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Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, Todi SK, Mohan A, Hegde A, Jagiasi BG, Krishna B, Rodrigues C, Govil D, Pal D, Divatia JV, Sengar M, Gupta M, Desai M, Rungta N, Prayag PS, Bhattacharya PK, Samavedam S, Dixit SB, Sharma S, Bandopadhyay S, Kola VR, Deswal V, Mehta Y, Singh YP, Myatra SN. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024; 28:S104-S216. [PMID: 39234229 PMCID: PMC11369928 DOI: 10.5005/jp-journals-10071-24677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/20/2024] [Indexed: 09/06/2024] Open
Abstract
How to cite this article: Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, et al. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024;28(S2):S104-S216.
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Affiliation(s)
- Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
| | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Subhash K Todi
- Department of Critical Care, AMRI Hospital, Kolkata, West Bengal, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Ashit Hegde
- Department of Medicine & Critical Care, P D Hinduja National Hospital, Mumbai, India
| | - Bharat G Jagiasi
- Department of Critical Care, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, Maharashtra, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St John's Medical College and Hospital, Bengaluru, India
| | - Camila Rodrigues
- Department of Microbiology, P D Hinduja National Hospital, Mumbai, India
| | - Deepak Govil
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Divya Pal
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mukesh Desai
- Department of Immunology, Pediatric Hematology and Oncology Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Narendra Rungta
- Department of Critical Care & Anaesthesiology, Rajasthan Hospital, Jaipur, India
| | - Parikshit S Prayag
- Department of Transplant Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Pradip K Bhattacharya
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Srinivas Samavedam
- Department of Critical Care, Ramdev Rao Hospital, Hyderabad, Telangana, India
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Sudivya Sharma
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Susruta Bandopadhyay
- Department of Critical Care, AMRI Hospitals Salt Lake, Kolkata, West Bengal, India
| | - Venkat R Kola
- Department of Critical Care Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Vikas Deswal
- Consultant, Infectious Diseases, Medanta - The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Yogendra P Singh
- Department of Critical Care, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Faiela C, Sevene E. Antibiotic prescription for HIV-positive patients in primary health care in Mozambique: A cross-sectional study. S Afr J Infect Dis 2022; 37:340. [PMID: 35284563 PMCID: PMC8905412 DOI: 10.4102/sajid.v37i1.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Antibiotic overuse is a major public health challenge worldwide and it can result in the emergence and spread of drug resistance. In Mozambique, there are limited data related to primary care physicians' antibiotic prescription patterns. The aim of this study was to assess the antibiotic prescription patterns for HIV- positive patients in primary health care. Methods A prospective cross-sectional quantitative study was conducted in eight primary health care units in Southern Mozambique. The study was based on recording outpatient prescriptions using a structured questionnaire. Three hundred and sixty-nine prescriptions and clinical records of HIV-positive patients from 31 prescribers were assessed. A total of eight general practitioners, 13 medical technicians and 10 nurses participated. Results Antibiotics were used in 65.9% of prescriptions, with an average of 0.9 antibiotics per prescription. Of a total of 334 prescribed antibiotics, 69.8% were for the treatment of infections and 30.2% for prophylaxis. Penicillin (29.2%), sulphonamides (19.7%), and quinolones (16.3%) were the most prescribed classes of antibiotics for treatment. For prophylaxis, only sulphonamides (93.1%) and macrolides (6.9%) were prescribed. The diagnosis was the only variable that had a significant association with antibiotic prescription (p < 0.001). Most of penicillins (68.0%) and sulphonamides (21.4%) were prescribed to treat infections related to the respiratory tract. Conclusion The prescription of antibiotics was high and influenced by patient clinical conditions. Antibiotics were prescribed either for treatment or prophylaxis of infections, mostly to treat respiratory tract infections. Prescribers should be encouraged to adopt a rational use of antibiotics to reduce unnecessary prescriptions.
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Affiliation(s)
- Candido Faiela
- Department of Biological Science, Faculty of Science, Eduardo Mondlane University, Maputo, Mozambique
- Department of Physiological Science, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Esperanca Sevene
- Department of Physiological Science, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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Gandra S, Alvarez-Uria G, Turner P, Joshi J, Limmathurotsakul D, van Doorn HR. Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries. Clin Microbiol Rev 2020; 33:e00048-19. [PMID: 32522747 PMCID: PMC7289787 DOI: 10.1128/cmr.00048-19] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious global health threat and is predicted to cause significant health and economic impacts, particularly in low- and middle-income countries (LMICs). AMR surveillance is critical in LMICs due to high burden of bacterial infections; however, conducting AMR surveillance in resource-limited settings is constrained by poorly functioning health systems, scarce financial resources, and lack of skilled personnel. In 2015, the United Nations World Health Assembly endorsed the World Health Organization's Global Action Plan to tackle AMR; thus, several countries are striving to improve their AMR surveillance capacity, including making significant investments and establishing and expanding surveillance networks. Initial data generated from AMR surveillance networks in LMICs suggest the high prevalence of resistance, but these data exhibit several shortcomings, such as a lack of representativeness, lack of standardized laboratory practices, and underutilization of microbiology services. Despite significant progress, AMR surveillance networks in LMICs face several challenges in expansion and sustainability due to limited financial resources and technical capacity. This review summarizes the existing health infrastructure affecting the establishment of AMR surveillance programs, the burden of bacterial infections demonstrating the need for AMR surveillance, and current progress and challenges in AMR surveillance efforts in eight South and Southeast Asian countries.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, Anantapur, Andhra Pradesh, India
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jyoti Joshi
- Center for Disease Dynamics, Economics and Policy, New Delhi, India
| | - Direk Limmathurotsakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam
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Malchione MD, Torres LM, Hartley DM, Koch M, Goodman JL. Carbapenem and colistin resistance in Enterobacteriaceae in Southeast Asia: Review and mapping of emerging and overlapping challenges. Int J Antimicrob Agents 2019; 54:381-399. [DOI: 10.1016/j.ijantimicag.2019.07.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/16/2019] [Accepted: 07/21/2019] [Indexed: 01/21/2023]
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Reed TAN, Krang S, Miliya T, Townell N, Letchford J, Bun S, Sar B, Osbjer K, Seng S, Chou M, By Y, Vanchinsuren L, Nov V, Chau D, Phe T, de Lauzanne A, Ly S, Turner P. Antimicrobial resistance in Cambodia: a review. Int J Infect Dis 2019; 85:98-107. [PMID: 31176035 DOI: 10.1016/j.ijid.2019.05.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Following the launch of the Global Antimicrobial Resistance Surveillance System (GLASS), antimicrobial resistance (AMR) rates in many countries remain poorly described. This review provides an overview of published AMR data from Cambodia in the context of recently initiated national human and food-animal surveillance. METHODS PubMed and the Cochrane Database of Systematic Reviews were searched for articles published from 2000 to 2018, which reported antimicrobial susceptibility testing (AST) data for GLASS specific organisms isolated from Cambodia. Articles were screened using strict inclusion/exclusion criteria. AST data was extracted, with medians and ranges of resistance rates calculated for specific bug-drug combinations. RESULTS Twenty-four papers were included for final analysis, with 20 describing isolates from human populations. Escherichia coli was the most commonly described organism, with median resistance rates from human isolates of 92.8% (n=6 articles), 46.4% (n=4), 55.4% (n=8), and 46.4% (n=5) to ampicillin, 3rd generation cephalosporins, fluoroquinolones, and gentamicin respectively. CONCLUSIONS Whilst resistance rates are high for several GLASS organisms, there were insufficient data to draw robust conclusions about the AMR situation in Cambodia. The recently implemented national AMR surveillance systems will begin to address this data gap.
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Affiliation(s)
- Thomas A N Reed
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Sidonn Krang
- Department of Communicable Diseases Control, Ministry of Health, Phnom Penh, Cambodia
| | - Thyl Miliya
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Nicola Townell
- Diagnostic Microbiology Development Program, Phnom Penh, Cambodia
| | - Joanne Letchford
- Diagnostic Microbiology Development Program, Phnom Penh, Cambodia
| | - Sreng Bun
- United States Centers for Disease Control and Prevention, Phnom Penh, Cambodia
| | - Borann Sar
- United States Centers for Disease Control and Prevention, Phnom Penh, Cambodia
| | - Kristina Osbjer
- Food and Agriculture Organisation of the United Nations, Phnom Penh, Cambodia
| | - Sokerya Seng
- Food and Agriculture Organisation of the United Nations, Phnom Penh, Cambodia
| | - Monidarin Chou
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | - Youlet By
- Fondation Mérieux, Phnom Penh, Cambodia
| | | | - Vandarith Nov
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Darapheak Chau
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Thong Phe
- Sihanouk Hospital Center of Hope, Phnom Penh, Cambodia
| | | | - Sovann Ly
- Department of Communicable Diseases Control, Ministry of Health, Phnom Penh, Cambodia
| | - Paul Turner
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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Bloodstream infections in patients living with HIV in the modern cART era. Sci Rep 2019; 9:5418. [PMID: 30931978 PMCID: PMC6443940 DOI: 10.1038/s41598-019-41829-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 03/14/2019] [Indexed: 12/12/2022] Open
Abstract
Retrospective multicentre study aiming at analysing the etiology, characteristics and outcome of bloodstream infections (BSI) in people living with HIV (PLWHIV) in an era of modern antiretroviral therapy. Between 2008 and 2015, 79 PLWHIV had at least 1 BSI, for a total of 119 pathogens isolated. Patients were mainly male (72.1%), previous intravenous drug users (55.7%), co-infected with HCV or HBV (58.2%) and in CDC stage C (60.8%). Gram-positive (G+) pathogens caused 44.5% of BSI, followed by Gram-negative (G−), 40.3%, fungi, 10.9%, and mycobacteria, 4.2%. Candida spp. and coagulase-negative staphylococci were the most frequent pathogens found in nosocomial BSI (17% each), while E.coli was prevalent in community-acquired BSI (25%). At the last available follow-up, (mean 3.2 ± 2.7 years) the overall crude mortality was 40.5%. Factors associated with mortality in the final multivariate analysis were older age, (p = 0.02; HR 3.8, 95%CI 1.2–11.7) CDC stage C (p = 0.02; HR 3.3, 95%CI 1.2–9.1), malignancies, (p = 0.004; HR 3.2, 95%CI 1.4–7.0) and end stage liver disease (p = 0.006; HR 3.4, 95%CI 1.4–8.0). In conclusion, the study found high mortality following BSI in PLWHIV. Older age, neoplastic comorbidities, end stage liver disease and advanced HIV stage were the main factors correlated to mortality.
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Rameshkumar MR, Arunagirinathan N, Swathirajan CR, Vignesh R, Balakrishnan P, Solomon SS. Do the clonally different Escherichia coli isolates causing different infections in a HIV positive patient affect the selection of antibiotics for their treatment? Indian J Med Res 2018; 148:341-344. [PMID: 30425226 PMCID: PMC6251270 DOI: 10.4103/ijmr.ijmr_730_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Marimuthu Ragavan Rameshkumar
- Department of Microbiology and Biotechnology, Presidency College (Autonomous); Infectious Diseases Laboratory, YRG Centre for AIDS Research and Education, Voluntary Health Services Hospital Campus, Chennai, India
| | - Narasingam Arunagirinathan
- Department of Microbiology and Biotechnology, Presidency College (Autonomous); Faculty of Allied Health Sciences, Meenakshi Academy of Higher Education and Research (Deemed to be University), Chennai, India
| | | | - Ramachandran Vignesh
- Infectious Diseases Laboratory, YRG Centre for AIDS Research and Education, Voluntary Health Services Hospital Campus, Chennai, India; Preclinical Department, Faculty of Medicine, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Pachamuthu Balakrishnan
- Infectious Diseases Laboratory, YRG Centre for AIDS Research and Education, Voluntary Health Services Hospital Campus, Chennai, India
| | - Sunil Suhas Solomon
- Infectious Diseases Laboratory, YRG Centre for AIDS Research and Education, Voluntary Health Services Hospital Campus, Chennai, India; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Kengne M, Lebogo MBB, Nwobegahay JM, Ondigui BE. Antibiotics susceptibility pattern of Streptococcus pneumoniae isolated from sputum cultures of human immunodeficiency virus infected patients in Yaoundé, Cameroon. Pan Afr Med J 2018; 31:16. [PMID: 30918544 PMCID: PMC6430946 DOI: 10.11604/pamj.2018.31.16.11195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 08/06/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction The susceptibility of Streptococcus pneumoniae to commonly used antibiotics is threatened by the emergence of resistance of S. pneumonia strains. So, to improve the management of lower respiratory tract infections (LRTIs) in human immunodeficiency virus infected patients, we assessed the antibiotic susceptibility of Streptococcus pneumoniae which is the most common bacterial cause of LRTIs in patients. Methods A cross sectional study was carried out from May to October 2014. HIV infected patients suspected of LRTIs attending the Center Medical laboratory and those followed up at the authorized treatment center of Yaounde Military Hospital in Cameroon were enrolled. Sputum was collected from each patient and cultured; identification of microorganisms was performed following standard methods. The disk diffusion method was used for antibacterial susceptibility testing according to the Antibiogram Committee of French Society for Microbiology guidelines. Results A total of 51 (25.5%) isolates of S. pneumoniae were recovered from sputum samples obtained from 200 HIV infected patients aged 19-66 years old (mean age: 36±10.087 years old); 144 (72%) of them were female (sex ratio M/F: 1/3). S. pneumoniae carriage was not age dependent (P = 0.384) and was significantly higher in male compared to female (P = 0.008). S. pneumoniae isolates were susceptible to amoxicillin-clavulinic acid (100%), pristinamycin (100%), erythromycin (100%) and cefixime (98.04 %). Highest resistance rates were recorded with fusidic acid (100%), fosfomycin (100%) and tetracyclin (100%). Conclusion S. pneumoniae is still susceptible to some agents in our study area however; ongoing surveillance for antimicrobial susceptibility remains essential to identify emerging resistance and attempt to limit its spread.
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Affiliation(s)
- Michel Kengne
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | | | - Julius Mbekem Nwobegahay
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon.,Yaoundé Military Hospital, Cameroon
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Calik Basaran N, Ascioglu S. Epidemiology and management of healthcare-associated bloodstream infections in non-neutropenic immunosuppressed patients: a review of the literature. Ther Adv Infect Dis 2017; 4:171-191. [PMID: 29662673 DOI: 10.1177/2049936117733394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Advancements in medicine have led to a considerable increase in the proportion of patients living with severe chronic diseases, malignancies, and HIV infections. Most of these conditions are associated with acquired immune-deficient states and treatment-related immunosuppression. Although infections as a result of neutropenia have long been recognized and strategies for management were developed, non-neutropenic immunosuppression has been overlooked. Recently, community-acquired infections in patients with frequent, significant exposure to healthcare settings and procedures have been classified as 'healthcare-associated infections' since they are more similar to hospital-acquired infections. Most of the non-neutropenic immunosuppressed patients have frequent contact with the healthcare system due to their chronic and severe diseases. In this review, we focus on the healthcare-associated bloodstream infections in the most common non-neutropenic immunosuppressive states and provide an update of the recent evidence for the management of these infections.
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Affiliation(s)
- Nursel Calik Basaran
- Department of Internal Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Sibel Ascioglu
- Department of Infectious Diseases and Microbiology, Hacettepe University Medical School, Ankara, Turkey; GlaxoSmithKline Pte Ltd., Singapore
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Abstract
In the combined antiretroviral therapy era, HIV-infected patients remain a vulnerable population for the onset of bloodstream infections (BSI). Worldwide, nontyphoid salmonellae, Streptococcus pneumoniae, Escherichia coli, Staphylococcus aureus and coagulase negative staphylococci are the most important pathogens. Intravenous catheter associated infection, skin-soft tissue infection and endocarditis are associated with Gram-positive bacteremia. Among the Gram-negative, nontyphoidal Salmonella have been previously correlated to sepsis. Other causes of BSI in HIV-infected patients are mycobacteria and fungi. Mycobacteria constitute a major cause of BSI in limited resource countries. Fungal BSI are not frequent and among them Cryptococcus neoformans is the most common life-threatening infection. The degree of immunosuppression remains the key prognostic factor leading to the development of BSI.
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Affiliation(s)
- Lucia Taramasso
- a Infectious Diseases Unit, IRCCS AOU San Martino-IST, University of Genoa , Genoa , Italy
| | - Paola Tatarelli
- a Infectious Diseases Unit, IRCCS AOU San Martino-IST, University of Genoa , Genoa , Italy
| | - Antonio Di Biagio
- a Infectious Diseases Unit, IRCCS AOU San Martino-IST, University of Genoa , Genoa , Italy
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Gaskell KM, Feasey NA, Heyderman RS. Management of severe non-TB bacterial infection in HIV-infected adults. Expert Rev Anti Infect Ther 2016; 13:183-95. [PMID: 25578883 DOI: 10.1586/14787210.2015.995631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite widespread antiretroviral therapy use, severe bacterial infections (SBI) in HIV-infected adults continue to cause significant morbidity and mortality globally. Four main pathogens account for the majority of documented SBI: Streptococcus pneumoniae, non-typhoidal strains of Salmonella enterica, Escherichia coli and Staphylococcus aureus. The epidemiology of SBI is dynamic, both in developing countries where, despite dramatic successes in antiretroviral therapy, coverage is far from complete, and in settings in both resource-poor and resource-rich countries where antiretroviral therapy failure is becoming increasingly common. Throughout the world, this complexity is further compounded by rapidly emerging antimicrobial resistance, making management of SBI very challenging in these vulnerable patients. We review the causes and treatment of SBI in HIV-infected people and discuss future developments in this field.
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Affiliation(s)
- Katherine M Gaskell
- Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
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Lee CC, Chu FY, Ko WC, Chi CH. Different clinical presentation of community-onset bacteremia among human immunodeficiency virus-infected and human immunodeficiency virus-uninfected adults in the ED. Am J Emerg Med 2014; 32:1241-7. [PMID: 25171801 DOI: 10.1016/j.ajem.2014.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/14/2014] [Accepted: 07/26/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The objective of this study is to analyze the differences in clinical presentation and outcome of community-onset bacteremia between human immunodeficiency virus (HIV)-infected adults and HIV-uninfected adults visiting the emergency department (ED). METHODS A multicenter, case-control study with a ratio of 1:4 was conducted retrospectively over an 8-year period. Demographic characteristics, severity of illness, and clinical outcomes determined from chart records were analyzed. RESULTS In total, 74 HIV-infected adults (case patients) and 288 HIV-uninfected adults (control patients) were examined. Significant differences in clinical presentation, severity, and the source of bacteremia as well as bacteremia-causing microorganisms between the case patients and control patients were observed by univariate analyses. Using multivariate analyses, the following variables were positively associated with case patients: male sex (odds ratio [OR], 3.42; P = .01), bacteremia due to endocarditis (OR, 7.68; P = .007), bacteremia due to Salmonella enteritidis (OR, 4.29; P = .03), and comorbidity with chronic hepatitis (OR, 5.65; P < .001). Moreover, several independent risk factors of 28-day mortality were discovered, including inappropriate empirical antibiotic therapy after the ED visit (OR, 9.01; P < .001), an initial syndrome with septic shock (OR, 5.37; P < .001); a Pittsburgh bacteremia score greater than or equal to 4 points at the ED (OR, 4.28; P = .002), severe underlying disease based on McCabe classification (rapid and ultimately fatal; OR, 3.31; P = .002), and bacteremia due to pneumonia (OR, 2.66; P = .03). Of note, HIV infection was not a significant factor affecting 28-day mortality. CONCLUSIONS This study demonstrated that the clinical characteristics, the severity, and the character of bacteremia in HIV-infected and uninfected patients varied among community-onset bacteremic patients visiting the ED, despite the limited impact of HIV infection on short-term outcomes.
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Affiliation(s)
- Ching-Chi Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Feng-Yuan Chu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan 710, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan 704, Taiwan
| | - Chih-Hsien Chi
- Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan 704, Taiwan.
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Huson MAM, Stolp SM, van der Poll T, Grobusch MP. Community-acquired bacterial bloodstream infections in HIV-infected patients: a systematic review. Clin Infect Dis 2013; 58:79-92. [PMID: 24046307 DOI: 10.1093/cid/cit596] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Information on community-acquired bacterial bloodstream infections (BSIs) in individuals infected with human immunodeficiency virus (HIV) is limited. We conducted a systematic literature review. The case fraction of community-acquired bacterial BSIs in hospitalized patients is 20% and 30% in adults and children, respectively, compared to 9% in HIV-negative adults and children. Worldwide, the main pathogens of community-acquired BSI are nontyphoid salmonellae (NTS), Streptococcus pneumoniae, Escherichia coli, and Staphylococcus aureus, but regional differences are apparent, especially for S. pneumoniae. Compared to HIV-negative populations, HIV patients are particularly at risk to develop NTS bacteremia. Bacteremia incidence is related to immunosuppression, and antiretroviral therapy reduces the incidence of BSI in HIV patients (rate ratios, 0.63-0.02). Mortality rates varied between 7% and 46%. These results suggest that bacterial BSI is more likely to be found in HIV-positive than in HIV-negative patients upon hospitalization, and that causative pathogens vary by region.
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Affiliation(s)
- Michaëla A M Huson
- Division of Infectious Diseases, Center of Experimental and Molecular Medicine, Center of Infection and Immunity and Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
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