ESCMID Online Lecture Library. by author
|
|
|
- Derrick Ryan
- 6 years ago
- Views:
Transcription
1 Interactive case: Approaching intra-abdominal sepsis Ph Montravers Department of Anaesthesiology and Critical Care Medicine CHU Bichat Claude Bernard, APHP Université Paris VII Denis Diderot-Sorbonne Cite Paris, France
2 Disclosure Expert/Advisor or lectures for the following companies Astellas Astra-Zeneca Cubist Gilead Merck Sharp Dohme Chibret Pfizer
3 Mrs L. 56 year old Admitted to hospital with severe abdominal pain Past medical history : Heavy smoker (40 g/d 20 years) Several antibiotic treatments for repeated UTI (FQ twice in the last 6 months) Recent weight loss (-35 kg/4 months following slimming cure) current weight 87kg/183 cm Previous surgery : None Current medication : None
4 The current story started 15 days before admission : anorexia, abdominal pain, deterioration of clinical status and bowel dysfunction without vomiting. The pain got much worse which led to admission. At arrival in the Emergency Department the patient was in major distress AP : 65/40 mm Hg ; HR 142, Temperature 38.9 C Major abdominal pain with rigidity of rectus abdominis Absence of bowel sounds and of bowel movements ( 24 hrs) Signs of peripheral hypoperfusion and acute respiratory failure Orotracheal intubation and mechanical ventilation were performed + Fluid loading (Ringer 1000 ml/10 mn then 1000 ml/30mn) + Epinephrine 0.4 µg/kg/min (2 mg/h) started immediately
5 Because the patient has an acute abdomen with fever and evidence of bowel obstruction, an exploratory laparotomy was mandatory. A bowel perforation was highly suspected. Due to the severity of the presentation, the medico surgical team decided an immediate laparotomy without additional inquiries.
6 What is the frequency of severe sepsis in the course of abdominal sepsis? 10 % of the cases admitted in ICU 20% 40% More 8-10 % of all the cases
7 37% of septic shock among 124 cases of generalized peritonitis (single center study) 3,147 patients enrolled in the SOAP Study (epidemiology of sepsis in 198 ICUs in Europe) 777 (25%) had sepsis on ICU admission 162 (21%) pts abdominal infections 69.8% had severe sepsis 40.1% had septic shock Riche F et al. Crit Care 2009; 13 R99 Volakli E F et al. Crit Care 2010; 14 R32 9% of septic shock among 234 community-acquired cases (25 centers in France) Montravers P et al. J Antimicrob Chemother 2009;63:785-94
8 Riche F et al. Crit Care 2009; 13 R99
9 In the course of abdominal sepsis what is the most frequent location of infection? Appendicitis Biliary tract Colon Gastroduodenal All of these locations
10 Source of infection Roehrborn Krobot Riche Colon 29% 27% 38% Gastroduodenal 28% 22% 22% Small intestine 6% - 18% Biliary tract 7% 7% 8% Appendix 29% 38% 8% Other - 6% 6% Roehrborn A et al. Clin Infect Dis 2001; 33: Krobot K et al. Eur J Clin Microbiol Infect Dis : Riche F et al. Crit Care 2009; 13 R99
11 Admission parameters Sedation ; Mechanical ventilation FiO2 100% ; Epinephrine 0.4 µg/kg/min (2 mg/h)ekg : sinus tachycardia AP : 95 / 55 ; HR : 125 ; Diuresis : none ph : 7.05 ; PaCO 2 : 38 mm Hg ; PaO 2 : 170 mm Hg ; SaO 2 : 97% ; HCO 3-12 Na : 136 ; K : 4 ; BUN : 10.1 mmol ; Creatinine : 120 µmol Glycemia : 8.3 mmol ; Lactates 6.5 mmol ; Troponin < 0.15 UI/L WBC : /L; Hematocrit : 39% ; Platelets : 198, /L; PT : 73 % ; PTT 36/30
12 What is the frequency of positive blood cultures in the course of abdominal sepsis? 10 % of the cases admitted in ICU 20% 40% More
13 Krobot Riche Montravers (Ann Surg 2004) Montravers (JAC 2009) Type of pts CA-IAI Secondary IAI ICU pts Non postoperative IAI CA-IAI (ICU and ward cases) Bacteremia 43% 14% 16% 6% Krobot K et al. Eur J Clin Microbiol Infect Dis : Riche F et al. Crit Care 2009; 13 R99 Montravers P et al. Ann Surg 2004; 239: Montravers P et al. J Antimicrob Chemother 2009;63:785-94
14 Solomkin J et al. Clin Infect Dis 2010;50:
15 When do you start antibiotic empiric treatment? Immediately in the emergency room After collection of blood cultures At the arrival in the operating room After collection of peritoneal samples Guided by direct examination of peritoneal samples
16 Solomkin J et al. Clin Infect Dis 2010;50:
17 PK meropenem in peritonitis Meropenem 1 g / 8 h Intra-abdominal Infections Healthy Volunteers Cmax (mcg/ml) AUC (mcg.h/ml) T 1/2 (h) Cl (ml/mn) V ss (l) Bedikian A. Antimicrob Agents Chemother. 1994;38:151-4.
18 Crit Care 2010,14:R126
19 What regimen do you select for antibiotic empiric treatment? Amoxicillin/clavulanic acid Amoxicillin/clavulanic acid + aminoglycosides Piperacillin/tazobactam Ertapenem Imipenem/meropenem/doripenem Cefoxitin Cefotaxime/ceftriaxone + metronidazole Fluoroquinolone + metronidazole (or
20 Gram positive cocci Gram negative bacilli Anaerobes Streptococci Enterococci Staphylococci Enterobacteriaceae E coli,klebsiella, Enterobacter non fermenting GNB Pseudomonas, Acinetobacter Cocci Streptococci, Peptostreptocci Bacilli Bacteroides, Clostridium,Fusobacterium
21 % observed Bacterial synergy enterobacteriaceae and anaerobes Mortality Abcesses E. coli E. faecalis B. fragilis E. coli + E. faecalis E. coli + B. fragilis E. faecalis + B. fragilis Onderdonk Infect Immun 1976
22 % Mortality Abcesses Contrôle Gentamicine Clindamycine Clindamycine + Gentamicine Weinstein JID 1975
23 Solomkin J et al. Clin Infect Dis 2010;50:
24 Solomkin J et al. Clin Infect Dis 2010;50:
25 Solomkin J et al. Clin Infect Dis 2010;50:
26 Surgical report: Diffuse stercoral peritonitis Diastatic coecal perforation Obstruction carcinoma of left colon Total colectomy + Ileostomy + Hartmann procedure Peritoneal lavage Peroperative management Heavy fluid loading (5,000 ml of cristalloids) Norepinephrine 2 µg/kg/min (10 mg / h) Antibiotic therapy : Piperacillin/tazobactam + Gentamicin
27 Admission in ICU in the postoperative period Sedation ; Mechanical ventilation FiO2 100% ; EKG : sinus tachycardia Temp 35 C ; AP : 95 / 55 ; HR : 125 ; Diuresis : none ph : 7.08 ; PaCO 2 : 59 mm Hg ; PaO 2 : 150 mm Hg ; SaO 2 : 92% ; HCO Na : 136 ; K : 4 ; BUN : 6.1 mmol ; Creatinine : 81 µmol Glycemia : 3.3 mmol ; Lactates 2.5 mmol ; Troponin < 0.15 UI/L Bilirubin : 62 mmol ; liver enzymes : Normal value WBC : /L; Hematocrit : 25% ; Platelets : 98, /L; PT : 33 % ; PTT 66/30 APACHE II Score : 28 SAPS II Score : 94 SOFA Score : 15 (Hemo 4, Resp 3, Coagulation 2, Kidney 4, Liver 2) OSF 3 (Cv + Resp + Kidney)
28 Early management : Sedation Vasopressure support Haemofiltration for acute renal failure and metabolic acidosis Change of empiric antibiotic therapy? Peroperative abdominal samples : Gram negative bacilli (enterobacteriaceae) Gram positive cocci (diplococci) Gram positive bacilli Any additional treatment?
29 Cruz DN. JAMA 2009;301:2445
30 Day 1 after surgery Persistent multiple organ failure Sedation Vasopressure support Haemofiltration for acute renal failure and metabolic acidosis Antibiotic therapy Risk of relaparotomy (on demand) in the next coming days
31 Cultures of peritoneal fluid : E coli, E faecium, Peptostreptococcus magnus, B fragilis AMX AMC TIC TIM PIP PTZ CTX CAZ EPM IMI E coli R R R S S S S S S S E faecium R R R R R R R AMX : amoxicillin ; AMC : amoxicillin + clavulanic acid ; TIC : ticarcillin ; TIM : ticarcillin + clavulanic acid ; PIP : piperacillin ; PTZ: piperacillin + tazobactam; CTX : cefotaxime ; CAZ : Ceftazidime; EPM : Ertapenem; IMI : Imipenem GEN TOB AMK CIP MOXI VAN TEC TIGE LINEZ E coli S S S S S - - S - E faecium Rlo w R R - - S S S S GEN : gentamicin ; TOB : tobramycin ; AMK : amikacin ; CIP : ciprofloxacin ; MOXI: moxifloxacin ; VAN : vancomycin ; TEC: teicoplanin ; TIGE : tigecycline ; LINEZ: linezolide
32 Etude épidémiologique Bactério-clinique des Infections Intra- Abdominales (EBIIA) Microbiological and clinical epidemiology of intra-abdominal infections 6 months January-June university and 14 non-university hospitals ICU and surgical ward Patients > 18 years Abdominal surgery (open/coelioscopic) for peritonitis with purulent material Microbiological culture of peroperative intra-abdominal samples Montravers P et al. J Antimicrob Chemother 2009;63:785-94
33 AMC TZP CTX CAZ IPM AMC: amoxicillin/clavulanic acid ; TZP: piperacillin/tazobactam; CTX: cefotaxime; CAZ : ceftazidime ; IPM: imipenem/cilastatin; EPM: Ertapenem EPM Among carbapenems, only imipenem and ertapenem routinely used in France Montravers P et al. J Antimicrob Chemother 2009;63:785-94
34 AMC TZP CTX CAZ IPM GEN AMK CIP EPM GEN: gentamicin ; AMK: amikacin ; CIP: ciprofloxacin Montravers P et al. J Antimicrob Chemother 2009;63:785-94
35 AMX: amoxicillin ; EPM: Ertapenem ; GEN: Gentamicin AMX EPM GEN Montravers P et al. J Antimicrob Chemother 2009;63:785-94
36 AMX: amoxicillin ; EPM: Ertapenem ; GEN: Gentamicin AMX EPM GEN OXA VAN TEC OXA: oxacillin ; VAN: Vancomycin ; TEC: Teicoplanin Montravers P et al. J Antimicrob Chemother 2009;63:785-94
37 AMX AMC TIC TIM FOX AMX: amoxicillin; AMC: amoxicillin/clavulanic acid ; TIC: Ticarcillin ; TIM: Ticarcillin/clavulanic acid; FOX: cefoxitin Montravers P et al. J Antimicrob Chemother 2009;63:785-94
38 AMX AMC TIC TIM FOX IPM EPM CLI MTR IPM: imipenem/cilastatin; EPM: Ertapenem; CLI: Clindamycin; MTR: metronidazole Montravers P et al. J Antimicrob Chemother 2009;63:785-94
39 Early management : Sedation Vasopressure support Haemofiltration for acute renal failure and metabolic acidosis Antibiotic therapy Tigecycline for 10 days
40 Volakli E F et al. Crit Care 2010; 14 R32
41 Multivariate analysis 2 failing organs : RR 5.51 CI95%[ ] p=0.001 Okubo R. Surg Today 2008;38:413-19
42 Riche F et al. Crit Care 2009; 13 R99
43 Multivariate analysis Risk factors of death Presence of yeasts from peritoneal fluid for POP: RR 4.28 CI95%[ ] p=0.03 Riche F et al. Crit Care 2009; 13 R99
44 Riche F et al. Crit Care 2009; 13 R99
45 Outcome: Progressive improvement over the following 8 days Rapid decrease and interruption of vasoactive drugs Decreased temperature (38 2) and WBC count ( /L) Return of diuresis Return of bowel function Weaning from mechanical ventilation at D8 Discharge from ICU at D12 Discharge from hospital at D 16
46 In summary Early management Source control Importance of adequate antibiotic treatment Limited proof for additional treatments
2015 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
Antibiotic Updates: Part II
Antibiotic Updates: Part II Fredrick M. Abrahamian, DO, FACEP, FIDSA Health Sciences Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California Financial Disclosures
2017 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
Intrinsic, 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
2012 ANTIBIOGRAM. Central Zone Former DTHR Sites. Department of Pathology and Laboratory Medicine
2012 ANTIBIOGRAM Central Zone Former DTHR Sites Department of Pathology and Laboratory Medicine Medically Relevant Pathogens Based on Gram Morphology Gram-negative Bacilli Lactose Fermenters Non-lactose
2016 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
Intra-Abdominal Infections. Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018
Intra-Abdominal Infections Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018 Select guidelines Mazuski JE, et al. The Surgical Infection
PIPERACILLIN- 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
Antibiotic Abyss. Discussion Points. MRSA Treatment Guidelines
Antibiotic Abyss Fredrick M. Abrahamian, D.O., FACEP, FIDSA Professor of Medicine UCLA School of Medicine Director of Education Department of Emergency Medicine Olive View-UCLA Medical Center Sylmar, California
Case 2 Synergy satellite event: Good morning pharmacists! Case studies on antimicrobial resistance
Case 2 Synergy satellite event: Good morning pharmacists! Case studies on antimicrobial resistance 22nd Congress of the EAHP "Hospital pharmacists catalysts for change", 22-24 March 2017, Cannes Disclosure
Secondary peritonitis
Secondary peritonitis Caused by spillage of gastrointestinal microorganisms into the peritoneal cavity secondary to loss of the integrity of the mucosal barriers Etiology: perforation of peptic ulcer traumatic
PRACTIC 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
Surgical infection ผ.ศ. น.พ. กำธร มำลำธรรม หน วยโรคต ดเช อ ภำคว ชำอำย รศำสตร คณะแพทยศำสตร โรงพยำบำลรำมำธ บด
Surgical infection ผ.ศ. น.พ. กำธร มำลำธรรม หน วยโรคต ดเช อ ภำคว ชำอำย รศำสตร คณะแพทยศำสตร โรงพยำบำลรำมำธ บด 1 Scope Surgical prophylaxis: Pharmacologic approach to prevent SSI Antimicrobial therapy for
Appropriate 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,
Update 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
Antimicrobial 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
Dr. 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
ESBL- and carbapenemase-producing microorganisms; state of the art. Laurent POIREL
ESBL- and carbapenemase-producing microorganisms; state of the art Laurent POIREL Medical and Molecular Microbiology Unit Dept of Medicine University of Fribourg Switzerland INSERM U914 «Emerging Resistance
VCH PHC SURGICAL PROPHYLAXIS RECOMMENDATIONS
VCH PHC SURGICAL PROPHYLAXIS RECOMMENDATIONS CARDIAC Staphylococcus aureus, S. epidermidis, except for For patients with known MRSA colonization, recommend decolonization with Antimicrobial Photodynamic
EUCAST-and CLSI potency NEO-SENSITABS
EUCASTand CLSI potency NEOSENSITABS Neo Sensitabs Page 1 / 6 Document: 6.2.0 Fastidious organisms EUCAST Interpretation zones and MIC breakpoints according to recommendations by the "Comité de l'antibiogramme
Suggestions 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
Interactive 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
Antibiotic. 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
Antimicrobial Pharmacodynamics
Antimicrobial Pharmacodynamics November 28, 2007 George P. Allen, Pharm.D. Assistant Professor, Pharmacy Practice OSU College of Pharmacy at OHSU Objectives Become familiar with PD parameters what they
21 st Expert Committee on Selection and Use of Essential Medicines Peer Review Report Antibiotics Review
(1) Have all important studies/evidence of which you are aware been included in the application? Yes No Please provide brief comments on any relevant studies that have not been included: (2) For each of
Guidelines 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
GENERAL 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
Int.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
Bacterial Pathogens in Urinary Tract Infection and Antibiotic Susceptibility Pattern from a Teaching Hospital, Bengaluru, India
ISSN: 2319-7706 Volume 4 Number 11 (2015) pp. 731-736 http://www.ijcmas.com Original Research Article Bacterial Pathogens in Urinary Tract Infection and Antibiotic Susceptibility Pattern from a Teaching
2010 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
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
Copyright 2012 Diabetes In Control, Inc. For permission to reprint, please contact Heather Moran, Production Editor, at
Malignant Otitis Externa Inflammation and damage at the base of the skull due to an untreated outer ear P. aeruginosa most common organism Yellow-green drainage from the ear Odor Fever Deep inner ear pain
Antimicrobial 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
Bacterial 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
Perichondritis: Source: UpToDate Ciprofloxacin 10 mg/kg/dose PO (max 500 mg/dose) BID Inpatient: Ceftazidime 50 mg/kg/dose q8 hours IV
Empiric Antibiotics for Pediatric Infections Seen in ED NOTE: Choice of empiric antibiotic therapy must take into account local pathogen frequency and resistance patterns, individual patient characteristics,
ESCMID Online Lecture Library. by author
Anaerobic infections: antibiotic therapy and development of resistance Inge C Gyssens 1 0ctober 2014 Objectives To review the clinical aspects of some anaerobic infections To understand the epidemiology
Guidelines 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
3/20/2011. Code 215 of Hammurabi: If a physician performed a major operation on
The Good Antibiotics: the Good, the Bad and the Ugly John P. Cello, MD Professor of Medicine and Surgery, University of California, San Francisco Most organisms can be readily identified by culture, special
IDSA GUIDELINES EXECUTIVE SUMMARY
IDSA GUIDELINES Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America Joseph
EARS-Net Belgium Data call for 2016: Instructions for participating laboratories, including data definition. (version 4, 20/3/2017)
EARS-Net Belgium Data call for 2016: Instructions for participating laboratories, including data definition. (version 4, 20/3/2017) Questions on this document can be directed towards: Karl Mertens Scientific
Mono- 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,
Antibiotic Usage Guidelines in Hospital
SUPPLEMENT TO JAPI december VOL. 58 51 Antibiotic Usage Guidelines in Hospital Camilla Rodrigues * Use of surveillance data information of Hospital antibiotic policy guidelines from Hinduja Hospital. The
EUCAST recommended strains for internal quality control
EUCAST recommended strains for internal quality control Escherichia coli Pseudomonas aeruginosa Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Haemophilus influenzae ATCC 59 ATCC
Super Bugs and Wonder Drugs: Protecting the One While Respecting the Many
Super Bugs and Wonder Drugs: Protecting the One While Respecting the Many Vicki Stringfellow, MSN, CPNP-AC/PC Werner Division of Pediatric Critical Care University of Kentucky Lexington, KY Disclosure
Aberdeen Hospital. Antibiotic Susceptibility Patterns For Commonly Isolated Organisms For 2015
Aberdeen Hospital Antibiotic Susceptibility Patterns For Commonly Isolated s For 2015 Services Laboratory Microbiology Department Aberdeen Hospital Nova Scotia Health Authority 835 East River Road New
Trea%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
Help with moving disc diffusion methods from BSAC to EUCAST. Media BSAC EUCAST
Help with moving disc diffusion methods from BSAC to EUCAST This document sets out the main differences between the BSAC and EUCAST disc diffusion methods with specific emphasis on preparation prior to
2009 ANTIBIOGRAM. University of Alberta Hospital and the Stollery Childrens Hospital
2009 ANTIBIOGRAM University of Alberta Hospital and the Stollery Childrens Hospital Division of Medical Microbiology Department of Laboratory Medicine and Pathology 2 Table of Contents Page Introduction.....
RESISTANT PATHOGENS. John E. Mazuski, MD, PhD Professor of Surgery
RESISTANT PATHOGENS John E. Mazuski, MD, PhD Professor of Surgery Disclosures Contracted Research: AstraZeneca, Bayer, Merck. Advisory Boards/Consultant: Allergan (Actavis, Forest Laboratories), AstraZeneca,
Available 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
Original Date: 02/2010 Purpose: To maximize antibiotic stewardship for intraabdominal infection in the Precedes: 4/2013
Division of Acute Care Surgery Clinical Practice Policies, Guidelines, and Algorithms: Antibiotic Therapy: Intra-Abdominal Infections Clinical Practice Algorithm Original Date: 02/2010 Purpose: To maximize
ESCMID Online Lecture Library. by author
Anaerobic Bacteria in Intra-Abdominal Infections and Bacteremia Maria Hedberg, Umeå University, Umeå, Sweden Anaerobic Bacteria: Next Generation Technology Meets Anaerobic Diagnostics ESCMID Postgraduate
2015 Antibiotic Susceptibility Report
Citrobacter freundii Enterobacter aerogenes Enterobacter cloacae Escherichia coli Haemophilus influenzenza Klebsiella oxytoca Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa Serratia marcescens
Childrens Hospital Antibiogram for 2012 (Based on data from 2011)
Childrens Hospital Antibiogram for 2012 (Based on data from 2011) Prepared by: Department of Clinical Microbiology, Health Sciences Centre For further information contact: Andrew Walkty, MD, FRCPC Medical
These 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
Mercy Medical Center Des Moines, Iowa Department of Pathology. Microbiology Department Antibiotic Susceptibility January December 2016
Mercy Medical Center Des Moines, Iowa Department of Pathology Microbiology Department Antibiotic Susceptibility January December 2016 These statistics are intended solely as a GUIDE to choosing appropriate
Scottish Medicines Consortium
Scottish Medicines Consortium tigecycline 50mg vial of powder for intravenous infusion (Tygacil ) (277/06) Wyeth 9 June 2006 The Scottish Medicines Consortium (SMC) has completed its assessment of the
2016 Antibiotic Susceptibility Report
Fairview Northland Medical Center and Elk River, Milaca, Princeton and Zimmerman Clinics 2016 Antibiotic Susceptibility Report GRAM-NEGATIVE ORGANISMS 2016 Gram-Negative Non-Urine The number of isolates
Intra-abdominal Infections
Intra-abdominal Infections Marnie Peterson, Pharm.D., Ph.D., BCPS College of Pharmacy peter377@umn.edu 2006 Marnie Peterson. This presentation is provided to facilitate the learning of participants within
Management 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
Pneumonia 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
SMART WORKFLOW SOLUTIONS Introducing DxM MicroScan WalkAway System* ...
SMART WORKFLOW SOLUTIONS Introducing DxM MicroScan WalkAway System* The next-generation MicroScan WalkAway System combines proven technology and reliability with enhanced ease-of-use features to streamline
Optimizing Selection of Empirical Antimicrobial Therapy in the Era of Precision Medicine
Optimizing Selection of Empirical Antimicrobial Therapy in the Era of Precision Medicine Majdi Al-Hasan, MBBS Associate Professor of Medicine University of South Carolina School of Medicine Disclosure
Routine internal quality control as recommended by EUCAST Version 3.1, valid from
Routine internal quality control as recommended by EUCAST Version.1, valid from 01-01-01 Escherichia coli Pseudomonas aeruginosa Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Haemophilus
Antimicrobial 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
Recommendations 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
Principles 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.,
Antimicrobial 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
National Surveillance of Antimicrobial Resistance in Pseudomonas aeruginosa Isolates Obtained from Intensive Care Unit Patients from 1993 to 2002
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Dec. 2004, p. 4606 4610 Vol. 48, No. 12 0066-4804/04/$08.00 0 DOI: 10.1128/AAC.48.12.4606 4610.2004 Copyright 2004, American Society for Microbiology. All Rights
RCH antibiotic susceptibility data
RCH antibiotic susceptibility data The following represent RCH antibiotic susceptibility data from 2008. This data is used to inform antibiotic guidelines used at RCH. The data includes all microbiological
Intra-abdominal anaerobic infections. Diagnostics and therapy
Intra-abdominal anaerobic infections. Diagnostics and therapy Elisabeth Nagy MD. PhD. DSc. Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged 4th ESCMID School, Szeged, Hungary
THERAPY OF ANAEROBIC INFECTIONS LUNG ABSCESS BRAIN ABSCESS
THERAPY OF ANAEROBIC INFECTIONS Douglas Black, Pharm.D. Associate Professor School of Pharmacy University of Washington dblack@u.washington.edu LUNG ABSCESS A lung abscess is a localized pus cavity in
Sepsis 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
10/13/14. Low: not well absorbed. Good: [blood and tissue] < than if given IV. High: > 90% absorption orally
![10/13/14. Low: not well absorbed. Good: [blood and tissue] < than if given IV. High: > 90% absorption orally](/thumbs/79/80222162.jpg "10/13/14. Low: not well absorbed. Good: [blood and tissue] < than if given IV. High: > 90% absorption orally")
Low: not well absorbed PO agent not for serious infection nitrofurantoin Good: [blood and tissue] < than if given IV [Therapeutic] in excess of [effective] eg. cephalexin High: > 90% absorption orally
European Committee on Antimicrobial Susceptibility Testing
European Committee on Antimicrobial Susceptibility Testing Routine and extended internal quality control as recommended by EUCAST Version 5.0, valid from 015-01-09 This document should be cited as "The
Received: February 29, 2008 Revised: July 22, 2008 Accepted: August 4, 2008
J Microbiol Immunol Infect. 29;42:317-323 In vitro susceptibilities of aerobic and facultative anaerobic Gram-negative bacilli isolated from patients with intra-abdominal infections at a medical center
Introduction to Pharmacokinetics and Pharmacodynamics
Introduction to Pharmacokinetics and Pharmacodynamics Diane M. Cappelletty, Pharm.D. Assistant Professor of Pharmacy Practice Wayne State University August, 2001 Vocabulary Clearance Renal elimination:
Non-Susceptibility of Bacterial Pathogens Causing Hospital-Onset Pneumonia UK and Ireland,
Non-Susceptibility of Bacterial Pathogens Causing Hospital-Onset Pneumonia UK and Ireland, 2008-2016 Alicia Russell Federation of Infection Societies conference 14 th November 2018 alisia_russell BSAC
Antimicrobial Monotherapy versus Combination Therapy for the Treatment of Complicated Intra-Abdominal Infections
Antimicrobial Mono versus Combination Therapy for the Treatment of Complicated Intra-Abdominal Infections Sarah E. Petite, 1 * Seth R. Bauer, 2 Jessica E. Bollinger, 2 Christine L. Ahrens, 2 and Lisa M.
Choosing Antibiotics for Intra-Abdominal Infections: What Do We Mean by High Risk?*
SURGICAL INFECTIONS Volume 10, Number 1, 2009 Mary Ann Liebert, Inc. DOI: 10.1089/sur.2007.041 Choosing Antibiotics for Intra-Abdominal Infections: What Do We Mean by High Risk?* Brian R. Swenson, 1 Rosemarie
Safe 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
The role of carbapenems in the hospital
The role of carbapenems in the hospital Matteo Bassetti, MD, PhD Infectious Diseases Division Santa Maria Misericordia University Hospital Udine, Italy Rationale for Antibiotic Optimizaton: Balancing The
* gender factor (male=1, female=0.85)
Usual Doses of Antimicrobials Typically Not Requiring Renal Adjustment Azithromycin 250 500 mg Q24 *Amphotericin B 1 3-5 mg/kg Q24 Clindamycin 600 900 mg Q8 Liposomal (Ambisome ) Doxycycline 100 mg Q12
Fighting 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
Grey Nuns Community Hospital (GNCH) Antimicrobial Stewardship July December 2017
Grey Nuns Community Hospital (GNCH) Antimicrobial Stewardship July December 217 Table of Contents Table of Contents... 2 I. Executive Summary... 3 II. GNCH Total Antimicrobial Utilization... 4 III. GNCH
Outline. Antimicrobial resistance. Antimicrobial resistance in gram negative bacilli. % susceptibility 7/11/2010
Multi-Drug Resistant Organisms Is Combination Therapy the Way to Go? Sutthiporn Pattharachayakul, PharmD Prince of Songkhla University, Thailand Outline Prevalence of anti-microbial resistance in Acinetobacter
Objectives. Review basic categories of intra-abdominal infection and their respective treatments. Community acquired intra-abdominal infection
Objectives Review basic categories of intra-abdominal infection and their respective treatments Community acquired intra-abdominal infection Mild/Moderate Severe Acute biliary tract infections Nosocomial
ORIGINAL 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
Taiwan Surveillance of Antimicrobial Resistance (TSAR)
Taiwan Surveillance of Antimicrobial Resistance (TSAR) 2009 MIRL Symposium July 17, 2009 Tsai-Ling Yang Lauderdale ( ) Microbial Infections Reference Laboratory (MIRL) Division of Infectious Diseases,
Detecting / Reporting Resistance in Nonfastidious GNR Part #2. Janet A. Hindler, MCLS MT(ASCP)
Detecting / Reporting Resistance in Nonfastidious GNR Part #2 Janet A. Hindler, MCLS MT(ASCP) Methods Described in CLSI M100-S21 for Testing non-enterobacteriaceae Organism Disk Diffusion MIC P. aeruginosa
GASTRO-INTESTINAL TRACT INFECTIONS - ANTIMICROBIAL MANAGEMENT
GASTRO-INTESTINAL TRACT INFECTIONS - ANTIMICROBIAL MANAGEMENT DRAFT AS CURRENTLY OUT FOR CONSULTATION BUT CAN BE UTILISED IN PRESENT FORMAT Name & Title Of Author: Date Revised: Approved by Committee/Group:
1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient
1 Chapter 79, Self-Assessment Questions 1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient with normal renal function is: A. Trimethoprim-sulfamethoxazole B. Cefuroxime
Supplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Bennett-Guerrero E, Pappas TN, Koltun WA, et al. Gentamicin
Including data call, instructions for participating laboratories, data definition, reporting procedure.
EARS-Net Belgium 2016 - Protocol: Including data call, instructions for participating laboratories, data definition, reporting procedure. (version 7, 6/7/2017) Questions on this document can be directed
MDR Acinetobacter baumannii. Has the post antibiotic era arrived? Dr. Michael A. Borg Infection Control Dept Mater Dei Hospital Malta
MDR Acinetobacter baumannii Has the post antibiotic era arrived? Dr. Michael A. Borg Infection Control Dept Mater Dei Hospital Malta 1 The Armageddon recipe Transmissible organism with prolonged environmental
Concise 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
Witchcraft for Gram negatives
Witchcraft for Gram negatives Dr Subramanian S MD DNB MNAMS AB (Medicine, Infect Dis) Infectious Diseases Consultant Global Health City, Chennai www.asksubra.com Drug resistance follows the drug like a
EARS Net Report, Quarter
EARS Net Report, Quarter 4 213 March 214 Key Points for 213* Escherichia coli: The proportion of patients with invasive infections caused by E. coli producing extended spectrum β lactamases (ESBLs) increased
QUICK REFERENCE. Pseudomonas aeruginosa. (Pseudomonas sp. Xantomonas maltophilia, Acinetobacter sp. & Flavomonas sp.)
Pseudomonas aeruginosa (Pseudomonas sp. Xantomonas maltophilia, Acinetobacter sp. & Flavomonas sp.) Description: Greenish gray colonies with some beta-hemolysis around each colony on blood agar (BAP),
Antimicrobial Therapy
Antimicrobial Therapy David H. Spach, MD Professor of Medicine Division of Infectious Diseases University of Washington, Seattle Disclosure: Dr. Spach has no significant financial interest in any of the