When antibiotic treatment fails

Bassetti, Matteo; Garnacho-Montero, José; Paiva, José Artur

doi:10.1007/s00134-017-4962-2

Cited by 37 publications

(34 citation statements)

References 12 publications

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“…Second, our assessment of antibiotic sensitivity within polymicrobial communities showed that in some cases, antibiotics selected with the standard method did not eliminate even the dominant bacteria in mixed microbial communities. Such false-positive data might result in the selection of ineffective antibiotics and therapy failure (80). The reason for false-positive results generated by the gold standard method may be because this method enables growth of monobacterial cultures but does not take into consideration higher tolerance to antibiotics of bacteria within mixed communities (15).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the novel culture-based FAST-T system allowing selection of optimal antibiotics for critically ill patients within 4 h (for other than bloodstream infectious).

Tetz¹,

Tetz²

2019

Preprint

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Rapid diagnostic tests are needed to improve patient care, particularly in immunocompromised hosts. Here, we describe the validation of a new phenotypic culture-based FAST-T method for rapid selection of antibiotics in vitro using specimens with mono- and polybacterial infections. FAST-T approach, which can be applied to any type of non-blood tissue, does not require isolation of pure bacterial cultures. FAST-T-selected antibiotics are those that can completely eliminate mixed bacterial infections in specimens. The method uses a novel FASM-T medium that allows more rapid bacterial growth of gram-positive and gram-negative monoisolates compared with that achieved with conventional laboratory media. The application of the FAST-T method in 122 bacterial species demonstrated overall sensitivity, specificity, positive predictive value, and negative predictive value of 99.6%, 98.1%, 98.5%, and 99.4%, respectively, already after 4 h. The overall category agreement with the outcome of standard testing was 98.9% with very major errors and major errors being detected in 1.2% and 0.6% of cases. The use of FASM-T medium in 20 clinical polymicrobial samples allowed culturing a more diverse set of bacteria, including fastidious species, compared with that achieved with the standard laboratory diagnostic and enabled, already within 4 h, accurate selection of the antibiotics that completely eliminated all cultivatable bacteria from clinical samples. In conclusion, FAST-T system may be a valuable tool in improving phenotypic-based antibiotic selection, enabling targeted empirical therapy and accurate antibiotic replacement, which is especially important in high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the novel culture-based FAST-T system allowing selection of optimal antibiotics for critically ill patients within 4 h (for other than bloodstream infectious).

Tetz¹,

Tetz²

2019

Preprint

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“…Moreover, the main difference between treatment groups occurred early, responsible for impaired clinical response during treatment, while the rate of HAP-VAP relapse was not statistically different. In this context, antibiotic pharmacokinetic and pharmacodynamic (PK/PD) issues could explain these discrepancies, especially in patients with severe HAP-VAP, high distribution volume and/or augmented renal clearance [19].…”

Section: Discussionmentioning

confidence: 99%

“…Finally, there is no consensus statement on the definition of treatment failure. Sustained defervescence, clinical stability and reduction of SOFA score in a 48-72-h timeframe are the variables that are considered in several studies and seem to better reflect clinical response [19]. However, external validation of the study end-point was not blinded to the allocated treatment group and therapeutic drug monitoring is lacking to rule out under-dosing of antimicrobial agents.…”

Section: Discussionmentioning

confidence: 99%

Piperacillin-tazobactam should be preferred to third-generation cephalosporins to treat wild-type inducible AmpC-producing Enterobacteriaceae in critically ill patients with hospital or ventilator-acquired pneumonia. A propensity score-matched analysis

Carrié

Bardonneau

Petit

et al. 2019

Preprint

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BACKGROUND The aim of this study was to compare the rate of therapeutic failure and emergence of resistance in critically ill patients treated by third-generation cephalosporins (3GCs) or piperacillin-tazobactam (PTZ) for wild-type AmpC-producing Enterobacteriaceae pulmonary infections. METHODS In a multicenter retrospective cohort study over a 4-year period, all patients treated for a pulmonary infection related to wild-type AmpC-producing Enterobacteriaceae who received documented antibiotic therapy with 3GCs or PTZ after less than 48 hours of empirical antibiotic therapy were eligible. The main outcome was the rate of therapeutic failure, defined by an impaired clinical response under treatment and/or a relapse of pulmonary infection related to the same pathogen. The secondary outcome was a secondary acquisition of derepressed cephalosporinase-producing Enterobacteriaceae. RESULTS Over the study period, 244 patients were included; 56 (23%) experienced therapeutic failure and 19 (8%) experienced secondary acquisition of resistance. In the non-adjusted cohort, the rate of therapeutic failure and emergence of resistance were significantly higher in the 3GCs group (32 vs. 18%, p = 0.011 and 13 vs. 5%, p = 0.035, respectively). In the propensity score-matched population, the 3GCs group was associated with higher rates of therapeutic failure (HR = 1.61 [1.27 – 2.07]). The secondary de-escalation to 3GCs after 48h of PTZ as a first-line antibiotic therapy was not associated with increased rate of emergence of resistance. CONCLUSION Our study confirms that third-generation cephalosporins should be avoided as first-line antibiotic therapy in wild-type AmpC-producing Enterobacteriaceae pulmonary infections.

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“…Low molecular weight heparin was indicated in patients with acute respiratory failure when D-dimer level increased (according to physician’s judgment whether patient has potential risk of pulmonary embolism formation based on pulmonary embolism Caprini score) (19). Culture results were used reassess the appropriateness of the initial therapy prescribed, along with the patient’s clinical progress and other investigation results (20–22). No animal products or restricted herbal ingredients were used in this study.…”

Section: Methodsmentioning

confidence: 99%

XueBiJing Injection Versus Placebo for Critically Ill Patients With Severe Community-Acquired Pneumonia: A Randomized Controlled Trial

Song

Yao

et al. 2019

Critical Care Medicine

117

125

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When antibiotic treatment fails

Cited by 37 publications

References 12 publications

Evaluation of the novel culture-based FAST-T system allowing selection of optimal antibiotics for critically ill patients within 4 h (for other than bloodstream infectious).

Evaluation of the novel culture-based FAST-T system allowing selection of optimal antibiotics for critically ill patients within 4 h (for other than bloodstream infectious).

Piperacillin-tazobactam should be preferred to third-generation cephalosporins to treat wild-type inducible AmpC-producing Enterobacteriaceae in critically ill patients with hospital or ventilator-acquired pneumonia. A propensity score-matched analysis

XueBiJing Injection Versus Placebo for Critically Ill Patients With Severe Community-Acquired Pneumonia: A Randomized Controlled Trial

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