Archive for July 30, 2018

Severe Community-Acquired Pneumonia due to Acinetobacter baumannii in North America: Case Report and Review of the Literature

Open Forum Infectious Diseases, March 2018 V.5 N.3

David P Serota; Mary Elizabeth Sexton; Colleen S Kraft; Federico Palacio

Acinetobacter baumannii is a rare but emerging cause of fulminant community-acquired pneumonia (CAP-AB). We describe a patient from a rural area who developed acute respiratory distress syndrome and septic shock. We describe risk factors and characteristics of this syndrome and review published cases of CAP-AB from North America.

FULL TEXT

https://academic.oup.com/ofid/article/5/3/ofy044/4926000

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July 30, 2018 at 9:24 am

Time Course of C-Reactive Protein and Procalcitonin Levels During the Treatment of Acute Bacterial Skin Infections

Open Forum Infectious Diseases, March 2018 V.5 N.3

BRIEF REPORTS

Timothy C Jenkins; Jason S Haukoos; Eleanor Cotton; David Weitzenkamp; Daniel N Frank …

In a pilot study of 22 patients with an acute bacterial skin infection, serum levels of C-reactive protein and procalcitonin tended to be elevated at presentation and declined within 3–5 days of treatment. Further study of a biomarker-guided treatment strategy to reduce antibiotic overuse in skin infections is warranted.

FULL TEXT

https://academic.oup.com/ofid/article/5/3/ofy029/4830034

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July 30, 2018 at 9:23 am

Actinotignum schaalii Infection: A Clandestine Cause of Sterile Pyuria?

Open Forum Infectious Diseases, February 2018 V.5 N.2

Lucy E Horton; Sanjay R Mehta; Lejla Aganovic; Joshua Fierer

Actinotignum schaalii is an underappreciated cause of urinary tract infections (UTIs) in older adults. The diagnosis may be missed due to difficulty isolating and identifying the organism. Complications can result because the organism is intrinsically resistant to 2 commonly used drugs to treat UTI, as illustrated by this case.

FULL TEXT

https://academic.oup.com/ofid/article/5/2/ofy015/4848651

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July 30, 2018 at 9:21 am

Potential Adverse Effects of Broad-Spectrum Antimicrobial Exposure in the Intensive Care Unit

Open Forum Infectious Diseases, February 2018 V.5 N.2

EDITOR’S CHOICE

Jenna Wiens; Graham M Snyder; Samuel Finlayson; Monica V Mahoney; Leo Anthony Celi

Background

The potential adverse effects of empiric broad-spectrum antimicrobial use among patients with suspected but subsequently excluded infection have not been fully characterized. We sought novel methods to quantify the risk of adverse effects of broad-spectrum antimicrobial exposure among patients admitted to an intensive care unit (ICU).

Methods

Among all adult patients admitted to ICUs at a single institution, we selected patients with negative blood cultures who also received ≥1 broad-spectrum antimicrobials. Broad-spectrum antimicrobials were categorized in ≥1 of 5 categories based on their spectrum of activity against potential pathogens. We performed, in serial, 5 cohort studies to measure the effect of each broad-spectrum category on patient outcomes. Exposed patients were defined as those receiving a specific category of broad-spectrum antimicrobial; nonexposed were all other patients in the cohort. The primary outcome was 30-day mortality. Secondary outcomes included length of hospital and ICU stay and nosocomial acquisition of antimicrobial-resistant bacteria (ARB) or Clostridium difficile within 30 days of admission.

Results

Among the study cohort of 1918 patients, 316 (16.5%) died within 30 days, 821 (42.8%) had either a length of hospital stay >7 days or an ICU length of stay >3 days, and 106 (5.5%) acquired either a nosocomial ARB or C. difficile. The short-term use of broad-spectrum antimicrobials in any of the defined broad-spectrum categories was not significantly associated with either primary or secondary outcomes.

Conclusions

The prompt and brief empiric use of defined categories of broad-spectrum antimicrobials could not be associated with additional patient harm.

FULL TEXT

https://academic.oup.com/ofid/article/5/2/ofx270/4762255

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July 30, 2018 at 9:20 am

An Updated Review of Iclaprim: A Potent and Rapidly Bactericidal Antibiotic for the Treatment of Skin and Skin Structure Infections and Nosocomial Pneumonia Caused by Gram-Positive Including Multidrug-Resistant Bacteria

Open Forum Infectious Diseases, February 2018 V.5 N.2

REVIEW ARTICLE

David B Huang; Catherine D Strader; James S MacDonald; Mark VanArendonk; Richard Peck …

New antibiotics are needed because of the increased morbidity and mortality associated with multidrug-resistant bacteria. Iclaprim, a bacterial dihydrofolate reductase inhibitor, not currently approved, is being studied for the treatment of skin infections and nosocomial pneumonia caused by Gram-positve bacteria, including multidrug-resistant bacteria. Iclaprim showed noninferiority at –10% to linezolid in 1 of 2 phase 3 studies for the treatment of complicated skin and skin structure infections with a weight-based dose (0.8 mg/kg) but did not show noninferiority at –10% to linezolid in a second phase 3 study. More recently, iclaprim has shown noninferiority at –10% to vancomycin in 2 phase 3 studies for the treatment of acute bacterial skin and skin structure infections with an optimized fixed dose (80 mg). A phase 3 study for the treatment of hospital-acquired bacterial and ventilator-associated bacterial pneumonia is upcoming. If, as anticipated, iclaprim becomes available for the treatment of skin and skin structure infections, it will serve as an alternative to current antibiotics for treatment of severe infections. This article will provide an update to the chemistry, preclinical, pharmacology, microbiology, clinical and regulatory status of iclaprim.

FULL TEXT

https://academic.oup.com/ofid/article/5/2/ofy003/4791932

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July 30, 2018 at 9:19 am

Guidelines vs Actual Management of Skin and Soft Tissue Infections in the Emergency Department

Open Forum Infectious Diseases, January 2018 V.5 N.1 

Background Rahul S Kamath; Deepthi Sudhakar; Julianna G Gardner; Vagish Hemmige; Hossam Safar …

Infections of skin and soft tissue (SSTI) commonly cause visits to hospital emergency departments (EDs). The Infectious Diseases Society of America (IDSA) has published guidelines for the management of SSTI, but it is unclear how closely these guidelines are followed in practice.

Methods

We reviewed records of patients seen in the ED at a large tertiary care hospital to determine guidelines adherence in 4 important areas: the decision to hospitalize, choice of antibiotics, incision and drainage (I&D) of abscesses, and submission of specimens for culture.

Results

The decision to hospitalize did not comply with guidelines in 19.6% of cases. Nonrecommended antibiotics were begun in the ED in 71% of patients with nonpurulent infections and 68.4% of patients with purulent infections. Abscesses of mild severity were almost always treated with antibiotics, and I&D was often not done (both against recommendations). Blood cultures were done (against recommendations) in 29% of patients with mild-severity cellulitis. Abscess drainage was almost always sent for culture (recommendations neither favor nor oppose). Overall, treatment fully complied with guidelines in 20.1% of cases.

Conclusions

Our results show a striking lack of concordance with IDSA guidelines in the ED management of SSTI. Social factors may account for discordant decisions regarding site of care. Use of trimethoprim/sulfamethoxazole (TMP/SMX) in cellulitis was the most common source of discordance; this practice is supported by some medical literature. Excess antibiotics were often used in cellulitis and after I&D of simple abscesses, opposing antibiotic stewardship. Ongoing education of ED doctors and continued review of published guidelines are needed.

FULL TEXT

https://academic.oup.com/ofid/article/5/1/ofx188/4804297

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July 30, 2018 at 9:17 am


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