Posts filed under ‘GUIDELINES’
Infective Endocarditis in Adults – Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association.
Circulation. 2015 Sep 15.
Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O’Gara P, Taubert KA.
Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today’s myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances.
METHODS AND RESULTS:
This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidenced-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations.
Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.
Gastrointest Endosc. MAR 2014 V.79 N.3 P.363-72. .
ASGE Ensuring Safety in the Gastrointestinal Endoscopy Unit Task Force, Calderwood AH, Chapman FJ, Cohen J, Cohen LB, Collins J, Day LW, Early DS.
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. firstname.lastname@example.org
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.
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.
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.
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.
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.