Antimicrobial de-escalation is part of appropriate antibiotic usage in ICU

Timsit, Jean François; Lipman, Jeffrey; Bassetti, Matteo

doi:10.1007/s00134-020-05951-5

Cited by 6 publications

(2 citation statements)

References 16 publications

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“…(2) Combination of priority antimicrobials was defined as the use of two or more antimicrobials in the priority list published by National Institute of Hospital Administration of China, which includes carbapenems (imipenem, meropenem, panipenem, biapenem and ertapenem), glycopeptides (vancomycin and teicoplanin), tigecycline, linezolid, polymyxin, and cefoperazone sulbactam. (3) Unreasonable prescription of antimicrobials was defined as non-compliance with at least one of the following rules: (i) documented antibacterial indication, (ii) appropriate collection of samples for microbiological test, (iii) reasonable dose of antimicrobial, (iv) reasonable course of antimicrobial therapy, (v) appropriate de-escalation strategy ( Timsit et al., 2020 ). The Antimicrobial Management Committee of the hospital where this study was conducted assessed the unreasonable prescription of antimicrobials through the electronic prescription records very two weeks under above five rules.…”

Section: Methodsmentioning

confidence: 99%

A dynamic nomogram to predict invasive fungal super-infection during healthcare-associated bacterial infection in intensive care unit patients: an ambispective cohort study in China

Li,

Zhang

et al. 2024

Front. Cell. Infect. Microbiol.

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ObjectivesInvasive fungal super-infection (IFSI) is an added diagnostic and therapeutic dilemma. We aimed to develop and assess a nomogram of IFSI in patients with healthcare-associated bacterial infection (HABI).MethodsAn ambispective cohort study was conducted in ICU patients with HABI from a tertiary hospital of China. Predictors of IFSI were selected by both the least absolute shrinkage and selection operator (LASSO) method and the two-way stepwise method. The predictive performance of two models built by logistic regression was internal-validated and compared. Then external validity was assessed and a web-based nomogram was deployed.ResultsBetween Jan 1, 2019 and June 30, 2023, 12,305 patients with HABI were screened in 14 ICUs, of whom 372 (3.0%) developed IFSI. Among the fungal strains causing IFSI, the most common was C.albicans (34.7%) with a decreasing proportion, followed by C.tropicalis (30.9%), A.fumigatus (13.9%) and C.glabrata (10.1%) with increasing proportions year by year. Compared with LASSO-model that included five predictors (combination of priority antimicrobials, immunosuppressant, MDRO, aCCI and S.aureus), the discriminability of stepwise-model was improved by 6.8% after adding two more predictors of COVID-19 and microbiological test before antibiotics use (P<0.01).And the stepwise-model showed similar discriminability in the derivation (the area under curve, AUC=0.87) and external validation cohorts (AUC=0.84, P=0.46). No significant gaps existed between the proportion of actual diagnosed IFSI and the frequency of IFSI predicted by both two models in derivation cohort and by stepwise-model in external validation cohort (P=0.16, 0.30 and 0.35, respectively).ConclusionThe incidence of IFSI in ICU patients with HABI appeared to be a temporal rising, and our externally validated nomogram will facilitate the development of targeted and timely prevention and control measures based on specific risks of IFSI.

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Section: Methodsmentioning

confidence: 99%

A dynamic nomogram to predict invasive fungal super-infection during healthcare-associated bacterial infection in intensive care unit patients: an ambispective cohort study in China

Li,

Zhang

et al. 2024

Front. Cell. Infect. Microbiol.

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“…It is crucial to balance adequate empirical treatment and the risk of development of resistance [4 ▪▪ ]. De-escalation to a specific, more narrow-spectrum treatment is very important as soon as antimicrobial susceptibility testing is available [11]. A reliable and prompt microbiology service is necessary to achieve this.…”

Section: Empirical Therapy Of Complicated Urinary Tract Infections Wi...mentioning

confidence: 99%

Treatment options for multidrug-resistant Gram-negatives in urinary tract infections

Zollner‐Schwetz

König

2023

Current Opinion in Urology

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Purpose of reviewInfections due to multidrug-resistant (MDR) Gram-negative bacteria are challenging to treat because of limited treatment options and potential side effects of less frequently used anti-infectives. In the past few years, several new antimicrobial agents effective against MDR Gram-negatives have become available. This review focuses on the treatment options for complicated urinary tract infections (cUTIs) caused by MDR Gram-negatives. Recent findingsThe novel combinations, betalactam or carbapenem and betalactamase inhibitor, ceftazidime/avibactam and meropenem/vaborbactam, are effective for infections caused by KPC-carbapenemase-producing pathogens. Imipenem/relebactam, another carbapenem/betalactamase inhibitor combination, has been approved for the treatment of cUTI. However, data on the efficacy of imipenem/relebactam against carbapenem-resistant pathogens is still limited. Ceftolozane/tazobactam is mainly used for the treatment of MDR Pseudomonas aeruginosa infections. For the treatment of cUTI caused by extended-spectrum betalactamases producing Enterobacterales aminoglycosides or intravenous fosfomycin should be considered.

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Management of Infections Caused by Multidrug-resistant Gram-negative Pathogens: Recent Advances and Future Directions

Bassetti¹,

Vena²,

Giacobbe³

et al. 2021

Archives of Medical Research

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Antimicrobial de-escalation is part of appropriate antibiotic usage in ICU

Cited by 6 publications

References 16 publications

A dynamic nomogram to predict invasive fungal super-infection during healthcare-associated bacterial infection in intensive care unit patients: an ambispective cohort study in China

A dynamic nomogram to predict invasive fungal super-infection during healthcare-associated bacterial infection in intensive care unit patients: an ambispective cohort study in China

Treatment options for multidrug-resistant Gram-negatives in urinary tract infections

Management of Infections Caused by Multidrug-resistant Gram-negative Pathogens: Recent Advances and Future Directions

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