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Álvarez-Lerma, Francisco; Alvarez, B.; Luqué, Pilar; Ruiz, Francisco; Dominguez-Roldan, J.M.; Quintana, E.; Sanz-Rodrı́guez, César

doi:10.1186/cc4919

Cited by 110 publications

(32 citation statements)

References 26 publications

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“…In our study, the teaching hospital with a large surgical centre had the lowest frequency of narrowing therapy and highest antibiotic usage and longest length of stay, probably because of the high complexity of cases. Although it is beyond the scope of our study to determine whether this use rate was optimal, prospective studies focusing on specific infections and controlling for these factors have noted frequently missed streamlining opportunities in hospital-associated pneumonia, 7 Staphylococcus aureus bloodstream infection, 33 and complicated urinary tract infections. 19 …”

Section: Discussionmentioning

confidence: 99%

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Assessment of empirical antibiotic therapy optimisation in six hospitals: an observational cohort study

Braykov

Morgan

Schweizer

et al. 2014

The Lancet Infectious Diseases

118

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Summary Background Modification of empirical antimicrobials when warranted by culture results or clinical signs is recommended to control antimicrobial overuse and resistance. We aimed to assess the frequency with which patients were started on empirical antimicrobials, characteristics of the empirical regimen and the clinical characteristics of patients at the time of starting antimicrobials, patterns of changes to empirical therapy at different timepoints, and modifiable factors associated with changes to the initial empirical regimen in the first 5 days of therapy. Methods We did a chart review of adult inpatients receiving one or more antimicrobials in six US hospitals on 4 days during 2009 and 2010. Our primary outcome was the modification of antimicrobial regimen on or before the 5th day of empirical therapy, analysed as a three-category variable. Bivariate analyses were used to establish demographic and clinical variables associated with the outcome. Variables with p values below 0.1 were included in a multivariable generalised linear latent and mixed model with multinomial logit link to adjust for clustering within hospitals and accommodate a non-binary outcome variable. Findings Across the six study sites, 4119 (60%) of 6812 inpatients received antimicrobials. Of 1200 randomly selected patients with active antimicrobials, 730 (61%) met inclusion criteria. At the start of therapy, 220 (30%) patients were afebrile and had normal white blood cell counts. Appropriate cultures were collected from 432 (59%) patients, and 250 (58%) were negative. By the 5th day of therapy, 12·5% of empirical antimicrobials were escalated, 21·5% were narrowed or discontinued, and 66·4% were unchanged. Narrowing or discontinuation was more likely when cultures were collected at the start of therapy (adjusted OR 1·68, 95% CI 1·05–2·70) and no infection was noted on an initial radiological study (1·76, 1·11–2·79). Escalation was associated with multiple infection sites (2·54, 1·34–4·83) and a positive culture (1·99, 1·20–3·29). Interpretation Broad-spectrum empirical therapy is common, even when clinical signs of infection are absent. Fewer than one in three inpatients have their regimens narrowed within 5 days of starting empirical antimicrobials. Improved diagnostic methods and continued education are needed to guide discontinuation of antimicrobials. Funding US Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion; Robert Wood Johnson Foundation; US Department of Veterans Administration; US Department of Homeland Security.

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Section: Discussionmentioning

confidence: 99%

“…6 The initial reassessment should occur as early as culture data are available, at which point clinical improvement and bacteriological results usually allow the removal of one or more antimicrobials. 6,7 …”

Section: Introductionmentioning

confidence: 99%

Assessment of empirical antibiotic therapy optimisation in six hospitals: an observational cohort study

Braykov

Morgan

Schweizer

et al. 2014

The Lancet Infectious Diseases

118

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“…These long testing times lead to patients being prescribed empiric, wide spectrum therapies, which can result in poor patient response and, moreover, contribute to increases in multi-drug resistant pathogens. 4 As a result, there is a need for an AST method that can provide results within hours rather than days, enabling patients to be treated more rapidly and with more appropriate therapies, 5 while minimizing increases in drug resistant populations. 4,6–8 The ongoing goal of the authors is to develop an ultra-rapid technology that expedites and refines the use of antibiotics for patients with life-threatening bacterial infections, including outbreaks due to newly emerged antibiotic resistant strains.…”

Section: Introductionmentioning

confidence: 99%

Asynchronous Magnetic Bead Rotation Microviscometer for Rapid, Sensitive, and Label-Free Studies of Bacterial Growth and Drug Sensitivity

et al. 2012

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The long turnaround time in antimicrobial susceptibility testing (AST) endangers patients and encourages the administration of wide spectrum antibiotics, thus resulting in alarming increases of multi-drug resistant pathogens. A method for faster detection of bacterial proliferation presents one avenue towards addressing this global concern. We report on a label-free asynchronous magnetic bead rotation (AMBR) based viscometry method that rapidly detects bacterial growth and determines drug sensitivity by measuring changes in the suspension’s viscosity. With this platform, we observed the growth of a uropathogenic Escherichia coli isolate, with an initial concentration of 50 cells per drop, within 20 minutes; in addition, we determined the gentamicin minimum inhibitory concentration (MIC) of the E. coli isolate within 100 minutes. We thus demonstrated a label-free, micro-viscometer platform that can measure bacterial growth and drug susceptibility more rapidly, with lower initial bacterial counts than existing commercial systems, and potentially with any microbial strains.

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“…Physicians should perform bacteriological examinations to estimate and/or identify responsible pathogens, consider drug sensitivity, and prescribe the most appropriate antibiotics. De-escalation strategy, that is the practice as above mentioned, is one of the key strategies in antibiotic treatment 23–25. The JRS guidelines recommend against the use of broad-spectrum antibiotics by physicians without sufficient review of the medication’s appropriateness, and also suggest that estimating and/or identifying the responsible pathogen would lead to the effective use of antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Practice patterns for lower respiratory tract infections in hospital patients with particular focus on bacteriological examinations and injection antibiotics use

Wada¹,

Nakayama²,

Ishizaki³

et al. 2013

IJGM

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BackgroundVarious types of medical institutions perform treatments for lower respiratory tract infections. However, few studies have assessed and compared practice patterns across different medical institutions in Japan. To assess practice patterns for community-acquired lower respiratory tract infections among patients who needed hospitalization, we examined the use of injection antibiotics and the implementation of bacteriological examinations, and compared these across medical institutions. We then evaluated whether bacteriological examinations were being adequately implemented.MethodsA cross-sectional study was conducted using a database of health insurance claims. Subjects were patients (≥16 years old) who received injection antibiotics to treat lower respiratory tract infections, and who were listed among 2004–2007 insurance claims data. For each type of antibiotic, we obtained the dose prescribed, the number of patients treated, and the frequency of bacteriological examinations.ResultsA total of 1649 patients were evaluated. The implementation rate of Gram stain and sputum culture was 14% at clinics (<20 beds), approximately 30% at small hospitals (20–99 beds), and 40%–45% at medium-sized (100–499 beds) and large hospitals (≥500 beds). As a whole, beta-lactams were most frequently used, accounting for 80% of all antibiotics used. Among beta-lactams, penicillins comprised 25% of the total amount of drugs used at hospitals with ≥300 beds, but approximately 13% at clinics and small hospitals.ConclusionPractice patterns varied depending on the size of the medical institution. The implementation rate of bacteriological examinations was not high enough, especially at clinics and small hospitals.

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Cited by 110 publications

References 26 publications

Assessment of empirical antibiotic therapy optimisation in six hospitals: an observational cohort study

Assessment of empirical antibiotic therapy optimisation in six hospitals: an observational cohort study

Asynchronous Magnetic Bead Rotation Microviscometer for Rapid, Sensitive, and Label-Free Studies of Bacterial Growth and Drug Sensitivity

Practice patterns for lower respiratory tract infections in hospital patients with particular focus on bacteriological examinations and injection antibiotics use

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