Drugs Against Bugs - microbiology issues in the ICU (original) (raw)
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The most recent concepts for the management of bacterial and fungal infections in ICU
Intensive Care Medicine, 2018
The pattern of infections globally is changing as a result of myriad factors including global warming, increasing antimicrobial resistance, and population migration patterns. In Europe large numbers of refugees from the Middle East, Africa and elsewhere have introduced multidrug-resistant (MDR) tuberculosis and MDR Gramnegative bacteria including Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (MRSA) [1]. Escherichia coli has the highest resistance rates (up to 38.1%) against broad-spectrum cephalosporins in Southern and Eastern Europe, while carbapenem-resistant Klebsiella pneumoniae is also increasingly common (59.4% in Greece, 34.3% in Italy, 20.5% in Romania and less than 2% in other EU countries) [1]. Carbapenem resistance has also been reported in more than 50% of A. baumannii isolates in Portugal, Greece, Italy, Cyprus, Romania and Bulgaria. The clinical importance of increasing prevalence of MDR bacterial infections was highlighted by a systematic review assessing the impact of non-covering (inappropriate) empirical antibiotic treatment (IEAT) [2]. Multi-covariate analyses demonstrated that the prevalence of any MDR pathogen, Acinetobacter spp. specifically, and more recent study years were associated with IEAT. MDR rates were independently associated with mortality and the prevalence of MDRs was associated with IEAT [2]. The prevalence of infection in critically ill patients caused by MDR bacteria is rapidly evolving. Clinical studies aimed at improving our understanding of
Overview of antimicrobial therapy in intensive care units
Expert Review of Anti-infective Therapy, 2011
In the management of a patient with severe sepsis, it is important to suspect the infection early, to collect samples immediately after diagnosis and to promptly initiate a broad-spectrum antibiotic treatment. The choice of this empirical antimicrobial therapy should be based on host characteristics, site of infection, local ecology and pharmacokinetics/pharmacodynamics of antibiotics. In severe infection, guidelines recommend the use of a combination of antibiotics. After results of cultures are obtained, treatment should be re-evaluated to either de-escalate or escalate the antibiotic prescription. This is associated with optimal costs, decreased incidence of superinfection and minimal development of antimicrobial resistance. All these steps should rely on written protocols, and the compliance to these protocols should be continuously monitored in order to detect violations and implement corrective procedures.
GMS Krankenhaushygiene Interdisziplinär, 2007
In infectious diseases we can discern a cause and effect chain, which in particular offers the practicable perspectives of prophylaxis and treatment. However, to date we have not been able to control them. Apart from new epidemics, such as those caused by HIV and SARS, long-forgotten scourges like TB are enjoying a comeback. Furthermore, the advances made in clinical medicine mean that induced immunosuppression, for instance as a result of major surgery or organ transplantation, has become a serious problem in intensive care units. The body's natural barriers are breached through medical interventions while, on the other hand, immunocompromising therapeutic agents such as cytostacis and glucocorticoids ensure that invading microorganisms will be able to multiply. Drugs administered as stress ulcus prophylaxis give rise to a shift in the bacterial flora of the throat, thus laying the foundation for a lower respiratory tract infection. With regard to bacterial resistance, antibiot...
GMS Krankenhaushygiene Interdisziplinar, 2007
In infectious diseases we can discern a cause and effect chain, which in particular offers the practicable perspectives of prophylaxis and treatment. However, to date we have not been able to control them. Apart from new epidemics, such as those caused by HIV and SARS, long-forgotten scourges like TB are enjoying a comeback. Furthermore, the advances made in clinical medicine mean that induced immunosuppression, for instance as a result of major surgery or organ transplantation, has become a serious problem in intensive care units. The body’s natural barriers are breached through medical interventions while, on the other hand, immunocompromising therapeutic agents such as cytostacis and glucocorticoids ensure that invading microorganisms will be able to multiply. Drugs administered as stress ulcus prophylaxis give rise to a shift in the bacterial flora of the throat, thus laying the foundation for a lower respiratory tract infection. With regard to bacterial resistance, antibiotic t...
Asian Journal of Pharmaceutical and Clinical Research, 2018
Objective: To identify the pattern of drug utilization of antimicrobials in prescriptions of patients admitted at medical intensive care unit (MICU) and surgical intensive care unit (SICU) department and to analyze the utilization of different classes of drugs. Methods: A prospective observational study was carried out in 10 bedded medical and surgical intensive care unit (ICU) of tertiary care hospital, Adayar, from October 1 st 2016 to March 1 st 2016. The study was performed in 100 prescriptions. The relevant data on drug prescription of each patient were collected from in-patient records. The demographic data, disease data, and the utilization of different classes of antimicrobial agents (AMAs) were analyzed. Results: In MICU, a total of 648 drugs were prescribed during the period of stay and AMAs accounted for 15% of total drug. The average length of stay was found to be 8 (±8.73). The mean number of drugs received by patients is 11.6 ± 2 drugs. The most frequently prescribed AMAs were ceftriaxone followed by meropenem and clindamycin. Cephalosporin is commonly prescribed due to their relatively lower toxicity and broader spectrum activity. The generally prescribed AMA combination was amoxicillin + clavulanic acid (32.50%) and piperacillin + tazobactam (27.50%). The laboratory reported positive cultures for 30 patients. The most prevailing organisms were Escherichia coli (50%). In SICU, a total of 780 drugs were prescribed during the period of stay and AMAs accounted for 18% of total drug. An average of 5 (±2.0) drugs was prescribed for each patient and each prescription contains an average of 2 (±0.9) AMAs. The results indicated that ceftriaxone was the most commonly prescribed AMAs (22%), followed by meropenem (18%), ciprofloxacin (18%), and colistin (8%). A total of five AMA combination therapies were used in SICU. Among them, piperacillin+clavulanic acid (36.84%) was the most commonly prescribed combination. In the study, 30 (60 %) cases had microbial growth and have performed sensitivity test. Conclusion: A wide class and percentage of AMAs were prescribed in ICUs. There is a need of antimicrobial agent's usage guidelines and restriction policies for the rational prescribing of antimicrobials in critically ill patients.
Strategies for appropriate antibiotic use in intensive care unit
Einstein (São Paulo), 2015
The comsumption of antibiotics is high, mainly in intensive care units. Unfortunately, most are inappropriately used leading to increased multi-resistant bacteria. It is well known that initial empirical therapy with broad-spectrum antibiotics reduce mortality rates. However the prolonged and irrational use of antimicrobials may also increase the risk of toxicity, drug interactions and diarrhea due to Clostridium difficile. Some strategies to rational use of antimicrobial agents include avoiding colonization treatment, de-escalation, monitoring serum levels of the agents, appropriate duration of therapy and use of biological markers. This review discusses the effectiveness of these strategies, the importance of microbiology knowledge, considering there are agents resistant to Staphylococcus aureus andKlebsiella pneumoniae, and reducing antibiotic use and bacterial resistance, with no impact on mortality.
Critical Care, 2008
all 10 cities including the rural areas of the province of Kerman. All data were finally analyzed by SPSS software (version 11.5). Results On the basis of recorded statistical analysis, the mortality cases of human rabies in the province of Kerman during one decade was 10 persons (eight males and two females). One-half of them (50%) were bitten by dogs and the others (50%) by foxes. Among the reported deaths, 40% were from Kahnooj county (Jiroft region). The reported data indicated that 21,546 persons were bitten by animals during 10 years in the province of Kerman. The mean of age of the people who were bitten by dogs was 24.80 years (SD = ±14.6), while the mean age of the people who were bitten by foxes was 57.25 years (SD = ±1.50). There was a significant difference between the mean age of these two groups of the people (P < 0.05). The most frequent rate of injured people was reported in the age group 10-19 years old and the frequency rate of males (76.00%) was more than females (24.00%). Therefore, there was a statistically significant difference between males and females in this study (P < 0.01). About 60% of all persons that were bitten by animals were from rural areas and 40% of them were from urban areas (P < 0.05). Among the people who were bitten and injured by animals during one decade in the province of Kerman, 85.70% of them were not treated by the rabies prophylaxis treatment regimen. Among all of them who were bitten by animals, 50% were injured through hands and feet, 40%