Current and Future Opportunities for Rapid Diagnostics in Antimicrobial Stewardship

Timbrook, Tristan T; Spivak, Emily S; Hanson, Kimberly E.

doi:10.1016/j.mcna.2018.05.004

Cited by 15 publications

(10 citation statements)

References 51 publications

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“…Several recent reviews have highlighted the potential advantages and limitations of these RDTs. [50][51][52][53] We will provide a brief description of the most commonly employed technologies with potential application in the ICU (►Table 1).…”

Section: Rdt Approaches To Hasten Detection Of Pathogens and Antimicrmentioning

confidence: 99%

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Guillamet

Burnham

Kollef

2019

Semin Respir Crit Care Med

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Antibiotic resistance is recognized as a key determinant of outcome in patients with serious infections influencing empiric antibiotic practices especially for critically ill patients. Within the intensive care unit (ICU), nosocomial infections and increasingly community-onset infections are caused by multidrug-resistant bacteria. Escalating rates of antibiotic resistance adds substantially to the morbidity, mortality, and cost related to infections treated in the ICU. Both gram-positive organisms, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, and gram-negative bacteria, including Pseudomonas aeruginosa, Acinetobacter species, carbapenem-resistant Enterobacteriaceae, and extended spectrum β-lactamase producing organisms, are urgent threats. The rising rates of antimicrobial resistance have resulted in routine empiric administration of broad-spectrum antibiotics by clinicians to critically ill patients even when bacterial infection is microbiologically absent. Moreover, new broad-spectrum antibiotics are a challenge to use effectively while avoiding emergence of further resistance. Use of rapid diagnostic technologies (RDTs) will likely provide an important methodology for achieving this important balance. There is an urgent need for integrating the administration of new and existing antibiotics with RDTs in a way that is safe, cost-effective, applicable in all countries, and sustainable.

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Section: Rdt Approaches To Hasten Detection Of Pathogens and Antimicrmentioning

confidence: 99%

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Guillamet

Burnham

Kollef

2019

Semin Respir Crit Care Med

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“…In light of the emerging threat posed by antimicrobial resistance it is imperative that we find not only new treatments for resistant bacterial infections, but also new diagnostic tools so that the physician can rapidly identify a suitable course of treatment for the presenting patient [24,25]. This paper focuses upon the first of these requirements, and serves as a reminder that there are many useful compounds for treatment of bacterial infections that are already known, but have lay dormant in some cases for decades because at the time of their initial discovery there were many other options available.…”

Section: Discussionmentioning

confidence: 99%

Phosphonopeptides Revisited, in an Era of Increasing Antimicrobial Resistance

et al. 2020

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Given the increase in resistance to antibacterial agents, there is an urgent need for the development of new agents with novel modes of action. As an interim solution, it is also prudent to reinvestigate old or abandoned antibacterial compounds to assess their efficacy in the context of widespread resistance to conventional agents. In the 1970s, much work was performed on the development of peptide mimetics, exemplified by the phosphonopeptide, alafosfalin. We investigated the activity of alafosfalin, di-alanyl fosfalin and β-chloro-L-alanyl-β-chloro-L-alanine against 297 bacterial isolates, including carbapenemase-producing Enterobacterales (CPE) (n = 128), methicillin-resistant Staphylococcus aureus (MRSA) (n = 37) and glycopeptide-resistant enterococci (GRE) (n = 43). The interaction of alafosfalin with meropenem was also examined against 20 isolates of CPE. The MIC50 and MIC90 of alafosfalin for CPE were 1 mg/L and 4 mg/L, respectively and alafosfalin acted synergistically when combined with meropenem against 16 of 20 isolates of CPE. Di-alanyl fosfalin showed potent activity against glycopeptide-resistant isolates of Enterococcus faecalis (MIC90; 0.5 mg/L) and Enterococcus faecium (MIC90; 2 mg/L). Alafosfalin was only moderately active against MRSA (MIC90; 8 mg/L), whereas β-chloro-L-alanyl-β-chloro-L-alanine was slightly more active (MIC90; 4 mg/L). This study shows that phosphonopeptides, including alafosfalin, may have a therapeutic role to play in an era of increasing antibacterial resistance.

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“…This may assist antimicrobial stewardship by safeguarding the effectiveness of current antimicrobials. 36 With regard to timings, the time taken from collecting the BC to receipt in the laboratory varied significantly with a range of 16 minutes to 66 hours 9 minutes. This likely affected the treatment plan for each patient, due to the delay in obtaining relevant positive or negative microbiology results; thus, BC should be loaded on analyzer without delay.…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of Antibiotic Treatment Review following Blood Culture Collection

Dhanda

Gray

Bashir

et al. 2019

J Pediatr Infect Dis

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Objective Inappropriate antibiotic treatment can significantly affect antimicrobial resistance, resulting in treatments becoming less effective in the future. Previous studies have not identified the possible de-escalation rate. The aim of this study was to assess the appropriateness of antibiotic treatment in patients who have a blood culture collected, in particular, calculating how many days of antibiotics can be de-escalated. Methods A patient series, observational study was conducted that included all patient blood culture, regardless of whether they were positive or negative, over a period of 4 days. The study was repeated three times to attain a larger sample. The adequacy of antibiotic treatment was determined based on microbiology results, prescription drug administration, and patient notes/charts. Results Of the 69 suitable cases, 36 (52.17%) received appropriate treatment and 33 (47.83%) received inappropriate treatment. Of the inappropriate cases, it was calculated that 83 days of de-escalation were possible. Fifteen (21%) of the cases could have de-escalated use of meropenem. Conclusion The results highlight that there is opportunity to review and de-escalate patient's treatment, after taking a blood culture and practices such as rationalizing antibiotic choices and educating physicians on reviewing antibiotics is appropriate.

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Current and Future Opportunities for Rapid Diagnostics in Antimicrobial Stewardship

Cited by 15 publications

References 51 publications

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Phosphonopeptides Revisited, in an Era of Increasing Antimicrobial Resistance

Appropriateness of Antibiotic Treatment Review following Blood Culture Collection

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