Infection control for neutropenic cancer patients : the use of prophylactic antibiotics. by author
|
|
- Piers McCarthy
- 5 years ago
- Views:
Transcription
1 Infection control for neutropenic cancer patients : the use of prophylactic antibiotics Jean A. Klastersky Institut Jules Bordet, Université Libre de Bruxelles (ULB) Brussels, Belgium
2 Complications and mortality associated with febrile neutropenia No Bacteremia Bacteremia Total Complications Deaths Total Complications Deaths Solid tumors (8 %) 25 (3 %) Hematological cancer (13 %) 32 (4 %) (22 %) 17 (13 % ) (21 %) 32 (9 %) J. Klastersky et al.,
3 Complications associated with febrile neutropenia Hypotension : systolic blood pressure less than 90 mmhg or need for pressor support to maintain blood pressure Respiratory failure : arterial oxygen pressure less than 60mmHg while breathing room air or need for mechanical ventilation Disseminated intravascular coagulation Confusion or altered mental state Congestive cardiac failure seen on chest X-ray and requiring treatment Bleeding severe enough to require transfusion Arrhythmia or ECG changes requiring treatment Renal failure requiring investigation and/or treatment with IV fluids, dialysis, or any other intervention J. Klastersky et al.,
4 Cost of febrile neutropenia Initial hospitalization Initial hospitalization plus all downstream neutropenia care $ $ D. Weyckler et al.,
5 Use of oral antibiotics in protected units environment : clinical effectiveness and role in the emergence of antibiotic-resistant strains «the incidence of proven infection was significantly reduced» «no advantage of isolation in addition to antibiotics could be detected» «bacteria isolated from decontamined patients were considerably more resistant» J. Klastersky et al.,
6 Infection-control interventions for cancer patients after chemotherapy : a systematic review and meta-analysis «protective isolation, including air quality control, prophylactic antibiotics and barrier isolation (29 studies) brought about a significant reduction in all-cause mortality : risk ratio 0.60» «inclusion of prophylactic antibiotics in the intervention was necessary to show the effect on mortality» A. Schlesinger et al.,
7 Occurrence of infections among placebo and trimethoprim-sulfamethoxazole (TMP-SXT)-treated patients Treatment group Total N of Patients No (%) Patients with Any Infection Bacteremia Placebo (39) 32 (19) * TMP-SXT (26) 22 (12) * p = * P = (p = if patients with acute leukemia were excluded) EORTC Antimicrobial Therapy Project Group
8 Prophylaxis with fluoroquinolones (Levofloxacin) in patients with expected neutropenia (adapted from L. Leibovici et al., 2006) Patients Acute leukemia and stem cell transplantation* Febrile neutropenia Bacterial Infection Solid Tumors and Lymphomas Febrile Neutropenia Bacterial Infection Relative Risk Absolute Risk in the Control Group N of treated Patients needed to prevent 1 Event * G. Bucaneve et al., 2005 M. Cullen et al.,
9 Deaths caused by infection in patients receiving prophylaxis for febrile neutropenia Levofloxacin Placebo P value Bucaneve et al. (2005) 10 / 373 (2.8 %) 18 / 363 (4.9 %) 0.15 Cullen et al. (2005) 4 / 781 (0.5 %) 3 / 784 (0.3 %) NS 9
10 Meta-analysis of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in patients with solid tumors or/and lymphomas (3.493 patients) Infection-related mortality Absolute Occurrence Relative Risk Reduction 1.5 % ( 2.8 %) 45 % (p = 0.018) Febrile neutropenia 22.4 % ( 39.5 %) 46 % (p < ) N. Kuderer et al.,
11 Meta-analysis of prophylaxis with granulocyte colonystimulating factors (G-CSF and GM-CSF) on febrile neutropenia and mortality autologous and allogeneic stem cell transplantation (2.669 patients) Relative Risk Reduction Documented infections 13 % (p = 0.05) Duration parenteral antibiotics days (p = 0.02) Infection-related mortality 24 % (p = 0.4) Grade 2-4 GVHD 0 % (p = 0.8) Treatment-related mortality 0 % (p = 0.9) A. Dekker et al.,
12 Prophylactic antibiotics or G-CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy : The Cochrane Collaboration «there is no evidence for or against antibiotics compared to G(M)-CSF s for prevention of infections in cancer patients» C. Herbst et al.,
13 Bacterial isolates from cases of bacteremia due to a single organism Trial Total n of isolates Gram-negative Gram-positive I: (71 %) 42 (29 %) II: (67 %) 37 (33 %) III: (59 %) 58 (41 %) IV: (59 %) 90 (41 %) V: (37 %) 135 (63 %) VIII: (31 %) 104 (69 %) IX: (33 %) 108 (67 %) EORTC International Antimicrobial Therapy Cooperative Group,
14 Gram-positive organisms isolated during trial VIII Organism N isolated Streptococcus species 57 Viridans group 44 Group D 5 Streptococcus pneumoniae 4 Other 4 Coagulase-negative staphylococci 49 Staphylococcus aureus 20 Corynebacterium species 5 Other gram-positive organisms 3 EORTC International Antimicrobial Therapy Cooperative Group,
15 «New» gram-positive pathogens in patients with neutropenia Viridans streptococci e.g., Streptococcus mitis, Streptococcus milleri Leuconostoc species Enterococcus species, especially vancomycin-resistant Corynebacterium jeikeium, Corynebacterium urealyticum Rhodococcus equi Stomatococcus mucilaginosus Lactobacillus rhamnosus Bacillus cereus Clostridium septicum, Clostridium tertium S.H. Zinner,
16 «New» gram-negative pathogens in patients with neutropenia Stenotrophomonas (Xanthomonas, Pseudomonas) maltophilia Alteromonas (Pseudomonas) putrifaciens Legionella pneumophila, Legionella micdadei Vibrio parahaemolyticus Capnocytophaga species Alcaligenes xylosoxidans Chryseobacterium meningosepticum Burkholderia cepacia Fusobacterium nucleatum Leptotrichia buccalis Methylobacterium species Moraxella-like organisms S.H. Zinner,
17 Antibiotic-resistant bugs in the 21st century a clinical super-challenge «we have come almost full circle and arrived at a point as frightening as the preantibiotic era : for patients infected with multidrugresistant bacteria, there is no magic bullet» C.A. Arias and B.E. Murray,
18 Bacteremia due to viridans streptococci that are highly resistant to penicillin : increase among neutropenic patients with cancer (260 episodes of bacteremia) «rates of bacteremia due to highly penicillinresistant increased significantly from zero (1987) to 17 episodes (1992) per admissions (p = 0.003)» «the administration of β-lactam antibiotics during the 2 previous weeks was the only factor significantly associated» J. Carratala et al.,
19 Use of fluoroquinolone prophylaxis and frequency of fluoroquinolone-resistant bacteremia isolates in neutropenic patients with cancer Variable Patients given prophylaxis/all patients (%) Prophylaxis 3/219 (1.4) 228/694 (33) 318/706 (45) Isolate Escherichia coli Coagulase-negative staphylococci Pseudomonas aeruginosa Klebsiella pneumoniae Fluoroquinolone-resistant strains/strains tested (%) 0/26 0/22 1/25 (4) 0/3 0/66 44/172 (26) 1/39 (3) 1/17 (6) A. Cometta et al., /40 (28) 23/38 (61) 1/13 (8) 1/13 (8) 19
20 Emergence of fluoroquinolone-resistant Escherichia coli at a cancer center : incidence of fluoroquinolone-resistant E. coli per yearly number of discharges from the medical service Year a P = 0.03 b P = 0.17 Incidence (per discharges) Leukemia Other diseases P value a < 1.5 b a 3.6 b < W.V. Kern et al.,
21 Emergence of fluoroquinolone-resistant Escherichia coli at a cancer center «bacteremia increased from < 0.5 % in and 0.8 % in to 4.5 % in (p < 0.01)» «MIC raised between 8-16 µg/ml and indicated resistance to TMP/SXT, ampicillin, doxycycline and chloramphenicol» «4 genotypes were identified, suggesting both independant development and horizontal spread» W.V. Kern et al.,
22 Fluoroquinolone resistance of Escherichia coli at a cancer center : epidemiologic evolution and effects of discontinuing prophylactic fluoroquinolone use in neutropenic patients with leukemia Resistance Pre-intervention ( ) Discontinuation of fluoroquinolones (1998) Post-intervention (1999) rate > 50 % 15 % > 50 % E. coli bacteremia 8 % 20 % * 9 % * p < 0.01 * p = 0.03 W.V. Kern et al.,
23 Recent changes in bacterial epidemiology and the emergence of fluoroquinoloneresistant Escherichia coli among patients with hematological malignancies : results of a prospective study of 823 patients at a single institution Percentage (%) of pathogens responsible for microbiologically documented infections Prophylaxis No prophylaxis Staph. aureus * Coagulase negative staphylococci Enterococci E. coli * Other enterobacteriacae Pseudomonas * P < 0.05 fluoroquinolone-resistant E. coli accounted for 86.8 % of all isolates of E. coli C. Cattaneo et al.,
24 Prediction of the outcome of febrile neutropenia : the MASCC scoring system Characteristic Weight Burden of illness : no or mild symptoms 5 No hypotension 5 No chronic obstructive pulmonary disease 4 Solid tumour or no previous fungal infection 4 No dehydration 3 Burden of illness : moderate symptoms 3 Outpatients status 3 Age < 60 years 2 The maximum score is 26 Scores 21 predict for a risk of severe complications < 5 % J. Klastersky,
25 Oral moxifloxacin or intravenous ceftriaxone for the treatment of low-risk (MASCC score 21) neutropenic fever in cancer patients suitable for early hospital discharge Overall success of home-antibiotic strategy Results according to the treatment Ceftriaxone IV 46 Moxifloxacin PO (73.9 %) 38 (79.2 %) Response in FUO 28/33 26/33 Response in MDI 2/7 8/9 Discontinuation for toxicity 2 (4.3 %) 0 (0 %) C. Seblan et al.,
26 Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications : reasons for not administering oral treatment to patients predicted at low-risk of serious complication development (MASCC score 21) Reason N of patients % Antibacterial prophylaxis and/or treatment Inability to swallow Contraindication(s) to oral therapy 17 6 Protocol violation 16 6 Refusal (by patient or physician) 11 5 Allergy to penicillin or quinolones 2 1 J. Klastersky et al.,
27 Effect of antimicrobial prophylaxis on the rate of and time to infection : antimicrobial prophylaxis typically diminishes and delays the occurrence of an infection but rarely obviates the risk L.R. Baden,
28 Caveats with the use of prophylactic antibiotics Cost Side effects Impact on further therapy Decrease of colonization resistance (C. difficile, Salmonella sp) Emergence, amplification and dissemination of resistant strains effect on patient s and collective flora time dependency of the process impact on the use of antimicrobials need for close monitoring and extensive infection control L.R. Baden,
29 Who should be considered for preventive strategies? Many commonly used chemotherapy have a low risk for FN The risk of FN is the greatest in the initial cycle(s) If FN occurs, the likehood of FN during the next cycle is high The risk of FN varies considerably by disease groups A number of other factors than tumor and chemotherapy affect the risk for FN J.R. Wingard and M. Elmongy,
30 Patient assessment algorithm to decide prophylactic G-CSF usage M.S. Aapro et al.,
31 The key questions Final Conclusion 1) Who needs prophylaxis? 2) G-CSF s or antibiotics? 31
32 Thank you for your kind attention and «Au revoir» 32
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
More informationThe Inpatient Management of Febrile Neutropenia
UCSF Medical Center Adult Blood and Marrow Transplant Program 400 Parnassus Avenue, San Francisco, CA 94143 SOP # CL 120.05 The Inpatient Management of Febrile Neutropenia BACKGROUND: Neutropenia results
More informationEscherichia Coli: an Important Pathogen in Patients with Hematologic Malignancies
MEDITERRANEAN JOURNAL OF HEMATOLOGY AND INFECTIOUS DISEASES www.mjhid.org ISSN 2035-3006 Original Article Escherichia Coli: an Important Pathogen in Patients with Hematologic Malignancies Daniel Olson,
More informationAberdeen 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
More informationReceived 8 April 2012; received in revised form 15 December 2012; accepted 28 December 2012
Journal of Infection and Public Health (2013) 6, 216 221 Antimicrobial agent prescription patterns for chemotherapy-induced febrile neutropenia in patients with hematological malignancies at Sultan Qaboos
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 informationDuke University Hospital Guideline for Empiric Inpatient Treatment of Cancer- Related Neutropenic Fever in Adult Patients
Duke University Hospital Guideline for Empiric Inpatient Treatment of Cancer- Related Neutropenic Fever in Adult Patients PURPOSE Fever among neutropenic patients is common and a significant cause of morbidity
More informationUCSF Medical Center Guidelines for Inpatient Management of Febrile Neutropenia
Published on Infectious Diseases Management Program at UCSF (https://idmp.ucsf.edu) Home > UCSF Medical Center Guidelines for Inpatient Management of Febrile Neutropenia UCSF Medical Center Guidelines
More informationObjectives. Basic Microbiology. Patient related. Environment related. Organism related 10/12/2017
Basic Microbiology Vaneet Arora, MD MPH D(ABMM) FCCM Associate Director of Clinical Microbiology, UK HealthCare Assistant Professor, Department of Pathology and Laboratory Medicine University of Kentucky
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 informationQUICK 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),
More information2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer
IDSA GUIDELINES 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer Walter T. Hughes, 1 Donald Armstrong, 2 Gerald P. Bodey, 3 Eric J. Bow, 7 Arthur E. Brown, 2 Thierry
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 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 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 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 informationC&W Three-Year Cumulative Antibiogram January 2013 December 2015
C&W Three-Year Cumulative Antibiogram January 213 December 215 Division of Microbiology, Virology & Infection Control Department of Pathology & Laboratory Medicine Contents Comments and Limitations...
More information4 th and 5 th generation cephalosporins. Naderi HR Associate professor of Infectious Diseases
4 th and 5 th generation cephalosporins Naderi HR Associate professor of Infectious Diseases Classification Forth generation: Cefclidine, cefepime (Maxipime),cefluprenam, cefoselis,cefozopran, cefpirome
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 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 informationHelp 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
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 informationAntimicrobial susceptibility testing challenges. Linda Joyce St Vincent s Hospital Melbourne
Antimicrobial susceptibility testing challenges Linda Joyce St Vincent s Hospital Melbourne Bacteria/antimicrobials without breakpoints (B.A.W.B.S.) Enterobacteriacae Pseudomonas aeruginosa, Acinetobacter
More information2009 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.....
More informationSuitability of Antibiotic Treatment for CAP (CAPTIME) The duration of antibiotic treatment in community acquired pneumonia (CAP)
STUDY PROTOCOL Suitability of Antibiotic Treatment for CAP (CAPTIME) Purpose The duration of antibiotic treatment in community acquired pneumonia (CAP) lasts about 9 10 days, and is determined empirically.
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 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 informationTable 1. Commonly encountered or important organisms and their usual antimicrobial susceptibilities.
Table 1. Commonly encountered or important organisms and their usual antimicrobial susceptibilities. Gram-positive cocci: Staphylococcus aureus: *Resistance to penicillin is almost universal. Resistance
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 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 informationBurton's Microbiology for the Health Sciences. Chapter 9. Controlling Microbial Growth in Vivo Using Antimicrobial Agents
Burton's Microbiology for the Health Sciences Chapter 9. Controlling Microbial Growth in Vivo Using Antimicrobial Agents Chapter 9 Outline Introduction Characteristics of an Ideal Antimicrobial Agent How
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 informationSimilar to Penicillins: -Chemically. -Mechanism of action. -Toxicity.
Similar to Penicillins: -Chemically. -Mechanism of action. -Toxicity. Cephalosporins are divided into Generations: -First generation have better activity against gram positive organisms. -Later compounds
More informationSafety of an Out-Patient Intravenous Antibiotics Programme
Safety of an Out-Patient Intravenous Antibiotics Programme Chan VL, Tang ESK, Leung WS, Wong L, Cheung PS, Chu CM Department of Medicine & Geriatrics United Christian Hospital Outpatient Parental Antimicrobial
More information1. 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
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 informationStanding Orders for the Treatment of Outpatient Peritonitis
Standing Orders for the Treatment of Outpatient Peritonitis 1. Definition of Peritonitis: a. Cloudy effluent. b. WBC > 100 cells/mm3 with >50% polymorphonuclear (PMN) cells with minimum 2 hour dwell. c.
More informationCost high. acceptable. worst. best. acceptable. Cost low
Key words I Effect low worst acceptable Cost high Cost low acceptable best Effect high Fig. 1. Cost-Effectiveness. The best case is low cost and high efficacy. The acceptable cases are low cost and efficacy
More informationAdvanced Practice Education Associates. Antibiotics
Advanced Practice Education Associates Antibiotics Overview Difference between Gram Positive(+), Gram Negative(-) organisms Beta lactam ring, allergies Antimicrobial Spectra of Antibiotic Classes 78 Copyright
More informationAntibiotic Stewardship Program (ASP) CHRISTUS SETX
Antibiotic Stewardship Program (ASP) CHRISTUS SETX Program Goals I. Judicious use of antibiotics Decrease use of broad spectrum antibiotics and deescalate use based on clinical symptoms Therapeutic duplication:
More informationCLINICAL PROTOCOL FOR COMMUNITY ACQUIRED PNEUMONIA. SCOPE: Western Australia. CORB score equal or above 1. All criteria must be met:
CLINICAL PROTOCOL F COMMUNITY ACQUIRED PNEUMONIA SCOPE: Western Australia All criteria must be met: Inclusion Criteria Exclusion Criteria CB score equal or above 1. Mild/moderate pneumonia confirmed by
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 informationStanding Orders for the Treatment of Outpatient Peritonitis
Standing Orders for the Treatment of Outpatient Peritonitis 1. Definition of Peritonitis: a. Cloudy effluent. b. WBC > 100 cells/mm3 with >50% polymorphonuclear (PMN) cells with minimum 2 hour dwell. c.
More informationInitial Management of Infections in the Era of Enhanced Antimicrobial Resistance
Initial Management of Infections in the Era of Enhanced Antimicrobial Resistance Robert C Welliver Sr, MD Hobbs-Recknagel Endowed Chair in Pediatrics Chief, Pediatric infectious Diseases Children s Hospital
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 informationCipro for gram positive cocci in urine
Buscar... Cipro for gram positive cocci in urine 20-6-2017 Pneumonia can be generally defined as an infection of the lung parenchyma, in which consolidation of the affected part and a filling of the alveolar
More informationجداول میکروارگانیسم های بیماریزای اولویت دار و آنتی بیوتیک های تعیین شده برای آزمایش تعیین حساسیت ضد میکروبی در برنامه مهار مقاومت میکروبی
جداول میکروارگانیسم های بیماریزای اولویت دار و آنتی بیوتیک های تعیین شده برای آزمایش تعیین حساسیت ضد میکروبی در برنامه مهار مقاومت میکروبی ویرایش دوم بر اساس ed., 2017 CLSI M100 27 th تابستان ۶۹۳۱ تهیه
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 informationLevofloxacin and moxifloxacin resistant Haemophilus influenzae in a patient with common variable immunodeficiency (CVID): a case report
46 Case Report Levofloxacin and moxifloxacin resistant Haemophilus influenzae in a patient with common variable immunodeficiency (CVID): a case report CT Hapuarachchi 1, GK Karunaratne 2, NR de Silva 3,
More information4/3/2017 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 informationCONTAGIOUS COMMENTS Department of Epidemiology
VOLUME XXIX NUMBER 3 November 2014 CONTAGIOUS COMMENTS Department of Epidemiology Bugs and Drugs Elaine Dowell SM MLS (ASCP), Marti Roe SM MLS (ASCP), Sarah Parker MD, Jason Child PharmD, and Samuel R.
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 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 informationResponsible use of antibiotics
Responsible use of antibiotics Uga Dumpis MD, PhD Department of Infectious Diseases and Infection Control Pauls Stradiņs Clinical University Hospital Challenges in the hospitals Antibiotics are still effective
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 informationUPDATE ON ANTIMICROBIAL STEWARDSHIP REGULATIONS AND IMPLEMENTATION OF AN AMS PROGRAM
UPDATE ON ANTIMICROBIAL STEWARDSHIP REGULATIONS AND IMPLEMENTATION OF AN AMS PROGRAM Diane Rhee, Pharm.D. Associate Professor of Pharmacy Practice Roseman University of Health Sciences Chair, Valley Health
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 information11/10/2016. Skin and Soft Tissue Infections. Disclosures. Educational Need/Practice Gap. Objectives. Case #1
Disclosures Selecting Antimicrobials for Common Infections in Children FMR-Contemporary Pediatrics 11/2016 Sean McTigue, MD Assistant Professor of Pediatrics, Pediatric Infectious Diseases Medical Director
More informationPneumonia considerations Galia Rahav Infectious diseases unit Sheba medical center
Pneumonia considerations 2017 Galia Rahav Infectious diseases unit Sheba medical center Sir William Osler (1849 1919) "Father of modern medicine Pneumonia: The old man's friend The captain of the men of
More informationCentral Nervous System Infections
Central Nervous System Infections Meningitis Treatment Bacterial meningitis is a MEDICAL EMERGENCY. ANTIBIOTICS SHOULD BE STARTED AS SOON AS THE POSSIBILITY OF BACTERIAL MENINGITIS BECOMES EVIDENT, IDEALLY
More informationINFECTIOUS DISEASES DIAGNOSTIC LABORATORY NEWSLETTER
INFECTIOUS DISEASES DIAGNOSTIC LABORATORY NEWSLETTER University of Minnesota Health University of Minnesota Medical Center University of Minnesota Masonic Children s Hospital May 2017 Printed herein are
More informationControl emergence of drug-resistant. Reduce costs
...PRESENTATIONS... Guidelines for the Management of Community-Acquired Pneumonia Richard E. Chaisson, MD Presentation Summary Guidelines for the treatment of community-acquired pneumonia (CAP) have been
More informationLeveraging the Lab and Microbiology Department to Optimize Stewardship
Leveraging the Lab and Microbiology Department to Optimize Stewardship Presented by: Andrew Martinez MLS(ASCP), MT(AMT), MBA Alaska Native Medical Center Microbiology Supervisor Maniilaq Health Center
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 informationClassification of Bacteria
Classification of Bacteria MICROBIOLOGY -TAXONOMY Taxonomy is the system to classify living organisms Seven groups kingdom, phylum or div, class, order, family, genus, species Binomial system of nomenclature
More informationAntimicrobial stewardship: Quick, don t just do something! Stand there!
Antimicrobial stewardship: Quick, don t just do something! Stand there! Stanley I. Martin, MD, FACP, FIDSA Director, Division of Infectious Diseases Director, Antimicrobial Stewardship Program Geisinger
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 informationmoxifloxacin intravenous, 400mg/250mL, solution for infusion (Avelox ) SMC No. (650/10) Bayer Schering
moxifloxacin intravenous, 400mg/250mL, solution for infusion (Avelox ) SMC No. (650/10) Bayer Schering 05 November 2010 The Scottish Medicines Consortium (SMC) has completed its assessment of the above
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 informationGuidelines for Treatment of Urinary Tract Infections
Guidelines for Treatment of Urinary Tract Infections Overview This document details the Michigan Hospital Medicine Safety (HMS) Consortium preferred antibiotic choices for treatment of uncomplicated and
More informationAntibiotic stewardship in long term care
Antibiotic stewardship in long term care Shira Doron, MD Associate Professor of Medicine Division of Geographic Medicine and Infectious Diseases Tufts Medical Center Boston, MA Consultant to Massachusetts
More informationAntimicrobial Stewardship:
Antimicrobial Stewardship: Inpatient and Outpatient Elements Angela Perhac, PharmD afperhac@carilionclinic.org Disclosure I have no relevant finances to disclose. Objectives Review the core elements of
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 informationCLINICAL USE OF BETA-LACTAMS
CLINICAL USE OF BETA-LACTAMS Douglas Black, Pharm.D. Associate Professor School of Pharmacy University of Washington dblack@u.washington.edu WHY IS INFECTIOUS DISEASE PHARMACOTHERAPY SO CONFUSING? Microbial
More informationNewsflash: Hospital Medicine JOHN C. CHRISTENSEN, MD FACP AMERICAN COLLEGE OF PHYSICIANS, UTAH CHAPTER SCIENTIFIC MEETING FEBRUARY 10, 2017
Newsflash: Hospital Medicine JOHN C. CHRISTENSEN, MD FACP AMERICAN COLLEGE OF PHYSICIANS, UTAH CHAPTER SCIENTIFIC MEETING FEBRUARY 10, 2017 Newsflash: Fluoroquinolones Newsflash: Fluoroquinolones Don t
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 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 informationRCH 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
More informationSource: Portland State University Population Research Center (
Methicillin Resistant Staphylococcus aureus (MRSA) Surveillance Report 2010 Oregon Active Bacterial Core Surveillance (ABCs) Office of Disease Prevention & Epidemiology Oregon Health Authority Updated:
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 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 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 informationnumber Done by Corrected by Doctor Dr.Malik
number 27 Done by Fatimah Farhan Corrected by Basil Al-Bakri Doctor Dr.Malik Note: anything in red is just extra info and you will not be asked about it in the exam. In this sheet we will continue talking
More informationAbstract. Introduction
Clinical Impact of Fluoroquinolone-Resistant Escherichia coli in the Fecal Flora of Hematological Patients with Neutropenia and Levofloxacin Prophylaxis Yong Chong 1 *, Shinji Shimoda 1, Hiroko Yakushiji
More informationVaccination as a potential strategy to combat Antimicrobial Resistance in the elderly
Vaccination as a potential strategy to combat Antimicrobial Resistance in the elderly Wilbur Chen, MD, MS 22-23 March 2017 WHO meeting on Immunization of the Elderly The Problem Increasing consumption
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 informationEuropean Committee on Antimicrobial Susceptibility Testing
European Committee on Antimicrobial Susceptibility Testing Routine and extended internal quality control for MIC determination and disk diffusion as recommended by EUCAST Version 8.0, valid from 018-01-01
More informationDiagnosis: Presenting signs and Symptoms include:
PERITONITIS TREATMENT PROTOCOL CARI - Caring for Australasians with Renal Impairment - CARI Guidelines complete list ISPD Guidelines: http://www.ispd.org/lang-en/treatmentguidelines/guidelines Objective
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 informationPharmacist-Driven ASP. Jessica Holt, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Coordinator October 24 th, 2013
Pharmacist-Driven ASP Jessica Holt, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Coordinator October 24 th, 2013 Abbott Northwestern Hospital Largest not-for-profit hospital in the Twin Cities area
More informationGive the Right Antibiotics in Trauma Mitchell J Daley, PharmD, BCPS
Give the Right Antibiotics in Trauma Mitchell J Daley, PharmD, BCPS Clinical Pharmacy Specialist, Critical Care Dell Seton Medical Center at the University of Texas and Seton Healthcare Family Clinical
More informationPharmacokinetics. Absorption of doxycycline is not significantly affected by milk or food, but coadministration of antacids or mineral supplements
Pharmacokinetics. Absorption of doxycycline is not significantly affected by milk or food, but coadministration of antacids or mineral supplements should be avoided. PDR Drug Summaries are concise point-of-care
More informationGrey Nuns Community Hospital (GNCH) Antimicrobial Stewardship Report
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 Grey Nuns Community Hospital (GNCH) Antimicrobial Stewardship Report to 214 Table of Contents I. Introduction..
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 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 informationOral Ciprofloxacin Compared with Intravenous Ceftazidim on Low Risk Febrile Neutropenia in Acute Lymphocytic Leukemia
Original Article Oral Ciprofloxacin Compared with Intravenous Ceftazidim on Low Risk Febrile Neutropenia in Acute Lymphocytic Leukemia Downloaded from ijpho.ssu.ac.ir at 11:08 IRDT on Sunday July 1st 2018
More informationTreatment of Respiratory Tract Infections Prof. Mohammad Alhumayyd Dr. Aliah Alshanwani
Treatment of Respiratory Tract Infections Prof. Mohammad Alhumayyd Dr. Aliah Alshanwani 30-1-2018 1 Objectives of the lecture At the end of lecture, the students should be able to understand the following:
More information2015 Antibiotic Susceptibility Report
Citrobacter freundii Enterobacter aerogenes Enterobacter cloacae Escherichia coli Haemophilus influenzenza Klebsiella oxytoca Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa Serratia marcescens
More information03/09/2014. Infection Prevention and Control A Foundation Course. Talk outline
Infection Prevention and Control A Foundation Course 2014 What is healthcare-associated infection (HCAI), antimicrobial resistance (AMR) and multi-drug resistant organisms (MDROs)? Why we should be worried?
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 information