Outcome of acute prosthetic joint infections due to gram-negative bacilli. treated with open débridement and retention of the prosthesis
|
|
- Virgil Berry
- 6 years ago
- Views:
Transcription
1 AAC Accepts, published online ahead of print on 17 August 2009 Antimicrob. Agents Chemother. doi: /aac Copyright 2009, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved. Outcome of acute prosthetic joint infections due to gram-negative bacilli treated with open débridement and retention of the prosthesis Nº de AACh AAC , Version 4 Juan C. Martínez-Pastor 1, Ernesto Muñoz-Mahamud 1, Félix Vilchez 1, Sebastián García- Ramiro 1, Guillem Bori 1, Josep Sierra 2, José A Martínez 2, Lluis Font 1, Josep Mensa 2, and Alex Soriano 2. 1 Department of Orthopaedics of Hospital Clinic of Barcelona. 2 Department of Infectious Diseases of Hospital Clínic of Barcelona. Hospital Clínic Universitari. IDIBAPS. Barcelona. Running title: Prosthetic infection by Gram-negative bacilli. Keywords: prosthetic joint infection, gram-negative bacilli, outcome, open débridement. Correspondence to: Dr. Alex Soriano Department of Infectious Diseases. Hospital Clínic of Barcelona. C/ Villarroel 170. Barcelona asoriano@clinic.ub.es Phone number: Fax:
2 Abstract Background: the aim of our study was to evaluate the outcome of acute prosthetic joint infections (PJI) due to Gram-negative bacilli (GNB) treated without implant removal. Methods: patients with an acute PJI due to GNB diagnosed from 2000 to 2007 were prospectively registered. Demographics, co-morbidity, type of implant, microbiology data, surgical treatment, antimicrobial therapy and outcome were recorded. CART analysis, Kaplan-Meier survival method and Cox regression model were applied. Results: 47 patients were included. Mean age was 70.7 years, there were 15 hip and 32 knee prostheses. The median number of days from arthroplasty was 20. The most frequent pathogens were Enterobacteriaceae in 41 cases and Pseudomonas in 20. Among the Enterobacteriaceae, 14 were resistant to ciprofloxacin, while all P. aeruginosa were susceptible. The median duration of intravenous and oral antibiotics was 14 and 64 days, respectively. A total of 35 (74.5%) patients were in remission after a median (IQR) followup of 463 ( ) days. Using a Kaplan-Meier survival curve, a C-reactive protein (CRP) 15 mg/dl (p=0.03) and to receipt of a fluoroquinolone, when all the isolated Gramnegatives were susceptible (p=0.0009), were associated with a better outcome. In a Cox regression model, CRP 15 mg/dl (OR:3.57, CI95%: , p=0.043) and receiving a fluoroquinolone (OR:9.09, CI95%: , p=0.005) were independently associated with a better outcome. Conclusion: open débridement without removing the implant had a success rate of 74.5% and factors associated with good prognosis were a CRP at the time of diagnosis 15 mg/dl and treatment with a fluoroquinolone.
3 Introduction Acute postoperative prosthetic joint infection is an uncommon but severe complication after joint arthroplasty. The infection rate is 1-3% and the most frequently isolated microorganisms are Gram positive cocci, including Staphylococcus aureus, coagulasenegative staphylococci and Streptococcus spp (12). However, it is of note that Gramnegative bacilli (GNB) are isolated in 10% of cases of PJI and frequently these infections are polymicrobial (9). The success rate in staphylococcal acute prosthetic joint infections treated with open débridement without implant removal and a prolonged course of antibiotics is higher than 75% (2,13,17). However, the experience using the same surgical and antibiotic treatment in infections due to Gram-negative bacilli is scarce (3,8). In addition, a major concern associated with prosthetic joint infections due to GNB is the emergence of resistant strains to many antibiotics and the lack of alternatives (15). The aims of the present study were to review our experience in acute prosthetic joint infections due to GNB treated with open débridement and retention of the implant followed by antibiotic treatment and to analyse those factors associated with outcome.
4 Patients and methods From January 2000 to December 2007 all patients with a prosthetic joint infection (hip hemiarthroplasty, total hip and knee arthroplasty) were prospectively registered in a database and retrospectively reviewed. All patients were treated in the same hospital in the bone and joint infection unit that includes orthopedic surgeons and infectious diseases specialists. Relevant information about demographics, co-morbidity, type of implant (hip or knee prosthesis), clinical manifestations, leukocyte count, value of C-reactive protein (CRP) at the time of admission for infection, surgical treatment, isolated microorganism, antimicrobial therapy and outcome were recorded. In the present study, only those cases with an acute, mono or polymicrobial prosthetic joint infection due to GNB were included. Acute prosthetic joint infection due to GNB in the present study was defined by the presence of local inflammation of acute onset (<15 days of symptoms duration), macroscopic evidence of extension of the infection through the capsule during open débridement and isolation of GNB in deep samples. Infections were classified as follows: 1) postoperative infections were those diagnosed within the 90 days after joint arthroplasty and 2) haematogenous infections those that represent haematogenous seeding of the joint from another primary site with no previous prosthesis dysfunction. In terms of débridement, pre-existing incisions were always used, necrotic tissue was excised and the joint was washed out with 6 litters of sterile water. The components were left in situ after confirming at the time of surgery that there were no signs of loosening. In knee arthroplasties the polyethylene component was removed and replaced by a new component, while in total hip arthroplasties the polyethylene, as well as the femoral head when possible, were substituted. Only when systemic or local signs of infection persisted after débridement, the patients were taken back to the operating room for repeating the
5 irrigation. When this was performed within the week after the first débridement, it was not considered as failure. At least three deep samples of synovial fluid or periprosthetic tissue were submitted to the microbiology laboratory. Synovial fluid was aspirated and 50% inoculated into aerobic and 50% into anaerobic blood culture flasks (BACTEC 9240 system, BD Diagnostic Systems). The volume inoculated in each flask was approximately 1-3 ml. Solid samples from periprosthetic tissue were taken and placed into sterile containers. Finally, swab cultures were obtained by passing a sterile swab over intracapsular area, bone or fluid and immediately keep in transport medium (AMIES transport medium). Each culture was transported, processed and analysed in the Microbiology laboratory. Blood culture flasks containing the aspirated synovial fluid were incubated in the BACTEC 9240 system up to 5 days (5). Positive cultures were Gram stained and the microorganisms were identified by conventional microbiological methods. The periprosthetic tissue and swabs were cultured in Thioglicolate broth, blood agar in aerobic conditions and Schaedler agar (in anaerobic conditions). All samples were incubated up to five days. Positive cultures were re-grown in an appropriated media. All isolated microorganisms were identified with standard biochemical procedures. In addition, blood cultures were performed to patients with fever at the moment of admission for infection. An antibiogram for all the isolates was performed by the microdilution method. After open débridement, a broad-spectrum intravenous antimicrobial regimen including vancomycin 1g/12h (monitored to attain a trough concentration of 15 mg/l) plus ceftazidime 2g/8h was started and maintained until obtaining definitive microbiological results. Intravenous antibiotics for GNB susceptible to third generation cephalosporins were ceftriaxone 1 g/24h or cefotaxime 2 g/6h, for ESBL-enterobacteriaceae imipenem 1g/8h or meropenem 1g/8h, for P. aeruginosa ceftazidime 2g/6h plus ciprofloxacin 400 mg/12-8h.
6 Oral antibiotics were ciprofloxacin 750 mg/12h or levofloxacin 500 mg/24h for fluoroquinolone-susceptible Gram-negatives, ceftibuten 400 mg/24h, cotrimoxazole 800 mg/12h or amoxiclavulanate 875/125 mg/8h for fluoroquinolone-resistant Gram-negatives. For staphylococci and streptococci, patients received levofloxacin, cotrimoxazole or linezolid 600 mg/12h according to the antibiogram, associated with rifampin 600 mg/24h. For enterococci patients received amoxicillin 1 g/8h or linezolid according to the antibiogram. The dosages were adjusted according to renal function. The duration of intravenous and oral antibiotics was not standardized and this was decided according to the clinical manifestations and the CRP values of each case. After being discharged, the patients were followed-up monthly while they were on treatment. Once the treatment was finished they were followed-up every 3 months where clinical response and secondary effects of the antimicrobial therapy were recorded. Outcome was evaluated according to the following definitions: 1) remission: when the patient showed no symptoms of infection, the prosthesis was retained and CRP values were lower than 1 mg/dl, and 2) failure: when inflammatory signs and high CRP values remained during the treatment or re-appeared after having completed it (relapse or re-infection depending on the isolated microorganism). Statistical analysis Continuous variables were expressed as mean and standard deviation (SD) or median and interquartile range (IQR). Continuous variables were: age, time from arthroplasty to diagnosis of infection (age of implant), leukocyte count, duration of intravenous and oral antibiotic. Categorical variables were: sex, co-morbidity (having or not having one or more of the following entities: diabetes mellitus, liver cirrhosis, chronic renal failure, rheumatoid
7 arthritis or chronic obstructive pulmonary disease), type of infection (post-surgical or haematogenous), type of prosthesis (hip or knee), positive blood cultures, the need of a second débridement, polymicrobial infection, infection due to Pseudomonas spp and antibiotic treatment. Continuous variables were compared using U-Mann-Whitney test and comparison of proportions was made using χ 2 test or Fisher exact test when necessary. Continuous and categorical variables were analysed using Classification and Regression Tree Analysis (CART) to identify predictors of outcome and useful breakpoints of continuous variables. The Kaplan-Meier survival method was used to estimate the cumulative probability of treatment failure from open débridement to the last visit. Log Rank test was applied to evaluate the influence of each variable. A Cox regression model was applied to identify the independent variables associated with failure after open débridement. Only those variables with significantly higher cumulative probability of failure in the Kaplan-Meier curve were included in the Cox regression model. Statistical significance was defined as a two-tailed p value < The analysis was done by the program SPSS (version 12.0; SPSS, Inc., Chicago, IL, U.S.A.) and CART software (Salford Systems, version 6.0, San Diego, CA, U.S.A.).
8 Results During the study period, a total of 47 patients met the inclusion criteria of the study. The main characteristics of the patients according to the outcome are summarized in table 1. Mean (SD) age was 70.7 (11.3) years, there were 15 hip prosthesis and 32 knee prosthesis. The median (IQR) number of days from arthroplasty to the diagnosis of the infection was 20 (16-28) days. There were 44 acute post-surgical deep infections with a median (IQR) number of days from arthroplasty of 19 ( ) and 3 haematogenous with 168, 673 and 682 days from arthroplasty, respectively. Gram-negative bacilli and their main traits of resistance are listed in table 2. The most common isolates were Enterobacteriaceae in 41 cases (Escherichia coli in 20) and Pseudomonas aeruginosa in 19. There were 28 polymicrobial infections (59.5%), 10 due to more than one Gram-negative bacillus and 18 due to a mixed infection including Gram-negative bacilli and Gram-positive cocci (table 3). In 21 out of 28 polymicrobial infections 2 different microorganisms were isolated, in 7 cases 2 different Gram-negatives and in 14 a Gram-negative and a Gram-positive. In the rest of polymicrobial infections (7 cases), 3 different microorganisms were identified, in 3 cases 3 different Gram-negatives, in 3 two different Gram-negatives and a Gram-positive and in 1 case one Gram-negative and two different Gram-positives. Among Enterobacteriaceae, 14 were resistant to ciprofloxacin, 8 extended spectrum beta-lactamase (ESBL) and 1 chromosomal beta-lactamase (AmpC) producers. All P. aeruginosa were susceptible to ciprofloxacin. Including B. fragilis, 13 patients had an infection due to a fluoroquinolone-resistant Gram-negative bacillus and they were associated with poor outcome (table 1). The median (IQR) duration of intravenous and oral antibiotics was 14 (8-24) and 64 ( ) days, respectively. Intravenous antibiotic regimens were a beta-lactam (n=24), a
9 beta-lactam with activity against P. aeruginosa plus ciprofloxacin (n=17) and ciprofloxacin alone (n=6). Fluoroquinolones (ciprofloxacin or levofloxacin) were the definitive antibiotic treatment in 35 cases. Among these patients, 28 had an infection due to fluorquinolonesusceptible Gram-negatives while the other 7 had susceptible and resistant Gram-negatives and they received other antibiotics (cotrimoxazole in 5 and amoxiclavulanate in 2 cases) in addition to fluoroquinolones. Among the 12 patients that did not receive fluorquinolones, all of them received an intravenous betalactam and 8 switched to oral therapy with cotrimoxazole in 6 cases, and ceftibuten and amoxiclavulanate in one case each. Those patients with an infection due to a fluorquinolone-susceptible Gram-negative who received a fluorquinolone (n=28), had a high success rate (26 out of 28, 92.8%) (table 1). A total of 35 (74.5%) patients were in remission after a median (IQR and range) follow-up of 463 ( and ) days after open débridement. There were 12 (24.5%) failures, 9 relapses, 2 reinfections and one case was not possible to classify because no microorganism was identified. Among relapses, in 8 cases the same Gram-negative bacilli of the index infection was isolated, E. coli in 6 cases (4 ESBL-producers), B. fragilis and E. cloacae in 1 case each. The other relapse was due to the Gram-positive component (coagulase-negative staphylococci) of the index infection. Reinfections were due to S. aureus and coagulase-negative staphylococci. Although P. aeruginosa was part of the flora identified in the index infection of 4 out of 12 failures, in no one case this microorganism was the cause of relapse. CART model only identified the C-reactive protein value as a predictor of outcome and the breakpoint to delineate the failure risk was 15 mg/dl. Using the Kaplan-Meier survival curve a C-reactive protein (CRP) 15 mg/dl (p=0.03) and receiving a fluoroquinolone, when all the isolated Gram-negatives were susceptible (p=0.0009), were associated with a
10 better outcome (figure 1 and 2). There were infections due to more than 1 GNB with different susceptibilities to fluoroquinolones and treatment with fluoroquinolones indeed showed a trend towards a better outcome but it was not significant (p=0.13, table 1). In the Cox regression model, including significant variables in univariate analysis (table 1), a CRP 15 mg/dl (OR:3.57, CI95%: , p=0.043) and receipt of a fluoroquinolone, when all the isolated Gram-negatives were susceptible (OR:9.09, CI95%: , p=0.005), were independently associated with a better outcome. Having an infection due to a fluoroquinolone-resistant strain was not an independent predictor of failure. Among patients with a CRP 15 mg/dl, those that received a fluoroquinolone when all the isolated strains were susceptible to ciprofloxacin had a remission rate of 95.4% (21 out of 22) while those with resistant strains or who did not receive a fluoroquinolone had a remission rate of 61.5% (8 out of 13). In addition, among patients with a CRP >15 mg/dl, those that received a fluoroquinolone when all the isolated strains were susceptible to ciprofloxacin had a remission rate of 83.3% (5 out of 6) while those with resistant strains or who did not receive a fluoroquinolone had a remission rate of only 16.7% (1 out of 6) (table 4).
11 Discussion The present study suggests that open débridement with retention of the implant followed by antibiotic treatment is a good option in acute prosthetic joint infections due to GNB. The success rate was 74.5%, similar to that reported by other authors in acute prosthetic joint infections due to staphylococci (2,4,7,13). A CRP 15 mg/dl and treatment with a fluoroquinolone when all the isolated GNB were susceptible to fluoroquinolones were factors independently associated with a better outcome. In fact, patients that received a fluoroquinolone when all the isolated strains were susceptible had a remission rate higher than 90% (26 out of 28). Previous published clinical experience with a similar therapeutic approach is scarce but supports the efficacy of fluoroquinolones. Brouqui et al (3), using a combination of ceftazidime and ciprofloxacin, cured nine osteosynthetic devices and four out of five prosthetic joint infections due to P. aeruginosa. Recently, Legout et al (8) reviewed their experience without removing the implant in 12 patients with an orthopaedic device infection (internal fixation or joint prosthesis) due to a Gram-negative bacilli. Antibiotic treatment consisted of intravenous cefepime for 4 weeks combined with oral ofloxacin or ciprofloxacin for 3 to 9 months and the cure rate was 67% (8 out of 12). The efficacy of fluoroquinolones in the treatment of implant infections and osteomyelitis due to Gram-negative bacilli is probably due to 2 facts: 1) their diffusion to synovial fluid and bone (11) and 2) their activity against biofilms. In an in vitro model of Pseudomonas biofilm, Tanaka et al (14) showed that the bactericidal action of beta-lactams against biofilm cells was affected by the low cell growth rate inside the biofilm, while that of fluoroquinolones was considerably greater and independent from the growth rate. Unfortunately, 14 out of 43 (32.5%) Enterobacteriaceae isolated in our study were resistant to ciprofloxacin. In addition, 8 prosthetic joint infections were due to ESBL-
12 Enterobacteriaceae producers, to our knowledge the first description of these pathogens as a cause of prosthetic joint infections, with a cure rate of only 50%. The activity of tigecycline against in vitro Gram-negative biofilms (Acinetobacter baumanii and Klebsiella pneumoniae) was evaluated in a previous study (1) and it was lower than in Gram-positive biofilms (6,10), however, there was an considerable synergism between N-acetylcisteine and tigecycline. In the future, it is necessary to evaluate new strategies to treat implantrelated infections due to Gram-negative bacilli. The duration of antimicrobial therapy in acute prosthetic joint infections has not been well established. Based on expert opinion, duration of 3-6 months is recommended (16). In our protocol, antibiotic therapy is maintained until clinical resolution of infectious symptoms and normalization of CRP. We have obtained good results using this protocol, most especially when a fluoroquinolone was administered. More than 60% of the infections in our study were polymicrobial and although it might seem a high rate, a recent article from Oxford (9) described 12 acute infections due to GNB and 8 (66.6%) were polymicrobial. In fact, in that study 47% of acute prosthetic joint infections were polymicrobial. The suggested duration of follow-up in prosthetic joint infections is at least 2 years based on experiences where the major pathogens were Gram-positives. A drawback of our study was that only 40% of our patients reach a 2-year follow-up, however, data about the outcome and natural history in prosthetic joint infections due to Gram-negatives is scarce and, in fact, this is the largest reported series of patients treated with conservative surgery and antimicrobial therapy. However, the small sample size implies limited statistical power and the conclusions should be interpreted with caution. Other drawback from our study was that the antimicrobial therapy was not randomized, but it was administered according to the
13 susceptibility pattern of the isolated microorganisms. The design of clinical trials in these infections is difficult and for this reason it is necessary to progress from observational cohort studies. In conclusion, open débridement without removing the implant in acute PJI due to Gramnegative bacilli had a success rate of 74.5%. Factors associated with good prognosis were a CRP at the moment of diagnosis 15 mg/dl and treatment with a fluoroquinolone when all the strains isolated were susceptible to ciprofloxacin. In the future, it will be necessary to evaluate new therapeutic strategies for those infections due to fluoroquinolone-resistant strains.
14 Acknowledgements: REIPI, Red Española para la Investigación en Patología Infecciosa. Potential conflict of interest: at the time of publication none of the authors disclosed any potential conflicts of interest.
15 REFERENCES 1. Aslam S, Trautner BW, Ramanathan V et al Combination of tigecycline and N-acetylcysteine reduces biofilm-embedded bacteria on vascular catheters. Antimicrob Agents Chemother. 51: Barberan J, Aguilar L, Carroquino G et al Conservative treatment of staphylococcal prosthetic joint infections in elderly patients. Am J Med. 119: Brouqui P, Rousseau MC, Stein A et al Treatment of Pseudomonas aeruginosa-infected orthopedic prostheses with ceftazidime-ciprofloxacin antibiotic combination. Antimicrob Agents Chemother. 39: Giulieri SG, Graber P, Ochsner PE et al Management of infection associated with total hip arthroplasty according to a treatment algorithm. Infection. 32: Hughes JG, Vetter EA, Patel R et al Culture with BACTEC Peds Plus/F bottle compared with conventional methods for detection of bacteria in synovial fluid. J Clin Microbiol. 39:
16 6. Labthavikul P, Petersen PJ, Bradford PA In vitro activity of tigecycline against Staphylococcus epidermidis growing in an adherent-cell biofilm model. Antimicrob Agents Chemother. 47: Laffer RR, Graber P, Ochsner PE et al Outcome of prosthetic kneeassociated infection: evaluation of 40 consecutive episodes at a single centre. Clin Microbiol Infect. 12: Legout L, Senneville E, Stern R et al Treatment of bone and joint infections caused by Gram-negative bacilli with a cefepime-fluoroquinolone combination. Clin Microbiol Infect. 12: Moran E, Masters S, Berendt AR et al Guiding empirical antibiotic therapy in orthopaedics: The microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention. J Infect. 55: Raad I, Hanna H, Jiang Y et al Comparative Activities of Daptomycin, Linezolid, and Tigecycline against Catheter-Related Methicillin-Resistant Staphylococcus Bacteremic Isolates Embedded in Biofilm. Antimicrob Agents Chemother. 51: Rimmele T, Boselli E, Breilh D et al Diffusion of levofloxacin into bone and synovial tissues. J Antimicrob Chemother. 53:
17 12. Soriano A, Bori G, Garcia-Ramiro S et al Timing of antibiotic prophylaxis for primary total knee arthroplasty performed during ischemia. Clin Infect Dis. 46: Soriano A, Garcia S, Bori G et al Treatment of acute post-surgical infection of joint arthroplasty. Clin Microbiol Infect. 12: Tanaka G, Shigeta M, Komatsuzawa H et al Effect of the growth rate of Pseudomonas aeruginosa biofilms on the susceptibility to antimicrobial agents: betalactams and fluoroquinolones. Chemotherapy. 45: Wenzel RP The antibiotic pipeline--challenges, costs, and values. N Engl J Med. 351: Zimmerli W, Trampuz A, Ochsner PE Prosthetic-joint infections. N Engl J Med. 351: Zimmerli W, Widmer AF, Blatter M et al Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. JAMA. 279:
18 Table 1. Characteristics of patients according to the outcome. Characteristics Failure Remission (n=12)* (n=35) Median (IQR) of age (years) 71 ( ) 75 (63-79) 0.96 Sex (female) 7 (58.3) 24 (68.3) 0.37 Comorbidity # 6 (50) 15 (42.9) 0.46 Type of prosthesis Hip Knee 4 (33.5) 8 (66.7) 11 (31.4) 24 (68.6) 0.58 Median (IQR) of age of prosthesis 19 ( ) 21 (13-31) 0.71 (days) Type of infection Post-surgical Haematogeneous (91.4) 3 (8.6) 0.40 Median (IQR) of Leukocyte count 8750 ( ( (cells/mm 3 ) 11122) 10417) Median (IQR) of C-reactive protein 11.4 ( ( (mg/dl) 21.4) 12.9) C-reactive protein > 15 mg/dl 6 (50) 6 (17.1) 0.03 Bacteremia 0 4 (11.4) 0.29 Polymicrobial infection 7 (58.3) 21 (60) 0.59
19 Mixed infection with Gram positives 3 (25) 15 (42.9) 0.32 Infection due to Pseudomonas spp & 4 (33.5) 16 (45.7) 0.34 Infection due to fluoroquinoloneresistant strain 8 (66.7) 5 (14.3) Infection due to an ESBL- 4 (33.3) 4 (11.4) 0.17 Enterobacteriaceae Need of a 2 on débridement 3 (25) 4 (11.4) 0.24 Median (IQR) of antibiotic therapy (oral and intravenous) duration (days) 84.5 ( (47-135) ) Median (IQR) duration of oral 95 ( ( antibiotic therapy (days) $ 165.2) 101.5) Treatment with fluoroquinolones 7 (58.3) 28 (80) 0.13 Treatment with fluoroquinolones when all isolated GNB were susceptible 2 (16.7) 26 (74.3) GNB: Gram-negative bacilli. ESBL, extended spectrum beta-lactamase producer. * Including relapse and U Mann-Whitney test, Chi-square test or Fisher exact test when necessary. # Diabetes mellitus, liver cirrhosis, chronic renal failure, rheumatoid arthritis or chronic obstructive pulmonary disease. & P. aeruginosa in 19 cases and P. stutzeri in 1. $ The information is referred to those patients that received oral antibiotics (n=41).
20 Table 2. Gram-negative bacilli isolated from deep peri-prosthetic samples of either monomicrobial and polymicrobial infections. Microorganism Number (%) Gram-negative bacilli 63 Enterobacteriaceae 41 (65) Escherichia coli Resistant to ciprofloxacin ESBL-producer* AmpC-producer* Proteus mirabilis Resistant to ciprofloxacin Enterobacter cloacae Resistant to ciprofloxacin Klebsiella pneumonia Resistant to ciprofloxacin and ESBL-producer Other Enterobacteriaceae # Resistant to ciprofloxacin 20 (48.8) (19.5) 2 7 (17) 0 2 (4.9) 1 4 (9.5) 1 Non-fermenter Gram-negative bacilli 21 (33.3) Pseudomonas aeruginosa Resistant to ciprofloxacin Other non-fermenters $ Resistant to ciprofloxacin 19 (90.4) 0 2 (9.6) 0 Anaerobes 1 (1.6)
21 Bacteroides fragilis 1 GNB, Gram-negative bacilli. The number of microorganisms isolated was higher than the number of patients due to polymicrobial infections. * 5 ESBL-producers and the AMPc-producer were resistant to ciprofloxacin. # Citrobacter diversus, Serratia marcescens, Providencia rettgeri, Morganella morgagnii. $ Pseudomonas stutzeri, Acinetobacter baumanii.
22 Table 3. Other pathogens isolated in polymicrobial infections. Microorganism Number (%) Gram-positive cocci * 19 Coagulase-negative staphylococci 8 (42.1) Staphylococcus aureus 3 (15.8) Enterococcus faecalis 6 (31.6) Streptococcus viridans 1 (5.2) Streptococcus agalactiae 1 (5.2) * The number of patients with a polymicrobial infection including Gram-negatives and Gram-positives was 18 (see text), but the total number of Gram-positives was 19 because in one patient 2 different Gram-positives were isolated.
23 Table 4. Outcome according to the value of C-reactive protein and the antimicrobial therapy received. Value of CRP Failure, Remission, P* n=12 (%) n=35 (%) 15 mg/dl - no fluoroquinolone or resistant strain (n=13) 5 (83.3) 8 (27.6) - fluoroquinolone (n=22) > 15 mg/dl - no fluoroquinolone or resistant strain (n=11) - fluoroquinolone (n=12) 1 (16.7) 5 (83.3) 1 (16.7) 21 (72.4) (16.7) 5 (83.3) 0.04 * Fisher exact test.
24 Figure 1. Cumulative probability of survival (free of failure) according to the C-reactive protein value at the time of admission for infection. % free of failure acum CRP 15 mg/dl CRP > 15 mg/dl Log Rank test, p= Follow-up from open débridement (days)
25 Figure 2. Cumulative probability of survival (free of failure) according to receipt of a fluoroquinolone when isolates were susceptible or non-receipt a fluoroquinolone or receipt of a fluoroquinolone it when at least 1 isolate was resistant to ciprofloxacin. % free of failure Fluoroquinolone Non-fluoroquinolone or resistant isolate Log Rank test, p= Follow-up from open débridement (days)
Outcome of Acute Prosthetic Joint Infections Due to Gram-Negative Bacilli Treated with Open Debridement and Retention of the Prosthesis
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Nov. 2009, p. 4772 4777 Vol. 53, No. 11 0066-4804/09/$12.00 doi:10.1128/aac.00188-09 Copyright 2009, American Society for Microbiology. All Rights Reserved. Outcome
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 information2012 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 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 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 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 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 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 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 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 informationIntrinsic, implied and default resistance
Appendix A Intrinsic, implied and default resistance Magiorakos et al. [1] and CLSI [2] are our primary sources of information on intrinsic resistance. Sanford et al. [3] and Gilbert et al. [4] have been
More informationIn Vitro Antimicrobial Activity of CP-99,219, a Novel Azabicyclo-Naphthyridone
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Feb. 993, p. 39-353 0066-0/93/0039-05$0.00/0 Copyright 993, American Society for Microbiology Vol. 37, No. In Vitro Antimicrobial Activity of, a Novel Azabicyclo-Naphthyridone
More informationDrug Class Prior Authorization Criteria Intravenous Antibiotics
Drug Class Prior Authorization Criteria Intravenous Antibiotics Line of Business: Medicaid P&T Approval Date: August 15, 2018 Effective Date: October 1, 2018 This drug class prior authorization criteria
More informationFull Title of Guideline. Author: Contact Name and Job Title. Division & Speciality. Review date December 2020
Full Title of Guideline Author: Contact Name and Job Title Division & Speciality Guideline for the treatment of prosthetic joint infections in adults Mr Peter James - Consultant Orthopaedic Surgeon Dr
More informationBACTERIAL SUSCEPTIBILITY REPORT: 2016 (January 2016 December 2016)
BACTERIAL SUSCEPTIBILITY REPORT: 2016 (January 2016 December 2016) VA Palo Alto Health Care System April 14, 2017 Trisha Nakasone, PharmD, Pharmacy Service Russell Ryono, PharmD, Public Health Surveillance
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 informationmicrobiology testing services
microbiology testing services You already know Spectra Laboratories for a wide array of dialysis-related testing services. Now get to know us for your microbiology needs. As the leading provider of renal-specific
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 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 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 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 informationPocket Guide to Diagnosis & Treatment of Cardiovascular Implantable Electronic Device (CIED) Infections
Pocket Guide to Diagsis & Treatment of Cardiovascular Implantable Electronic Device (CIED) Infections Draft Version : November 208 DEFINITION Pocket infection, if all 4 criteria are fulfilled: Investigation/sign
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 informationThe β- Lactam Antibiotics. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018
The β- Lactam Antibiotics Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018 Penicillins. Cephalosporins. Carbapenems. Monobactams. The β- Lactam Antibiotics 2 3 How
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 informationEpidemiology and Microbiology of Surgical Wound Infections
JOURNAL OF CLINICAL MICROBIOLOGY, Feb. 2000, p. 918 922 Vol. 38, No. 2 0095-1137/00/$04.00 0 Copyright 2000, American Society for Microbiology. All Rights Reserved. Epidemiology and Microbiology of Surgical
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 information2016 Antibiotic Susceptibility Report
Fairview Northland Medical Center and Elk River, Milaca, Princeton and Zimmerman Clinics 2016 Antibiotic Susceptibility Report GRAM-NEGATIVE ORGANISMS 2016 Gram-Negative Non-Urine The number of isolates
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 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 informationAntibiotic Abyss. Discussion Points. MRSA Treatment Guidelines
Antibiotic Abyss Fredrick M. Abrahamian, D.O., FACEP, FIDSA Professor of Medicine UCLA School of Medicine Director of Education Department of Emergency Medicine Olive View-UCLA Medical Center Sylmar, California
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 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 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 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 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 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 TOTAL JOINT ARTHROPLASTY INFECTIONS
MANAGEMENT OF TOTAL JOINT ARTHROPLASTY INFECTIONS Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine TOTAL JOINT ARTHROPLASTIES In 2009: 1 million THA and TKA By 2030,
More informationCUMULATIVE ANTIBIOGRAM
BC Children s Hospital and BC Women s Hospital & Health Centre CUMULATIVE ANTIBIOGRAM 2017 Division of Medical Microbiology Department of Pathology and Laboratory Medicine Page 1 of 5 GRAM-POSITIVE BACTERIA
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 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 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 informationAntimicrobial susceptibility
Antimicrobial susceptibility PATTERNS Microbiology Department Canterbury ealth Laboratories and Clinical Pharmacology Department Canterbury District ealth Board March 2011 Contents Preface... Page 1 ANTIMICROBIAL
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 informationCONTAGIOUS COMMENTS Department of Epidemiology
VOLUME XXIII NUMBER 1 July 2008 CONTAGIOUS COMMENTS Department of Epidemiology Bugs and Drugs Elaine Dowell, SM (ASCP), Marti Roe SM (ASCP), Ann-Christine Nyquist MD, MSPH Are the bugs winning? The 2007
More informationRandomized Controlled Trial on Adjunctive Lavage for Severe Peritoneal Dialysis- Related Peritonitis
Randomized Controlled Trial on Adjunctive Lavage for Severe Peritoneal Dialysis- Related Peritonitis Steve SM Wong Alice Ho Miu Ling Nethersole Hospital Background PD peritonitis is a major cause of PD
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 informationEnterococcal PJI. Miquel Ekkelenkamp
Enterococcal PJI Miquel Ekkelenkamp Enterococci: Gram-positive and round Formerly streptococci (but really quite different) Main clinical species : E. faecalis and E. faecium Mostly opportunistic pathogen
More informationManagement of Native Valve
Management of Native Valve Infective Endocarditis 2005 AHA 2015 Baddour LM, et al. Circulation. 2015;132(15):1435-86 2009 ESC 2015 Habib G, et al. Eur Heart J. 2015;36(44):3075-128 ESC 2015: Endocarditis
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 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 information2015 Antimicrobial Susceptibility Report
Gram negative Sepsis Outcome Programme (GNSOP) 2015 Antimicrobial Susceptibility Report Prepared by A/Professor Thomas Gottlieb Concord Hospital Sydney Jan Bell The University of Adelaide Adelaide On behalf
More informationMICRONAUT MICRONAUT-S Detection of Resistance Mechanisms. Innovation with Integrity BMD MIC
MICRONAUT Detection of Resistance Mechanisms Innovation with Integrity BMD MIC Automated and Customized Susceptibility Testing For detection of resistance mechanisms and specific resistances of clinical
More informationThe Basics: Using CLSI Antimicrobial Susceptibility Testing Standards
The Basics: Using CLSI Antimicrobial Susceptibility Testing Standards Janet A. Hindler, MCLS, MT(ASCP) UCLA Health System Los Angeles, California, USA jhindler@ucla.edu 1 Learning Objectives Describe information
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 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 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 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 informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Bennett-Guerrero E, Pappas TN, Koltun WA, et al. Gentamicin
More informationDOI: /zenodo
www.imiamn.org.ua /journal.htm 38 UDC 616-008.87:616-002:616-089.843 MICROBIOLOGICAL PARAMETERS IN PATIENTS WITH INFLAMMATORY COMPLICATIONS AFTER KNEE AND HIP JOINTS ENDOPROSTHESIS REPLACEMENT AND THEIR
More informationTHE NAC CHALLENGE PANEL OF ISOLATES FOR VERIFICATION OF ANTIBIOTIC SUSCEPTIBILITY TESTING METHODS
THE NAC CHALLENGE PANEL OF ISOLATES FOR VERIFICATION OF ANTIBIOTIC SUSCEPTIBILITY TESTING METHODS Stefanie Desmet University Hospitals Leuven Laboratory medicine microbiology stefanie.desmet@uzleuven.be
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 informationDetection of ESBL Producing Gram Negative Uropathogens and their Antibiotic Resistance Pattern from a Tertiary Care Centre, Bengaluru, India
ISSN: 2319-7706 Volume 4 Number 12 (2015) pp. 578-583 http://www.ijcmas.com Original Research Article Detection of ESBL Producing Gram Negative Uropathogens and their Antibiotic Resistance Pattern from
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 informationANTIBIOTICS USED FOR RESISTACE BACTERIA. 1. Vancomicin
ANTIBIOTICS USED FOR RESISTACE BACTERIA 1. Vancomicin Vancomycin is used to treat infections caused by bacteria. It belongs to the family of medicines called antibiotics. Vancomycin works by killing bacteria
More informationEuropean Committee on Antimicrobial Susceptibility Testing
European Committee on Antimicrobial Susceptibility Testing Routine and extended internal quality control as recommended by EUCAST Version 5.0, valid from 015-01-09 This document should be cited as "The
More informationIntra-Abdominal Infections. Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018
Intra-Abdominal Infections Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018 Select guidelines Mazuski JE, et al. The Surgical Infection
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 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 informationBacterial Pathogens in Urinary Tract Infection and Antibiotic Susceptibility Pattern from a Teaching Hospital, Bengaluru, India
ISSN: 2319-7706 Volume 4 Number 11 (2015) pp. 731-736 http://www.ijcmas.com Original Research Article Bacterial Pathogens in Urinary Tract Infection and Antibiotic Susceptibility Pattern from a Teaching
More informationPocket Guide to Diagnosis & Treatment of Vascular Graft Infections (VGI)
Pocket Guide to Diagsis & Treatment of Vascular Graft Infections (VGI) DEFINITION Investigation /sign Local signs of infection Histopathology Microbiology Definitive Criteria Purulent wound secretion sinus
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 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 informationGuidelines for Laboratory Verification of Performance of the FilmArray BCID System
Guidelines for Laboratory Verification of Performance of the FilmArray BCID System Purpose The Clinical Laboratory Improvement Amendments (CLIA), passed in 1988, establishes quality standards for all laboratory
More informationTreatment of Surgical Site Infection Meeting Quality Statement 6. Prof Peter Wilson University College London Hospitals
Treatment of Surgical Site Infection Meeting Quality Statement 6 Prof Peter Wilson University College London Hospitals TEG Quality Standard 6 Treatment and effective antibiotic prescribing: People with
More informationSecondary peritonitis
Secondary peritonitis Caused by spillage of gastrointestinal microorganisms into the peritoneal cavity secondary to loss of the integrity of the mucosal barriers Etiology: perforation of peptic ulcer traumatic
More informationWho should read this document? 2. Key practice points 2. Background/ Scope/ Definitions 2. What is new in this version? 3
Neurosurgical infections (adult only) Antibiotic Guidelines Classification: Clinical Guideline Lead Author: Antibiotic Steering Committee Additional author(s): as above Authors Division: DCSS & Tertiary
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 informationA retrospective analysis of urine culture results issued by the microbiology department, Teaching Hospital, Karapitiya
A retrospective analysis of urine culture results issued by the microbiology department, Teaching Hospital, Karapitiya LU Edirisinghe 1, D Vidanagama 2 1 Senior Registrar in Medicine, 2 Consultant Microbiologist,
More informationCARBAPENEM RESISTANT ENTEROBACTERIACEAE (KPC CRE)
CARBAPENEM RESISTANT ENTEROBACTERIACEAE (KPC CRE) Bartsch SM et al. Potential economic burden of carbapenem-resistent Enterobacteriaceae (CRE) in the United States. Clin Microbiol Infect 2017;23(1):48e9-e16.
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 informationCF WELL Pharmacology: Microbiology & Antibiotics
CF WELL Pharmacology: Microbiology & Antibiotics Bradley E. McCrory, PharmD, BCPS Clinical Pharmacy Specialist Pulmonary Medicine Cincinnati Children s Hospital Medical Center January 26, 2017 Disclosure
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 informationPDF hosted at the Radboud Repository of the Radboud University Nijmegen
PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/26062
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 informationThe role of oral antibiotics in Prosthetic joint infection. Matthew Dryden MD
The role of oral antibiotics in Prosthetic joint infection Matthew Dryden MD Persistence of bone infection Osteomyelitis in 1930 Prosthetic joint replacement demand is increasing When things go wrong Patient
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 informationFundamental Concepts in the Use of Antibiotics. Case. Case. TM is a 24 year old male admitted to ICU after TBI and leg fracture from MVA ICU day 3
Fundamental Concepts in the Use of Antibiotics Todd Miano, PharmD, MSCE Critical Care Pharmacist Pharmacoepidemiology Fellow Perelman School of Medicine at the University of Pennsylvania Case TM is a 24
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 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 informationAerobic bacterial infections in a burns unit of Sassoon General Hospital, Pune
Original article Aerobic bacterial infections in a burns unit of Sassoon General Hospital, Pune Patil P, Joshi S, Bharadwaj R. Department of Microbiology, B.J. Medical College, Pune, India. Corresponding
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 informationEXTENDED-SPECTRUM BETA-LACTAMASE (ESBL) TESTING
EXTENDED-SPECTRUM BETA-LACTAMASE (ESBL) TESTING CHN61: EXTENDED-SPECTRUM BETA-LACTAMASE (ESBL) TESTING 1.1 Introduction A common mechanism of bacterial resistance to beta-lactam antibiotics is the production
More informationSuper Bugs and Wonder Drugs: Protecting the One While Respecting the Many
Super Bugs and Wonder Drugs: Protecting the One While Respecting the Many Vicki Stringfellow, MSN, CPNP-AC/PC Werner Division of Pediatric Critical Care University of Kentucky Lexington, KY Disclosure
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 informationAntimicrobial Cycling. Donald E Low University of Toronto
Antimicrobial Cycling Donald E Low University of Toronto Bad Bugs, No Drugs 1 The Antimicrobial Availability Task Force of the IDSA 1 identified as particularly problematic pathogens A. baumannii and
More 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 informationBACTERIOLOGICAL PROFILE OF OSTEOMYELITIS IN A TERTIARY CARE HOSPITAL AT VISAKHAPATNAM, ANDHRA PRADESH
IJCRR Vol 05 issue 20 Section: Healthcare Category: Research Received on: 07/09/13 Revised on: 02/10/13 Accepted on: 24/10/13 BACTERIOLOGICAL PROFILE OF OSTEOMYELITIS IN A TERTIARY CARE HOSPITAL AT VISAKHAPATNAM,
More informationAntibacterials. Recent data on linezolid and daptomycin
Antibacterials Recent data on linezolid and daptomycin Patricia Muñoz, MD. Ph.D. (pmunoz@micro.hggm.es) Hospital General Universitario Gregorio Marañón Universidad Complutense de Madrid. 1 GESITRA Reasons
More informationAntibiotic Prophylaxis Update
Antibiotic Prophylaxis Update Choosing Surgical Antimicrobial Prophylaxis Peri-Procedural Administration Surgical Prophylaxis and AMS at Epworth HealthCare Mr Glenn Valoppi Dr Trisha Peel Dr Joseph Doyle
More information