Prospective open-label randomized comparative, non-inferiority study of two initial antibiotic strategies for patients with nursing- and healthcare-associated pneumonia: Guideline-concordant therapy versus empiric therapy

Matsuda, Shinji; Ogasawara, Takashi; Sugimoto, Shunsuke; Kato, Shigehisa; Umezawa, Hiroki; Yano, Toshiaki; Kasamatsu, Norio

doi:10.1016/j.jiac.2016.03.003

Cited by 9 publications

(4 citation statements)

References 25 publications

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“…Of 58 studies reporting mortality rate, 57 identified 73 relevant outcomes related to mortality rate. Among those studies, 54 studies reported 58 all-cause mortality rate outcomes [7, 11, 15, 19–22, 27, 28, 31–33, 35, 38, 40, 44–48, 50–52, 59, 62, 70, 72, 73, 75–82, 85, 91, 92, 95, 96, 98, 99, 102, 104, 105, 109, 110, 112, 113, 116–119]. Additionally, only 11 of the 57 relevant studies reported 15 infection-related mortality outcomes [7, 20, 48, 57, 74, 78, 79, 81, 83, 99, 109].…”

Section: Resultsmentioning

confidence: 99%

Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review

Nathwani

Varghese

Stephens

et al. 2019

Antimicrob Resist Infect Control

297

209

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BackgroundHospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of antimicrobials to combat antimicrobial resistance. For ASPs to be developed, adopted, and implemented, an economic value assessment is essential. Few studies demonstrate the cost-effectiveness of ASPs. This systematic review aimed to evaluate the economic and clinical impact of ASPs.MethodsAn update to the Dik et al. systematic review (2000–2014) was conducted on EMBASE and Medline using PRISMA guidelines. The updated search was limited to primary research studies in English (30 September 2014–31 December 2017) that evaluated patient and/or economic outcomes after implementation of hospital ASPs including length of stay (LOS), antimicrobial use, and total (including operational and implementation) costs.ResultsOne hundred forty-six studies meeting inclusion criteria were included. The majority of these studies were conducted within the last 5 years in North America (49%), Europe (25%), and Asia (14%), with few studies conducted in Africa (3%), South America (3%), and Australia (3%). Most studies were conducted in hospitals with 500–1000 beds and evaluated LOS and change in antibiotic expenditure, the majority of which showed a decrease in LOS (85%) and antibiotic expenditure (92%). The mean cost-savings varied by hospital size and region after implementation of ASPs. Average cost savings in US studies were $732 per patient (range: $2.50 to $2640), with similar trends exhibited in European studies. The key driver of cost savings was from reduction in LOS. Savings were higher among hospitals with comprehensive ASPs which included therapy review and antibiotic restrictions.ConclusionsOur data indicates that hospital ASPs have significant value with beneficial clinical and economic impacts. More robust published data is required in terms of implementation, LOS, and overall costs so that decision-makers can make a stronger case for investing in ASPs, considering competing priorities. Such data on ASPs in lower- and middle-income countries is limited and requires urgent attention.

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Section: Resultsmentioning

confidence: 99%

Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review

Nathwani

Varghese

Stephens

et al. 2019

Antimicrob Resist Infect Control

297

209

View full text Add to dashboard Cite

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“…And, HCAP was associated with an increased risk of MRSA infection (OR, 4.72; 95% CI, 3.69–6.04; p<0.0001)26. However, several recent studies on HCAP showed poor adherence to the 2005 ATS/IDSA antibiotic guidelines, and controversy has increased regarding the appropriate treatment for HCAP compared to CAP and HAP27. In addition, studies testing the prediction of MRSA infection and optimal selection of anti-MRSA agents in patients with HCAP were limited42728.…”

Section: Discussionmentioning

confidence: 99%

“…However, several recent studies on HCAP showed poor adherence to the 2005 ATS/IDSA antibiotic guidelines, and controversy has increased regarding the appropriate treatment for HCAP compared to CAP and HAP27. In addition, studies testing the prediction of MRSA infection and optimal selection of anti-MRSA agents in patients with HCAP were limited42728. Moreover, the 2005 ATS/IDSA antibiotic guidelines for HCAP did not establish a clear indication to select initial anti-MRSA agents10.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Methicillin-ResistantStaphylococcus aureusInfection in Elderly Patients with Community-Onset Pneumonia

2017

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BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) infection is a severe and life-threatening disease in patients with community-onset (CO) pneumonia. However, the current guidelines lack specificity for a screening test for MRSA infection.MethodsThis study was retrospectively conducted in elderly patients aged ≥65 years, who had contracted CO-pneumonia during hospitalization at the Jeju National University Hospital, between January 2012 and December 2014. We analyzed the risk factors of MRSA in these patients and developed a scoring system to predict MRSA infection.ResultsA total of 762 patients were enrolled in this study, including 19 (2.4%) with MRSA infection. Healthcare-associated pneumonia (HCAP) showed more frequent MRSA infection compared to community-acquired pneumonia (4.4% vs. 1.5%, respectively; p=0.016). In a multivariate logistic regression analysis, admissions during the influenza season (odds ratio [OR], 2.896; 95% confidence interval [CI], 1.022–8.202; p=0.045), chronic kidney disease (OR, 3.555; 95% CI, 1.157–10.926; p=0.027), and intensive care unit admission (OR, 3.385; 95% CI, 1.035–11.075; p=0.044) were identified as predictive factors for MRSA infection. However, the presence of HCAP was not significantly associated with MRSA infection (OR, 1.991; 95% CI, 0.720–5.505; p=0.185). The scoring system consisted of three variables based on the multivariate analysis, and showed moderately accurate diagnostic prediction (area under curve, 0.790; 95% CI, 0.680–0.899; p<0.001).ConclusionMRSA infection would be considered in elderly CO-pneumonia patients, with three risk factors identified herein. When managing elderly patients with pneumonia, clinicians might keep in mind that these risk factors are associated with MRSA infection, which may help in selecting appropriate antibiotics.

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“…Such treatment included initial MRSA and dual anti-pseudomonal coverage. A small open-label randomized study from Japan comparing guideline-concordant and empirical treatment in 111 patients failed to show improved outcomes (relapse and death rates, adverse outcomes and cost) with guideline-concordant treatment [39].…”

Section: Impact Of Guideline-concordant Treatmentmentioning

confidence: 99%

Healthcare-associated pneumonia: is there any reason to continue to utilize this label in 2019?

Ewig

Kolditz

Pletz

et al. 2019

Clinical Microbiology and Infection

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Background: There is an ongoing controversy on the role of the healthcare-associated pneumonia (HCAP) label in the treatment of patients with pneumonia. Objective: To provide an update of the literature on patients meeting criteria for HCAP between 2014 and 2018. Sources: The review is based on a systematic literature search using PubMed-Central full-text archive of biomedical and life sciences literature at the U.S. National Institutes of Health's National Library of Medicine (NIH/NLM). Content: Studies compared clinical characteristics of patients with HCAP and community-acquired pneumonia (CAP). HCAP patients were older and had a higher comorbidity. Mortality rates in HCAP varied from 5% to 33%, but seemed lower than those cited in the initial reports. Criteria behind the HCAP classification differed considerably within populations. Microbial patterns differed in that there was a higher incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, and, to a lesser extent, enterobacteriaceae. Definitions and rates of multidrug-resistant (MDR) pneumonia also varied considerably. Broad-spectrum guideline-concordant treatment did not reduce mortality in four observational studies. The HCAP criteria performed poorly as a predictive tool to identify MDR pneumonia or pathogens not covered by treatment for CAP. A new score (Drug Resistance in Pneumonia, DRIP) outperformed HCAP in the prediction of MDR pathogens. Comorbidity and functional status, but not different microbial patterns, seem to account for increased mortality. Implications: HCAP should no longer be used to identify patients at risk of MDR pathogens. The use of validated predictive scores along with implementation of de-escalation strategies and careful individual assessment of comorbidity and functional status seem superior strategies for clinical management.

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Prospective open-label randomized comparative, non-inferiority study of two initial antibiotic strategies for patients with nursing- and healthcare-associated pneumonia: Guideline-concordant therapy versus empiric therapy

Cited by 9 publications

References 25 publications

Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review

Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review

Predictive Factors of Methicillin-ResistantStaphylococcus aureusInfection in Elderly Patients with Community-Onset Pneumonia

Healthcare-associated pneumonia: is there any reason to continue to utilize this label in 2019?

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