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Masuda S, Imamura Y, Ichita C, Jinushi R, Kubota J, Kimura K, Makazu M, Sato R, Kako M, Kobayashi M, Uojima H, Taguri M, Orihara S, Koizumi K. Comparison of antimicrobial therapy termination in febrile and afebrile patients with acute cholangitis after drainage. Sci Rep 2024; 14:17858. [PMID: 39090409 PMCID: PMC11294559 DOI: 10.1038/s41598-024-68999-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 07/30/2024] [Indexed: 08/04/2024] Open
Abstract
The standard treatment duration for acute cholangitis (AC) involves a 4-7-day antimicrobial treatment post-biliary drainage; however, recent studies have suggested that a ≤ 2-3 days is sufficient. However, clinical practice frequently depends on body temperature as a criterion for discontinuing antimicrobial treatment. Therefore, in this study, we assessed whether patients with AC can achieve successful outcomes with a ≤ 7-day antimicrobial treatment, even with a fever, assuming the infection source is effectively controlled. We conducted a single-center retrospective study involving patients with AC, defined following the Tokyo Guidelines 2018 for any cause, who underwent successful biliary drainage and completed a ≤ 7-day antimicrobial treatment. Patients were categorized into the febrile and afebrile groups based on their body temperature within 24 h before completing antimicrobial treatment. The primary outcome was the clinical cure rate, defined as no initial presenting symptoms by day 14 post-biliary drainage without recurrence or death by day 30. The secondary outcome was a 3-month recurrence rate. Logistic regression with inverse probability of treatment weighting was used. Overall, 408 patients were selected, among whom 40 (9.8%) were febrile. The two groups showed no significant differences in the clinical cure and 3-month recurrence rates. Notably, the subgroups limited to patients with a ≤ 3-day antibiotic treatment duration also showed no differences in these outcomes. Therefore, our results suggest that discontinuing antibiotics within the initially planned treatment period was sufficient for successful drainage cases of AC, regardless of the patient's fever status during the 24 h leading up to termination.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
| | - Yoshinori Imamura
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
| | - Chikamasa Ichita
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Ryuhei Jinushi
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama, 350-1298, Japan
| | - Jun Kubota
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Karen Kimura
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Makomo Makazu
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Ryo Sato
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama, 350-1298, Japan
| | - Makoto Kako
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Masahiro Kobayashi
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Haruki Uojima
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Kamakura, Kanagawa, 252-0375, Japan
| | - Masataka Taguri
- Department of Health Data Science, Tokyo Medical University Graduate School of Medicine, Shinjyuku-ku, Tokyo, 160-0023, Japan
| | - Shunichiro Orihara
- Department of Health Data Science, Tokyo Medical University Graduate School of Medicine, Shinjyuku-ku, Tokyo, 160-0023, Japan
| | - Kazuya Koizumi
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
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Maraolo AE, Ceccarelli G, Venditti M, Oliva A. Short Course Antibiotic Therapy for Catheter-Related Septic Thrombosis: "Caveat Emptor!": Duration of Therapy Should Not Be Set a Priori. Pathogens 2024; 13:529. [PMID: 39057756 PMCID: PMC11280046 DOI: 10.3390/pathogens13070529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/24/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
There is a growing body of evidence showing no significant difference in clinical outcomes in patients with uncomplicated Gram-negative bloodstream infections (BSIs) receiving 7 or 14 days of therapy. However, the scenario may differ when complicated forms of BSI, such as catheter-related BSIs (CRBSIs) burdened by septic thrombosis (ST), are considered. A recent study showed that a short course of antimicrobial therapy (≤3 weeks) had similar outcomes to a prolonged course on CRBSI-ST. From this perspective, starting from the desirable goal of shortening the treatment duration, we discuss how the path to the correct diagnosis and management of CRBSI-ST may be paved with several challenges. Indeed, patients with ST due to Gram-negative bacteria display prolonged bacteremia despite an indolent clinical course, requiring an extended course of antibiotic treatment guided by negative FUBCs results, which should be considered the real driver of the decision-making process establishing the length of antibiotic therapy in CRBSI-ST. Shortening treatment of complicated CRBSIs burdened by ST is ambitious and advisable; however, a dynamic and tailored approach driven by a tangible outcome such as negative FUBCs rather than a fixed-duration paradigm should be implemented for the optimal antimicrobial duration.
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Affiliation(s)
- Alberto Enrico Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy;
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (G.C.); (M.V.)
- Infectious Diseases Department, Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (G.C.); (M.V.)
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (G.C.); (M.V.)
- Infectious Diseases Department, Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
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Amadieu R, Brehin C, Chahine A, Grouteau E, Dubois D, Munzer C, Flumian C, Brissaud O, Ros B, Jean G, Brotelande C, Travert B, Savy N, Boeuf B, Ghostine G, Popov I, Duport P, Wolff R, Maurice L, Dauger S, Breinig S. Compliance with antibiotic therapy guidelines in french paediatric intensive care units: a multicentre observational study. BMC Infect Dis 2024; 24:582. [PMID: 38867164 PMCID: PMC11170905 DOI: 10.1186/s12879-024-09472-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 06/04/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Bacterial infections (BIs) are widespread in ICUs. The aims of this study were to assess compliance with antibiotic recommendations and factors associated with non-compliance. METHODS We conducted an observational study in eight French Paediatric and Neonatal ICUs with an antimicrobial stewardship programme (ASP) organised once a week for the most part. All children receiving antibiotics for a suspected or proven BI were evaluated. Newborns < 72 h old, neonates < 37 weeks, age ≥ 18 years and children under surgical antimicrobial prophylaxis were excluded. RESULTS 139 suspected (or proven) BI episodes in 134 children were prospectively included during six separate time-periods over one year. The final diagnosis was 26.6% with no BI, 40.3% presumed (i.e., not documented) BI and 35.3% documented BI. Non-compliance with antibiotic recommendations occurred in 51.1%. The main reasons for non-compliance were inappropriate choice of antimicrobials (27.3%), duration of one or more antimicrobials (26.3%) and length of antibiotic therapy (18.0%). In multivariate analyses, the main independent risk factors for non-compliance were prescribing ≥ 2 antibiotics (OR 4.06, 95%CI 1.69-9.74, p = 0.0017), duration of broad-spectrum antibiotic therapy ≥ 4 days (OR 2.59, 95%CI 1.16-5.78, p = 0.0199), neurologic compromise at ICU admission (OR 3.41, 95%CI 1.04-11.20, p = 0.0431), suspected catheter-related bacteraemia (ORs 3.70 and 5.42, 95%CIs 1.32 to 15.07, p < 0.02), a BI site classified as "other" (ORs 3.29 and 15.88, 95%CIs 1.16 to 104.76, p < 0.03), sepsis with ≥ 2 organ dysfunctions (OR 4.21, 95%CI 1.42-12.55, p = 0.0098), late-onset ventilator-associated pneumonia (OR 6.30, 95%CI 1.15-34.44, p = 0.0338) and ≥ 1 risk factor for extended-spectrum β-lactamase-producing Enterobacteriaceae (OR 2.56, 95%CI 1.07-6.14, p = 0.0353). Main independent factors for compliance were using antibiotic therapy protocols (OR 0.42, 95%CI 0.19-0.92, p = 0.0313), respiratory failure at ICU admission (OR 0.36, 95%CI 0.14-0.90, p = 0.0281) and aspiration pneumonia (OR 0.37, 95%CI 0.14-0.99, p = 0.0486). CONCLUSIONS Half of antibiotic prescriptions remain non-compliant with guidelines. Intensivists should reassess on a day-to-day basis the benefit of using several antimicrobials or any broad-spectrum antibiotics and stop antibiotics that are no longer indicated. Developing consensus about treating specific illnesses and using department protocols seem necessary to reduce non-compliance. A daily ASP could also improve compliance in these situations. TRIAL REGISTRATION ClinicalTrials.gov: number NCT04642560. The date of first trial registration was 24/11/2020.
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Affiliation(s)
- Romain Amadieu
- Neonatal and Paediatric Intensive Care Unit, Children's Hospital, Toulouse University Hospital, 330 Avenue de Grande Bretagne, TSA 70034, Toulouse Cedex 9, 31059, France.
| | - Camille Brehin
- Paediatric Infectious Diseases Department, Children's Hospital, Toulouse University Hospital, Toulouse, France
- General Paediatrics Department, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Adéla Chahine
- Neonatal and Paediatric Intensive Care Unit, Children's Hospital, Toulouse University Hospital, 330 Avenue de Grande Bretagne, TSA 70034, Toulouse Cedex 9, 31059, France
| | - Erick Grouteau
- Paediatric Infectious Diseases Department, Children's Hospital, Toulouse University Hospital, Toulouse, France
- General Paediatrics Department, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Damien Dubois
- Bacteriology-Hygiene Department, Toulouse University Hospital, Toulouse, France
| | - Caroline Munzer
- Paediatric Clinical Research Department, Children's Hospital, Equipe MéDatAS-CIC 1436, Toulouse University Hospital, Toulouse, France
| | - Clara Flumian
- Paediatric Clinical Research Department, Children's Hospital, Equipe MéDatAS-CIC 1436, Toulouse University Hospital, Toulouse, France
| | - Olivier Brissaud
- Neonatal and Paediatric Intensive Care Unit, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Barbara Ros
- Neonatal and Paediatric Intensive Care Unit, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Gael Jean
- Neonatal and Paediatric Intensive Care Unit, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Camille Brotelande
- Paediatric Intensive Care Unit, Arnaud de Villeneuve University Hospital, Montpellier University, Montpellier, France
| | - Brendan Travert
- Neonatal and Paediatric Intensive Care Unit, Mère-Enfant University Hospital, Nantes University, Nantes, France
| | - Nadia Savy
- Neonatal and Paediatric Intensive Care Unit, Estaing University Hospital, Clermont-Ferrand University, Clermont-Ferrand, France
| | - Benoit Boeuf
- Neonatal and Paediatric Intensive Care Unit, Estaing University Hospital, Clermont-Ferrand University, Clermont-Ferrand, France
| | - Ghida Ghostine
- Neonatal and Paediatric Intensive Care Unit, Amiens-Picardie University Hospital, Amiens University, Amiens, France
| | - Isabelle Popov
- Neonatal and Paediatric Intensive Care Unit, Amiens-Picardie University Hospital, Amiens University, Amiens, France
| | - Pauline Duport
- Neonatal and Paediatric Intensive Care Unit, Felix Guyon University Hospital, La Réunion University, Saint-Denis, Ile de la Réunion, France
| | - Richard Wolff
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Laure Maurice
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Stephane Dauger
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Sophie Breinig
- Neonatal and Paediatric Intensive Care Unit, Children's Hospital, Toulouse University Hospital, 330 Avenue de Grande Bretagne, TSA 70034, Toulouse Cedex 9, 31059, France
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Karlo J, Vijay A, Phaneeswar MS, Singh SP. Sensing the Bactericidal and Bacteriostatic Antimicrobial Mode of Action Using Raman Deuterium Stable Isotope Probing (DSIP) in Escherichia coli. ACS OMEGA 2024; 9:23753-23760. [PMID: 38854576 PMCID: PMC11154948 DOI: 10.1021/acsomega.4c01666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024]
Abstract
The mode of action of antibiotics can be broadly classified as bacteriostatic and bactericidal. The bacteriostatic mode leads to the arrested growth of the cells, while the bacteriocidal mode causes cell death. In this work, we report the applicability of deuterium stable isotope probing (DSIP) in combination with Raman spectroscopy (Raman DSIP) for discriminating the mode of action of antibiotics at the community level. Escherichia coli, a well-known model microbe, was used as an organism for the study. We optimized the concentration of deuterium oxide required for metabolic activity monitoring without compromising the microbial growth. Our findings suggest that changes in the intensity of the C-D band in the high-wavenumber region could serve as a quantifiable marker for determining the antibiotic mode of action. This can be used for early identification of the antibiotic's mode of action. Our results explore the new perspective that supports the utility of deuterium-based vibrational tags in the field of clinical spectroscopy. Understanding the antibiotic's mode of action on bacterial cells in a short and objective manner can significantly enhance the clinical management abilities of infectious diseases and may also help in personalized antimicrobial therapy.
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Affiliation(s)
- Jiro Karlo
- Department of Biosciences
and Bioengineering, Indian Institute of
Technology Dharwad, Dharwad, Karnataka 580011, India
| | - Arunsree Vijay
- Department of Biosciences
and Bioengineering, Indian Institute of
Technology Dharwad, Dharwad, Karnataka 580011, India
| | - Mahamkali Sri Phaneeswar
- Department of Biosciences
and Bioengineering, Indian Institute of
Technology Dharwad, Dharwad, Karnataka 580011, India
| | - Surya Pratap Singh
- Department of Biosciences
and Bioengineering, Indian Institute of
Technology Dharwad, Dharwad, Karnataka 580011, India
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5
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Ohashi K, Matsuoka T, Shinoda Y, Takahashi T, Shikano H, Kagajo M, Yagi T, Usami E. Evaluation of long-term pharmacist-led prospective audit and feedback in antimicrobial stewardship: An 8-year study. Am J Infect Control 2024; 52:670-677. [PMID: 38142775 DOI: 10.1016/j.ajic.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Limited research has evaluated the long-term outcomes of prospective audit and feedback (PAF) led by pharmacists. We assessed pharmacist-led PAF processes and outcome measures over 8 years. METHODS This study was conducted at a single public hospital in Japan. Between 2014 and 2021, pharmacists conducted weekday PAFs for hospitalized patients and annually evaluated the process and outcome measures. The endpoints included detection of drug-resistant bacteria, drug susceptibility rates, duration of antimicrobial therapy, and proportion of long-term administration. RESULTS Among inpatients, methicillin-resistant Staphylococcus aureus significantly decreased from 50.9% in 2014 to 32.8% in 2021 (P < .001). The susceptibility rate of Pseudomonas aeruginosa to meropenem significantly increased from 91.2% in 2014 to 94.4% in 2021 (P < .001) and levofloxacin increased from 84.9% in 2014 to 89.3% in 2021 (P < .001). Antimicrobial therapy duration did not differ significantly between 2014 and 2016, but decreased significantly from 2017 onwards (P < .001), except in 2018. The number of patients receiving intravenous antimicrobials for >10 days decreased significantly between 2014 and 2021 (P < .001). CONCLUSIONS Long-term continuous PAF interventions by pharmacists contribute to improving and maintaining process and outcome indicators and prevent the spread of drug-resistant bacteria.
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Affiliation(s)
- Kengo Ohashi
- Department of Pharmacy, Ogaki Municipal Hospital, Gifu, Japan; The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan.
| | - Tomoko Matsuoka
- Department of Pharmacy, Ogaki Municipal Hospital, Gifu, Japan; The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan
| | - Yasutaka Shinoda
- Department of Pharmacy, Ogaki Municipal Hospital, Gifu, Japan; The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan
| | - Takamasa Takahashi
- The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan; Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan
| | - Hiroaki Shikano
- The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan; Department of Pediatrics, Ogaki Municipal Hospital, Gifu, Japan
| | - Michiko Kagajo
- The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan; Department of Respiratory Medicine, Ogaki Municipal Hospital, Gifu, Japan
| | - Tetsuya Yagi
- The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan; Department of Infectious Diseases, Nagoya, University Hospital, Nagoya, Japan
| | - Eiseki Usami
- Department of Pharmacy, Ogaki Municipal Hospital, Gifu, Japan
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Masuda S, Imamura Y, Ichita C, Jinushi R, Kubota J, Kimura K, Makazu M, Sato R, Uojima H, Koizumi K. Efficacy of Short-Course Antibiotic Therapy for Acute Cholangitis With Positive Blood Cultures: A Retrospective Study. Cureus 2024; 16:e58883. [PMID: 38800172 PMCID: PMC11117024 DOI: 10.7759/cureus.58883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Short-term treatment of acute cholangitis is sufficient for cure compared with the standard treatment duration. Whether this short-course antimicrobial therapy is effective in patients with acute cholangitis with positive blood cultures has not been fully investigated. This study assessed whether patients with acute cholangitis could achieve successful outcomes with a three-day or shorter antimicrobial treatment period, even with a positive blood culture. METHODS This single-center retrospective study involved patients with acute cholangitis, defined according to the Tokyo Guidelines 2018 for any cause, who underwent successful biliary drainage and completed a seven-day or shorter antimicrobial treatment. Patients were categorized into six groups based on the duration of antibiotic use (short or standard) after endoscopic retrograde cholangiopancreatography and blood culture findings (positive, negative, or no collection). The primary outcome was the clinical cure rate, defined as no initial presenting symptoms by day 14 after biliary drainage and no recurrence or death by day 30. Secondary outcomes included a three-month recurrence rate and length of hospital stay. RESULTS In total, 389 cases were selected, and 27 patients (6.9%) undergoing short-course therapy tested positive for blood culture. The clinical cure rate (n=25, 92.6%) in this group was comparable to that in the other groups. For the three-month recurrence rate (n=1, 3.7%) and median hospital stay (six days), this group's outcomes were either better or similar to those of the other groups. CONCLUSIONS For cases of successful drainage in acute cholangitis, even with positive blood cultures, short-term antibiotic therapy may be appropriate.
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Affiliation(s)
- Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
| | - Yoshinori Imamura
- Division of Medical Oncology/Hematology, University of Fukui Hospital, Fukui, JPN
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
| | - Ryuhei Jinushi
- Department of Gastroenterology, Saitama Medical University international Medical Center, Hidaka, JPN
| | - Jun Kubota
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
| | - Makomo Makazu
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
| | - Ryo Sato
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Haruki Uojima
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, JPN
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7
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Destoop J, Vanhaecke C, Bani-Sadr F, Plenier Y, Viguier MA, Hentzien M. Significantly reduced duration of antibiotic prescription for erysipelas subsequent to the 2019 French guidelines on skin and soft tissue infection: A before-after study. Infect Dis Now 2024; 54:104887. [PMID: 38492802 DOI: 10.1016/j.idnow.2024.104887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND New skin and soft tissue infections (SSTI) guidelines were published in 2019 in France, changing the recommended duration for antibiotic treatment. The objective of the present study was to assess the impact of the publication of the 2019 French guidelines on SSTIs on the duration of antibiotic prescription for erysipelas. METHODS In a before-after study (a year before and a year after April 1st, 2019), we included all adult patients diagnosed with erysipelas in Reims University Hospital medical wards and the emergency department. We retrospectively retrieved antibiotic prescription duration in the patients' medical files. RESULTS Among 50 patients in the "before" and 39 in the "after" group, the mean duration of antibiotic prescription was significantly shorter in the "after" group (9.4 ± 2.8 vs. 12.4 ± 3.8 days, p = 0.0001). CONCLUSIONS A 25% decrease in the duration of antibiotic prescription for erysipelas was observed following the implementation of these guidelines, providing useful information for an antibiotic stewardship policy.
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Affiliation(s)
- Justin Destoop
- Department of Dermatology, Robert Debré University Hospital, Avenue du general Koenig, 51092 Reims Cedex, France.
| | - Clélia Vanhaecke
- Department of Dermatology, Robert Debré University Hospital, Avenue du general Koenig, 51092 Reims Cedex, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Robert Debré University Hospital, Avenue du general Koenig, 51092 Reims Cedex, France
| | - Yannick Plenier
- Pediatric Emergency Department, American Memorial Hospital, 47 Rue Cognacq-Jay, 51100 Reims, France
| | - Manuelle-Anne Viguier
- Department of Dermatology, Robert Debré University Hospital, Avenue du general Koenig, 51092 Reims Cedex, France
| | - Maxime Hentzien
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Robert Debré University Hospital, Avenue du general Koenig, 51092 Reims Cedex, France; University of Reims Champagne-Ardenne, Reims, France
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8
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Baclet N, Forestier E, Gavazzi G, Roubaud-Baudron C, Hiernard V, Hequette-Ruz R, Alfandari S, Aumaître H, Botelho-Nevers E, Caraux-Paz P, Charmillon A, Diamantis S, Fraisse T, Gazeau P, Hentzien M, Lanoix JP, Paccalin M, Putot A, Ruch Y, Senneville E, Beuscart JB. One Hundred Explicit Definitions of Potentially Inappropriate Prescriptions of Antibiotics in Hospitalized Older Patients: The Results of an Expert Consensus Study. Antibiotics (Basel) 2024; 13:283. [PMID: 38534718 DOI: 10.3390/antibiotics13030283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND In geriatrics, explicit criteria for potentially inappropriate prescriptions (PIPs) are useful for optimizing drug use. OBJECTIVE To produce an expert consensus on explicit definitions of antibiotic-PIPs for hospitalized older patients. METHODS We conducted a Delphi survey involving French experts on antibiotic stewardship in hospital settings. During the survey's rounds, the experts gave their opinion on each explicit definition, and could suggest new definitions. Definitions with a 1-to-9 Likert score of between 7 and 9 from at least 75% of the participants were adopted. The results were discussed during consensus meetings after each round. RESULTS Of the 155 invited experts, 128 (82.6%) participated in the whole survey: 59 (46%) infectious diseases specialists, 45 (35%) geriatricians, and 24 (19%) other specialists. In Round 1, 65 explicit definitions were adopted and 21 new definitions were suggested. In Round 2, 35 other explicit definitions were adopted. The results were validated during consensus meetings (with 44 participants after Round 1, and 54 after Round 2). CONCLUSIONS The present study is the first to have provided a list of explicit definitions of potentially inappropriate antibiotic prescriptions for hospitalized older patients. It might help to disseminate key messages to prescribers and reduce inappropriate prescriptions of antibiotics.
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Affiliation(s)
- Nicolas Baclet
- CHU Lille, University of Lille, F-59000 Lille, France
- Groupe Hospitalier de l'Institut Catholique (GHICL), Service de Maladies Infectieuses, Université Catholique de Lille, F-59160 Lille, France
| | - Emmanuel Forestier
- Service de Maladies Infectieuses, Centre Hospitalier Métropole Savoie, F-73000 Chambéry, France
| | - Gaëtan Gavazzi
- Clinique Universitaire de Médecine Gériatrique, Centre Hospitalier Universitaire de Grenoble-Alpes, GREPI EA7408 Université Grenoble-Alpes, F-38000 Grenoble, France
| | - Claire Roubaud-Baudron
- CHU Bordeaux, Pôle de Gérontologie Clinique, University of Bordeaux, INSERM 1312 BRIC, F-33000 Bordeaux, France
| | | | | | - Serge Alfandari
- Service Universitaire de Maladies Infectieuses et Tropicales, Hôpital Gustave Dron, F-59200 Tourcoing, France
| | - Hugues Aumaître
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Perpignan, F-66000 Perpignan, France
| | - Elisabeth Botelho-Nevers
- Infectious Diseases Department, University Hospital of Saint-Etienne, GIMAP (EA 3064), F-42055 Cedex 02 Saint-Etienne, France
- Faculty of Medicine of Saint-Etienne, University of Saint-Etienne, F-42023 Cedex 02 Saint-Etienne, France
- Faculty of Medicine, University of Lyon, F-69000 Lyon, France
| | - Pauline Caraux-Paz
- Service de Maladies Infectieuses et Tropicales, Hôpital Intercommunal de Villeneuve-Saint-Georges, F-94190 Villeneuve-Saint-Georges, France
| | - Alexandre Charmillon
- CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
- Grand Est Antibiotic Stewardship Network Coordinator, AntibioEst, F-54000 Nancy, France
| | - Sylvain Diamantis
- Service de Maladies Infectieuses et Tropicales, Hôpital de Melun, F-77000 Melun, France
- Unité de Recherche DYNAMIC, Université Paris-Est Créteil, F-94000 Créteil, France
| | - Thibaut Fraisse
- Court Séjour Gériatrique Aigu, Centre Hospitalier Alès-Cévennes, F-30100 Alès, France
| | - Pierre Gazeau
- Service des Maladies Infectieuses et Tropicales, CHRU de Brest, F-29609 Brest Cedex, France
| | - Maxime Hentzien
- Department of Internal Medicine, Infectious Diseases and Clinical Immunology, University Hospital of Reims, F-51100 Reims, France
- EA3797-Viellissement Fragilité, Reims Champagne Ardennes University, F-51100 Reims, France
| | - Jean-Philippe Lanoix
- AGIR UR 4294, University Picardie Jules Verne, F-80000 Amiens, France
- Department of Infectious Diseases, Amiens University Hospital, F-80000 Amiens, France
| | - Marc Paccalin
- Pôle de Gériatrie, CHU Poitiers, Université Poitiers, F-86000 Poitiers, France
- Centre d'Investigation Clinique CIC 1402, INSERM CHU Poitiers, Université Poitiers, F-86000 Poitiers, France
| | - Alain Putot
- Médecine Interne et Maladies Infectieuses, Hôpitaux du Pays du Mont Blanc, F-74700 Sallanches, France
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires, Université de Bourgogne, F-21000 Dijon, France
| | - Yvon Ruch
- Department of Infectious Diseases, Strasbourg University Hospital, F-67000 Strasbourg, France
| | - Eric Senneville
- Service Universitaire de Maladies Infectieuses et Tropicales, Hôpital Gustave Dron, F-59200 Tourcoing, France
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9
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L A Cross E, Quan TP, Hayward GN, Walker AS, Llewelyn MJ. Development and validation of the Baseline Recurrence Risk in Cellulitis (BRRISC) score. J Infect 2024; 88:103-111. [PMID: 38128701 DOI: 10.1016/j.jinf.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Cellulitis is often treated with antibiotics for longer than recommended by guidelines. Prolonged therapy may reduce recurrence in certain patients, but it is not known which patients are at greatest risk. Our objective was to develop and temporally validate a risk prediction score to identify patients attending hospital with cellulitis at highest risk of recurrence. METHODS We included UK adult patients with cellulitis attending hospital in an electronic health records (EHR) study to identify demographic, comorbid, physiological, and laboratory factors predicting recurrence (before death) within 90 days, using multivariable logistic regression with backwards elimination in complete cases. A points-based risk score integerised model coefficients for selected predictors. Performance was assessed using the C-index in development and temporal validation samples. RESULTS The final model included 4938 patients treated for median 8 days (IQR 6-11); 8.8% (n = 436) experienced hospitalisation-associated recurrence. A risk score using eight variables (age, heart rate, urea, platelets, albumin, previous cellulitis, venous insufficiency, and liver disease) ranged from 0-15, with C-index = 0.65 (95%CI: 0.63-0.68). Categorising as low (score 0-1), medium (2-5) and high (6-15) risk, recurrence increased fourfold; 3.2% (95%CI: 2.3-4.4%), 9.7% (8.7-10.8%), and 16.6% (13.3-20.4%). Performance was maintained in the validation sample (C-index = 0.63 (95%CI: 0.58-0.67)). Among patients at high risk, four distinct clinical phenotypes were identified using hierarchical clustering 1) young, acutely unwell with liver disease; 2) comorbid with previous cellulitis and venous insufficiency; 3) chronic renal disease with severe renal impairment; and 4) acute severe illness, with substantial inflammatory responses. CONCLUSIONS Risk of cellulitis recurrence varies markedly according to individual patient factors captured in the Baseline Recurrence Risk in Cellulitis (BRRISC) score. Further work is needed to optimise the score, considering baseline and treatment response variables not captured in EHR data, and establish the utility of risk-based approaches to guide optimal antibiotic duration.
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Affiliation(s)
- Elizabeth L A Cross
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer BN1 9PS, UK
| | - T Phuong Quan
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; NIHR Biomedical Research Centre, Oxford OX3 9DU, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
| | - Gail N Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, UK
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; NIHR Biomedical Research Centre, Oxford OX3 9DU, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
| | - Martin J Llewelyn
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer BN1 9PS, UK.
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10
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Stoldick M, Vannier M, Verdalle-Cazes M, Etienne M, Alexandre K. Short-Course Versus Prolonged-Course Antimicrobial Therapy in Adults With Catheter-Related Septic Thrombosis: A Propensity-Weighted Retrospective Study. Open Forum Infect Dis 2023; 10:ofad530. [PMID: 37953819 PMCID: PMC10638491 DOI: 10.1093/ofid/ofad530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023] Open
Abstract
Background Optimal duration of antimicrobial therapy (AT) for catheter-related septic deep venous thrombosis (DVT) is unknown. We aimed to compare the outcomes of patients receiving short-course AT (≤21 days) versus prolonged-course AT (>21 days). Methods This was a monocentric retrospective study comparing adults with catheter-related septic DVT from 2015 to 2020 treated with short- or prolonged-course AT. A propensity score-weighted analysis was used to mitigate potential bias. The primary outcome was a composite of all-cause mortality or recurrent bloodstream infection 30 days after AT discontinuation. Results Of 172 patients with catheter-related septic DVT, 104 were treated with prolonged-course AT and 68 with short-course AT. In the propensity score analysis, we found no significant difference in 30-day all-cause mortality or relapse between the 2 groups (inverse probability of treatment weighted hazard ratio [wHR], 2.16 [95% confidence interval {CI}, .68-6.88]; P = .192). No differences in 90-day all-cause mortality and 90-day relapse were observed between the treatment groups (wHR, 1.01 [95% CI, .49-2.05], P = .987 and 1.13 [95% CI, .08-15.62], P = .928, respectively). Conclusions A 21-day AT could be an effective and safe option to treat catheter-related septic DVT. Further randomized studies are needed to establish the optimal duration of AT for patients with catheter-related septic DVT.
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Affiliation(s)
- Marine Stoldick
- Department of Infectious Diseases, Centre hospitalier universitaire Rouen, Rouen, France
| | - Margot Vannier
- Department of Biostatistics, Centre hospitalier universitaire Rouen, Rouen, France
| | | | - Manuel Etienne
- Univ Rouen Normandie, Université de Caen, INSERM, Normandie Univ, DYNAMICURE Unité mixte de recherche 1311, Centre hospitalier universitaire Rouen, Department of Infectious Diseases, Rouen, France
| | - Kévin Alexandre
- Univ Rouen Normandie, Université de Caen, INSERM, Normandie Univ, DYNAMICURE Unité mixte de recherche 1311, Centre hospitalier universitaire Rouen, Department of Infectious Diseases, Rouen, France
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11
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Strazzulla A, Ballarin M, Postorino MC, Lee R, Leroy P, Castan B, Diamantis S. Knowledge of recommended antibiotic treatments for community-acquired infections in general medical practice: a cross-sectional study in Occitanie region, France. Sci Rep 2023; 13:17312. [PMID: 37828124 PMCID: PMC10570346 DOI: 10.1038/s41598-023-43809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
To assess and analyse the knowledge of recommended antibiotic treatments, focusing on the appropriate drugs and treatment durations for the most common community-acquired infections in general medical practice in Occitanie region, France. A web-based survey was conducted over a 3-month period, from October, 2018 to January, 2019. All participants answered directly through the online platform. For the analysis of overtreatment risk, a score based system was adopted and two scores were produced: the duration score and the treatment score. 413 general practitioners completed the survey. The overall rate of concordance with guidelines in terms of both drug choice and treatment length was 2974/4956 (60%) answers. Diseases with at least 70% good answers included cystitis, group A streptococcal pharyngitis, and bacterial superficial skin infections. Diseases with fewer than 50% good answers included pyelonephritis, dog bite wounds, and community-acquired pneumonia in patients aged ≥ 65 years. Factors associated with the risk of overtreatment were age > 40 years, country setting and hospital employment. Knowledge of treatment durations is satisfactory with 60% of recommendations being met. However, varying levels were observed according to different diseases. This study highlighted a very high rate of adherence when recommendations were clear. In contrast, low levels of adherence were observed when recommendations were ambiguous or when conflicting guidelines existed.
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Affiliation(s)
- Alessio Strazzulla
- Internal Medicine Unit, Groupe Hospitalier Sud Ile de France, Melun, France.
| | - Manuel Ballarin
- Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France
| | | | - Raphaël Lee
- Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Pierre Leroy
- Public Health Unit, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Bernard Castan
- Infectious Diseases Unit, Centre Hospitalier de Périgueux, Périgueux, France
| | - Sylvain Diamantis
- Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France
- Public Health Unit, Groupe Hospitalier Sud Ile de France, Melun, France
- Research Unit "DYNAMIC", Université Paris-Est Créteil, Créteil, France
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12
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Nve E, Badia JM, Amillo-Zaragüeta M, Juvany M, Mourelo-Fariña M, Jorba R. Early Management of Severe Biliary Infection in the Era of the Tokyo Guidelines. J Clin Med 2023; 12:4711. [PMID: 37510826 PMCID: PMC10380792 DOI: 10.3390/jcm12144711] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/28/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Sepsis of biliary origin is increasing worldwide and has become one of the leading causes of emergency department admissions. The presence of multi-resistant bacteria (MRB) is increasing, and mortality rates may reach 20%. This review focuses on the changes induced by the Tokyo guidelines and new concepts related to the early treatment of severe biliary disease. If cholecystitis or cholangitis is suspected, ultrasound is the imaging test of choice. Appropriate empirical antibiotic treatment should be initiated promptly, and selection should be performed while bearing in mind the severity and risk factors for MRB. In acute cholecystitis, laparoscopic cholecystectomy is the main therapeutic intervention. In patients not suitable for surgery, percutaneous cholecystostomy is a valid alternative for controlling the infection. Treatment of severe acute cholangitis is based on endoscopic or transhepatic bile duct drainage and antibiotic therapy. Endoscopic ultrasound and other new endoscopic techniques have been added to the arsenal as novel alternatives in high-risk patients. However, biliary infections remain serious conditions that can lead to sepsis and death. The introduction of internationally accepted guidelines, based on clinical presentation, laboratory tests, and imaging, provides a framework for their rapid diagnosis and treatment. Prompt assessment of patient severity, timely initiation of antimicrobials, and early control of the source of infection are essential to reduce morbidity and mortality rates.
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Affiliation(s)
- Esther Nve
- Department of Surgery, Hospital Universitari Mútua de Terrassa, 08221 Barcelona, Spain;
- School of Medicine, Universitat Rovira i Virgili, 43003 Tarragona, Spain;
| | - Josep M. Badia
- Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain; (M.A.-Z.); (M.J.)
| | - Mireia Amillo-Zaragüeta
- Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain; (M.A.-Z.); (M.J.)
| | - Montserrat Juvany
- Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain; (M.A.-Z.); (M.J.)
| | - Mónica Mourelo-Fariña
- Intensive Care Unit, Complexo Hospitalario Universitario A Coruña, 15006 A Coruña, Spain;
| | - Rosa Jorba
- School of Medicine, Universitat Rovira i Virgili, 43003 Tarragona, Spain;
- Department of Surgery, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
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13
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Bouza E, Burillo A, Muñoz P. How to manage skin and soft-tissue infections in the emergency department. Curr Opin Infect Dis 2023; 36:81-88. [PMID: 36853739 DOI: 10.1097/qco.0000000000000906] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Our purpose is to review the state-of-the-art on the management of skin and soft tissue infections (SSTI) in emergency departments (ED).Although the information is scarce, SSTI may account for 3-30% of all cases presenting to an ED, of which 25-40% require hospital admission.SSTI include very different entities in aetiology, location, pathogenesis, extension, and severity. Therefore, no single management can be applied to them all. A simple approach is to classify them as non-purulent, purulent, and necrotising, to which a severity scale based on their systemic repercussions (mild, moderate, and severe) must be added.The initial approach to many SSTIs often requires no other means than anamnesis and physical examination, but imaging tests are an indispensable complement in many other circumstances (ultrasound, computerized tomography, magnetic resonance imaging…). In our opinion, an attempt at etiological filiation should be made in severe cases or where there is suspicion of a causality other than the usual one, with tests based not only on cultures of the local lesion but also molecular tests and blood cultures. RECENT FINDINGS Recent contributions of interest include the value of bedside ultrasound and the potential usefulness of biomarkers such as thrombomodulin to differentiate in early stages the presence of necrotising lesions not yet explicit.New antimicrobials will allow the treatment of many of these infections, including severe ones, with oral drugs with good bioavailability and for shorter periods. SUMMARY The ED has an essential role in managing SSTIs, in their classification, in decisions on when and where to administer antimicrobial treatment, and in the rapid convening of multidisciplinary teams that can deal with the most complex situations.
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Affiliation(s)
- Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute (IiSGM)
- CIBER of Respiratory Diseases (CIBERES CB06/06/0058), Madrid, Spain
| | - Almudena Burillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute (IiSGM)
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute (IiSGM)
- CIBER of Respiratory Diseases (CIBERES CB06/06/0058), Madrid, Spain
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Lacasse M, Derolez S, Bonnet E, Amelot A, Bouyer B, Carlier R, Coiffier G, Cottier JP, Dinh A, Maldonado I, Paycha F, Ziza JM, Bemer P, Bernard L. 2022 SPILF - Clinical Practice guidelines for the diagnosis and treatment of disco-vertebral infection in adults. Infect Dis Now 2023; 53:104647. [PMID: 36690329 DOI: 10.1016/j.idnow.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
These guidelines are an update of those made in 2007 at the request of the French Society of Infectious Diseases (SPILF, Société de Pathologie Infectieuse de Langue Française). They are intended for use by all healthcare professionals caring for patients with disco-vertebral infection (DVI) on spine, whether native or instrumented. They include evidence and opinion-based recommendations for the diagnosis and management of patients with DVI. ESR, PCT and scintigraphy, antibiotic therapy without microorganism identification (except for emergency situations), therapy longer than 6 weeks if the DVI is not complicated, contraindication for spinal osteosynthesis in a septic context, and prolonged dorsal decubitus are no longer to be done in DVI management. MRI study must include exploration of the entire spine with at least 2 orthogonal planes for the affected level(s). Several disco-vertebral samples must be performed if blood cultures are negative. Short, adapted treatment and directly oral antibiotherapy or early switch from intravenous to oral antibiotherapy are recommended. Consultation of a spine specialist should be requested to evaluate spinal stability. Early lifting of patients is recommended.
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Affiliation(s)
- M Lacasse
- Medecine Interne et Maladies Infectieuses, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - S Derolez
- Rhumatologie, 125 rue de Stalingrad, CHU Avicenne, 93000 Bobigny, France
| | - E Bonnet
- Maladies Infectieuses, Pl. Dr Baylac, CHU Purpan, 31000 Toulouse, France.
| | - A Amelot
- Neurochirurgie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - B Bouyer
- Chirurgie orthopédique et traumatologique, CHU de Bordeaux, Place Amélie Raba-léon, 33076 Bordeaux, France
| | - R Carlier
- Imagerie, Hôpital Raymond Poincaré, 104 Bd R Poincaré, 92380 Garches, France
| | - G Coiffier
- Rhumatologie, GH Rance-Emeraude, Hôpital de Dinan, 22100 Dinan, France
| | - J P Cottier
- Radiologie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - A Dinh
- Maladies Infecteiuses, CHU Raymond Poicaré, 92380 Garches, France
| | - I Maldonado
- Radiologie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - F Paycha
- Médecine Nucléaire, Hôpital Lariboisière, 2 rue Ambroise Paré 75010 Paris, France
| | - J M Ziza
- Rhumatologie et Médecine Interne. GH Diaconesses Croix Saint Simon, 75020 Paris, France
| | - P Bemer
- Microbiologie, CHU de Nantes, 1 Place A. Ricordeau, Nantes 44000 Cedex 1, France
| | - L Bernard
- Medecine Interne et Maladies Infectieuses, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
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de Nettancourt A, Derdevet J, Dahmane L, Jaffal K, Perronne V, Tordjman M, Noussair L, Dinh A. [A vertebral polymicrobial osteomyelitis with atypicial microorganisms: A case report]. Rev Med Interne 2023; 44:190-194. [PMID: 36775692 DOI: 10.1016/j.revmed.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/10/2022] [Accepted: 01/08/2023] [Indexed: 02/12/2023]
Abstract
Vertebral Osteomyelitis (VO) is a rare disease, which has seen a gradual increase in its incidence over the past years. Here, we report a case, showing how difficult it can be to diagnose and manage a therapy in case of atypical microorganism. A 68-year-old man was hospitalized for a VO documented by blood cultures at Bacteroides fragilis. He first progressed favorably, but an increase in lumbar pain prompted, after an IRM, a percutaneous needle biopsy (PNB) that documented a recurrent VO at Corynebacterium striatum. In the face of this multi-microbial VO with atypicals microorganisms, a first PNB could have been discussed despite the positive blood cultures. This case report illustrates the complexity of management of VO, and its evolution according to the latest recommendations (interest of RMI during the follow-up, place of the TEP-scan, terms and conditions of immobilization, antibiotic administration methods).
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Affiliation(s)
- A de Nettancourt
- Service de maladies infectieuses et tropicales, hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - J Derdevet
- Service de maladies infectieuses et tropicales, hôpital Raymond-Poincaré, AP-HP, Garches, France.
| | - L Dahmane
- Service de maladies infectieuses et tropicales, hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - K Jaffal
- Service de maladies infectieuses et tropicales, hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - V Perronne
- Service de maladies infectieuses et tropicales, hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - M Tordjman
- Service de radiologie, hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - L Noussair
- Service de microbiologie, hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - A Dinh
- Service de maladies infectieuses et tropicales, hôpital Raymond-Poincaré, AP-HP, Garches, France
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Hajji M, Neji M, Agrebi S, Nessira SB, Hamida FB, Barbouch S, Harzallah A, Abderrahim E. Incidence and challenges in management of hemodialysis catheter-related infections. Sci Rep 2022; 12:20536. [PMID: 36446808 PMCID: PMC9709051 DOI: 10.1038/s41598-022-23787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/04/2022] [Indexed: 11/30/2022] Open
Abstract
Catheter-related infections (CRI) are a major cause of morbidity and mortality in chronic hemodialysis (HD) patients. In this paper, we share our experience with CRI in HD patients. We recorded 49 cases of CRI among 167 patients during a period of 40 months (January 2018-April 2021). The incidence of CRI was 3.7 per 1000 catheter-days. The revealing symptoms were dominated by fever or chills (90%). Inflammatory signs were observed in 74% of cases with respectively concurrent exit-site (51%) and tunnel infection (6%). The biological inflammatory syndrome was found in 74% of patients (average CRP level = 198.9 mg/l). Blood cultures were performed in all cases and were positive in 65% of cases. Thirteen patients have been diagnosed with Infection complications, which were respectively infective endocarditis in 7 cases, septic arthritis in 3 cases, infective myositis in one case, cerebral thrombophlebitis in 1 case and mediastinitis in 1 case. The death occurred in eleven patients, it was due to septic shock in 9 cases, pulmonary embolism in one case and neurologic alterations related to cerebral thrombophlebitis. The mean seniority in HD was 16.5 months in the group with CRI and 3.7 months in the group without CRI (p < 0.04). We did not notice significant difference in mortality between tunnelled and non-tunnelled catheters. CRI does not seem to be more severe in patients with diabetes. Duration of use of the HD catheter (p < 0.007) and ferritin level (p < 0.0001) were independent factors that predispose to CRI in our population.
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Affiliation(s)
- Meriam Hajji
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Manel Neji
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sahar Agrebi
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Saoussen Ben Nessira
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Samia Barbouch
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Amel Harzallah
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzedine Abderrahim
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Piraux A, Hammoud R, Riou J, Lebdai S, Faure S. Assessment of the Compliance of Cystitis Management According to French Recommendations through the Analysis of Prescriptions Collected in Community Pharmacies. Antibiotics (Basel) 2022; 11:antibiotics11070976. [PMID: 35884230 PMCID: PMC9312117 DOI: 10.3390/antibiotics11070976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 02/01/2023] Open
Abstract
Urinary tract infections, especially cystitis, are common infections; they are the second most prevalent cause of antibiotic prescriptions in community pharmacies. To reduce antimicrobial resistance, guidelines are revised regularly. This study aims to assess compliance between prescriptions collected in community pharmacies and French cystitis guidelines. A treatment is considered compliant if the nature, dosage, and duration of the antibiotics are correct. Only women aged 18–65 years with a diagnosis of cystitis were eligible. The participation of 16 pharmacies resulted in 303 prescriptions. Most infections were classified as uncomplicated cystitis (79.2%), general practitioners were the prescribers in more than 9 out of 10 cases, and fosfomycin trometamol was the antibiotic dispensed for 1 in 2 women. An average compliance of 66% was observed, but with disparities according to the type of cystitis. Two-thirds of cases of uncomplicated cystitis and recurrent cystitis followed the recommendations, whereas only 15% of cystitis cases that were at risk of complication did so. The inclusion of a urine examination in uncomplicated cystitis decreased the overall compliance rate to 5.8%. These results show the essential role played by pharmacists; they are the last line of defence before dispensing antibiotics. They must know the recommendations in order to apply them.
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Affiliation(s)
- Arthur Piraux
- University of Angers, Inserm, CNRS, MINT, SFR ICAT, F-49000 Angers, France;
- Correspondence:
| | - Ramy Hammoud
- Methodology and Biostatistics Department, University of Angers, F-49000 Angers, France;
| | - Jérémie Riou
- University of Angers, Inserm, CHU Angers, CNRS, MINT, SFR ICAT, F-49000 Angers, France;
| | - Souhil Lebdai
- Department of Urology, Angers University Hospital, F-49000 Angers, France;
| | - Sébastien Faure
- University of Angers, Inserm, CNRS, MINT, SFR ICAT, F-49000 Angers, France;
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Le Bot A, Sokal A, Choquet A, Maire F, Fantin B, Sauvanet A, de Lastours V. Clinical and microbiological characteristics of reflux cholangitis following bilio-enteric anastomosis. Eur J Clin Microbiol Infect Dis 2022; 41:1139-1143. [DOI: 10.1007/s10096-022-04468-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/20/2022] [Indexed: 12/07/2022]
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Jaffey JA. Feline cholangitis/cholangiohepatitis complex - what have we learned? J Small Anim Pract 2022; 63:573-589. [PMID: 35522164 DOI: 10.1111/jsap.13508] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 02/19/2022] [Accepted: 04/11/2022] [Indexed: 12/07/2022]
Abstract
Cholangitis/cholangiohepatitis complex in cats is commonly encountered in clinical practice worldwide. Diagnosis and management of cats with this complex is difficult because of the ambiguity of clinical signs, diagnostic test results and commonality of comorbid disorders. These impediments can delay disease identification and treatment, which can increase morbidity and mortality. In this narrative review, we aimed to provide a thorough review of the unique physioanatomic features of the biliary system as well as clinically relevant updates on cholangitis/cholangiohepatitis complex in cats.
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Affiliation(s)
- J A Jaffey
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, 85308, USA
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Acquier M, De Précigout V, Delmas Y, Dubois V, M'Zali F, Zabala A, De-La-Faille R, Rubin S, Cazanave C, Puges M, Combe C, Kaminski H. [Diagnosis and treatment of catheter-related bloodstream infection in hemodialysis: 10 years later]. Nephrol Ther 2022; 18:80-88. [PMID: 35033479 DOI: 10.1016/j.nephro.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 10/19/2022]
Abstract
Patients in hemodialysis on central venous catheter as vascular access are at risk of infections. Catheter-related bloodstream infection is one of the most serious catheter-complications in hemodialysis patients. Its clinical and microbiological diagnosis is challenging. The implementation of empiric antibiotic therapy is based on old recommendations proposing the combination of a molecule targeting methicillin-resistant Staphylococcus aureus and a betalactamin active on P. aeruginosa, and also adapting this probabilistic treatment by carrying out a microbiological register on a local scale, which is rarely done. In our hemodialysis center at Bordeaux University Hospital, an analysis of the microorganisms causing all catheter-related bloodstream infection over the period 2018-2020 enabled us to propose, in agreement with the infectious disease specialists, an adapted probabilistic antibiotic therapy protocol. This approach allowed us to observe a low incidence of meticillinoresistance of Staphylococcus. For catheters inserted more than 6 months ago, we observed no Staphylococcus, no multi-resistant Pseudomonas, and only 2% of Enterobacteria resistant to cephalosporins. A frequent updating of the microbiological epidemiology of catheter-related bloodstream infection, in partnership with the infectious diseases team in each hemodialysis center, allowing an adaptation of the probabilistic antibiotic therapy, and seems to have a good feasibility. This strategy might favor the preservation of microbial ecology on an individual and collective scale in maintenance hemodialysis patients.
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Affiliation(s)
- Mathieu Acquier
- Service de néphrologie-transplantation-dialyse-aphérèses, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Valérie De Précigout
- Service de néphrologie-transplantation-dialyse-aphérèses, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Yahsou Delmas
- Service de néphrologie-transplantation-dialyse-aphérèses, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Véronique Dubois
- Laboratoire de bactériologie, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Fatima M'Zali
- UMR 5234 CNRS, université de Bordeaux, 33000 Bordeaux, France
| | - Arnaud Zabala
- UMR 5234 CNRS, université de Bordeaux, 33000 Bordeaux, France
| | - Renaud De-La-Faille
- Service de néphrologie-transplantation-dialyse-aphérèses, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Sébastien Rubin
- Service de néphrologie-transplantation-dialyse-aphérèses, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Charles Cazanave
- Service de maladies infectieuses et tropicales, hôpital Pellegrin, CHU de Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - Mathilde Puges
- Service de maladies infectieuses et tropicales, hôpital Pellegrin, CHU de Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - Christian Combe
- Service de néphrologie-transplantation-dialyse-aphérèses, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Unité Inserm 1026 Biotis, université de Bordeaux, 33000 Bordeaux, France
| | - Hannah Kaminski
- Service de néphrologie-transplantation-dialyse-aphérèses, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; CNRS-UMR 5164 ImmunoConcEpT, université de Bordeaux, 33076 Bordeaux, France.
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21
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Current international and national guidelines for managing skin and soft tissue infections. Curr Opin Infect Dis 2022; 35:61-71. [PMID: 35067522 DOI: 10.1097/qco.0000000000000814] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Skin and soft tissue infections account for a significant percentage of both community and nosocomial infections. Several nosological entities are included in this concept. However, there is a very scarce body of doctrine for their treatment based on randomised trials. Therefore, we considered it necessary to review current treatment guidelines to bring new recommendations and improvements to our colleagues. In this review of recent literature, we identified updated guidelines in this area by searching the databases PubMed, evidence-based medicine online, York University reviewers group, Cochrane, MBE-Trip and Sumsearch using the terms: soft tissue infection, therapy, guideline. RECENT FINDINGS Developments focus on using new antimicrobials and on the prescription of shorter antibiotic treatment courses. SUMMARY With the development of new drugs and the current evidence of their use, there is a need to refine the appropriate drug's decision-making. Drugs with a long half-life, which allows weekly administration, can reduce hospital admission and length of stay with fewer healthcare resources. Shorter courses of antibiotics are recommended. The role of stewardship programmes will continue to expand. The surgical indication and its value are evident in many patients. Therefore, management should rely on a collaborative group with experience in this disease.
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Baclet N, Calafiore M, Fregnac C, Gavazzi G, Forestier E, Roubaud-Baudron C, Fraisse T, Alfandari S, Senneville E, Beuscart JB. Explicit definitions of potentially inappropriate prescriptions of antibiotics in hospitalized older patients. Infect Dis Now 2022; 52:214-222. [PMID: 35158094 DOI: 10.1016/j.idnow.2022.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/25/2021] [Accepted: 02/08/2022] [Indexed: 11/27/2022]
Abstract
CONTEXT The use of explicit definitions of potentially inappropriate prescriptions of antibiotics (antibiotic PIPs) might constitute an innovative means to fight against antimicrobial resistance. Explicit definitions of PIPs can reduce the rate of inappropriate prescriptions, but explicit definitions of antibiotic PIPs in geriatric medicine are currently lacking. The objective of the study was to develop explicit definitions of antibiotic PIPs for hospitalized older patients. METHOD We performed a qualitative study of focus groups involving geriatricians and infectious disease specialists. The study complied with the Consolidated Criteria for Reporting Qualitative Research. Transcripts of audio recordings were analyzed in a two-step independent reviewing process. The exact wording of the definitions was validated by a steering committee, an independent expert group, and the focus group participants. RESULTS The four focus groups comprised 28 stakeholders. Our analysis identified 65 explicit definitions of antibiotic PIPs: 47 (73%) concerned misuse, 15 (23%) concerned overuse and three (5%) concerned underuse. Most definitions were related to critically important antibiotics: 11 (17%) for fluoroquinolones, eight (12%) for amoxicillin-clavulanic acid, eight (12%) for cephalosporins, seven (11%) for aminoglycosides, and five (8%) for carbapenems. CONCLUSION To address the public health challenge of antimicrobial resistance, our study generated explicit definitions for antibiotic PIPs in older patients. We intend to refine and to validate these definitions through a national Delphi survey; the resulting consensus might provide key messages for prescribers and open up perspectives for reducing the incidence of antibiotic PIPs.
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Affiliation(s)
- N Baclet
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Lille Catholic Hospitals, Department of Infectious Diseases, F-59160 Lille, France
| | - M Calafiore
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - C Fregnac
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - G Gavazzi
- Clinique Universitaire de Médecine Gériatrique, Centre Hospitalier Universitaire de Grenoble-Alpes, GREPI EA7408 Université Grenoble-Alpes, F-38000 Grenoble, France
| | - E Forestier
- Service de Maladies Infectieuses, Centre Hospitalier Métropole Savoie, F-73000 Chambéry, France
| | - C Roubaud-Baudron
- CHU Bordeaux, Pôle de Gérontologie Clinique, Univ. Bordeaux, INSERM 1053 BaRITOn, F-33000 Bordeaux, France
| | - T Fraisse
- Court Séjour Gériatrique Aigu, Centre Hospitalier Alès-Cévennes, F-30100 Alès, France
| | - S Alfandari
- Gustave Dron Hospital, University Department of Infectious Diseases, F-59200 Tourcoing, France
| | - E Senneville
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Gustave Dron Hospital, University Department of Infectious Diseases, F-59200 Tourcoing, France
| | - J-B Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.
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Kurapatti M, Oakley C, Singh V, Aggarwal VK. Antibiotic Therapy in 2-Stage Revision for Periprosthetic Joint Infection: A Systematic Review. JBJS Rev 2022; 10:01874474-202201000-00003. [PMID: 35020709 DOI: 10.2106/jbjs.rvw.21.00143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Patients undergoing total joint arthroplasty (TJA) are at risk for developing periprosthetic joint infection (PJI). To treat PJI, orthopaedic surgeons can perform 1-stage or 2-stage revision arthroplasty. Although 2-stage revision yields superior long-term outcomes, the optimal antibiotic therapy duration and route of administration between stages remain uncertain. In this systematic review, we aimed to identify if variations in antibiotic therapy, duration, and administration during 2-stage hip or knee revision arthroplasty affect PJI eradication rates and surgical outcome measures. METHODS A literature search was performed using the PubMed and Google Scholar databases to identify all original reports from January 2000 to June 2021 involving 2-stage revision arthroplasty to treat PJI. Studies were included if they specified antibiotic duration, an intravenous (IV) route of antibiotic administration, type of antibiotic, and 2-stage revision PJI eradication rate and had a mean or median follow-up of at least 2 years after the second-stage operation. Included studies were classified into 3 groups based on the length of IV antibiotic therapy after prosthesis explantation: prolonged IV antibiotic therapy of 4 to 6 weeks, shortened IV antibiotic therapy of ≤2 weeks, and shortened course of IV antibiotic therapy followed by 6 to 12 weeks of oral antibiotics. RESULTS Nine studies were included. Three studies utilizing a prolonged IV antibiotic therapy had PJI eradication rates of 79% to 96%. Four studies using a shortened IV antibiotic therapy showed PJI eradication rates of 88% to 100%. Finally, 2 studies utilizing a shortened course of IV antibiotic therapy with oral antibiotics had PJI eradication rates of 95% and 97%. There was no significant difference in eradication rates across IV antibiotic duration strategies, despite a diverse array of cultured microorganisms across the studies. CONCLUSIONS Although the numbers are small, this systematic review suggests that prolonged IV antibiotic duration, shortened IV antibiotic duration, and shortened IV antibiotic duration supplemented with oral antibiotics confer similar PJI eradication rates after hip or knee arthroplasty. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mark Kurapatti
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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24
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Perera WPTD, Dissanayake DMRK, Unagolla JM, De Silva RT, Bathige SDNK, Pahalagedara LR. Albumin grafted coaxial electrosparyed polycaprolactone-zinc oxide nanoparticle for sustained release and activity enhanced antibacterial drug delivery. RSC Adv 2022; 12:1718-1727. [PMID: 35425191 PMCID: PMC8978970 DOI: 10.1039/d1ra07847j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/03/2022] [Indexed: 12/01/2022] Open
Abstract
One of the most serious issues faced by the healthcare sector is the development of multidrug resistance among various pathogens. It is such that developing new and more capable drugs takes far too long to counter such resistance. In order to overcome these concerns, this study focused on improving upon the coaxial electrospraying process by producing cloxacillin loaded albumin polycaprolactone (PCL) with a ZnO coating for sustained and activity enhanced drug delivery. Albumin-grafted, polycaprolactone-coated, zinc oxide-loaded cloxacillin (APCL-CLOX-ZnO) nanoparticles with a diameter of 85-110 nm were obtained via a coaxial electrospray technique. The encapsulation efficiency of cloxacillin of ZnO-CLOX was found to be approximately 60%. The loading efficiencies of ZnO-CLOX and APCL-CLOX-ZnO were found to be 40% and 28% respectively. Albumin was employed in order to impart immune evasion properties to the formulation. Drug-loaded ZnO NPs were analyzed using SEM, TEM, FT-IR and TGA. This novel formulation was shown to possess sustained release characteristics owing to the PCL and albumin coatings, relative to uncoated counterparts. ZnO-CLOX and APCL-CLOX-ZnO exhibited 72% and 52% cloxacillin release within 24 h. APCL-CLOX-ZnO exhibited potent antimicrobial activity against S. epidermidis, B. cereus and P. aeruginosa and some activity against E. coli with inhibition zones 32 ± 1.4, 34 ± 0.3, 32 ± 0.6 and 11 ± 0.4 mm, respectively. Cytotoxicity studies against murine preosteoblast cells revealed that the albumin-PCL coating served to drastically reduce initial toxicity against healthy mammalian cells. In vitro lung deposition study showed 70% of APCL-CLOX-ZnO particles can reach up to the alveoli level. Therefore, this novel coaxial nanoformulation may serve as a promising drug delivery platform for the treatment of bacterial infections including respiratory tract complications.
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Affiliation(s)
- W Pamoda Thavish D Perera
- Academy of the Sri Lanka Institute of Nanotechnology Nanotechnology and Science Park, Mahenwatte, Pitipana Homagama 10206 Sri Lanka
- Sri Lanka Institute of Nanotechnology Nanotechnology and Science Park, Mahenwatte, Pitipana Homagama 10206 Sri Lanka
| | - D M Ranga K Dissanayake
- Sri Lanka Institute of Nanotechnology Nanotechnology and Science Park, Mahenwatte, Pitipana Homagama 10206 Sri Lanka
- Department of Pharmacy and Pharmaceutical Sciences, University of Sri Jayewardenepura Gangodawila Nugegoda 10250 Sri Lanka
| | - Janitha M Unagolla
- Department of Bioengineering, College of Engineering, University of Toledo Toledo OH 43607 USA
| | - Rangika T De Silva
- Sri Lanka Institute of Nanotechnology Nanotechnology and Science Park, Mahenwatte, Pitipana Homagama 10206 Sri Lanka
| | - Sanjaya D N K Bathige
- Sri Lanka Institute of Nanotechnology Nanotechnology and Science Park, Mahenwatte, Pitipana Homagama 10206 Sri Lanka
| | - Lakshitha R Pahalagedara
- Sri Lanka Institute of Nanotechnology Nanotechnology and Science Park, Mahenwatte, Pitipana Homagama 10206 Sri Lanka
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Efficacy of antibiotic short course for bloodstream infections in acute myeloid leukemia patients with febrile neutropenia: A retrospective comparative study. J Infect 2022; 84:1-7. [PMID: 34715238 DOI: 10.1016/j.jinf.2021.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/04/2021] [Accepted: 10/18/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES There is no specific recommendation about antimicrobial treatment length for documented infections in chemotherapy induced febrile neutropenia (FN). Practices have changed along time in our center regarding length of antibiotic treatment. The aim of this study was to compare long versus short antibiotic course for bloodstream infection (BSI) treatment in acute myeloid leukemia (AML) patients during FN. METHODS This monocentric retrospective comparative study included all consecutive BSI episodes among AML patients with FN for 3 years (2017-2019). Episodes were classified regarding the length of antibiotic treatment, considered as short course if the treatment lasted ≤ 7 days, except for nonfermenting bacteria and Staphylococcus aureus or lugdunensis for which the threshold was ≤ 10 days and ≤ 14 days, respectively. The primary outcome was the number of BSI relapses in both groups within 30 days of antibiotic discontinuation. RESULTS Among 71 AML patients, 104 BSI episodes were included; 48 (46%) received short course treatment. Only 8 (7.6%) BSI episodes relapsed within 30 days of antibiotic discontinuation, 5 having received short course treatment. No association was found between risk of relapse and short course of antibiotic treatment (p = 0.37). The only risk factor significantly associated with BSI relapse was neutropenia duration (p = 0.005). CONCLUSION Antibiotic short course seemed as effective as prolonged treatment for BSI in AML patients during FN, with very few relapses at day 30. These encouraging findings should be confirmed through prospective studies.
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Jaffey JA. Canine intrahepatic biliary disease - what have we learned? J Small Anim Pract 2021; 63:167-173. [PMID: 34585753 DOI: 10.1111/jsap.13433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/08/2021] [Accepted: 09/06/2021] [Indexed: 12/07/2022]
Abstract
The intrahepatic biliary tract is essential for physiologic homeostasis. Disease that results in aberrant function can have serious deleterious consequences and result in considerable morbidity and mortality. This review aimed to summarise clinically relevant updates on intrahepatic biliary disorders in dogs including human corollaries.
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Affiliation(s)
- J A Jaffey
- Department of Specialty Medicine, Midwestern University, College of Veterinary Medicine, 19555 N 59th Avenue, Glendale, AZ, 85308, USA
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Cefepime use: A need for antimicrobial stewardship. Infect Dis Now 2021; 51:445-450. [PMID: 33960301 DOI: 10.1016/j.idnow.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/30/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Unlike other 3GCs, Cefepime is a cephalosporin that has, in animal model studies, shown a low risk of selecting resistant mutants. It also enables carbapenems to be saved in treatment of Pseudomonasaeruginosa and the CESP group (Citrobacter, Enterobacter, Serratia and Providencia, as well as the genus Klebsiellaaerogenes, Morganella and Hafnia), consequently producing cephalosporinase. We aimed to determine whether its prescription in a French teaching hospital met criteria for proper use. PATIENTS AND METHODS We conducted a retrospective study of proper cefepime use between March 1st, 2018 and February 28th, 2019, to assess indication, antimicrobial stewardship, dosing schedule, microbiological documentation, reevaluation, and treatment duration. Prescriptions were then compared to local guidelines established from international literature. RESULTS Out of 142 cefepime prescriptions, 97.2% were prescribed as validated according to indication. The duration of the documented treatments matched the guidelines for 56.5% of patients, dosage was adapted to the indication for 77.4% and to kidney function for 97.2%. Bacteriological documentation was performed in all cases and an antibiogram was generated in 99.2% of cases. The treatment was reassessed between 48 and 72h and between the 7th and 10th day for 44.2% and 60.9% of the prescriptions respectively. The antimicrobial stewardship team managed half of the prescriptions. Only 13.4% of prescriptions met all criteria for proper use. CONCLUSION Notwithstanding a highly sizable majority of validated indications, a very small proportion of cefepime prescriptions met all the criteria for proper use. In the context of increased cefepime consumption, which is favored by its increased place in the latest recommendations published in 2019, proper use of cefepime prescriptions needs to be more effectively promoted.
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Erba L, Furlan L, Monti A, Marsala E, Cernuschi G, Solbiati M, Bracco C, Bandini G, Pecorino Meli M, Casazza G, Montano N, Sbrojavacca R, Costantino G. Short vs long-course antibiotic therapy in pyelonephritis: a comparison of systematic reviews and guidelines for the SIMI choosing wisely campaign. Intern Emerg Med 2021; 16:313-323. [PMID: 32566969 DOI: 10.1007/s11739-020-02401-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Italian Society of Internal Medicine (SIMI) Choosing Wisely Campaign has recently proposed, among its five items, to reduce the prescription of long-term intravenous antibiotics if not indicated. The aim of our study was to assess the available evidences on optimal duration of antibiotic treatment in pyelonephritis through a systematic review of secondary studies. MATERIALS AND METHODS We searched for all guidelines on pyelonephritis and systematic reviews assessing the optimal duration of antibiotic therapy in this type of infection. We compared the recommendations of the three most cited and recent guidelines on the topic of interest. We extracted data of non-duplicated RCT from the selected systematic reviews and performed meta-analyses for clinical and microbiological failure. A trial sequential analysis (TSA) was also achieved to identify the need for further evidence. RESULTS We identified 4 systematic reviews, including data from 10 non-duplicated RCTs (1536 patients). The meta-analysis showed a higher rate of clinical cure for short-course antibiotic treatment (RR for clinical failure 0.70, 95% CI [0.53-0.94]). No significant difference in the rate of microbiological failure (RR 1.06, 95% CI [0.75-1.49]) was observed. In terms of clinical cure, the TSA suggests that current evidence is sufficient to consider short course at least as effective as long-course treatment. Selected guidelines recommend considering shorter courses, but do not cite most of the published RCTs. CONCLUSIONS Short-course antibiotic treatment is at least as effective as longer courses for both microbiological and clinical success in the treatment of acute uncomplicated pyelonephritis.
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Affiliation(s)
- Luca Erba
- Università Degli Studi Di Milano, Milan, Italy.
| | | | - Alice Monti
- Università Degli Studi Di Milano, Milan, Italy
| | | | - Giulia Cernuschi
- UOC Pronto Soccorso E Medicina D'Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Solbiati
- UOC Pronto Soccorso E Medicina D'Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Christian Bracco
- Department of Internal Medicine, Santa Croce and Carle General Hospital, Cuneo, Italy
| | - Giulia Bandini
- Medicina Interna, Università Degli Studi Di Firenze, AOU Careggi, Firenze, Italy
| | - Monica Pecorino Meli
- Dipartimento Delle Professioni Sanitarie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Dipartimento Di Scienze Biomediche E Cliniche "L. Sacco", Università Degli Studi Di Milano, Milan, Italy
| | - Nicola Montano
- Dipartimento Di Medicina Interna, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento Di Scienze Cliniche E Di Comunità, Università Degli Studi Di Milano, Milan, Italy
| | - Rodolfo Sbrojavacca
- Dipartimento Di Pronto Soccorso E Medicina D'Urgenza, Azienda Ospedaliera Universitaria Di Udine, Udine, Italy
| | - Giorgio Costantino
- UOC Pronto Soccorso E Medicina D'Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento Di Scienze Cliniche E Di Comunità, Università Degli Studi Di Milano, Milan, Italy
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Gauzit R, Castan B, Bonnet E, Bru JP, Cohen R, Diamantis S, Faye A, Hitoto H, Issa N, Lebeaux D, Lesprit P, Maulin L, Poitrenaud D, Raymond J, Strady C, Varon E, Verdon R, Vuotto F, Welker Y, Stahl JP. Anti-infectious treatment duration: The SPILF and GPIP French guidelines and recommendations. Infect Dis Now 2021; 51:114-139. [PMID: 34158156 DOI: 10.1016/j.idnow.2020.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023]
Affiliation(s)
- R Gauzit
- Infectiologie transversale, CHU Cochin, AP-HP, 75014 Paris, France.
| | - B Castan
- Maladies infectieuses et tropicales, CHG, 24000 Périgueux, France
| | - E Bonnet
- Équipe Mobile d'Infectiologie, Hôpital Joseph-Ducuing, Clinique Pasteur, 31300 Toulouse, France
| | - J P Bru
- Maladies Infectieuses, CH Annecy-Genevois, 74374 Pringy, France
| | - R Cohen
- Unité petits nourrissons, CHI, 94000 Créteil, France
| | - S Diamantis
- Maladies Infectieuses et Tropicales, groupe hospitalier Sud Île-de-France, 77000 Melun, France
| | - A Faye
- Pédiatrie Générale et maladies infectieuses, Hôpital Robert-Debré, Université de Paris, AP-HP, 75019 Paris, France
| | - H Hitoto
- Maladies Infectieuses et Tropicales, CH, 72037 Le Mans, France
| | - N Issa
- Réanimation médicale et maladies infectieuses, Hôpital Saint-André, CHU, 33000 Bordeaux, France
| | - D Lebeaux
- Université de Paris, 75006 Paris, France; Microbiologie, Unité Mobile d'Infectiologie, HEGP, AP-HP, 75015 Paris, France
| | - P Lesprit
- Unité transversale d'hygiène et d'infectiologie, Service de Biologie Clinique, Hôpital Foch, 92150 Suresnes, France
| | - L Maulin
- Maladies Infectieuses et tropicales, CHIAP, 13616 Aix-en-Provence, France
| | - D Poitrenaud
- Unité fonctionnelle d'Infectiologie Régionale, CH Ajaccio, 20303 Ajaccio, France
| | - J Raymond
- Bactériologie, Centre Hospitalier Bicêtre, 94270 Kremlin-Bicêtre, France
| | - C Strady
- Cabinet d'infectiologie, Groupe Courlancy, 51100 Reims, France
| | - E Varon
- Laboratoire de Biologie Médicale et Centre National de Référence des Pneumocoques, CHIC, 94000 Créteil, France
| | - R Verdon
- Maladies Infectieuses et Tropicales, CHU, 14033 Caen, France; Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Univ, UNICAEN, UNIROUEN, GRAM 2.0, 14000 Caen, France
| | - F Vuotto
- Maladies Infectieuses, CHU, Hôpital Huriez, 59000 Lille, France
| | - Y Welker
- Maladies Infectieuses, CHI, 78100 Saint-Germain-en-Laye, France
| | - J P Stahl
- Infectiologie, CHU Grenoble Alpes, 38043 Grenoble, France
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Flateau C, Dinia M, Raulet N, Sayegh S, Diamantis S, Jager M. Does a 5-day course of antibiotics in elderly patients with community-acquired pneumonia achieve the established criteria of clinical stability? Infect Dis Now 2020; 51:377-379. [PMID: 33096201 DOI: 10.1016/j.medmal.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/30/2020] [Accepted: 10/14/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to determine the proportion of elderly patients hospitalised for community-acquired pneumonia (CAP) in whom a 5-day antibiotic therapy would achieve clinical stability according to American Thoracic Society (ATS) criteria. METHODS Patients aged≥75 years, hospitalised for CAP between November 2018 and August 2019, were analysed retrospectively. The American Thoracic Society (ATS) clinical stability criteria (temperature≤37°C, heart rate≤100/min, respiratory rate≤24/min, systolic blood pressure≥90mmHg, oxygen saturation≥90% in room air) were assessed after five days of antibiotic therapy. RESULTS Seventy-five patients (mean age 88 years, 49% requiring oxygen therapy) were included. Six died, and at day 5, 36/69 (52%) fulfilled 4/5 stability criteria. The median duration of treatment was 9 days. In 28 patients (41%), it was ≤7 days. CONCLUSION In 52% of elderly patients with CAP, a 5-day treatment regimen resulted in clinical stability.
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Affiliation(s)
- C Flateau
- Service des maladies infectieuses, Santépôle, groupe hospitalier sud Île-de-France, 270, avenue Marc-Jacquet, 77000 Melun, France.
| | - M Dinia
- Service de gériatrie, Santépôle, groupe hospitalier sud Île-de-France, 270, avenue Marc-Jacquet, 77000 Melun, France
| | - N Raulet
- Service de gériatrie, Santépôle, groupe hospitalier sud Île-de-France, 270, avenue Marc-Jacquet, 77000 Melun, France
| | - S Sayegh
- Département d'informatique médicale, Santépôle, groupe hospitalier sud Île-de-France, 270, avenue Marc-Jacquet, 77000 Melun, France
| | - S Diamantis
- Service des maladies infectieuses, Santépôle, groupe hospitalier sud Île-de-France, 270, avenue Marc-Jacquet, 77000 Melun, France
| | - M Jager
- Service de gériatrie, Santépôle, groupe hospitalier sud Île-de-France, 270, avenue Marc-Jacquet, 77000 Melun, France
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Kong E. F-18 fluorodeoxyglucose positron emission tomography/computed tomography in the infection of heart. Yeungnam Univ J Med 2020; 38:95-106. [PMID: 33053614 PMCID: PMC8016625 DOI: 10.12701/yujm.2020.00479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/10/2020] [Indexed: 02/05/2023] Open
Abstract
Infections involving the heart are becoming increasingly common, and a timely diagnosis of utmost importance, despite its challenges. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a recently introduced diagnostic tool in cardiology. This review focuses on the current evidence for the use of FDG PET/CT in the diagnosis of infective endocarditis, cardiac implantable device infection, left ventricular assist device infection, and secondary complications. The author discusses considerations when using FDG PET/CT in routine clinical practice, patient preparation for reducing physiologic myocardial uptake, acquisition of images, and interpretation of PET/CT findings. This review also functions to highlight the need for a standardized acquisition protocol.
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Affiliation(s)
- Eunjung Kong
- Department of Nuclear Medicine, Yeungnam University College of Medicine, Daegu, Korea
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Li X, Liu C, Mao Z, Li Q, Qi S, Zhou F. Short-course versus long-course antibiotic treatment in patients with uncomplicated gram-negative bacteremia: A systematic review and meta-analysis. J Clin Pharm Ther 2020; 46:173-180. [PMID: 32981149 PMCID: PMC7820952 DOI: 10.1111/jcpt.13277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/27/2020] [Accepted: 09/07/2020] [Indexed: 12/18/2022]
Abstract
What is known and objective Gram‐negative bacteremia remains a major health problem around the world. The optimal duration of antibiotic treatment has been poorly defined, and there are significant differences of opinion between clinicians. We conducted this systematic review and meta‐analysis to compare the clinical outcomes of short‐course and long‐course treatments in patients with uncomplicated gram‐negative bacteremia. Methods We searched public databases (PubMed, EMBASE and Cochrane Library) to identify eligible studies. The primary outcomes were all‐cause mortality and the incidence of recurrent bacteremia through day 30. We used the Cochrane risk of bias assessment tool to evaluate the risk of bias for randomized controlled trials (RCTs) and the Newcastle‐Ottawa Scale for non‐RCTs. Results and discussion Six studies involving 2689 patients were included in the systematic review and meta‐analysis. No significant difference was found between short‐course and long‐course antibiotic treatments in 30‐day mortality (risk ratio [RR] 0.85; 95% confidence interval [CI] 0.65‐1.13; P = .26), 30‐day recurrent bacteremia (RR 1.07; 95% CI 0.68‐1.67; P = .78), 90‐day mortality (RR 0.84; 95% CI 0.57‐1.24; P = .38), 90‐day recurrent bacteremia (RR 0.98; 95% CI 0.50‐1.89; P = .94), adverse events (RR 1.14; 95% CI 0.89‐1.45; P = .30), Clostridium difficile infection (RR 0.86; 95% CI 0.40‐1.86; P = .71) or resistance development (RR 1.19; 95% CI 0.66‐2.14; P = .57). What is new and conclusion Short‐course was non‐inferior to long‐course antibiotic treatments for patients with uncomplicated gram‐negative bacteremia. Considering the drug‐related side effects and cost‐effectiveness, a shorter duration of antibiotic treatment may be preferable for this particular population. However, additional high‐quality RCTs are needed to further assess whether a shorter course of antibiotic treatment is of greater benefit for patients with uncomplicated gram‐negative bacteremia.
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Affiliation(s)
- Xiaoming Li
- Medical School of Chinese PLA, Beijing, China.,Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Chao Liu
- Medical School of Chinese PLA, Beijing, China
| | - Zhi Mao
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Qinglin Li
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Shuang Qi
- Medical School of Chinese PLA, Beijing, China.,Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Feihu Zhou
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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Wicky J, Ménétré S, Charmillon A, Schweitzer C, Demoré B. Assessment of antibiotic prescriptions in pediatric care units in a regional university hospital. Infect Dis Now 2020; 51:55-60. [PMID: 32360394 DOI: 10.1016/j.medmal.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/17/2019] [Accepted: 04/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The main objective was to assess the relevance of antibiotic prescriptions in the pediatric wards of a regional university hospital in France. Secondary objectives were to assess adequacy of the dose, administration frequency, administration route, treatment duration, adaptation to bacteriological results, and treatment reevaluation. PATIENTS AND METHODS We assessed antibiotic prescriptions in pediatric settings. We included all patients under 18 years of age hospitalized in a pediatric ward who received a computerized prescription for antibiotic treatment between June 1st and June 30th, 2018; 163 clinical cases for 157 patients were analyzed. Patients hospitalized in neonatology, pediatric intensive care unit, and onco-hematology wards were excluded. RESULTS The rate of relevance was 71%. The rates of adequacy for the other criteria were 60% for the dose, 99% for the administration frequency, 98% for the administration route, 72% for treatment duration, 98% for treatment adaptation to microbiological results, and 100% for treatment revaluation. All criteria combined, the overall rate of adequacy was 28%. CONCLUSIONS Effort should be made regarding doses and treatment durations. Areas for improvement have been suggested to the wards: standardized prescription protocols, pediatric prescription guide, training of residents, setting up of the operational team in pediatric wards and a second clinical evaluation.
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Affiliation(s)
- J Wicky
- Pharmacie, centre hospitalier régional universitaire de Nancy, rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France.
| | - S Ménétré
- Pharmacie, centre hospitalier régional universitaire de Nancy, rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France
| | - A Charmillon
- Maladies infectieuses et tropicales, centre hospitalier régional universitaire de Nancy, rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France
| | - C Schweitzer
- Pôle enfant-néonatologie, hôpital d'enfants, centre hospitalier régional universitaire de Nancy, rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France; EVAH EA 3450, faculté de médecine, université de Lorraine, avenue de la Forêt-de-Haye, 54505 Vandœuvre-Lès-Nancy cedex, France
| | - B Demoré
- Pharmacie, centre hospitalier régional universitaire de Nancy, rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France; APEMAC, université de Lorraine, avenue de la Forêt-de-Haye, 54505 Vandœuvre-Lès-Nancy cedex, France
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Dudareva M, Kümin M, Vach W, Kaier K, Ferguson J, McNally M, Scarborough M. Short or Long Antibiotic Regimes in Orthopaedics (SOLARIO): a randomised controlled open-label non-inferiority trial of duration of systemic antibiotics in adults with orthopaedic infection treated operatively with local antibiotic therapy. Trials 2019; 20:693. [PMID: 31815653 PMCID: PMC6902346 DOI: 10.1186/s13063-019-3832-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/22/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Orthopaedic infections, such as osteomyelitis, diabetic foot infection and prosthetic joint infection, are most commonly treated by a combination of surgical debridement and a prolonged course of systemic antibiotics, usually for at least 4-6 weeks. Use of local antibiotics, implanted directly into the site of infection at the time of surgery, may improve antibiotic delivery and allow us to shorten the duration of systemic antibiotic therapy, thereby limiting the frequency of side effects, cost and selection pressure for antimicrobial resistance. METHODS SOLARIO is a multicentre open-label randomised controlled non-inferiority trial comparing short and long systemic antibiotic therapy alongside local antibiotic therapy. Adult patients with orthopaedic infection, who have given informed consent, will be eligible to participate in the study provided that no micro-organisms identified from deep tissue samples are resistant to locally implanted antibiotics. Participants will be randomised in a 1:1 ratio to receive either a short course (≤ 7 days) or currently recommended long course (≥ 4 weeks) of systemic antibiotics. The primary outcome will be treatment failure by 12 months after surgery, as ascertained by an independent Endpoint Committee blinded to treatment allocation. An absolute non-inferiority margin of 10% will be used for both per-protocol and intention-to-treat populations. Secondary outcomes will include probable and definite treatment failure, serious adverse events, treatment side effects, quality of life scores and cost analysis. DISCUSSION This study aims to assess a treatment strategy that may enable the reduction of systemic antibiotic use for patients with orthopaedic infection. If this strategy is non-inferior, this will be to the advantage of patients and contribute to antimicrobial stewardship. TRIAL REGISTRATION Clinicaltrials.gov, NCT03806166. Registered on 11 November 2019.
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Affiliation(s)
- Maria Dudareva
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.
| | - Michelle Kümin
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Werner Vach
- Department of Orthopaedics and Traumatology, Universitätsspital Basel, Basel, Switzerland
| | - Klaus Kaier
- Institute of Medical Biometry and Medical Informatics, Universitätsklinikums Freiburg, Freiburg, Germany
| | - Jamie Ferguson
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - Martin McNally
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - Matthew Scarborough
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
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37
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Abbara S, Domenech de Cellès M, Batista R, Mira JP, Poyart C, Poupet H, Casetta A, Kernéis S. Variable impact of an antimicrobial stewardship programme in three intensive care units: time-series analysis of 2012-2017 surveillance data. J Hosp Infect 2019; 104:150-157. [PMID: 31605739 DOI: 10.1016/j.jhin.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/29/2019] [Accepted: 10/01/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Preprescription authorization (PPA) and postprescription review with feedback (PPRF) were successively implemented in 2012 and 2016 in our 1500-bed hospital. AIM The impact of PPA and PPRF on carbapenems use and resistance levels of Pseudomonas aeruginosa was assessed in three intensive care units (ICUs). METHODS Carbapenems use (in DDDs/1000 occupied bed-days) and resistance of P. aeruginosa (percentage of non-susceptible (I+R) isolates to imipenem and/or meropenem) were analysed using a controlled interrupted time-series method. Two periods were compared: 2012-2015 (PPA) and 2016-2017 (PPA+PPRF). Models were adjusted on the annual incidence of extended-spectrum β-lactamase-producing enterobacteriacae. FINDINGS Carbapenem use was stable over the PPA period in all ICUs, with a significant change of slope over the PPA+PPRF period only in ICU1 (β2 = -12.8, 95% confidence interval (CI) = -19.5 to -6.1). There was a switch from imipenem to meropenem during the PPA period in all three units. Resistances of P. aeruginosa were stable over the study period in ICU1 and ICU2, and significantly decreased over the PPA+PPRF period in ICU3 (β2 = -0.18, CI = -0.3 to -0.03). CONCLUSION In real-life conditions and with the same antimicrobial stewardship programme (AMSP) led by a single team, the impact of PPRF was heterogeneous between ICUs. Factors driving the impact of AMSPs should be further assessed in comparable settings through real-life data, to target where they could prove cost-effective.
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Affiliation(s)
- S Abbara
- INSERM, UMR 1181, Biostatistics, Biomathematics, Pharmacoepidemiology, and Infectious Diseases (B2PHI), Paris, France; Institut Pasteur, B2PHI, Paris, France; Versailles Saint-Quentin University, UMR 1181, B2PHI, Montigny-le-Bretonneux, France; Antimicrobial Stewardship Team, Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre-Site Cochin, Paris, France.
| | - M Domenech de Cellès
- INSERM, UMR 1181, Biostatistics, Biomathematics, Pharmacoepidemiology, and Infectious Diseases (B2PHI), Paris, France; Institut Pasteur, B2PHI, Paris, France; Versailles Saint-Quentin University, UMR 1181, B2PHI, Montigny-le-Bretonneux, France
| | - R Batista
- Pharmacy, Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre - Site Cochin, Paris, France
| | - J P Mira
- Medical Intensive Care Unit, Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre - Site Cochin, Paris, France; Université Paris Descartes, Sorbonne Paris cité, Paris, France
| | - C Poyart
- Université Paris Descartes, Sorbonne Paris cité, Paris, France; Department of Bacteriology, Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre - Site Cochin, Paris, France
| | - H Poupet
- Department of Bacteriology, Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre - Site Cochin, Paris, France
| | - A Casetta
- Infection Control Team, Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre - Site Cochin, Paris, France
| | - S Kernéis
- INSERM, UMR 1181, Biostatistics, Biomathematics, Pharmacoepidemiology, and Infectious Diseases (B2PHI), Paris, France; Institut Pasteur, B2PHI, Paris, France; Versailles Saint-Quentin University, UMR 1181, B2PHI, Montigny-le-Bretonneux, France; Université Paris Descartes, Sorbonne Paris cité, Paris, France; Antimicrobial Stewardship Team, Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre-Site Cochin, Paris, France
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Macheda G, Luc A, Béraud G, Castan B, Gauzit R, Lesprit P, Tattevin P, Thilly N, Pulcini C. Impact of the French Infectious Diseases Society's (SPILF) proposals for shorter antibiotic therapies. Med Mal Infect 2019; 49:456-462. [PMID: 31351803 DOI: 10.1016/j.medmal.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/31/2018] [Accepted: 07/03/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To compare the practices of French infection specialists related to antibiotic therapy duration between 2016 and 2018. METHODS We conducted two identical surveys (in 2016 and 2018) targeting hospital-based infection specialists (medical physicians, pharmacists) who gave at least weekly advice on antibiotic prescriptions. The questionnaire included 15 clinical vignettes. Part A asked about the durations of antibiotic therapies they would usually advise to prescribers, and part B asked about the shortest duration they would be willing to advise for the same clinical situations. RESULTS We included 325 specialists (165 in 2016 and 160 in 2018), mostly infectious disease specialists (82.4%, 268/325), members of antibiotic stewardship teams in 72% (234/325) of cases. Shorter antibiotic treatments (as compared with the literature) were advised to prescribers in more than half of the vignettes by 71% (105/147) of respondents in 2018, versus 46% (69/150) in 2016 (P<0.001). Guidelines used by participants displayed fixed durations for 77% (123/160) of cases in 2018 versus 21% (35/165) in 2016. Almost all respondents (89%, 131/160) declared they were aware of the 2017 SPILF's proposal. CONCLUSION The release of guidelines promoting shorter durations of antibiotic therapy seems to have had a favourable impact on practices of specialists giving advice on antibiotic prescriptions.
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Affiliation(s)
- G Macheda
- Infectious diseases department, université de Lorraine, CHRU de Nancy, 54000 Nancy, France
| | - A Luc
- Plateforme d'aide à la recherche clinique, CHRU de Nancy, 54000 Nancy, France
| | - G Béraud
- Médecine interne et maladies infectieuses, CHU de Poitiers, 86021 Poitiers, France; Centre de recherche du CHU de Québec, université Laval, hôpital Saint-Sacrement, chemin Sainte-Foy, Québec, Canada; Hasselt university, interuniversity institute for biostatistics and statistical bioinformatics, Censtat, Hasselt, Belgium
| | - B Castan
- Unité fonctionnelle d'infectiologie régionale, centre hospitalier d'Ajaccio, 20303 Ajaccio, France
| | - R Gauzit
- Équipe mobile d'infectiologie, université Paris Descartes, hôpitaux universitaires Paris centre-site Cochin, AP-HP, 75014 Paris, France
| | - P Lesprit
- Hôpital Foch, 92151 Suresnes, France
| | - P Tattevin
- Maladies infectieuses et réanimation médicale, hôpital Pontchaillou, CHU de Rennes, 35033 Rennes, France
| | - N Thilly
- Plateforme d'aide à la recherche clinique, CHRU de Nancy, 54000 Nancy, France; Université de Lorraine, APEMAC, 54000 Nancy, France
| | - C Pulcini
- Infectious diseases department, université de Lorraine, CHRU de Nancy, 54000 Nancy, France; Université de Lorraine, APEMAC, 54000 Nancy, France.
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The optimal duration of treatment for skin and soft tissue infections and acute bacterial skin and skin structure infections. Curr Opin Infect Dis 2019; 31:155-162. [PMID: 29356694 DOI: 10.1097/qco.0000000000000440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize the current finding on SSTIs/ABSSSIs treatment duration. RECENT FINDINGS In 2013, the FDA approved the definition of acute bacterial skin and skin structure infections (ABSSSIs). From a clinical point of view, the new definition may present some advantages: the definition of the severity of the disease, the measurement of reduction in lesion size, and effectiveness of treatment primary endpoint at 48-72 h after treatment initiation. New therapeutic options with improved efficacy, safety, and/or pharmacodynamics are available for ABSSSIs and so far, several questions still need to be addressed for the management of these infections, including treatment duration. SUMMARY There is a wide variation of duration of antimicrobial treatment in skin and soft tissue infections. Plenty of published data available suggest that we should focus on the early response to shorten duration of treatment, and that the antimicrobial stewardship perspective is extremely helpful in underscoring the need for composite outcomes in clinical practice, as multiple tools are available to increase cost-efficacy, including reduction of treatment changes, early oral switch, early discharge (even from the Emergency Department), outpatient antimicrobial treatment, long-acting antibiotics, and all together, de-escalation treatment strategies.
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40
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Macheda G, Dyar OJ, Luc A, Beovic B, Béraud G, Castan B, Gauzit R, Lesprit P, Tattevin P, Thilly N, Pulcini C. Are infection specialists recommending short antibiotic treatment durations? An ESCMID international cross-sectional survey. J Antimicrob Chemother 2019; 73:1084-1090. [PMID: 29346568 DOI: 10.1093/jac/dkx528] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/18/2017] [Indexed: 12/21/2022] Open
Abstract
Objectives To evaluate the current practice and the willingness to shorten the duration of antibiotic therapy among infection specialists. Methods Infection specialists giving at least weekly advice on antibiotic prescriptions were invited to participate in an online cross-sectional survey between September and December 2016. The questionnaire included 15 clinical vignettes corresponding to common clinical cases with favourable outcomes; part A asked about the antibiotic treatment duration they would usually advise to prescribers and part B asked about the shortest duration they were willing to recommend. Results We included 866 participants, mostly clinical microbiologists (22.8%, 197/863) or infectious diseases specialists (58.7%, 507/863), members of an antibiotic stewardship team in 73% (624/854) of the cases, coming from 58 countries on all continents. Thirty-six percent of participants (271/749) already advised short durations of antibiotic therapy (compared with the literature) to prescribers for more than half of the vignettes and 47% (312/662) chose shorter durations in part B compared with part A for more than half of the vignettes. Twenty-two percent (192/861) of the participants declared that their regional/national guidelines expressed durations of antibiotic therapy for a specific clinical situation as a fixed duration as opposed to a range and in the multivariable analysis this was associated with respondents advising short durations for more than half of the vignettes (adjusted OR 1.5, P = 0.02). Conclusions The majority of infection specialists currently do not advise the shortest possible duration of antibiotic therapy to prescribers. Promoting short durations among these experts is urgently needed.
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Affiliation(s)
- Gabriel Macheda
- CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
| | - Oliver J Dyar
- Karolinska Institutet, Department of Public Health Sciences, Global Health - Health Systems and Policy, Stockholm, Sweden
| | - Amandine Luc
- CHRU de Nancy, Plateforme d'Aide à la Recherche Clinique, Nancy, France
| | - Bojana Beovic
- University Medical Centre Ljubljana, Ljubljana, Slovenia.,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Guillaume Béraud
- CHU de Poitiers, Médecine Interne et Maladies Infectieuses, Poitiers, France.,Centre de recherche du CHU de Québec-Université Laval, Hôpital Saint-Sacrement, Chemin Sainte-Foy (Québec), Canada.,Hasselt University, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Censtat, Hasselt, Belgium
| | - Bernard Castan
- CH Ajaccio, Unité fonctionnelle d'infectiologie régionale, Ajaccio, France
| | - Rémy Gauzit
- AP-HP, hôpitaux universitaires Paris centre-site Cochin, université Paris Descartes, Équipe mobile d'infectiologie, Paris, France
| | | | - Pierre Tattevin
- CHU de Rennes, hôpital Pontchaillou, Maladies infectieuses et réanimation médicale, Rennes, France
| | - Nathalie Thilly
- CHRU de Nancy, Plateforme d'Aide à la Recherche Clinique, Nancy, France.,Université de Lorraine, EA 4360 APEMAC, Nancy, France
| | - Céline Pulcini
- CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France.,Université de Lorraine, EA 4360 APEMAC, Nancy, France
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Ihm C, Sutton JD, Timbrook TT, Spivak ES. Treatment Duration and Associated Outcomes for Skin and Soft Tissue Infections in Patients With Obesity or Heart Failure. Open Forum Infect Dis 2019; 6:ofz217. [PMID: 31211160 DOI: 10.1093/ofid/ofz217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/06/2019] [Indexed: 11/14/2022] Open
Abstract
Background Although existing literature supports durations of 5-7 days for skin and soft tissue infections (SSTIs), longer durations are commonly used. Obesity and heart failure (HF) have been associated with increased risk for treatment failure of SSTIs; however, whether prolonged antibiotic durations reduce the risk of treatment failure is unknown. We evaluated practice patterns for SSTIs in patients with obesity and/or HF and whether short antibiotic durations (≤8 days) were associated with treatment failure. Methods We performed a single-center, retrospective cohort study of inpatients between January 1, 2006, and December 30, 2016, with SSTIs based on International Classification of Diseases (ICD) coding, and obesity and/or HF. Charts were manually reviewed to collect demographic, clinical, treatment, and outcome data. Propensity score matching was used to estimate the risk of treatment failure between the 2 groups. Secondary outcomes included length of stay, 30-day readmission, and Clostridium difficile infection rates. Results A total of 207 patients were included. Forty-nine (23.7%) received a short antibiotic duration and 158 (76.3%) a long duration. The median duration of therapy (interquartile range [IQR]) was 7 (7-8) days in the short group and 14 (10-15) days in the long group. In the propensity score-matched cohort, 28 (28.6%) treatment failures occurred in the long group, as compared with 5 (10.2%) in the short group (P = .02), as well as a shorter length of stay (IQR) in the short- vs long-duration group (2 [2-3] vs 3 [2-5] days, respectively; P = .002). There was no difference in other secondary outcomes. Conclusions The majority of patients with obesity or HF received a longer antibiotic course for SSTIs; however, a longer antibiotic course was not associated with lower treatment failure rates. Higher failure rates in the long-duration group may be reflective of clinical decisions made in the face of diagnostic uncertainty and warrant further evaluation.
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Affiliation(s)
- Claudia Ihm
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | | | | | - Emily S Spivak
- Department of Medicine, University of Utah, Salt Lake City, Utah.,Veterans Affairs Medical Center, Salt Lake City, Utah
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42
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Assessing the benefit of the 72-hour antibiotic therapy reassessment documentation. Med Mal Infect 2019; 49:187-193. [DOI: 10.1016/j.medmal.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/09/2018] [Indexed: 11/21/2022]
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43
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Millar BC, de Camargo RA, Alavi A, Moore JE. PET/Computed Tomography Evaluation of Infection of the Heart. PET Clin 2019; 14:251-269. [PMID: 30826023 DOI: 10.1016/j.cpet.2018.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The 2015 European Society of Cardiology guidelines for the management of infective endocarditis included 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in the diagnostic work-up of prosthetic valve endocarditis. This article examines the literature from the last 3 years to highlight the additional role 18F-FDG-PET/CT can contribute to an accurate diagnosis of cardiac infections and associated infectious complications. The challenges and pitfalls associated with 18F-FDG-PET/CT in such clinical settings must be recognized and these are discussed along with the suggested protocols that may be incorporated in an attempt to address these issues.
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Affiliation(s)
- Beverley Cherie Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Corry Building, Belfast City Hospital, Lisburn Road, Belfast, Co. Antrim BT9 7AD, Northern Ireland, UK.
| | - Raphael Abegão de Camargo
- Nuclear Medicine and Infectious Diseases, University of Sao Paulo Medical School (FMUSP), Sao Paulo, Sao Paulo, Brazil; Hospital Aristides Maltez, Avenida Dom João VI, n° 332, Serviço de Medicina Nuclear, 2° subssolo, Brotas, CEP: 40285-001, Salvador-BA, Brazil
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 110 Donner Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - John Edmund Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Corry Building, Belfast City Hospital, Lisburn Road, Belfast, Co. Antrim BT9 7AD, Northern Ireland, UK
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44
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Management of established pressure ulcer infections in spinal cord injury patients. Med Mal Infect 2019; 49:9-16. [DOI: 10.1016/j.medmal.2018.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/31/2017] [Accepted: 05/29/2018] [Indexed: 12/20/2022]
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45
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Ohashi K, Matsuoka T, Shinoda Y, Mori T, Yoshida S, Yoshimura T, Sugiyama T. Clinical outcome of pharmacist-led prospective audit with intervention and feedback after expansion from patients using specific antibiotics to those using whole injectable antibiotics. Eur J Clin Microbiol Infect Dis 2019; 38:593-600. [PMID: 30680565 DOI: 10.1007/s10096-018-03465-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/26/2018] [Indexed: 12/29/2022]
Abstract
Prospective audit with intervention and feedback (PAF) and preauthorisation of antimicrobials are core strategies for antimicrobial stewardship (AS). PAF participants were expanded from patients using specific antibiotics to those using whole injectable antibiotics to evaluate clinical outcome. From January 2016 to December 2016, PAF was performed in patients using specific antibiotics (period 1) and from January 2017 to December 2017, PAF was performed in patients using whole injectable antibiotics (period 2). PAF was implemented for 5 days every week by pharmacists involved in infectious diseases chemotherapy. In total, 11,571 and 11,103 patients used antibiotic injections during periods 1 and 2, respectively. No significant difference in mortality within 30 days from the initial use of injection antibiotics was observed. The average duration of hospitalisation was significantly shorter during period 2 among patients using antibiotics; however, this was not significantly different from that of patients not receiving antibiotics. The average duration of therapy for intravenous antibiotics was significantly shorter during period 2 than during period 1. The ratio of methicillin-resistant Staphylococcus aureus (MRSA) to S. aureus was significantly low during period 2. The duration of intravenous antibiotic therapy for Escherichia coli bacteraemia during period 2 decreased significantly. De-escalation and appropriate antimicrobial treatment rates at specific doses during period 2 increased significantly. Expansion of patients eligible for PAF from patients using specific antibiotics to patients using whole injectable antibiotics shortened hospital stays, suppressed drug resistance, and promoted the appropriate use of antibiotics.
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Affiliation(s)
- Kengo Ohashi
- Department of Pharmacy, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-city, Gifu, 503-8502, Japan.
| | - Tomoko Matsuoka
- Department of Pharmacy, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-city, Gifu, 503-8502, Japan
| | - Yasutaka Shinoda
- Department of Pharmacy, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-city, Gifu, 503-8502, Japan.,Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan
| | - Takayuki Mori
- Department of Pharmacy, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-city, Gifu, 503-8502, Japan
| | - Shinya Yoshida
- Department of Pharmacy, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-city, Gifu, 503-8502, Japan
| | - Tomoaki Yoshimura
- Department of Pharmacy, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-city, Gifu, 503-8502, Japan.,Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan
| | - Tadashi Sugiyama
- Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan
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Lormeau C, Cormier G, Sigaux J, Arvieux C, Semerano L. Management of septic bursitis. Joint Bone Spine 2018; 86:583-588. [PMID: 31615686 DOI: 10.1016/j.jbspin.2018.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
Superficial septic bursitis is common, although accurate incidence data are lacking. The olecranon and prepatellar bursae are the sites most often affected. Whereas the clinical diagnosis of superficial bursitis is readily made, differentiating aseptic from septic bursitis usually requires examination of aspirated bursal fluid. Ultrasonography is useful both for assisting in the diagnosis and for guiding the aspiration. Staphylococcus aureus is responsible for 80% of cases of superficial septic bursitis. Deep septic bursitis is uncommon and often diagnosed late. The management of septic bursitis varies considerably across centers, notably regarding the use of surgery. Controlled trials are needed to establish standardized recommendations regarding antibiotic treatment protocols and the indications of surgery.
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Affiliation(s)
- Christian Lormeau
- Service de rhumatologie, centre hospitalier de Niort, 40, avenue Charles-de-Gaulle, 79021 Niort, France.
| | - Grégoire Cormier
- Service de rhumatologie, centre hospitalier départemental Vendée, boulevard Stéphane-Moreau, 85928 La Roche-sur-Yon, France
| | - Johanna Sigaux
- Inserm, UMR 1125, 1, rue de Chablis, 93017 Bobigny, France; Sorbonne Paris Cité, université Paris 13, 1, rue de Chablis, 93017 Bobigny, France; Service de rhumatologie, groupe hospitalier Avicenne-Jean-Verdier-René-Muret, Assistance publique-Hôpitaux de Paris (AP-HP), 125, rue de Stalingrad, 93017 Bobigny, France
| | - Cédric Arvieux
- Clinique des maladies infectieuses, CHU de Rennes Pontchaillou, rue Henri-Le-Guilloux, 35043 Rennes, France; Centre de référence en infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), CHU de Rennes, 35043 Rennes cedex, France
| | - Luca Semerano
- Inserm, UMR 1125, 1, rue de Chablis, 93017 Bobigny, France; Sorbonne Paris Cité, université Paris 13, 1, rue de Chablis, 93017 Bobigny, France; Service de rhumatologie, groupe hospitalier Avicenne-Jean-Verdier-René-Muret, Assistance publique-Hôpitaux de Paris (AP-HP), 125, rue de Stalingrad, 93017 Bobigny, France
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Cohen R, Grimprel E, Hau I, Madhi F, Gaudelus J, Raymond J. Principles of curative antibiotic treatment. Arch Pediatr 2018; 24:S1-S5. [PMID: 29290228 DOI: 10.1016/s0929-693x(17)30510-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Infectious diseases are constantly evolving for many reasons. New infectious agents are regularly discovered, mainly because of the development of identification methods, including the molecular tools and mass spectrometry. Changes in the epidemiology of infectious diseases are not always understood, but several factors undoubtedly play an important role, notably the impact of vaccination implementations, the ecological consequences of antibiotic treatments and their excessive use, and the secular epidemiological trends of pathogenic agents. Antibiotic resistance has been recognized as one of the major challenges for humanity and few new antibiotics with potent activity against resistant Gram-negative rods have been developed in recent years. The rationalization of antibiotic treatments is a key for reducing or limiting antimicrobial resistance. This guide takes into account the latest recommendations, the consensus conferences, and the guidelines of the Pediatric Infectious Diseases Group of the French Society of Pediatric, the French Infectious Diseases Society, and French official agencies. For each clinical situation, the main bacterial target of the antibiotic treatment, the first-choice antibiotic and the alternative treatment, as well as the most important findings for the diagnosis and treatment of the infection are detailed.
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Affiliation(s)
- R Cohen
- Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, France; ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France; Groupe de Pathologie Infectieuse Pédiatrique de la Société Française de Pédiatrie, Saint-Maur des Fossés, France.
| | - E Grimprel
- Groupe de Pathologie Infectieuse Pédiatrique de la Société Française de Pédiatrie, Saint-Maur des Fossés, France; Université Pierre & Marie Curie, Paris 6, France; Service de pédiatrie générale et aval des urgences, Hôpital Armand-Trousseau, Paris, France
| | - I Hau
- Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Groupe de Pathologie Infectieuse Pédiatrique de la Société Française de Pédiatrie, Saint-Maur des Fossés, France; Service de Pédiatrie Générale, Centre Hospitalier Intercommunal de Créteil, France
| | - F Madhi
- Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Groupe de Pathologie Infectieuse Pédiatrique de la Société Française de Pédiatrie, Saint-Maur des Fossés, France; Service de Pédiatrie Générale, Centre Hospitalier Intercommunal de Créteil, France
| | - J Gaudelus
- Groupe de Pathologie Infectieuse Pédiatrique de la Société Française de Pédiatrie, Saint-Maur des Fossés, France; Service de Pédiatrie Générale, Centre Hospitalier Jean Verdier, Bobigny, France
| | - J Raymond
- Groupe de Pathologie Infectieuse Pédiatrique de la Société Française de Pédiatrie, Saint-Maur des Fossés, France; Université Paris Descartes, Hôpital Cochin, Paris, France
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48
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Sutton JD, Sayood S, Spivak ES. Top Questions in Uncomplicated, Non- Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2018; 5:ofy087. [PMID: 29780851 PMCID: PMC5952922 DOI: 10.1093/ofid/ofy087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/18/2018] [Indexed: 01/23/2023] Open
Abstract
The Infectious Diseases Society of America infection-specific guidelines provide limited guidance on the management of focal infections complicated by secondary bacteremias. We address the following 3 commonly encountered questions and management considerations regarding uncomplicated bacteremia not due to Staphylococcus aureus: the role and choice of oral antibiotics focusing on oral beta-lactams, the shortest effective duration of therapy, and the role of repeat blood cultures.
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Affiliation(s)
- Jesse D Sutton
- Department of Pharmacy, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
| | - Sena Sayood
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Emily S Spivak
- Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine & Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
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49
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Management of bloodstream infections by infection specialists in France and Germany: a cross-sectional survey. Infection 2018; 46:333-339. [PMID: 29397537 DOI: 10.1007/s15010-018-1122-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/29/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Bloodstream infections (BSI) are frequent infections worldwide. Our objective was to explore variation in the management of patients with BSI by infection specialists in France and Germany. METHODS This work is part of an international ESCMID cross-sectional internet-based questionnaire survey that was opened from December 2016 to February 2017. All hospital-based infection specialists, senior or trainees, giving at least weekly advice on positive blood cultures could participate. Their practices were evaluated using six clinical vignettes presenting an uncomplicated BSI due to different pathogens. RESULTS A hundred and ninety-six professionals (125 from Germany and 71 from France) participated. Systematic expert advice for positive blood cultures was more often available in Germany as compared with France (73 vs. 56%, p = 0.004). In Germany, the professional providing the expert advice was more often a microbiologist or a pharmacist as compared with France (p = 0.001 and p = 0.037, respectively) where it was more often an infectious diseases specialist. Fewer German respondents reported to advise systematic IV-oral switch of antibiotic therapy. German respondents also recommended less often combination therapy: for example for Enterococcus faecalis (64 vs. 43%, p = 0.015), ESBL E. coli (94 vs. 67%, p < 0.001) and Pseudomonas aeruginosa (76 vs. 37%, p < 0.001). Overall, management of candidaemia was more often compliant with the IDSA guidelines in France as compared with Germany, but no difference was noted for MRSA bacteraemia. CONCLUSION Our survey shows that wide variations exist between two neighboring countries in the recommendations by infection specialists for the management of BSI. International guidelines are needed.
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Diallo K, Thilly N, Luc A, Beraud G, Ergonul Ö, Giannella M, Kofteridis D, Kostyanev T, Paňo-Pardo JR, Retamar P, Kern W, Pulcini C. Management of bloodstream infections by infection specialists: an international ESCMID cross-sectional survey. Int J Antimicrob Agents 2018; 51:794-798. [PMID: 29309899 DOI: 10.1016/j.ijantimicag.2017.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/19/2017] [Accepted: 12/16/2017] [Indexed: 12/17/2022]
Abstract
Bloodstream infections (BSIs) are common, however international guidelines are available only for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia and candidaemia. This international ESCMID cross-sectional survey, open from December 2016 to February 2017, explored the management of BSIs by infection specialists. All infection specialists (senior or trainees) giving at least weekly advice on positive blood cultures could participate. Their practices were evaluated using six clinical vignettes presenting uncomplicated BSI cases. A total of 616 professionals from 56 countries participated [333/616 (54%) infectious diseases specialists, 188/616 (31%) clinical microbiologists], of whom 76% (468/616) were members of an antimicrobial stewardship team. Large variations in practice were noted, in particular for the Escherichia coli, Enterococcus faecalis and Pseudomonas aeruginosa vignettes. Echocardiography was considered standard of care by 81% (373/459) of participants for MRSA, 78% (400/510) for methicillin-susceptible S. aureus and 60% (236/395) for Candida albicans. Antimicrobial combination therapy was recommended by 2% (8/360) of respondents for C. albicans, 11% (43/378) for E. coli, 27% (114/420) for MRSA and 39% (155/393) for E. faecalis. Intravenous-to-oral switch was considered in 68% (285/418) for MRSA, 79% (306/388) for E. faecalis, 72% (264/366) for P. aeruginosa and 75% (270/362) for C. albicans. In multivariable analysis, IDSA guideline-compliant practice was more frequent among participants belonging to an antimicrobial stewardship team (aOR = 1.7, P = 0.018 for the MRSA vignette; and aOR = 2.0, P = 0.008 for the candidaemia vignette). This survey showed large variations in practice among infection specialists. International guidelines on management of BSI are urgently needed.
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Affiliation(s)
- Kévin Diallo
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, F-54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Plateforme d'Aide à la Recherche Clinique, F-54000 Nancy, France
| | - Amandine Luc
- Université de Lorraine, CHRU-Nancy, Plateforme d'Aide à la Recherche Clinique, F-54000 Nancy, France
| | - Guillaume Beraud
- Centre de recherche du CHU de Québec-Université Laval, Hôpital Saint-Sacrement, Chemin Sainte-Foy (Québec), Canada; CHU de Poitiers, Médecine Interne et Maladies Infectieuses, Poitiers, France; Hasselt University, CenStat, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt, Belgium
| | - Önder Ergonul
- Koç University, School of Medicine, Department of Infectious Diseases, Istanbul, Turkey
| | - Maddalena Giannella
- Sant'Orsola-Malpighi Hospital, University of Bologna, Department of Medical and Surgical Sciences, Infectious Disease Unit, Bologna, Italy
| | - Diamantis Kofteridis
- University Hospital of Heraklion and University of Crete, Faculty of Medicine, Department of Internal Medicine, Heraklion, Crete, Greece
| | - Tomislav Kostyanev
- University of Antwerp, Vaccine & Infectious Disease Institute, Department of Medical Microbiology, Wilrijk, Belgium
| | | | - Pilar Retamar
- Hospital Virgen Macarena-IBiS, Clinical Microbiology and Infectious Diseases Unit, Seville, Spain
| | - Winfried Kern
- University of Freiburg, Faculty of Medicine and Medical Center, Division of Infectious Diseases, Department of Medicine II, Freiburg, Germany
| | - Céline Pulcini
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France; Université de Lorraine, APEMAC, F-54000 Nancy, France.
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