Archive for August 25, 2016

Extended-Infusion versus standard-infusion piperacillin-tazobactam for sepsis syndromes at a tertiary medical center.

Antimicrob Agents Chemother. 2014 Aug;58(8):4470-5.

Cutro SR1, Holzman R2, Dubrovskaya Y3, Chen XJ3, Ahuja T3, Scipione MR3, Chen D2, Papadopoulos J3, Phillips MS2, Mehta SA2.

Author information

1Division of Infectious Diseases, New York University School of Medicine, New York, New York, USA scott.r.cutro@gmail.com

2Division of Infectious Diseases, New York University School of Medicine, New York, New York, USA.

3Department of Pharmacy, New York University-Langone Medical Center, New York, New York, USA.

Abstract

Piperacillin-tazobactam (PTZ) is frequently used as empirical and targeted therapy for Gram-negative sepsis. Time-dependent killing properties of PTZ support the use of extended-infusion (EI) dosing; however, studies have shown inconsistent benefits of EI PTZ treatment on clinical outcomes. We performed a retrospective cohort study of adult patients who received EI PTZ treatment and historical controls who received standard-infusion (SI) PTZ treatment for presumed sepsis syndromes. Data on mortality rates, clinical outcomes, length of stay (LOS), and disease severity were obtained. A total of 843 patients (662 with EI treatment and 181 with SI treatment) were available for analysis. Baseline characteristics of the two groups were similar, except for fewer female patients receiving EI treatment. No significant differences between the EI and SI groups in inpatient mortality rates (10.9% versus 13.8%; P = 0.282), overall LOS (10 versus 12 days; P = 0.171), intensive care unit (ICU) LOS (7 versus 6 days; P = 0.061), or clinical failure rates (18.4% versus 19.9%; P = 0.756) were observed. However, the duration of PTZ therapy was shorter in the EI group (5 versus 6 days; P < 0.001). Among ICU patients, no significant differences in outcomes between the EI and SI groups were observed. Patients with urinary or intra-abdominal infections had lower mortality and clinical failure rates when receiving EI PTZ treatment. We did not observe significant differences in inpatient mortality rates, overall LOS, ICU LOS, or clinical failure rates between patients receiving EI PTZ treatment and patients receiving SI PTZ treatment. Patients receiving EI PTZ treatment had a shorter duration of PTZ therapy than did patients receiving SI treatment, and EI dosing may provide cost savings to hospitals.

PDF

http://aac.asm.org/content/58/8/4470.full.pdf+html

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August 25, 2016 at 8:19 am

Effect of meropenem administration in extended infusion on the clinical outcome of febrile neutropenia: a retrospective observational study

J Antimicrob Chemother. 2014 Sep;69(9):2556-62.

Fehér C1, Rovira M2, Soriano A3, Esteve J2, Martínez JA4, Marco F5, Carreras E2, Martínez C2, Fernández-Avilés F2, Suárez-Lledó M2, Mensa J4.

Abstract

OBJECTIVES:

Information on the efficacy of extended meropenem administration in neutropenic patients is scarce. Our objective was to determine whether the administration of meropenem in a 4 h extended infusion (EI) leads to a better clinical outcome in patients with febrile neutropenia than the conventional short infusion (SI).

METHODS:

This was a retrospective observational study. The subjects were neutropenic patients who presented with fever after receiving haematopoietic stem-cell transplantation or induction chemotherapy for acute myeloid leukaemia. The primary endpoint was the success of treatment after 5 days of meropenem therapy, defined as follows: the disappearance of fever leading to a maintained (≥ 24 h) feverless state; the resolution or improvement of the clinical signs and symptoms of infection; the absence of persistent or breakthrough bacteraemia; and no additional antibiotics prescribed because of an unsatisfactory clinical evolution.

RESULTS:

Eighty-eight patients received meropenem (1 g/8 h) in SI and 76 received the same dose in EI. Treatment success on day 5 was superior in the EI group [52/76 (68.4%) versus 36/88 (40.9%); P<0.001]. Meropenem administered in EI was independently associated with success (OR 3.13, 95% CI 1.61-6.10). Fewer additional antibiotics were prescribed in the EI group during the first 5 days of treatment [20/76 (26.3%) versus 44/88 (50.0%); P=0.002]. Using Kaplan-Meier survival analysis a more prompt defervescence and a faster decrease in C-reactive protein concentration were observed in the EI group (P=0.021 and P=0.037, respectively). There were no significant differences in the length of hospital stay and in the mortality rate.

CONCLUSIONS:

Meropenem administration in EI results in a better clinical outcome for febrile neutropenia episodes, with fewer additional antibiotics needed.

PDF

http://jac.oxfordjournals.org/content/69/9/2556.full.pdf+html

August 25, 2016 at 8:17 am

Immunization of Health-Care Providers: Necessity and Public Health Policies.

Healthcare (Basel). 2016 Aug 1;4(3).

Maltezou HC1, Poland GA2.

Author information

1Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, 3-5 Agrafon Street, Athens 15123, Greece. helen-maltezou@ath.forthnet.gr

2Mayo Clinic Vaccine Research Group, 611C Guggenheim Building, Mayo Clinic and Foundation, 200 First Street, SW Rochester, Rochester, MN 55905, USA. poland.gregory@mayo.edu

Abstract

Health-care providers (HCPs) are at increased risk for exposure to vaccine-preventable diseases (VPDs) in the workplace. The rationale for immunization of HCPs relies on the need to protect them and, indirectly, their patients from health-care-associated VPDs. Published evidence indicates significant immunity gaps for VPDs of HCPs globally. Deficits in knowledge and false perceptions about VPDs and vaccines are the most common barriers for vaccine uptake and may also influence communication about vaccines between HCPs and their patients. Most countries have immunization recommendations for HCPs; however, there are no universal policies and significant heterogeneity exists between countries in terms of vaccines, schedules, frame of implementation (recommendation or mandatory), and target categories of HCPs. Mandatory influenza immunization policies for HCPs have been implemented with high vaccine uptake rates. Stronger recommendations for HCP immunization and commitment at the level of the health-care facility are critical in order to achieve high vaccine coverage rates. Given the importance to health, mandatory immunization policies for VPDs that can cause serious morbidity and mortality to vulnerable patients should be considered

PDF (CLIC DOWNLOAD PDF)

http://www.mdpi.com/2227-9032/4/3/47

August 25, 2016 at 8:15 am


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