Optimizing Empirical Antimicrobial Therapy for Infection due to Gram‐Negative Pathogens in the Intensive Care Unit: Utility of a Combination Antibiogram (original) (raw)
Related papers
Diagnostic Microbiology and Infectious Disease, 2014
The Study for Monitoring Antimicrobial Resistance Trends program monitors the activity of antibiotics against aerobic and facultative Gram-negative bacilli (GNBs) from intra-abdominal infections (IAIs) in patients worldwide. Methods In 2011, 1 929 aerobic and facultative GNBs from 21 hospitals in 16 cities in China were collected. All isolates were tested using a panel of 12 antimicrobial agents, and susceptibility was determined following the Clinical Laboratory Standards Institute guidelines. Results Among the Gram-negative pathogens causing IAIs, Escherichia coli (47.3%) was the most commonly isolated, followed by Klebsiella pneumoniae (17.2%), Pseudomonas aeruginosa (10.1%), and Acinetobacter baumannii (8.3%). Enterobacteriaceae comprised 78.8% (1521/1929) of the total isolates. Among the antimicrobial agents tested, ertapenem and imipenem were the most active agents against Enterobacteriaceae, with susceptibility rates of 95.1% and 94.4%, followed by amikacin (93.9%) and piperacillin/tazobactam (87.7%). Susceptibility rates of ceftriaxone, cefotaxime, ceftazidime, and cefepime against Enterobacteriaceae were 38.3%, 38.3%, 61.1%, and 50.8%, respectively. The leastactive agent against Enterobacteriaceae was ampicillin/sulbactam (25.9%). The extended-spectrum β-lactamase (ESBL) rates among E. coli, K. pneumoniae, Klebsiella oxytoca, and Proteus mirabilis were 68.8%, 38.1%, 41.2%, and 57.7%, respectively. Conclusions Enterobacteriaceae were the major pathogens causing IAIs, and the most active agents against the study isolates (including those producing ESBLs) were ertapenem, imipenem, and amikacin. Including the carbapenems, most agents exhibited reduced susceptibility against ESBL-positive and multidrug-resistant isolates.
ABSTRACT Introduction: Antibiotic resistance is a major emerging world-wide problem in the intensive care unit (ICU). The aim of this study was to study the antimicrobial resistance patern of microbial isolates from patients in intensive care units (ICUs). Material and methods: Al isolates from diferent clinical samples were colected and procesed by standard microbiological techniques. Antimicrobial susceptibilty testing was performed by modified Kirby Bauer method. Al gram negative organisms were further tested for ESBL and MBL production. Results:Of 451 isolates, 353 (78.2%) were gram negative and 98 (21.7%) were gram positve coci. The most frequent infections were lower respiratory tract infections (32.9%). The most frequently isolated organisms were P. aeruginosa (20.1%) and Staphylococus epidermidis (8.6%). Higher resistance (60-10%) was observed to amoxycilin, ceftazidime, amoxyclav, ciprofloxacin and cotrimoxazole.ESBLs production was found in (45.3%) isolates. 75.0% of Staphylococus aureus and 20.5% of S.epidermidiswere MRSA positve. 85.7% showed MBL production. Conclusion: Surveilance of antibiotic susceptibilty paterns of predominant bacteria is necesary to monitor changes in susceptibilty paterns and to guide the clinician in chosing empirical or directed therapy apropriately, especialy in ICU seting. KEYWORDS: Intensive Care Unit, antibiotic resistance, MRSA.
Anaerobe
The study was performed to assess microorganisms and antibiotic susceptibility patterns during ten years in intensive care units of a University Hospital. Infection Control Committee has active, prospective surveillance in ICUs for thirteen years. Ten years data of ICUs was evaluated retrospectively from surveillance forms. Microorganisms and their antibiotic resistance were recorded according to the years. During ten years, gram negative microorganisms were the most frequent isolated microorganisms from clinical specimens. Acinetobacter baumannii (21.8%), Pseudomonas aerigunosa (16%), Escherichia coli (10.4%) and Klebsiella pneumoniae (8%) were the most common gram negative microorganisms. However, Staphylococcus aureus was the most prevalent gram positive microorganism, the incidence decreased from 18.6% to 4.8% during ten years. Also antibiotic susceptibility of microorganisms changed during ten years. Carbapenem resistance increased from 44% to 92% in A. baumannii and ciprofloxacin resistance increased in E. coli from 28% to 60% and in K. pneumoniae from 21% to 55% during ten years. However, methicilin resistance decreased in S. aureus from 96% to 54%. In conclusion, antibiotic resistance is growing problem in ICUs. Rationale antibiotic policies and infection control measures will prevent the development of resistance.
Science of The Total Environment, 2019
• Total consumption of antimicrobials for 2017 was evaluated in a Romanian hospital. • Antibiotic sensitivity analysis was performed using a cumulative antibiogram. • The most frequently prescribed antibiotics were cephalosporins and fluoroquinolones. • Urinary and respiratory tract infections dominate in the Intensive Care Unit. • The most common pathogens: Acinetobacter baumannii, E. coli and Enterobacter spp.
Study Design: A cross-sectional study. Place and Duration: In the Medicine Unit-II of Jinnah Hospital Lahore for one-year duration from April 2019 to April 2020. Methods: 100 samples were collected from patients admitted to the ICU with symptoms or symptoms of nosocomial infection. Blood, urine, tracheal aspirate, sputum, wound swab, pus, and tracheal tubes were sampled from each patient, cultured, and analyzed by antibiogram. Results: The most common primary diagnosis was aspiration pneumonia (49%) and UTI (20%), respectively. The most common sites of infection were tracheal aspirates (54%). The most common sample-derived Gram-negative microorganisms were Acinetobacter spp (29%), Klebsiella spp (26%) and Pseudomonas spp (18%). Klebsiella spp., Acinetobacter spp. And Pseudomonas spp. They were the most common resistant organisms of all. Klebsiella spp were resistant to ceftriaxone (84.6%), ceftazidime (82.6%), amikacin (46.1%), gentamicin (66.6%) and quinolones (65-66.6%), respectively. Acinetobacter spp were resistant to ceftriaxone (85%), ceftazidime (88.8%), cefotaxime (85.7%), meropenem (79.3%), amikacin (86.2%), gentamicin (84.5%) and quinolones (86.2-89.2%). Pseudomonas spp were resistant to ceftriaxone (70.5%), ceftazidime (66.6%), amikacin (68.7%), gentamicin (58.8%), meropenem (52.9%) and quinolones (81 2-86.6%). Meropenem was the most sensitive antibiotic to Klebsiella spp (84.6%), and co-trimoxazole in Acinetobacter spp (60%), respectively. Escherichia coli were mostly isolated from urine, which was sensitive to amikacin (73.3%) and meropenem (86.6%), respectively. Conclusion: Gram-negative pathogens obtained from ICU patients in our facilities show high resistance to antibiotics. Regular monitoring of resistance patterns of common pathogens in intensive care units is essential for the current application of sound antibiotic ceilings.
Pharmaceutical Sciences Asia
Antimicrobial resistance (AMR) has become a concerning health issue worldwide, and this resistance leads to poor treatment outcomes and high mortality, especially, AMR of NP in ICU. To determine the reality of AMR and find the factors related to AMR of NP in the ICU. We performed a cross-sectional study in the ICU Department from July 2015 to July 2019. We calculated the incidence of the degree of multidrug-resistant strains and the percentages of factors related to AMR. Data management and analysis were performed by SPSS version 22.0. Of the initial observation of 281 patients, all participants had NP due to gram-negative bacteria; 91 (32.4%) were early-onset and 190 (67.6%) were lately-onset NP. Out of all pathogens examined, above 80% were resistant to quinolone, carbapenem, and cephalosporin. Moreover, multiple drug resistance in bacteria was about 87.5%. Furthermore, bacteria, changed antibiotics have been significantly associated with the multi-resistance of bacteria. Besides, the increase in antibiotic use, especially ciprofloxacin and imipenem, is also related to antibiotic resistance. These results show that the resistance to quinolones, carbapenem, and cephalosporin is high in the ICU, with rates exceeding 80%. Furthermore, the bacteria, change of antibiotics, and the increasing use of antibiotics have been significantly associated with multiple antibiotic resistance.
Antimicrobial susceptibility in intensive care units: MYSTIC Program Brazil 2002
Brazilian Journal of Infectious Diseases, 2005
OBJECTIVE: Establish the susceptibility pattern of Gram-negative bacteria causing infections in ICU patients, MYSTIC Program Brazil 2002. MATERIAL AND METHODS: Gram-negative bacteria (n = 503) causing nosocomial infections were collected at seven Brazilian centers. The central laboratory confirmed the identification and performed the susceptibility tests by E-test methodology (AB Biodisk, Solna, Sweden) for meropenem, imipenem, ciprofloxacin, ceftazidime, cefepime, cefotaxime, piperacillin/tazobactam, gentamicin, and tobramycin. Interpretation criteria used were according to National Committee for Clinical Laboratory Standards (NCCLS). RESULTS: Pseudomonas aeruginosa (33%) was the most frequently isolated, followed by A. baumannii (17.1%), K. pneumoniae (12.1%), E. coli (10.5%), and E. cloacae (7.9%). Pseudomonas aeruginosa isolates had susceptibility rates of 67.5% to piperacillin/tazobactam, 59.8% to meropenem, 57.3% to imipenem. A. baumannii presented susceptibility rates to meropenem of 89.5%, 88.4% to imipenem, and 74.4% to tobramycin. E. coli and K. pneumoniae were fully susceptible to both carbapenems. CONCLUSIONS: Carbapenem resistance among Enterobacteriaceae is still rare in this region. A. baumannii and P. aeruginosa presented elevated resistance rates to all antimicrobials. Since these two bacterial species play an important role in nosocomial infections, the use of empirical combination therapy to treat these pathogens may be justified.
IP Innovative Publication Pvt. Ltd, 2017
Background: To study the bacteriological profile of infections in patients admitted to ICU and to determine the antibiotic susceptibility patterns of the bacterial isolates. This study was done as Prospective study of 2 months period with a study population of patients admitted to Intensive care unit of a tertiary care hospital. Materials and Methods: Selection criteria for this study was with an inclusion criteria of patients admitted to ICU for various reasons and developing infection within 48 hours of admission and the exclusion criteria was patients admitted to ICU and not developing infection and patients admitted to ICU with an already existing infection. All the samples were processed as per standard microbiology guidelines. Results: Gram negative bacilli were predominant with 73.35% as compared to Gram positive cocci of 9.97% of the total aerobic bacteria grown from various samples of patients admitted in Intensive care unit. Escherichia coli were more common with 26.67% of the total bacteria isolated. This was followed by Acinetobacter species 16.67%, Pseudomonas aeruginosa 16.67%, Klebsiella pneumoniae 6.67% and Enterobacter species6.67%. Among the Gram positive cocci, Staphylococcus aureus was more commonly isolated with 16.67% followed by Enterococcus species 6.67% and Streptococcus species 3.30%. Antibiotic resistance was observed by most bacteria to Penicillins, third generation Cephalosporins, Fluoroquinolones like Ciprofloxacin, Cotrimoxazole. Conclusion: Multi-drug resistance is a major hurdle in treating patients admitted to ICU setting in a hospital. Regular surveillance of antibiotic susceptibility patterns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients.
Journal of Antimicrobial Chemotherapy, 2010
Background: The lack of prospective, randomized, controlled trial data to guide optimal antibiotic use in bacteraemic critically ill patients has led to a wide variety of strategies and major issues with drug resistance. We therefore prospectively investigated the epidemiology of bacteraemia and fungaemia in intensive care units (ICUs); and the impact of timing, type and appropriateness of antibiotic intervention. Methods: We conducted a multinational, multicentre, prospective observational study in 132 ICUs from 26 countries with no interventions. Results: 1702 patients [European (69.6%), Australasian (12.2%), South American (8.3%) and Asian (9.9%)] developed 1942 bacteraemic episodes over the study period. Mortality rates were similar for those receiving empirical (40.5%), semi-targeted (37.6%) or fully targeted (33.3%) antibiotic therapy (P ¼ 0.40), and in those initially receiving broad-(39.3%) or restricted-spectrum (39.1%) therapy (P ¼ 0.94). First-line therapy was effective in terms of the antibiogram (where available) in 70.4% of cases. This in vitro susceptibility ranged from 76.3% for broad-spectrum antibiotics to 46.3% for restricted-spectrum antibiotics (P,0.0001). However, no antibiotic policy-associated variable, including in vitro susceptibility (odds ratio 0.89, 95% confidence interval 0.61-1.30), was a statistically significant predictor of mortality. Conclusions: We could not show an impact of antibiotics on mortality in critically ill patients, despite in vitro activity and early commencement. Randomized, multicentre trials are urgently needed to establish the appropriate duration, timing and combinations of antibiotics that will both optimally treat infection and minimize development of resistance and other complications.