Archive for February 4, 2014

A Multidisciplinary Intervention to Reduce Infections of ESBL- and AmpC-Producing, Gram-Negative Bacteria at a University Hospital.

PLoS One. 2014 Jan 23;9(1):e86457.

Knudsen JD1, Andersen SE2; Bispebjerg Intervention Group.

Abstract

In response to a considerable increase in the infections caused by ESBL/AmpC-producing Klebsiella pneumonia in 2008, a multidisciplinary intervention, with a main focus on antimicrobial stewardship, was carried out at one university hospital. Four other hospitals were used as controls.

Stringent guidelines for antimicrobial treatment and prophylaxis were disseminated throughout the intervention hospital; cephalosporins were restricted for prophylaxis use only, fluoroquinolones for empiric use in septic shock only, and carbapenems were selected for penicillin-allergic patients, infections due to ESBL/AmpC-producing and other resistant bacteria, in addition to their use in severe sepsis/septic shock.

Piperacillin-tazobactam ± gentamicin was recommended for empiric treatments of most febrile conditions. The intervention also included education and guidance on infection control, as well as various other surveillances.

Two year follow-up data on the incidence rates of patients with selected bacterial infections, outcomes, and antibiotic consumption were assessed, employing before-and-after analysis and segmented regression analysis of interrupted time series, using the other hospitals as controls.

The intervention led to a sustained change in antimicrobial consumption, and the incidence of patients infected with ESBL-producing K. pneumoniae decreased significantly (p<0.001).

The incidences of other hospital-associated infections also declined (p’s<0.02), but piperacillin-tazobactam-resistant Pseudomonas aeruginosa and Enterococcus faecium infections increased (p’s<0.033).

In wards with high antimicrobial consumption, the patient gut carrier rate of ESBL-producing bacteria significantly decreased (p = 0.023). The unadjusted, all-cause 30-day mortality rates of K. pneumoniae and E. coli were unchanged over the four-year period, with similar results in all five hospitals.

Although not statistically significant, the 30-day mortality rate of patients with ESBL-producing K. pneumoniae decreased, from 35% in 2008-2009, to 17% in 2010-2011.

The two-year follow-up data indicated that this multidisciplinary intervention led to a statistically significant decrease in the incidence of ESBL/AmpC-resistant K. pneumoniae infections, as well as in the incidences of other typical hospital-associated bacterial infections.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900527/pdf/pone.0086457.pdf

February 4, 2014 at 12:11 pm

Pseudomonas Aeruginosa Bacteraemia in Two UK District Hospitals.

Infect Dis Rep. 2013 Sep 11;5(1):e4.

Enoch DA1, Kuzhively J2, Sismey A1, Grynik A3, Karas JA.

Abstract

Pseudomonas aeruginosa bacteraemia is associated with significant morbidity and mortality.

We retrospectively studied the epidemiology of bacteraemia due to P. aeruginosa in two UK district hospitals so as to determine prevention strategies and assess the efficacy and compliance with local hospital antibiotic guidelines.

Eighty six episodes occurred in 85 patients over the 3 year period. There was a year on year increase in bacteraemias, due predominantly to an increased proportion of community-onset episodes. Urinary catheterisation was a significant risk factor, along with anaemia, renal disease, malignancy and diabetes.

The antibiotic guidelines were adequate for 92.8% of episodes but only 73.8% of patients received adequate therapy. Failure to follow the guidelines was principally due to unwillingness to use gentamicin due to concerns about nephrotoxicity.

The antibiotic guidelines may need reviewing to accommodate this problem and further work is required to address urinary catheter care in both the hospital and community.

Pseudomonas aeruginosa should be considered a significant pathogen when patients are admitted with features of sepsis.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3892617/pdf/idr-2013-1-e4.pdf

February 4, 2014 at 12:09 pm

A systematic review of the influence of anti-TNF on infection rates in patients with rheumatoid arthritis.

Rev Bras Reumatol. 2013 Dec;53(6):501-515.

Goh L, Jewell T, Laversuch C, Samanta A.

Abstract

OBJECTIVE:

The present article aims to provide a systematic review of the influence of antitumor necrosis factor (TNF) on infection rates in patients with rheumatoid arthritis (RA).

METHOD:

Medline was searched to obtain quality control information on infection rates in RA patients treated with anti-TNF.

RESULTS:

A high proportion of RA patients are now established users of anti-TNF agents. Data from national registries in European countries of patients with RA treated with anti-TNF suggest that biological therapies are closely linked to sepsis. Although previous studies reported a higher risk of infections, there are now emerging data with longer duration of follow-up that suggested an adjusted hazard risk of 1.2. Elderly patients and those with longstanding disease may have a higher rate of serious infections compared to their counterparts who were younger with early disease. There are now emerging data to suggest that anti-TNF therapy is associated with the development of neutropenia shortly after the commencement of treatment. The biologic registries found that RA patients treated with monoclonal antibodies are at increased risk of tuberculosis (TB) compared to those on TNF receptor blockers. This risk of infection needs to be weighed against the established benefits of TNF blockers.

CONCLUSION:

Current evidence suggests that anti-TNF treatment in RA is closely linked to infection. Patients need to be aware of the risk of infection together with the established benefits of TNF blockers in order to give informed consent for treatment.

PDF

http://www.scielo.br/pdf/rbr/v53n6/en_v53n6a09.pdf

February 4, 2014 at 12:04 pm


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