Impact of inappropriate empirical antibiotic therapy on outcome of bacteremic adults visiting the ED

Lee, Ching Chi; Lee, Chung-Hsun; Chuang, Ming Che; Hong, Ming-Yuan; Hsu, Hsiang‐Chin; Ko, Wen Chien

doi:10.1016/j.ajem.2011.11.010

Cited by 58 publications

(43 citation statements)

References 21 publications

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“…We propose the following reasons that may contribute to the negative impact of HIV infection on patients' outcome. Similar to previous ED-based studies of community-onset bacteremia [12,30], a strong relationship between severity of bacteremia or comorbidity and patient's outcome was also well established in our population. And there was a lower severity of comorbidity and bacteremic onset observed in HIV-infected patients compared with HIV-uninfected patients in our population.…”

Section: Discussionsupporting

confidence: 88%

“…To our knowledge, the importance of empirical antibiotic therapy in bacteremic patients has been emphasized in previous ED-based studies, particularly in critically ill patients [30,31]. It was reasonable that the low severity of comorbidity and bacteremic onset observed in HIV-infected patients resulted in limited influence of inappropriate empirical antibiotic therapy on short-term outcome.…”

Section: Discussionmentioning

confidence: 99%

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Different clinical presentation of community-onset bacteremia among human immunodeficiency virus-infected and human immunodeficiency virus-uninfected adults in the ED

Lee

Chu

et al. 2014

The American Journal of Emergency Medicine

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Different clinical presentation of community-onset bacteremia among human immunodeficiency virus-infected and human immunodeficiency virus-uninfected adults in the ED

Lee

Chu

et al. 2014

The American Journal of Emergency Medicine

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“…The clinical impact is likely to be greatest for the more virulent organisms (such as Staphylococcus aureus, Listeria monocytogenes, and Vibrio vulnificus) and for organisms with predictable resistance to cephalosporins (Enterobacter spp.) and carbapenems (Stenotrophomonas maltophilia and Flavobacterium meningosepticum) (23)(24)(25)(26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

Direct Bacterial Identification in Positive Blood Cultures by Use of Two Commercial Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Systems

et al. 2013

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. Overall, the Biotyper system generated significantly more accurate identifications than the Vitek MS IVD system (P ‫؍‬ 0.016; 177 versus 167 out of 181 specimens). The Biotyper system identified the minority species among polymicrobial blood cultures. We also compared the performance of an in-house extraction method with that of the Sepsityper on both MALDI-TOF MS systems. The in-house method generated more correct identifications at the genus level than the Sepsityper (96.7% versus 93.5%) on the Biotyper system, whereas the two methods exhibited the same performance level (88.0% versus 88.0%) on the Vitek MS IVD system. Our study confirmed the practical advantages of MALDI-TOF MS, and our in-house extraction method reduced the reagent cost to $1 per specimen, with a shorter turnaround time of 3 h, which is highly cost-effective for a diagnostic microbiology service. Bloodstream infection is a condition associated with high morbidity and mortality (1, 2). The rapid identification of bloodstream pathogens is critical to clinical management and the choice of appropriate antibiotic treatments (3, 4). Currently, microbiologic diagnosis of bacteremia relies on subculture of positive blood culture broths on solid medium for an 18-to 24-h incubation period followed by biochemical tests or an automated preformed enzyme assay for identification of the bacteria (5). In general, laboratory diagnosis of common pathogens requires 18 to 48 h, while diagnosis of fastidious organisms requires longer incubation and identification procedures. Although the use of modern techniques such as fluorescence in situ hybridization and PCR can shorten the identification time (6), these operations require specialized equipment and technical expertise and the targeted pathogens are limited in a single run (7). Therefore, the introduction of a simple, rapid, broad-spectrum, and cost-effective system for the identification of blood culture pathogens is imperative.Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) was developed in the 1980s, and this technique had been widely used for biomolecule analysis in the chemical industry for over 10 years. In recent years, MALDI-TOF MS was introduced for bacterial identification, which revolutionized the diagnostic microbiology service (8). Two manufacturers, bioMérieux (Marcy l'Etoile, France) and Bruker Daltonics (Bremen, Germany), are marketing efficient MALDI-TOF systems, the Vitek-MS and the Microflex LT, respectively, that allow the identification of bacteria and yeasts in a few minutes instead of the hours required by traditional methods. The practical use of MALDI-TOF MS for microorganism identification directly from positive blood culture specimens has been substantiated by a number of studies (9-13). Generally, studies have shown high identification rates for various types of organisms with the use of MALDI-TOF MS . However, various organism isolation methods from blood were used in those studies and therefore method standardization is necessary. The...

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“…Therefore, swift administration of antibiotics based on empiric treatment is crucial following diagnosis (5). However, excessive use of antibiotics has been associated with the appearance of resistant bacteria and risk of destroying the patient's normal bacterial flora (6).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Benefits of De-Escalation for Patients with Sepsis in the Emergency Intensive Care Unit

et al. 2018

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-Purpose. Although the 2016 Japanese guidelines for the management of sepsis recommend de-escalation of treatment after identification of the causative pathogen, adherence to this practice remain unknown. The objective of this study was to evaluate the benefits of de-escalating treatment for sepsis patients at an advanced critical care and emergency medical centre. Methods. Based on electronic patient information, 85 patients who were transported to the centre by ambulance, and diagnosed with sepsis between January 2008 and September 2013 were enrolled and evaluated. Patients were divided into two groups with and without deescalation, and comparisons were conducted for several variables, including length of hospital stay, and length of antibiotic administration. Two types of subgroup analysis were conducted between patients with septic shock or positive blood cultures. Statistical analysis was conducted using chi-square and Mann-Whitney U tests.

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Impact of inappropriate empirical antibiotic therapy on outcome of bacteremic adults visiting the ED

Cited by 58 publications

References 21 publications

Different clinical presentation of community-onset bacteremia among human immunodeficiency virus-infected and human immunodeficiency virus-uninfected adults in the ED

Different clinical presentation of community-onset bacteremia among human immunodeficiency virus-infected and human immunodeficiency virus-uninfected adults in the ED

Direct Bacterial Identification in Positive Blood Cultures by Use of Two Commercial Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Systems

Evaluation of the Benefits of De-Escalation for Patients with Sepsis in the Emergency Intensive Care Unit

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