Antibiotic Therapy In Group Research Articles

Association of antimicrobial use and incidence of hospital-acquired pneumonia in critically ill trauma patients with pulmonary contusion: an observational study

BackgroundPneumonia occurs in about 20% of trauma patients with pulmonary contusions. This study aims to evaluate the association between empirical antibiotic therapy and nosocomial pneumonia in this population. MethodsRetrospective cohort of adult patients admitted to a trauma-surgical ICU. The Antibiotic Therapy Group (ATG) was defined by intravenous antibiotic use for more than 48 h starting on hospital admission, while the Conservative Group (CG) was determined by antibiotic use no longer than 48 h. Primary outcome was microbiologically documented nosocomial pneumonia within 14 days after hospital admission. Logistic regression was used to estimate the association between group allocation and primary outcome. Exploratory analyses evaluating the association between resistant strains in pneumonia and antibiotic use were performed. ResultsThe study included 177 patients with chest trauma and pulmonary contusion on CT scan. ATG were more severely ill than CG, as shown by higher Injury Severity Score, SAPS3, SOFA score, higher rates, and longer duration of mechanical ventilation. In the multivariate analysis, ATG was associated with a lower incidence of primary outcome (OR = 0.25, 95% CI 0.09–0.64; p < 0.01). Similar results were found in the sensitivity analysis with another set of variables. However, each day of antibiotic use was associated with an increased risk of pneumonia by resistant bacteria (OR = 1.18 per day, 95% CI 1.05–1.36; p < 0.01). ConclusionsEmpiric antibiotic therapy was independently associated with lower incidence of nosocomial pneumonia in critically ill patients with pulmonary contusion. However, each day of antibiotic use was associated with increased resistant strains in infected patients.

Allogenic adipose derived mesenchymal stem cells are effective than antibiotics in treating endometritis

Endometritis is a uterine inflammatory disease that causes reduced livestock fertility, milk production and lifespan leading to significant economic losses to the dairy industry. Mesenchymal stem cells (MSC) may act as an alternative for inefficacy of antibiotics and rising antibiotic resistance in endometritis. The present study aimed to cure the chronic endometritic buffaloes using allogenic adipose-derived MSCs (AD-MSC). AD-MSCs were isolated from buffalo adipose tissue and characterized by multilineage differentiation as well as MSC-specific markers. The in vivo safety and efficacy were assessed after infusion of AD-MSCs. In safety trial, cells were administered in healthy buffaloes via different routes (IV and IC) followed by examination of clinical and hematological parameters. In efficacy study, AD-MSCs treatments (IV and IC) and antibiotic therapy (ABT) in endometritic buffaloes were comparatively evaluated. AD-MSCs did not induced any immunological reaction in treated buffaloes. PMN count, CRP levels and VDS were significantly (p ≤ 0.05) reduced after AD-MSCs infusions in IV and IC groups and no significant difference was observed in antibiotic group. The IV group was marked with 50% absolute risk reduction in endometritis and 50% live calf births after artificial insemination in comparison with ABT group. Anti-inflammatory cytokines (IL4 and IL10) and anti-microbial peptides (PI3, CATHL4, LCN2 and CST3) expressions were significantly (p ≤ 0.05) upregulated in IV group. The calf delivery rate after the treatments in IV group was higher (50%, 3 calves) than the other groups (IC: 33.3%, 2 calves; ABT: 16.6%, 1 calf). In conclusion, the administration of AD-MSCs through IV route was found to be safe and efficacious for alleviating chronic endometritis in dairy buffaloes.

Upfront appendectomy vs interval appendectomy in acute appendicitis with mass formation in pediatric age group: Little difference in major outcome

Aim: The aim of this study is to compare Conservative treatment followed by Interval Appendicectomy, versus Emergency Appendicectomy for the management of appendicular masses in children. Methods: Retrospective review of all appendicectomy performed in Tallaght university hospital, in Paediatric Surgery Department between January 2013 and June 2016. We included 397 procedures of Appendicectomy, among those, 16% (n=64) were diagnosed as appendicular masses. Cases were classified into two groups. Group I included those who were managed conservatively and then underwent Interval Appendicectomy after 6 to 8 weeks, (n=20) 31.3%. Group II included those who were managed with Emergency Appendicectomy, (n=44) 68.8%. The outcomes in the two groups were compared based on three parameters; the duration of hospital stay, the duration of Intravenous Antibiotics and post-operative morbidities. Results: We found that the median duration of hospitalization in group I was significantly longer than in group II (10 days vs 5 days, P&lt;0.0001). The mean duration of antibiotic therapy in group I was also significantly longer than in group II (10.4±3.17 days) vs (5.19±2.53 days), P&lt;0.0001). Nevertheless, the overall complication rate in Group I was similar to that of group II (38.1% vs 25.6%, P=0.304). Conclusion: No major difference in outcomes between the conservative and emergency operative approaches in managing appendicular mass in children. However, operative management is more cost-effective with less duration of hospital stay, as compared to the conservative approach.

PD24-12 ASSOCIATION BETWEEN ANTIBIOTIC THERAPY AND TREATMENT EFFICACY IN RENAL CELL CARCINOMA PATIENTS RECEIVING EITHER IMMUNE CHECKPOINT INHIBITORS OR TYROSINE KINASE INHIBITORS

You have accessJournal of UrologyCME1 Apr 2023PD24-12 ASSOCIATION BETWEEN ANTIBIOTIC THERAPY AND TREATMENT EFFICACY IN RENAL CELL CARCINOMA PATIENTS RECEIVING EITHER IMMUNE CHECKPOINT INHIBITORS OR TYROSINE KINASE INHIBITORS Avery Braun, Laura Bukavina, Mengying Deng, Elizabeth Handorf, and Philip Abbosh Avery BraunAvery Braun More articles by this author , Laura BukavinaLaura Bukavina More articles by this author , Mengying DengMengying Deng More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , and Philip AbboshPhilip Abbosh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003302.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The gut microbiome affects response to immune checkpoint inhibition (ICI). As such, we hypothesized antibiotic therapy (ABT) would negatively affect outcomes in metastatic renal cell carcinoma (mRCC) patients receiving ICI. We investigated the association between ABT and overall survival (OS)/real-world progression free survival (rwPFS) in mRCC patients receiving ICI or tyrosine kinase inhibitors (TKIs) as a reference group. METHODS: We included 5,306 patients with mRCC from the nationwide de-identified electronic health record-derived Flatiron Health database (ICI N=1805; TKI N=3501). Three-month landmark Kaplan Meier and log-rank tests were used to compare rwPFS and OS among ABT groups (3 months pre- vs 3 months post-treatment vs none). Cox models were used to investigate the association between rwPFS, OS, ABT and treatment modality. RESULTS: 375 (20.8%) ICI and 616 (17.8%) TKI patients received ABT (p=0.005). In multivariable analysis, male gender (OR 0.771, p=0.006) and advanced age (OR 0.981, p<0.001) were associated with lower ABT use; ICI (OR 1.273, p=0.016) and poor IMDC (OR 1.528, p=0.012) were associated with higher ABT use. ABT was associated with reduced rwPFS and OS in ICI (rwPFS median: 9.0 vs 11.6 months; p=0.014; OS median: 23.7 vs 33.6, p=0.017) and TKI recipients (rwPFS median: 7.98 vs 9.53, p=0.014; OS median: 18.5 vs 25.9, p<0.001) (Figure 1). Post-treatment ABT was associated with reduced OS and rwPFS (OS ICI median: 22.5 vs 36.2 vs 33.6, p=0.006; OS TKI median: 17.8 vs 21.4 vs 25.9, p<0.001; rwPFS ICI median: 8.21 v 11.50 vs 11.60, p=0.006; rwPFS TKI median: 7.95 vs 8.02 vs 9.53, p=0.004) (Figure 2). ABT was associated with reduced OS (ICI HR=1.28, p=0.018; TKI HR=1.27, p<0.001) and rwPFS (ICI HR=1.29, p=0.013; TKI HR=1.26, p=0.001) in both groups. CONCLUSIONS: We identified a negative association between ABT and OS/rwPFS in mRCC patients receiving ICI or TKI. These results support continued investigation of the gut microbiome health on RCC treatment efficacy. Source of Funding: DoD # (CA181178)Fox Core Grant # (P30 CA 006927) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e727 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Avery Braun More articles by this author Laura Bukavina More articles by this author Mengying Deng More articles by this author Elizabeth Handorf More articles by this author Philip Abbosh More articles by this author Expand All Advertisement PDF downloadLoading ...

Association of antibiotic therapy and treatment efficacy in urothelial cell carcinoma patients receiving immune checkpoint inhibitors.

4578 Background: The content of gut microbiome has been linked to the effectiveness of immune checkpoint inhibitory (ICI) therapy in various cancer types. Antibiotic therapy (ABT) induces significant alterations in gut microbiota; however, only a limited number of single-institutional studies have examined the impact of ABT on ICI treatment. Utilizing a national database, we sought to provide ‘real world outcomes’ by investigating the association between ABT and ICI on overall survival (OS) and real-world progression free survival (rwPFS) in advanced urothelial carcinoma (aUC). Methods: We used the electronic health record (EHR)-derived de-identified FlatIron Health (FIH) database after Institutional Review Board approval was obtained, and included a waiver of informed consent to select 1491 subjects with aUC who received ICI therapy. Patient characteristics were described and compared between those with known ABT use and without known ABT use (in the 3 months pre/post ICI initiation), using ANOVA and Chi-square tests. rwPFS and OS were calculated from date of initiation of ICI to date of real-world progression/date of death. 3-month landmark Kaplan Meier methods and log-rank tests were used to estimate and compare rwPFS and OS between patients with-ABT and without-ABT, as well as patients with ABT use pre-ICI initiation, post-ICI initiation, and no known ABT use. Cox proportional models were used to investigate the association between rwPFS, OS, and antibiotic use, adjusting for patient characteristics. Results: In patients who received ICI, we included 407 patients who received ABT and 1084 who did not. Those who received ABT were younger (p &lt; 0.001), more likely Caucasian (p = 0.046) and insured by Medicare (p &lt; 0.001). rwPFS (median: 9.0 vs 10.0 months; p = 0.41) and OS (median: 14.0 vs 16.0 months; p = 0.073) were not significantly different between the with or without ABT subgroups. We included 101, 182, and 715 patients who received ABT prior to ICI, after ICI initiation, or did not receive ABT. When assessing timing of ABT, there was a significant difference in OS amongst pre-ICI initiation ABT, post-ICI initiation ABT and no known ABT groups (median: 17.0 vs 10.9 vs 16.0; p = 0.005). However, rwPFS (median: 10.1 vs 7.5 vs 10.0 months; p = 0.22) was not statistically different. Multivariable analysis identified no antibiotic use as a significant predictor of improved OS (HR 0.733, CI 0.598-0.898; p = 0.003). Other factors associated with OS were male gender (HR 1.158, Cl 1.005-1.335; p = 0.043) and receipt of extirpative surgery (HR 0.785, Cl 0.684-0.900; p &lt; 0.001). Conclusions: This study identifies a potential negative association of ABT and OS, particularly after starting ICI. These results support the relevance of the gut microbiome on the efficacy of ICI treatment, may guide future efforts to improve the efficacy of ICI, and emphasize the importance of antibiotic stewardship.

Association of antibiotic therapy and treatment efficacy in patients with renal cell carcinoma receiving immune checkpoint inhibitors.

4556 Background: There is growing evidence indicating that gut microbiome content is associated with the effectiveness of immune checkpoint inhibitory (ICI) therapy in various cancer types. Antibiotic therapy (ABT) induces significant changes in gut microbiota; however, the effects of ABT on oncologic outcomes with ICI therapy has only been explored in small, single-institution studies. We aimed to investigate the relationship between ABT on overall survival (OS) and real-world progression free survival (rwPFS) in subjects with advanced renal cell carcinoma (RCC) treated with ICI utilizing a national database. Methods: We queried the nationwide electronic health record (EHR)-derived de-identified FlatIron Health (FIH) database after Institutional Review Board approval was obtained and included a waiver of informed consent to select 1809 subjects who received ICI therapy. Patient characteristics were described and compared between those with known ABT use and without known ABT use (in the 3 months pre/post ICI initiation) using ANOVA and Chi-square tests. rwPFS and OS were calculated from date of initiation of ICI to date of real-world progression/date of death. Three-month landmark Kaplan Meier and log-rank tests were used to compare rwPFS and OS between groups defined by ABT use (any ABT, and ABT in 3 months pre-ICI vs 3 months post-ICI initiation). Cox proportional models were used to investigate the association between rwPFS, OS, and antibiotic use, adjusting for patient characteristics. Results: Patients receiving ABT group were younger (p = 0.007) and more likely female (p = 0.024) but similar in other measured demographic variables. rwPFS (median: 9.03 vs 11.6 months; p = 0.015) and OS (median: 23.7 vs 31.8 months; p = 0.019) were significantly shorter in the with-ABT group than in the without-ABT group. When assessing ABT use 3 months prior to initiation of ICI (vs ABT during/no known ABT use), neither rwPFS (median: 9.53 vs 11.66, p = 0.38) nor OS (median: 23.7 vs 22.6 months; p = 0.38) were significantly different. However, rwPFS (median: 23.5 vs 14.0 months vs not reached; p = 0.004) and OS (median: 36.2 vs 22.5 vs 31.8; p = 0.007) were statistically significantly different when stratifying based on exposure and timing of ABT amongst pre-ICI initiation ABT, post-ICI initiation ABT and no ABT groups, respectively. Multivariable analysis identified as a significant predictor of rwPFS (HR = 0.725, CI = 0.579-0.908; p =.005) and OS (HR = 0.722, CI = 0.573-0.911; p = 0.006). Conclusions: This study identifies a significant negative prognostic association of ABT administration on survival in advanced RCC treated by ICI in the first line setting. These results are consistent with the growing body of evidence suggesting that alterations in gut microbiome secondary to antibiotics appear to blunt efficacy of ICI treatment and emphasize the importance of antibiotic stewardship.

Adequacy of probabilistic prehospital antibiotic therapy for septic shock.

Guidelines on sepsis management recommend early recognition, diagnosis and treatment, especially early antibiotic therapy (ABT) administration in order to reduce septic shock (SS) mortality. However, the adequacy of probabilistic prehospital ABT remains unknown. From May 2016 to March 2021, all consecutive patients with SS cared for by a prehospital mICU intervention were retrospectively analyzed. Among 386 patients retrospectively analyzed, 119 (33%) received probabilistic prehospital ABT, among which 74% received a 3rd generation cephalosporin: 31% cefotaxime and 42% ceftriaxone. No patient had a serious adverse effect related to ABT administration. Overall mortality rate on day-30 was 29%. Among the 119 patients with prehospital ABT, bacteriological identification was obtained for 81 (68%) patients with adequate prehospital ABT for 65 patients (80%) of which 10 (15%) deceased on day-30. Conversely, among the 16 (20%) patients with inadequate prehospital ABT, 9 patients (56%) were deceased on day-30. Prehospital adequate ABT was significantly different between alive and deceased patients on day-30 (p=4.10-3). After propensity score matching, a significant association between adequate prehospital ABT administration and day-30 mortality was observed (aOR=0.09 [0.01-0.47]). Inverse probability treatment weighting with multivariable logistic regression reported a day-30 mortality decrease in the adequate prehospital ABT group: aOR=0.70 [0.53-0.93]. Among SS cared for by a mICU, probabilistic prehospital ABT is adequate most of the time and associated with a day-30 mortality decrease. Further prospective studies are needed to confirm these results and the weight of prehospital ABT in the prehospital bundle of care for SS.

Placental dysfunction as a basic pathology of perinatal complications

Research aim was to study the features of perinatal complications depending on the nature and timing of therapy in pregnant women with primary placental dysfunction.Materials and methods. 82 pregnant women with verified placental dysfunction (chorionic hypoplasia at 12–13 weeks) against the background of the threat of pregnancy termination and genital tract infections were included. All examined were divided into 2 groups: group I consisted of 42 pregnant women who started treatment before 16 weeks of gestation, group II consisted of 40 pregnant women whose treatment was started after 16 weeks of gestation. Women in group I received micronized progesterone, venotonic Normoven, Magnicum and Artihol. Antibacterial sanitation was carried out before 16 weeks of gestation. Group II also received micronized progesterone only. Antibacterial sanitation in this group was carried out after 16 weeks of gestation.Research results. After antibiotic therapy in group I monoinfections value decreased from 26.8 to 9.5%, mixed infections value decreased from 56.1 to 20.7%, while in group II the effectiveness of antibacterial therapy after 16 weeks was significantly lower. Statistically significant differences in weight, volume and area of the placenta in patients of studied groups were obtained. Assessing perinatal complications showed that the frequency of gestosis, premature birth, intrauterine growth retardation and intrauterine infection of the fetus were almost 2 times less frequent in group I than in group II.Conclusions. Placental dysfunction, which developed in the first trimester against the background of the threat of pregnancy termination and genital tract infections, is the basic pathology for complications of the perinatal period. A timely prescribed set of medical supplies, including micronized progesterone, venotonic Normoven, Artihol and Magnicum, was as an effective method of preventing perinatal complications in pregnant women with primary placental dysfunction. Antibiotic therapy up to 16 weeks of gestation does not fully prevent the development of perinatal complications, but it can significantly reduce the level of severe gestational pathology.

Bacterial Biofilm Suppression with Antibiotics for Ulcerative and Indeterminate Colitis: Consequences of Aggressive Treatment

Antibiotics are commonly used in inflammatory bowel disease (IBD). Little is known about their effect on the mucosal flora. The mucosal flora was investigated in colonoscopic biopsies from six groups of 20 IBD patients each. Patients were selected with regard to duration of/interval to combined metronidazole and ciprofloxacin therapy: group I patients with 1 day and group II with 7-14 days of antibiotic therapy, group III-V patients evaluated 1-4 weeks, 2-18 weeks, 26-36 weeks after cessation of antibiotic therapy, respectively. The control group VI included patients without antibiotic therapy. Thirty different fluorescent in situ hybridization (FISH) probes representative of the diversity of the human intestinal flora were applied to all specimens. Bacteria adherent to mucosa could be seen exclusively in DAPI stain and were practically nonamenable to FISH probes in patients on antibiotics (0.001-3+/-0.001-5)x10(10)/mL. Occurrence and concentrations were significantly reduced in groups I and II as compared to untreated controls. The mucosal bacteria were significantly augmented after cessation of antibiotic therapy in group III (13.2+/-4.3) and group IV (5.8+/-2) but not in group V (1.1+/-0.8) as compared to group VI (0.5+/-0.4)x10(10)/mL. Neither Bacteroides nor Enterobacteriaceae groups were permanently suppressed by metronidazole-ciprofloxacin therapy. The suppressing effects of antibiotics on the mucosal flora are accompanied by massive rebound effects. The concentrations of mucosal bacteria are dramatically increased as soon as 1 week after cessation of antibiotic therapy, remaining at a level that is at least one power higher over a period of 5 months as compared to the group without antibiotic treatment.

Symptomatic Relapse of Group A β-Hemolytic Streptococcal Tonsillopharyngitis in Children

The frequency of symptomatic relapses following various antibiotic treatments for group A beta-hemolytic streptococcal tonsillopharyngitis was evaluated in 1080 pediatric patients. Within 5 days of completing therapy, the rank-order frequency of treatment failures was (1) penicillin, (2) amoxicillin, (3) first-generation cephalosporins, (4) beta-lactamase stable cephalosporins and amoxicillin-clavulanate ( P = .005). Retreatment of symptomatic failures resulted in another symptomatic relapse more often with penicillin than with cephalosporins (P = .02). Clinicians should be aware that the rate of symptomatic failures after antibiotic therapy for group A beta-hemolytic streptococcal tonsillopharyngitis differs by drug and is not an uncommon event.