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Cheolin Kang - One of the best experts on this subject based on the ideXlab platform.
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clinical effectiveness of oral Antimicrobial Therapy for acute pyelonephritis caused by extended spectrum β lactamase producing enterobacteriales
European Journal of Clinical Microbiology & Infectious Diseases, 2020Co-Authors: Siho Kim, Cheolin Kang, Doo Ryeon Chung, Kyoung Ree Lim, Hyunju Lee, Kyungmin Huh, Sun Young Cho, Kyong Ran PeckAbstract:Infections caused by extended-spectrum β-lactamase-producing Enterobacteriales (ESBL-PE) are commonly treated with intravenous antibiotics. This study investigated whether oral Antimicrobial Therapy (OAT) is as effective as intravenous Antimicrobial Therapy (IVT) for acute pyelonephritis (APN) caused by ESBL-PE. A retrospective cohort of patients with APN caused by ESBL-PE was studied at a tertiary-care hospital from January 2014 through December 2016. The OAT group comprised patients treated with an appropriate oral Antimicrobial agent following 7 days or less of IVT. The primary endpoint was treatment failure defined as clinical and/or microbiological failure. The secondary endpoint was length of hospital stay and recurrences of APN within 2 months and within 1 year. Propensity score matching and multivariable Cox proportional hazard modeling were used to minimize bias. Among 238 eligible cases, Escherichia coli (83.6%) was the most common pathogen. Sixty patients received OAT after a median of four days of appropriate IVT, and 178 patients completed treatment with IVT. Fluoroquinolones (58.3%) were the most commonly prescribed OAT, followed by trimethoprim-sulfamethoxazole and amoxicillin-clavulanate. OAT was not associated with treatment failure (adjusted OR 0.66; 95% CI 0.18–2.44) and hospitalization length was shorter in the OAT group (6.2 days versus 10.7 days; P < 0.01). APN recurrence caused by ESBL-PE infection within 2 months was not associated with OAT (adjusted HR 0.56; 95% CI 0.16–2.00). OAT reduced hospital stay without adverse effects on treatment outcome. OAT could be safely applied as a carbapenem-saving option in treatment of APN.
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impact of inappropriate Antimicrobial Therapy on outcome in patients with hospital acquired pneumonia caused by acinetobacter baumannii
Journal of Infection, 2010Co-Authors: Mi Kyong Joung, Cheolin Kang, Ki Tae Kwon, Hae Suk Cheong, Jiyoung Rhee, Dong Sik Jung, Seung Min Chung, Sooyoun Moon, Kwan Soo Ko, Doo Ryeon ChungAbstract:Summary Objectives The purpose of this study was to evaluate the impact of inappropriate Antimicrobial Therapy on the outcome of patients with hospital-acquired pneumonia (HAP) caused by Acinetobacter baumannii . Methods All cases of HAP caused by A. baumannii from January 2000 to March 2006 at the Samsung Medical Center (Seoul, Korea) were analyzed retrospectively. Results A total of 116 patients with clinically significant Acinetobacter HAP were enrolled. Among the A. baumannii isolates, 60.3% showed multi-drug resistance (MDR), 16.4% were found to have imipenem resistance, and 15.5% had pan-drug resistance (PDR). The mean APACHE II score of the patients was 22.3 ± 7.9. The overall in-hospital and pneumonia-related mortality rates were 47.4% and 37.9%, respectively. The univariate analysis showed that the factors associated with pneumonia-related mortality were: MDR, PDR, high APACHE II score, inappropriate empirical Antimicrobial Therapy, and inappropriate definitive Antimicrobial treatment (All p Conclusions The appropriate definitive Antimicrobial Therapy should be provided in patients with HAP caused by A. baumannii .
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bloodstream infections caused by antibiotic resistant gram negative bacilli risk factors for mortality and impact of inappropriate initial Antimicrobial Therapy on outcome
Antimicrobial Agents and Chemotherapy, 2005Co-Authors: Cheolin Kang, Sunghan Kim, Wan Beom Park, Kideok Lee, Hong Bin Kim, Euichong Kim, Kangwon ChoeAbstract:The marked increase in the incidence of infections due to antibiotic-resistant gram-negative bacilli in recent years is of great concern, as patients infected by those isolates might initially receive antibiotics that are inactive against the responsible pathogens. To evaluate the effect of inappropriate initial Antimicrobial Therapy on survival, a total of 286 patients with antibiotic-resistant gram-negative bacteremia, 61 patients with Escherichia coli bacteremia, 65 with Klebsiella pneumoniae bacteremia, 74 with Pseudomonas aeruginosa bacteremia, and 86 with Enterobacter bacteremia, were analyzed retrospectively. If a patient received at least one Antimicrobial agent to which the causative microorganisms were susceptible within 24 h of blood culture collection, the initial Antimicrobial Therapy was considered to have been appropriate. High-risk sources of bacteremia were defined as the lung, peritoneum, or an unknown source. The main outcome measure was 30-day mortality. Of the 286 patients, 135 (47.2%) received appropriate initial empirical Antimicrobial Therapy, and the remaining 151 (52.8%) patients received inappropriate Therapy. The adequately treated group had a 27.4% mortality rate, whereas the inadequately treated group had a 38.4% mortality rate (P = 0.049). Multivariate analysis showed that the significant independent risk factors of mortality were presentation with septic shock, a high-risk source of bacteremia, P. aeruginosa infection, and an increasing APACHE II score. In the subgroup of patients (n = 132) with a high-risk source of bacteremia, inappropriate initial Antimicrobial Therapy was independently associated with increased mortality (odds ratio, 3.64; 95% confidence interval, 1.13 to 11.72; P = 0.030). Our data suggest that inappropriate initial Antimicrobial Therapy is associated with adverse outcome in antibiotic-resistant gram-negative bacteremia, particularly in patients with a high-risk source of bacteremia.
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bloodstream infections due to extended spectrum β lactamase producing escherichia coli and klebsiella pneumoniae risk factors for mortality and treatment outcome with special emphasis on Antimicrobial Therapy
Antimicrobial Agents and Chemotherapy, 2004Co-Authors: Cheolin Kang, Myoungdon Oh, Wan Beom Park, Kangwon ChoeAbstract:This study was conducted to evaluate risk factors for mortality and treatment outcome of bloodstream infections due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK). ESBL production in stored K. pneumoniae and E. coli blood isolates from Jan 1998 to Dec 2002 was phenotypically determined according to NCCLS guidelines and/or the double-disk synergy test. A total of 133 patients with ESBL-EK bacteremia, including 66 patients with ESBL-producing K. pneumoniae and 67 with ESBL-producing E. coli, were enrolled. The overall 30-day mortality rate was 25.6% (34 of 133). Independent risk factors for mortality were severe sepsis, peritonitis, neutropenia, increasing Acute Physiology and Chronic Health Evaluation II score, and administration of broad-spectrum cephalosporin as definitive Antimicrobial Therapy (P < 0.05 for each of these risk factors). In 117 of the 133 patients, excluding 16 patients who died within 3 days after blood culture sample acquisition, the 30-day mortality rates according to definitive antibiotics were as follows: carbapenem, 12.9% (8 of 62); ciprofloxacin, 10.3% (3 of 29); and others, such as cephalosporin or an aminoglycoside, 26.9% (7 of 26). When patients who received appropriate definitive antibiotics, such as carbapenem or ciprofloxacin, were evaluated, mortality in patients receiving inappropriate empirical Antimicrobial Therapy was found not to be significantly higher than mortality in those receiving appropriate empirical Antimicrobial Therapy (18.9 versus 15.5%; P = 0.666). Carbapenem and ciprofloxacin were the most effective antibiotics in Antimicrobial Therapy for ESBL-EK bacteremia. A delay in appropriate definitive Antimicrobial Therapy was not associated with higher mortality if Antimicrobial Therapy was adjusted appropriately according to the susceptibility results. Our data suggest that more prudent use of carbapenem as empirical antibiotic may be reasonable.
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pseudomonas aeruginosa bacteremia risk factors for mortality and influence of delayed receipt of effective Antimicrobial Therapy on clinical outcome
Clinical Infectious Diseases, 2003Co-Authors: Cheolin Kang, Sang Won Park, Youngju Choe, Myoungdon Oh, Kangwon ChoeAbstract:Abstract Among the nosocomial pathogens, Pseudomonas aeruginosa is recognized as a major cause of morbidity and mortality. Data on 136 patients with P. aeruginosa bacteremia were retrospectively analyzed to evaluate risk factors for mortality. The median age of the patients was 55 years (range, 15-85 years), 78.7% of the cases were hospital-acquired, and the 30-day mortality rate was 39% (53 of 136 patients). Multivariate analysis demonstrated that risk factors for mortality included severe sepsis, pneumonia, delay in starting effective Antimicrobial Therapy, and an increasing APACHE II score (all P values <.05). In 123 of the 136 patients (excluding 13 patients treated with inadequate definitive antibiotics), 30-day mortality was 27.7% (13 of 47 patients) in the group of patients who received initially effective empirical Antimicrobial Therapy, and 43.4% (33 of 76) in the group of patients who received delayed effective Antimicrobial Therapy (P=.079). There was a trend toward higher mortality as the length of delay increased. Delay in starting effective Antimicrobial Therapy for P. aeruginosa bacteremia tended to be associated with higher mortality.
Kangwon Choe - One of the best experts on this subject based on the ideXlab platform.
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bloodstream infections caused by antibiotic resistant gram negative bacilli risk factors for mortality and impact of inappropriate initial Antimicrobial Therapy on outcome
Antimicrobial Agents and Chemotherapy, 2005Co-Authors: Cheolin Kang, Sunghan Kim, Wan Beom Park, Kideok Lee, Hong Bin Kim, Euichong Kim, Kangwon ChoeAbstract:The marked increase in the incidence of infections due to antibiotic-resistant gram-negative bacilli in recent years is of great concern, as patients infected by those isolates might initially receive antibiotics that are inactive against the responsible pathogens. To evaluate the effect of inappropriate initial Antimicrobial Therapy on survival, a total of 286 patients with antibiotic-resistant gram-negative bacteremia, 61 patients with Escherichia coli bacteremia, 65 with Klebsiella pneumoniae bacteremia, 74 with Pseudomonas aeruginosa bacteremia, and 86 with Enterobacter bacteremia, were analyzed retrospectively. If a patient received at least one Antimicrobial agent to which the causative microorganisms were susceptible within 24 h of blood culture collection, the initial Antimicrobial Therapy was considered to have been appropriate. High-risk sources of bacteremia were defined as the lung, peritoneum, or an unknown source. The main outcome measure was 30-day mortality. Of the 286 patients, 135 (47.2%) received appropriate initial empirical Antimicrobial Therapy, and the remaining 151 (52.8%) patients received inappropriate Therapy. The adequately treated group had a 27.4% mortality rate, whereas the inadequately treated group had a 38.4% mortality rate (P = 0.049). Multivariate analysis showed that the significant independent risk factors of mortality were presentation with septic shock, a high-risk source of bacteremia, P. aeruginosa infection, and an increasing APACHE II score. In the subgroup of patients (n = 132) with a high-risk source of bacteremia, inappropriate initial Antimicrobial Therapy was independently associated with increased mortality (odds ratio, 3.64; 95% confidence interval, 1.13 to 11.72; P = 0.030). Our data suggest that inappropriate initial Antimicrobial Therapy is associated with adverse outcome in antibiotic-resistant gram-negative bacteremia, particularly in patients with a high-risk source of bacteremia.
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bloodstream infections due to extended spectrum β lactamase producing escherichia coli and klebsiella pneumoniae risk factors for mortality and treatment outcome with special emphasis on Antimicrobial Therapy
Antimicrobial Agents and Chemotherapy, 2004Co-Authors: Cheolin Kang, Myoungdon Oh, Wan Beom Park, Kangwon ChoeAbstract:This study was conducted to evaluate risk factors for mortality and treatment outcome of bloodstream infections due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK). ESBL production in stored K. pneumoniae and E. coli blood isolates from Jan 1998 to Dec 2002 was phenotypically determined according to NCCLS guidelines and/or the double-disk synergy test. A total of 133 patients with ESBL-EK bacteremia, including 66 patients with ESBL-producing K. pneumoniae and 67 with ESBL-producing E. coli, were enrolled. The overall 30-day mortality rate was 25.6% (34 of 133). Independent risk factors for mortality were severe sepsis, peritonitis, neutropenia, increasing Acute Physiology and Chronic Health Evaluation II score, and administration of broad-spectrum cephalosporin as definitive Antimicrobial Therapy (P < 0.05 for each of these risk factors). In 117 of the 133 patients, excluding 16 patients who died within 3 days after blood culture sample acquisition, the 30-day mortality rates according to definitive antibiotics were as follows: carbapenem, 12.9% (8 of 62); ciprofloxacin, 10.3% (3 of 29); and others, such as cephalosporin or an aminoglycoside, 26.9% (7 of 26). When patients who received appropriate definitive antibiotics, such as carbapenem or ciprofloxacin, were evaluated, mortality in patients receiving inappropriate empirical Antimicrobial Therapy was found not to be significantly higher than mortality in those receiving appropriate empirical Antimicrobial Therapy (18.9 versus 15.5%; P = 0.666). Carbapenem and ciprofloxacin were the most effective antibiotics in Antimicrobial Therapy for ESBL-EK bacteremia. A delay in appropriate definitive Antimicrobial Therapy was not associated with higher mortality if Antimicrobial Therapy was adjusted appropriately according to the susceptibility results. Our data suggest that more prudent use of carbapenem as empirical antibiotic may be reasonable.
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pseudomonas aeruginosa bacteremia risk factors for mortality and influence of delayed receipt of effective Antimicrobial Therapy on clinical outcome
Clinical Infectious Diseases, 2003Co-Authors: Cheolin Kang, Sang Won Park, Youngju Choe, Myoungdon Oh, Kangwon ChoeAbstract:Abstract Among the nosocomial pathogens, Pseudomonas aeruginosa is recognized as a major cause of morbidity and mortality. Data on 136 patients with P. aeruginosa bacteremia were retrospectively analyzed to evaluate risk factors for mortality. The median age of the patients was 55 years (range, 15-85 years), 78.7% of the cases were hospital-acquired, and the 30-day mortality rate was 39% (53 of 136 patients). Multivariate analysis demonstrated that risk factors for mortality included severe sepsis, pneumonia, delay in starting effective Antimicrobial Therapy, and an increasing APACHE II score (all P values <.05). In 123 of the 136 patients (excluding 13 patients treated with inadequate definitive antibiotics), 30-day mortality was 27.7% (13 of 47 patients) in the group of patients who received initially effective empirical Antimicrobial Therapy, and 43.4% (33 of 76) in the group of patients who received delayed effective Antimicrobial Therapy (P=.079). There was a trend toward higher mortality as the length of delay increased. Delay in starting effective Antimicrobial Therapy for P. aeruginosa bacteremia tended to be associated with higher mortality.
Julie Ann Justo - One of the best experts on this subject based on the ideXlab platform.
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cumulative effect of an Antimicrobial stewardship and rapid diagnostic testing bundle on early streamlining of Antimicrobial Therapy in gram negative bloodstream infections
Antimicrobial Agents and Chemotherapy, 2017Co-Authors: Julie Ann Justo, Joseph Kohn, P B Bookstaver, Elizabeth Nimmich, T J Smith, Katie Hammer, C Troficanto, H A AlbrechtAbstract:The use of rapid diagnostic tests (RDTs) enhances Antimicrobial stewardship program (ASP) interventions in optimization of Antimicrobial Therapy. This quasi-experimental cohort study evaluated the combined impact of an ASP/RDT bundle on the appropriateness of empirical Antimicrobial Therapy (EAT) and time to de-escalation of broad-spectrum Antimicrobial agents (BSAA) in Gram-negative bloodstream infections (GNBSI). The ASP/RDT bundle consisted of system-wide GNBSI treatment guidelines, prospective stewardship monitoring, and sequential introduction of two RDTs, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and the FilmArray blood culture identification (BCID) panel. The preintervention period was January 2010 through December 2013, and the postintervention period followed from January 2014 through June 2015. The postintervention period was conducted in two phases; phase 1 followed the introduction of MALDI-TOF MS, and phase 2 followed the introduction of the FilmArray BCID panel. The interventions resulted in significantly improved appropriateness of EAT (95% versus 91%; P = 0.02). Significant reductions in median time to de-escalation from combination Antimicrobial Therapy (2.8 versus 1.5 days), antipseudomonal beta-lactams (4.0 versus 2.5 days), and carbapenems (4.0 versus 2.5 days) were observed in the postintervention compared to the preintervention period (P < 0.001 for all). The reduction in median time to de-escalation from combination Therapy (1.0 versus 2.0 days; P = 0.03) and antipseudomonal beta-lactams (2.2 versus 2.7 days; P = 0.04) was further augmented during phase 2 compared to phase 1 of the postintervention period. Implementation of an Antimicrobial stewardship program and RDT intervention bundle in a multihospital health care system is associated with improved appropriateness of EAT for GNBSI and decreased utilization of BSAA through early de-escalation.
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cumulative effect of an Antimicrobial stewardship and rapid diagnostic testing bundle on early streamlining of Antimicrobial Therapy in gram negative bloodstream infections
Antimicrobial Agents and Chemotherapy, 2017Co-Authors: Julie Ann Justo, Joseph Kohn, P B Bookstaver, Elizabeth Nimmich, T J Smith, Katie Hammer, C Troficanto, H A AlbrechtAbstract:ABSTRACT The use of rapid diagnostic tests (RDTs) enhances Antimicrobial stewardship program (ASP) interventions in optimization of Antimicrobial Therapy. This quasi-experimental cohort study evaluated the combined impact of an ASP/RDT bundle on the appropriateness of empirical Antimicrobial Therapy (EAT) and time to de-escalation of broad-spectrum Antimicrobial agents (BSAA) in Gram-negative bloodstream infections (GNBSI). The ASP/RDT bundle consisted of system-wide GNBSI treatment guidelines, prospective stewardship monitoring, and sequential introduction of two RDTs, matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) and the FilmArray blood culture identification (BCID) panel. The preintervention period was January 2010 through December 2013, and the postintervention period followed from January 2014 through June 2015. The postintervention period was conducted in two phases; phase 1 followed the introduction of MALDI-TOF MS, and phase 2 followed the introduction of the FilmArray BCID panel. The interventions resulted in significantly improved appropriateness of EAT (95% versus 91%; P = 0.02). Significant reductions in median time to de-escalation from combination Antimicrobial Therapy (2.8 versus 1.5 days), antipseudomonal beta-lactams (4.0 versus 2.5 days), and carbapenems (4.0 versus 2.5 days) were observed in the postintervention compared to the preintervention period ( P P = 0.03) and antipseudomonal beta-lactams (2.2 versus 2.7 days; P = 0.04) was further augmented during phase 2 compared to phase 1 of the postintervention period. Implementation of an Antimicrobial stewardship program and RDT intervention bundle in a multihospital health care system is associated with improved appropriateness of EAT for GNBSI and decreased utilization of BSAA through early de-escalation.
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optimal duration of Antimicrobial Therapy for uncomplicated gram negative bloodstream infections
Infection, 2017Co-Authors: Avery N Nelson, Julie Ann Justo, Brandon P Bookstaver, Joseph Kohn, Helmut Albrecht, Majdi N AlhasanAbstract:Optimal Antimicrobial treatment duration for Gram-negative bloodstream infection (BSI) remains unclear. This retrospective cohort study examined effectiveness of short (7–10 days) and long (>10 days) courses of Antimicrobial Therapy for uncomplicated Gram-negative BSI. Hospitalized adults with uncomplicated Gram-negative BSI at Palmetto Health hospitals in Columbia SC, USA from January 1, 2010 to December 31, 2013 were identified. Multivariate Cox proportional hazards regression with propensity score adjustment was used to examine risk of treatment failure in the two groups. During the study period, 117 and 294 patients received short and long courses of Antimicrobial Therapy for uncomplicated Gram-negative BSI, respectively. Overall, the median age was 67 years, 258 (63%) were women, 282 (69%) had urinary source of infection, and 271 (66%) had BSI due to Escherichia coli. The median duration of Antimicrobial Therapy was 8.5 and 13.3 days in the short and long treatment groups, respectively. After adjustment for the propensity to use a short course of Therapy, risk of treatment failure was higher in patients receiving short compared to long courses of Antimicrobial agents (HR 2.60, 95% CI: 1.20–5.53, p = 0.02). Other risk factors for treatment failure included liver cirrhosis (HR 5.83, 95% CI: 1.89–15.02, p = 0.004) and immune compromised status (HR 4.30, 95% CI: 1.57–10.80, p = 0.006). Definitive Antimicrobial Therapy with intravenous or highly bioavailable oral agents was associated with reduced risk of treatment failure (HR 0.33, 95% CI: 0.14–0.73, p = 0.006). The current results support common clinical practice of 2 weeks of Antimicrobial Therapy for uncomplicated Gram-negative BSI.
Ebbing Lautenbach - One of the best experts on this subject based on the ideXlab platform.
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comparison of unit specific and hospital wide antibiograms potential implications for selection of empirical Antimicrobial Therapy
Infection Control and Hospital Epidemiology, 2006Co-Authors: Shawn Binkley, Neil O Fishman, Irving Nachamkin, Warren B Bilker, Lori A Larosa, Ann Marie Marr, David Wordell, Ebbing LautenbachAbstract:Objective. To identify differences between unit‐specific and hospital‐wide antibiograms and to determine the potential impact of these differences on selection of empirical Antimicrobial Therapy. Setting. A 625‐bed tertiary care medical center. Methods. Antimicrobial susceptibility results were collected for all inpatient clinical bacterial isolates recovered over a 3‐year period; isolates were categorized by the hospital location of the patient at the time of sampling and by the anatomic site from which the isolate was recovered. Antibiograms from each unit were compiled for the most commonly isolated organisms and were compared to the hospital‐wide antibiogram. Results. A total of 9,970 bacterial isolates were evaluated in this study, including 2,646 enterococcal isolates, 2,806 S. aureus isolates, 2,795 E. coli isolates, and 1,723 Pseudomonas aeruginosa isolates. The percentages of bacterial isolates resistant to Antimicrobials were significantly higher in the medical ICU and surgical ICU than the hosp...
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identification of optimal combinations for empirical dual Antimicrobial Therapy of pseudomonas aeruginosa infection potential role of a combination antibiogram
Infection Control and Hospital Epidemiology, 2006Co-Authors: Mari Mizuta, Angela Sheridan, Mark G Weiner, Neil O Fishman, Darren R. Linkin, Irving Nachamkin, Ebbing LautenbachAbstract:: To better determine the optimal combinations for empirical dual Antimicrobial Therapy of Pseudomonas aeruginosa infection, we evaluated the utility of a novel combination antibiogram. Although the combination antibiogram allowed modest fine-tuning of choices for dual antibiotic Therapy, selections based on the 2 antibiograms did not differ substantively. Drug combinations with the broadest coverage were consistently composed of an aminoglycoside and a beta-lactam.
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impact of inadequate initial Antimicrobial Therapy on mortality in infections due to extended spectrum β lactamase producing enterobacteriaceae variability by site of infection
JAMA Internal Medicine, 2005Co-Authors: Emily P Hyle, Irving Nachamkin, Theoklis E. Zaoutis, Warren B Bilker, Adam D Lipworth, Ebbing LautenbachAbstract:Background Infections due to extended-spectrum β-lactamase–producing Escherichia coli and Klebsiella species (ESBL-EK) have increased markedly in recent years. Risk factors for mortality among ESBL-EK infections have not been studied. Methods This retrospective cohort study was conducted in a 625-bed tertiary care medical center and a 344-bed urban community hospital to determine whether inadequate initial Antimicrobial Therapy (IIAT) (>48 hours between the time a culture was obtained and initiation of an agent to which the infecting organism was susceptible) is associated with mortality in ESBL-EK infections. All hospitalized patients with an ESBL-EK infection between June 1, 1997, and December 31, 2002, were eligible for inclusion. Subsequently, we conducted a nested case-control study to identify risk factors for IIAT. Results Of 187 subjects, 32 (17.1%) died while in the hospital. Clinical site of infection was a significant effect modifier in the association between IIAT and mortality. The presence of IIAT was an independent risk factor for mortality, but only for nonurinary ESBL-EK infections (adjusted odds ratio [95% confidence interval], 10.04 [1.90-52.96]). Independent risk factors for IIAT were (1) infection with a multidrug-resistant ESBL-EK (ie, resistant to sulfamethoxazole-trimethoprim, aminoglycosides, and quinolones) (14.58 [1.91-111.36]) and (2) health care–acquired ESBL-EK infection (4.32 [1.49-12.54]). Conclusions Inadequate initial Antimicrobial Therapy is an independent risk factor for mortality in ESBL-EK infections, but only among nonurinary infections. Multidrug resistance was a strong risk factor for IIAT.
P B Bookstaver - One of the best experts on this subject based on the ideXlab platform.
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cumulative effect of an Antimicrobial stewardship and rapid diagnostic testing bundle on early streamlining of Antimicrobial Therapy in gram negative bloodstream infections
Antimicrobial Agents and Chemotherapy, 2017Co-Authors: Julie Ann Justo, Joseph Kohn, P B Bookstaver, Elizabeth Nimmich, T J Smith, Katie Hammer, C Troficanto, H A AlbrechtAbstract:ABSTRACT The use of rapid diagnostic tests (RDTs) enhances Antimicrobial stewardship program (ASP) interventions in optimization of Antimicrobial Therapy. This quasi-experimental cohort study evaluated the combined impact of an ASP/RDT bundle on the appropriateness of empirical Antimicrobial Therapy (EAT) and time to de-escalation of broad-spectrum Antimicrobial agents (BSAA) in Gram-negative bloodstream infections (GNBSI). The ASP/RDT bundle consisted of system-wide GNBSI treatment guidelines, prospective stewardship monitoring, and sequential introduction of two RDTs, matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) and the FilmArray blood culture identification (BCID) panel. The preintervention period was January 2010 through December 2013, and the postintervention period followed from January 2014 through June 2015. The postintervention period was conducted in two phases; phase 1 followed the introduction of MALDI-TOF MS, and phase 2 followed the introduction of the FilmArray BCID panel. The interventions resulted in significantly improved appropriateness of EAT (95% versus 91%; P = 0.02). Significant reductions in median time to de-escalation from combination Antimicrobial Therapy (2.8 versus 1.5 days), antipseudomonal beta-lactams (4.0 versus 2.5 days), and carbapenems (4.0 versus 2.5 days) were observed in the postintervention compared to the preintervention period ( P P = 0.03) and antipseudomonal beta-lactams (2.2 versus 2.7 days; P = 0.04) was further augmented during phase 2 compared to phase 1 of the postintervention period. Implementation of an Antimicrobial stewardship program and RDT intervention bundle in a multihospital health care system is associated with improved appropriateness of EAT for GNBSI and decreased utilization of BSAA through early de-escalation.
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cumulative effect of an Antimicrobial stewardship and rapid diagnostic testing bundle on early streamlining of Antimicrobial Therapy in gram negative bloodstream infections
Antimicrobial Agents and Chemotherapy, 2017Co-Authors: Julie Ann Justo, Joseph Kohn, P B Bookstaver, Elizabeth Nimmich, T J Smith, Katie Hammer, C Troficanto, H A AlbrechtAbstract:The use of rapid diagnostic tests (RDTs) enhances Antimicrobial stewardship program (ASP) interventions in optimization of Antimicrobial Therapy. This quasi-experimental cohort study evaluated the combined impact of an ASP/RDT bundle on the appropriateness of empirical Antimicrobial Therapy (EAT) and time to de-escalation of broad-spectrum Antimicrobial agents (BSAA) in Gram-negative bloodstream infections (GNBSI). The ASP/RDT bundle consisted of system-wide GNBSI treatment guidelines, prospective stewardship monitoring, and sequential introduction of two RDTs, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and the FilmArray blood culture identification (BCID) panel. The preintervention period was January 2010 through December 2013, and the postintervention period followed from January 2014 through June 2015. The postintervention period was conducted in two phases; phase 1 followed the introduction of MALDI-TOF MS, and phase 2 followed the introduction of the FilmArray BCID panel. The interventions resulted in significantly improved appropriateness of EAT (95% versus 91%; P = 0.02). Significant reductions in median time to de-escalation from combination Antimicrobial Therapy (2.8 versus 1.5 days), antipseudomonal beta-lactams (4.0 versus 2.5 days), and carbapenems (4.0 versus 2.5 days) were observed in the postintervention compared to the preintervention period (P < 0.001 for all). The reduction in median time to de-escalation from combination Therapy (1.0 versus 2.0 days; P = 0.03) and antipseudomonal beta-lactams (2.2 versus 2.7 days; P = 0.04) was further augmented during phase 2 compared to phase 1 of the postintervention period. Implementation of an Antimicrobial stewardship program and RDT intervention bundle in a multihospital health care system is associated with improved appropriateness of EAT for GNBSI and decreased utilization of BSAA through early de-escalation.