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Xu X, Zheng Y, Zhang X, Zhang C, Gai W, Yang Z. Utility of Metagenomic Next-Generation Sequencing for Diagnosis of Infectious Diseases in Critically Ill Immunocompromised Pediatric Patients. Infect Drug Resist 2024; 17:3579-3591. [PMID: 39165848 PMCID: PMC11334925 DOI: 10.2147/idr.s472129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 08/09/2024] [Indexed: 08/22/2024] Open
Abstract
Purpose Infections cause high rates of illness and death in children worldwide. However, studies on the clinical value of metagenomic next-generation sequencing (mNGS) for immunocompromised children are still limited. Patients and Methods From June 2021 to December 2023, 119 samples were collected at Pediatric Intensive Care Unit (PICU) of a single-center pediatric hospital and classified into two groups based on their immune states. We compared the diagnostic performance of mNGS and conventional microbiological test (CMT) for pathogen identification, and assessed the clinical impacts of mNGS. Results Among the 119 samples, 48 (40.34%) belonged to the immunocompromised children. mNGS had a higher positivity rate than CMT (76.47% vs 55.46%, P = 0.0006). The positive percent agreement (PPA) of mNGS for immunocompromised children was higher compared to immunocompetent children (95.24% vs 77.78%). The most common pathogens for immunocompromised patients were gram-negative bacteria and herpesvirus. However, immunocompetent children showed a higher detection rate for gram-positive bacteria and respiratory viruses. Furthermore, the proportions of the positive impact of mNGS results were significantly higher in immunocompromised patients compared to immunocompetent patients for both diagnosis (91.67% vs 57.75%) and treatment (95.83% vs 64.79%) (P < 0.0001). Immunocompromised state, length of hospital stays, times stay in ICU, Pediatric Risk of Mortality (PRISM) score, neutrophil percentage (NEUT%) and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) were considered independent factors for poor prognosis in critically ill pediatric patients. Conclusion In patients from PICU, mNGS had a greater clinical significance in immunocompromised children compared to immunocompetent children. mNGS technology is an important auxiliary method for achieving accurate diagnosis and treatment of critically ill pediatric patients.
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Affiliation(s)
- Xiangzhi Xu
- Department of Pediatric Intensive Care Unit, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yafeng Zheng
- WillingMed Technology (Beijing) Co., Ltd, Beijing, People’s Republic of China
| | - Xiaojing Zhang
- WillingMed Technology (Beijing) Co., Ltd, Beijing, People’s Republic of China
| | - Chenmei Zhang
- Department of Pediatric Intensive Care Unit, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Wei Gai
- WillingMed Technology (Beijing) Co., Ltd, Beijing, People’s Republic of China
| | - Zihao Yang
- Department of Pediatric Intensive Care Unit, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
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Han J, Wei FL, Wu HX, Guo LY, Guo S, Han Y, Sun YN, Hou W, Hu ZJ. Clinical evaluation of droplet digital pcr for suspected ascites infection in patients with liver cirrhosis. Hepatol Int 2024; 18:1249-1260. [PMID: 38683274 DOI: 10.1007/s12072-024-10669-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/01/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Droplet digital PCR (ddPCR) is increasingly used in diagnosing clinical pathogens, but its effectiveness in cirrhosis patients with suspected ascites infection remains uncertain. METHODS The diagnostic performance of ddPCR was assessed in 305 ascites samples, utilizing culture and clinical composite standards. The quantitative value and potential clinical impact of ddPCR were further analyzed in patients with spontaneous bacterial peritonitis. RESULTS With culture standards, ddPCR demonstrated a sensitivity of 86.5% and specificity of 83.2% for bacterial or fungal detection. After adjustment of clinical composite criteria, specificity increased to 96.4%. Better diagnostic performance for all types of targeted pathogens, particularly fungi, was observed with ddPCR compared to culture, and more polymicrobial infections were detected (30.4% versus 5.7%, p < 0.001). Pathogen loads detected by ddPCR correlated with white blood cell count in ascites and blood, as well as polymorphonuclear cell (PMN) count in ascites, reflecting infection status rapidly. A positive clinical impact of 55.8% (43/77) was observed for ddPCR, which was more significant among patients with PMN count ≤ 250/mm3 in terms of medication adjustment and new diagnosis. ddPCR results for fungal detection were confirmed by clinical symptoms and other microbiological tests, which could guide antifungal therapy and reduce the risk of short-term mortality. CONCLUSIONS ddPCR, with appropriate panel design, has advantages in pathogen detection and clinical management of ascites infection, especially for patients with fungal and polymicrobial infections. Patients with atypical spontaneous bacterial peritonitis benefited more from ddPCR.
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Affiliation(s)
- Jie Han
- Beijing You'An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China
- Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing Institute of Hepatology, Beijing You'An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China
| | - Fei-Li Wei
- Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing Institute of Hepatology, Beijing You'An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China
| | - Hao-Xin Wu
- Beijing You'An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China
| | - Lu-Yao Guo
- Beijing You'An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China
| | - Shan Guo
- Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing Institute of Hepatology, Beijing You'An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China
| | - Ying Han
- Beijing You'An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China
| | - Ya-Nan Sun
- Beijing You'An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China
| | - Wei Hou
- Beijing You'An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China.
| | - Zhong-Jie Hu
- Beijing You'An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China.
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Wu X, Sun T, He H, Xing L, Cheng Z, Geng S, Xu D, Luo H, Chen C, Jiang M, Hou G, Zhai T, Cai Y, Liu Y, Li J, Ni L, Li X, Qu B, Lei C, Wang Y, Gu Z, Zhang P, Huang X, Li M, Xia J, He L, Zhan Q. Effect of Metagenomic Next-Generation Sequencing on Clinical Outcomes of Patients With Severe Community-Acquired Pneumonia in the ICU: A Multicenter, Randomized Controlled Trial. Chest 2024:S0012-3692(24)04863-3. [PMID: 39067508 DOI: 10.1016/j.chest.2024.07.144] [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: 12/12/2023] [Revised: 07/05/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Metagenomic next-generation sequencing (mNGS) was previously established as a method that can increase the pathogen identification rate in patients with severe community-acquired pneumonia (SCAP). RESEARCH QUESTION What is the impact on clinical outcomes of mNGS of BAL fluid (BALF) in patients with SCAP in the ICU? STUDY DESIGN AND METHODS A multicenter, randomized controlled, open-label clinical trial was conducted in 10 ICUs. Patients were randomized in a 1:1 ratio to undergo BALF assessment with conventional microbiological tests (CMTs) only (ie, the CMT group) or BALF assessment with both mNGS and CMTs (ie, the mNGS group). The primary outcome was the time to clinical improvement, defined as the time from randomization to either an improvement of two points on a six-category ordinal scale or discharge from the ICU, whichever occurred first. RESULTS A total of 349 patients were randomized to treatment between January 1, 2021, and November 18, 2022; 170 were assigned to the CMT group and 179 to the mNGS group. In the intention-to-treat analysis, the time to clinical improvement was better in the mNGS group than in the CMT group (10 days vs 13 days; difference, -2.0 days; 95% CI, -3.0 to 0.0 days). Similar results were obtained in the per-protocol analysis. The proportion of patients with clinical improvement within 14 days was significantly higher in the mNGS group (62.0%) than in the CMT group (46.5%). There was no significant difference in other secondary outcomes. INTERPRETATION Compared with the use of CMTs alone, mNGS combined with CMTs reduced the time to clinical improvement for patients with SCAP. CLINICAL TRIAL REGISTRATION ChiCTR2000037894.
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Affiliation(s)
- Xiaojing Wu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing; Department of Respiratory and Critical Care Medicine, Beijing
| | - Ting Sun
- The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang; Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing; Department of Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Hangyong He
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing
| | - Lihua Xing
- Binzhou Medical University Hospital, Binzhou; The Respiratory Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Zhenshun Cheng
- Department of Respiratory and Critical Care Medicine, Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Zhongnan Hospital of Wuhan University
| | - Shuang Geng
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Dexiang Xu
- Department of Pulmonary and Critical Care Medicine, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao
| | - Hong Luo
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha
| | - Cheng Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou
| | - Mingyan Jiang
- Department of Pulmonary and Critical Care Medicine, Xiang Tan Central Hospital of Hunan Province, Xiangtan
| | - Guopeng Hou
- Department of Pulmonary and Critical Care Medicine, The Third People's Hospital of Datong, Datong
| | - Tianshu Zhai
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing
| | - Ying Cai
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing
| | - Yijie Liu
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing
| | - Junlu Li
- Binzhou Medical University Hospital, Binzhou; The Respiratory Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Lan Ni
- Department of Respiratory and Critical Care Medicine, Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Zhongnan Hospital of Wuhan University
| | - Xueying Li
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Binbin Qu
- Department of Pulmonary and Critical Care Medicine, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao
| | - Cheng Lei
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha
| | - Yang Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou
| | - Zi Gu
- Department of Pulmonary and Critical Care Medicine, Xiang Tan Central Hospital of Hunan Province, Xiangtan
| | - Peng Zhang
- Department of Pulmonary and Critical Care Medicine, The Third People's Hospital of Datong, Datong
| | - Xu Huang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing
| | - Min Li
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing
| | - Jingen Xia
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing
| | - Lian He
- Department of Pulmonary and Critical Care Medicine, The Second People's Hospital of Guiyang, Guiyang, China
| | - Qingyuan Zhan
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing.
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de Lorenzi-Tognon M, Schrenzel J. Simplified Spectrum Score (S 3) app for pathogen-agnostic antimicrobial drug spectrum ranking to assess for antimicrobial de-escalation events. Sci Rep 2024; 14:9776. [PMID: 38684841 PMCID: PMC11059348 DOI: 10.1038/s41598-024-60041-6] [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: 12/14/2023] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
Antimicrobial/antibiotic de-escalation (ADE) is a key feature of antimicrobial stewardship programs (ASP) that relies mainly on individual panels for determining ADE events based on subjective ranking of antibiotics' spectrum activity. The lack of consensus among ASP experts leads to reproducibility issues in the measure of this clinical outcome, making difficult to assess its real impact on patient care. The S3 score (Simplified Spectrum Score) app was developed to allow an objective ranking of antibiotics. Ranking was achieved by developing a database harboring pairs of bacteria-antibiotics for which each molecule was assigned a score based on published and clinically validated data from a recognized international committee. S3 score shows a strong correlation relationship and substantial agreement to a clinically validated spectrum score, and its framework enables any person to use it for ADE detection without assuming prior knowledge or training. In addition, its design enables regular updates and sustainability.
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Affiliation(s)
- Mikaël de Lorenzi-Tognon
- Bacteriology Laboratory, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland.
- Genomic Research Laboratory, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Jacques Schrenzel
- Bacteriology Laboratory, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland
- Genomic Research Laboratory, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
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5
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Yan M, Zou X, Wang Y, Wang C, Wang Y, Liu Z, Shang L, Cui X, Cao B. Impact of Metagenomic Next-Generation Sequencing of Bronchoalveolar Lavage Fluid on Antimicrobial Stewardship in Patients With Lower Respiratory Tract Infections: A Retrospective Cohort Study. J Infect Dis 2024; 229:223-231. [PMID: 37506257 DOI: 10.1093/infdis/jiad296] [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: 03/19/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The impact of metagenomic next-generation sequencing (mNGS) on antimicrobial stewardship in patients with lower respiratory tract infections (LRTIs) is still unknown. METHODS This retrospective cohort study included patients who had LRTIs diagnosed and underwent bronchoalveolar lavage between September 2019 and December 2020. Patients who underwent both mNGS and conventional microbiologic tests were classified as the mNGS group, while those with conventional tests only were included as a control group. A 1:1 propensity score match for baseline variables was conducted, after which changes in antimicrobial stewardship between the 2 groups were assessed. RESULTS A total of 681 patients who had an initial diagnosis of LRTIs and underwent bronchoalveolar lavage were evaluated; 306 patients were finally included, with 153 in each group. mNGS was associated with lower rates of antibiotic escalation than in the control group (adjusted odds ratio, 0.466 [95% confidence interval, .237-.919]; P = .02), but there was no association with antibiotic de-escalation. Compared with the control group, more patients discontinued the use of antivirals in the mNGS group. CONCLUSIONS The use of mNGS was associated with lower rates of antibiotic escalation and may facilitate the cessation of antivirals, but not contribute to antibiotic de-escalation in patients with LRTIs.
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Affiliation(s)
- Mengwei Yan
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Capital Medical University, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaohui Zou
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Capital Medical University, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Yeming Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Capital Medical University, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Chenhui Wang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yimin Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Zhibo Liu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Lianhan Shang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaojing Cui
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Capital Medical University, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Tsinghua University School of Medicine, Beijing, China
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Moehring R, Vaughn VM. Development of Inpatient Stewardship Metrics: Is It Time for Public Reporting? Infect Dis Clin North Am 2023; 37:853-871. [PMID: 37661471 DOI: 10.1016/j.idc.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Given the complexity and nuance needed to make antimicrobial prescribing decisions, metrics aiming to assess these decisions can be complex in method, require resource investment for measurement, and demand thoughtfulness in how to use data for program implementation and messaging to key partners. Antimicrobial stewardship programs today use several metrics of antimicrobial use in parallel with other clinical data for a multitude of purposes and audiences. Here, we discuss goals for inpatient stewardship metrics, current metrics used by stewardship programs locally and nationally, and future directions for antimicrobial use metric development.
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Affiliation(s)
| | - Valerie M Vaughn
- Division of General Internal Medicine, University of Utah, 30 Mario Capecchi Drive, 3S149, Salt Lake City, UT 84112, USA
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Baghdadi JD, Goodman KE, Magder LS, Heil EL, Claeys K, Bork J, Harris AD. Clinical, contextual and hospital-level factors associated with escalation and de-escalation of empiric Gram-negative antibiotics among US inpatients. JAC Antimicrob Resist 2023; 5:dlad054. [PMID: 37193004 PMCID: PMC10182731 DOI: 10.1093/jacamr/dlad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/19/2023] [Indexed: 05/18/2023] Open
Abstract
Background Empiric Gram-negative antibiotics are frequently changed in response to new information. To inform antibiotic stewardship, we sought to identify predictors of antibiotic changes using information knowable before microbiological test results. Methods We performed a retrospective cohort study. Survival-time models were used to evaluate clinical factors associated with antibiotic escalation and de-escalation (defined as an increase or decrease, respectively, in the spectrum or number of Gram-negative antibiotics within 5 days of initiation). Spectrum was categorized as narrow, broad, extended or protected. Tjur's D statistic was used to estimate the discriminatory power of groups of variables. Results In 2019, 2 751 969 patients received empiric Gram-negative antibiotics at 920 study hospitals. Antibiotic escalation occurred in 6.5%, and 49.2% underwent de-escalation; 8.8% were changed to an equivalent regimen. Escalation was more likely when empiric antibiotics were narrow-spectrum (HR 19.0 relative to protected; 95% CI: 17.9-20.1), broad-spectrum (HR 10.3; 95% CI: 9.78-10.9) or extended-spectrum (HR 3.49; 95% CI: 3.30-3.69). Patients with sepsis present on admission (HR 1.94; 95% CI: 1.91-1.96) and urinary tract infection present on admission (HR 1.36; 95% CI: 1.35-1.38) were more likely to undergo antibiotic escalation than patients without these syndromes. De-escalation was more likely with combination therapy (HR 2.62 per additional agent; 95% CI: 2.61-2.63) or narrow-spectrum empiric antibiotics (HR 1.67 relative to protected; 95% CI: 1.65-1.69). Choice of empiric regimen accounted for 51% and 74% of the explained variation in antibiotic escalation and de-escalation, respectively. Conclusions Empiric Gram-negative antibiotics are frequently de-escalated early in hospitalization, whereas escalation is infrequent. Changes are primarily driven by choice of empiric therapy and presence of infectious syndromes.
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Affiliation(s)
- Jonathan D Baghdadi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katherine E Goodman
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laurence S Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emily L Heil
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Kimberly Claeys
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Jacqueline Bork
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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LaPlante R, Claeys KC, Bork JT, Banoub M, Noval M. Evaluating the Follow-up of Post-discharge Positive Sterile Site Cultures and the Impact on Infection-Related Complications. Infect Dis Ther 2023; 12:989-996. [PMID: 36884212 PMCID: PMC10017885 DOI: 10.1007/s40121-023-00786-1] [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: 01/04/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Numerous patients have cultures pending at discharge which, if not addressed, may delay diagnosis and initiation of appropriate antimicrobials. The purpose of the study is to evaluate the appropriateness of discharge antimicrobial therapy and result documentation in patients with positive cultures finalized post-discharge. METHODS This was a cross-sectional cohort study of patients admitted from July 1 to December 31, 2019 with positive sterile-site microbiologic cultures finalized post-discharge. Pertinent inclusion and exclusion factors were admission ≥ 48 h and non-sterile sites, respectively. The primary objective was to determine the frequency of discharged patients warranting antimicrobial changes based on finalized cultures. Secondary objectives included prevalence and timeliness of result documentation and rates of 30-day readmission, among intervention warranted versus not warranted. Chi-squared or Fisher's exact tests were used as appropriate. Binary multivariable logistic regression was completed for 30-day readmission stratified by infectious disease (ID) involvement due to the potential for effect modification. RESULTS A total of 208 of 768 patients screened were included. Most patients were discharged from a surgical service (45.7%); deep tissue and blood were the most common culture sites (29.3%). Change in discharge antimicrobial was warranted in 36.5% of patients (n = 76). Result documentation was overall low (35.5%). Time to documentation was significantly shorter in patients warranting antimicrobial intervention (4 days vs. 9 days, P = 0.039), although rates of hospital readmission were higher in this group (32.9% vs. 22.7%, P = 0.109). Finally, in patients not being followed by ID, documentation of finalized results was associated with decreased odds of 30-day readmission (aOR 0.19; 95% CI 0.07-0.53). CONCLUSIONS A significant number of patients with cultures finalized post-discharge warranted antimicrobial intervention. Acknowledgment of finalized culture results may decrease the risk of 30-day hospital readmission, particularly in patients not followed by ID. Quality improvement efforts should focus on methods to improve documentation and action on pending cultures to positively impact patient outcomes.
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Affiliation(s)
- Reid LaPlante
- Department of Pharmacy, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Kimberly C Claeys
- Department of Pharmacy, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA.,Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Jacqueline T Bork
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA.,Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mary Banoub
- Department of Pharmacy, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Mandee Noval
- Department of Pharmacy, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA. .,Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
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Lin K, Zhao Y, Xu B, Yu S, Fu Z, Zhang Y, Wang H, Song J, Fan M, Zhou Y, Ai J, Qiu C, Zhang H, Zhang W. Clinical Diagnostic Performance of Droplet Digital PCR for Suspected Bloodstream Infections. Microbiol Spectr 2023; 11:e0137822. [PMID: 36602351 PMCID: PMC9927361 DOI: 10.1128/spectrum.01378-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/01/2022] [Indexed: 01/06/2023] Open
Abstract
Accurate and timely etiological diagnosis is crucial for bloodstream infections (BSIs) due to their high disability and mortality. We conducted a single-center prospective cohort study to compare the digital droplet PCR (ddPCR) assay with traditional blood culture. A total of 169 blood samples from 122 patients with suspected BSIs were collected, mostly from the department of infectious diseases, the emergency department, and the intensive care units, and the clinical data were also recorded. Nucleic acid was extracted from the blood samples, and a 5-fluorescent-channel droplet digital PCR assay was performed and then fed back with the pathogen and its copies. In BSI patients, ddPCR reported an overall 85.71% (12/14) (95% confidence interval [CI], 56.15 to 97.48%) sensitivity, 100% (7/7) (95% CI, 56.09 to 100.00%) and 71.43% (5/7) (95% CI, 30.26 to 94.89%) sensitivity in patients without empirical treatment and in empirically treated patients, respectively. Compared to traditional blood culture, the overall detection rate of ddPCR was significantly higher, 11.27% (16/142) (95% CI, 6.78 to 17.93%) versus 30.28% (43/142) (95% CI, 23.01 to 38.64%), and the extra detection rate of ddPCR was 19.01% (27/142) (95% CI, 13.11 to 26.63%). Of the ddPCR-positive culture-negative cases, 74.19% (23/31) (95% CI, 55.07 to 87.46%) were consistent with the final clinical diagnosis, including 10 bacteria and fungi. The detection rate of ddPCR was significantly higher in patients with white blood cell (WBC) counts of >10 · 109/L, C-reactive protein (CRP) of >70 mg/L, or procalcitonin (PCT) of >0.9 ng/L. Pathogen loads detected by ddPCR are correlated with WBC, CRP, and especially, PCT levels, precisely and rapidly reflecting clinical disease progression. ddPCR has an important guiding value for the clinical use of antibiotics to achieve the best pathogen coverage and the antibacterial effect. Collectively, ddPCR showed a great diagnostic performance in BSIs and had an overall higher detection rate than blood culture. In addition, ddPCR could be used to dynamically monitor the disease progression and provide medication guidance on antibiotic use. IMPORTANCE ddPCR is a promising method to address the current challenges of BSI diagnosis and precise treatment, as it is highly efficient in DNA detection. It shortens the identification of BSI-related pathogens from several days of traditional bacterial culture to 4 to 5 h. It is extremely sensitive and more tolerant to PCR inhibitors, which may facilitate the amplification and enable the detection of a meager amount of DNA fragments in detecting BSI-related pathogens and drug-resistant genes. It can identify almost 20 pathogens in one reaction, which reduces the usage of clinical blood samples to no more than 2 mL. Additionally, dynamic monitoring, assessment of pathogens, and antibiotic resistance genes in patients could be used to guide timely and precise adjustment of antimicrobial prescription. The short turnaround time of ddPCR may have the potential to guide antimicrobial treatment in the very early stage of sepsis and reduce the mortality and disability rate of sepsis.
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Affiliation(s)
- Ke Lin
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
| | - Yuanhan Zhao
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
| | - Bin Xu
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
| | - Shenglei Yu
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
| | - Zhangfan Fu
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
| | - Yi Zhang
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
| | - Hongyu Wang
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
| | - Jieyu Song
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
| | - Mingxiang Fan
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
| | - Yang Zhou
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
| | - Jingwen Ai
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
| | - Chao Qiu
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
| | - Haocheng Zhang
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
| | - Wenhong Zhang
- Department of Infectious Disease of Huashan Hospital, National Medical Center for Infectious Diseases and Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Fudan University, Shanghai, China
- Key Laboratory of Medical Molecular Virology (MOE/MOH) and Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
- State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China
- National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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10
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Moehring RW, Yarrington ME, Warren BG, Lokhnygina Y, Atkinson E, Bankston A, Collucio J, David MZ, Davis AE, Davis J, Dionne B, Dyer AP, Jones TM, Klompas M, Kubiak DW, Marsalis J, Omorogbe J, Orajaka P, Parish A, Parker T, Pearson JC, Pearson T, Sarubbi C, Shaw C, Spivey J, Wolf R, Wrenn RH, Dodds Ashley ES, Anderson DJ. Evaluation of an Opt-Out Protocol for Antibiotic De-Escalation in Patients With Suspected Sepsis: A Multicenter, Randomized, Controlled Trial. Clin Infect Dis 2023; 76:433-442. [PMID: 36167851 DOI: 10.1093/cid/ciac787] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/09/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sepsis guidelines recommend daily review to de-escalate or stop antibiotics in appropriate patients. This randomized, controlled trial evaluated an opt-out protocol to decrease unnecessary antibiotics in patients with suspected sepsis. METHODS We evaluated non-intensive care adults on broad-spectrum antibiotics despite negative blood cultures at 10 US hospitals from September 2018 through May 2020. A 23-item safety check excluded patients with ongoing signs of systemic infection, concerning or inadequate microbiologic data, or high-risk conditions. Eligible patients were randomized to the opt-out protocol vs usual care. Primary outcome was post-enrollment antibacterial days of therapy (DOT). Clinicians caring for intervention patients were contacted to encourage antibiotic discontinuation using opt-out language. If continued, clinicians discussed the rationale for continuing antibiotics and de-escalation plans. To evaluate those with zero post-enrollment DOT, hurdle models provided 2 measures: odds ratio of antibiotic continuation and ratio of mean DOT among those who continued antibiotics. RESULTS Among 9606 patients screened, 767 (8%) were enrolled. Intervention patients had 32% lower odds of antibiotic continuation (79% vs 84%; odds ratio, 0.68; 95% confidence interval [CI], .47-.98). DOT among those who continued antibiotics were similar (ratio of means, 1.06; 95% CI, .88-1.26). Fewer intervention patients were exposed to extended-spectrum antibiotics (36% vs 44%). Common reasons for continuing antibiotics were treatment of localized infection (76%) and belief that stopping antibiotics was unsafe (31%). Thirty-day safety events were similar. CONCLUSIONS An antibiotic opt-out protocol that targeted patients with suspected sepsis resulted in more antibiotic discontinuations, similar DOT when antibiotics were continued, and no evidence of harm. CLINICAL TRIALS REGISTRATION NCT03517007.
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Affiliation(s)
- Rebekah W Moehring
- Department of Medicine, Infectious Diseases, Duke University, Durham, North Carolina, USA.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Michael E Yarrington
- Department of Medicine, Infectious Diseases, Duke University, Durham, North Carolina, USA.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Bobby G Warren
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Yuliya Lokhnygina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Erica Atkinson
- Department of Pharmacy, Southeastern Regional Medical Center, Lumberton, North Carolina, USA
| | - Allison Bankston
- Department of Pharmacy, Piedmont Newnan Hospital, Newnan, Georgia, USA
| | - Julia Collucio
- Department of Pharmacy, Piedmont Atlanta Hospital, Atlanta, Georgia, USA
| | - Michael Z David
- Department of Medicine, Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Angelina E Davis
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Janice Davis
- Department of Pharmacy, Piedmont Fayette Hospital, Fayette, Georgia, USA
| | - Brandon Dionne
- Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Pharmacy and Health Systems Sciences, Northeastern University School of Pharmacy and Pharmaceutical Sciences, Boston, Massachusetts, USA
| | - April P Dyer
- Department of Medicine, Infectious Diseases, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Travis M Jones
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Michael Klompas
- Department of Medicine, Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - David W Kubiak
- Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John Marsalis
- Department of Pharmacy, Piedmont Newnan Hospital, Newnan, Georgia, USA
| | | | - Patricia Orajaka
- Department of Pharmacy, Iredell Health, Statesville, North Carolina, USA
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Todd Parker
- Department of Pharmacy, Piedmont Atlanta Hospital, Atlanta, Georgia, USA
| | - Jeffrey C Pearson
- Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tonya Pearson
- Department of Pharmacy, Piedmont Fayette Hospital, Fayette, Georgia, USA
| | - Christina Sarubbi
- Department of Pharmacy, UNC REX Healthcare, Raleigh, North Carolina, USA
| | - Christian Shaw
- Department of Pharmacy, Wilson Medical Center, Wilson, North Carolina, USA
| | - Justin Spivey
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA.,Department of Pharmacy, Duke University Medical Center, Durham, North Carolina, USA
| | - Robert Wolf
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rebekah H Wrenn
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA.,Department of Pharmacy, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth S Dodds Ashley
- Department of Medicine, Infectious Diseases, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Deverick J Anderson
- Department of Medicine, Infectious Diseases, Duke University, Durham, North Carolina, USA.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
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11
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Haseeb A, Saleem Z, Altaf U, Batool N, Godman B, Ahsan U, Ashiq M, Razzaq M, Hanif R, E-Huma Z, Amir A, Hossain MA, Raafat M, Radwan RM, Iqbal MS, Kamran SH. Impact of Positive Culture Reports of E. coli or MSSA on De-Escalation of Antibiotic Use in a Teaching Hospital in Pakistan and the Implications. Infect Drug Resist 2023; 16:77-86. [PMID: 36636371 PMCID: PMC9831081 DOI: 10.2147/idr.s391295] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
Background Antibiotic de-escalation is a key element of antimicrobial stewardship programs that restrict the spread and emergence of resistance. This study was performed to evaluate the impact of positive culture sensitivity reports of E. coli or Methicillin sensitive Staphylococcus aureus (MSSA) on de-escalation of antibiotic therapy. Methods This prospective observational study was performed on 256 infected patients. The samples were obtained principally from the pus of infected sites for the identification of pathogens and culture-sensitivity testing. The data were collected from patient medical files, which included their demographic data, sample type, causative microbe and antimicrobial treatment as empiric or definitive treatment based on cultures. Data were analyzed using SPSS. Results Of 256 isolated microbes, 138 (53.9%) were MSSA and 118 were E. coli (46.1%). MSSA showed 100% sensitivity to cefoxitin, oxacillin, vancomycin, fosfomycin, colistin and more than 90% to linezolid (95.3%), tigecycline (93.1%), chloramphenicol (92.2%) and amikacin (90.2%). E. coli showed 100% sensitivity to only fosfomycin and more than 90% to colistin (96.7%), polymyxin-B (95.1%) and tigecycline (92.9%). The high use of cefoperazone+sulbactam (151), amikacin (149), ceftriaxone (33), metronidazole (30) and piperacillin + tazobactam (22) was seen with empiric prescribing. Following susceptibility testing, the most common antibiotics prescribed for E. coli were meropenem IV (34), amikacin (34), ciprofloxacin (29) and cefoperazone+sulbactam (25). For MSSA cases, linezolid (48), clindamycin (30), cefoperazone+ sulbactam IV (16) and amikacin (15) was used commonly. Overall, there was 23% reduction in antibiotic use in case of E. coli and 43% reduction in MSSA cases. Conclusion Culture sensitivity reports helped in the de-escalation of antimicrobial therapy, reducing the prescribing of especially broad-spectrum antibiotics. Consequently, it is recommended that local hospital guidelines be developed based on local antimicrobial susceptibility patterns while preventing the unnecessary use of broad-spectrum antibiotics for empiric treatment.
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Affiliation(s)
- Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm AL-Qura University, Makkah, Saudi Arabia
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan,Correspondence: Zikria Saleem, Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan, Email
| | - Ummara Altaf
- Department of Pharmacy, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Narjis Batool
- Australian Institute of Health Innovation, Center of Health Systems and Safety Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK,School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa,Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Umar Ahsan
- Department of Infection Prevention and Control, Al Noor Specialist Hospital, Ministry of health, Makkah, Kingdom of Saudi Arabia
| | - Mehreen Ashiq
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Mutiba Razzaq
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Rabia Hanif
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Zill E-Huma
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Afreenish Amir
- Department of Microbiology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Mohammad Akbar Hossain
- Department of Pharmacology and Toxicology, Faculty of Medicine in Al-Qunfudah, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Mohamed Raafat
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm AL-Qura University, Makkah, Saudi Arabia
| | - Rozan Mohammad Radwan
- Pharmaceutical Care Department, Al Noor Specialist Hospital, Ministry of Health, Makkah, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
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12
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Maeda M, Nakata M, Naito Y, Yamaguchi K, Yamada K, Kinase R, Takuma T, On R, Tokimatsu I. Days of Antibiotic Spectrum Coverage Trends and Assessment in Patients with Bloodstream Infections: A Japanese University Hospital Pilot Study. Antibiotics (Basel) 2022; 11:1745. [PMID: 36551402 PMCID: PMC9774691 DOI: 10.3390/antibiotics11121745] [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: 11/09/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/11/2022] Open
Abstract
The antibiotic spectrum is not reflected in conventional antimicrobial metrics. Days of antibiotic spectrum coverage (DASC) is a novel quantitative metric for antimicrobial consumption developed with consideration of the antibiotic spectrum. However, there were no data regarding disease and pathogen-specific DASC. Thus, this study aimed to evaluate the DASC trend in patients with bloodstream infections (BSIs). DASC and days of therapy (DOT) of in-patients with positive blood culture results during a 2-year interval were evaluated. Data were aggregated to calculate the DASC, DOT, and DASC/DOT per patient stratified by pathogens. During the 2-year study period, 1443 positive blood culture cases were identified, including 265 suspected cases of contamination. The overall DASC, DASC/patient, DOT, DOT/patient, and DASC/DOT metrics were 226,626; 157.1; 28,778; 19.9; and 7.9, respectively. A strong correlation was observed between DASC and DOT, as well as DASC/patient and DOT/patient. Conversely, DASC/DOT had no correlation with other metrics. The combination of DASC and DOT would be a useful benchmark for the overuse and misuse evaluation of antimicrobial therapy in BSIs. Notably, DASC/DOT would be a robust metric to evaluate the antibiotic spectrum that was selected for patients with BSIs.
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Affiliation(s)
- Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Mari Nakata
- Department of Hospital Pharmaceutics, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Yuika Naito
- Department of Hospital Pharmaceutics, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Kozue Yamaguchi
- Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Kaho Yamada
- Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Ryoko Kinase
- Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Takahiro Takuma
- Division of Infection Diseases, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Rintaro On
- Division of Infection Diseases, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Issei Tokimatsu
- Division of Infection Diseases, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
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13
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Epidemiology and Economic Outcomes Associated with Timely versus Delayed Receipt of Appropriate Antibiotic Therapy among US Patients Hospitalized for Native Septic Arthritis: A Retrospective Cohort Study. Antibiotics (Basel) 2022; 11:antibiotics11121732. [PMID: 36551387 PMCID: PMC9774525 DOI: 10.3390/antibiotics11121732] [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: 10/18/2022] [Revised: 11/17/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Timely administration of appropriate antibiotic therapy is associated with better patient outcomes and lower costs of care compared to delayed appropriate therapy, yet initial treatment is often empiric since causal pathogens are typically unknown upon presentation. The challenge for clinicians is balancing selection of adequate coverage treatment regimens, adherence to antimicrobial stewardship principles to deter resistance, and financial constraints. This retrospective cohort study aimed to assess the magnitude and impact of delayed appropriate antibiotic therapy among patients hospitalized with septic arthritis (SA) in the U.S. from 2017 to 2019 using healthcare encounter data. Timely appropriate therapy was defined as the receipt of antibiotic(s) with in vitro activity against identified pathogens within two days of admission; all other patients were assumed to have received delayed appropriate therapy. Of the 517 patients admitted to hospital for SA who met all selection criteria, 26 (5.0%) received delayed appropriate therapy. In inverse-probability-treatment-weighting-adjusted analyses, the receipt of delayed appropriate therapy was associated with an additional 1.1 days of antibiotic therapy, 1.4 days in length of stay, and $3531 in hospital costs (all vs. timely appropriate therapy; all p ≤ 0.02). Timely appropriate therapy was associated with a twofold increased likelihood of antibiotic de-escalation during the SA admission.
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14
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Spectrum scores: Toward a better definition of de-escalation. Infect Control Hosp Epidemiol 2022:1-3. [DOI: 10.1017/ice.2022.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Spectrum scores measure antimicrobial utilization while also quantifying the spectrum of activity. Accordingly, changes in spectrum score can be used to identify antimicrobial de-escalation. We show that spectrum-score–based de-escalation has a 95.7% positive percentage agreement and 81.6% negative percentage agreement versus de-escalation defined as stopping either antistaphylococcal or antipseudomonal agents.
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15
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Madhobi KF, Kalyanaraman A, Anderson DJ, Dodds Ashley E, Moehring RW, Lofgren ET. Use of Contact Networks to Estimate Potential Pathogen Risk Exposure in Hospitals. JAMA Netw Open 2022; 5:e2225508. [PMID: 35930285 PMCID: PMC9356318 DOI: 10.1001/jamanetworkopen.2022.25508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Person-to-person contact is important for the transmission of health care-associated pathogens. Quantifying these contact patterns is crucial for modeling disease transmission and understanding routes of potential transmission. OBJECTIVE To generate and analyze the mixing matrices of hospital patients based on their contacts within hospital units. DESIGN, SETTING, AND PARTICIPANTS In this quality improvement study, mixing matrices were created using a weighted contact network of connected hospital patients, in which contact was defined as occupying the same hospital unit for 1 day. Participants included hospitalized patients at 299 hospital units in 24 hospitals in the Southeastern United States that were part of the Duke Antimicrobial Stewardship Outreach Network between January 2015 and December 2017. Analysis was conducted between October 2021 and February 2022. MAIN OUTCOMES AND MEASURES The mixing matrices of patients for each hospital unit were assessed using age, Elixhauser Score, and a measure of antibiotic exposure. RESULTS Among 1 549 413 hospitalized patients (median [IQR] age, 44 [26-63] years; 883 580 [56.3%] women) in 299 hospital units, some units had highly similar patterns across multiple hospitals, although the number of patients varied to a great extent. For most of the adult inpatient units, frequent mixing was observed for older adult groups, while outpatient units (eg, emergency departments and behavioral health units) showed mixing between different age groups. Most units mixing patterns followed the marginal distribution of age; however, patients aged 90 years or older with longer lengths of stay created a secondary peak in some medical wards. From the mixing matrices by Elixhauser Score, mixing between patients with relatively higher comorbidity index was observed in intensive care units. Mixing matrices by antibiotic spectrum, a 4-point scale based on priority for antibiotic stewardship programs, resulted in 6 major distinct patterns owing to the variation of the type of antibiotics used in different units, namely those dominated by a single antibiotic spectrum (narrow, broad, or extended), 1 pattern spanning all antibiotic spectrum types and 2 forms of narrow- and extended-spectrum dominant exposure patterns (an emergency room where patients were exposed to one type of antibiotic or the other and a pediatric ward where patients were exposed to both types). CONCLUSIONS AND RELEVANCE This quality improvement study found that the mixing patterns of patients both within and between hospitals followed broadly expected patterns, although with a considerable amount of heterogeneity. These patterns could be used to inform mathematical models of health care-associated infections, assess the appropriateness of both models and policies for smaller community hospitals, and provide baseline information for the design of interventions that rely on altering patient contact patterns, such as practices for transferring patients within hospitals.
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Affiliation(s)
- Kaniz Fatema Madhobi
- School of Electrical Engineering and Computer Science, Washington State University, Pullman
| | - Ananth Kalyanaraman
- School of Electrical Engineering and Computer Science, Washington State University, Pullman
| | - Deverick J. Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Elizabeth Dodds Ashley
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Rebekah W. Moehring
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Eric T. Lofgren
- Paul G. Allen School for Global Health, Washington State University, Pullman
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16
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Measuring empiric antibiotic spectrum—A journey through space and time. Infect Control Hosp Epidemiol 2022; 44:565-569. [PMID: 35762168 DOI: 10.1017/ice.2022.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Objectives:
The typical 5-day work week affects healthcare outcomes. Structured work hours have also been implicated in antimicrobial prescribing choice. We developed a visualization tool to aid in evaluating breadth of antibiotic use in various time (day of week and hour of day) and space (patient location) combinations.
Methods:
We evaluated antibiotic administration data from a tertiary-care academic medical center between July 1, 2018, and July 1, 2020. We calculated a cumulative empiric antibiotic spectrum score by adapting a previously validated antibiotic spectrum index (ASI) and applying that score to empiric antibiotic use. We visualized these data as a heat map based on various day-of-week–time combinations and then compared the distribution of scores between weekday nights, weekend days, and weekend nights to the typical workweek hours (weekday days, weekday days) using the Mann-Whitney U nonparametric test with a Bonferroni correction.
Results:
The analysis included 76,535 antibiotic starts across 53,900 unique patient admissions over 2 years. The mean cumulative ASI was higher in all 3 night and weekend combinations (weekday nights, 7.3; weekend days, 7.6; weekend nights, 7.5) compared to the weekday daytime hours (weekday days, 7.1) and the distribution of scores was different in all groups compared to the weekday daytime reference. The cumulative ASI was also higher in intensive care units.
Conclusions:
Empiric antibiotic prescribing patterns differed across space and time; broader antibiotic choices occurred in the intensive care units and on nights and weekends. Visualization of these patterns aids in antimicrobial prescribing pattern recognition and may assist in finding opportunities for additional antimicrobial stewardship interventions.
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Goodman KE, Heil EL, Claeys KC, Banoub M, Bork JT. Real-World Antimicrobial Stewardship Experience in a Large Academic Medical Center: Using Statistical and Machine Learning Approaches to Identify Intervention “Hotspots” in an Antibiotic Audit and Feedback Program. Open Forum Infect Dis 2022; 9:ofac289. [PMID: 35873287 PMCID: PMC9297307 DOI: 10.1093/ofid/ofac289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/07/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
Prospective audit with feedback (PAF) is an impactful strategy for antimicrobial stewardship program (ASP) activities. However, because PAF requires reviewing large numbers of antimicrobial orders on a case-by-case basis, PAF programs are highly resource-intensive. The current study aimed to identify predictors of ASP intervention (i.e., feedback), and to build models to identify orders that can be safely bypassed from review, to make PAF programs more efficient.
Methods
We performed a retrospective cross-sectional study of inpatient antimicrobial orders reviewed by the University of Maryland Medical Center’s PAF program between 2017–2019. We evaluated the relationship between antimicrobial and patient characteristics with ASP intervention using multivariable logistic regression models. Separately, we built prediction models for ASP intervention using statistical and machine learning approaches and evaluated performance on held-out data.
Results
Across 17,503 PAF reviews, 4,219 (24%) resulted in intervention. In adjusted analyses, a clinical pharmacist on the ordering unit or receipt of an ID consult were associated with 17% and 56% lower intervention odds, respectively (aORs 0.83 and 0.44, P values ≤ 0.001). Fluoroquinolones had the highest adjusted intervention odds (aOR 3.22, 95% CI: 2.63–3.96). A machine learning classifier (C-statistic 0.76) reduced reviews by 49% while achieving 78% sensitivity. A “workflow simplified” regression model that restricted to antimicrobial class and clinical indication variables, two strong machine-learning-identified predictors, reduced reviews by one-third while achieving 81% sensitivity.
Conclusions
Prediction models substantially reduced PAF review caseloads while maintaining high sensitivities. Our results and approach may offer a blueprint for other ASPs.
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Affiliation(s)
- Katherine E Goodman
- Correspondence: Katherine E. Goodman, JD, PhD, University of Maryland School of Medicine, 10 S Pine St, Baltimore, MD 21201, USA ()
| | - Emily L Heil
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Kimberly C Claeys
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Mary Banoub
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Jacqueline T Bork
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Anderson DJ, Moehring RW, Parish A, David MZ, Hsueh K, Cressman L, Tolomeo P, Habrock-Bach T, Hill CL, Ryan M, O'Brien C, Lokhnygina Y, Dodds Ashley E. The Impact of CMS SEP-1 Core Measure Implementation on Antibacterial Utilization: a retrospective multicenter longitudinal cohort study with interrupted time-series analysis. Clin Infect Dis 2021; 75:503-511. [PMID: 34739080 DOI: 10.1093/cid/ciab937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The impact of the U.S. Centers for Medicare and Medicaid Services (CMS) Severe Sepsis and Septic Shock: Management Bundle (SEP-1) Core Measure on overall antibacterial utilization is unknown. METHODS We performed a retrospective multicenter longitudinal cohort study with interrupted time series analysis to determine the impact of SEP-1 implementation on antibacterial utilization and patient outcomes. All adult patients admitted to 26 hospitals between October 1, 2014, and September 30, 2015 (the "SEP-1 preparation period") and between November 1, 2015, and October 31, 2016 (the "SEP-1 implementation period") were evaluated for inclusion.The primary outcome was total antibacterial utilization measured as days of therapy (DOT) per 1,000 patient days. RESULTS The study cohort included 701,055 eligible patient admissions and 4.2 million patient days. Overall antibacterial utilization increased 2% each month during SEP-1 preparation (RR=1.02 per month [95% CI 1.00-1.04]; p=0.02). Cumulatively, the mean monthly DOT/1,000 patient-days increased 24.4% [95% CI 18.0, 38.8] over the entire study period (October 2014-October 2016). The rate of sepsis diagnosis/1,000 patients increased 2% each month during SEP-1 preparation (RR=1.02 per month [95% CI 1.00-1.04]; p=0.04). The rate of all-cause mortality/1,000 patients decreased during the study period (SEP-1 preparation RR=0.95 [0.92-0.98]; p=0.001 and SEP-1 implementation RR=0.98 [95% CI 0.97-1.00]; p=0.01). Cumulatively, the monthly mean all-cause mortality/1,000 patients declined 38.5% [95% CI 25.9, 48.0] over the study period. CONCLUSIONS Announcement and implementation of the CMS SEP-1 process measure was associated with increased diagnosis of sepsis and antibacterial utilization and decreased mortality among hospitalized patients.
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Affiliation(s)
- Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
| | - Rebekah W Moehring
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
| | - Alice Parish
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA
| | - Michael Z David
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Hsueh
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Leigh Cressman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Tracey Habrock-Bach
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Cherie L Hill
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew Ryan
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
| | - Cara O'Brien
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Yuliya Lokhnygina
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA
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Boussion K, Zappella N, Grall N, Ribeiro-Parenti L, Papin G, Montravers P. Epidemiology, clinical relevance and prognosis of staphylococci in hospital-acquired postoperative intra-abdominal infections: an observational study in intensive care unit. Sci Rep 2021; 11:5884. [PMID: 33723332 PMCID: PMC7960962 DOI: 10.1038/s41598-021-85443-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/24/2021] [Indexed: 12/29/2022] Open
Abstract
The pathogenic role of staphylococci in hospital-acquired postoperative intra-abdominal infections (HAIs) has never been evaluated. In a tertiary care university hospital, we assessed the clinical characteristics and outcomes of patients admitted to the intensive care unit for HAIs according to the presence of staphylococci (S-HAI) or their absence (nS-HAI) in peritoneal cultures. Patients with S-HAIs were compared to nS-HAIs patients. Overall, 380 patients were analyzed, including 87 (23%) S-HAI patients [29 Staphylococcus aureus (Sa-HAIs) and 58 coagulase-negative staphylococci (CoNS-HAIs)]. The clinical characteristics did not differ between the S-HAI and nS-HAI patients. Adequacy of empirical anti-infective therapy was achieved less frequently in the staphylococci group (54 vs 72%, respectively, p < 0.01). The 90-day (primary endpoint) and one-year mortality rates did not differ between these groups. The S-HAI patients had decreased rates of postoperative complication (p < 0.05). The adjusted analysis of the clinical outcomes reported a decreased frequency of surgical complications in the staphylococci group (OR 0.43, 95% CI [0.20–0.93], p = 0.03). While the trends toward decreased morbidity criteria were observed in S-HAI patients, the clinical outcomes were not different between the CoNS-HAI and Sa-HAI patients. In summary, our data are not substantial enough to conclude that staphylococci exhibit no pathogenicity in HAIs.
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Affiliation(s)
- Kévin Boussion
- Hôpitaux de Paris, Department of Anesthesiology and Critical Care Medicine, DMU PARABOL Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Nathalie Zappella
- Hôpitaux de Paris, Department of Anesthesiology and Critical Care Medicine, DMU PARABOL Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Nathalie Grall
- Hôpitaux de Paris, Department of Bacteriology, Bichat-Claude Bernard Hospital, Paris, France.,Université de Paris, Paris, France.,INSERM UMR 1137, IAME, Paris, France
| | - Lara Ribeiro-Parenti
- Hôpitaux de Paris, Department of General, Esogastric and Bariatic Surgery, Bichat-Claude Bernard Hospital, Paris, France.,Université de Paris, Paris, France.,Inserm UMR1149, Paris, France
| | - Grégory Papin
- Hôpitaux de Paris, Department of Anesthesiology and Critical Care Medicine, DMU PARABOL Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Philippe Montravers
- Hôpitaux de Paris, Department of Anesthesiology and Critical Care Medicine, DMU PARABOL Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France. .,Université de Paris, Paris, France. .,INSERM UMR1152, ANR-10-LABX-17, Paris, France.
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20
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Evaluation of an initiative to improve prophylactic antimicrobial prescribing in patients on extracorporeal membrane oxygenation (ECMO) through the application of three antimicrobial-spectrum scores. Infect Control Hosp Epidemiol 2021; 43:96-98. [PMID: 33557991 DOI: 10.1017/ice.2021.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Antimicrobial spectrum scoring is a method to quantify the spectrum of antimicrobial utilization. Herein, we applied a locally adapted scoring system, with other pre-existing scoring systems, using a data set of prophylactically administered antibiotics following a 2-stage antimicrobial stewardship program (ASP) intervention in a population of patients on extracorporeal membrane oxygenation (ECMO).
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