Posts filed under ‘GUIDELINES’

Antibiotic consumption and antimicrobial susceptibility evolution in the Centro Hospitalario Pereira Rossell in methicillin resistant Staphylococcus aureus era.

Rev Chilena Infectol. 2009 Oct;26(5):413-9.

Telechea H1, Speranza N, Lucas L, Santurio A, Giachetto G, Algorta G, Nanni L, Pírez MC.

1Depto. de Farmacología y Terapéutica Montevideo, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. hmteleor@hotmail.com

Abstract

INTRODUCTION:

In the past few years, an increase in methicillin resistant-not multiresistant Staphylococcus aureus was observed in Uruguay among children with community acquired infections. Recommendations for empiric antibiotic treatment required adjustments and new national guidelines were recommended in July 2004. Adherence to these guidelines was indirectly performed by monitoring antibiotic consumption and antimicrobial susceptibility patterns in Uruguay.

OBJECTIVE:

To describe and compare antibiotic consumption and antimicrobial susceptibility of Staphylococcus aureus in a Pediatric Hospital of the Centro Hospitalario Pereira Rossell (PH-CHPR) between 2001 and 2006.

METHODS:

Antibiotic consumption in hospitalized children was calculated using the Defined Daily Dose per 100 bed-days (DDD/100). Reference values were obtained from the World Health Organization Collaborating Center for Drug Statistics Methodology of. Consumption. Data were obtained using the WinPharma programme of the Pharmacy Department of CHPR. The fraction of annual occupancy of hospital beds was obtained from the Statistic Division of CHPR. Antibiotic consumption was evaluated between 2001 and 2006 and expressed as DDD/100 and percent change. Antimicrobial susceptibility was evaluated using CHPR’s Microbiology Laboratory data during the same time period.

RESULTS:

After 2003 a significant increase in consumption of clindamycin, ceftriaxone, trimethoprim-sulphamethoxazole, cefuroxime, vancomycin and gentamycin was observed, except for cephradine. Consumption of clindamycin, ceftriaxone and trimethoprim-sulphamethoxazole showed the highest increase (6.15%; 1.44% and 1.17% respectively). Detection of Staphylococcus aureus increased significantly mostly from skin and soft tissue infections. Oxacillin susceptibility of S. aureus strains obtained from different sites had a significant and persistent decrease after 2003 (from 81 % during year 2001 to 40% in year 2006 (p < 0.05). Susceptibility to others antibiotics did not decrease. Between 2004 and 2006 the “D effect” decreased from 28% to 21 %. Antimicrobial susceptibility patterns did not differ by site of infection.

CONCLUSIONS:

Methicillin resistant-not multiresistant Staphylococcus aureus has established itself as a regular community pathogen in Uruguayan children. Changes in antimicrobial consumption patterns reflect the impact of this pathogen in clinical practice and the overall adherence to new recommendations. This change was not associated with an increase in antibiotic resistance. Clindamycin is an alternative treatment although Clindamycin inducible resistance is a worry. Continuous monitoring of antibiotic consumption and local susceptibility patterns are required to promote rational use of antibiotics.

PDF

http://www.scielo.cl/pdf/rci/v26n5/art03.pdf

May 27, 2015 at 9:10 am

Management of community-acquired pneumonia in older adults.

Ther Adv Infect Dis. 2014 Feb;2(1):3-16.

Simonetti AF1, Viasus D2, Garcia-Vidal C2, Carratalà J3.

1Department of Infectious Diseases, Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain.

2Department of Infectious Diseases, Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain and Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain.

3Department of Infectious Diseases, Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Feixa Llarga s/n, 08907, L’Hospitalet de Llobregat, Barcelona, Spain.

Abstract

Community-acquired pneumonia (CAP) is an increasing problem among the elderly. Multiple factors related to ageing, such as comorbidities, nutritional status and swallowing dysfunction have been implicated in the increased incidence of CAP in the older population.

Moreover, mortality in patients with CAP rises dramatically with increasing age.

Streptococcus pneumoniae is still the most common pathogen among the elderly, although CAP may also be caused by drug-resistant microorganisms and aspiration pneumonia.

Furthermore, in the elderly CAP has a different clinical presentation, often lacking the typical acute symptoms observed in younger adults, due to the lower local and systemic inflammatory response.

Several independent prognostic factors for mortality in the elderly have been identified, including factors related to pneumonia severity, inadequate response to infection, and low functional status.

CAP scores and biomarkers have lower prognostic value in the elderly, and so there is a need to find new scales or to set new cut-off points for current scores in this population.

Adherence to the current guidelines for CAP has a significant beneficial impact on clinical outcomes in elderly patients. Particular attention should also be paid to nutritional status, fluid administration, functional status, and comorbidity stabilizing therapy in this group of frail patients.

This article presents an up-to-date review of the main aspects of CAP in elderly patients, including epidemiology, causative organisms, clinical features, and prognosis, and assesses key points for best practices for the management of the disease.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4072047/pdf/10.1177_2049936113518041.pdf

May 25, 2015 at 7:38 pm

Guidelines for the management of community-acquired pneumonia in the elderly patient.

Rev Esp Quimioter. 2014 Mar;27(1):69-86.

González-Castillo J1, Martín-Sánchez FJ, Llinares P, Menéndez R, Mujal A, Navas E, Barberán J; Spanish Society of Emergency Medicine and Emergency Care; Spanish Society of Geriatrics and Gerontology; Spanish Society of Chemotherapy; Spanish Society of Pneumology and Thoracic Surgery; Spanish Society of Home Hospitalization.

1Juan González-Castillo, Servicio de Urgencias. Hospital Clínico San Carlos, Calle Profesor Martín-Lagos s/n, 28040 Madrid, Spain. jgonzalezcast@gmail.com   

Abstract

The incidence of community-acquired pneumonia (CAP) increases with age and is associated with an elevated morbimortality due to the physiological changes associated with aging and a greater presence of chronic disease.

Taking into account the importance of this disease from an epidemiological and prognostic point of view, and the enormous heterogeneity described in the clinical management of the elderly, we believe a specific consensus document regarding this patient profile is necessary.

The purpose of the present work was to perform a review of the evidence related to the risk factors for the etiology, the clinical presentation, the management and the treatment of CAP in elderly patients with the aim of elaborating a series of specific recommendations based on critical analysis of the literature.

This document is the fruit of the collaboration of different specialists representing the Spanish Society of Emergency Medicine and Emergency Care (SEMES), the Spanish Society of Geriatrics and Gerontology (SEGG), the Spanish Society of Chemotherapy (SEQ), the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) and the Spanish Society of Home Hospitalization (SEHAD).

PDF

http://seq.es/seq/0214-3429/27/1/gonzalez.pdf

May 25, 2015 at 7:32 pm

Acute bacterial skin infections: developments since the 2005 Infectious Diseases Society of America (IDSA) guidelines.

J Emerg Med. 2013 Jun;44(6):e397-412.

Moran GJ1, Abrahamian FM, Lovecchio F, Talan DA.

1Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA.

Abstract

BACKGROUND:

Patients with acute bacterial skin and skin structure infections (ABSSSI) commonly present to Emergency Departments (EDs) where physicians encounter a wide spectrum of disease severity. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has increased in the past decade, and CA-MRSA is now a predominant cause of purulent ABSSSI in the United States (US).

OBJECTIVES:

This article reviews significant developments since the most recent Infectious Diseases Society of America (IDSA) guidelines for the management of ABSSSI in the CA-MRSA era, focusing on recent studies and recommendations for managing CA-MRSA, newer antimicrobials with improved MRSA activity, new diagnostic technologies, and options for outpatient parenteral antimicrobial therapy (OPAT).

DISCUSSION:

The increasing prevalence of CA-MRSA has led the IDSA and other organizations to recommend empiric coverage of CA-MRSA for purulent ABSSSI. The availability of rapid MRSA detection assays from skin and soft tissue swabs could potentially facilitate earlier selection of targeted antimicrobial therapy. Several newer intravenous antibiotics with expanded MRSA coverage, including ceftaroline fosamil, daptomycin, linezolid, and telavancin, may be utilized for treatment of ABSSSI. OPAT may be an option for intravenous administration of antibiotics in selected patients and may prevent or shorten hospitalizations, decrease readmission rates, and reduce nosocomial infections and complications.

CONCLUSION:

The growing prevalence of CA-MRSA associated with ABSSSI in the US has a significant impact on clinical management decisions in the ED. Recent availability of new diagnostic testing and therapeutic options may help meet the demand for effective antistaphylococcal agents.

PDF

http://www.jem-journal.com/article/S0736-4679(12)01574-0/pdf

May 25, 2015 at 4:13 pm

Benefits of WSES guidelines application for the management of intra-abdominal infections

World J of Emerg Surg 2015

Belinda De Simone1*, Federico Coccolini2 , Fausto Catena1, Massimo Sartelli3, Salomone Di Saverio4,

Rodolfo Catena5, Antonio Tarasconi6 and Luca Ansaloni2

1 Department of Emergency and Trauma Surgery, University Hospital of Parma, Via Gramsci 11, 43100 Parma, Italy

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411795/pdf/13017_2015_Article_13.pdf

May 24, 2015 at 5:34 pm

Management of community-acquired pneumonia in older adults.

Ther Adv Infect Dis. 2014 Feb;2(1):3-16.

Simonetti AF1, Viasus D2, Garcia-Vidal C2, Carratalà J3.

1Department of Infectious Diseases, Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain.

2Department of Infectious Diseases, Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain and Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain.

3Department of Infectious Diseases, Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Feixa Llarga s/n, 08907, L’Hospitalet de Llobregat, Barcelona, Spain.

Abstract

Community-acquired pneumonia (CAP) is an increasing problem among the elderly.

Multiple factors related to ageing, such as comorbidities, nutritional status and swallowing dysfunction have been implicated in the increased incidence of CAP in the older population. Moreover, mortality in patients with CAP rises dramatically with increasing age.

Streptococcus pneumoniae is still the most common pathogen among the elderly, although CAP may also be caused by drug-resistant microorganisms and aspiration pneumonia. Furthermore, in the elderly CAP has a different clinical presentation, often lacking the typical acute symptoms observed in younger adults, due to the lower local and systemic inflammatory response.

Several independent prognostic factors for mortality in the elderly have been identified, including factors related to pneumonia severity, inadequate response to infection, and low functional status. CAP scores and biomarkers have lower prognostic value in the elderly, and so there is a need to find new scales or to set new cut-off points for current scores in this population.

Adherence to the current guidelines for CAP has a significant beneficial impact on clinical outcomes in elderly patients. Particular attention should also be paid to nutritional status, fluid administration, functional status, and comorbidity stabilizing therapy in this group of frail patients.

This article presents an up-to-date review of the main aspects of CAP in elderly patients, including epidemiology, causative organisms, clinical features, and prognosis, and assesses key points for best practices for the management of the disease.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4072047/pdf/10.1177_2049936113518041.pdf

May 24, 2015 at 12:49 pm

Management of severe community-acquired pneumonia in Brazil: a secondary analysis of an international survey.

Rev Bras Ter Intensiva. 2015 Jan-Mar;27(1):57-63.

Rabello L1, Conceição C2, Ebecken K1, Lisboa T3, Bozza FA1, Soares M1, Póvoa P2, Salluh JI1.

1Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brasil.

2Unidade Polivalente de Terapia Intensiva, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, CEDOC, Faculdade Médica NOVA, Nova Universidade de Lisboa, Lisboa, Portugal.

3Unidade de Terapia Intensiva e Comitê de Controle de Infecção, Hospital das Clínicas, Programa de Pós-Graduação em Pneumologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.

Abstract

OBJECTIVE:

This study aimed to evaluate Brazilian physicians’ perceptions regarding the diagnosis, severity assessment, treatment and risk stratification of severe community-acquired pneumonia patients and to compare those perceptions to current guidelines.

METHODS:

We conducted a cross-sectional international anonymous survey among a convenience sample of critical care, pulmonary, emergency and internal medicine physicians from Brazil between October and December 2008. The electronic survey evaluated physicians’ attitudes towards the diagnosis, risk assessment and therapeutic interventions for patients with severe community-acquired pneumonia.

RESULTS:

A total of 253 physicians responded to the survey, with 66% from Southeast Brazil. The majority (60%) of the responding physicians had > 10 years of medical experience. The risk assessment of severe community-acquired pneumonia was very heterogeneous, with clinical evaluation as the most frequent approach. Although blood cultures were recognized as exhibiting a poor diagnostic performance, these cultures were performed by 75% of respondents. In contrast, the presence of urinary pneumococcal and Legionella antigens was evaluated by less than 1/3 of physicians. The vast majority of physicians (95%) prescribe antibiotics according to a guideline, with the combination of a 3rd/4th generation cephalosporin plus a macrolide as the most frequent choice.

CONCLUSION:

This Brazilian survey identified an important gap between guidelines and clinical practice and recommends the institution of educational programs that implement evidence-based strategies for the management of severe community-acquired pneumonia.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396898/pdf/rbti-27-01-0057.pdf

May 24, 2015 at 12:46 pm

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