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Barrett J, Edgeworth J, Wyncoll D. Shortening the course of antibiotic treatment in the intensive care unit. Expert Rev Anti Infect Ther 2015; 13:463-71. [PMID: 25645293 DOI: 10.1586/14787210.2015.1008451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Effective antimicrobial stewardship is an increasingly important concern for healthcare providers globally. Antibiotics are frequently prescribed for patients who develop sepsis in the intensive care unit and traditionally courses are prolonged, with uncertain benefit and probable harm. There is little evidence to support many guidelines recommending between 10 and 14 days, and a number of studies suggest substantially shorter courses of less than 7 days may suffice. Safely reducing course length is likely to depend on a number of preconditions, including thorough eradication of any septic foci; optimization of serum antibiotic concentrations, particularly when there is physiological derangement; and use of novel biomarkers such as procalcitonin. The critical care environment is well suited to this aim as patients are closely monitored. With these measures in place, it is reasonable to believe short antibiotic courses can safely be used for the majority of intensive care infections.
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Affiliation(s)
- Jessica Barrett
- Department of Infectious Diseases, Kings College London and Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
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Sogaard M, Norgaard M, Dethlefsen C, Schonheyder HC. Temporal Changes in the Incidence and 30-Day Mortality associated with Bacteremia in Hospitalized Patients from 1992 through 2006: A Population-based Cohort Study. Clin Infect Dis 2011; 52:61-9. [DOI: 10.1093/cid/ciq069] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schønheyder HC, Søgaard M. Existing data sources for clinical epidemiology: The North Denmark Bacteremia Research Database. Clin Epidemiol 2010; 2:171-8. [PMID: 20865114 PMCID: PMC2943179 DOI: 10.2147/clep.s10139] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Indexed: 11/25/2022] Open
Abstract
Bacteremia is associated with high morbidity and mortality. Improving prevention and treatment requires better knowledge of the disease and its prognosis. However, in order to study the entire spectrum of bacteremia patients, we need valid sources of information, prospective data collection, and complete follow-up. In North Denmark Region, all patients diagnosed with bacteremia have been registered in a population-based database since 1981. The information has been recorded prospectively since 1992 and the main variables are: the patient’s unique civil registration number, date of sampling the first positive blood culture, date of admission, clinical department, date of notification of growth, place of acquisition, focus of infection, microbiological species, antibiogram, and empirical antimicrobial treatment. During the time from 1981 to 2008, information on 22,556 cases of bacteremia has been recorded. The civil registration number makes it possible to link the database to other medical databases and thereby build large cohorts with detailed longitudinal data that include hospital histories since 1977, comorbidity data, and complete follow-up of survival. The database is suited for epidemiological research and, presently, approximately 60 studies have been published. Other Danish departments of clinical microbiology have recently started to record the same information and a population base of 2.3 million will be available for future studies.
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Affiliation(s)
- Henrik C Schønheyder
- Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
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Abstract
Patients presenting with active infections or at increased risk for infections pose a significant challenge in critical care nursing. It is important for critical care nurses to use effective antimicrobial strategies in patient management to reduce the potential development of antimicrobial resistance. They should be involved actively in promoting patient management through development of research-based nursing guidelines and protocols.
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Affiliation(s)
- Maria A Smith
- School of Nursing, Middle Tennessee State University, 1500 Greenland Drive, PO Box 81, Murfreesboro, TN 37132, USA.
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Ben Jemaa Z, Mahjoubi F, Ben Haj H'mida Y, Hammami N, Ben Ayed M, Hammami A. [Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Sfax-Tunisia (1993-1998)]. ACTA ACUST UNITED AC 2004; 52:82-8. [PMID: 15001236 DOI: 10.1016/j.patbio.2003.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2003] [Accepted: 04/25/2003] [Indexed: 11/30/2022]
Abstract
Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Sfax-Tunisia (1993-1998). The choice of antimicrobial therapy for the treatment of bacteremia is often empirical and based on the knowledge of susceptibility profiles of the most common bacteria causing such infections. This study determines the bacterial etiology of bacteremic episodes and antimicrobial susceptibility patterns recorded at a teaching hospital, from January 1993 to December 1998. We collected 2979 strains responsible for bacteremia. Gram negative bacteria were predominant (60%). The organisms recovered most frequently were Staphylococcus aureus (18.9%), Escherichia coli (14.7%), Klebsiella pneumoniae (14%) and Pseudomonas aeruginosa (7.6%). The incidence of resistance to methicillin were 17.4% for Staphylococcus aureus and 26.8% for coagulase negative Staphylococcus. No resistance to glycopeptides was observed among the enterococci and staphylococci studied. 27.7% of enterobacteriaceae were resistant to third generation cephalosporins. Imipenem was the most active agent against gram negative bacteria. To carry out a surveillance of bacteremic episodes occurring at every hospital, it is necessary to provide valuable information which should be the basis for effective empiric therapy.
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Affiliation(s)
- Z Ben Jemaa
- Laboratoire de microbiologie, CHU Habib-Bourguiba, 3029 Sfax, Tunisie
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Larson EL, Gomez-Duarte C, Lee LV, Della-Latta P, Kain DJ, Keswick BH. Microbial flora of hands of homemakers. Am J Infect Control 2003; 31:72-9. [PMID: 12665739 DOI: 10.1067/mic.2003.33] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES AND METHODS Because of increasing concern about antimicrobial resistance in the community, aerobic flora of hands of 224 healthy homemakers in northern Manhattan, New York, were examined. RESULTS Mean log colony-forming unit counts before and after handwashing were 5.72 and 5.69, respectively, P =.60; mean number of species identified/sample was 3.6 before washing and 3.3 after (P =.02). After handwashing gram-negative bacteria were isolated from 75.1% of subjects; yeast from 32.9%; and Staphylococcus aureus from 18.5%, 1 of which (2.4%) was oxacillin-resistant. Generally, these community isolates were more sensitive than isolates from inpatients in the local hospital, although community isolates of Pseudomonas aeruginosa were significantly more resistant than inpatient isolates for 4/10 agents tested. CONCLUSIONS Hands of healthy persons in the community were usually colonized with gram-negative bacteria, a single handwash had little impact on microbial counts, and hands of healthy adults may increasingly become one reservoir for antimicrobial resistance.
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Sirot J, Nicolas-Chanoine MH, Chardon H, Avril JL, Cattoen C, Croix JC, Dabernat H, Fosse T, Ghnassia JC, Lecaillon E, Marmonier A, Roussel-Delvallez M, Soussy CJ, Trevoux A, Vandenesch F, Dib C, Moniot-Ville N, Rezvani Y. Susceptibility of Enterobacteriaceae to beta-lactam agents and fluoroquinolones: a 3-year survey in France. Clin Microbiol Infect 2002; 8:207-13. [PMID: 12047412 DOI: 10.1046/j.1469-0691.2002.00393.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess trends in the susceptibility to beta-lactam agents and to fluoroquinolones of clinically relevant Enterobacteriaceae isolated over a 3-year period in 14 French hospital laboratories. METHODS During the second quarter of 1996, 1997 and 1998, 180 consecutive non-duplicate isolates of Enterobacteriaceae were collected in each center. Sixteen beta-lactams and four quinolones were tested by the disk diffusion method. In addition, the double-disk synergy test was used to screen for the production of extended-spectrum beta-lactamase (ESBL). RESULTS Totals of 2507, 2312 and 2506 clinical isolates were obtained in each period, respectively. The distribution of Enterobacteriaceae species according to clinical specimens and wards was similar in each study period. No significant variation in the susceptibility rates to beta-lactams and fluoroquinolones was observed, except in Klebsiella pneumoniae and Enterobacter aerogenes. The prevalence of ESBL-producing isolates decreased from 18% to 9% in the former, while it increased from 32% to 54% in the latter. At the same time, the susceptibility to ofloxacin and pefloxacin increased for K. pneumoniae (P < 0.003) and cephalosporinase-producing species (P < 0.05), except Enterobacter spp. CONCLUSION Over the 3-year study period beta-lactams and fluoroquinolones remained highly active against Enterobacteriaceae clinical isolates, with the exception of E. aerogenes, probably as a result of the dissemination of multiresistant clones in French hospitals.
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Affiliation(s)
- J Sirot
- Laboratoire de Bactériologie, Faculté de Médecine, Centre Hospitalo-Universitaire, Clermont-Ferrand, France.
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Tünger O, Ozabakkaloğlu B, Aksoy H. Trends in antimicrobial resistant staphylococci in an university hospital over a 6-year period. Int J Antimicrob Agents 2001; 18:93-6. [PMID: 11512542 DOI: 10.1016/s0924-8579(01)00345-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Köseoğlu O, Kocagöz S, Gür D, Akova M. Nosocomial bloodstream infections in a Turkish university hospital: study of Gram-negative bacilli and their sensitivity patterns. Int J Antimicrob Agents 2001; 17:477-81. [PMID: 11397618 DOI: 10.1016/s0924-8579(01)00325-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Treatment of nosocomial bacteraemia is usually governed by the surveillance results of the particular unit. Such results are especially important when antimicrobial resistance rates are high. Multiresistant isolates including Gram-negatives producing extended-spectrum beta-lactamases have been frequently reported in tertiary care units in Turkey. In this study, antimicrobial susceptibilities of Gram-negative blood isolates (n=348) were determined by microbroth dilution tests. The results showed carbapenems (meropenem and imipenem) to be uniformly more potent in vitro than any other drug against the Enterobacteriaceae. Quinolone antibiotics were more active in vitro than aminoglycosides against a range of bacteria. Gram-negative bloodstream isolates were highly resistant to many antimicrobial agents in the hospital. In order to prevent hospital infection and antimicrobial resistance, surveillance of aetiological agents must be performed regularly.
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Affiliation(s)
- O Köseoğlu
- Department of Clinical Microbiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey.
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Abstract
Antibiotics are one of the most common therapies administered in the intensive care unit setting. In addition to treating infections, antibiotic use contributes to the emergence of resistance among pathogenic microorganisms. Therefore, avoiding unnecessary antibiotic use and optimizing the administration of antimicrobial agents will help to improve patient outcomes while minimizing further pressures for resistance. This review will present several strategies aimed at achieving optimal use of antimicrobial agents. It is important to note that each intensive care unit should have a program in place which monitors antibiotic utilization and its effectiveness. Only in this way can the impact of interventions aimed at improving antibiotic use (e.g. antibiotic rotation, de-escalation therapy) be evaluated at the local level.
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Affiliation(s)
- M H Kollef
- Department of Internal Medicine, Pulmonary and Critical Care Division, Washington University School of Medicine, Barnes-Jewish Hospital, Campus Box 8052, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Sandvang D, Aarestrup FM. Characterization of aminoglycoside resistance genes and class 1 integrons in porcine and bovine gentamicin-resistant Escherichia coli. Microb Drug Resist 2000; 6:19-27. [PMID: 10868804 DOI: 10.1089/mdr.2000.6.19] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A total of 78 gentamicin-resistant Escherichia coli strains from swine (27) and cattle (51) were characterized by phenotypic resistance, presence of selected aminoglycoside resistance genes, class 1 integrons and gene cassettes, and pulsed-field gel electrophoresis. Gentamicin resistance was mainly encoded by the ant(2'')-I gene that was found in 76% of all the strains investigated, whereas the aac(3)-IIa gene was found in 14%. The ant(2'')-I gene was predominant in strains from cattle, whereas the porcine strains contained both ant(2'')-I, aac(3)-IIa, and the aac(3)-IVa genes. The pulsed-field gel electrophoresis (PFGE) investigation indicated a close clonal relationship in half of the bovine strains whereas the remaining E. coli were unrelated. Among the E. coli investigated, 20% contained class 1 integrons. Genes encoding resistance to trimethoprim (dhfrI, dhfrIb, and dhfrVII), gentamicin, tobramycin, and kanamycin (ant(2'')-Ia streptomycin and spectinomycin (ant(3'')-Ia) and streptothricin (sat1) were identified as gene cassettes. The most prevalent gene cassettes were ant(3'')-Ia (11 isolates) and the dhfrI (nine isolates).
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Affiliation(s)
- D Sandvang
- Danish Veterinary Laboratory, Copenhagen.
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Goering R, Nord CE, Hare R, Sabatelli F. In vitro activity of evernimicin and selected antibiotics against methicillin-resistant staphylococci: a 24-country study. Clin Microbiol Infect 2000; 6:549-56. [PMID: 11168049 DOI: 10.1046/j.1469-0691.2000.00167.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To collect and analyze data on susceptibility of methicillin-resistant staphylococci to evernimicin and other antimicrobial agents. METHODS Recent clinical isolates of methicillin-resistant staphylococci from 33 laboratories in North America, Europe and South Africa were investigated. RESULTS Of the antimicrobial agents tested, evernimicin had the lowest MIC90s for methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative staphylococci (0.75 and 1.0 mg/L, respectively). Resistance to ciprofloxacin and erythromycin was widespread, with higher levels of resistance in North America than in other regions. CONCLUSIONS Susceptibility surveys help to determine the antimicrobial activity of new agents. Ciprofloxacin- and erythromycin-resistant staphylococci were prevalent throughout all regions.
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Affiliation(s)
- R Goering
- Department of Microbiology, Saint Joseph Hospital at Creighton University Medical Center, Omaha, Nebraska, USA.
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O'Connell NH, Smyth EG, Marshall C, Humphreys H. Continuing high prevalence of methicillin resistance amongst Staphylococcus aureus blood culture isolates. J Antimicrob Chemother 1999; 44:300. [PMID: 10473246 DOI: 10.1093/jac/44.2.300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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