Elizabeth B Nimmich1, P Brandon Bookstaver2,3, Joseph Kohn3, Julie Ann Justo2,3, Katie L Hammer4, Helmut Albrecht5,6, Majdi N Al-Hasan5,6. 1. Lexington Medical Center, West Columbia, SC, USA. 2. College of Pharmacy, University of South Carolina, Columbia, USA. 3. Palmetto Health Richland, Columbia, SC, USA. 4. Carolinas HealthCare System, Charlotte, NC, USA. 5. University of South Carolina School of Medicine, Columbia, USA. 6. Palmetto Health USC Medical Group, Columbia, USA.
Abstract
Background: Appropriate empirical antimicrobial therapy is associated with improved outcomes of patients with Gram-negative bloodstream infections (BSI). Objective: Development of evidence-based institutional management guidelines for empirical antimicrobial therapy of Gram-negative BSI. Methods: Hospitalized adults with Gram-negative BSI in 2011-2012 at Palmetto Health hospitals in Columbia, SC, USA, were identified. Logistic regression was used to examine the association between site of infection acquisition and BSI due to Pseudomonas aeruginosa or chromosomally mediated AmpC-producing Enterobacteriaceae (CAE). Antimicrobial susceptibility rates of bloodstream isolates were stratified by site of acquisition and acute severity of illness. Retained antimicrobial regimens had predefined susceptibility rates ≥90% for noncritically ill and ≥95% for critically ill patients. Results: Among 390 patients, health care-associated (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.5-6.3] and hospital-acquired sites of acquisition (OR: 3.7, 95% CI: 1.6-8.4) were identified as risk factors for BSI due to P aeruginosa or CAE, compared with community-acquired BSI (referent). Based on stratified bloodstream antibiogram, ceftriaxone met predefined susceptibility criteria for community-acquired BSI in noncritically ill patients (95%). Cefepime and piperacillin-tazobactam monotherapy achieved predefined susceptibility criteria in noncritically ill (95% both) and critically ill patients with health care-associated and hospital-acquired BSI (96% and 97%, respectively) and critically ill patients with community-acquired BSI (100% both). Conclusions: Incorporation of site of acquisition, local antimicrobial susceptibility rates, and acute severity of illness into institutional guidelines provides objective evidence-based approach for optimizing empirical antimicrobial therapy for Gram-negative BSI. The suggested methodology provides a framework for guideline development in other institutions.
Background: Appropriate empirical antimicrobial therapy is associated with improved outcomes of patients with Gram-negative bloodstream infections (BSI). Objective: Development of evidence-based institutional management guidelines for empirical antimicrobial therapy of Gram-negative BSI. Methods: Hospitalized adults with Gram-negative BSI in 2011-2012 at Palmetto Health hospitals in Columbia, SC, USA, were identified. Logistic regression was used to examine the association between site of infection acquisition and BSI due to Pseudomonas aeruginosa or chromosomally mediated AmpC-producing Enterobacteriaceae (CAE). Antimicrobial susceptibility rates of bloodstream isolates were stratified by site of acquisition and acute severity of illness. Retained antimicrobial regimens had predefined susceptibility rates ≥90% for noncritically ill and ≥95% for critically illpatients. Results: Among 390 patients, health care-associated (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.5-6.3] and hospital-acquired sites of acquisition (OR: 3.7, 95% CI: 1.6-8.4) were identified as risk factors for BSI due to P aeruginosa or CAE, compared with community-acquired BSI (referent). Based on stratified bloodstream antibiogram, ceftriaxone met predefined susceptibility criteria for community-acquired BSI in noncritically ill patients (95%). Cefepime and piperacillin-tazobactam monotherapy achieved predefined susceptibility criteria in noncritically ill (95% both) and critically illpatients with health care-associated and hospital-acquired BSI (96% and 97%, respectively) and critically illpatients with community-acquired BSI (100% both). Conclusions: Incorporation of site of acquisition, local antimicrobial susceptibility rates, and acute severity of illness into institutional guidelines provides objective evidence-based approach for optimizing empirical antimicrobial therapy for Gram-negative BSI. The suggested methodology provides a framework for guideline development in other institutions.
Authors: Pilar Retamar; María M Portillo; María Dolores López-Prieto; Fernando Rodríguez-López; Marina de Cueto; María V García; María J Gómez; Alfonso Del Arco; Angel Muñoz; Antonio Sánchez-Porto; Manuel Torres-Tortosa; Andrés Martín-Aspas; Ascensión Arroyo; Carolina García-Figueras; Federico Acosta; Juan E Corzo; Laura León-Ruiz; Trinidad Escobar-Lara; Jesús Rodríguez-Baño Journal: Antimicrob Agents Chemother Date: 2011-10-17 Impact factor: 5.191
Authors: Andrew F Shorr; Scott T Micek; Emily C Welch; Joshua A Doherty; Richard M Reichley; Marin H Kollef Journal: Crit Care Med Date: 2011-01 Impact factor: 7.598
Authors: Timothy H Dellit; Robert C Owens; John E McGowan; Dale N Gerding; Robert A Weinstein; John P Burke; W Charles Huskins; David L Paterson; Neil O Fishman; Christopher F Carpenter; P J Brennan; Marianne Billeter; Thomas M Hooton Journal: Clin Infect Dis Date: 2006-12-13 Impact factor: 9.079
Authors: Kalpana Gupta; Thomas M Hooton; Kurt G Naber; Björn Wullt; Richard Colgan; Loren G Miller; Gregory J Moran; Lindsay E Nicolle; Raul Raz; Anthony J Schaeffer; David E Soper Journal: Clin Infect Dis Date: 2011-03-01 Impact factor: 9.079
Authors: Sarah E Cain; Joseph Kohn; P Brandon Bookstaver; Helmut Albrecht; Majdi N Al-Hasan Journal: Antimicrob Agents Chemother Date: 2014-10-27 Impact factor: 5.191
Authors: Brian C Pien; Punidha Sundaram; Natalia Raoof; Sylvia F Costa; Stanley Mirrett; Christopher W Woods; L Barth Reller; Melvin P Weinstein Journal: Am J Med Date: 2010-09 Impact factor: 4.965
Authors: G B Orsi; A Bencardino; A Vena; A Carattoli; C Venditti; M Falcone; A Giordano; M Venditti Journal: Infection Date: 2012-10-16 Impact factor: 3.553
Authors: Majdi N Al-Hasan; Brian D Lahr; Jeanette E Eckel-Passow; Larry M Baddour Journal: J Antimicrob Chemother Date: 2009-05-12 Impact factor: 5.790
Authors: David L Paterson; Wen-Chien Ko; Anne Von Gottberg; Sunita Mohapatra; Jose Maria Casellas; Herman Goossens; Lutfiye Mulazimoglu; Gordon Trenholme; Keith P Klugman; Robert A Bonomo; Louis B Rice; Marilyn M Wagener; Joseph G McCormack; Victor L Yu Journal: Ann Intern Med Date: 2004-01-06 Impact factor: 25.391
Authors: E Merino; A Gimeno; M Alcalde; J Coy; V Boix; C Molina-Pardines; M P Ventero; A Galiana; E Caro; J C Rodríguez Journal: Rev Esp Quimioter Date: 2021-03-23 Impact factor: 1.553
Authors: Rajiv Amipara; Hana Rac Winders; Julie Ann Justo; P Brandon Bookstaver; Joseph Kohn; Majdi N Al-Hasan Journal: EClinicalMedicine Date: 2021-03-30
Authors: Dev Dash; Arjun Gokhale; Birju S Patel; Alison Callahan; Jose Posada; Gomathi Krishnan; William Collins; Ron Li; Kevin Schulman; Lily Ren; Nigam H Shah Journal: Appl Clin Inform Date: 2022-03-02 Impact factor: 2.342
Authors: Tolbert B Sonda; Pius G Horumpende; Happiness H Kumburu; Marco van Zwetselaar; Stephen E Mshana; Michael Alifrangis; Ole Lund; Frank M Aarestrup; Jaffu O Chilongola; Blandina T Mmbaga; Gibson S Kibiki Journal: PLoS One Date: 2019-08-05 Impact factor: 3.240