Antibiotic prophylaxis (AP) for an inpatient surgical care unit (SCU) and also intensive care unit (ICU) remains a controversial treatment option. Though in a many instances AP is considered as an invaluable measure to minimize the mortality rate, in other instances AP has been shown to exacerbate the Antibiotic Resistance Pathogen (ARP) induced mortality rate in both SCU and ICU. A rationale is presented to purge the practice of AP in STBI/TBI admitted in ICU to Rout AR Induced Mortality. In a case report where the role of “Colonization Pressure” (CP) (i.e., the proportion of other patients colonized with ARP) analysis indicate, that in an ICU the average expected median time until the acquisition of Vancomycin‐Resistant Enterococci (VRE) ‐ is approximately 19 days when both antibiotic pressure and CP are 25% but 6 days when CP is 75% and antibiotic pressure is 25%. In an another case report, 250 trauma patients in a Surgical Intensive Care Unit (SICU) requiring an one or more surgical modality requiring a stay of 3 days or more received AP by 1 antibiotic (Cefoxitin sodium or ampicillin sodium/sulbactam sodium) for 24 hours (SHORT group or 1 or more antibiotics ( a combination of piperacillin sodium sterile and tazobactam sodium, or the combination of ampicillin, gentamicin sulfate, and metronidazole) prophylaxis administered longer than 24 hours with multiple antibiotics fail to improve morbidity. In a case report focused on patients admitted to the trauma intensive care unit (TICU) from January, 2001 through December, 2004 with blunt, non‐operative traumatic brain injury who is managed solely with an intracranial pressure (ICP) monitor, among those receiving no antibiotics prior to or during ICP monitoring ; and those already receiving antibiotics at the time of ICP monitor insertion were, n = 84. This study concluded that AP does not reduce the CNS infection rate and is associated with more MDR pathogens in any subsequent infectious complications. In a study aimed to determine the role of nosocomial transmission in both deployed hospitals and receiving military medical centers (MEDCENs) eighteen thousand five hundred sixty of 21,272 patients (2005 to 2009) were screened for Multidrug‐resistant organism (MDRO) colonization. Although colonization with Acinetobacter (ACB) declined during the following 5 years, an increase ARP including extended spectrum β‐lactamase (ESBL) ‐producing Enterobacteriaceae were shown to be increasing. However, the risk of ARP selection caused by the antibiotic administration for 48 hours or more, outweighed potential benefits. A study aimed to determine the impact of prolonged use of CNS device for dispensing AP as a factor in inducing the ARP and Clostridium difficile where, patient receiving AP, n = 116, and control group patients had mean APACHE II scores of 17.7 ± 9.2 and 15.1 ± 10.6 with 53.4 and 24.6 % receiving craniotomies. A higher incidence of ARP in patients receiving prolonged AP with a CNS device, but incidence of C. difficile were not significant compared to controls. Taken together, in the absence of Glasgow Coma Scale (GCS) rating upon admission of STBI/TBI patients in ICU, performing culture and sensitivity assay in CSF, implementing prudent antibiotic stewardship and implementing Antibiotic Time Out (ATO) followed by induction of “Trans” state possibly to make suggestions enabling a psychological propensity to sojourn the infectious state would limit the AR induced mortality.Support or Funding InformationSupported by Professional Development funds of SWTJC to Subburaj KannanThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
Based on the analysis of clinical mycology data on treatment of fungal infection, following preventive measures are suggested to avoid the use of Antibiotics for treating primary Fungal Infection(s): a. Clinical diagnosis matching the microbial sensitivity assay specific for fungal infections data confirmed and reviewed by pharmacists; b. Mandatory implementation of ATO across the globe in particular Intensive Care Unit, (ICU) & Emergency Room (ER) and infectious diseases ward; c. Cessation of antibiotic prophylactic therapy in the surgical ward, ICU, ER unless a team of a pharmacist, clinical microbiologist, and physician with infectious disease specialization to provide mandatory evaluation of need and beneficial impact analysis report to the attending physician with appropriate guidelines for the treatment option, d. mandatory antibiogram (preparation and analysis) from the antibiotic culture sensitivity of specimens from primary infection, during the treatment progressions and also secondary infection during the post‐surgical treatment, e. confirmation with data on file delineating accurate diagnosis whether bacterial/fungal/secondary infection) prior to administration of broad‐spectrum antibiotics, f. periodic review of colonization pressure in the concerned health care facility, g. global effort to implement medical testing technology for clinical microbiology lab diagnostic tool for identification and characterization of bacterial vs. fungal infections in particular third world countries; h: increase the awareness across the globe on the need for differential diagnosis on the fungal infection, bacterial infections (primary vs secondary), appropriate use of antifungal vs. antibacterial vs. antiviral vs. anti‐parasitic vs. anti‐helminthic infections among the third world countries, i. monitoring the use of antifungal pesticides in agricultural practices, j. analysis of particulate matter (PM) in the air quality for residual fungicides and determination of fungicides in the soil, water and plants( during the development and after harvesting), k. Establish and implement an effective strategy to rule out the, “Antibiotic‐Resistant Bacterium”(ARB). as per the need during the primary, secondary and pre‐surgery, post‐surgery treatment. l. Antibiogram based differential diagnosis of fungal vs. bacteria including sepsis/septicemia/septic shock; smear‐negative pulmonary tuberculosis must be tested for aspergillosis; differential diagnosis of fungal asthma, invasive aspergillosis with a comorbidity of chronic obstructive pulmonary disease, Pneumocystis pneumonia in HIV‐positive patients; universal availability of nonculture fungal diagnostics, m. universal adoption of “Antibiotic Time Out” (ATO) prior to definitive diagnosis of bacterial (culture sensitivity assay, n. Establishment of Clinical Patterns: Primary resistance (organisms never exposed in that host to the drug of interest)/Secondary resistance, (acquired resistance, arises only after exposure of the organism to the drug)/Intrinsic resistance ( resistance of all or almost all isolates of one species to a certain drug)/Clinical resistance; o. global moratorium on the practice of empirical antibacterial/antifungal therapy including topical application of antibacterial/antifungal and also in Intensive Care Unit (ICU). Taken together, adopting the aforesaid measure would plausibly mitigate the Ab‐AF:RP.Support or Funding InformationSupported by the Professional Development Funds by SWTJC to Subburaj Kannan.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
To determine the role of AR in irreversible coma subsequent to TBI, a case report has been critically appraised (J Neurosci Rural Pract. 2016 Jul–Sep; 7(3):450–2). Day 1: A 75‐year‐old patient with small right subdural hematoma with frontal contusion upon admission to Intensive Care Unit (ICU) had Glasgow Coma Scale (GCS) 7 (E1V1M5) with bilateral equal and reacting pupils treated with Colistin and tigecycline for management of external ventricular device (EVD)‐related ventriculitis. EVD was placed for monitoring of intracranial pressure (ICP). The patient was in treatment with ceftriaxone 1 g/12 hourly for aspiration pneumonia. Day 3: GCS drooped to 4 (E1M3Vt). Day 4: Patient developed a fever (up to 103°F) suspected to be of EVD associated ventriculitis. Antibiotics were empirically upgraded to vancomycin and ceftazidime. Cerebrospinal fluid (CSF) culture and sensitivity revealed A. baumannii sensitive only to colistin and tigecycline and resistant to all other antibiotics including carbapenems. Day 4: Intravenous colistin was started at the dose of 2 million International Units (IU) 8 hourly and 200,000 IU through intraventricular route daily. Tigecycline was administered intravenously at a loading dose of 100 mg followed by 50 mg twice daily. CSF culture after 3 days of starting colistin (7th day of treatment) and tigecycline was negative. On day 8th however, there was a progressive decline in GCS to 2 (E1M1Vt). Due to declining renal function, iv dose of colistin was decreased to 2 million IU 24 hourly on the 12th day of starting colistin. Intravenous colistin and tigecycline were continued for 14 days (Total period of treatment 21 days) subsequent to withdrawal of life support as poor neurological outcome anticipated. From the 12th day of treatment a. culture and sensitivity lab test on the patient's CSF, b. antibiogram, and c. information on the implementation of antibiotics timeout (ATO) was not presented in the case report. It is acknowledged that up until 8th‐day appropriate measures reflecting ATO was in practice. However, from 12th day onwards aforesaid factors reflecting the evolution of AR has not been attempted. Taken together, it is suggested that the factors that govern the AR, was inadequately monitored from day 12th to the time of withdrawal of life support. Contrary to the claim of, “successful microbiological cure”, it is suggested that progression of AR overwhelmed the lymphatic system with sepsis inducing neurotoxicity, nephrotoxicity and possibly antibiotics induced toxic shock syndrome, In the absence of acute physiology and chronic health evaluation II score, sequential organ failure assessment, systemic inflammatory response syndrome score, injury severity score, exclusively based GCS to 2 (E1M1Vt) the life support has been withdrawn. The profile of antibiotic resistance pathogenic microbes (ARP) and its role in septicemia leading up to multi organ system failure has not been addressed adequately. Considering the age as pivotal factor, administering the tigecycline as a component of multidrug and multi‐route therapy is a serious risk factor with potential site for colonization for ARP. Lack of adequately qualified Intensive Care Unit personnel, improper intraventricular catheter handling, and CSF sampling only when clinically necessary, and periodic replacement of drainage catheter with maximum care could have eliminated the plausible cause for the septicemia in addition to the parameters defining sepsis and septic shock(sepsis‐3).Support or Funding InformationSupported by the Professional Development Funds by SWTJC to Subburaj Kannan.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
Based on an appraisal of the criteria required for deriving the SAPS‐II scores reinforced by statistical significance, a rationale is presented to include factors determining AR, thus enable the clinical decision making to withdraw life support in TBI subsequent to coma (Glasgow Coma Scale (GCS) ranging from a Severe: GCS 3–8; Moderate: GCS 9–12; Mild: GCS 13–15). The SAPS‐II is a severity score and mortality estimation tool developed from a large sample of medical and surgical patients in North America and Europe. The SAPS II includes 17 variables of which 12 physiological variables, age, types of admission (scheduled surgical, unscheduled surgical, or medical), and three underlying disease variables (acquired immunodeficiency syndrome, metastatic cancer, and hematologic malignancy). Within the first 24 hours of admission to Intensive Care Unit (ICU), following factors which determine AR, are suggested to be included: a. performing a culture and sensitivity lab test on the patient's Cerebrospinal fluid (CSF), b. generating an Antibiograms (Antimicrobial Susceptibilities of Selected Pathogens), c. implementation of antibiotics timeout (ATO), and also d. performing antibiotic prophylaxis in case of surgical intervention in TBI is essential for an acceptable neurological outcome. In the event of using the External ventricular device (EVD) for monitoring intracranial pressure (ICP), it is pivotal to monitor the infection of central nervous system (CNS). Acinetobacter baumannii is a known risk factor as a nosocomial infectious agent and associated with high mortality ranging from 15% to 71%. (J Neurosci Rural Pract 2016;7:450–2). Data shows that continuation of antibiotic therapy in TBI with scheduled surgical, or unscheduled surgical cases, are determined based on the detection of AR pathogens causing sepsis. If the patient had antibiotic resistance pathogen including (Colistin resistance) septicemia (Sepsis (Blood Infection) and Septic Shock (J. Neurotrauma 2007;24 Suppl 1: S45–54; Lancet Infect Dis 2009;9:245–55; Infection 2014;42:801–9) a poor neurological outcome is likely. Colistimethate sodium (CMS) as primary or salvage therapy for multi‐drug resistant (MDR) Gram‐negative organisms are known to cause nephrotoxicity, and neurotoxicity in critically ill patients (Ann Intensive Care. 2011; 1:14). Detection of Colistin resistant pathogens in a TBI patient is a reflection of impending septicemia, nephrotoxicity and/or renal failure (associated with poor neurological outcome. Though renal failure depends on the total cumulative dose and duration of Colistin therapy, the severity of TBI, factors such as AR, age, are at a higher risk for nephrotoxicity, possibly a higher rate of mortality. In essence, it is suggested that inclusion of factors causing AR, and SAPS‐II scores ranging from 77 to >80 points would be a determining factor in the clinical decision to withdraw life support in TBI patients in ICU by forestalling an irreversible coma. In the event of the patient (TBI) with Moderate: GCS 9–12; to Mild: GCS 13–15, measures to mitigate AR would plausibly increase acceptable neurological outcome with a possibility of recovery (Lancet.1974 Jul 13; 2(7872):81–4); J Trauma Acute Care Surg. 2015 Oct; 79(4 Suppl 2): S197–203Support or Funding InformationSupported by the Professional Development Funds by SWTJC to Subburaj Kannan.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
PM originating from large‐scale beef cattle feed yards was shown to spread antibiotics, antibiotic resistance genes (ARG) to tetracycline, and ruminant‐associated microbes (EHP. 2015:123:337–343). To acquire firsthand information on the industrial practice of implementing preventive measures to minimize or avoid the PM, we have undertaken an in‐depth field survey at a Feed yard Z, (Name withheld), Quemado, Texas. 16,000 cattle reside in feedlot, which is obtained mainly from Mexico and around the area. Upon arrival, cattle were first weighed and put into pins for about ten days by the cowboys. Cattle housing is calculated based on 1 cattle for every 10 acres. Prophylactic medication was administered and observed for a period of time prior to releasing into the home pin. Cattle are fed a mixture of molasses, corn, proteins, and hay. The cattle are checked for their well being every single day during the early morning and evening by the cowboys at the feedlot. The United States Department of Agriculture (USDA) appointed a veterinarian to monitor the feeding regimen, health, and overall sanitary conditions of the feed yard on a regular basis and to document it. We have observed that animals grazing pattern were in accordance with the stipulations presented during the review. Though the antibiotics such as monensin and tetracycline antibiotics used in feed yards on a regular basis, our inquiry determined that is not the case. Formation of PM is a complex reaction resulting from the reactions of sulfur dioxide, nitrogen oxides, and other organic matters such as antibiotics. The United States Environmental Protection Agency defines the PM sizes, as PM10 (inhalable particles, with diameters that are generally 10 micrometers and smaller); and PM2.5 (fine inhalable particles, with diameters that are generally 2.5 micrometers and smaller). As per the National Weather Service, on an average, the wind flow speed pattern in this location is Wind ESE 9 MPH, Visibility 7 mi, and barometer 30.15 inches. Formation and transport of PM are dependent on temperature inversion, frontal activities (wind velocities subjected to surface and atmospheric turbulence), differential distribution in downwind (carry more PM – density dependent) vs. upwind, geographical point, and finally the dynamic flex of atmospheric moisture with reference to the altitude. Though, our effort to obtain epidemiological data on PM induced spread infectious diseases compared to the regions devoid of feedlots in Texas were unsuccessful, we were able to discern that the biggest risk factor in raising the cattle in the big housing pins are the flies and the organic wastes generated especially during the summer. Effective measures as Biological Integrated Insect Control (BIIC) programs as a part of Integrated Pest Management (IPM) programs are implemented as per the need. Upon identification, sick cattle are isolated and housed in hospital pens that are managed by cowboys who are highly trained. We have been advised that multitude of agencies such as Texas Commission on Environmental Quality, Texas Water Development Board, TCEQ and USEPA are involved in monitoring the environment, animal welfare, and industry standards. Taken together, it is concluded that implementation of measures would possibly mitigate the PM induced ARP. However, aforesaid contributing factors for the formation of PM are a serious cause for concern in a mass CAFO such as Lubbock, Texas and Oklahoma and developing countries.Support or Funding InformationSupported by RISE ‐ high‐impact practices in the learning environment – SWTJC and professional development funds to Subburaj KannanThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.