Development and implementation of a short duration antibiotic therapy algorithm for uncomplicated gram-negative bloodstream infections

Bae, Esther Y; Dzintars, Kathryn; Bernice, Fidelia; Cosgrove, Sara E.; Avdic, Edina

doi:10.1017/ice.2021.166

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…Data from studies, conducted in different care settings (including ICUs) and assessing different sites of infection, showed that the duration of antibiotic therapy can be significantly reduced without the risk of leading to a worsening of the achievable outcome [52][53][54][55]. This concept cannot be based on a standardized model, but its applicability depends on the clinical evolution of the disease, the trend in biohumoral markers predictive of outcome, the results of microbiological follow-up and the immunological condition of the individual.…”

Section: Statements and Rationalesmentioning

confidence: 99%

Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement

Cortegiani

Antonelli

Falcone

et al. 2023

J Anesth Analg Crit Care

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Background Antimicrobial resistance represents a major critical issue for the management of the critically ill patients hospitalized in the intensive care unit (ICU), since infections by multidrug-resistant bacteria are characterized by high morbidity and mortality, high rates of treatment failure, and increased healthcare costs worldwide. It is also well known that antimicrobial resistance can emerge as a result of inadequate antimicrobial therapy, in terms of drug selection and/or treatment duration. The application of antimicrobial stewardship principles in ICUs improves the quality of antimicrobial therapy management. However, it needs specific considerations related to the critical setting. Methods The aim of this consensus document gathering a multidisciplinary panel of experts was to discuss principles of antimicrobial stewardship in ICU and to produce statements that facilitate their clinical application and optimize their effectiveness. The methodology used was a modified nominal group discussion. Conclusion The final set of statements underlined the importance of the specific interpretation of antimicrobial stewardship’s principles in critically ill patient management, quasi-targeted therapy, the use of rapid diagnostic methods, the personalization of antimicrobial therapies’ duration, obtaining microbiological surveillance data, the use of PK/PD targets, and the use of specific indicators in antimicrobial stewardship programs.

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Section: Statements and Rationalesmentioning

confidence: 99%

Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement

Cortegiani

Antonelli

Falcone

et al. 2023

J Anesth Analg Crit Care

View full text Add to dashboard Cite

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Assessment of antibiotic appropriateness at discharge: experience from a quaternary care hospital setting

Saleh¹,

Nekidy

El-Lababidi³

2022

JAC-Antimicrobial Resistance

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Background There is a gap in antimicrobial stewardship in transitions of care. Objectives To assess the appropriateness of antibiotics utilized and prescribing habits at hospital discharge. Methods A retrospective, observational study was conducted at our quaternary care hospital between January 2021 and March 2021. During the study period, all patients discharged on antibiotics for pneumonia (PNA), skin and soft tissue infections (SSTI), urinary tract infections (UTI) and intra-abdominal infections (IAI) were included. The overall appropriateness of therapy was assessed based on the following combined criteria: agent, dose, frequency, duration of therapy, and ability to meet diagnostic criteria. Results One hundred and forty-five subjects met the inclusion criteria. Of these, 44 (30.3%) were determined to have received overall appropriate antibiotic therapy. The most common infections were UTI, followed by IAI, PNA, and SSTI, respectively. Further, from the group deemed to have received overall inappropriate therapy, 26 of the 101 (25.7%) patients received an inappropriate antibiotic choice, 6 (5.9%) an inappropriate dose, and 84 (83.2%) an inappropriate duration of therapy. Conclusions Inappropriate duration of therapy represented the most challenging problem with antibiotic regimens at discharge. Larger studies are needed to identify potential interventions that are effective, and can be implemented in all settings, including resource-limited ones.

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Risk factors for positive follow-up blood cultures in critically ill adults with Gram-negative bacteraemia

Mayes,

Siegrist,

Mathew

et al. 2024

JAC-Antimicrobial Resistance

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Objectives To evaluate the utility of follow-up blood cultures (FUBCs) for Gram-negative bloodstream infection (BSI) in ICU patients and identify risk factors for repeat positive cultures. Methods This was a single-centre, retrospective cohort study of critically ill adults with Gram-negative BSI between 1 January 2015 and 1 January 2020. Critically ill patients with one or more blood cultures positive for a Gram-negative organism were included. Descriptive and inferential statistics were performed with an alpha of 0.05. Results A total of 148 critically ill patients with Gram-negative BSI were included, with 42 patients (28.4%) having one or more positive FUBCs. The majority (66.2%) were admitted to a medical ICU. The most common organisms isolated were Escherichia coli (n = 56, 37.8%) and Klebsiella pneumoniae (n = 26, 17.6%). Significant patient risk factors associated with a positive FUBC on univariate regression included: MDR organisms, immunocompromised status, fever, vasopressor use at time of FUBC, lack of source control attainment, and higher quick Pitt bacteraemia score. Multivariable penalized logistic regression indicated that lack of source control containment and less time from index to FUBC remained significantly associated with repeat positive FUBC. Conclusions This is the first study to investigate the use of FUBC for Gram-negative BSI in exclusively ICU patients. Risk factors for repeat positive FUBC in this population include lack of source control and less time between index and FUBC. Prospective studies are needed to fully elucidate the role of FUBCs in critically ill patients with Gram-negative BSI.

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Development and implementation of a short duration antibiotic therapy algorithm for uncomplicated gram-negative bloodstream infections

Cited by 3 publications

References 6 publications

Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement

Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement

Assessment of antibiotic appropriateness at discharge: experience from a quaternary care hospital setting

Risk factors for positive follow-up blood cultures in critically ill adults with Gram-negative bacteraemia

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