Antibiotic-Resistant Bacteria in Surveillance Stool Cultures of
|
|
- Elfreda Cox
- 6 years ago
- Views:
Transcription
1 ANTIMICROBIAI AGENTS AND CHEMOTHERAPY, Sept. 1986, p /86/ $0)2.00/0 Copyright American Society for Microbiology Vol. 30, No. 3 Antibiotic-Resistant Bacteria in Surveillance Stool Cultures of Patients with Prolonged Neutropenia JOHN R. WINGARD,'* JAMES DICK,2 PATRICIA CHARACHE,2 AND REIN SARALI The Oncology CeniteIt- andi Department of Laboratory Medi(ine,2 The Jo/hins Hopkinis Medi(al Institiutionls, Baltimore, Marvland Received 30 January 1986/Accepted 8 June 1986 The value of stool surveillance for antibiotic-resistant gram-negative bacteria was analyzed in 86 neutropenic bone marrow transplant patients. Twice-weekly specimens were inoculated onto culture medium containing gentamicin plus carbenicillin. The recovered organisms were identified to the species level and tested for antibiotic susceptibility. Forty-eight resistant organisms were recovered from 35 patients. Thirteen isolates persistently colonized patients. Escherichia coli (29%) and Pseudomonas aeruginosa (19%) were the most frequently recqvered organisms. Although most organisms were recovered while patients were on antibiotics, 15 isolates, including eight of nine resistant P. aeruginosa, were detected before antibiotics were initiated. The duration of antibiotic use was longer for patients persistently colonized than for those not colonized (P = 0.03). Of the 15 resistant organisms which caused infection, 12 were detected in the surveillance cultures. Infections by antibiotic-resistant organisms occurred more frequently in patients colonized than in those not colonized (P = 0.006) and more frequently in patients persistently colonized than in those colonized only once (P = 0.01). The absence of colonization or persistent colonization correlated well with the absence of infection (negative predictive values of 94 and 91%, respectively). Neutropenic patients are especially prone to life-threatening infection due to gram-negative bacteria. Because potential gram-negative pathogens are present in the gastrointestinal tracts of these patients, a number of studies have examined the utility of stool surveillance cultures in predicting infections in neutropenic patients (1-5, 7, 8, 10, 12-15). However, identification of all organisms present on routine surveillance cultures not only is not feasible for clinical laboratories but also has been proven of limited clinical value. With the routine use of empiric broad-spectrum antibiotics for fever during neutropenia, the emergence of antibioticresistant gram-negative bacteria as potential pathogens has become an increasing problem in recent years. One previous study considered the significance of antibiotic-resistant Pseiudomonas aleru- gitnosa in stool surveillance cultures (7) and found that resistant variants may be less virulent than susceptible strains. A program of stool surveillance cultures in bone marrow transplant (BMT) patients has been in effect at this institution to alert clinicians to potential pathogens which would not be covered by the standard empirically derived therapeutic protocols. Patients were monitored during a cytotoxic therapy that was expected to result in neutropenia exceeding 14 days in duration. Our surveillance program was designed to detect carbenicillin and aminoglycoside-resistant organisms colonizing the intestinal tract. This study is an evaluation of the information gained from that program. MATERIALS AND METHODS Patients studied. Eighty-six consecutively treated patients underwent allogeneic BMT with marrow from genotypically HLA-identical siblings as treatment for leukemia or aplastic anemia over a 2-year period. Patients with leukemia were either in complete remission or early bone marrow relapse. * Corresponding author. The patients with leukemia received either cyclophosphamide plus total body irradiation or busulfan plus cyclophosphamide. Patients with aplastic anemia were treated with cyclophosphamide plus total body irradiation or cyclophosphamide alone (one patient). Corticosteroids plus either cyclophosphamide or cyclosporine were given for graft versus host disease prophylaxis. The patients and infections before engraftment have been described elsewhere (J. R. Wingard, G. W. Santos, and R. Saral, Program Abstr. 25th Intersci. Conf. Antimicrob. Agents Chemother., abstr. no ). The median patient age was 22 years (range, 3 to 39 years). The onset of neutropenia occurred after a median of 1 day following marrow infusion. The median duration of neutropenia was 18 days (mean, 20 days; range, 7 to 135 days). Engraftment occurred in 83 of 86 patients. Three patients died before engraftment. One patient died on day 9 from pulmonary failure because of acute respiratory distress syndrome, another patient died on day 12 from multiorgan failure attributed to treatment toxicity, and a third patient died on day 129 from refractory shock. In this last patient, sepsis was suspected even though cultures were negative (autopsy was not permitted). Patient management. All patients were treated in single rooms, each of which was equipped with HEPA air filtration systems that generated 30 air exchanges per h. All patients had indwelling central venous catheters (usually Hickman catheters) placed before BMT for administration of medications and blood products. Prophylactic antibiotics or granulocyte transfusions were not used. Erythrocyte and platelet transfusions were administered as needed to maintain the hematocrit above 30% and the platelet count above 20,000 platelets per p.l. Patients were placed on broad-spectrum antibiotics when fever occurred. In general, these consisted of ticarcillin and either tobramycin or gentamicin. Gentamicin or tobramycin levels were checked periodically, and doses were adjusted to maintain a level 1 h postdose of 6 to 10 jig/ml, as measured by a fluorescence polarization immunoassay (9). In addition, miconazole was started concom- 435
2 436 WINGARD ET AL. itantly with the institution of antibiotics. If fever persisted for >72 h after the institution of antibiotics, the aminoglycoside was generally discontinued, and trimethoprimsulfamethoxazole was substituted. If an additional 72 h passed without defervescence, an empiric trial of amphotericin B was usually instituted. Once instituted, antibiotics were then continued until granulocyte recovery and modified according to the schema described above or as dictated by cultures and clinical state. Surveillance cultures. Stool or rectal swab specimens were screened twice weekly for antibiotic-resistant gram-negative bacteria. Stool specimens were plated on Trypticase soy agar (BBL Microbiology Systems, Cockeysville, Md.), on agar containing 10,ug of gentamicin per ml and 250,ug of carbenicillin per ml, and on Pseudomonas agar base with Pseudo C-N supplement (Oxoid USA, Inc., Columbia, Md.). Any morphologically distinct colonies grown on these screening media at 24 h were picked and identified to the species level for further accurate susceptibility testing by the standard agar dilution method (11). Ticarcillin was used in place of carbenicillin at this second stage of testing. Isolates were judged to be resistant if the MIC of gentamicin or tobramycin exceeded 4,ug/ml and the MIC of ticarcillin exceeded 32,ug/ml. There was generally no greater than one twofold antibiotic dilution difference between the MICs of gentamicin and tobramycin. Organisms resistant to ticarcillin and gentamicin will be referred to as antibiotic resistant hereafter. Isolates recovered from two or more samples from a given patient were considered persistent colonizers of that patient. Organisms were considered susceptible to tetracycline (Tets), chloramphenicol (Chls), cephalothin (Ceps), amikacin (Amis), piperacillin (Pips), sulfamethoxazole (Suls), trimethoprim-sulfamethoxazole (T-S), cefotaxime (Ctxs), and moxalactam (Moxs) at MICs of less than or equal to 4, 8, 8, 8, 64, 32, 1.6 and 32, 8, and 8,ug/ml, respectively. Criteria for association with infection. An isolate was considered to be the cause of infection if the organism was recovered from the blood or from a localized site of infection. Analysis. Predictive values were calculated according to the methods of Galen and Gambino (6) and are defined as follows. The positive predictive value is the percentage of patients with positive surveillance culture results who developed infection and was calculated as (true positives/true plus false positives) x 100, where the true positives are the number of patients with positive surveillance culture results and infection, and the true plus false positives are the total number of patients with positive culture results. The negative predictive value is the correlation of negative surveillance cultures with the absence of infection and was calculated as (true negatives/true plus false negatives) x 100, where the true negatives are the number of patients with negative culture results and without disease, and the true plus false negatives are the total number of patients with negative culture results. The sensitivity is the percentage of patients with infection who had positive surveillance cultures and was calculated as (true positives/true positives plus false negatives) x 100, where the true positives are as stated above, and the true positives plus false negatives are the sum of all patients with infection. The specificity is the percentage of patients without infection who had negative test results and was calculated as (true negatives/true negatives plus false positives) x 100, where the true negatives are as stated as above and the true negatives plus false positives are the total number of all patients without infection. Patients colonized or infected by more than one antibiotic-resistant ANTIMICROB. AGENTS CHEMOTHER. TABLE 1. Gram-negative bacteria resistant to gentamicin and ticarcillin recovered from the stool specimens of 86 consecutive allogeneic BMT patients (48 isolates in 35 patients) No. No. No.fFirst of Frt of isolates (%) Organism (no. of isolates) persistent appearance present cooiesa of isolate prsn antibiotics (dy) Escherichia coli (14) (14) Pseudomonas aeruginosa (9) (89) Citrobacterfreundii (6) (17) Enterobacter cloacae (4) (0) Klebsiella oxytoca (4) (25) Serratia marcescens (3) (33) Klebsiella pneumoniae (3) (0) Pseudomonas putida (3) (33) Pseudomonas acidovorans (1) (0) Enterobacter aerogenes (1) (0) a Present on two or more samples. b Mean number of days after initiation of antibiotics. organism were counted once for each organism in these calculations. Other data were analyzed by the Fisher exact test or the Student t test as computed by Epistat, a computer software program. RESULTS Antibiotic-resistant bacteria in stool specimens. No antibiotic-resistant organisms were isolated from the stool specimens of 51 patients. Forty-eight antibiotic-resistant organisms were isolated from the stool specimens of 35 of 86 patients (Table 1). Thirteen of these organisms were present on multiple surveillance cultures and were termed persistent colonizers. Escherichia coli and P. aeruginosa were the most frequent antibiotic-resistant organisms isolated, and together they accounted for 48% of all resistant organisms recovered. Although most organisms were transient colonizers, Enterobacter cloacae isolates were persistently recovered from stool specimens in all four occurrences of the organism. The first appearance of E. cloacae always occurred late in the course of antibiotic therapy (mean, 11.8 days after the start of antibiotics). Time of first appearance. P. aeruginosa and E. coli were early colonizers (means, -7.7 and 2.4 days, respectively, after the initiation of antibiotics) (Table 1). P. aeruginosa appeared earlier than did E. coli (P = 0.009), E. cloacae (P = 0.002), Klebsiella oxytoca (P = 0.01), Citrobacterfreundii (P = 0.005), and Klebsiella pneumoniae (P = 0.02). E. coli appeared earlier than did E. cloacae (P = 0.004), C. freundii (P = 0.05), K. pneiumoniae (P = 0.008), and K. oxytoca (P = 0.01). Fifteen antibiotic-resistant isolates were recovered from stool specimens before the initiation of antibiotics (Table 1). Although for most organisms isolation before the start of antibiotics was uncommon, eight of the nine antibiotic-resistant P. aeruginosa isolates were present before the initiation of antibiotics. The likelihood of recovery before antibiotic use was greater for the P. aeruginosa isolates (8 of 9) than for the other organisms combined (7 of 39) (P = ). Of the 15 isolates present before antibiotic use, only 3 were present in the first stool specimen obtained. The other 12 were first detected after an average of 2.3 negative stool cultures. Relationship of the presence of antibiotic-resistant bacteria in stool specimens to duration of antibiotic use. The duration of antibiotic use was not significantly longer among patients
3 VOL. 30, 1986 SURVEILLANCE CULTURES DURING NEUTROPENIA 437 TABLE 2. Antibiotic susceptibility of resistant gram-negative bacteria recovered from stool specimens of 86 consecutive allogenic BMT patients No. of isolates that were:" Organism (no. of isolates) Tets Chls Ceps Amis Pip' Sul' T-Ss Ctxs Mox' NTb Escherichia coli (14) Pseudomonas aeruginosa (9) Citrobacterfreundii (6) Enterobacter cloacae (4) Klebsiella oxytoca (4) Serratia marcescens (3) Klebsiella pneumoniae (3) Pseudomonas putida (3) Pseudomonas acidovorans (1) Enterobacter aerogenes (1) a Total number of isolates susceptible to each antibiotic out of total number of isolates were as follows M%): Tet', 33; Chl', 31; Ceps, 4; AmiP, 35; Pip', 22; Suls, 6; T-Ss, 25; Ctxs, 62; Moxs, 66. bnt, Not tested against piperacillin, cefotaxime, or moxalactam. colonized with resistant organisms than it not colonized (25 and 16 days, respectively; P = 0.21). Among patients persistently colonized, antibiotic use was significantly longer than it was among those not colonized (40 and 16 days, respectively; P = 0.03). Susceptibility to other antibiotics. The susceptibility of the 48 stool surveillance culture isolates is shown in Table 2. All isolates were resistant to ampicillin, ticarcillin, gentamicin, and tobramycin, and these MICs are not included in the table. Of the antibiotics tested, cefotaxime and moxalactam demonstrated the best in vitro activity against the surveillance culture isolates, although they had no activity against any of the P. aeruiginosa isolates. Recovery of bacteria not resistant to both carbenicillin and gentamicin. Nine isolates (from nine patients) were recovered on the screening plates but did not prove to be resistant to both ticarcillin and gentamicin on subsequent confirmatory testing. Five isolates were resistant to ticarcillin but not to gentamicin (two E. coli and K. oxytoca isolates each and one C. freundii isolate), three P. aeruiginosa isolates were susceptible to both ticarcillin and gentamicin, and one P. aeruginosa isolate was resistant to gentamicin but susceptible to ticarcillin. None of these isolates were associated with infection. Infections due to antibiotic-resistant bacteria. Fifteen antibiotic-resistant organisms caused 13 infections. There were eight perianal infections, one perianal infection with bacteremia, and four episodes (caused by six organisms) of bacteremia unassociated with localized infection. Twelve of these organisms were present in the stool surveillance cul- was among those TABLE 3. Association of colonization and infection due to antibiotic-resistant bacteria in 86 consecutive allogeneic BMT patients No. of patients" Colonization Infected Noninfected Patients colonizedb Once 5 30 Persistently" 7 6 Patients not colonized 3 51 Patients colonized by more than one antibiotic-resistant organism were counted once for each organism. opatients colonized at least once were more likely to become infected than those not colonized (P = 0.006). Patients persistently colonized were more likely to become infected than those colonized only once (P = 0.01). tures. Three organisms (which caused two episodes of bacteremia, one of which was in combination with an organism that was detected in the stool surveillance cultures) were not detected in the stool cultures; these occurred in patients colonized by other antibiotic-resistant organisms. None of the 51 patients whose stool cultures were free of the antibiotic-resistant organisms developed infection due to antibiotic-resistant organisms. These data are given in Table 3, where patients (and infections) are counted once for each unique organism encountered, as described in Materials and Methods. Data comparing persistently colonized patients with those not persistently colonized are also given in Table 3. Infection due to antibiotic-resistant organisms occurred more frequently among patients colonized by these organisms (12 of 48 patients) than among patients not colonized (3 of 54 patients) (P = 0.006). Although infection occurred in 7 of 13 persistently colonized patients, infection occurred in only 5 of 35 patients colonized only once (P = 0.01). The sensitivity, specificity, positive predictive values, and negative predictive values are given in Table 4 for colonization and persistent colonization. Persistent colonization had greater specificity and a greater positive predictive value than colonization, but it had a lower sensitivity. The negative predictive values were high for both colonization and persistent colonization. Infections due to other organisms. Six antibiotic-susceptible gram-negative bacteria caused bacteremia. All occurred in patients not receiving antibiotics at the time of the first fever during neutropenia, and all were controlled by the empiric antibiotic regimen. This is in contrast to the five bacteremic infections caused by seven antibiotic-resistant gram-negative bacteria, all of which occurred in patients receiving antibiotics (P = 0.002). TABLE 4. Ability of surveillance cultures to predict infection due to antibiotic-resistant bacteria in 86 consecutive allogeneic BMT patients No. of patients/patients studied (%)" Colonization Positive Negative Sensitivity Specificity predictive predictive value value Colonization 12/15 (80) 51/87 (59) 12/48 (25) 51/54 (94) Persistent colonization 7/15 (47) 81/87 (93) 7/13 (54) 81/89 (91) " Patients colonized by more than one antibiotic-resistant organism were counted once for each organism. Predictive values are defined in the text.
4 438 WINGARD ET AL. Twenty-one infections due to gram-positive organisms and two infections due to fungi were also noted in the 86 patients. DISCUSSION Neutropenic patients are extremely susceptible to morbidity and mortality from infection due to gram-negative bacteria. Early empiric antibiotic use has been shown to reduce morbidity and mortality. Because most neutropenic patients are exposed to antibiotics, the risk of developing infections from antibiotic-resistant organisms is substantial. In addition, it is critical that neutropenic patients be placed on the appropriate antibiotics promptly when infection occurs. Therefore, identification of neutropenic patients at high risk of infection due to antibiotic-resistant bacteria is a high priority. Studies by surveillance cultures of the bacterial flora of neutropenic patients have been done previously (1-5, 7, 8, 10, 12-15). These studies were not designed to detect resistant strains but rather to examine the significance of isolates present on media that contained no antibiotics. In one study Schimpff et al. (14) found that colonization by P. aeruginosa was associated with sepsis in most neutropenic patients. After improvements in hygienic measures and changes in oral antibiotics, this association decreased substantially (13). Gurwith et al. (8) found that 20 of 42 evaluable bacteremic episodes had antecedent positive surveillance cultures. However, in 14 of 42 episodes, there was no correlation between surveillance and bacteremic organisms. Fainstein et al. (5) noted that changes in throat and stool flora occurred during hospitalization; although organisms acquired during hospitalization were more apt to cause infection, most colonizing organisms did not cause infection. A program of identification of all organisms present on surveillance cultures as performed in these earlier investigations is not feasible for routine use in most hospital laboratories and has been proven in these earlier studies to be of limited clinical value. To minimize the cost and labor, we instituted a program to identify only those organisms which were resistant to the antibiotics employed in our empiric regimen, i.e., ticarcillin plus gentamicin or tobramycin. Our hypothesis was that a failure to detect antibiotic-susceptible organisms would have minimal clinical impact, since signs and symptoms of sepsis would lead to the institution of antibiotics active against the organisms and to the subsequent control of the infection. Our findings in this study support this contention, since susceptible bacteria caused sepsis only in patients not on antibiotics, and these episodes were readily controlled by the institution of antibiotics. The patients in this study were found to frequently harbor resistant bacteria. Almost a third of the organisms were present before the institution of antibiotics. P. aeruginosa was especially apt to colonize patients before antibiotic use. Of the 15 isolates recovered before antibiotic use, only 3 were present in the first stool specimen obtained. The other 12 isolates first appeared after an average of more than 1 week of negative cultures. This suggests hospital acquisition, but variability in the sampling makes this supposition necessarily tentative. Greene et al. (7) found that the P. aeruginosa variants that were resistant to both carbenicillin and gentamicin appeared to be less virulent than did the susceptible strains. Although our study was not designed to compare virulence of susceptible and resistant bacterial variants, our finding that only susceptible organisms caused bacteremia in patients not receiving antibiotics is compatible with the findings of ANTIMICROB. AGENTS CHEMOTHER. Greene et al. that susceptible bacteria have a competitive advantage over resistant bacteria. Alternatively, titers of resistant organisms could have been lower than those of susceptible organisms, giving the resistant organisms a competitive disadvantage. Only 12% of the P. aeruginosa isolates recovered from our patients caused infection in our study. In contrast, 29% of the resistant E. coli isolates caused infection. This may have been due to the greater persistence of the E. coli isolates or to the difference in the number of organisms. The disparity may also suggest that the resistant P. aeriugfinosa variants are less virulent than are the resistant E. c oli variants. Because the antibiotic protocol that was used for these patients was instituted promptly for fever and modified by knowledge of the stool surveillance cultures, positive blood cultures and localized sites of infections were infrequently documented. For this reason, conclusions regarding the helpfulness of the surveillance program necessarily underestimate the ability of the surveillance program to predict infection. Only documented infections were included in the analysis. Thirteen febrile patients from whom bacteria were not recovered from blood and in whom no local site of infection was documented showed clinical response only when antibiotics were modified appropriately in response to the organisms recovered on surveillance cultures. Although the sensitivity of overall colonization was good, the specificity was much lower, and the positive predictive value was poor. Many patients colonized with resistant organisms developed no infection from these organisms. When persistent colonization alone was considered, the sensitivity and positive predictive value were low, but the specificity was good. The negative predictive values of both overall and persistent colonization were excellent: negative cultures predicted absence of infection to a high degree. Thus, in this group of patients with prolonged neutropenia caused by cytotoxic therapy (which also damaged the gastrointestinal mucosal integrity), surveillance to detect antibiotic-resistant bacteria was helpful in identifying patients at low risk for developing antibiotic-resistant bacterial infection, although surveillance was somewhat less helpful in identifying those at high risk. Three organisms implicated in two bacteremic episodes were not detected. Thus, continued study is required to optimize the value of such surveillance culture programs and to determine the patient populations for which this approach has greatest value. ACKNOWLEDGMENTS This work was supported in part by Public Health Service grants CA and CAO-6973 from the National Institutes of Health and by the Harley Howell Foundation. We thank Stephen Baust for his assistance. LITERATURE CITED 1. Bodey, G. P Oral antibiotic prophylaxis in protected environment units: effect of nonabsorbable and absorbable antibiotics on the fecal flora. Antimicrob. Agents Chemother. 1: Bodey, G. P., and B. Rosenbaum Effect of prophylactic measures on the microbial flora of patients in protected environment units. Medicine (Baltimore) 53: Bodey, G. P., and B. Rosenbaum Microbiological monitoring of protected environment units: effects of antibiotic prophylaxis and type of unit. Eur. J. Cancer 16: de Vries-Hospers, H. G., D. T. SleiJfer, N. H. Mulder, D. van der Waaij, H. 0. Nieweg, and H. K. F. van Saene Bacteriological aspects of selective decontamination of the digestive
5 VOL. 30, 1986 SURVEILLANCE CULTURES DURING NEUTROPENIA 439 tract as a method of infection prevention in granulocytopenic patients. Antimicrob. Agents Chemother. 19: Fainstein, V., V. Rodriquez, M. Turck, G. Hermann, B. Rosenbaum, and G. P. Bodey Patterns of oropharyngeal and fecal flora in patients with acute leukemia. J. Infect. Dis. 144: Galen, P. S., and S. R. Gambino Beyond normality: the predictive value and efficiency of medical diagnoses, p John Wiley & Sons, Inc., New York. 7. Greene, W. H., M. Moody, S. Schimpif, and V. M. Young Pseudomonas aeruginosa resistant to carbenicillin and gentamicin. Ann. Intern. Med. 79: Gurwith, M. J., J. L. Brunton, B. A. Lank, A. R. Ronald, and G. K. M. Harding Granulocytopenia in hospitalized patients. I. Prognostic factors and etiology of fever. Am. J. Med. 64: Jolley, M. E., S. D. Stroupe, C. J. Wang, H. N. Panas, C. L. Keegan, R. L. Schmidt, and K. S. Schwenzer Fluorescence polarization immunoassay. I. Monitoring aminoglycoside antibiotics in serum and plasma. Clin. Chem. 27: Levine, A. S., S. E. Siegel, A. D. Schreiber, B. S. Hauser, H. Preisler, I. M. Goldstein, F. Seidler, R. Simon, S. Perry, J. E. Bennett, and E. S. Henderson Protected environments and prophylactic antibiotics. A prospective controlled study of their utility in the therapy of acute leukemia. N. Engl. J. Med. 288: National Committee for Clinical Laboratory Standards Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically, vol. 5. no. M7-A. National Committee for Clinical Laboratory Standards, Villanova, Pa. 12. Preisler, H. D., I. M. Goldstein, and E. S. Henderson Gastrointestinal "sterilization" in the treatment of patients with acute leukemia. Cancer 26: Remington, J. S., S. C. Schimpif, W. T. Hughes, D. Armstrong, J. Klastersky, and G. P. Bodey Life-threatening infections in the compromised host, p In W. Siegenthaler and R. Luthy (ed.), Current chemotherapy. Proceedings of the 10th International Congress of Chemotherapy, vol. 1. American Society for Microbiology, Washington, D.C. 14. Schimpif, S. C., V. M. Young, W. H. Greene, G. D. Vermeulen, M. R. Moody, and P. H. Wiernik Origin of infection in acute nonlymphocytic leukemia: significance of hospital acquisition of potential pathogens. Ann. Intern. Med. 77: Sleijfer, D. T., N. H. Mulder, H. G. de Vries-Hospers, V. Fidler, H. 0. Nieweg, D. van der Waaij, and H. K. F van Saene Infection prevention in granulocytopenic patients by selective decontamination of the digestive tract. Eur. J. Cancer 16: Downloaded from on July 10, 2018 by guest
An evaluation of the susceptibility patterns of Gram-negative organisms isolated in cancer centres with aminoglycoside usage
Journal of Antimicrobial Chemotherapy (1991) 27, Suppl. C, 1-7 An evaluation of the susceptibility patterns of Gram-negative organisms isolated in cancer centres with aminoglycoside usage J. J. Muscato",
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 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 information1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient
1 Chapter 79, Self-Assessment Questions 1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient with normal renal function is: A. Trimethoprim-sulfamethoxazole B. Cefuroxime
More informationEscherichia Coli: an Important Pathogen in Patients with Hematologic Malignancies
MEDITERRANEAN JOURNAL OF HEMATOLOGY AND INFECTIOUS DISEASES www.mjhid.org ISSN 2035-3006 Original Article Escherichia Coli: an Important Pathogen in Patients with Hematologic Malignancies Daniel Olson,
More informationمادة االدوية المرحلة الثالثة م. غدير حاتم محمد
م. مادة االدوية المرحلة الثالثة م. غدير حاتم محمد 2017-2016 ANTIMICROBIAL DRUGS Antimicrobial drugs Lecture 1 Antimicrobial Drugs Chemotherapy: The use of drugs to treat a disease. Antimicrobial drugs:
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 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 informationStaphylococcus aureus
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, OCt. 1981, p. 463-469 0066-4804/81/100463-07$02.00/0 Vol. 20, No. 4 In Vitro and In Vivo Studies of Three Antibiotic Combinations Against Gram-Negative Bacteria and
More informationFlorida Health Care Association District 2 January 13, 2015 A.C. Burke, MA, CIC
Florida Health Care Association District 2 January 13, 2015 A.C. Burke, MA, CIC 11/20/2014 1 To describe carbapenem-resistant Enterobacteriaceae. To identify laboratory detection standards for carbapenem-resistant
More informationDuke University Hospital Guideline for Empiric Inpatient Treatment of Cancer- Related Neutropenic Fever in Adult Patients
Duke University Hospital Guideline for Empiric Inpatient Treatment of Cancer- Related Neutropenic Fever in Adult Patients PURPOSE Fever among neutropenic patients is common and a significant cause of morbidity
More informationEvaluation of the BIOGRAM Antimicrobial Susceptibility Test System
JOURNAL OF CLINICAL MICROBIOLOGY, Nov. 1985, p. 793-798 0095-1137/85/110793-06$02.00/0 Copyright 1985, American Society for Microbiology Vol. 22, No. 5 Evaluation of the BIOGRAM Antimicrobial Susceptibility
More informationInappropriate Use of Antibiotics and Clostridium difficile Infection. Jocelyn Srigley, MD, FRCPC November 1, 2012
Inappropriate Use of Antibiotics and Clostridium difficile Infection Jocelyn Srigley, MD, FRCPC November 1, 2012 Financial Disclosures } No conflicts of interest } The study was supported by a Hamilton
More informationEvaluation of a computerized antimicrobial susceptibility system with bacteria isolated from animals
J Vet Diagn Invest :164 168 (1998) Evaluation of a computerized antimicrobial susceptibility system with bacteria isolated from animals Susannah K. Hubert, Phouc Dinh Nguyen, Robert D. Walker Abstract.
More informationExperimental Pseudomonas Bacteremia in Neutropenic Rats
ANTIMICROBIAL AGENTs AND CHZMOTHERAPY, OCt. 1976, p. 646-651 Copyright C) 1976 American Society for Microbiology Vol. 10, No. 4 Printed in U.S.A. Synergistic Activity of Carbenicillin and Gentamicin in
More informationa. 379 laboratories provided quantitative results, e.g (DD method) to 35.4% (MIC method) of all participants; see Table 2.
AND QUANTITATIVE PRECISION (SAMPLE UR-01, 2017) Background and Plan of Analysis Sample UR-01 (2017) was sent to API participants as a simulated urine culture for recognition of a significant pathogen colony
More informationGeneral Approach to Infectious Diseases
General Approach to Infectious Diseases 2 The pharmacotherapy of infectious diseases is unique. To treat most diseases with drugs, we give drugs that have some desired pharmacologic action at some receptor
More 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 informationGranulocytopenic Cancer Patients
ANTIMICROBIL AGZNTS AND CHzMOTHzRAPY, Nov. 1977, p. 618-624 Copyright 0 1977 American Society for Microbiology Vol. 12, No. 5 Printed in U.S.A. Amikacin and Cephalothin: Empiric Regimen for Granulocytopenic
More informationIn Vitro Activity of Netilmicin, Gentamicin, and Amikacin
ANTIMICROBIAL AGzNTS AND CHEMOTHERAPY, Jan. 1977, p. 126-131 Copyright X 1977 American Society for Microbiology Vol. 11, No. 1 Printed in U.S.A. In Vitro Activity of Netilmicin, Gentamicin, and Amikacin
More informationPreventing 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 informationOvernight identification of imipenem-resistant Acinetobacter baumannii carriage in hospitalized patients
TABLE 1. Origin and carbapenem resistance characteristics of the 64 Acinetobacter baumannii stock D-750 Overnight identification of imipenem-resistant Acinetobacter baumannii carriage in hospitalized patients
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 informationDrug resistance in relation to use of silver sulphadiazine cream in a burns unit
J. clin. Path., 1977, 30, 160-164 Drug resistance in relation to use of silver sulphadiazine cream in a burns unit KIM BRIDGES AND E. J. L. LOWBURY From the MRC Industrial Injuries and Burns Unit, Birmingham
More informationConsiderations in antimicrobial prescribing Perspective: drug resistance
Considerations in antimicrobial prescribing Perspective: drug resistance Hasan MM When one compares the challenges clinicians faced a decade ago in prescribing antimicrobial agents with those of today,
More informationSepsis 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 informationCombination vs Monotherapy for Gram Negative Septic Shock
Combination vs Monotherapy for Gram Negative Septic Shock Critical Care Canada Forum November 8, 2018 Michael Klompas MD, MPH, FIDSA, FSHEA Professor, Harvard Medical School Hospital Epidemiologist, Brigham
More 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 informationTitle: N-Acetylcysteine (NAC) Mediated Modulation of Bacterial Antibiotic
AAC Accepts, published online ahead of print on June 00 Antimicrob. Agents Chemother. doi:0./aac.0070-0 Copyright 00, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights
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 informationMulti-Drug Resistant Gram Negative Organisms POLICY REVIEW DATE EXTENDED Printed copies must not be considered the definitive version
Multi-Drug Resistant Gram Negative Organisms POLICY REVIEW DATE EXTENDED 2018 Printed copies must not be considered the definitive version DOCUMENT CONTROL POLICY NO. IC-122 Policy Group Infection Control
More informationPILOT STUDY OF THE ANTIMICROBIAL SUSCEPTIBILITY OF SHIGELLA IN NEW ZEALAND IN 1996
PILOT STUDY OF THE ANTIMICROBIAL SUSCEPTIBILITY OF SHIGELLA IN NEW ZEALAND IN 996 November 996 by Maggie Brett Antibiotic Reference Laboratory ESR Communicable Disease Centre Porirua CONTENTS Page SUMMARY
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 informationF and therapeutic problem in patients with
MANAGEMENT OF FEVE OF UNKNOWN OIGIN IN PATIENTS WITH NEOPLASMS AND NEUTOPENIA VICTOIO ODIGUEZ, MD, MICHAEL BUGESS, AND GEALD P. BODEY, MD* MD, During 81 -febrile episodes, 76 cancer patients with neutropenia
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 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 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 informationProtein Synthesis Inhibitors
Protein Synthesis Inhibitors Assistant Professor Dr. Naza M. Ali 11 Nov 2018 Lec 7 Aminoglycosides Are structurally related two amino sugars attached by glycosidic linkages. They are bactericidal Inhibitors
More informationReceived 8 April 2012; received in revised form 15 December 2012; accepted 28 December 2012
Journal of Infection and Public Health (2013) 6, 216 221 Antimicrobial agent prescription patterns for chemotherapy-induced febrile neutropenia in patients with hematological malignancies at Sultan Qaboos
More 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 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 informationEvaluation of the AutoMicrobic System for Susceptibility Testing of Aminoglycosides and Gram-Negative Bacilli
JOURNAL OF CLINICAL MICROBIOLOGY, Mar. 1987, p. 546-550 0095-1137/87/030546-05$02.00/0 Copyright C 1987, American Society for Microbiology Vol. 25, No. 3 Evaluation of the AutoMicrobic System for Susceptibility
More informationDiagnosis: Presenting signs and Symptoms include:
PERITONITIS TREATMENT PROTOCOL CARI - Caring for Australasians with Renal Impairment - CARI Guidelines complete list ISPD Guidelines: http://www.ispd.org/lang-en/treatmentguidelines/guidelines Objective
More 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 informationDetection and Quantitation of the Etiologic Agents of Ventilator Associated Pneumonia in Endotracheal Tube Aspirates From Patients in Iran
Letter to the Editor Detection and Quantitation of the Etiologic Agents of Ventilator Associated Pneumonia in Endotracheal Tube Aspirates From Patients in Iran Mohammad Rahbar, PhD; Massoud Hajia, PhD
More information17June2017. Parampal Deol, Ph.D, MBA Senior Director, R&D Microbiology North America
RAPID DETECTION OF BACTERIAL CONTAMINANTS IN PLATELET COMPONENTS: COMPARISON OF TIME TO DETECTION BETWEEN THE BACT/ALERT 3D AND THE BACT/ALERT VIRTUO SYSTEMS. 17June2017 Parampal Deol, Ph.D, MBA Senior
More informationCOMMITTEE FOR VETERINARY MEDICINAL PRODUCTS
The European Agency for the Evaluation of Medicinal Products Veterinary Medicines and Inspections EMEA/CVMP/627/01-FINAL COMMITTEE FOR VETERINARY MEDICINAL PRODUCTS GUIDELINE FOR THE DEMONSTRATION OF EFFICACY
More informationInfection Control of Emerging Diseases
2016 EPS Training Event Martin E. Evans, MD Director, VHA MDRO Program National Infectious Diseases Service Lexington, KY & Cincinnati, OH Infection Control of Emerging Diseases 2016 EPS Training Event
More informationPreventing and Responding to Antibiotic Resistant Infections in New Hampshire
Preventing and Responding to Antibiotic Resistant Infections in New Hampshire Benjamin P. Chan, MD, MPH NH Dept. of Health & Human Services Division of Public Health Services May 23, 2017 To bring a greater
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 informationAppropriate Management of Common Pediatric Infections. Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases
Appropriate Management of Common Pediatric Infections Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases It s all about the microorganism The common pathogens Viruses
More informationNorthwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16
Northwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16 These criteria are based on national and local susceptibility data as well as Infectious Disease Society of America
More informationApproach to pediatric Antibiotics
Approach to pediatric Antibiotics Gassem Gohal FAAP FRCPC Assistant professor of Pediatrics objectives To be familiar with common pediatric antibiotics o Classification o Action o Adverse effect To discus
More informationSHC Clinical Pathway: HAP/VAP Flowchart
SHC Clinical Pathway: Hospital-Acquired and Ventilator-Associated Pneumonia SHC Clinical Pathway: HAP/VAP Flowchart v.08-29-2017 Diagnosis Hospitalization (HAP) Pneumonia develops 48 hours following: Endotracheal
More informationComparative Activity of Netilmicin, Gentamicin, Amikacin, and Tobramycin Against Pseudomonas aeruginosa and Enterobacteriaceae
ANTIMICROBIAL AGzNTS AND CHEMOTHERAPY, Oct. 1976, P. 592-597 Copyright 1976 American Society for Microbiology Vol. 1, No. 4 Printed in U.S.A. Comparative Activity of Netilmicin, Gentamicin, Amikacin, and
More informationCurricular Components for Infectious Diseases EPA
Curricular Components for Infectious Diseases EPA 1. EPA Title Promoting antimicrobial stewardship based on microbiological principles 2. Description of the A key role for subspecialists is to utilize
More informationJanuary 2014 Vol. 34 No. 1
January 2014 Vol. 34 No. 1. and Minimal Inhibitory Concentration (MIC) Interpretive Standards for Testing Conditions Medium: diffusion: Mueller-Hinton agar (MHA) roth dilution: cation-adjusted Mueller-Hinton
More informationempirical therapy of febrile neutropenia in paediatric cancer patients
Original Article Singapore Med.1 2007, 48 (7) : 615 Cefepime plus amikacin as an initial empirical therapy of febrile neutropenia in paediatric cancer patients Hamidah A, Lim Y S, Zulkifli S Z, Zarina
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 informationRELIABLE AND REALISTIC APPROACH TO SENSITIVITY TESTING
RELIABLE AND REALISTIC APPROACH TO SENSITIVITY TESTING Pages with reference to book, From 94 To 97 S. Hafiz, N. Lyall, S. Punjwani, Shahida Q. Zaidi ( Department of Microbiology, The Aga Khan University
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 informationAntimicrobial Susceptibility in Gram-Negative Bacteremia: Are
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Nov. 1989, p. 1855-1859 0066-4804/89/111855-05$02.00/0 Copyright 1989, American Society for Microbiology Vol. 33, No. 11 Antimicrobial Susceptibility in Gram-Negative
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 informationIsolation of Urinary Tract Pathogens and Study of their Drug Susceptibility Patterns
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 5 Number 4 (2016) pp. 897-903 Journal homepage: http://www.ijcmas.com Original Research Article http://dx.doi.org/10.20546/ijcmas.2016.504.101
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 informationProtocol for Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland
Protocol for Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland Version 1.0 23 December 2011 General enquiries and contact details This is the first version (1.0) of the Protocol
More informationDATA COLLECTION SECTION BY FRONTLINE TEAM. Patient Identifier/ Medical Record number (for facility use only)
Assessment of Appropriateness of ICU Antibiotics (Patient Level Sheet) **Note this is intended for internal purposes only. Please do not return to PQC.** For this assessment, inappropriate antibiotic use
More informationnumber Done by Corrected by Doctor Dr.Malik
number 27 Done by Fatimah Farhan Corrected by Basil Al-Bakri Doctor Dr.Malik Note: anything in red is just extra info and you will not be asked about it in the exam. In this sheet we will continue talking
More informationShould we test Clostridium difficile for antimicrobial resistance? by author
Should we test Clostridium difficile for antimicrobial resistance? Paola Mastrantonio Department of Infectious Diseases Istituto Superiore di Sanità, Rome,Italy Clostridium difficile infection (CDI) (first
More informationInfections in Immunocompromised Patients TH 5001: Therapeutics III Fall, 2003 Sara L. Lanfear, Pharm.D., BCPS
Infections in Immunocompromised Patients TH 5001: Therapeutics III Fall, 2003 Sara L. Lanfear, Pharm.D., BCPS Required Reading Fish DN. Infections in Immunocompromised Patients. In: Dipiro JT, Talbert
More informationEfficacy of Ceftriaxone in Serious Bacterial Infections
ANTIMIROBIAL AGENTS AND HEMOTHERAPY, Mar 1982, p 402-406 0066-4804/82/030402-05$0200/0 Vol 21, No 3 Efficacy of eftriaxone in Serious Bacterial Infections JAY S EPSTEIN, SUSAN M HASSELQUIST, AND GARY L
More informationESCMID Online Lecture Library. by author
Expert rules in susceptibility testing EUCAST-ESGARS-EPASG Educational Workshop Linz, 16 19 September, 2014 Dr. Rafael Cantón Hospital Universitario Ramón y Cajal SERVICIO DE MICROBIOLOGÍA Y PARASITOLOGÍA
More informationEmergence of Gentamicin- and Carbenicillin-Resistant Pseudomonas aeruginosa in a Hospital Environment
ANTImICROBsuL AGENTS AND CHEMOTHERAPY, Mar. 1976, p. 474-48 Copyright 1976 American Society for Microbiology Vol. 9, No. 3 Printed in U.S.A. Emergence of Gentamicin- and Carbenicillin-Resistant Pseudomonas
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 informationTREAT Steward. Antimicrobial Stewardship software with personalized decision support
TREAT Steward TM Antimicrobial Stewardship software with personalized decision support ANTIMICROBIAL STEWARDSHIP - Interdisciplinary actions to improve patient care Quality Assurance The aim of antimicrobial
More informationAntimicrobial Susceptibility Patterns of Salmonella Typhi From Kigali,
In the name of God Shiraz E-Medical Journal Vol. 11, No. 3, July 2010 http://semj.sums.ac.ir/vol11/jul2010/88030.htm Antimicrobial Susceptibility Patterns of Salmonella Typhi From Kigali, Rwanda. Ashok
More informationDefining Extended Spectrum b-lactamases: Implications of Minimum Inhibitory Concentration- Based Screening Versus Clavulanate Confirmation Testing
Infect Dis Ther (2015) 4:513 518 DOI 10.1007/s40121-015-0094-6 BRIEF REPORT Defining Extended Spectrum b-lactamases: Implications of Minimum Inhibitory Concentration- Based Screening Versus Clavulanate
More informationDisk Susceptibility Studies with Cefazolin and Cephalothin
ANTIMICROBiAL AGENTS AND CHEMOTHEMRAPY, Jan. 1974, p. 63-67 Copyright i 1974 American Society for Microbiology Vol. 5, No. 1 Printed in U.SA. Disk Susceptibility Studies with Cefazolin and Cephalothin
More informationavailable. and P. aeruginosa resistant to gentamicin by standardized disk testing (1) in the Microbiology Laboratory
ANTimICROBIAL AGENTh AND CHEMOTHERAPY, OCt. 1976, p. 677-681 Copyright 1976 American Society for Microbiology Vol. 10, No. 4 Printed in U.S.A. In Vitro Susceptibility of Gentamicin-Resistant Enterobacteriaceae
More informationInfection control for neutropenic cancer patients : the use of prophylactic antibiotics. by author
Infection control for neutropenic cancer patients : the use of prophylactic antibiotics Jean A. Klastersky Institut Jules Bordet, Université Libre de Bruxelles (ULB) Brussels, Belgium Complications and
More informationThese recommendations were approved for use by the Pharmaceutical and Therapeutics Committee, RCWMCH on 1 February 2017.
Antibiotic regimens for suspected hospital-acquired infection (HAI) outside the Paediatric Intensive Care Unit at Red Cross War Memorial Children s Hospital (RCWMCH) Lead author: Brian Eley Contributing
More informationPost-operative surgical wound infection
Med. J. Malaysia Vol. 45 No. 4 December 1990 Post-operative surgical wound infection Yasmin Abu Hanifah, MBBS, MSc. (London) Lecturer Department of Medical Microbiology, Faculty of Medicine, University
More informationCarbapenemase-producing Enterobacteriaceae (CRE) T H E L A T E S T I N T H E G R O W I N G L I S T O F S U P E R B U G S
Carbapenemase-producing Enterobacteriaceae (CRE) T H E L A T E S T I N T H E G R O W I N G L I S T O F S U P E R B U G S CRE Enterobacteriaceae (Gram Negative Bacilli) Citrobacter species Escherichia coli***
More informationTITLE: NICU Late-Onset Sepsis Antibiotic Practice Guideline
Site: Saint Joseph Hospital - NICU Original Effective Date: 6/1/2016 Next Review Date: 6/1/2019 TITLE: Practice Guideline Purpose: Timely and appropriate treatment of late-onset sepsis with antibiotic
More informationApril 25, 2018 Edited by: Gregory K. Perry, PharmD, BCPS-AQID
VOLUME FOUR; ISSUE 4 April 25, 2018 Edited by: Gregory K. Perry, PharmD, BCPS-AQID InPHARMation Pharmacy and Therapeutics Committee Update April 25 th, 2018 Meeting The Pharmacy and Therapeutics Committee
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 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 informationPrevalence of Metallo-Beta-Lactamase Producing Pseudomonas aeruginosa and its antibiogram in a tertiary care centre
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 4 Number 9 (2015) pp. 952-956 http://www.ijcmas.com Original Research Article Prevalence of Metallo-Beta-Lactamase
More informationEvaluating the Role of MRSA Nasal Swabs
Evaluating the Role of MRSA Nasal Swabs Josh Arnold, PharmD PGY1 Pharmacy Resident Pharmacy Grand Rounds February 28, 2017 2016 MFMER slide-1 Objectives Identify the pathophysiology of MRSA nasal colonization
More informationComparative Clinical Evaluation of the T2Bacteria Panel versus Blood Culture for the Diagnosis of Bacteremia
Comparative Clinical Evaluation of the T2Bacteria Panel versus Blood Culture for the Diagnosis of Bacteremia MH Nguyen, W Pasculle, PG Pappas, G Alangaden, G Pankey, B Schmitt, M Weinstein, R Widen, D
More informationThe International Collaborative Conference in Clinical Microbiology & Infectious Diseases
The International Collaborative Conference in Clinical Microbiology & Infectious Diseases PLUS: Antimicrobial stewardship in hospitals: Improving outcomes through better education and implementation of
More informationAntimicrobial stewardship in managing septic patients
Antimicrobial stewardship in managing septic patients November 11, 2017 Samuel L. Aitken, PharmD, BCPS (AQ-ID) Clinical Pharmacy Specialist, Infectious Diseases slaitken@mdanderson.org Conflict of interest
More 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 informationagainst Clinical Isolates of Gram-Positive Bacteria
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Feb. 993, p. 366-370 Vol. 37, No. 0066-0/93/00366-05$0.00/0 Copyright 993, American Society for Microbiology In Vitro Activity of CP-99,9, a New Fluoroquinolone,
More informationNosocomial 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 informationAntibiotic Usage Guidelines in Hospital
SUPPLEMENT TO JAPI december VOL. 58 51 Antibiotic Usage Guidelines in Hospital Camilla Rodrigues * Use of surveillance data information of Hospital antibiotic policy guidelines from Hinduja Hospital. The
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 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 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 informationThe First Report of CMY, AAC(6')-Ib and 16S rrna Methylase Genes among Pseudomonas aeruginosa Isolates from Iran
1 2 The First Report of CMY, AAC(6')-Ib and 16S rrna Methylase Genes among Pseudomonas aeruginosa Isolates from Iran Sedigheh Rafiei Tabatabaei, MD, MPH Associate Professor of Pediatric Infectious Diseases
More information