Role of Unit-Specific Combination Antibiograms for Improving the Selection of Appropriate Empiric Therapy for Gram-Negative Pneumonia

Pogue, Jason M.; Alaniz, Cesar; Carver, Peggy L.; Pleva, Melissa; Newton, Duane W.; DePestel, Daryl D.

doi:10.1086/658665

Cited by 24 publications

(25 citation statements)

References 7 publications

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“…They concluded that reporting antibiotic susceptibility data in the form of a combination antibiogram may be useful to clinicians who are considering empirical antimicrobial therapy in the intensive care unit. A study by Pogue et al (2011) examined the susceptibility and resistance patterns of 467 gram negative ICU respiratory isolates. They found that the addition of a fluoroquinolone to an antipseudomonal beta-lactam did not substantially improve coverage, since nearly all beta-lactam resistant isolates were subsequently cross-resistant to fluoroquinolones.…”

Section: Discussionmentioning

confidence: 99%

“…To assist clinicians in selecting the most effective twodrug antibiotic regimen, combination antibiograms have been employed (Apisarnthanarak and Mundy, 2008;Christoff et al, 2010;Fox et al, 2008;Mizuta et al, 2006;Pogue et al, 2011). These antibiograms can be displayed in matrix form showing the percentage of isolates susceptible to various single agents and combinations of antibiotics.…”

Section: Ajidmentioning

confidence: 99%

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UTILITY OF A COMBINATION ANTIBIOGRAM FOR TREATING <i>PSEUDOMONAS AERUGINOSA</i>

Thurman¹

2014

American Journal of Infectious Diseases

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Empiric combination antibiotic therapy is often used to treat severe P. aeruginosa infections. Combination antibiograms have been employed to assist clinicians in selecting the most effective two-drug antibiotic regimens. The objectives of this study were to develop a combination antibiogram in order to compare betalactam monotherapy versus dual-therapy with a fluoroquinolone or aminoglycoside, identify optimal combination regimens, describe the differences between combination therapies with an aminoglycoside versus a fluoroquinolone and to evaluate susceptibility rates based on the source of infection and Intensive Care Unit (ICU) or non-ICU location. A retrospective observational study at a Veterans Affairs (VA) hospital in the Southwestern region of the U.S. was conducted. P. aeruginosa isolates were collected between January 2008 and February 2012 in hospitalized veterans. A total of 374 isolates were included, of which 61 (16%) were obtained from the ICU. Susceptibility rates for monotherapy with a beta-lactam ranged from 83.7 to 90.6%. Collectively, all P. aeruginosa isolates benefited in coverage with the addition of a fluoroquinolone or an aminoglycoside to one of the beta-lactams considered for monotherapy (p<0.01 for each comparison). Monotherapy with a beta-lactam could be considered for mild to moderate wound infections which had beta-lactam susceptibility rates greater than 90% and the addition of a fluoroquinolone did not significantly extend the spectrum. Combination susceptibility rates ranged from 89.0 to 99.2%. Dual therapy of a beta-lactam with amikacin or tobramycin resulted in significantly better coverage than with a fluoroquinolone (p<0.03 for all combinations). For severe infections dual therapy with tobramycin or amikacin may be preferred over fluoroquinolones, but the risks versus benefits of aminoglycoside therapy must be weighed for each patient. In conclusion, combination antibiograms are useful for evaluating the treatment of P. aeruginosa. Choosing the ideal antibiotic regimen ultimately deals with many factors and results of this combination antibiogram are only specific to this institution.

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Section: Discussionmentioning

confidence: 99%

Section: Ajidmentioning

confidence: 99%

UTILITY OF A COMBINATION ANTIBIOGRAM FOR TREATING <i>PSEUDOMONAS AERUGINOSA</i>

Thurman¹

2014

American Journal of Infectious Diseases

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“…Regardless, appropriate diagnostic and microbiological workup should be performed with rapid escalation, de-escalation and/or discontinuation when appropriate. for DAAT [53]. Combination antibiograms offer significant advantages over traditional antibiograms as they focus on susceptibility of potential second agents for combination (e.g.…”

Section: Risk Profilingmentioning

confidence: 99%

“…Furthermore, unit-specific combination antibiograms have the ability to differentiate susceptibility profiles among various units of an institution. Pogue and colleagues used this technique to identify that the most effective combination regimen in the medical intensive care unit (an anti-pseudomonal β-lactam plus amikacin) was different from that in the surgical intensive care unit (an anti-pseudomonal β-lactam plus levofloxacin) at their institution [53]. Data from Nicasio and colleagues suggest that combination antibiograms could be "taken to the next level" by including MIC distributions and pharmacodynamic dosing recommendations for ventilator associated pneumonia [54].…”

Section: Risk Profilingmentioning

confidence: 99%

Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens

Pogue

Kaye

Cohen

et al. 2015

Clinical Microbiology and Infection

120

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The past decade has brought a significant rise in antimicrobial resistance, and the ESKAPE pathogens have become a significant threat to public health. Three epidemiological features that negatively impact patients, which are consistently seen with the ESKAPE pathogens, are the following: 1) there has been a rise in incidence of these organisms as causative human pathogens, 2) there has been a significant increase in antimicrobial resistance in these bacterial species, and 3) the infections caused by these resistant strains are associated with worse outcomes when compared with infections caused by their susceptible counterparts. Significant delays in time to appropriate antimicrobial therapy of up to 5 days have been reported in infections due to these organisms and this is the strongest predictor of mortality with ESKAPE pathogens, particular in critically ill patients, where every hour delay has an incremental survival disadvantage for patients. Strategies to decrease these delays are urgently needed. Although routine broad-spectrum empiric coverage for these organisms would ideally limit this delay, agents with activity against these organisms are sometimes less effective, have significant toxicity risk, and their use can result in the development of resistance. Therefore, strategies to optimize therapy, although limiting unnecessary use of broad-spectrum antimicrobials, are urgently needed. This review will discuss potential strategies to optimize empiric therapy in the age of multi-drug resistance, the limitations of these strategies, and will discuss future directions and opportunities.

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“…Whereas institution-specific antibiograms serve clinicians who provide patient care in a variety of care units, unit-specific antibiograms have emerged as a useful tool for institutions with units devoted to a homogeneous patient population [6][7][8]. Unitspecific antibiograms can guide initial antibiotic choices for different populations within the same institution [7,9].…”

mentioning

confidence: 99%

Antimicrobial Susceptibilities of Respiratory Pathogens in the Surgical/Trauma Intensive Care Unit Compared with the Hospital-Wide Respiratory Antibiogram in a Level I Trauma Center

Al-Dahir

Brakta

et al. 2015

Surgical Infections

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Background: Unit-specific antibiograms have developed to guide clinicians to appropriate antibiotic choices for subsets of patients. The additional level of a unit-and respiratory-specific antibiogram for surgical and trauma patients defines key differences in susceptibility information for treating hospital-acquired pneumonia.Methods: This was a three-year, retrospective single-center study. A total of 729 positive respiratory specimens from 612 patients were analyzed using Quality Compass Pathfinder

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Role of Unit-Specific Combination Antibiograms for Improving the Selection of Appropriate Empiric Therapy for Gram-Negative Pneumonia

Cited by 24 publications

References 7 publications

UTILITY OF A COMBINATION ANTIBIOGRAM FOR TREATING <i>PSEUDOMONAS AERUGINOSA</i>

UTILITY OF A COMBINATION ANTIBIOGRAM FOR TREATING <i>PSEUDOMONAS AERUGINOSA</i>

Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens

Antimicrobial Susceptibilities of Respiratory Pathogens in the Surgical/Trauma Intensive Care Unit Compared with the Hospital-Wide Respiratory Antibiogram in a Level I Trauma Center

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