Association between appropriate empiric antimicrobial therapy and mortality from bloodstream infections in the intensive care unit

Yamaga, Satoshi; Shime, Nobuaki

doi:10.1016/j.jiac.2017.11.011

Cited by 19 publications

(13 citation statements)

References 11 publications

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“…pneumonia) and Gram-negative bacteria. 39,47–50 Therefore, adequate empirical antimicrobial coverage of patients with suspicion of bacteraemia is important but should always be tailored to avoid the overuse of broad-spectrum antimicrobial agents. This is far from easy; best decisions are taken considering the severity and source of the infection, the features of the patient, knowledge of colonization status of the patients and other specific risk factors for antimicrobial resistance, and local epidemiology.…”

Section: Introductionmentioning

confidence: 99%

Impact of infectious diseases consultation on the outcome of patients with bacteraemia

Jiménez-Aguilar

López-Cortés

2019

Therapeutic Advances in Infection

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Bacteraemia or bloodstream infections (BSI) are associated with much morbidity and mortality. Management of patients with bacteraemia is complex, and the increase in immunosuppressed patients and multidrug-resistant organisms poses additional challenges. The objective of this review is to assess the available published information about the impact of different aspects of management on the outcome of patients with BSI, and, specifically, the importance of infectious diseases specialists (IDS) consultation. The impact of management by IDS on different aspects, including interpretation of newer rapid techniques, early evaluation and treatment, and follow up, are reviewed. Overall, the available data suggest that IDS intervention improves the management and outcome of patients with BSI, either through consultation or structured unsolicited interventions in the context of multidisciplinary bacteraemia programmes.

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Section: Introductionmentioning

confidence: 99%

Impact of infectious diseases consultation on the outcome of patients with bacteraemia

Jiménez-Aguilar

López-Cortés

2019

Therapeutic Advances in Infection

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“…Without timely control, a BSI can have a poor prognosis, further deteriorate into sepsis or septic shock, and even cause death in patients. BSI is a common infectious disease in hospitals [1,2] and the infectious types mainly include gram-negative BSI (GN-BSI), gram-positive BSI (GP-BSI) and fungal-BSI. [3,4]…”

Section: Introductionmentioning

confidence: 99%

The clinical value of IL-3, IL-4, IL-12p70, IL17A, IFN-γ, MIP-1β, NLR, P-selectin, and TNF-α in differentiating bloodstream infections caused by gram-negative, gram-positive bacteria and fungi in hospitalized patients

Yuan

Wang

2019

Medicine

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Early differential diagnosis of bloodstream infections (BSIs) caused by different sources and species of bacteria in hospitalized patients is crucial for the timely targeted interventions including appropriate use of antibiotics. The aim of this study was to identify 9 biomarkers for the early differentiation of gram-negative-bloodstream infection (GN-BSI), gram-positive (GP)-BSI, and fungal-BSI.A prospective study was conducted for a total of 390 inpatients who underwent blood culture in the Chinese PLA General Hospital from September 2015 to March 2018. Patients with positive culture of a single pathogen were divided into GN-BSI, GP-BSI, and Fungal-BSI groups, and a culture-negative disease control group was also established. The serum levels of macrophage inflammatory protein 1β (MIP-1β), tumor necrosis factor α (TNF-α), interleukin (IL)-3, interferon (IFN)-γ, IL-17A, IL-4, IL-12p70, and P-selectin were detected and the NLR was calculated from routine blood test. Receiver-operating characteristic analysis was used to determine the efficacy of various indicators in the differential diagnosis of BSIs. Prediction and validation experiments on clinical patient samples (263 cases) were also performed.The level of IL-3 in the GP-BSI group was significantly higher than those in the other 3 groups. The level of IFN-γ in the fungal-BSI group was significantly higher than those in the other 3 groups. NLR, MIP-1β, TNF-α, IL-17A, and IL3 exhibited some efficacy when distinguishing between GN-BSI and GP-BSI and NLR had the largest area under curve (AUC) (0.728), followed by MIP-1β with an AUC of 0.679. IFN-γ and IL-3 exhibited some value in differential diagnosis between GN-BSI and Fungal-BSI. IL-3, MIP-1β, TNF-α, IFN-γ, NLR, IL-17A, and IL-4 exhibited some value in distinguishing fungal-BSI and GP-BSI, with IL-3 had the largest AUC (0.722), followed by MIP-1β with an AUC of 0.703.NLR and MIP-1β may be valuable in differentiating GN-BSI from GP-BSI in hospitalized patients. IFN-γ and IL-3 may be helpful in differential diagnosis GN-BSI and fungal-BSI. IL-3 and MIP-1β exhibited some diagnostic efficacy in distinguishing fungal-BSI and GP-BSI. Additionally, IL-3 with high serum level may be a marker for GP-BSI and IFN-γ with high serum level may be a valuable marker for the prediction of Fungal-BSI. The utility of these biomarkers to predict BSIs owing to different pathogens in hospitalized patients needs to be assessed in further studies.

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“…Importantly, the mortality of bacteremia is directly correlated to the first adequate anti-infectious therapy. In a study on patients of intensive care units (ICU) in Japan,the initiation of an appropriate empirical antimicrobial treatment was associated with a lower 60-day mortality than that of an inappropriate therapy [2]. The selection of an empirical antimicrobial drug therapy should be based on clinical and epidemiological data.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial susceptibility among gram-positive and gram-negative blood-borne pathogens collected between 2012-2016 as part of the Tigecycline Evaluation and Surveillance Trial

Zhang

Meng

et al. 2018

Antimicrob Resist Infect Control

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BackgroundAntimicrobial activity of tigecycline and comparator agents was assessedin vitroagainst 27857 isolates source from blood samples collected between 2012 and 2016 as part of the Tigecycline Evaluation and Surveillance Trial (TEST).MethodsThe broth microdilution methods was used to determine minimum inhibitory concentrations (MIC) of blood-borne isolates according to guildlines of the Clinical and Laboratory Standards Institute (CLSI). Antimicrobial susceptibility breakpoints from CLSI guidelines were used as standards to determine susceptibility against comparator agents, whereas tigecycline breakpoints were provided by the US Food and Drug Administration (FDA).ResultsMore than 91% Enterobacteriaceae isolates, belonging to Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacaeandSerratia marcescens, were susceptible to amikacin, meropenem, and tigecycline. Meropenem resistance was observed in 8% ofK.pneumoniae isolates worldwide. Extended-spectrum β-lactamase (ESBL) was produced in 15.9 and 20.9%E.coli and K.pneumoniaeisolates, respectively. MIC90 of tigecycline against Acinetobacter baumannii was 2 μg/ml. The highest proportion of susceptible A.baumanniiisolates was 70.8% for minocycline. Among P.aeruginose isolates worldwide, 71.1–94.9% were susceptible to six antibiotics. Almost all Staphylococcus aureusisolates were susceptible to linezolid(100%), vancomycin(100%), and tigecycline (99.9%). The proportion of methicillin-resistant S.aureus (MRSA) was 33.0% among S.aureusisolates worldwide; it was highest in Asia with 46.6%, followed by North America and Latin America with 37.7 and 34.2%, respectively. Vancomycin-resistant (VR) isolates represented 1.4% ofEnterococcus faecalis (VR.E.faecalis) and 27.6% of Enterococcus faecium(VR.E.faecium). Highest percentages of VR.E.faeciumwere found in North America and Latin America, with 61.6 and 58.1% of the isolates, respectively. Production of penicillin-resistant Streptococcus pneumoniae(PRSP) represented 9.0% of S. pneumoniae isolates worldwide; the PRSP proportion was 25.8% in Asia, 13.0% in Africa, and 11.8% in Latin America.ConclusionsIn our study, tigecycline was the only antibiotic that was active against over 90% of all major blood-borne pathogens. A global comparison revealed that antimicrobial resistance was higher in Africa, Asia and Latin America than in Europe and North America.

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Association between appropriate empiric antimicrobial therapy and mortality from bloodstream infections in the intensive care unit

Cited by 19 publications

References 11 publications

Impact of infectious diseases consultation on the outcome of patients with bacteraemia

Impact of infectious diseases consultation on the outcome of patients with bacteraemia

The clinical value of IL-3, IL-4, IL-12p70, IL17A, IFN-γ, MIP-1β, NLR, P-selectin, and TNF-α in differentiating bloodstream infections caused by gram-negative, gram-positive bacteria and fungi in hospitalized patients

Antimicrobial susceptibility among gram-positive and gram-negative blood-borne pathogens collected between 2012-2016 as part of the Tigecycline Evaluation and Surveillance Trial

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