Antibiotic treatment in the ICU 1. ICU Fellowship Training Radboudumc

Size: px
Start display at page:

Download "Antibiotic treatment in the ICU 1. ICU Fellowship Training Radboudumc"

Transcription

1 Antibiotic treatment in the ICU 1 ICU Fellowship Training Radboudumc

2 Main issues Delayed identification of microorganisms Impact of critical illness on Pk/Pd High prevalence of antibiotic resistant strains

3 Delicate balance Antibiotic resistance ICU 30-60% of antibiotics Unnecessary Inappropriate Suboptimal Antibiotic development

4 Antibacterial resistance across the globe Range of resistance (%) for the main resistant bacteria worldwide (clinical isolates) African region Americas region Eastern Mediterranean region European region Southeast Asia region Western Pacific region Escherichia coli resistant to third generation cephalosporins Escherichia coli: resistance to fluoroquinolones Klebsiella pneumoniae: resistance to carbapenems MRSA Antimicrobial resistance: global report on surveillance. World Health Organization 2014 De Waele JJ. Intensive Care Med 2018;44:

5 Antibiotica resistants among migrants Country Migrants with AMR, n Migrants, n Prevalence, % (95% CI) Weight, % Angeletti et al (2016) 39 Dudareva et al (2011) 43 Georgakopoulou et al (2016) 45 Gustaffson et al (2006) 46 Hagleitner et al (2012) 47 Heudorf et al (2016) 48 Krüger et al (2016) 50 Lederer et al (2015) 51 Marschall et al (2006) 53 Oliva et al (2013) 54 Ravensbergen et al (2015) 56 Reinheimer et al (2016) 57 Steger et al (2016) 58 Tenenbaum et al (2016) 60 Valverde et al (2015) 61 Overall (I 2 =98%, p<0 0001) Italy Germany Greece Sweden Netherlands Germany Germany Austria Switzerland Italy Netherlands Germany Germany Germany Spain % ( ) 2 2% ( ) 53 9% ( ) 56 5% ( ) 13 0% ( ) 35 3% ( ) 24 7% ( ) 60 0% ( ) 0 0% ( ) 0 0% ( ) 30 8% ( ) 64 3% ( ) 11 4% ( ) 33 9% ( ) 27 3% ( ) 25 4% ( ) 6 45% 8 41% 3 34% 4 56% 7 93% 7 34% 7 03% 3 70% 8 46% 8 44% 7 49% 7 51% 7 86% 8 03% 3 46% % 0% 50% 100% Nellums LB. Lancet Infect Dis 2018;18:

6

7 High antibiotic use in the ICU Fig. 1 Elements contributing to high antibiotic consumption in the De Waele JJ. Intensive Care Med 2018;44:

8 ESBL carrier-ship induces meropenem use OUTCOMERA database 318 ESBL carriers Meropenem initiation No documented infection 63% 9% IVAC Non VAP infection 21% 15% Infection related ventilator-associated complication N = 576 Non ESBL VAP 13% 42% ESBL VAP 3% 56% Barbier F. Intensive Care Med 2018;44:

9 De Waele JJ. Intensive Care Med 2018;44:

10 Antibiotic stewardship Rapid identification of patients with bacterial sepsis Better empirical treatment selection Optimized antibiotic dosing with PK-PD models De-escalation when culture result are available Shortening therapy duration

11 Antibiotic stewardship Rapid identification of patients with bacterial sepsis Better empirical treatment selection Optimized antibiotic dosing with PK-PD models De-escalation when culture result are available Shortening therapy duration

12 Rapid adequate initiation of antibiotics essential Septic shock (N = 2154) Cumulative effective antimicrobial initiation Survival fraction 1.0 Fraction of total patients > 36 Time from onset hypotension (hrs) Kumar A. Crit Care Med 2006;34:

13 Severe sepsis/septic shock (N = 28150) 0.38 Predicted hospital mortality > 6 Time to first antibiotics (hrs) Ferrer C. Crit Care Med 2014;42:

14 However with lower disease severity.. Effect of early antibiotic administration less evident Delay in antibiotic treatment in hemodynamically stable patients with suspected infections until infection is confirmed is probably warranted Hranjec T. Lancet Infect Dis 2012;12:

15 Delay in antibiotics even if given < 6 hours 3 N = (Emergency department) Increase absolute mortality / hour delay (%) 2 1 0,3 0,4 1,8 0 Sepsis Severe sepsis Septic shock Liu VX. Am J Respir Crit Care Med 2017;196:

16 Progression from severe sepsis to septic shock Each hour delay in antibiotics associated with 8% increased conversion to septic shock Whiles BB. Crit Care Med 2017;45:

17 Can biomarkers predict the presence of sepsis? CRP, strem-1, PCT PCT good marker for community acquired- but not for hospital-acquired infections PCT can rise in various non-infectious diseases or remain low in proven infections (contained infection with local production or delayed rise)

18 Wacker C. Lancet Infect Dis 2013;13: Role of biomarkers in diagnosing sepsis?

19 Cut-off value 1-2 ng/ml Wacker C. Lancet Infect Dis 2013;13:

20 cterial 27 (17.9) al 35 (23.2) -infection 10 (6.6) PCT in acute exacerbations of COPD 0.28 ( ) T < 0. 1 μg/l, n (%) PCT < 0.25 μg/l, n (%) T 0.25 μg/l, n (%) ta unknown, n (%) ocyte count ( 109/L) dian (Q1 Q3) 27 (17.9) (2.0) H0 (μg/l) an (SD) 26 (17.2) 0.19 ( ) 37 (25.0) 39 (25.8) 33 (22.3) 40 (28.2) 78 (52.7) 63 (44.4) 3 (2.0) 9 (6.3) 15,003 (12,578) 14,825 (10,630) 12,040 ( ,775) 12,820 ( ,152) N = 302 Fig. 3 Patients receiving antibiotics during the PCT algorithm phase Fig. 4 Effect of the PCT protocol on in-icu (a) and in-hospital (b) antibiotic treatment durations in the groups randomized according to the presence or absence of pneumonia g. 2 Effect of the PCT protocol on all-cause mortality PCT based initiation + duration of therapy vs usual care Discussion control group, p = 0.75, respectively) (Fig. 4). Notathe in-icu antibiotic exposure duration was not nificantly lower in AECOPDs without pneumonia in In this multicenter, randomized, controlled clinical study, the use of PCT-guided antibiotic therapydaubin failed to demc. Intensive Care Med 2018;44:

21 New diagnostic techniques Real-time multiplex PCR? Matrix-assisted laser desorption/ionization time-offlight mass spectrometry? Identification infecting organism in 1-2 hrs Shorter time to effective therapy, reduced LOS, reduced costs

22 Are cultures still necessary? 616 blood cultures, 180 pneumonia, 110 sterile fluid/tissue samples PCR-Electrospray Ionization Mass Spectrometry - resultaten beschikbaar < 6 uur Blood cultures PCR/ EIMS + - Total Sens 81% Spec 69% PPV 24% Total NPV 97% Sputum culture PCR/ EIMS + - Total Sens 84% Spec 53% PPV 58% Total NPV 81% Vincent JL. Crit Care Med 2015;43:

23 Antibiotic stewardship Rapid identification of patients with bacterial sepsis Better empirical treatment selection Optimized antibiotic dosing with PK-PD models De-escalation when culture result are available Shortening therapy duration

24 Initial antibiotic therapy Empirical broad-spectrum antibiotics based on available local antimicrobial susceptibility patterns, anticipated side effects and previously received antibiotics in the preceding 2 weeks Potential role of surveillance culture Often broad-spectrum β-lactam + amino glycoside

25 ARREST trial - adding rifampicine for S. Aureus bacteriamia 20 Placebo Rifampicin P = 0.81 P = 0.81 P = 0.01 P = 0.30 % N = Total events (composite) Failure Recurrence Death without either 14 D of rifampicine/placebo added to standard therapy Thwaites GE. Lancet 2018;391:

26 Effects of cycling or mixing of antibiotics on antibiotic resistance Mixing Hospital A B C D E F G H Sample Cycling N = months periods Prevalence (%) Week number Week number No difference in all cause mortality No effect on antibiotic resistance van Duijn PJ. Lancet Infect Dis 2018;18:

Successful stewardship in hospital settings

Successful 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 information

Appropriate antimicrobial therapy in HAP: What does this mean?

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,

More information

Antimicrobial de-escalation in the ICU

Antimicrobial de-escalation in the ICU Antimicrobial de-escalation in the ICU A FOCUS ON EVIDENCE-BASED STRATEGIES Dave Leedahl, PharmD, BCPS-AQ ID, BCCCP Pharmacy Clinical Manager Sanford Health Fargo, ND, USA I have no conflicts of interest

More information

Antimicrobial Cycling. Donald E Low University of Toronto

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

More information

Mono- versus Bitherapy for Management of HAP/VAP in the ICU

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,

More information

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 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 information

The International Collaborative Conference in Clinical Microbiology & Infectious Diseases

The 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 information

Responsible use of antibiotics

Responsible 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 information

Procalcitonin to Predict Septic Shock & Guide Antibiotic Therapy

Procalcitonin to Predict Septic Shock & Guide Antibiotic Therapy Procalcitonin to Predict Septic Shock & Guide Antibiotic Therapy William T. McGee, M.D. MHA, FCCM, FCCP Critical Care Medicine Associate Professor of Medicine and Surgery University of Massachusetts 759

More information

Methicillin-Resistant Staphylococcus aureus Nasal Swabs as a Tool in Antimicrobial Stewardship

Methicillin-Resistant Staphylococcus aureus Nasal Swabs as a Tool in Antimicrobial Stewardship Methicillin-Resistant Staphylococcus aureus Nasal Swabs as a Tool in Antimicrobial Stewardship Natalie R. Tucker, PharmD Antimicrobial Stewardship Pharmacist Tyson E. Dietrich, PharmD PGY2 Infectious Diseases

More information

Nosocomial Infections: What Are the Unmet Needs

Nosocomial Infections: What Are the Unmet Needs Nosocomial Infections: What Are the Unmet Needs Jean Chastre, MD Service de Réanimation Médicale Hôpital Pitié-Salpêtrière, AP-HP, Université Pierre et Marie Curie, Paris 6, France www.reamedpitie.com

More information

Multi-drug resistant microorganisms

Multi-drug resistant microorganisms Multi-drug resistant microorganisms Arzu TOPELI Director of MICU Hacettepe University Faculty of Medicine, Ankara-Turkey Council Member of WFSICCM Deaths in the US declined by 220 per 100,000 with the

More information

Combination vs Monotherapy for Gram Negative Septic Shock

Combination 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 information

Antimicrobial stewardship in managing septic patients

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

More information

The Use of Procalcitonin to Improve Antibiotic Stewardship

The Use of Procalcitonin to Improve Antibiotic Stewardship The Use of Procalcitonin to Improve Antibiotic Stewardship Disclosures I have no actual or potential conflict of interest in relation to this presentation. Patrick A. Laird, DNP, RN, ACNP-BC Objectives

More information

Dr Eleri Davies. Consultant Microbiologist and Infection Control Doctor, Public Health Wales NHS Trust

Dr Eleri Davies. Consultant Microbiologist and Infection Control Doctor, Public Health Wales NHS Trust Dr Eleri Davies Consultant Microbiologist and Infection Control Doctor, Public Health Wales NHS Trust Antimicrobial stewardship What is it? Why is it important? Treatment and management of catheter-associated

More information

Bacterial infections complicating cirrhosis

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

More information

SHC Clinical Pathway: HAP/VAP Flowchart

SHC 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 information

11/22/2016. Antimicrobial Stewardship Update Disclosures. Outline. No conflicts of interest to disclose

11/22/2016. Antimicrobial Stewardship Update Disclosures. Outline. No conflicts of interest to disclose Antimicrobial Stewardship Update 2016 APIC-CI Conference November 17 th, 2016 Jay R. McDonald, MD Chief, ID Section VA St. Louis Health Care System Assistant Professor of medicine Washington University

More information

UCSF guideline for management of suspected hospital-acquired or ventilatoracquired pneumonia in adult patients

UCSF 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 information

Antibiotic usage in nosocomial infections in hospitals. Dr. Birgit Ross Hospital Hygiene University Hospital Essen

Antibiotic usage in nosocomial infections in hospitals. Dr. Birgit Ross Hospital Hygiene University Hospital Essen Antibiotic usage in nosocomial infections in hospitals Dr. Birgit Ross Hospital Hygiene University Hospital Essen Infection control in healthcare settings - Isolation - Hand Hygiene - Environmental Hygiene

More information

Antimicrobial Stewardship

Antimicrobial Stewardship Antimicrobial Stewardship Background Why Antimicrobial Stewardship 30-50% of antibiotic use in hospitals are unnecessary or inappropriate Appropriate antimicrobial use is a medication-safety and patient-safety

More information

The challenge of growing resistance

The challenge of growing resistance EXECUTIVE SUMMARY Around 2.4 million people could die in Europe, North America and Australia between 2015-2050 due to superbug infections unless more is done to stem antibiotic resistance. However, three

More information

Advances in Antimicrobial Stewardship (AMS) at University Hospital Southampton

Advances in Antimicrobial Stewardship (AMS) at University Hospital Southampton Advances in Antimicrobial Stewardship (AMS) at University Hospital Southampton Dr Julian Sutton Consultant in Infectious Diseases & Medical Microbiology Federation of Infection Societies 1 st December,

More information

P< cells/µl mg/dl P<0.01 P<0.01

P< cells/µl mg/dl P<0.01 P<0.01 Technical Reports Judicious Use of s for Pediatric Infection Global Strategies to Prevent the Increase of Bacterial Resistance Kazunobu OUCHI Principle of antimicrobial therapy in children is to select

More information

OPTIMIZATION OF PK/PD OF ANTIBIOTICS FOR RESISTANT GRAM-NEGATIVE ORGANISMS

OPTIMIZATION 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 information

4/3/2017 CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA DISCLOSURE LEARNING OBJECTIVES

4/3/2017 CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA DISCLOSURE LEARNING OBJECTIVES CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA BILLIE BARTEL, PHARMD, BCCCP APRIL 7 TH, 2017 DISCLOSURE I have had no financial relationship over the past 12 months with any commercial

More information

Sepsis is the most common cause of death 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

More information

Appropriate 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 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 information

WHO s first global report on antibiotic resistance reveals serious, worldwide threat to public health

WHO s first global report on antibiotic resistance reveals serious, worldwide threat to public health New WHO report provides the most comprehensive picture of antibiotic resistance to date, with data from 114 countries 30 APRIL 2014 GENEVA - A new report by WHO its first to look at antimicrobial resistance,

More information

Antibiotic Stewardship in the Hospital Setting

Antibiotic Stewardship in the Hospital Setting Antibiotic Stewardship in the Hospital Setting G. Evans, MD FRCPC Medical Director, Infection Prevention & Control Kingston General Hospital & Hotel Dieu Hospital EOPIC September 26, 2012 Stewardship stew-ard-ship

More information

Antimicrobial stewardship: Quick, don t just do something! Stand there!

Antimicrobial 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 information

Cost high. acceptable. worst. best. acceptable. Cost low

Cost 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 information

Collecting and Interpreting Stewardship Data: Breakout Session

Collecting and Interpreting Stewardship Data: Breakout Session Collecting and Interpreting Stewardship Data: Breakout Session Michael S. Calderwood, MD, MPH Regional Hospital Epidemiologist, Dartmouth-Hitchcock Medical Center March 20, 2019 None Disclosures Outline

More information

Early Antibiotics for Sepsis and Septic Shock: A Gold Standard

Early Antibiotics for Sepsis and Septic Shock: A Gold Standard Early Antibiotics for Sepsis and Septic Shock: A Gold Standard Anand Kumar MD, FRCPC, FCCP, FCCM Professor of Medicine University of Manitoba Health Sciences Centre St. Boniface Hospital Winnipeg, Manitoba

More information

ESISTONO 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 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 information

AND MISCONCEPTIONS IN THE MANAGEMENT OF SEPSIS

AND MISCONCEPTIONS IN THE MANAGEMENT OF SEPSIS MYTHS AND MISCONCEPTIONS IN THE MANAGEMENT OF SEPSIS SEPSISMADE EASY SURVIVINGSEPSIS COOKBOOK SEPSIS ISAPIE MERVYN SINGER BLOOMSBURY INSTITUTE OF INTENSIVE CARE MEDICINE UNIVERSITY COLLEGE LONDON, UK DISCUSSION

More information

DOES TIMING OF ANTIBIOTICS IMPACT OUTCOME IN SEPSIS? Saravana Kumar MD HEAD,DEPT OF EM,DR MEHTA S HOSPITALS CHENNAI,INDIA

DOES TIMING OF ANTIBIOTICS IMPACT OUTCOME IN SEPSIS? Saravana Kumar MD HEAD,DEPT OF EM,DR MEHTA S HOSPITALS CHENNAI,INDIA DOES TIMING OF ANTIBIOTICS IMPACT OUTCOME IN SEPSIS? Saravana Kumar MD HEAD,DEPT OF EM,DR MEHTA S HOSPITALS CHENNAI,INDIA drsaravanakumar.ep@gmail.com JOINT SECRETARY RECOMMENDATIONS: INITIAL RESUSCITATION

More information

Reducing Antibiotic Exposure

Reducing Antibiotic Exposure Reducing Antibiotic Exposure B R A H M S PCT (Procalcitonin) sensitive KRYPTOR An Effective Tool for Antibiotic Stewardship and Assessing the Risk of Bacterial Infection B R A H M S PCT (Procalcitonin)

More information

Antimicrobial resistance (EARS-Net)

Antimicrobial resistance (EARS-Net) SURVEILLANCE REPORT Annual Epidemiological Report for 2014 Antimicrobial resistance (EARS-Net) Key facts Over the last four years (2011 to 2014), the percentages of Klebsiella pneumoniae resistant to fluoroquinolones,

More information

Responsible Antibiotic Use

Responsible Antibiotic Use Procalcitonin Levels to Promote Responsible Antibiotic Use Judy Neubrander, EdD, FNP-BC Western Carolina University School of Nursing Learning Objectives To understand the issues associated with the increase

More information

Does Early and Appropriate Antibiotic Administration Improve Mortality in Emergency Department Patients with Severe Sepsis or Septic Shock?

Does Early and Appropriate Antibiotic Administration Improve Mortality in Emergency Department Patients with Severe Sepsis or Septic Shock? References and Literature Grading Does Early and Appropriate Antibiotic Administration Improve Mortality in Emergency Department Patients with Severe Sepsis or Septic Shock? (9/6/2015) 1. Dellinger, R.P.,

More information

Impact of Antimicrobial Resistance on Human Health. Robert Cunney HSE HCAI/AMR Programme and Temple Street Children s University Hospital

Impact of Antimicrobial Resistance on Human Health. Robert Cunney HSE HCAI/AMR Programme and Temple Street Children s University Hospital Impact of Antimicrobial Resistance on Human Health Robert Cunney HSE HCAI/AMR Programme and Temple Street Children s University Hospital AMR in Foodchain Conference, UCD, Dec 2014 Sir Patrick Dun s Hospital

More information

Int.J.Curr.Microbiol.App.Sci (2017) 6(3):

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

More information

Duke 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 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 information

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 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 information

Stratégie et action européennes

Stratégie et action européennes Résistance aux antibiotiques : une impasse thérapeutique? Implications nationales et internationales Stratégie et action européennes Dominique L. Monnet, Senior Expert and Head of Disease Programme Antimicrobial

More information

Antibiotic resistance: the rise of the superbugs

Antibiotic resistance: the rise of the superbugs Antibiotic resistance: the rise of the superbugs Allen Cheng Associate Professor of Infectious Diseases Epidemiology, Alfred Health; Monash University About me Specialist in infectious diseases Head, Infection

More information

ETX2514SUL (sulbactam/etx2514) for the treatment of Acinetobacter baumannii infections

ETX2514SUL (sulbactam/etx2514) for the treatment of Acinetobacter baumannii infections ETX2514SUL (sulbactam/etx2514) for the treatment of Acinetobacter baumannii infections Robin Isaacs Chief Medical Officer, Entasis Therapeutics Dr. Isaacs is a full-time employee of Entasis Therapeutics.

More information

PCT GUIDED ANTIBIOTIC THERAPY FOR LRTI *

PCT GUIDED ANTIBIOTIC THERAPY FOR LRTI * BIOMÉRIEUX PCT GUIDED ANTIBIOTIC THERAPY FOR LRTI * Enhancing patient care Improving antibiotic stewardship * Lower Respiratory Tract Infections 34.3 Million Antibiotic prescriptions unnecessary 1 50%

More information

Reducing the Burden of Severe Sepsis and Infections in Indian ICUs

Reducing the Burden of Severe Sepsis and Infections in Indian ICUs Reducing the Burden of Severe Sepsis and Infections in Indian ICUs J.V. Divatia Professor & Head Department of Anaesthesia, Critical Care & Pain Tata Memorial Hospital Mumbai India Infections in the ICU

More information

Optimize Durations of Antimicrobial Therapy

Optimize 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 information

La sepsi Il ruolo dell antibiotico terapia

La sepsi Il ruolo dell antibiotico terapia Congresso Nazionale AcEMC Fermo 11-12 Maggio 2017 La sepsi Il ruolo dell antibiotico terapia Michele Bartoletti Infectious Disease Unit - Sant Orsola Hospital, Bologna, Italy Disclosures: none Epidemiology

More information

Optimizing Antibiotic Stewardship in the ED

Optimizing Antibiotic Stewardship in the ED Optimizing Antibiotic Stewardship in the ED Michael Pulia, MD MS FAAEM FACEP Director, UW EM Antibiotic Stewardship Research Program Chair, AAEM Antimicrobial Stewardship Task Force @DrMichaelPulia Learning

More information

Antibiotics in the future tense: The Application of Antibiotic Stewardship in Veterinary Medicine. Mike Apley Kansas State University

Antibiotics in the future tense: The Application of Antibiotic Stewardship in Veterinary Medicine. Mike Apley Kansas State University Antibiotics in the future tense: The Application of Antibiotic Stewardship in Veterinary Medicine Mike Apley Kansas State University Changes in Food Animal Antibiotic Use How the uses of antibiotics in

More information

Antibacterial Resistance: Research Efforts. Henry F. Chambers, MD Professor of Medicine University of California San Francisco

Antibacterial Resistance: Research Efforts. Henry F. Chambers, MD Professor of Medicine University of California San Francisco Antibacterial Resistance: Research Efforts Henry F. Chambers, MD Professor of Medicine University of California San Francisco Resistance Resistance Dose-Response Curve Antibiotic Exposure Anti-Resistance

More information

Summary of the latest data on antibiotic consumption in the European Union

Summary of the latest data on antibiotic consumption in the European Union Summary of the latest data on antibiotic consumption in the European Union ESAC-Net surveillance data November 2016 Provision of reliable and comparable national antimicrobial consumption data is a prerequisite

More information

Antibiotic 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. 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 information

Preventing Multi-Drug Resistant Organism (MDRO) Infections. For National Patient Safety Goal

Preventing Multi-Drug Resistant Organism (MDRO) Infections. For National Patient Safety Goal Preventing Multi-Drug Resistant Organism (MDRO) Infections For National Patient Safety Goal 07.03.01 2009 Methicillin Resistant Staphlococcus aureus (MRSA) About 3-8% of the population at large is a carrier

More information

2016 Updates to the Hospital Acquired- and Ventilator Associated-Pneumonia Guidelines

2016 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 information

CHAPTER: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 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 information

DETERMINANTS OF TARGET NON- ATTAINMENT IN CRITICALLY ILL PATIENTS RECEIVING β-lactams

DETERMINANTS OF TARGET NON- ATTAINMENT IN CRITICALLY ILL PATIENTS RECEIVING β-lactams DETERMINANTS OF TARGET NON- ATTAINMENT IN CRITICALLY ILL PATIENTS RECEIVING β-lactams Jan J. De Waele MD PhD Surgical ICU Ghent University Hospital Ghent, Belgium Disclosures Financial: consultancy for

More information

Taiwan Crit. Care Med.2009;10: %

Taiwan Crit. Care Med.2009;10: % 2008 30% 2008 2008 2004 813 386 07-346-8339 E-mail srwann@vghks.gov.tw 66 30% 2008 1 2008 2008 Intensive Care Med (2008)34:17-60 67 2 3 C activated protein C 4 5,6 65% JAMA 1995;273(2):117-23 Circulation,

More information

Sustaining an Antimicrobial Stewardship

Sustaining 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 information

Duration of antibiotic therapy:

Duration of antibiotic therapy: Duration of antibiotic therapy: How low can you go? Thomas Holland, MD Hilton Head, SC July 2017 Disclosures Consulting: The Medicines Company, Basilea Pharmaceutica Adjudication committee: Achaogen Grant

More information

Hospital ID: 831. Bourguiba Hospital. Tertiary hospital

Hospital ID: 831. Bourguiba Hospital. Tertiary hospital Global Point Prevalence Survey of Antimicrobial Consumption and Resistance in hospitals worldwide Hospital ID: 831 Habib Bourguiba Hospital Tertiary hospital Tunisia Point Prevalence Survey Habib 2017

More information

Vaccination as a potential strategy to combat Antimicrobial Resistance in the elderly

Vaccination 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 information

Antibiotic Stewardship. Matthew Dryden MD Hampshire Hospitals, Southampton University

Antibiotic Stewardship. Matthew Dryden MD Hampshire Hospitals, Southampton University Antibiotic Stewardship Matthew Dryden MD Hampshire Hospitals, Southampton University matthew.dryden@hhft.nhs.uk Overview The Problem What antibiotic have achieved Antibiotic stewardship Rapid diagnostics

More information

New Opportunities for Microbiology Labs to Add Value to Antimicrobial Stewardship Programs

New Opportunities for Microbiology Labs to Add Value to Antimicrobial Stewardship Programs New Opportunities for Microbiology Labs to Add Value to Antimicrobial Stewardship Programs Patrick R. Murray, PhD Senior Director, WW Scientific Affairs 2017 BD. BD, the BD Logo and all other trademarks

More information

Global Status of Antimicrobial Resistance with a Focus on Nepal

Global 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 information

WHO laboratory-based global survey on multidrug-resistant organisms (MDROs) in health care interim analysis

WHO laboratory-based global survey on multidrug-resistant organisms (MDROs) in health care interim analysis WHO laboratory-based global survey on multidrug-resistant organisms (MDROs) in health care interim analysis Aim: to estimate the burden of MDROs isolated among inpatients in a wide range of health-care

More information

ICU Volume 14 - Issue 4 - Winter 2014/ Matrix

ICU Volume 14 - Issue 4 - Winter 2014/ Matrix ICU Volume 14 - Issue 4 - Winter 2014/2015 - Matrix Antibiotic Management in the ICU Eleni Patrozou ******@***gmail.com Intensivist - Hygeia Hospital, Athens, Greece Infectious Diseases Division - Alpert

More information

Trea%ng Sepsis in 2016 Are the Big Guns Losing the War?

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

More information

Rise of Resistance: From MRSA to CRE

Rise of Resistance: From MRSA to CRE Rise of Resistance: From MRSA to CRE Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine SUPERBUGS (AKA MDROs) MRSA Methicillin-resistant S. aureus Evolution of Drug Resistance

More information

Rational management of community acquired infections

Rational 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 information

The contribution of a Procalcitonin test in patients with suspicion of infection

The contribution of a Procalcitonin test in patients with suspicion of infection The contribution of a Procalcitonin test in patients with suspicion of infection 1 Clinical questions: Patient presenting with clinical signs of potential infection: Is that of infectious origin? Is there

More information

«Antibiotic Stewardship» programmes & antibiotic resistance

«Antibiotic Stewardship» programmes & antibiotic resistance «Antibiotic Stewardship» programmes & antibiotic resistance Winfried V. Kern Abteilung Infektiologie Universitätsklinikum Freiburg www.if-freiburg.de Agenda Definition Healthcare quality & patient safety

More information

Summary of the latest data on antibiotic consumption in the European Union

Summary of the latest data on antibiotic consumption in the European Union Summary of the latest data on antibiotic consumption in the European Union November 2012 Highlights on antibiotic consumption Antibiotic use is one of the main factors responsible for the development and

More information

Epidemiology and Economics of Antibiotic Resistance

Epidemiology and Economics of Antibiotic Resistance Epidemiology and Economics of Antibiotic Resistance Eili Y. Klein February 17, 2016 Health Watch USA Meeting I. The burden of antibiotic resistance is a growing global threat, but hard numbers are lacking

More information

Get Smart For Healthcare

Get Smart For Healthcare Get Smart For Healthcare Know When Antibiotics Work Marry Bardin, Quality Improvement Advisor June 9, 2015 Why We Need to Improve In-patient Antibiotic Use Antibiotics are misused in hospitals Antibiotic

More information

EARS Net Report, Quarter

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

More information

GUIDE TO INFECTION CONTROL IN THE HOSPITAL. Antibiotic Resistance

GUIDE TO INFECTION CONTROL IN THE HOSPITAL. Antibiotic Resistance GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 4: Antibiotic Resistance Author M.P. Stevens, MD, MPH S. Mehtar, MD R.P. Wenzel, MD, MSc Chapter Editor Michelle Doll, MD, MPH Topic Outline Key Issues

More information

Evaluating the Role of MRSA Nasal Swabs

Evaluating 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 information

Antimicrobial Stewardship. Where are we now and where do we need to go?

Antimicrobial Stewardship. Where are we now and where do we need to go? Safe Patient Care Bugs and Drugs The ongoing challenge of MDROs and AMR 2017 @SPC2016Cork Antimicrobial Stewardship. Where are we now and where do we need to go? Frank O Riordan Antimicrobial pharmacist,

More information

Governance e sostenibilità nell antibioticoterapia. Anna Maria Cattelan UOC Malattie Infettive Azienda Ospedaliera Universitaria Padova

Governance e sostenibilità nell antibioticoterapia. Anna Maria Cattelan UOC Malattie Infettive Azienda Ospedaliera Universitaria Padova Governance e sostenibilità nell antibioticoterapia Anna Maria Cattelan UOC Malattie Infettive Azienda Ospedaliera Universitaria Padova 16 years ago, in an editorial in the first issue of The Lancet Infectious

More information

Antimicrobial Stewardship Programs The Same, but Different. Sara Nausheen, MD Kevin Kern, PharmD

Antimicrobial Stewardship Programs The Same, but Different. Sara Nausheen, MD Kevin Kern, PharmD Antimicrobial Stewardship Programs The Same, but Different Sara Nausheen, MD Kevin Kern, PharmD Antimicrobial Stewardship Programs The Same, but Different Objectives: Outline the overall function of an

More information

Antibiotics: Take a Time Out

Antibiotics: Take a Time Out Antibiotics: Take a Time Out Christine LaRocca, MD Telligen April 27, 2018 This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract

More information

MAGNITUDE OF ANTIMICROBIAL USE. Antimicrobial Stewardship in Acute and Long Term Healthcare Facilities: Design, Implementation and Challenges

MAGNITUDE OF ANTIMICROBIAL USE. Antimicrobial Stewardship in Acute and Long Term Healthcare Facilities: Design, Implementation and Challenges Antimicrobial Stewardship in Acute and Long Term Healthcare Facilities: Design, Implementation and Challenges John A. Jernigan, MD, MS Division of Healthcare Quality Promotion Centers for Disease Control

More information

DR. MICHAEL A. BORG DIRECTOR OF INFECTION PREVENTION & CONTROL MATER DEI HOSPITAL - MALTA

DR. MICHAEL A. BORG DIRECTOR OF INFECTION PREVENTION & CONTROL MATER DEI HOSPITAL - MALTA DR. MICHAEL A. BORG DIRECTOR OF INFECTION PREVENTION & CONTROL MATER DEI HOSPITAL - MALTA The good old days The dread (of) infections that used to rage through the whole communities is muted Their retreat

More information

High Risk Emergency Medicine. Antibiotic Pitfalls

High Risk Emergency Medicine. Antibiotic Pitfalls High Risk Emergency Medicine Antibiotic Pitfalls David, MD MS Assistant Professor Department of Emergency Medicine University of California, San Francisco I. Antibiotic Resistance Development of resistance

More information

What is the problem? Latest data on antibiotic resistance

What is the problem? Latest data on antibiotic resistance European Antibiotic Awareness Day 2009 What is the problem? Latest data on antibiotic resistance Zsuzsanna Jakab, ECDC Director Launch Seminar for EAAD Stockholm, 18 November 2009 Fluoroquinolone-resistant

More information

Sepsis. ...striking a balance. Dr Ron Daniels.

Sepsis. ...striking a balance. Dr Ron Daniels. Sepsis...striking a balance Dr Ron Daniels Fellow: NHS Improvement Faculty Chair: United Kingdom Sepsis Group, Sepsis Trust & UK SSC Sepsis as a Global Emergency Committee, Global Sepsis Alliance Midland

More information

How is Ireland performing on antibiotic prescribing?

How is Ireland performing on antibiotic prescribing? European Antibiotic Awareness Campaign 2016 November Webinar Series on Antibiotic Prescribing How is Ireland performing on antibiotic prescribing? Dr Rob Cunney National Clinical Lead HCAI AMR Clinical

More information

NUOVE IPOTESI e MODELLI di STEWARDSHIP

NUOVE IPOTESI e MODELLI di STEWARDSHIP Esperienze di successo di antimicrobial stewardship Bologna, 18 novembre 2014 NUOVE IPOTESI e MODELLI di STEWARDSHIP Pierluigi Viale Clinica di Malattie Infettive Policlinico S. Orsola Malpighi Interventions

More information

Management of Hospital-acquired Pneumonia

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

More information

2017 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 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 information

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 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 information

Scottish Medicines Consortium

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

More information

Treatment Guidelines and Outcomes of Hospital- Acquired and Ventilator-Associated Pneumonia

Treatment Guidelines and Outcomes of Hospital- Acquired and Ventilator-Associated Pneumonia SUPPLEMENT ARTICLE Treatment Guidelines and Outcomes of Hospital- Acquired and Ventilator-Associated Pneumonia Antoni Torres, Miquel Ferrer, and Joan Ramón Badia Pneumology Department, Clinic Institute

More information

Fighting MDR Pathogens in the ICU

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

More information