Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis

Harbarth, Stéphan Juergen; Garbino, Jorge; Pugin, Jérôme; Romand, Jacques-André; Lew, Daniel Pablo; Pittet, Didier

doi:10.1016/j.amjmed.2003.07.005

Cited by 560 publications

(363 citation statements)

References 37 publications

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“…We performed a secondary analysis of a randomised clinical trial of 904 patients with microbiologically documented severe sepsis and found that inadequate antimicrobial treatment of severe sepsis of abdominal origin (n=123) was associated with a significantly increased risk of death after adjusting for confounding factors (OR, 2.8; 95%CI, 1.3-5.9); inadequately treated enterococcal infection contributed to this increased risk [42]. Certainly, new diagnostic approaches and interventions aimed at improving the detection and treatment of early gram-positive sepsis are urgently needed.…”

Section: What Is the Potential Impact Of Inadequate Enterococcal Covementioning

confidence: 99%

Are there Patients with Peritonitis Who Require Empiric Therapy for Enterococcus?

Harbarth

Uçkay

2004

European Journal of Clinical Microbiology & Infectious Dise

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Enterococci are an increasingly important cause of nosocomial infections. While the clinical impact of enterococci in cases of bacteremia and super-infections in selected patient populations has been well-established, their role as primary pathogens in polymicrobial intraabdominal infections remains controversial. While it has been suggested that the presence of enterococci increases the rate of infectious post-operative complication, it has also been demonstrated that polymicrobial intra-abdominal infections involving enterococci can be treated successfully with appropriate surgical drainage and antibiotics, such as cephalosporins, that are not active against enterococci. Therefore, the question arises of whether or not antibiotic coverage against enterococci should be included in the empirical treatment of peritonitis in certain high-risk patient populations. An extensive literature review revealed some evidence arguing in favour of using empirical therapy with enterococcal coverage for intra-abdominal infections in the following cases: (i) immunocompromised patients with nosocomial, post-operative peritonitis; (ii) patients with severe sepsis of abdominal origin who have previously received cephalosporins and other broad-spectrum antibiotics selecting for Enterococcus spp.; (iii) patients with peritonitis and valvular heart disease or prosthetic intravascular material, which place them at high risk of endocarditis. The ideal therapeutic regimen for these high-risk patients remains to be determined, but empirical therapy directed against enterococci should be considered.

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Section: What Is the Potential Impact Of Inadequate Enterococcal Covementioning

confidence: 99%

Are there Patients with Peritonitis Who Require Empiric Therapy for Enterococcus?

Harbarth

Uçkay

2004

European Journal of Clinical Microbiology & Infectious Dise

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“…Antibiotic treatment tailored to the causative pathogen is beneficial to the patient, potentially leading to reductions in morbidity and mortality, while having economic benefits such as shorter hospital stay. Numerous studies have shown that adjustment of antimicrobial therapy for bloodstream infections based on availability of antibiotic susceptibility results can improve clinical outcome [20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Performance of Kiestra Total Laboratory Automation Combined with MS in Clinical Microbiology Practice

et al. 2014

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Background: Microbiological laboratories seek technologically innovative solutions to cope with large numbers of samples and limited personnel and financial resources. One platform that has recently become available is the Kiestra Total Laboratory Automation (TLA) system (BD Kiestra B.V., the Netherlands). This fully automated sample processing system, equipped with digital imaging technology, allows superior detection of microbial growth. Combining this approach with matrix-assisted laser desorption ionization time-offlight mass spectrometry (MS) (Bruker Daltonik, Germany) is expected to enable more rapid identification of pathogens.Methods: Early growth detection by digital imaging using Kiestra TLA combined with MS was compared to conventional methods (CM) of detection. Accuracy and time taken for microbial identification were evaluated for the two methods in 219 clinical blood culture isolates. The possible clinical impact of earlier microbial identification was assessed according to antibiotic treatment prescription.Results: Pathogen identification using Kiestra TLA combined with MS resulted in a 30.6 hr time gain per isolate compared to CM. Pathogens were successfully identified in 98.4% (249/253) of all tested isolates. Early microbial identification without susceptibility testing led to an adjustment of antibiotic regimen in 12% (24/200) of patients. Conclusions:The requisite 24 hr incubation time for microbial pathogens to reach sufficient growth for susceptibility testing and identification would be shortened by the implementation of Kiestra TLA in combination with MS, compared to the use of CM. Not only can this method optimize workflow and reduce costs, but it can allow potentially life-saving switches in antibiotic regimen to be initiated sooner.

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“…(1) Additionally, patients receiving inappropriate antibiotics who, when the culture results became available, had their antibiotic therapy tailored to the cultured agent sensitivity, had improved survival rates, although their outcomes were worse than the outcomes of patients who were initially treated appropriately. The earlier appropriate therapy is started, the better the patient's prognosis will be (B).…”

Section: Is the Causative Agent Identification Relevant?mentioning

confidence: 99%

“…The earlier appropriate therapy is started, the better the patient's prognosis will be (B). (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) Appropriate antibiotic therapy allows for deescalation from empirical therapy to a more specific antibiotic regimen, which is suitable for organism sensitivity and may prevent the risk of selecting resistant bacteria (D). (17)(18)(19)(20) Antibiotic de-escalation to more specific and less numerous antibiotic regimens reduces the overall cost of therapy (B).…”

Section: Is the Causative Agent Identification Relevant?mentioning

confidence: 99%

“…Additionally, tailoring antibiotic therapy to the organism sensitivity data results in lower mortality (B) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)21,22,(24)(25)(26) (D). (17)(18)(19)(20) Some studies have shown that running blood cultures in patients without risk factors hospitalized for community-acquired pneumonia may not be costeffective given the low rate of positive results (B) (31) (C) (32) .…”

Section: Recommendationmentioning

confidence: 99%

See 1 more Smart Citation

Diretrizes para tratamento da sepse grave/choque séptico: abordagem do agente infeccioso - diagnóstico

Diament¹,

Salomão²,

Rigatto³

et al. 2011

Rev. bras. ter. intensiva

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Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis

Cited by 560 publications

References 37 publications

Are there Patients with Peritonitis Who Require Empiric Therapy for Enterococcus?

Are there Patients with Peritonitis Who Require Empiric Therapy for Enterococcus?

Performance of Kiestra Total Laboratory Automation Combined with MS in Clinical Microbiology Practice

Diretrizes para tratamento da sepse grave/choque séptico: abordagem do agente infeccioso - diagnóstico

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