Infectious Diseases Consultation Improves Treatment and Decreases Mortality by Enterococcal Bacteremia in Children

Furuichi, Munehiro; Furuichi, Mihoko; Horikoshi, Yuho; Miyairi, Isao

doi:10.1097/inf.0000000000001919

Cited by 21 publications

(28 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Specifically, ID consultation in the treatment of enterococcal bacteremia was associated with lower 30-day mortality compared with patients who did not receive ID consultation, especially when Enterococcus faecium was isolated [ 9 ]. An additional retrospective analysis assessed the impact of ID consultation in children with enterococcal bacteremia [ 10 ]. This analysis showed ID specialist involvement to be associated with a significant improvement in outcomes, such as higher rates of appropriate empiric therapy, appropriate definitive therapy, and increased survival at 1 year [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Understanding and Application of Daptomycin-Susceptible Dose-Dependent Category for Enterococcus: A Mixed-Methods Study

Adema

Lake

Stevens

et al. 2022

Open Forum Infectious Diseases

View full text Add to dashboard Cite

Background In 2018, the Clinical Microbiology Laboratory at our institution adopted updated daptomycin Enterococcus–susceptible dose-dependent breakpoints. While the introduction of susceptible dose-dependent (SDD) was intended to guide practice toward optimal dosing, the understanding and application of daptomycin SDD breakpoints for enterococci were unknown. Methods This mixed-methods study combined a clinician survey with a retrospective pre–post prescribing analysis. An 8-question survey was distributed to infectious diseases (ID) and internal medicine (IM) clinicians. A retrospective chart review of hospitalized adults with infections due to Enterococcus spp. was conducted before (pre-SDD) and after (post-SDD) adoption of SDD reporting for enterococci. Results Survey response rates were 40 of 98 (41%) for IM and 22 of 34 (65%) for ID clinicians. ID clinicians scored significantly higher than IM clinicians in knowledge of SDD. Chart review of 474 patients (225 pre- vs 249 post-SDD) showed that daptomycin dosage following susceptibility testing was significantly higher post-SDD compared with pre-SDD (8.5 mg/kg vs 6.4 mg/kg; P < .001) with no difference in empiric dosing (6.3 mg/kg vs 6.2 mg/kg; P = .67). Definitive daptomycin use varied between the pre- and post-SDD periods (35.1% vs 16.9%; P < .001). Conclusions The survey revealed that ID clinicians placed more importance on and had more confidence in the SDD category over IM clinicians. SDD reporting was associated with a change in definitive daptomycin dosing. ID specialist involvement is recommended in the care of infections due to enterococci for which daptomycin is reported as SDD given their expertise.

show abstract

Section: Discussionmentioning

confidence: 99%

Understanding and Application of Daptomycin-Susceptible Dose-Dependent Category for Enterococcus: A Mixed-Methods Study

Adema

Lake

Stevens

et al. 2022

Open Forum Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…A recent investigation from Japan evaluated the impact of IDC on enterococcal bacteremia in children; ID consultations were significantly associated with appropriate empiric and definitive therapy, appropriate treatment duration, and lower risk of 1-year mortality [28]. Zasowski et al reported that IDC within 24 h was significantly associated with a lower risk for delayed appropriate therapy, and therefore with a lower 30-day mortality in 190 patients with enterococcal BSI [14].…”

Section: Discussionmentioning

confidence: 99%

Enterococcus faecalis bloodstream infection: does infectious disease specialist consultation make a difference?

et al. 2021

View full text Add to dashboard Cite

Purpose To evaluate the relationship between mortality or relapse of bloodstream infection (BSI) due to Enterococcus faecalis and infectious diseases specialist consultation (IDC) and other factors potentially associated with outcomes. Methods In a tertiary-care center, consecutive adult patients with E. faecalis BSI between January 1, 2016 and January 31, 2019, were prospectively followed. The management of E. faecalis BSI was evaluated in terms of adherence to evidence-based quality-of-care indicators (QCIs). IDC and other factors potentially associated with 90-day-mortality or relapse of E. faecalis BSI were analyzed by multivariate logistic regression. Results A total of 151 patients with a median age of 68 years were studied. IDC was performed in 38% of patients with E. faecalis BSI. 30 cases of endocarditis (20%) were diagnosed. All-cause in-hospital mortality was 23%, 90-day mortality was 37%, and 90-day relapsing E. faecalis BSI was 8%. IDC was significantly associated with better adherence to 5 QCIs. Factors significantly associated with 90-day mortality or relapsing EfB in multivariate analysis were severe sepsis or septic shock at onset (HR 4.32, CI 2.36e7.88) and deep-seated focus of infection (superficial focus HR 0.33, CI 0.14e0.76). Conclusion Enterococcus faecalis bacteremia is associated with a high mortality. IDC contributed to improved diagnostic and therapeutic management.

show abstract

“…Few studies have highlighted the value of pediatric infectious diseases specialists, which may range from outbreak recognition to improving mortality. [10][11][12] In established situations, such assets are intangible and may be underestimated. The relatively clear differences shown in our study, most likely reflect the emergence and recognition of pediatric infectious diseases as a clinical subspecialty in the past decade in Japan.…”

Section: Discussionmentioning

confidence: 99%

Prospective monitoring of carbapenem use and pseudomonal resistance across pediatric institutions

Miyairi

Shoji

Iwamoto

et al. 2020

Infect. Control Hosp. Epidemiol.

Self Cite

View full text Add to dashboard Cite

Objective: To determine whether carbapenem consumption and Pseudomonas aeruginosa resistance rates can be used as benchmarks to compare and improve antimicrobial stewardship programs across multiple pediatric hospitals. Design: A prospective study. Setting and participants: Healthcare institutions in Japan with >100 pediatric beds. Methods: An annual survey of the total days of therapy (DOT) per 1,000 patient days for carbapenem antibiotics (meropenem, imipenem-cilastatin, panipenem-betamipron, doripenem) and susceptibility rates of Pseudomonas aeruginosa to meropenem and imipenem-cilastatin from each institution was conducted over a 7-year period. Data were reported to the administration, as well as to the infection control team, of each institution annually. Results: Data were obtained from 32 facilities. The median total carbapenem DOT per 1,000 patient days was 16.6 and varied widely, with a range of 2.7 to 59.0. The median susceptibility to meropenem was 86.6%, ranging from 78.6% to 96.6%. We detected an inverse correlation between total carbapenem DOT versus susceptibility (r = – 0.36; P < .01). Over the 7-year period, the DOT per 1,000 patient days of carbapenem decreased by 27% from a median of 16.0 to 11.7 (P < .01). We also observed an improvement in susceptibility to meropenem from a median of 87% to 89.7% (P = .01) and to imipenem-cilastatin from 79% to 85% (P < .01). The decreases in the use of carbapenem were greater in institutions with antimicrobial stewardship programs led by pediatric infectious disease specialists. Conclusions: Antimicrobial use and resistance, targeting carbapenems and P. aeruginosa, respectively, can serve as benchmarks that can be utilized to promote antimicrobial stewardship across pediatric healthcare institutions.

show abstract

Infectious Diseases Consultation Improves Treatment and Decreases Mortality by Enterococcal Bacteremia in Children

Abstract: ID consultation was associated with a higher rate of appropriate therapy and may decrease mortality because of enterococcal bacteremia in children.

Cited by 21 publications

References 18 publications

Understanding and Application of Daptomycin-Susceptible Dose-Dependent Category for Enterococcus: A Mixed-Methods Study

Understanding and Application of Daptomycin-Susceptible Dose-Dependent Category for Enterococcus: A Mixed-Methods Study

Enterococcus faecalis bloodstream infection: does infectious disease specialist consultation make a difference?

Prospective monitoring of carbapenem use and pseudomonal resistance across pediatric institutions

Contact Info

Product

Resources

About