Duration of antibiotic therapy in Gram-negative infections with a particular focus on multidrug-resistant pathogens

Haddad, Samuel; Allaw, Fatima; Kanj, Souha S.

doi:10.1097/qco.0000000000000861

Cited by 8 publications

(7 citation statements)

References 40 publications

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“…While many studies have supported the use of shorter antimicrobial courses to decrease AMR, cost, and adverse effects [ 117 ], the evidence on shortening the duration of treatment for a pseudomonal infection remains inconclusive. The duration of treatment for P. aeruginosa severe sepsis should be individualized according to the primary site of infection, the patient’s risk factors and underlying comorbidities, source control, susceptibility testing, trends of inflammatory biomarkers, and clinical improvement [ 118 ]. A recently published retrospective study comparing a short (6–10 days) course of antibiotics to a longer (11–15 days) course for P. aeruginosa bacteremia found no difference in mortality or bacteremia recurrence but found a significantly reduced hospitalization duration with shorter duration of treatment [ 119 ].…”

Section: Key Factors Related To Therapymentioning

confidence: 99%

Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis

et al. 2022

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Pseudomonas aeruginosa is a pathogen often encountered in a healthcare setting. It has consistently ranked among the most frequent pathogens seen in nosocomial infections, particularly bloodstream and respiratory tract infections. Aside from having intrinsic resistance to many antibiotics, it rapidly acquires resistance to novel agents. Given the high mortality of pseudomonal infections generally, and pseudomonal sepsis particularly, and with the rise of resistant strains, treatment can be very challenging for the clinician. In this paper, we will review the latest evidence for the optimal treatment of P. aeruginosa sepsis caused by susceptible as well as multidrug-resistant strains including the difficult to treat pathogens. We will also discuss the mode of drug infusion, indications for combination therapy, along with the proper dosing and duration of treatment for various conditions with a brief discussion of the use of non-antimicrobial agents.

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Section: Key Factors Related To Therapymentioning

confidence: 99%

Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis

et al. 2022

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“…To the best of our knowledge, no existing study has reported long-term antimicrobial therapy as a risk factor for the development of resistant organisms in patients with AC. However, a relationship between long-term antimicrobial therapy and the development of resistant organisms was reported in patients with other infectious diseases 16 17 32 . Therefore, we investigated the factors involved in the development of resistant organisms in patients with recurrent cholangitis, including long-term antimicrobial therapy.…”

Section: Methodsmentioning

confidence: 99%

Association of short-course antimicrobial therapy and bacterial resistance in acute cholangitis: Retrospective cohort study

Masuda,

Jinushi,

Imamura

et al. 2024

Endosc Int Open

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Background and study aims Although the number of resistant bacteria tends to increase with prolonged antimicrobial therapy, no studies have examined the relationship between the duration of antimicrobial therapy and increase in the number of resistant bacteria in acute cholangitis. We hypothesized that the short-term administration of antimicrobial agents in acute cholangitis would suppress bacterial resistance. Patients and methods This was a single-center, retrospective, observational study of patients with acute cholangitis admitted between January 2018 and June 2020 who met the following criteria: successful biliary drainage, positive blood or bile cultures, bacteria identified from cultures sensitive to antimicrobials, and subsequent cholangitis recurrence by January 2022. The patients were divided into two groups: those whose causative organisms at the time of recurrence became resistant to the antimicrobial agents used at the time of initial admission (resistant group) and those who remained susceptible (susceptible group). Multivariate analysis was used to examine risk factors associated with the development of resistant pathogens. Multivariate analysis investigated antibiotics used with the length of 3 days or shorter after endoscopic retrograde cholangiopancreatography (ERCP) and previously reported risk factors for the development of bacterial resistance. Results In total, 89 eligible patients were included in this study. There were no significant differences in patient background or ERCP findings between the groups. The use of antibiotics, completed within 3 days after ERCP, was associated with a lower risk of developing bacterial resistance (odds ratio, 0.17; 95% confidence interval, 0.04–0.65; P=0.01). Conclusions In acute cholangitis, the administration of antimicrobials within 3 days of ERCP may suppress the development of resistant bacteria.

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“…Controlling duration of therapy is among the most important pillars of antimicrobial stewardship. As the evidence accumulates against long duration of treatment, most guidelines have moved towards recommending shorter duration of therapy for various infections particularly for Gram-negative pathogens (81). However, little to no data is available about the efficacy of a shorter duration of treatment for PVE.…”

Section: Duration Of Therapymentioning

confidence: 99%

Infective Endocarditis after Transcatheter Aortic Valve Replacement: Challenges in the Diagnosis and Management

Zakhour¹,

Allaw²,

Kalash³

et al. 2023

Preprint

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Although initially conceived for high-risk patients who are ineligible for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) is now recommended in a wider spectrum of indications including young patients. However, as for SAVR, TAVR is also associated with a risk of infectious complications, namely prosthetic valve endocarditis (PVE). As the number of performed TAVR procedure increases, and despite the low incidence of PVE post TAVR, clinicians should be familiar with the associated risk factors and the clinical presentation. Whereas the diagnosis of native valve endocarditis can be straightforward applying the modified Duke criteria, the diagnosis of PVE is more challenging given its atypical symptoms, lower sensitivity of the criteria, and low diagnostic yield of conventional echocardiography. Delay in proper management can be associated with increased morbidity and mortality. Therefore, clinicians should have a high index of suspicion and initiate proper work-up according to the severity of illness, the underlying host, and the local epidemiology of the causative organisms. The most common causative pathogens are Gram-positive bacteria such as S. aureus, coagulase negative staphylococci, Enterococcus spp. and Streptococcus spp. (particularly the viridans group) and, less likely Gram-negative and fungal pathogens. The high prevalence of antimicrobial resistance complicates the choice of therapy. There remain controversies regarding the optimal management strategies including indications for surgical interventions. Surgical assessment is recommended early in the course of illness and surgical intervention should be considered in selected patients. As in other PVE, duration of therapy depends on the isolated pathogen, the host, and the clinical response. Since TAVR is a relatively new procedure, the outcome of TAVR-PVE is yet to be fully understood.

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Duration of antibiotic therapy in Gram-negative infections with a particular focus on multidrug-resistant pathogens

Cited by 8 publications

References 40 publications

Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis

Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis

Association of short-course antimicrobial therapy and bacterial resistance in acute cholangitis: Retrospective cohort study

Infective Endocarditis after Transcatheter Aortic Valve Replacement: Challenges in the Diagnosis and Management

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