Not for patients with immunosuppression.
|
|
- Jasper Briggs
- 5 years ago
- Views:
Transcription
1
2 CID Sept 2016 (previous 2005). Littérature: jusque nov experts dont un Espagnol ( J Carratalà), un Allemand (S Ewig) et un Australien (JA Roberts). ATS/IDSA/SHEA/SCCM 25 items; 50 pages Sept 2017 (previous 2009). Littérature: jusque Sept experts dont 3 Américains: Michael S. Niederman, Marin Kollef and Richard Wunderink. ERS/ESICM/ESCMID/ALAT 7 items; 26 pages
3 CID Sept 2016 (previous 2005). Littérature: jusque nov experts dont un Espagnol ( J Carratalà), un Allemand (S Ewig) et un Australien (JA Roberts). ATS/IDSA/SHEA/SCCM 25 items; 50 pages Méthodologie: GRADE + PICO Sept 2017 (previous 2009). Littérature: jusque Sept experts dont 3 Américains: Michael S. Niederman, Marin Kollef and Richard Wunderink. ERS/ESICM/ESCMID/ALAT 7 items; 26 pages Méthodologie: GRADE + PICO Not for patients with immunosuppression.
4 USA: The major differences between this guideline and the 2005 version: 1. méthodologie GRADE/PICO 2. Disparition du concept HCAP Europe: not covered. There is increasing evidence from a growing number of studies that many patients defined as having HCAP are not at high risk for MDR pathogens.
5 USA: The major differences between this guideline and the 2005 version: 3. each hospital generate antibiograms to guide healthcare professionals with respect to the optimal choice of antibiotics: to decrease the unnecessary use of dual gram-negative and empiric methicillin-resistant Staphylococcus aureus (MRSA) antibiotic treatment. 4. short-course antibiotic therapy for most patients with HAP or VAP independent of microbial etiology. 5. antibiotic de-escalation.
6 the definitions of HAP and VAP, same as delineated in the 2005 guidelines: new lung infiltrate plus clinical evidence that the infiltrate is of an infectious origin, which include the new onset of fever, purulent sputum, leukocytosis, and decline in oxygenation. HAP is defined as a pneumonia not incubating at the time of hospital admission and occurring 48 hours or more after admission. VAP is defined as a pneumonia occurring >48 hours after endotracheal intubation. In fact, the concept of early vs late VAP should be based on hospital admission as the starting point, rather than intubation.
7 For VAP: colonization patterns in the upper and lower airways changed within the first 3 4 days from a communitylike to a typical nosocomial pattern. Others found that the threshold may also be extended to 7 days (Chastre et Trouillet 1998). the presence of risk factors for MDR should take precedence over the distinction between early- and late-onset pneumonia. With regard to the early vs late pneumonia concept, no data are available for HAP.
8 Most studies analyzed risk factors for MRSA colonization. patients with cystic fibrosis and bronchiectasis potential other risk factors, the published evidence is scarce and of low quality. FR pour MRSA ou Pseudomonas spécifique pour VAP ou HAP: voir + loin.
9 Early-onset HAP and VAP, defined as occurring within the first 4 days of hospitalization. Late-onset HAP and VAP ( 5 days of hospitalisation).
10 Diagnostic: VAP: Cultures of respiratory secretions would be obtained from all patients with suspected VAP before starting/changing ATB. HAP: We suggest noninvasive sampling with semiquantitative cultures to diagnose VAP (weak recommendation, lowquality evidence). Respiratory samples obtained noninvasively.
11 We recommend obtaining a lower respiratory tract sample (distal quantitative or proximal quantitative or qualitative culture) to focus and narrow the initial empiric antibiotic therapy. (Strong recommendation, low quality of evidence.) We suggest obtaining distal quantitative samples (prior to any antibiotic treatment) in order to reduce antibiotic exposure in stable patients with suspected VAP and to improve the accuracy of the results. (Weak recommendation, low quality of evidence.)
12 USA: The panel recognizes that invasive quantitative cultures will occasionally be performed by some clinicians. For patients with suspected VAP whose invasive quantitative culture results are below the diagnostic threshold for VAP, we suggest that antibiotics be withheld rather than continued (weak recommendation, very low quality evidence).
13 Remarks: Clinical factors should also be considered because they may alter the decision of whether to withhold or continue antibiotics. These include: the likelihood of an alternative source of infection, prior antimicrobial therapy at the time of culture, degree of clinical suspicion, signs of severe sepsis, and evidence of clinical improvement. Justifier dans dossier son attitude. Quid si AET < 10 5 CFU/mL? Stop?
14 approximately 15% of patients with VAP are bacteremic. at least 25% of positive blood cultures in suspected VAP patients are from a nonpulmonary source. blood culture results may provide further guidance for both antibiotic treatment and treatment de-escalation for HAP and VAP.
15 THE USE OF BIOMARKERS AND THE CLINICAL PULMONARY INFECTION SCORE TO DIAGNOSE VAP AND HAP: Clinical criteria alone Pas PCT serum PCT plus clinical criteria can diagnose HAP/VAP with a sensitivity and specificity of 67% and 83%, respectively: FN: 33% FP: 17%» Unnecessary ATB» Efforts to find the correct diagnosis may cease. Pas CRP
16 THE USE OF BIOMARKERS AND THE CLINICAL PULMONARY INFECTION SCORE TO DIAGNOSE VAP AND HAP: Clinical criteria alone Pas PCT serum PCT plus clinical criteria can diagnose HAP/VAP with a sensitivity and specificity of 67% and 83%, respectively: FN: 33% FP: 17%» Unnecessary ATB PCT: pas pour suivi ni pour stop si basé sur 7j de traitement. - USA et Europe.» Efforts to find the correct diagnosis may cease. Pas CRP
17 THE USE OF BIOMARKERS AND THE CLINICAL PULMONARY INFECTION SCORE TO DIAGNOSE VAP AND HAP: Clinical criteria alone Pas CPIS modifié Sensibilité 65% Spécificité 64% FN 35% FP 36%
18 VAT: Traitement: fever with no other recognizable cause, with new or increased sputum production, positive ETA culture (>10 6 CFU/mL) yielding a new bacteria, and no radiographic evidence of nosocomial pneumonia In patients with VAT, we suggest not providing antibiotic therapy (weak recommendation, lowquality evidence).
19 Traitement: VAT: fever with no other recognizable cause, with new or increased sputum production, positive ETA culture (>10 6 CFU/mL) yielding a new bacteria, and no radiographic evidence of nosocomial pneumonia In patients with VAT, we suggest not providing antibiotic therapy (weak recommendation, low-quality evidence). in conjunction with new systemic signs of infection plus worsening oxygenation and/or increasing ventilator settings, antibiotic treatment may be considered even in the absence of new or progressive persistent infiltrates on portable chest radiographs; the rationale for that is because of the high likelihood of a new VAP.
20 VAP: Traitement empirique: 1. We recommend that all hospitals regularly generate and disseminate a local antibiogram, ideally one that is specific to their intensive care population(s) if possible. 2. We recommend that empiric treatment regimens be informed by the local distribution of pathogens associated with VAP and their antimicrobial susceptibilities (or failing that, specific for ICU patients).
21 In patients with suspected VAP, we recommend including coverage for S. aureus, P. aeruginosa, and other gram negative bacilli in all empiric regimens (strong recommendation, low-quality evidence). VAP in the United States are S. aureus (approximately 20% 30% of isolates), P. aeruginosa (approximately 10% 20% of isolates), enteric gram-negative bacilli (approximately 20% 40% of isolates), and Acinetobacter baumannii (approximately 5% 10% of isolates)
22 CHU: VRI USI 2009 à 2014 Colonisation vs infection: 4793 bactéries Enterobactéries: 54,7% E coli: 17,3% Klebs spp: 18,6% Enterobacter spp: 18,1% H influenzae: 14,3% Non fermentants: 26,3% Pyo: 69% 18,2% du total Gram + : 19% St aureus: 75% 14,2% du total 23% = MRSA Pneumo: 21,4% MRSA AET USI 2016 et 2017: 20 et 25% LBA + St aureus: 4 en 2 ans: 100% MSSA
23 We suggest including an agent active against MRSA for the empiric treatment of suspected VAP only in patients with any of the following: a risk factor for antimicrobial resistance (Table 2), patients being treated in units where >10% 20% of S. aureus isolates are methicillin resistant, and patients in units where the prevalence of MRSA is not known. (weak recommendation, very low-quality evidence). MRSA: we recommend either vancomycin or linezolid. MSSA: piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. Target: 95% empiric is active. CHU
24 We suggest prescribing 2 antipseudomonal antibiotics from different classes for the empiric treatment of suspected VAP only in patients with any of the following: a risk factor for antimicrobial resistance (Table 2), patients in units where >10% of gram-negative isolates are resistant to an agent being considered for monotherapy, and patients in an ICU where local antimicrobial susceptibility rates are not available (weak recommendation, low-quality evidence). CHU Target: 95% empiric is active.
25
26
27
28 The rationale for including 2 gram-negative agents in empiric regimens is to increase the probability that at least one agent will be active against the patient s pathogen. The generally recommended compromise is to pair early and aggressive treatment with early and aggressive de-escalation.
29 We suggest using narrow-spectrum antibiotics (ertapenem, ceftriaxone, cefotaxime, moxifloxacin or levofloxacin) in patients with suspected low risk of resistance and early-onset HAP/VAP. (Weak recommendation, very low quality of evidence.) low risk patients: without septic shock, with no other risk factors for MDR pathogens and those who are not in hospitals with a high background rate of resistant pathogens. A prevalence of resistant pathogens in local microbiological data >25% is considered a high background rate (the rate of resistance in the ICU caring for the patient (not the hospital as a whole) is the relevant factor to consider).
30 We suggest using narrow-spectrum antibiotics (ertapenem, ceftriaxone, cefotaxime, moxifloxacin or levofloxacin) in patients with suspected low risk of resistance and earlyonset HAP/VAP. (Weak recommendation, very low quality of evidence.) low risk patients: without septic shock, with no other risk factors for MDR pathogens and those who are not in hospitals with a high background rate of resistant pathogens. A prevalence of resistant pathogens in local microbiological data >25% is considered a high background rate (the rate of resistance in the ICU caring for the patient (not the hospital as a whole) is the relevant factor to consider). - The percentage of potentially MDR pathogens is significant even in early-onset HAP/VAP. - At the present time, the number of patients with early-onset HAP who can safely receive empiric narrow-spectrum therapy is limited.
31 We recommend initial empiric combination therapy for high-risk HAP/VAP patients to cover Gram-negative bacteria and include antibiotic coverage for MRSA in those patients at risk. (Strong recommendation, moderate quality of evidence.) high-risk HAP/VAP : patients with septic shock and/or the following risk factors for potentially resistant microorganisms: hospital settings with high rates of MDR pathogens (i.e. a pathogen not susceptible to at least one agent from three or more classes of antibiotics): a prevalence of resistant pathogens in local microbiological data >25% represents a high-risk situation (including Gram-negative bacteria and MRSA). previous antibiotic use, recent prolonged hospital stay (>5 days of hospitalisation) and previous colonisation with MDR pathogens. consider selected patients at high risk for MDR pathogens for initial empiric monotherapy, if there is a single-antibiotic therapy that is effective against >90% of Gram-negative bacteria according to the local antibiogram.
32 Empiric antibiotic treatment algorithm for hospital-acquired pneumonia (HAP)/ventilatorassociated pneumonia (VAP). Antoni Torres et al. Eur Respir J 2017;50: by European Respiratory Society
33 Traitement empirique HAP: We recommend that all hospitals regularly generate and disseminate a local antibiogram, ideally one that is tailored to their HAP population, if possible. 2. We recommend that empiric antibiotic regimens be based upon the local distribution of pathogens associated with HAP and their antimicrobial susceptibilities. Pas disponible au CHU
34 24 études analysées: Non fermentants: 19% Enterobactéries: 16% St aureus: 16 % (10 % MRSA) Pas de différence précoce vs tardive.
35
36 Traitement adapté: Aérosols: Que amino ou coli si souche que S à une molécule (faire IV + aérosol). Pseudomonas: bithérapie poursuivie que si choc (stop quand choc OK) Haut risque de mortalité (> 25%) ESBL: selon ATBgramme (pas carba exclusif) Acineto: carba ou ampi/sulbactam Pas ajouter rif Pas tige
37 If initial combination therapy is started, we suggest continuing with a single agent based on culture results. Only consider maintaining definitive combination treatment based on sensitivities in patients with: extensively drug-resistant (XDR; i.e. susceptible to only one or two classes of antibiotics)/pan-drug-resistant (PDR; i.e. not susceptible to any antibiotics) nonfermenting Gram-negative bacteria and carbapenem-resistant Enterobacteriaceae (CRE) isolates. (Weak recommendation, low quality of evidence.)
38 Durée de traitement: For patients with VAP, we recommend a 7-day course of antimicrobial therapy rather than a longer duration (strong recommendation, moderate-quality evidence). For patients with HAP, we recommend a 7- day course of antimicrobial therapy (strong recommendation, very lowquality evidence)
39 We suggest using a 7 8-day course of antibiotic therapy in patients with VAP without: immunodeficiency, cystic fibrosis, empyema, lung abscess, cavitation or necrotising pneumonia and with a good clinical response to therapy.
40 Désescalade: For patients with HAP/VAP, we suggest that antibiotic therapy be de-escalated rather than fixed: De-escalation refers to changing an empiric broadspectrum antibiotic regimen to a narrower antibiotic regimen by changing the antimicrobial agent or changing from combination therapy to monotherapy.
41 Prévention VAP A: pas de détails E : SOD si résistances < 5% et si consommation antibiotiques < 1000 DDD/1000 JH attention à la chlorhexidine
42
43 Chlorhexidinevscontrol BMJ 2014 Price R et al
44 Roquilly et al CID 2015
4/3/2017 CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA DISCLOSURE LEARNING OBJECTIVES
CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA BILLIE BARTEL, PHARMD, BCCCP APRIL 7 TH, 2017 DISCLOSURE I have had no financial relationship over the past 12 months with any commercial
More informationManagement of Hospital-acquired Pneumonia
Management of Hospital-acquired Pneumonia Adel Alothman, MB, FRCPC, FACP Asst. Professor, COM, KSAU-HS Head, Infectious Diseases, Department of Medicine King Abdulaziz Medical City Riyadh Saudi Arabia
More informationSHC Clinical Pathway: HAP/VAP Flowchart
SHC Clinical Pathway: Hospital-Acquired and Ventilator-Associated Pneumonia SHC Clinical Pathway: HAP/VAP Flowchart v.08-29-2017 Diagnosis Hospitalization (HAP) Pneumonia develops 48 hours following: Endotracheal
More informationManagement of hospital-acquired pneumonia and ventilator-associated pneumonia: an ERS/ESICM/ESCMID/ ALAT guideline
ERS pocket guidelines Management of hospital-acquired pneumonia and ventilator-associated pneumonia: an ERS/ESICM/ESCMID/ ALAT guideline From the Task Force for the Management of Hospital-acquired Pneumonia
More informationAppropriate antimicrobial therapy in HAP: What does this mean?
Appropriate antimicrobial therapy in HAP: What does this mean? Jaehee Lee, M.D. Kyungpook National University Hospital, Korea KNUH since 1907 Presentation outline Empiric antimicrobial choice: right spectrum,
More informationUCSF guideline for management of suspected hospital-acquired or ventilatoracquired pneumonia in adult patients
Background/methods: UCSF guideline for management of suspected hospital-acquired or ventilatoracquired pneumonia in adult patients This guideline establishes evidence-based consensus standards for management
More informationNEW ATS/IDSA VAP-HAP GUIDELINES
NEW ATS/IDSA VAP-HAP GUIDELINES MARK L. METERSKY, MD PROFESSOR OF MEDICINE UNIVERSITY OF CONNECTICUT SCHOOL OF MEDICINE FARMINGTON, CT Mark Metersky, MD, FCCP, FACP is a Professor of Medicine at the University
More information2016 Updates to the Hospital Acquired- and Ventilator Associated-Pneumonia Guidelines
2016 Updates to the Hospital Acquired- and Ventilator Associated-Pneumonia Guidelines Janessa M. Smith, PharmD, BCPS Clinical Pharmacy Specialist, Infectious Diseases The Johns Hopkins Hospital Objectives
More informationClinical Infectious Diseases IDSA GUIDELINE
Clinical Infectious Clinical Diseases Infectious Diseases Advance Access published July 14, 2016 IDSA GUIDELINE Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical
More informationInternational ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia
TASK FORCE REPORT ERS/ESICM/ESCMID/ALAT GUIDELINES International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia Guidelines for the
More informationDr. Shaiful Azam Sazzad. MD Student (Thesis Part) Critical Care Medicine Dhaka Medical College
Dr. Shaiful Azam Sazzad MD Student (Thesis Part) Critical Care Medicine Dhaka Medical College INTRODUCTION ICU acquired infection account for substantial morbidity, mortality and expense. Infection and
More informationTreatment Guidelines and Outcomes of Hospital- Acquired and Ventilator-Associated Pneumonia
SUPPLEMENT ARTICLE Treatment Guidelines and Outcomes of Hospital- Acquired and Ventilator-Associated Pneumonia Antoni Torres, Miquel Ferrer, and Joan Ramón Badia Pneumology Department, Clinic Institute
More informationPRACTIC GUIDELINES for APPROPRIATE ANTIBIOTICS USE
PRACTIC GUIDELINES for APPROPRIATE ANTIBIOTICS USE Global Alliance for Infection in Surgery World Society of Emergency Surgery (WSES) and not only!! Aims - 1 Rationalize the risk of antibiotics overuse
More informationUpdate on Resistance and Epidemiology of Nosocomial Respiratory Pathogens in Asia. Po-Ren Hsueh. National Taiwan University Hospital
Update on Resistance and Epidemiology of Nosocomial Respiratory Pathogens in Asia Po-Ren Hsueh National Taiwan University Hospital Ventilator-associated Pneumonia Microbiological Report Sputum from a
More informationInt.J.Curr.Microbiol.App.Sci (2017) 6(3):
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 6 Number 3 (2017) pp. 891-895 Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2017.603.104
More information10 Golden rules of Antibiotic Stewardship in ICU. Jeroen Schouten, MD PhD intensivist, Nijmegen (Neth) Istanbul, Oct 6th 2017
10 Golden rules of Antibiotic Stewardship in ICU Jeroen Schouten, MD PhD intensivist, Nijmegen (Neth) Istanbul, Oct 6th 2017 10 golden rules of Antibiotic Stewardship in the ICU ID, Pharma & Micro advice
More informationHospital-acquired pneumonia: microbiological data and potential adequacy of antimicrobial regimens
Eur Respir J 2002; 20: 432 439 DOI: 10.1183/09031936.02.00267602 Printed in UK all rights reserved Copyright #ERS Journals Ltd 2002 European Respiratory Journal ISSN 0903-1936 Hospital-acquired pneumonia:
More informationMethicillin-Resistant Staphylococcus aureus Nasal Swabs as a Tool in Antimicrobial Stewardship
Methicillin-Resistant Staphylococcus aureus Nasal Swabs as a Tool in Antimicrobial Stewardship Natalie R. Tucker, PharmD Antimicrobial Stewardship Pharmacist Tyson E. Dietrich, PharmD PGY2 Infectious Diseases
More informationMono- versus Bitherapy for Management of HAP/VAP in the ICU
Mono- versus Bitherapy for Management of HAP/VAP in the ICU Jean Chastre, www.reamedpitie.com Conflicts of interest: Consulting or Lecture fees: Nektar-Bayer, Pfizer, Brahms, Sanofi- Aventis, Janssen-Cilag,
More informationNosocomial Pneumonia Recent Guidelines for Management
CHAPTER 37 Nosocomial Pneumonia Recent Guidelines for Management L. K. Meher Introduction Nosocomial pneumonia (NP) is the second most common nosocomial infection after urinary tract infection but is the
More informationThe International Collaborative Conference in Clinical Microbiology & Infectious Diseases
The International Collaborative Conference in Clinical Microbiology & Infectious Diseases PLUS: Antimicrobial stewardship in hospitals: Improving outcomes through better education and implementation of
More informationPIPERACILLIN- TAZOBACTAM INJECTION - SUPPLY PROBLEMS
PIPERACILLIN- TAZOBACTAM INJECTION - SUPPLY PROBLEMS The current supply of piperacillin- tazobactam should be reserved f Microbiology / Infectious Diseases approval and f neutropenic sepsis, severe sepsis
More informationDetection and Quantitation of the Etiologic Agents of Ventilator Associated Pneumonia in Endotracheal Tube Aspirates From Patients in Iran
Letter to the Editor Detection and Quantitation of the Etiologic Agents of Ventilator Associated Pneumonia in Endotracheal Tube Aspirates From Patients in Iran Mohammad Rahbar, PhD; Massoud Hajia, PhD
More informationAntimicrobial stewardship in managing septic patients
Antimicrobial stewardship in managing septic patients November 11, 2017 Samuel L. Aitken, PharmD, BCPS (AQ-ID) Clinical Pharmacy Specialist, Infectious Diseases slaitken@mdanderson.org Conflict of interest
More informationAppropriate Management of Common Pediatric Infections. Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases
Appropriate Management of Common Pediatric Infections Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases It s all about the microorganism The common pathogens Viruses
More informationOPTIMIZATION OF PK/PD OF ANTIBIOTICS FOR RESISTANT GRAM-NEGATIVE ORGANISMS
HTIDE CONFERENCE 2018 OPTIMIZATION OF PK/PD OF ANTIBIOTICS FOR RESISTANT GRAM-NEGATIVE ORGANISMS FEDERICO PEA INSTITUTE OF CLINICAL PHARMACOLOGY DEPARTMENT OF MEDICINE, UNIVERSITY OF UDINE, ITALY SANTA
More informationHospital-acquired pneumonia (HAP) is the second
Guidelines and Critical Pathways for Severe Hospital-Acquired Pneumonia* Stanley Fiel, MD, FCCP Hospital-acquired pneumonia (HAP) is associated with high morbidity and mortality. Early, appropriate, and
More information2017 Introduction to Infectious Diseases Clinical Seminar Saturday 30th September - Sunday 1st October 2017 Hotel Grand Chancellor Hobart, Tasmania
2017 Introduction to Infectious Diseases Clinical Seminar Saturday 30th September - Sunday 1st October 2017 Hotel Grand Chancellor Hobart, Tasmania Day 1: Saturday 30 th September 2017 09:00 09:20 Registration
More informationGuidelines for the Initiation of Empirical Antibiotic therapy in Respiratory Disease (Adults)
Guidelines for the Initiation of Empirical Antibiotic therapy in Respiratory Disease (Adults) Community Acquired Community Acquired 1) Is it pneumonia? ie new symptoms and signs of a lower respiratory
More informationMulti-drug resistant microorganisms
Multi-drug resistant microorganisms Arzu TOPELI Director of MICU Hacettepe University Faculty of Medicine, Ankara-Turkey Council Member of WFSICCM Deaths in the US declined by 220 per 100,000 with the
More informationCommunity Acquired Pneumonia. Epidemiology: Acute Lower Respiratory Tract Infections. Community Acquired Pneumonia (CAP) Outline
Community Acquired Pneumonia (CAP) Outline Lisa G. Winston, MD University of California, San Francisco Zuckerberg San Francisco General Epidemiology Diagnosis Microbiology Risk stratification Treatment
More informationThese recommendations were approved for use by the Pharmaceutical and Therapeutics Committee, RCWMCH on 1 February 2017.
Antibiotic regimens for suspected hospital-acquired infection (HAI) outside the Paediatric Intensive Care Unit at Red Cross War Memorial Children s Hospital (RCWMCH) Lead author: Brian Eley Contributing
More information2017 Introduction to Infectious Diseases Clinical Seminar Saturday 30th September - Sunday 1st October 2017 Hotel Grand Chancellor Hobart, Tasmania
2017 Introduction to Infectious Diseases Clinical Seminar Saturday 30th September - Sunday 1st October 2017 Hotel Grand Chancellor Hobart, Tasmania Day 1: Saturday 30 th September 2017 Time Topic/Activity
More informationESISTONO LE HCAP? Francesco Blasi. Sezione Medicina Respiratoria Dipartimento Toraco Polmonare e Cardiocircolatorio Università degli Studi di Milano
ESISTONO LE HCAP? Francesco Blasi Sezione Medicina Respiratoria Dipartimento Toraco Polmonare e Cardiocircolatorio Università degli Studi di Milano Community-acquired pneumonia (CAP): Management issues
More informationUnderstanding the Hospital Antibiogram
Understanding the Hospital Antibiogram Sharon Erdman, PharmD Clinical Professor Purdue University College of Pharmacy Infectious Diseases Clinical Pharmacist Eskenazi Health 5 Understanding the Hospital
More informationSuggestions for appropriate agents to include in routine antimicrobial susceptibility testing
Suggestions for appropriate agents to include in routine antimicrobial susceptibility testing These suggestions are intended to indicate minimum sets of agents to test routinely in a diagnostic laboratory
More informationInteractive session: adapting to antibiogram. Thong Phe Heng Vengchhun Felix Leclerc Erika Vlieghe
Interactive session: adapting to antibiogram Thong Phe Heng Vengchhun Felix Leclerc Erika Vlieghe Case 1 63 y old woman Dx: urosepsis? After 2 d: intermediate result: Gram-negative bacilli Empiric antibiotic
More informationNorthwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16
Northwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16 These criteria are based on national and local susceptibility data as well as Infectious Disease Society of America
More informationBacterial infections complicating cirrhosis
PHC www.aphc.info Bacterial infections complicating cirrhosis P. Angeli, Dept. of Medicine, Unit of Internal Medicine and Hepatology (), University of Padova (Italy) pangeli@unipd.it Agenda Epidemiology
More informationMisericordia Community Hospital (MCH) Antimicrobial Stewardship Report. July December 2013 Second and Third Quarters 2014
H e a l i n g t h e B o d y E n r i c h i n g t h e M i n d N u r t u r i n g t h e S o u l Misericordia Community Hospital (MCH) Antimicrobial Stewardship Report July December 213 Second and Third Quarters
More informationWhat is pneumonia? Infection of the lung parenchyma Causative agents include bacteria, viruses, fungi, protozoa.
Pneumonia What is pneumonia? Infection of the lung parenchyma Causative agents include bacteria, viruses, fungi, protozoa www.netmedicine.com/xray/xr.htm Definition acute infectious disease, etiology usually
More informationNosocomial Infections: What Are the Unmet Needs
Nosocomial Infections: What Are the Unmet Needs Jean Chastre, MD Service de Réanimation Médicale Hôpital Pitié-Salpêtrière, AP-HP, Université Pierre et Marie Curie, Paris 6, France www.reamedpitie.com
More informationGuidelines for the Initiation of Empirical Antibiotic therapy in Respiratory Disease (Adults)
Guidelines for the Initiation of Empirical Antibiotic therapy in Respiratory Disease (Adults) Community Acquired Pneumonia Community Acquired Pneumonia 1) Is it pneumonia? ie new symptoms and signs of
More informationSuccessful stewardship in hospital settings
Successful stewardship in hospital settings Pr Charles-Edouard Luyt Service de Réanimation Institut de Cardiologie Groupe Hospitalier Pitié-Salpêtrière Université Pierre et Marie Curie, Paris 6 www.reamedpitie.com
More informationConcise Antibiogram Toolkit Background
Background This toolkit is designed to guide nursing homes in creating their own antibiograms, an important tool for guiding empiric antimicrobial therapy. Information about antibiograms and instructions
More informationHealthcare-Associated Pneumonia in the Emergency Department
Healthcare-Associated Pneumonia in the Emergency Department Ellen M. Slaven, M.D., 1 Jairo I. Santanilla, M.D., 1,2 and Peter M. DeBlieux, M.D. 1 ABSTRACT Emergency medicine clinicians frequently diagnose
More informationLearning Points. Raymond Blum, M.D. Antimicrobial resistance among gram-negative pathogens is increasing
Raymond Blum, M.D. Learning Points Antimicrobial resistance among gram-negative pathogens is increasing Infection with antimicrobial-resistant pathogens is associated with increased mortality, length of
More informationHospital ID: 831. Bourguiba Hospital. Tertiary hospital
Global Point Prevalence Survey of Antimicrobial Consumption and Resistance in hospitals worldwide Hospital ID: 831 Habib Bourguiba Hospital Tertiary hospital Tunisia Point Prevalence Survey Habib 2017
More informationRecommendations for Implementation of Antimicrobial Stewardship Restrictive Interventions in Acute Hospitals in Ireland
Recommendations for Implementation of Antimicrobial Stewardship Restrictive Interventions in Acute Hospitals in Ireland A report by the Hospital Antimicrobial Stewardship Working Group, a subgroup of the
More informationNational Clinical Guideline Centre Pneumonia Diagnosis and management of community- and hospital-acquired pneumonia in adults
National Clinical Guideline Centre Antibiotic classifications Pneumonia Diagnosis and management of community- and hospital-acquired pneumonia in adults Clinical guideline 191 Appendix N 3 December 2014
More informationInfectious Disease 101: Helping the Consultant Pharmacist with Stewardship Principles
Infectious Disease 101: Helping the Consultant Pharmacist with Stewardship Principles Conflicts of Interest None at this time May be discussing off-label indications KALIN M. CLIFFORD, PHARM.D., BCPS,
More informationAntibiotic treatment in the ICU 1. ICU Fellowship Training Radboudumc
Antibiotic treatment in the ICU 1 ICU Fellowship Training Radboudumc Main issues Delayed identification of microorganisms Impact of critical illness on Pk/Pd High prevalence of antibiotic resistant strains
More informationAntimicrobial de-escalation in the ICU
Antimicrobial de-escalation in the ICU A FOCUS ON EVIDENCE-BASED STRATEGIES Dave Leedahl, PharmD, BCPS-AQ ID, BCCCP Pharmacy Clinical Manager Sanford Health Fargo, ND, USA I have no conflicts of interest
More informationEvaluating the Role of MRSA Nasal Swabs
Evaluating the Role of MRSA Nasal Swabs Josh Arnold, PharmD PGY1 Pharmacy Resident Pharmacy Grand Rounds February 28, 2017 2016 MFMER slide-1 Objectives Identify the pathophysiology of MRSA nasal colonization
More informationBest Practices: Goals of Antimicrobial Stewardship
Best Practices: Goals of Antimicrobial Stewardship Gail Scully, M.D, M.P.H. and Elizabeth Radigan, PharmD, BCPS UMass Memorial Medical Center Division of Infectious Disease Department of Medicine September
More informationGENERAL NOTES: 2016 site of infection type of organism location of the patient
GENERAL NOTES: This is a summary of the antibiotic sensitivity profile of clinical isolates recovered at AIIMS Bhopal Hospital during the year 2016. However, for organisms in which < 30 isolates were recovered
More informationFelipe N. Gutierrez MD, MPH Chief, Infectious Diseases Phoenix VA Healthcare
Felipe N. Gutierrez MD, MPH Chief, Infectious Diseases Phoenix VA Healthcare 100% of all wounds will yield growth If you get a negative culture you something is wrong! Pseudomonas while ubiquitous does
More informationTrea%ng Sepsis in 2016 Are the Big Guns Losing the War?
Trea%ng Sepsis in 2016 Are the Big Guns Losing the War? ERIC HODGSON FCA (Crit Care) Inkosi Albert Luthuli Central Hospital & NELSON R MANDELA SCHOOL OF MEDICINE DURBAN, KZN Declaration Advisory boards
More information1/30/ Division of Disease Control and Health Protection. Division of Disease Control and Health Protection
Surveillance, Outbreaks, and Reportable Diseases, Oh My! Assisted Living Facility, Nursing Home and Surveyor Infection Prevention Training February 2015 A.C. Burke, MA, CIC Health Care-Associated Infection
More informationCAUSATIVE AGENTS AND RESISTANCE AMONG HOSPITAL-ACQUIRED AND VENTILATOR-ASSOCIATED PNEUMONIA PATIENTS AT SRINAGARIND HOSPITAL, NORTHEASTERN THAILAND
CAUSATIVE AGENTS AND RESISTANCE AMONG HOSPITAL-ACQUIRED AND VENTILATOR-ASSOCIATED PNEUMONIA PATIENTS AT SRINAGARIND HOSPITAL, NORTHEASTERN THAILAND Wipa Reechaipichitkul 1, Saisamon Phondongnok 2, Janpen
More informationORIGINAL ARTICLES. Appropriate Use of the Carbapenems. 1. Introduction. 2. Ertapenem (group 1) 2.1 Appropriate use POSITION STATEMENT
POSITION STATEMENT Appropriate Use of the Carbapenems AJBrink, C Feldman, D C Grolman, D Muckart, J Pretorius, G A Richards, M Senekal, W Sieling The carbapenems are a group of broad-spectrum betalactam
More informationIDSA GUIDELINES COMMUNITY ACQUIRED PNEUMONIA
page 1 / 5 page 2 / 5 idsa guidelines community acquired pdf IDSA/ATS Guidelines for CAP in Adults CID 2007:44 (Suppl 2) S29 such as blood and sputum cultures. Conversely, these cultures may have a major
More informationNew Drugs for Bad Bugs- Statewide Antibiogram
New Drugs for Bad Bugs- Statewide Antibiogram Felicia Matthews, Pharm.D., BCPS Senior Consultant, Pharmacy Specialty BE MedMined Services Disclosures Employee of BD Corporation MedMined Services Agenda
More informationInfection Prevention Highlights for the Medical Staff. Pamela Rohrbach MSN, RN, CIC Director of Infection Prevention
Highlights for the Medical Staff Pamela Rohrbach MSN, RN, CIC Director of Infection Prevention Standard Precautions every patient every time a. Hand Hygiene b. Use of Personal Protective Equipment (PPE)
More informationMeasure Information Form
Release Notes: Measure Information Form Version 3.0b **NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE** Measure Set: Pneumonia (PN) Performance Measure Identifier: Measure Information Form
More informationAntimicrobial Susceptibility Patterns
Antimicrobial Susceptibility Patterns KNH SURGERY Department Masika M.M. Department of Medical Microbiology, UoN Medicines & Therapeutics Committee, KNH Outline Methodology Overall KNH data Surgery department
More informationIntrinsic, implied and default resistance
Appendix A Intrinsic, implied and default resistance Magiorakos et al. [1] and CLSI [2] are our primary sources of information on intrinsic resistance. Sanford et al. [3] and Gilbert et al. [4] have been
More informationAntimicrobial Stewardship: The Premier Health Experience
Antimicrobial Stewardship: The Premier Health Experience Steve Burdette, MD, FIDSA Professor of Medicine Wright State University Boonshoft School of Medicine Director of Antimicrobial Stewardship Miami
More informationAntimicrobial Stewardship Strategy: Antibiograms
Antimicrobial Stewardship Strategy: Antibiograms A summary of the cumulative susceptibility of bacterial isolates to formulary antibiotics in a given institution or region. Its main functions are to guide
More informationSepsis is the most common cause of death in
ADDRESSING ANTIMICROBIAL RESISTANCE IN THE INTENSIVE CARE UNIT * John P. Quinn, MD ABSTRACT Two of the more common strategies for optimizing antimicrobial therapy in the intensive care unit (ICU) are antibiotic
More informationPneumonia Antibiotic Guidance for Adults PAGL Inclusion Approved at January 2017 PGC
Pneumonia Antibiotic Guidance for Adults PAGL Inclusion Approved at January 2017 PGC APPROVED BY: Policy and Guidelines Committee TRUST REFERENCE: B9/2009 AWP Ref: AWP61 Date (approved): July 2008 REVIEW
More informationGeneral Surgery Small Group Activity (Facilitator Notes) Curriculum for Antimicrobial Stewardship
General Surgery Small Group Activity (Facilitator Notes) Curriculum for Antimicrobial Stewardship Facilitator instructions: Read through the facilitator notes and make note of discussion points for each
More informationAntibiotic Resistance. Antibiotic Resistance: A Growing Concern. Antibiotic resistance is not new 3/21/2011
Antibiotic Resistance Antibiotic Resistance: A Growing Concern Judy Ptak RN MSN Infection Prevention Practitioner Dartmouth-Hitchcock Medical Center Lebanon, NH Occurs when a microorganism fails to respond
More informationMeropenem for all? Midge Asogan ICU Fellow (also ID AT)
Meropenem for all? Midge Asogan ICU Fellow (also ID AT) Infections Common reason for presentation to ICU Community acquired - vs nosocomial - new infection acquired within hospital environment Treatment
More informationAntibiotic usage in nosocomial infections in hospitals. Dr. Birgit Ross Hospital Hygiene University Hospital Essen
Antibiotic usage in nosocomial infections in hospitals Dr. Birgit Ross Hospital Hygiene University Hospital Essen Infection control in healthcare settings - Isolation - Hand Hygiene - Environmental Hygiene
More informationPrinciples of Infectious Disease. Dr. Ezra Levy CSUHS PA Program
Principles of Infectious Disease Dr. Ezra Levy CSUHS PA Program I. Microbiology (1) morphology (e.g., cocci, bacilli) (2) growth characteristics (e.g., aerobic vs anaerobic) (3) other qualities (e.g.,
More informationFighting MDR Pathogens in the ICU
Fighting MDR Pathogens in the ICU Dr. Murat Akova Hacettepe University School of Medicine, Department of Infectious Diseases, Ankara, Turkey 1 50.000 deaths each year in US and Europe due to antimicrobial
More informationDifferences in distribution and drug sensitivity of pathogens in lower respiratory tract infections between general wards and RICU
Original Article Differences in distribution and drug sensitivity of pathogens in lower respiratory tract infections between general wards and RICU Ruoxi He, Bailing Luo, Chengping Hu, Ying Li, Ruichao
More informationMultidrug-Resistant Organisms: How Do We Define them? How do We Stop Them?
Multidrug-Resistant Organisms: How Do We Define them? How do We Stop Them? Roberta B. Carey, PhD Centers for Disease Control and Prevention Division of Healthcare Quality Promotion Why worry? MDROs Clinical
More informationIntermediate risk of multidrug-resistant organisms in patients who admitted intensive care unit with healthcare-associated pneumonia
ORIGINAL ARTICLE Korean J Intern Med 2016;31:525-534 Intermediate risk of multidrug-resistant organisms in patients who admitted intensive care unit with healthcare-associated pneumonia Hongyeul Lee, Ji
More information2015 Antibiogram. Red Deer Regional Hospital. Central Zone. Alberta Health Services
2015 Antibiogram Red Deer Regional Hospital Central Zone Alberta Health Services Introduction. This antibiogram is a cumulative report of the antimicrobial susceptibility rates of common microbial pathogens
More informationAvailable online at ISSN No:
Available online at www.ijmrhs.com ISSN No: 2319-5886 International Journal of Medical Research & Health Sciences, 2017, 6(4): 36-42 Comparative Evaluation of In-Vitro Doripenem Susceptibility with Other
More informationGUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS
Version 3.1 GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS Date ratified June 2008 Updated March 2009 Review date June 2010 Ratified by Authors Consultation Evidence base Changes
More informationAntimicrobial Stewardship Program: Local Experience
Antimicrobial Stewardship Program: Local Experience Dr. WU Tak Chiu Associate Consultant Division of Infectious Diseases Department of Medicine Queen Elizabeth Hospital 18th January 2011 QUEEN ELIZABETH
More information2010 ANTIBIOGRAM. University of Alberta Hospital and the Stollery Children s Hospital
2010 ANTIBIOGRAM University of Alberta Hospital and the Stollery Children s Hospital Medical Microbiology Department of Laboratory Medicine and Pathology Table of Contents Page Introduction..... 2 Antibiogram
More informationAntimicrobial Stewardship
Antimicrobial Stewardship Report: 11 th August 2016 Issue: As part of ensuring compliance with the National Safety and Quality Health Service Standards (NSQHS), Yea & District Memorial Hospital is required
More informationPneumonia. Community Acquired Pneumonia (CAP): definition. At least 2 new symptoms
Pneumonia Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital Community Acquired Pneumonia (CAP): definition At least 2 new symptoms Fever or hypothermia Cough Rigors
More informationHospital Acquired Infections in the Era of Antimicrobial Resistance
Hospital Acquired Infections in the Era of Antimicrobial Resistance Datuk Dr Christopher KC Lee Infectious Diseases Unit Department of Medicine Sungai Buloh Hospital Patient Story 23 Year old female admitted
More informationPresenter: Ombeva Malande. Red Cross Children's Hospital Paed ID /University of Cape Town Friday 6 November 2015: Session:- Paediatric ID Update
Emergence of invasive Carbapenem Resistant Enterobacteriaceae CRE infection at RCWMCH Ombeva Oliver Malande, Annerie du Plessis, Colleen Bamford, Brian Eley Presenter: Ombeva Malande Red Cross Children's
More informationAntibiotic. Antibiotic Classes, Spectrum of Activity & Antibiotic Reporting
Antibiotic Antibiotic Classes, Spectrum of Activity & Antibiotic Reporting Any substance of natural, synthetic or semisynthetic origin which at low concentrations kills or inhibits the growth of bacteria
More informationThe Nuts and Bolts of Antibiograms in Long-Term Care Facilities
The Nuts and Bolts of Antibiograms in Long-Term Care Facilities J. Kristie Johnson, Ph.D., D(ABMM) Professor, Department of Pathology University of Maryland School of Medicine Director, Microbiology Laboratories
More information2017 Antibiogram. Central Zone. Alberta Health Services. including. Red Deer Regional Hospital. St. Mary s Hospital, Camrose
2017 Antibiogram Central Zone Alberta Health Services including Red Deer Regional Hospital St. Mary s Hospital, Camrose Introduction This antibiogram is a cumulative report of the antimicrobial susceptibility
More informationBurn Infection & Laboratory Diagnosis
Burn Infection & Laboratory Diagnosis Introduction Burns are one the most common forms of trauma. 2 million fires each years 1.2 million people with burn injuries 100000 hospitalization 5000 patients die
More informationHPN HOSPITALIZED PNEUMONIA APPLICATION
HPN HOSPITALIZED PNEUMONIA APPLICATION Investigational Use. Not available for Sale in the United States. Content UNYVERO HPN HOSPITALIZED PNEUMONIA APPLICATION The Unyvero HPN Pneumonia Application combines
More informationAntimicrobial Cycling. Donald E Low University of Toronto
Antimicrobial Cycling Donald E Low University of Toronto Bad Bugs, No Drugs 1 The Antimicrobial Availability Task Force of the IDSA 1 identified as particularly problematic pathogens A. baumannii and
More informationGeneral Approach to Infectious Diseases
General Approach to Infectious Diseases 2 The pharmacotherapy of infectious diseases is unique. To treat most diseases with drugs, we give drugs that have some desired pharmacologic action at some receptor
More information8/17/2016 ABOUT US REDUCTION OF CLOSTRIDIUM DIFFICILE THROUGH THE USE OF AN ANTIMICROBIAL STEWARDSHIP PROGRAM
Mary Moore, MS CIC MT (ASCP) Infection Prevention Coordinator Great River Medical Center, West Burlington REDUCTION OF CLOSTRIDIUM DIFFICILE THROUGH THE USE OF AN ANTIMICROBIAL STEWARDSHIP PROGRAM ABOUT
More informationSafe Patient Care Keeping our Residents Safe Use Standard Precautions for ALL Residents at ALL times
Safe Patient Care Keeping our Residents Safe 2016 Use Standard Precautions for ALL Residents at ALL times #safepatientcare Do bugs need drugs? Dr Deirdre O Brien Consultant Microbiologist Mercy University
More information2016 Antibiogram. Central Zone. Alberta Health Services. including. Red Deer Regional Hospital. St. Mary s Hospital, Camrose
2016 Antibiogram Central Zone Alberta Health Services including Red Deer Regional Hospital St. Mary s Hospital, Camrose Introduction This antibiogram is a cumulative report of the antimicrobial susceptibility
More informationAntimicrobial Susceptibility Testing: Advanced Course
Antimicrobial Susceptibility Testing: Advanced Course Cascade Reporting Cascade Reporting I. Selecting Antimicrobial Agents for Testing and Reporting Selection of the most appropriate antimicrobials to
More information