Appropriate Antibiotic Therapy

Allison, Michael G.; Heil, Emily L.; Hayes, Bryan D.

doi:10.1016/j.emc.2016.08.003

Cited by 37 publications

(34 citation statements)

References 70 publications

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“…While antibiotics in ICU are used for many types and sources of infections, blood cultures may be used to direct the appropriate choice of antibiotic [ 11 , 27 , 28 ]. Our findings of infrequent testing of blood cultures, the low yield of positive results and the predominant use of broad-spectrum antibiotics suggest that most antibiotics were being used empirically for patients with suspected infection, without the guidance of blood cultures.…”

Section: Discussionmentioning

confidence: 99%

The use of antibiotics in the intensive care unit of a tertiary hospital in Malawi

et al. 2020

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Background Antibiotic resistance is on the rise. A contributing factor to antibiotic resistance is the misuse of antibiotics in hospitals. The current use of antibiotics in ICUs in Malawi is not well documented and there are no national guidelines for the use of antibiotics in ICUs. The aim of the study was to describe the use of antibiotics in a Malawian ICU. Methods A retrospective review of medical records of all admissions to the main ICU in Queen Elizabeth Central Hospital in Blantyre, Malawi, between January 2017 and April 2019. Data were extracted from the ICU patient register on clinical parameters on admission, diagnoses, demographics and antibiotics both prescribed and given for all patients admitted to the ICU. Usage of antibiotics in the ICU and bacterial culture results from samples taken in the ICU and in the peri-ICU period, (from 5 days before ICU admission to 5 days after ICU discharge), were described. Results Six hundred-and-forty patients had data available on prescribed and received medications and were included in the analyses. Of these, 577 (90.2%) were prescribed, and 522 (81.6%) received an antibiotic in ICU. The most commonly used antibiotics were ceftriaxone, given to 470 (73.4%) of the patients and metronidazole to 354 (55.3%). Three-hundred-and-thirty-three (52.0%) of the patients received more than one type of antibiotic concurrently – ceftriaxone and metronidazole was the most common combination, given to 317 patients. Forty five patients (7.0%) were given different antibiotics sequentially. One-hundred-and-thirty-seven patients (21.4%) had a blood culture done in the peri-ICU period, of which 70 (11.0% of the patients) were done in the ICU. Twenty-five (18.3%) of the peri-ICU cultures were positive and eleven different types of bacteria were grown in the cultures, of which 17.2% were sensitive to ceftriaxone. Conclusion We have found a substantial usage of antibiotics in an ICU in Malawi. Ceftriaxone, the last-line antibiotic in the national treatment guidelines, is commonly used, and bacteria appear to show high levels of resistance to it, although blood culture testing is infrequently used. Structured antibiotic stewardship programs may be useful in all ICUs.

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Section: Discussionmentioning

confidence: 99%

The use of antibiotics in the intensive care unit of a tertiary hospital in Malawi

et al. 2020

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“…In our study, we focused on patients diagnosed with a gynecologic malignancy who were frail and in some cases terminal,6 increasing their overall risk of developing serious complications of bacteremia, which in turn led to prolonged hospitalizations. Prolonged hospital stays decrease quality of life7 and create a serious risk of antibiotic resistance, which can negatively impact outcomes for the patient 8. Overall, 6.1% of all patients with a gynecologic malignancy treated in the Policlinico A Gemelli, developed a healthcare associated infection and, in this subset, more than 40% had a bloodstream infection.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for bloodstream infections in gynecological cancer

Franza

Costantini

Corrado

et al. 2020

International Journal of Gynecological Cancer

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ObjectiveInfections are a threat to frail patients as they have a higher risk of developing serious complications from bloodstream pathogens. The aim of this study was to determine which factors can predict or diagnose bloodstream infections in patients with an underlying gynecologic malignancy.Materials and MethodsBetween July 2016 and December 2017, 68 patients visiting the emergency room with an underlying gynecologic malignancy were evaluated. Variables concerning underlying disease, invasive procedures, and laboratory and clinical parameters were analyzed. Patients were divided into three groups based on their blood and urine specimens (positive blood specimens, positive urine specimens, and no positive specimens; patients who had both positive blood and urine specimens were included in the group of positive blood specimens). Risk factors for surgical site infections, recent (<30 days) surgery, and chemotherapy were studied separately.Results68 patients were included in the analysis. Mean age was 55.6 years (standard deviation 14.1). 44% of patients had ovarian cancer, 35% cervical cancer, 12% endometrial cancer, and 9% had other cancer types. In total, 96% of all patients had undergone surgery. Patients who had been treated with chemotherapy were at a higher risk of developing bloodstream infection (P=0.04; odds ratio (OR)=7.9). C reactive protein, bilirubin, and oxygen saturation (SO2) were significantly different between patients with an underlying infection and those who had none. Only C reactive protein maintained its significance in a linear model, with a cut-off of 180 mg/L (linear regression, P=0.03; OR=4).ConclusionsChemotherapy is a risk factor for the development of bloodstream infections in patients with an underlying gynecologic malignancy; C reactive protein could be a useful tool in making this diagnosis.

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“…Although inappropriate antibiotic treatment has been shown to increase the mortality rate by five times in these patients [5], the rate of inappropriate antibiotic administration at the ED may be as high as 40% [4,5,6,7]. A previous study found that patients with co-morbid diseases, such as COPD or hemodialysis, or who were immunocompromised were at risk of receiving inappropriate antibiotic treatment at the ED [8]. Most previous studies conducted on inappropriate antibiotic use at the ED were conducted in developed countries [4,5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Appropriate Antibiotic Use in Bacteremia Patients Presenting at the Emergency Department

et al. 2019

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Sepsis is a condition that requires appropriate antibiotic treatment at the emergency department (ED). Most previous studies conducted on inappropriate antibiotic use at the ED were conducted in developed countries with a low percentage of sepsis. This study aimed to find additional clinical predictors for appropriate antibiotic use in bacteremia patients presenting at the ED from a developing country, in which there is a higher proportion of patients with sepsis. We included adult patients who presented at the ED with clinical suspicion of infection and bacteremia. Patients allocated to the appropriate antibiotic group were those in whom the prescribed antibiotic was sensitive to the pathogen. Predictors and outcomes of appropriate antibiotic use were analyzed. A total of 3133 patients who met the study criteria presented at the ED during the study period. Of those, 271 patients were diagnosed with bacteremia, 48 of whom (17.71%) received inappropriate antibiotic prescriptions. Only pulse rate was an independent factor for appropriate antibiotic treatment, with an adjusted odds ratio of 1.019 (95% CI of 1.001, 1.036). In terms of clinical outcomes, the inappropriate antibiotic group had higher proportions of 28-day mortality (29.17% vs. 25.25%; p-value = 0.022) and longer hospitalization (14 vs. 9 days; p-value = 0.003). This study found that inappropriate antibiotics were prescribed in 17% of bacteremia patients presenting at the ED and that high pulse rate was an indicator for appropriate antibiotic prescription. Patients with inappropriate antibiotic administration had longer hospitalization and higher 28-day mortality than those who received appropriate antibiotic treatment.

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Appropriate Antibiotic Therapy

Cited by 37 publications

References 70 publications

The use of antibiotics in the intensive care unit of a tertiary hospital in Malawi

The use of antibiotics in the intensive care unit of a tertiary hospital in Malawi

Risk factors for bloodstream infections in gynecological cancer

Predictors of Appropriate Antibiotic Use in Bacteremia Patients Presenting at the Emergency Department

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