Serum Bactericidal Test as a Prognostic Indicator in Acute Pulmonary Exacerbations of Cystic Fibrosis

Cahen, P; M, Le Bourgeois; Delacourt, Christophe; Coustere, C; Nicaise, Pascale; J, de Blic; Véron, Michel; Scheinmann, P.; Jl, Gaillard

doi:10.1542/peds.91.2.451

Pediatrics

1993

DOI: 10.1542/peds.91.2.451

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Serum Bactericidal Test as a Prognostic Indicator in Acute Pulmonary Exacerbations of Cystic Fibrosis

P Cahen¹,

Le Bourgeois M²,

Christophe Delacourt³

et al.

Abstract: The serum bactericidal test has been used for many years for optimal assessment of the efficacy of antibiotic therapy in patients with infective endocarditis and other bacterial infections. Its capacity to predict the bacteriological outcome of acute pulmonary exacerbations in patients with cystic fibrosis was evaluated. A total of 54 courses of intravenous antibiotic therapy were analyzed in 22 patients, whose ages ranged from 4 months to 24 years (mean age: 10 years). The serum bactericidal activity of blood… Show more

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Cited by 11 publications

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1996

Pediatric Pulmonology

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The rapidly evolving managed care environment is challenging physicians and other members of the health care team to demonstrate the value of the care they deliver to patients in new terms. Increasingly, third party payers and patients demand that medical care be cost effective, produce high quality outcomes and be provided in a manner that is satisfying to patients and their families.Clinical practice guidelines which outline proper care of medical conditions and performance of clinical procedures are being developed by groups throughout the healthcare industry, including federal and state governments, medical specialty societies, academic medical centers and others. It is anticipated that guidelines will reduce inappropriate care and help control rising costs 1 • Clinical pathways are tools developed at specific institutions by key members of the health care team to define and standardize care in a particular setting 2 '3 . While pathways must be congruent with existing practice guidelines, they provide a more focused, detailed reference for daily management of a specific phase or episode of care in a given hospital or health care system. Clinical pathways, when developed and utilized appropriately, provide a framework for continuously evaluating outcomes including cost, patient acceptance, traditional measures such as complication rates and quality of life data 4 • While many centers successfully develop (write) pathways, the incorporation of these tools into practice, and the ongoing evaluation of the impact of the pathway is often poorly executed.The experience developing and using a pathway for the management of pneumonia in patients with cystic fibrosis is described. The Cystic Fibrosis with Pneumonia pathway has clear criteria for hospital admission as well as identification of patients who can appropriately be managed in the home setting. Key cost, quality and patient satisfaction indicators were selected and tracked. Preliminary data suggest that we have been able to reduce costs while maintaining clinical outcomes and providing services that are well received by patients. CXR PA a. uteral (II not done w /In Spirometry 48') PFT (Spirometry) ll:• not done w /in 48' • age >5 ~·n

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Symposium session summaries

1996

Pediatric Pulmonology

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Correlation between activity of beta-lactam agents in vitro and bacteriological outcome in acute pulmonary exacerbations of cystic fibrosis

Gaillard

Cahen

Delacourt

et al. 1995

Eur. J. Clin. Microbiol. Infect. Dis.

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A study was conducted to determine whether a direct relationship exists between beta-lactam and/or aminoglycoside activity measured in vitro and bacteriological outcome in acute pulmonary exacerbations of cystic fibrosis. Twenty-seven patients, aged between 6 months and 24 years (mean age 10 1/2 years), were included in the study and received 41 i.v. courses of a beta-lactam agent combined with an aminoglycoside. A total of 63 Pseudomonas aeruginosa strains were found in sputum taken on admission at densities exceeding 10(6) cfu/g of sputum. For each episode, the serum inhibitory quotient (SIQ) and the serum bactericidal quotient (SBQ) of the beta-lactam agent and of the aminoglycoside administered were determined for the Pseudomonas aeruginosa isolate(s). The SIQs and SBQs were calculated by dividing the average peak serum levels achievable in the patients by the minimal inhibitory concentrations and minimal bactericidal concentrations, respectively. The SIQs and SBQs were compared to bacteriological outcome. Bacteriological success was defined as a decrease of 2 log10 counts or more in the Pseudomonas aeruginosa density in sputum between days 0 and 7 of therapy. The SIQ and SBQ of beta-lactam agents were good predictors of bacteriological outcome: SIQs of < 1:16 were 100% predictive of failure (chi 2 28; p < 0.001) and of > or = 1:64 were 92.9% predictive of success (chi 2 35.68; p < 0.001); SBQs of < 1:8 were 100% predictive of failure (chi 2 42.78; p < 0.001) and of > or = 1:32 were 95.8% predictive of success (chi 2 31.5; p < 0.001). Aminoglycoside SIQs and SBQs were not predictive of outcome.

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Serum bactericidal titres for monitoring antimicrobial therapy: current status and potential role in the management of multidrug-resistant Gram-negative infections

Zaghi

Gaibani

Campoli

et al. 2020

Clinical Microbiology and Infection

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Background: Reports suggest that asymptomatic individuals (those with no symptoms at all throughout infection) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are infectious, but the extent of transmission based on symptom status requires further study. Purpose: This living review aims to critically appraise available data about secondary attack rates from people with asymptomatic, pre-symptomatic and symptomatic SARS-CoV-2 infection. Data sources: Medline, EMBASE, China Academic Journals full-text database (CNKI), and pre-print servers were searched from 30 December 2019 to 3 July 2020 using relevant MESH terms. Study selection: Studies that report on contact tracing of index cases with SARS-CoV-2 infection in either English or Chinese were included. Data extraction: Two authors independently extracted data and assessed study quality and risk of bias. We calculated the secondary attack rate as the number of contacts with SARS-CoV-2, divided by the number of contacts tested. Data synthesis: Of 927 studies identified, 80 were included. Summary secondary attack rate estimates were 1% (95% CI 0%e2%) with a prediction interval of 0%e10% for asymptomatic index cases in ten studies, 7% (95% CI 3%e11%) with a prediction interval of 1%e40% for pre-symptomatic cases in 11 studies and 6% (95% CI 5%e8%) with a prediction interval of 5%e38% for symptomatic index cases in 40 studies. The highest secondary attack rates were found in contacts who lived in the same household as the index case. Other activities associated with transmission were group activities such as sharing meals or playing board games with the index case, regardless of the disease status of the index case. Limitations: We excluded some studies because the index case or number of contacts were unclear. Conclusion: Asymptomatic patients can transmit SARS-CoV-2 to others, but our findings indicate that such individuals are responsible for fewer secondary infections than people with symptoms.

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Serum Bactericidal Test as a Prognostic Indicator in Acute Pulmonary Exacerbations of Cystic Fibrosis

Cited by 11 publications

References 0 publications

Symposium session summaries

Symposium session summaries

Correlation between activity of beta-lactam agents in vitro and bacteriological outcome in acute pulmonary exacerbations of cystic fibrosis

Serum bactericidal titres for monitoring antimicrobial therapy: current status and potential role in the management of multidrug-resistant Gram-negative infections

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