Striking The Balance. Risk Factors for Late Onset Infections Nosocomial. Risk Factors 6/15/2012
|
|
- Baldric Powell
- 5 years ago
- Views:
Transcription
1 . Is It An Infection??. Robin J Green MBBCh, DCH, FC Paed, DTM&H, MMed, FCCP, PhD, Dip Allergy, FAAAAI, FRCP Department of Paediatrics and Child Health Striking The Balance Overuse of Antibiotics: - Resistance - Side effects - Co-lateral damage -Cost Underuse of Antibiotics: - Increased mortality (10-30% for early onset sepsis) - Morbidity (prolonged stay) -Cost 1 2 Decide Do I need an antibiotic (Appropriate and Optimal Use) Some reasons not to use antibiotics: -No risk of sepsis -Neonate not ill - Inflammatory markers are negative What if the antibiotic isn t working: - Think again may not be an infection - Think again may be an abscess/pus Routine Antibiotics for all Preterm Neonates Have NO Role Clinical sepsis: - Intervention = 31.9% - Control = 25.4% (P=0.392) Mortality was equivalent in both groups The incidence of NEC and the duration of hospital stay were comparable in both groups Conclusion: In low risk preterm neonates we found no evidence that routine antibiotic use has a protective effect Tagare A, et al. J Hosp Infect 2010;74: Risk Factors Prolonged rupture membranes (>18 hours) Foetal distress Chorio-amnionitis Maternal fever Multiple obstetric procedures Extreme Prematurity? Suspected GBS (previous pregnancy, maternal culture) Risk Factors for Late Onset Infections Nosocomial Previous antibiotic use Inappropriate antibiotic use (especially Cepahalosporins) Length of stay Intubation Catheterisation Lack of enteral feeding Cipolla D, et al. J Matern Fetal Neonatal Med 2011;24:23-6 Deng C, et al. Pediatr Int 2011;53:
2 Microbiology Early-onset Sepsis: - E coli - Group B strep. (most important Day 1) Late-onset Sepsis: - Coagulase negative Staph. - Staph. aureus - Gram-negatives (esp MDR) - Fungal (esp VLBW) Preventing Nosocomial Sepsis Change intravenous lines < 21 days (Chathas MK, et al. Am J Dis Child 1990;144: ) Remove lines when cultured organism (Benjamin Jr DK, et al. Pediatrics 2001;107: ) NICU design (37-55 m per bed, sinks within 6 m each bed, equipment for each bed) (Clark R, et al. J Perinatol 2004;24: ) Vancomycin prophylaxis for central lines Guarded (Craft AP, et al. Cochrane Database Syst Rev 2000;2:CD001971) Careful antibiotic stewardship and policies (De Man P, et al. lancet 2000;355:973-8) 8 Prevention that Doesn t Work Prophylactic antibiotics No evidence (Austin N, et al. Cochrane Database Syst Rev 2009;7:CD003478) Surface coated enteral catheters No evidence in neonates Frequency endotracheal suctioning (4 vs 8 hrly) No difference (Cordero L, et al. J Perinatol 2000;20:151-6) Closed vs open tracheal suctioning - No effect (Deppe SA, et al. Crit Care Med 1990;18: ) Prevention that Doesn t Work Gowning before entering NICU No evidence (Donowitz LG. Pediatrics 1986;77:35-8 Tan SG, et al. Int J Nurs Pract 1995;1:52-8 Pelke S, et al. Arch paediatr Adolesc Med 1994;148: ) Intravenous FFP No effect (Acunas BA, et al. Arch Dis Child Fetal Neonatal Ed 1994;70:182-7) Skin protection with emolients - Harmful (Campbe ll JR, et al. Pedaitrics 2000;105: ) 9 10 Management Biomarkers ANTIBIOTICS Have a Policy/Guideline Know your Bugs Try for Stewardship CRP PCT WCC 2
3 Duration No culture + normal CRP* + well baby = 48 hours No culture + abnormal CRP* + unwell baby = 5 days No culture + abnormal normal CRP + unwell well baby = 48 hours after CRP normal/baby gets well Positive culture: GBS = 10 days (14 days CSF) -Gram negative = 10 days (21 days CSF) -Staph aureus = 2-3 weeks - Fungal = 2-3 weeks (after negative culture) Sensitivity 78% Al-Zwaini EJ. East Mediterr Health J 2009;15: Antibiotics for ESBL (lactose fermenters) Carbapenem -Ertapenem (Invanz) -Meropenem -Imipenem Cefepime (Maxipime) + Clavulanate Piperacillin/tazobactam Never Ciprofloxacin/Rocephin All of these induce co-lateral damage Antibiotics for MRSA Vancomycin Concerns:»Unfavourable PK/PD Dose close to MIC»Highly plasma protein bound poor lung penetration unsuitable for HAP»Adverse events kidney/ear/histamine release (anaphylaxis) Linezolid (Zyvoxid) Teicoplanin Neurodevelopmental Outcomes and Bloodstream Infections in Infants,1000 g 57% P < vs no infection Prophylactic Use Antifungals for Invasive Fungal Infection in VLBW Neonates Oral antifungal prophylaxis studies: - Under-powered - Quasi-randomization -Lack of blinding Meta-analyis found RR 0.19 ( ) invasive fungal infections No effect on mortality Diflucan (fluconazole)* A maintenance dose of at least 12 mg/kg day! is needed (in the first 90 days after birth) to achieve an AUC / MIC of >50 for Candida spp with an MIC of <8 µg/ml From PD point of view, recommended treatment dose is too low! May result in mycological failure! Is this a reason for the exhorbitant mortality rate of candida septicaemia in neonates (+/-22%)? Austin N, et al. Cochrane Database SystRev 2009;7:CD * Data for orginal 3
4 Organisms That Tell You Something And That Something Isn t Good Candida parapsolosis Acenitobacter baumanii Vancomycin resistant Enterococci NosocomialSepsis Prevention Strategies Physician willingness Antibiotic protocols Hand washing Sterile precautions Adequate Finances Patient spacing When Money is Short Doctors Need to Go The Extra Mile Epidemiology Physician willingness Antibiotic protocols Hand washing Sterile precautions Patient spacing Inadequate Finances Pneumonia = 2 nd most common nosocomial infection Accounts for 18 26% of nosocomial infections Children aged 2 12 months most affected 95% of nosocomial pneumonia occurs in ventilated children 21 Risk Factors for VAP Immunodeficiency Immunosuppression Neuromuscular blockage Septicaemia TPN Steroids H2-blockers Mechanical ventilation Re-intubation Transport while intubated Microbiology Early-onset HAP: - Strep pneumoniae - Haemophilus influenzae - Moraxella catarrhalis Late-onset HAP: -Staph aureus -MRSA - Pseudomonas aeruginosa/acenitobacter - MDR -Gram-negative Enterobacteriaceae -ESBL Often more resistant organisms 4
5 Criteria for VAP for Infants Younger than 12 Months of Age Clinical Criteria / Radiographic Criteria Worsening gas exchange with at least 3 of the clinical criteria: Temperature instability without other recognized cause White blood cells <4,000/mm 3 or > 15,000/mm 3 and band forms > 10% New onset purulent sputum or change in the character of sputum or increased respiratory secretions Apnea, tachypnea, increased work of breathing, or grunting Wheezing, rales, or rhonchi Cough Heart rate <100 beats/min or >170 beats/min plus radiographic criteria At least 2 serial chest x-rays with new or progressive and persistent infiltrate, consolidate, cavitation or pneumatocele that develops >48 hours after initiation of mechanical ventilation Prevention Strategies Infection control Head of bed elevation Daily sedation holidays Stress ulcer prophylaxis DVT prophylaxis In-line suctioning Oropharyngeal toilet Orotracheal intubation Change in ventilator circuits only when dirty Avoidance of re-intubation Wright ML, et al. Semin Pedaitr Infect Dis 2006;17:58-64 Biomarkers CRP + PCT may be useful to: - Document HAP/VAP - Determine bacterial aetiology - Determine duration of antibiotics Management ANTIBIOTICS Antibiotic selection policies Antibiotic rotation? Regular microbiology for a Antibiotic Stewardship: designed to optimize antimicrobial therapy administered to hospitalized patients, to ensure cost-effective therapy, improve patients' outcome while containing bacterial resistance. Selecting Antibiotics Dosage Mode of killing Concentration AUC/MI C Time Above MIC PK/PD Adverse events Intervene early and appropriately Consider antibiotic for relevant organisms Consider dosage interval and total dose depending on the antibiotic mode of killing PK = Effect of body on drug (absorption, availability, metabolism, excretion) PD = Effect of drug on body (receptor binding, tissue penetration) 5
6 PK = Dosage + Concentration Correct antibiotic dosages and duration Correct antibiotic administration -Concentration dependent antibiotics (Aminoglycosides, quinolones) = single daily concentration -Time dependent antibiotics (B-lactams, vancomycin, pip-taz, carbapenems, linezolid) = continuous infusion over 24 hours (3-4 hours for carbapenems, TDS for linezolid) Duration No culture = 3 days URTI = 3-5 days Positive culture = 5-7 days (including tonsillitis, sinusitis) or 3-5 days after clinical improvement Seldom need 10 days Exceptions Staph 2-3 weeks -PCP 3 weeks -Fungal 2-3 weeks Decontaminate Hand washing the most effective strategy to prevent resistance All personal and parents must hand wash Use notices and wall mounted sprays Anti-inflammatory strategies of Macrolides/Linezolid Dont Use third generation cephalosporins routinely (except meningitis) Use inappropriate antibiotics Use a long course Use too low a dose Routinely combine antibiotics Routinely use probiotics Why Linezolid is Best for MRSA MIC break point = 4mg/L Excellent lung penetration Quorum sensing ability = Anti-inflammatory effects Favourable safety profile Percentage of Bacteria at each MIC value (mg/l) (n=40) Antibiotic Linezolid Teicoplanin Vancomycin Kuti JL, et al. Clin Microbiol Infect 2008;14:
7 Antibiotic Stewardship A multidisciplinary team including at least an infectious disease physician and a clinical pharmacist is required. Feedback to the provider, education and antimicrobial restriction Antibiotic Stewardship Elements Treat only bacterial infections Do not treat colonisation Review antibiotics at 48 hours Prevent the chain of spread Infection control Select antibiotics carefully PK/PD Surveillance/audit Interact with the microbiologist Adequate staffing Eliminate non-essential tracheal suctioning Antibiotic Stewardship Definition Wise use of antibiotics to improve patient outcomes and minimise resistance and adverse outcomes Touch Don t touch the patient without washing hands Pause Pause before touching the next patient Engage Don t engage with the patients crib Conclusion Do I need an antibiotic? Select the most appropriate antibiotic Use the correct dose and interval Short courses are better Avoid 3 rd generation cephalosporins Antibiotic Protocols Antibiotic Stewardship WASH YOUR HANDS 42 7
Choosing an Antibiotic
Principles of Antibiotic Use - The 6 Step Plan Robin J Green MBBCh, DCH, FC Paed, DTM&H, MMed, FCCP, PhD, Dip Allergy, FAAAAI Department of Paediatrics and Child Health 1 Choosing an Antibiotic Disease/Site
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 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 informationAntibiotic Stewardship in the Neonatal Intensive Care Unit. Objectives. Background 4/20/2017. Natasha Nakra, MD April 28, 2017
Antibiotic Stewardship in the Neonatal Intensive Care Unit Natasha Nakra, MD April 28, 2017 Objectives 1. Describe antibiotic use in the NICU 2. Explain the role of antibiotic stewardship in the NICU 3.
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 informationTITLE: NICU Late-Onset Sepsis Antibiotic Practice Guideline
Site: Saint Joseph Hospital - NICU Original Effective Date: 6/1/2016 Next Review Date: 6/1/2019 TITLE: Practice Guideline Purpose: Timely and appropriate treatment of late-onset sepsis with antibiotic
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 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 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 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 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 09:00 09:20 Registration
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 informationEinheit für pädiatrische Infektiologie Antibiotics - what, why, when and how?
Einheit für pädiatrische Infektiologie Antibiotics - what, why, when and how? Andrea Duppenthaler andrea.duppenthaler@insel.ch Limping patient local pain swelling tenderness warmth fever acute Osteomyelitis
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 informationSustaining an Antimicrobial Stewardship
Sustaining an Antimicrobial Stewardship Much needless expense, untoward effect, harm and disappointment can be prevented by better judgment in the use of antimicrobials Whitney A. Jones, PharmD Antimicrobial
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 informationMercy 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
More informationCurricular Components for Infectious Diseases EPA
Curricular Components for Infectious Diseases EPA 1. EPA Title Promoting antimicrobial stewardship based on microbiological principles 2. Description of the A key role for subspecialists is to utilize
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 informationBacterial Resistance of Respiratory Pathogens. John C. Rotschafer, Pharm.D. University of Minnesota
Bacterial Resistance of Respiratory Pathogens John C. Rotschafer, Pharm.D. University of Minnesota Antibiotic Misuse ~150 million courses of antibiotic prescribed by office based prescribers Estimated
More informationCHAPTER:1 THE RATIONAL USE OF ANTIBIOTICS. BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY
CHAPTER:1 THE RATIONAL USE OF ANTIBIOTICS BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY Antibiotics One of the most commonly used group of drugs In USA 23
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 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 informationAntibiotic Resistance in the Post-Acute and Long-Term Care Settings: Strategies for Stewardship
Antibiotic Resistance in the Post-Acute and Long-Term Care Settings: Strategies for Stewardship J. Hudson Garrett Jr., PhD, MSN, MPH, FNP-BC, PLNC, CDONA, IP-BC, GDCN, CDP, CADDCT, CALN, VA-BC, AS-BC,
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 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 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 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 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 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 informationGlobal Status of Antimicrobial Resistance with a Focus on Nepal
Global Status of Antimicrobial Resistance with a Focus on Nepal John Ferguson, John Hunter Hospital, University of Newcastle, NSW, Australia Infectious Diseases Physician and Medical Microbiologist SIMON
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 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 informationJump Starting Antimicrobial Stewardship
Jump Starting Antimicrobial Stewardship Amanda C. Hansen, PharmD Pharmacy Operations Manager Carilion Roanoke Memorial Hospital Roanoke, Virginia March 16, 2011 Objectives Discuss guidelines for developing
More informationOptimize Durations of Antimicrobial Therapy
Optimize Durations of Antimicrobial Therapy Evidence & Application Jill Cowper, Pharm.D. Division Infectious Diseases Pharmacist Parallon Supply Chain Solutions Richmond, VA P: 607 221 5101 jill.butterfield@parallon.com
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 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 informationPharmacology Week 6 ANTIMICROBIAL AGENTS
Pharmacology Week 6 ANTIMICROBIAL AGENTS Mechanisms of antimicrobial action Mechanisms of antimicrobial action Bacteriostatic - Slow or stop bacterial growth, needs an immune system to finish off the microbe
More informationApproach to pediatric Antibiotics
Approach to pediatric Antibiotics Gassem Gohal FAAP FRCPC Assistant professor of Pediatrics objectives To be familiar with common pediatric antibiotics o Classification o Action o Adverse effect To discus
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 informationTreatment of peritonitis in patients receiving peritoneal dialysis Antibiotic Guidelines. Contents
Treatment of peritonitis in patients receiving Antibiotic Guidelines Classification: Clinical Guideline Lead Author: Jude Allen (Pharmacist) Additional author(s): Dr David Lewis, Dr Dimitrios Poulikakos,
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 informationAntimicrobial Stewardship 101
Antimicrobial Stewardship 101 Betty P. Lee, Pharm.D. Pediatric Infectious Disease/Antimicrobial Stewardship Pharmacist Lucile Packard Children s Hospital Stanford Disclosure I have no actual or potential
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 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 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 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 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 informationinicq 2018: Choosing Antibiotics Wisely FAQs
inicq 2018: Choosing Antibiotics Wisely FAQs Unit Setting Query 1. Will the inicq 2018 Collaborative be applicable just to the NICU? Or is there benefit for newborn nurseries or others who care for antibiotic-exposed
More informationOriginal Articles. K A M S W Gunarathne 1, M Akbar 2, K Karunarathne 3, JRS de Silva 4. Sri Lanka Journal of Child Health, 2011; 40(4):
Original Articles Analysis of blood/tracheal culture results to assess common pathogens and pattern of antibiotic resistance at medical intensive care unit, Lady Ridgeway Hospital for Children K A M S
More informationCell Wall Weakeners. Antimicrobials: Drugs that Weaken the Cell Wall. Bacterial Cell Wall. Bacterial Resistance to PCNs. PCN Classification
Cell Wall Weakeners Antimicrobials: Drugs that Weaken the Cell Wall Beta Lactams Penicillins Cephalosporins Carbapenems Aztreonam Vancomycin Teicoplanin Bacterial Cell Wall Bacterial cytoplasm is hypertonic
More informationRational management of community acquired infections
Rational management of community acquired infections Dr Tanu Singhal MD, MSc Consultant Pediatrics and Infectious Disease Kokilaben Dhirubhai Ambani Hospital, Mumbai Why is rational management needed?
More informationAntibiotic Stewardship in Nursing Homes SAM GUREVITZ PHARM D, CGP ASSOCIATE PROFESSOR BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCE
Antibiotic Stewardship in Nursing Homes SAM GUREVITZ PHARM D, CGP ASSOCIATE PROFESSOR BUTLER UNIVERSITY COLLEGE OF PHARMACY AND HEALTH SCIENCE Crisis: Antibiotic Resistance Success Strategy WWW.optimistic-care.org
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 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 informationThe CARI Guidelines Caring for Australians with Renal Impairment. 10. Treatment of peritoneal dialysis associated fungal peritonitis
10. Treatment of peritoneal dialysis associated fungal peritonitis Date written: February 2003 Final submission: July 2004 Guidelines (Include recommendations based on level I or II evidence) The use of
More informationß-lactams. Sub-families. Penicillins. Cephalosporins. Monobactams. Carbapenems
β-lactams ß-lactams Sub-families Penicillins Cephalosporins Monobactams Carbapenems ß-lactams Mode of action PBPs = Trans/Carboxy/Endo- peptidases PBP binding (Penicillin-Binding Proteins) activation of
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 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 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 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 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 informationNEONATAL Point Prevalence Survey. Ward Form
Appendix 2 NEONATAL Point Prevalence Survey Ward Form Please fill in one form for each ward included in PPS Date of survey Person completing form (Auditor code) Hospital Name Department/Ward Neonatal departments
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 informationIntro Who should read this document 2 Key practice points 2 Background 2
Antibiotic Guidelines: Obstetric Anti-Infective Prescribing Guidelines Classification: Clinical Guideline Lead Author: Antibiotic Steering Committee Additional author(s): Kelly Alexander / Frances Garraghan
More informationAntibiotic Prophylaxis in Spinal Surgery Antibiotic Guidelines. Contents
Antibiotic Prophylaxis in Spinal Antibiotic Guidelines Classification: Clinical Guideline Lead Author: Antibiotic Steering Committee Additional author(s): Authors Division: DCSS & Tertiary Medicine Unique
More informationChildrens 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
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 informationAntimicrobial Stewardship Esperienza Torinese
Pisa 15 Novembre 2016 Antimicrobial Stewardship Esperienza Torinese Francesco G. De Rosa Dipartimento di Scienze Mediche Università di Torino Antimicrobial Stewardship First introduced by Dale Gerding
More informationRole of the general physician in the management of sepsis and antibiotic stewardship
Role of the general physician in the management of sepsis and antibiotic stewardship Prof Martin Wiselka Dept of Infection and Tropical Medicine University Hospitals of Leicester Sepsis and antibiotic
More informationLINEE GUIDA: VALORI E LIMITI
Ferrara 28 novembre 2014 LINEE GUIDA: VALORI E LIMITI Pierluigi Viale Clinica di Malattie Infettive Policlinico S. Orsola Malpighi EVIDENCE BIASED GERIATRIC MEDICINE Older patients with comorbid conditions
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 informationThe Rise of Antibiotic Resistance: Is It Too Late?
The Rise of Antibiotic Resistance: Is It Too Late? Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine None DISCLOSURES THE PROBLEM Antibiotic resistance is one of the
More informationOptimizing Antimicrobial Stewardship Activities Based on Institutional Resources
Optimizing Antimicrobial Stewardship Activities Based on Institutional Resources Andrew Hunter, PharmD, BCPS Infectious Diseases Clinical Pharmacy Specialist Michael E. DeBakey VA Medical Center Andrew.hunter@va.gov
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 information* 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
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 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 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 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 informationMDR 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
More informationESBL Producers An Increasing Problem: An Overview Of An Underrated Threat
ESBL Producers An Increasing Problem: An Overview Of An Underrated Threat Hicham Ezzat Professor of Microbiology and Immunology Cairo University Introduction 1 Since the 1980s there have been dramatic
More informationAntimicrobial 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
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 informationOther Beta - lactam Antibiotics
Other Beta - lactam Antibiotics Assistant Professor Dr. Naza M. Ali Lec 5 8 Nov 2017 Lecture outlines Other beta lactam antibiotics Other inhibitors of cell wall synthesis Other beta-lactam Antibiotics
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 informationEarly Onset Neonatal Sepsis (EONS) A Gregory ST6 registrar at RHH
Early Onset Neonatal Sepsis (EONS) A Gregory ST6 registrar at RHH Background Early onset neonatal sepsis (EONS) is a significant cause of mortality and morbidity in newborn babies. Prompt antibiotic treatment
More informationHand Hygiene and MDRO (Multidrug-resistant Organisms) - Science and Myth PROF MARGARET IP DEPT OF MICROBIOLOGY
Hand Hygiene and MDRO (Multidrug-resistant Organisms) - Science and Myth PROF MARGARET IP DEPT OF MICROBIOLOGY MDROs and Hand Hygiene Guidelines HH Apr14 The Science of Hand Hygiene in Healthcare Settings
More informationAntibiotic Usage and Microbial Resistance: Indian Scenario
Antibiotic Usage and Microbial Resistance: Indian Scenario Dr. Srinivas Murki, Consultant Neonatologist,Fernandez Hospital, Hyderabad, Andhra Pradesh-503001, India Email: srinivas_murki2001@yahoo.com Abstract
More informationMDRO s, Stewardship and Beyond. Linda R. Greene RN, MPS, CIC
MDRO s, Stewardship and Beyond Linda R. Greene RN, MPS, CIC linda_greene@urmc.rochester.edu Evolving Threat of Antimicrobial Resistance Why are MDROs important? Limited treatment options Associated with:
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 informationCombination vs Monotherapy for Gram Negative Septic Shock
Combination vs Monotherapy for Gram Negative Septic Shock Critical Care Canada Forum November 8, 2018 Michael Klompas MD, MPH, FIDSA, FSHEA Professor, Harvard Medical School Hospital Epidemiologist, Brigham
More informationAntimicrobials. Antimicrobials
Antimicrobials For more than 50 years, antibiotics have come to the rescue by routinely producing rapid and long-lasting miracle cures. However, from the beginning antibiotics have selected for resistance
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 informationProphylactic antibiotic timing and dosage. Dr. Sanjeev Singh AIMS, Kochi
Prophylactic antibiotic timing and dosage Dr. Sanjeev Singh AIMS, Kochi Meaning - Webster Medical Definition of prophylaxis plural pro phy lax es \-ˈlak-ˌsēz\play : measures designed to preserve health
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 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 informationAntibiotic 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
More information9/30/2016. Dr. Janell Mayer, Pharm.D., CGP, BCPS Dr. Lindsey Votaw, Pharm.D., CGP, BCPS
Dr. Janell Mayer, Pharm.D., CGP, BCPS Dr. Lindsey Votaw, Pharm.D., CGP, BCPS 1 2 Untoward Effects of Antibiotics Antibiotic resistance Adverse drug events (ADEs) Hypersensitivity/allergy Drug side effects
More information