively. The predictive nomogram consisted of bloodstream infections, intensive care unit (ICU) admitted > 3 days, no prior surgery, metastasis and no source control. The AUCs of the training and validation cohorts were 0.895 (95% confidence interval [CI], 0.846–0.945) and 0.862 (95% CI, 0.770–0.955), respectively. The net benefit of the model performed better than “treatment for all” in DCA and was also better for opting low-risk patients out of treatment than “treatment for none” in opt-out DCA. Conclusion Cancer patients with invasive candidiasis exhibit high crude mortality. The predictive nomogram established in this study can provide a probability of mortality for a given patient, which will be beneficial for therapeutic strategies and outcome improvement.

2015 Nelson's Pediatric Antimicrobial Therapy

2015 ◽  
Keyword(s):  
Health Care ◽  
Infectious Diseases ◽  
Health Care Providers ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Complete Information ◽  
Care Providers ◽  
Dosing Regimens

New! This bestselling and widely used resource on pediatric antimicrobial therapy provides instant access to reliable, up-to-the-minute recommendations for treatment of all infectious diseases in children. For each disease, the authors provide a commentary to help health care providers select the best of all antimicrobial choices. Drug descriptions cover all antimicrobial agents available today, and include complete information about dosing regimens. In response to growing concerns about overuse of antibiotics, the book includes guidelines on when not to prescribe antimicrobials. Key 21st edition features! Contents

scholarly journals Inducible Macrolide Resistance inCorynebacterium jeikeium

2001 ◽  
Vol 45 (7) ◽  
pp. 1982-1989 ◽  
Author(s):  
Adriana E. Rosato ◽  
Bonnie S. Lee ◽  
Kevin A. Nash
Keyword(s):  
Drug Resistance ◽  
Resistance Genes ◽  
Broad Spectrum ◽  
Antimicrobial Agents ◽  
Opportunistic Pathogen ◽  
Macrolide Resistance ◽  
The Other ◽  
Broad Spectrum Resistance ◽  
Neutropenic Patients ◽  
Group 3

ABSTRACT Corynebacterium jeikeium is an opportunistic pathogen primarily of immunocompromised (neutropenic) patients. Broad-spectrum resistance to antimicrobial agents is a common feature of C. jeikeium clinical isolates. We studied the profiles of susceptibility of 20 clinical strains of C. jeikeium to a range of antimicrobial agents. The strains were separated into two groups depending on the susceptibility to erythromycin (ERY), with one group (17 strains) representing resistant organisms (MIC > 128 μg/ml) and the second group (3 strains) representing susceptible organisms (MIC ≤ 0.25 μg/ml). The ERY resistance crossed to other members of the macrolide-lincosamide-streptogramin B (MLSb) group. Furthermore, this resistance was inducible with MLSb agents but not non-MLSb agents. Expression of ERY resistance was linked to the presence of an allele of the class X erm genes,erm(X)cj, with >93% identity to other ermgenes of this class. Our evidence indicates that erm(X)cj is integrated within the chromosome, which contrasts with previous reports for the plasmid-associated erm(X) genes found inC. diphtheriae and C. xerosis. In 40% ofC. jeikeium strains, erm(X)cj is present within the transposon, Tn5432. However, in the remaining strains, the components of Tn5432 (i.e., the erm and transposase genes) have separated within the chromosome. The rearrangement of Tn5432 leads to the possibility that the other drug resistance genes have become included in a new composite transposon bound by the IS1249 elements.

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