Using Local Microbiologic Data To Develop Institution-Specific Guidelines for the Treatment of Hospital-Acquired Pneumonia

Beardsley, James; Williamson, John; Johnson, James W.; Ohl, Christopher; Karchmer, Tobi B.; Bowton, David L.

doi:10.1378/chest.130.3.787

Cited by 127 publications

(88 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Both Ibrahim et al and Soo Hoo et al conducted before-and-after studies demonstrating that treatment guidelines incorporating local epidemiology can greatly improve clinical outcomes of HAP (118,235). Beardsley and colleagues developed institution-specific guidelines for the treatment of HAP after retrospectively evaluating the pathogens associated with HAP in 111 patients (18). They found monotherapy to be appropriate for pneumonia developing within 10 days of hospitalization, while a ␤-lactam antibiotic in combination with an aminoglycoside was appropriate for late-onset HAP, and they concluded that local antimicrobial susceptibility data should guide institution-specific recommendations for the treatment of HAP.…”

Section: Hospital-acquired Pneumoniamentioning

confidence: 99%

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

2012

View full text Add to dashboard Cite

SUMMARY Combination antibiotic therapy for invasive infections with Gram-negative bacteria is employed in many health care facilities, especially for certain subgroups of patients, including those with neutropenia, those with infections caused by Pseudomonas aeruginosa , those with ventilator-associated pneumonia, and the severely ill. An argument can be made for empiric combination therapy, as we are witnessing a rise in infections caused by multidrug-resistant Gram-negative organisms. The wisdom of continued combination therapy after an organism is isolated and antimicrobial susceptibility data are known, however, is more controversial. The available evidence suggests that the greatest benefit of combination antibiotic therapy stems from the increased likelihood of choosing an effective agent during empiric therapy, rather than exploitation of in vitro synergy or the prevention of resistance during definitive treatment. In this review, we summarize the available data comparing monotherapy versus combination antimicrobial therapy for the treatment of infections with Gram-negative bacteria.

show abstract

Section: Hospital-acquired Pneumoniamentioning

confidence: 99%

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

2012

View full text Add to dashboard Cite

show abstract

“…In addition, AGs widen the spectrum of the antibiotic treatment, which should be advantageous in populations with an increased risk of resistant bacteria, such as intensive care unit (ICU) patients (3,4). Empirical antibiotic treatments including AGs could be more appropriate in up to 15 to 20% of cases than a ␤-lactam alone (5,6). In the ICU setting, modifications of the empirical antibiotic treatment or the addition of a new antibiotic occurs less frequently after bitherapy including an AG than after monotherapy (7).…”

mentioning

confidence: 99%

Propensity-Based Study of Aminoglycoside Nephrotoxicity in Patients with Severe Sepsis or Septic Shock

Picard

Bazin

Clouzeau

et al. 2014

Antimicrob Agents Chemother

View full text Add to dashboard Cite

cTo assess the risk of acute kidney injury (AKI) attributable to aminoglycosides (AGs) in patients with severe sepsis or septic shock, we performed a retrospective cohort study in one medical intensive care unit (ICU) in France. Patients admitted for severe sepsis/septic shock between November 2008 and January 2010 were eligible. A propensity score for AG administration was built using day 1 demographic and clinical characteristics. Patients still on the ICU on day 3 were included. Patients with renal failure before day 3 or endocarditis were excluded. The time window for assessment of renal risk was day 3 to day 15, defined according to the RIFLE (risk, injury, failure, loss, and end-stage renal disease) classification. The AKI risk was assessed by means of a propensity-adjusted Cox proportional hazards regression analysis. Of 317 consecutive patients, 198 received AGs. The SAPS II (simplified acute physiology score II) score and nosocomial origin of infection favored the use of AGs, whereas a preexisting renal insufficiency and the neurological site of infection decreased the propensity for AG treatment. One hundred three patients with renal failure before day 3 were excluded. AGs were given once daily over 2.6 ؎ 1.1 days. AKI occurred in 16.3% of patients in a median time of 6 (interquartile range, 5 to 10) days. After adjustment to the clinical course and exposure to other nephrotoxic agents between day 1 and day 3, a propensity-adjusted Cox proportional hazards regression analysis showed no increased risk of AKI in patients receiving AGs (adjusted relative risk ‫؍‬ 0.75 [0.32 to 1.76]). In conclusion, in critically septic patients presenting without early renal failure, aminoglycoside therapy for less than 3 days was not associated with an increased risk of AKI.A minoglycosides (AGs) have bactericidal activity, which has been proven to be synergic with that of ␤-lactams. Although adding an AG to a standard antibiotic treatment did not translate into a reduction of mortality in Gram-negative-bacterial sepsis in subgroups of patients with globally moderate degrees of severity (1), a decrease in mortality was recently reported in a meta-analysis comparing a bitherapy to therapy with a ␤-lactam alone for patients with septic shock (2). In addition, AGs widen the spectrum of the antibiotic treatment, which should be advantageous in populations with an increased risk of resistant bacteria, such as intensive care unit (ICU) patients (3, 4). Empirical antibiotic treatments including AGs could be more appropriate in up to 15 to 20% of cases than a ␤-lactam alone (5, 6). In the ICU setting, modifications of the empirical antibiotic treatment or the addition of a new antibiotic occurs less frequently after bitherapy including an AG than after monotherapy (7).Unfortunately, nephrotoxicity is an important potential limitation of AGs. There is a consensus that AG-related nephrotoxicity has decreased over the years due to better consideration of both reduced duration of treatment and once-daily administration (8). However...

show abstract

“…Guidelines recommend consideration of local microbiologic data and patient risk factors for drug resistance when choosing empirical therapy (2). ␤-Lactam antimicrobials play a prominent role in the therapy of many communityand health care-associated infections (3,4). Clinicians commonly encounter allergic intolerance to ␤-lactam antimicrobials, and this may limit therapeutic options, especially when the history includes a report of a severe reaction.…”

mentioning

confidence: 99%

Optimizing Empiric Antibiotic Therapy in Patients with Severe β-Lactam Allergy

Koliscak

Johnson

Beardsley

et al. 2013

Antimicrob Agents Chemother

Self Cite

View full text Add to dashboard Cite

Antibiotic selection is challenging in patients with severe ␤-lactam allergy due to declining reliability of alternate antibiotics. Organisms isolated from these patients may exhibit unique resistance phenotypes. The objective of this study was to determine which alternate antibiotics or combinations provide adequate empirical therapy for patients with ␤-lactam allergy who develop Gram-negative infections at our institution. We further sought to determine the effects of risk factors for drug resistance on empirical adequacy. A retrospective analysis was conducted for adult patients hospitalized from September 2009 to May 2010 who had a severe ␤-lactam allergy and a urine, blood, or respiratory culture positive for a Gram-negative organism and who met predefined criteria for infection. Patient characteristics, culture and susceptibility data, and predefined risk factors for antibiotic resistance were collected. Adequacies of ␤-lactam and alternate antibiotics were compared for all infections and selected subsets. The primary outcome was adequacy of each alternate antibiotic or combination for all infections. One hundred sixteen infections (40 pneumonias, 67 urinary tract infections, and 9 bacteremias) were identified. Single alternate agents were adequate less frequently than ␤-lactams and combination regimens. Only in cases without risk factors for resistance did single-agent regimens demonstrate acceptable adequacy rates; each factor conferred a doubling of risk for resistance. Resistance risk factors should be considered in selecting empirical antibiotics for Gram-negative pathogens in patients unable to take ␤-lactams due to severe allergy.

show abstract

Using Local Microbiologic Data To Develop Institution-Specific Guidelines for the Treatment of Hospital-Acquired Pneumonia

Cited by 127 publications

References 14 publications

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

Propensity-Based Study of Aminoglycoside Nephrotoxicity in Patients with Severe Sepsis or Septic Shock

Optimizing Empiric Antibiotic Therapy in Patients with Severe β-Lactam Allergy

Contact Info

Product

Resources

About