Duration Of Antibiotic Treatment Research Articles

Prophylactic 24 versus 48 h cephalosporins in cardiac surgery: A randomized trial

Background Recommendations for cardiac surgery advocate for antibiotic prophylaxis for up to 48 hour after surgery. However, recent reports found a significant reduction in surgical site infection with extended duration. We evaluated the effect of the type of prophylactic antibiotics and administration durations on the postoperative surgical site infection rate following cardiac surgery in adults. Methods An investigator-initiated randomized controlled trial was conducted from 2018 to 2022 on adult patients undergoing cardiac surgery. Patients were randomized into four groups based on antibiotic treatment type and duration: 24 h cefazolin, 24 h cefuroxime, 48 h cefazolin, and 48 h cefuroxime. The primary outcome was the rate of surgical site infections within 90 days of surgery. Results A total of 568 patients were included in this study. The four groups had similar baseline characteristics, including age, sex, EuroSCORE II, and baseline HbA1c. A total of 75 patients developed infection within 90 days postoperative. The overall infection rate was not statistically different across the four groups ( p = 0.193). The efficacy of cefazolin and cefuroxime in reducing infection was comparable ( p = 0.901). Extended prophylaxis was associated with a significantly reduced overall infection rate within 90 days postoperatively compared to 24-h prophylaxis (10.2% vs. 16.3%; risk ratio = 0.62, 95% confidence interval: 0.40–0.96, p = 0.032). Conclusion Using cefazolin or cefuroxime for 48 h instead of 24 h was more effective in reducing the overall surgical site infections rate up to 90 days after surgery.

Antibiotic treatment recommendations for acute respiratory tract infections in Scandinavian general practices—time for harmonization?

Introduction During recent years, the world—including Scandinavia—has experienced significant challenges with shortages of antibiotics. In Scandinavia, phenoxymethylpenicillin is recommended as first-line antibiotic treatment for most acute respiratory tract infections (ARTIs). However, the Scandinavian countries each constitute rather small markets for phenoxymethylpenicillin. The aim of this discussion paper is to enlighten the differences in Scandinavian ARTI antibiotic treatment recommendations. This information is fundamental for exploring the potential of harmonizing treatment recommendations in Denmark, Norway and Sweden—to help ensure sufficient future supply of phenoxymethylpenicillin. Methods Information from national ARTI antibiotic treatment recommendations from respectively Denmark, Norway and Sweden has been collated. Results Several discrepancies exist in recommendations. Adult dosage varies from a minimum of 660 mg x 4 (Denmark) to a maximum of 2000 mg × 3 (Sweden). Within Norway and Sweden, variations in recommended dosage also exist between the different types of ARTIs. A main challenge is that the tablet strengths recommended, and available on the market in the three countries, differs. Also, antibiotic treatment durations vary significantly between countries and infections treated—from five to 10 days of treatment. Conclusion In the capacity of a well-established network for antibiotic stewardship, we have enlightened the differences in Scandinavian ARTI antibiotic treatment recommendations. This paper is the first step moving forward to scrutinizing the potential for harmonizing recommendations for Denmark, Norway and Sweden—to help ensure continued supply of phenoxymethylpenicillin for use within the Scandinavian countries.

The association between drugs and vaccines commonly prescribed to older people and bullous pemphigoid: a case-control study.

Bullous pemphigoid (BP) is an autoimmune skin disease that affects mainly older people. Numerous drugs have been previously associated with BP based on case series and small hospital-based studies. More reliable and precise estimates of associations between a broad selection of drugs/vaccines and BP will enable greater awareness of potential increased risk of BP following certain medicines and help identify clinical, histological and genomic characteristics of drug-induced BP for different types of culprit drugs. Greater awareness could lead to earlier recognition or suspicion of BP and referral to a dermatologist for diagnosis. Earlier diagnosis may lead to less aggressive treatment and improved well-being. To determine the association between drugs/vaccines commonly prescribed to older people and BP risk. We conducted a population-based nested case-control study between 1998-2021 using electronic primary care records from the Clinical Practice Research Datalink. We matched BP cases with up to 5 controls. Exposures were drugs/vaccines commonly prescribed to older people. We used multivariable conditional logistic regression adjusting for multiple drug use. For antibiotics, we considered prescriptions may be prescribed for undiagnosed symptoms of BP which resemble skin infection (protopathic bias) in a sensitivity analysis. Antibiotics were the therapeutic group associated with the highest risk of BP (OR: 4.60; 95%CI 4.40-4.80). However, after adjusting for protopathic bias, the OR reduced to 2.08 (95%CI 1.99-2.17). After adjusting for protopathic bias, of all antibiotic classes and subclasses, penicillins and penicillinase-resistant penicillins had the strongest associations with BP risk (OR: 3.44; 95%CI 3.29-3.60; sensitivity analysis OR; 1.74; 1.66-1.84 and OR: 7.56; 95%CI 7.15-8.00; sensitivity analysis OR: 2.64; 95%CI 2.45-2.85, respectively). Other drugs strongly associated with increased risk were gliptins (OR: 2.77; 95% CI 2.37-3.23), and second-generation antipsychotics (OR: 2.58; 95%CI 2.20-3.03). Healthcare professionals need to be aware of BP risk in older people particularly when prescribing penicillinase-resistant penicillins, gliptins, and second-generation antipsychotic drugs to recognise and manage BP early. Due to the low prevalence of disease, we do not suggest avoidance of drugs/vaccines to prevent BP. Further research should consider recency, dosage, and duration of antibiotic treatments.

Feature importance explanation of prosthetic valve endocarditis through machine learning via SHAP

Abstract Introduction Diagnosing prosthetic valve endocarditis poses a significant challenge in daily clinical practice. Accurately identifying these patients is vital due to its treatment implications. Clinical and imaging assessment of suspected cases yields a substantial number of interrelated variables, which can be analyzed through machine learning techniques in order to improve diagnostic accuracy. Feature ranking facilitates identification and interpretability of relevant clinical and imaging variables in this task. Purpose To utilize machine learning feature ranking and modeling in order to improve interpretable identification of patients with prosthetic valve endocarditis. Methods 89 cases defined by the endocarditis team and 173 controls were analyzed. We implemented the SHapley Additive exPlanations (SHAP) method to evaluate feature importance. 5-fold cross-validated Xgboost models were trained and independently tested with additive clinical, echocardiographic and 18F-FDG PET/CT data. Performance was evaluated through confusion matrices, F1-scores and AUCs. These were compared against conventional logistic regression of the Duke Criteria classification. Results Mean age was 59.6 ± 15.7, with 29.7% women. 14 clinical (demographic, laboratory and cultures), 2 echocardiographic, and 5 PET/CT features were included. The XGBoost model trained with all additive features demonstrated an AUC of 0.91±0.1 and outperformed simpler models as well as the Duke classification model (AUC=0.85). The clinical variables alone achieved an AUC of 0.85±0.11, while integration with echocardiography enhanced its performance to 0.90±0.04 (Fig. 1). Feature ranking demonstrated that antibiotic treatment duration, positive blood cultures, valve type, weight and CRP were the most relevant clinical variables, while the presence of vegetation or abscess, and abnormal uptake and uptake focality on PET/CT represented the most relevant imaging variables (Fig. 2). Conclusion Machine learning-based feature ranking and modeling may significantly enhance identification of patients with prosthetic valve endocarditis beyond standard clinical criteria. Feature selection offers interpretable performance in identifying these cases, model testing in clinical decision support may be warranted.Fig. 1:Comparative AUC Analysis.Fig. 2:SHAP feature importance.

Systematic review of interventions to reduce hospital and emergency department stay in paediatric populations

IntroductionThis systemic review describes interventions designed to shorten length of stay (LOS) in hospital or the emergency department (ED).MethodsPapers published from 2000 until February 2024 were sought in MEDLINE, EMBASE,...

Procalcitonin-Guided Management and Duration of Antibiotic Therapy in Critically Ill Cancer Patients With Sepsis (Pro-Can Study): A Randomized Controlled Trial.

To evaluate the effect of procalcitonin-guided management on the duration of antibiotic therapy in critically ill cancer patients with sepsis. Randomized, controlled, single-blinded trial. A comprehensive multidisciplinary cancer hospital in Jordan. Adults with cancer treated in the ICU who were started on antibiotics for suspected infection, met the SEPSIS-3 criteria, and were expected to stay in the ICU greater than or equal to 48 hours. Patients were randomized to the procalcitonin-guided or standard care (SC) arms. All patients had procalcitonin measured daily, up to 5 days or until ICU discharge or death. For the procalcitonin arm, a procalcitonin-guided algorithm was provided to guide antibiotic management, but clinicians were allowed to override the algorithm, if clinically indicated. In the SC arm, ICU clinicians were blinded to the procalcitonin levels. Primary outcome was time to antibiotic cessation. We also evaluated the number of antibiotic-free days at 28 days, hospital discharge, or death, whichever came first, and antibiotic defined daily doses (DDDs). We enrolled 77 patients in the procalcitonin arm and 76 in the SC arm. Mean age was 58 ± 14 (sd) years, 67% were males, 74% had solid tumors, and 13% were neutropenic. Median (interquartile range [IQR]) Sequential Organ Failure Assessment scores were 7 (6-10) and 7 (5-9) and procalcitonin concentrations (ng/mL) at baseline were 3.4 (0.8-16) and 3.4 (0.5-26), in the procalcitonin and SC arms, respectively. There was no difference in the median (IQR) time to antibiotic cessation in the procalcitonin and SC arms, 8 (4-11) and 8 (5-13), respectively (p = 0.463). Median (IQR) number of antibiotic-free days were 20 (17-24) and 20 (16-23), (p = 0.484) and total DDDs were 1541.4 and 2050.4 in the procalcitonin and SC arms, respectively. In critically ill cancer patients with sepsis, procalcitonin-guided management did not reduce the duration of antibiotic treatment.

Factors prolonging antibiotic duration and impact of early surgery in thoracolumbar pyogenic spondylitis treated with minimally invasive posterior fixation.

A standard 6-12-week course of antibiotics is recommended for pyogenic spondylitis. Recent evidence supports early minimally invasive posterior fixation surgery; however, its effect on antibiotic treatment duration is unclear. This study aims to identify factors associated with prolonged antibiotic treatment in thoracolumbar pyogenic spondylitis patients resistant to conservative treatment and assess whether early surgery can reduce treatment duration. We retrospectively reviewed 74 patients with thoracolumbar pyogenic spondylitis undergoing minimally invasive posterior fixation at nine facilities. Patients were grouped based on antibiotic duration (≥ 6 or < 6 weeks) and timing of surgery (≤ 3 weeks or > 3 weeks of starting antibiotics). Univariable and multivariable logistic regression analyses were used to identify factors associated with prolonged antibiotic treatment and study the outcomes of patients undergoing early surgery. Forty-nine patients (66%) required prolonged antibiotic treatment. The presence of an iliopsoas abscess (p = 0.0006) and elevated C-reactive protein (CRP) levels (≥ 10mg/dL, p = 0.015) were independently associated with prolonged antibiotic treatment. Early surgery significantly reduced total antibiotic duration (5.3 weeks vs. 9.9 weeks, p < 0.0001) without increasing the incidence of postoperative infection recurrences and unplanned additional surgeries. Despite factors associated with prolonged antibiotic treatment, early surgery consistently shortened the treatment duration compared to late surgery. Early surgery (within three weeks) with minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis is associated with reduced antibiotic duration and overall treatment duration regardless of the presence of prolonging factors like iliopsoas abscess and elevated CRP levels.

Evaluation of the clinical characteristics, laboratory parameters, and antibiotic treatment in patients diagnosed with tularemia

IntroductionThis retrospective, cross-sectional, multi-center study aimed to evaluate the impact of laboratory results and treatments on the treatment response in patients diagnosed with tularemia. MethodsThe study included 190 adult patients diagnosed with tularemia between November 2023 and June 2024. Results67.9 % were female, mean age was 45.8 ± 14.9 years. The most frequently detected symptoms were sore throat (74.2 %), fatigue (71.6 %), and neck swelling (56.3 %). The most common form of tularemia was oropharyngeal (82.6 %) and glandular (14.2 %). The most used monotherapy was ciprofloxacin (80.5 %, n = 136), and combination therapy was streptomycin-ciprofloxacin (81.0 %, n = 17). Treatment failure was observed in 29 patients (15.2 %). No difference was found between patients who responded and didn't respond to treatment regarding laboratory parameters. Lymph node drainage or excision was performed in 47 patients (23 %). Suppurative lymphadenitis, abscess, necrosis, and conglomerate lymphadenopathy were more common in the lymph node drainage group. Reactive lymph nodes were more common in the group without lymph node drainage. There was no difference between the two groups regarding laboratory parameters of patients with and without lymph node drainage. The duration of antibiotic treatment was longer in patients who underwent lymph node drainage than in those who didn't. ConclusionRadiological evaluation of lymph nodes upon hospital admission, in addition to antibiotic therapy during treatment, may help predict which patients are more likely to require surgical drainage. Laboratory parameters may not provide significant benefits in predicting the need for lymph node drainage and long-term treatment did not affect the treatment response.

Impact of antibiotic changes on hospital stay and treatment duration in community-acquired pneumonia.

The misuse and overtreatment of antibiotics in hospitalized patients with community-acquired pneumonia (CAP) can cause multi-drug resistance and worsen clinical outcomes. We aimed to analyze the trends and appropriateness of antibiotic changes in hospitalized patients with CAP and their impact on clinical outcomes. This retrospective study enrolled patients with CAP, aged > 18 years, admitted from January 2017 to December 2021 at Seoul National University Bundang Hospital, South Korea. We examined the pathogens identified, antibiotics prescribed, and the appropriateness of antibiotic changes as reviewed by infectious disease specialists. Antibiotic appropriateness was assessed based on adherence to the 2019 ATS/IDSA guidelines and the 2018 Korean national guidelines for CAP, targeting appropriate pathogens, proper route, dosage, and duration of therapy. Outcomes measured included time to clinical stability (TCS), length of hospital stay, duration of antibiotic treatment, and in-hospital mortality. The study included 436 patients with a mean age of 72.11 years, of whom 35.1% were male. The average duration of antibiotic treatment was 13.5 days. More than 55% of patients experienced at least one antibiotic change, and 21.7% had consecutive changes. Throughout their hospital stay, 273 patients (62.6%) received appropriate antibiotic treatment, while 163 patients (37.4%) received at least one inappropriate antibiotic prescription. Those who received at least one inappropriate prescription experienced longer antibiotic treatment durations and extended hospital stays, despite having similar TCS. In conclusion, inappropriate antibiotic prescribing in hospitalized patients with CAP is associated with prolonged antibiotic treatment and increased length of stay. Emphasizing the appropriate initial antibiotic selection may help mitigate these negative effects.

Antimicrobial Treatment in Hospitalized Adults With Community-Acquired Pneumonia: Compliance and Factors Impacting Duration

To assess compliance with national and international guidelines for the initial empirical selection of antimicrobials, the duration of antimicrobial treatment in hospitalized patients with mild-to-moderate community-acquired pneumonia (CAP), and to analyze potential factors that could influence the duration of antimicrobials use. A retrospective study was conducted to collect medical records of patients admitted to the Department of Respiratory and Critical Care Medicine of Beijing Tongren Hospital with mild-to-moderate CAP from January 1, 2020 to November 30, 2022. The rationality of antimicrobial therapy was evaluated by comparing national and international guidelines, and the factors influencing the duration of antimicrobial therapy were analyzed by logistic regression. A total of 177 patients were enrolled. The age of patients was mainly distributed between 46 and 65 years old (38.42%). There were 82.49% of patients with basic diseases. In compliance with national, US, and European guidelines for the initial empirical antimicrobial selection in 177 CAP patients was 87.01%, 77.97%, and 78.53%. The mean duration of antibiotic treatment was 11.77±4.30 days, and patients switched from intravenous antimicrobial therapy to oral therapy within 2-10 days (5.15±2.84). Logistic regression analysis showed that the C-reactive protein (CRP) level at admission was an independent factor affecting the duration of antimicrobial use in hospitalized patients with mild-to-moderate CAP (OR=0.963, 95%CI: 0.947~0.979, p &lt; 0.05). The results of this study indicated that the patients with a CRP level of 43.89mg/L on admission to the hospital were more likely to require antimicrobial therapy for longer than 7 days.

The optimal antibiotic treatment duration for community-acquired pneumonia in adults diagnosed in general practice in Denmark (CAP-D): an open-label, pragmatic, randomised controlled trial

BackgroundUse of antibiotics is the main driver of antimicrobial resistance which is considered one of the biggest threats to human health. In Denmark, most antibiotics are prescribed in general practice. Acute lower respiratory tract infections, including community-acquired pneumonia (CAP), are among the most frequent indications for antibiotic prescribing. Phenoxymethylpenicillin is established as first-line treatment in general practice in Denmark. However, the treatment duration with phenoxymethylpenicillin is mostly based on traditions. Both 5 and 7 days of treatment is recommended in Danish guidelines, and when asking the general practitioners about what treatment duration, they prescribe the variation is even bigger. Several hospital-based studies have proven short course (≤ 6 days) antibiotic treatment non-inferior to long course (≥ 7 days) treatment of CAP. No evidence exists on the optimal treatment duration for CAP in non-hospitalised patients.This randomised controlled trial aim to investigate the optimal treatment duration with phenoxymethylpenicillin for CAP in adults diagnosed in general practice in Denmark.MethodsThis is an open-label, pragmatic, randomised controlled, five-arm DURATIONS trial. Participants will be recruited from at least 24 general practices in Denmark. Eligible participants are adults, with no pre-existing lung disease, presenting with symptoms of CAP, and in whom the general practitioner finds it relevant to treat with antibiotics. The study will compare treatment with phenoxymethylpenicillin 1.2 MIE q.i.d. in 3, 4, 5, 6, and 7 days.DiscussionThis study will provide evidence for the optimal antibiotic treatment duration of CAP in general practice and inform future guidelines on CAP in all countries using phenoxymethylpenicillin for the treatment of acute respiratory tract infections in adults. The results of this study might also be used to guide treatment recommendations in other countries using phenoxymethylpenicillin.Moreover, a (potential) reduction in antibiotic use might lower the development of antimicrobial resistance, increase patient treatment adherence, reduce risks of adverse events, and lower the economical expTrial registrationClinicalTrials.gov: NCT06295120. Registered 28 February 2024. The Scientific Ethics Committee for the North Denmark Region: N-20230039.

Durations of Antibiotic Treatment for Acute Otitis Media and Variability in Prescribed Durations Across Two Large Academic Health Systems.

Acute otitis media (AOM) accounts for roughly 25% of antibiotics prescribed to children annually. Despite national guidelines that recommend short (5-7 days) durations of antibiotics for children 2 years and older with AOM, most receive long (10 day) courses. This study aims to evaluate antibiotic durations prescribed for children aged 2-17 years with uncomplicated AOM across two pediatric academic health systems, and to assess the variability in prescribed durations between and within each system. Electronic medical record data from 135 care locations at two health systems were retrospectively analyzed. Outpatient encounters for children aged 2-17 years with a diagnosis of AOM from 2019 to 2022 were included. The primary outcome was the percent of 5-day prescriptions. Secondary outcomes included the proportion of 7-day prescriptions, 10-day prescriptions, prescriptions for nonfirst-line antibiotics, cases associated with treatment failure, AOM recurrence, and adverse drug events. Among 73 198 AOM encounters for children 2 years and older, 61 612 (84%) encounters resulted in an antibiotic prescription. Most prescriptions were for 10 days (45 689; 75%), 20% were for 7 days (12 060), and only 5% were for 5 days (3144). Treatment failure, AOM recurrence, adverse drug events, hospitalizations, and office, emergency department or urgent-care visits for AOM within 30 days after the index visit were rare. Despite national guidelines that recommend shorter durations for children with uncomplicated AOM, 75% of our cohort received 10-day durations. Shortening durations of therapy for AOM could reduce antibiotic exposure and should be a priority of pediatric antibiotic stewardship programs.

Appropriate antimicrobial prescribing for bacteriuria before urological procedures: A room for improvement

In the presence of a positive preoperative urine culture, the prescription of a preoperative antibiotic therapy is recommended. The choice of antibiotic therapy and prescription are usually made by the urologist or the general practitioner (GP). The objective of the treatment is urinary sterilization rather than parenchymal treatment, and the treatment choice is key to reduce selective pressure and antimicrobial resistance. The objective of this study was to evaluate prescription patterns made by urologists and GPs, then to compare the antibiotics chosen by urologists or GPs to the “ideal” treatment defined by infectious diseases specialists. We retrospectively reviewed all positive preoperative urine cultures obtained between November 2022 and July 2023. Data pertaining to antibiotic prescriptions, including the duration of treatment, antibiotic class, and prescriber were collected. An infectious disease specialist conducted a blind review of each urine culture, providing recommendations for the most appropriate antibiotic based on their assessment. In cases of disagreement, a second infectious disease specialist conducted a similar evaluation. Out of 196 preoperative antibiotic prescriptions, 40 (20%) differed from the recommendations provided by the infectious disease specialist, with 39 involving the use of overly broad-spectrum antibiotics. Both infectious disease specialists yielded congruent recommendations in all cases. Notably, in 50% of these instances, the preoperative antibiotic treatment duration unduly exceeded 48hours. A statistically significant increase (4.84days vs. 2.99days) in preoperative treatment duration was observed when a GP was the prescriber (P<0.001). There is room for improvement of urologists’ antibiotic prescription practices to reduce the ecological impact on the patient's microbiota and on a global scale. The delegation to GPs resulted in unjustified longer treatment durations and should be avoided without dedicated training. Level of evidence4.

Significant drop in serum C-reactive protein in patients with solid neoplasia and bacterial infection is associated with a better prognosis and identifies candidates for short-course antibiotic therapy

IntroductionThe greater predisposition to infections, as well as the possibility of a worse response to treatment, can lead to the excessive use of antimicrobials among cancer patients. C-reactive protein (CRP) has gained prominence as a tool for monitoring therapeutic responses and reducing the duration of antibiotic therapy; however, few studies have analyzed this protein in cancer patient populations. We hypothesize that cancer patients with a good response to antibiotic therapy show a faster decline in serum CRP levels, which would allow us to identify candidates for short-course treatments.ObjectiveTo evaluate the behavior of serum CRP levels among adult cancer patients using antibiotic therapy, and its association with the duration of this treatment, therapeutic response, and clinical recurrence.MethodsThis work consisted of a retrospective study with cancer patients admitted to a university hospital between September 2018 and December 2019. Adults (age ≥ 18 years) who underwent at least one course of antibiotic therapy were included. CRP behavior over the first 7 days of treatment was classified as: i) good response: when the CRP value on the fifth day of therapy reached 50% or less of the peak value detected in the first 48 h of treatment, and ii) poor response: Maintenance, within the same interval, of a CRP value > 50% of the peak value in the first 48 h. The duration of antibiotic therapy was categorized as up to seven full days or more. Outcomes were assessed by events that occurred during the 30 days of hospitalization or until hospital discharge. Primary outcome: Clinical recurrence of the index infection. Secondary outcomes: i) Death from any cause; ii) microbiological recurrence; iii) therapeutic response; iv) colitis associated with Clostridioides difficile; and v) isolation of multi-resistant bacteria, whether in clinical or surveillance samples.ResultsThe final analysis consisted of 212 patients, with a median age (IQ) of 59.2 (48 – 67) years old and a predominance of females (65%), who were hypertensive (35%), smokers (21%), and diabetics (17.8%). There was no difference in clinical recurrence between the two groups (8.1% vs. 12.2%; p = 0.364), with a lower 30-day mortality in the good CRP response group (32.2% vs. 14.5%; p = 0.002). Despite the tendency towards a lower occurrence of other secondary outcomes in the good response group, these differences were not statistically significant. In the poor CRP response group, outcomes like clinical recurrence, mortality, and therapeutic response were significantly worse, regardless of the duration of antibiotic treatment.ConclusionIn this study, cancer patients with a good CRP response during antibiotic therapy presented lower mortality and a higher proportion of satisfactory therapeutic responses. CRP can be a useful tool when combined with other clinical information in optimizing the duration of antimicrobial treatment in a hospitalized cancer population.

Impact of viral testing on duration of antibiotic treatment and hospitalisation of febrile infants.

To assess the duration of antimicrobial treatment; hospital length of stay; and invasive bacterial infections rates in hospitalised infants following the adoption of a management guideline. Faculty agreed to a standard of 24 h of antibiotic treatment for well-appearing febrile infants with proven viral infection and no growth on bacterial cultures. The outcomes were the duration of hospitalisation and antibiotic treatment of febrile infants less than 8 weeks of age who have enterovirus, parechovirus, respiratory viruses detected. We monitored re-admissions and missed invasive infections. Of the total 1696 infants studied, the median antibiotic treatment duration decreased from 31.5 to 24.8 h in virus-infected infants ≤21 days of age (p = 0.02) and from 26 to 19.7 h in infants 22-56 days of age (p < 0.001). The decrease was less in infants not infected with a virus. No patient had an invasive infection identified after discharge. The implementation of our care standard resulted in reduction in antibiotic treatment duration without known delayed diagnosis of bacterial infections. Infants without a proven viral aetiology may need further study to inform management decisions.

Clinical characteristics of apical segment lung abscess: a 10-year retrospective study.

Lung abscess in the apical segment of the lung is not rare and is often underestimated in clinical practice. However, the clinical features of apical segment lung abscess (AL) have scarcely been reported. Hence, this study aimed to determine the clinical characteristics of AL and explore moderate therapeutic strategies. This was a retrospective, single-center cohort study. We reviewed the medical records of consecutive patients who were admitted to Shanghai Pulmonary Hospital in Shanghai, China, from January 2009 to December 2018. This study collected information on patients with lung abscess, including demographics, symptoms, clinical findings, and treatment. The statistical methods used were descriptive statistics, Chi-squared test, Fisher's exact test, t-tests, and logistic regression analysis. Of 824 patients, 431 with lung abscess were finally eligible after a review of medical records. The patients were divided into two groups: the AL group (n=68) and the non-apical segment lung abscess (NAL) group (n=363). Compared with patients in the NAL group, those in the AL group had lower rates of chronic obstructive pulmonary disease (COPD) (5.9% vs. 17.4%, P=0.02), diabetes (14.7% vs. 32.2%, P=0.004) and hypoprealbuminemia (10.3% vs. 25.3%, P=0.007). Regarding clinical symptoms, patients in the AL group exhibited lower fever (38.2% vs. 58.4%, P=0.002) and less purulent sputum (32.4% vs. 45.5%, P=0.045). Moreover, regarding radiological features, the AL group had a lower proportion of air-fluid level on chest computed tomography (CT) (7.4% vs. 16.8%, P=0.047). In addition, the study demonstrated that the AL group had a shorter duration of intravenous antibiotic treatment [8 (7-8) vs. 10 (8-12) days, P <0.001]. Surprisingly, the AL group had a high rate of surgical treatment (36.8% vs. 15.4%, P<0.001). In multivariate analysis, surgical treatment occurred more frequently in patients with AL [odds ratio (OR): 2.58, 95% confidence interval (CI): 1.40-4.77, P=0.002], lower in patients who had fever (OR: 0.55, 95% CI: 0.31-0.98, P=0.04), and imaging features of liquefaction necrosis (OR: 0.32, 95% CI: 0.15-0.69, P=0.004). Patients with AL presented with atypical and relatively mild clinical symptoms. However, the rate of surgical treatment was significantly higher. These data should be considered when managing the AL.

Retrospective analysis of Acinetobacter baumannii bacteraemia risk factors, complications and mortality in a tertiary university hospital in Saudi Arabia.

Introduction. There are many multidrug-resistant isolates of the nosocomial pathogen, Acinetobacter baumannii, causing severe healthcare-acquired infections in terminally ill patients with high mortality and morbidity rates. Aim. This study aims to retrospectively analyse A. baumannii bacteraemia (ABB) cases in Saudi Arabia, where the information is sparse regarding the prevalence, risk factors, clinical disease, antibiotic regimen, antibiotic susceptibility, treatment outcomes and mortality associated with this infection. Methods. A retrospective chart review was conducted between 1 January 2015 and 31 December 2022 to identify all patients aged 14 years and above with ABB. Demographic and clinical data, as well as results from laboratory analyses, were collected from patients' electronic charts. Statistical analyses were performed on the data to identify factors associated with 90-day mortality. Results. Of the 122 ABB cases, 71 (63.4%) died. The factors that were found to be associated with 90-day mortality were the Charlson Comorbidity Index, Pitt bacteraemia score, quick Sequential Organ Failure Assessment score (P<0.001 for each), hospital ward (P<0.02), short duration of antibiotic treatment (P<0.01) and higher age (P<0.05). The most common source of infection was central line-associated bloodstream infection in 52.7%. Also associated with mortality were inappropriate antimicrobial therapy (P<0.02) and empirical use of colistin (P<0.05). In many patients, ABB was caused by carbapenem-resistant A. baumannii [(CRAB), 69.6%], and 74.4% of those patients died. Conclusion. To prevent ABB-associated mortality, an appropriate regimen and duration of treatment are necessary. Hospitals should also practice proper hygiene to prevent the spread of ABB. CRAB is a growing threat in hospitals in Saudi Arabia, especially in the critical care setting, and carries a very high risk of mortality.

Association of Raised C-Reactive Proteins With Prolonged ICU Stay in Children with Bronchopneumonia: A Cross Sectional Study

Objective To study the association of raised CRP with prolonged ICU stay in children with bronchopneumonia at Ghurki Trust Teaching Hospital, Lahore, Pakistan. Methodology This cross-sectional study was conducted in Paediatric Intensive Care Unit of Ghurki Trust Teaching Hospital, Lahore, Pakistan, for a duration of six months (June 2023 to December 2023). Out of 127 children admitted into ICU, 82 met the inclusion criteria, aged 2-60 months, diagnosed with bronchopneumonia. Upon admission, blood sample was taken for CRP levels and these levels were correlated with ICU stay, TLC count, O2 dependency, and antibiotics duration of the patients. Patients were divided into five groups based on CRP counts. CRP counts less than 0.3 mg/dL were taken as normal. CRP counts from 0.4-0.9 mg/dL were taken as mild, 1-10 mg/dL were considered moderate, 11-49 mg/dL were considered marked, and ≥50 mg/dL were considered severe. Results Out of 82 patients, 45 (54.88%) were males and 37 (45.12%) were females. This study found that raised CRP was present in 73 (89.02%) out of 82 children (p&lt;0.04). Amongst 73 (89.02%), 08 (10.96%) patients had mild elevation of CRP, 36 (49.32%) had moderate elevation, 22 (30.14%) had marked, 07 (9.59%) had severe elevation. Moreover, a direct relation was observed among CRP and ICU stay (3.82±3.12), O2 requirements (3.72±3.07), TLC (13.36±5.18), antibiotic treatment duration (9.52±3.94) of broncho pneumonic patients. Conclusion Higher CRP levels significantly result in longer ICU stays and higher oxygen requirements in children with bronchopneumonia.

Study protocol of the FRENCH24-ANIS study: postoperative anti-infective strategy following pancreaticoduodenectomy in patients with preoperative biliary stents—an intergroup FRENCH-ACHBT-SFAR prospective randomized controlled trial

BackgroundDespite advances in surgical techniques and care, pancreatoduodenectomy (PD) continues to have high morbidity and mortality rates. Complications such as sepsis, hemorrhage, pulmonary issues, shock, and pancreatic fistula are common postoperative challenges. A key concern in PD outcomes is the high incidence of infectious complications, especially surgical site infections (SSI) and postoperative pancreatic fistula (POPF). Bacteriobilia, or bile contamination with microorganisms, significantly contributes to these infections, increasing the risk of early postoperative complications. The occurrence of SSI in patients who undergo hepatobiliary and pancreatic (HPB) surgeries such as PD is notably higher than that in patients who undergo other surgeries, with rates ranging from 20 to 55%. Recent research by D'Angelica et al. revealed that, compared to cefoxitin, piperacillin/tazobactam considerably lowers the rate of postoperative SSI. However, these findings do not indicate whether extending the duration of antibiotic treatment is beneficial for patients at high risk of bacterial biliary contamination. In scenarios with a high risk of SSI, the specific agents, doses and length of antibiotic therapy remain unexplored. The advantage of prolonged antibiotic prophylaxis following PD has not been established through prospective studies in PD patients following biliary drainage.MethodsThis is an intergroup FRENCH-ACHBT-SFAR multicenter, open-labelled randomized, controlled, superiority trial comparing 2 broad-spectrum antibiotic (piperacillin/tazobactam) treatment modalities to demonstrate the superiority of 5-day postoperative antibiotic therapy to antibiotic prophylaxis against the occurrence of surgical site infections (SSI) following pancreaticoduodenectomy in patients with preoperative biliary stents. The primary endpoint of this study is the overall SSI rate, defined according to the ACS NSQIP, as a composite of superficial SSI, deep incisional SSI, and organ/space SSI.In addition, we will analyze overall morbidity, antibiotic resistance profiles, the pathogenicity of bacteriological and fungal cocontamination, the impact of complications after bile drainage and neoadjuvant treatment on the bacteriological and fungal profile of biliculture and cost-effectiveness.ConclusionThis FRENCH24-ANIS study aims to evaluate 5-day post-operative antibiotic therapy combined with antibiotic prophylaxis on the occurrence of surgical site infections (SSI) following pancreaticoduodenectomy in patients with preoperative biliary stents.Trial registrationClinicaTrials.gov number, NCT06123169 (Registration Date 08–11–2023); EudraCT number 2021–006991-18; EUCT Number: 2024–515181-14–00.

Linezolid in enterococcal urinary tract infection: a multicentre study.

Few data have been published on the efficacy of linezolid in enterococcal urinary tract infection (e-UTI). The aims of this study were to describe the characteristics of patients with enterococci UTI treated with linezolid, and to evaluate the efficacy and the tolerance of linezolid treatment. An observational multicentre retrospective study was conducted in 5 hospitals in France. Patients were included if they met the following criteria: ≥18 years, clinical and microbiological criteria for enterococcal UTI and linezolid treatment > 48h. Primary outcome was clinical failure. Eighty-one patients were included between January 2015 and December 2021. The median age was 73.0 [64; 83] years and 47 (58%) were men. The median Charlson comorbidity index was 3.00 [2; 6]. E. faecium was reported in 65 (80%) cases and E. faecalis in 26 cases (32%). Polymicrobial infections occurred in 41 (51%) cases. No enterococci was resistant to vancomycin. Before linezolid prescription an empiric antimicrobial treatment was started in 48 (59%) cases and was effective against enterococci in 19/48 (39.5%) patients for a median of 3.5 days [2.0; 4.0]. The median duration of linezolid antibiotic treatment was 13 days [10; 14]. Three adverse events were reported, none were serious but one led to discontinuation of treatment. Treatment failure was reported in 2 cases (2.5%). This study provides evidence for efficacy and safety of linezolid in enterococcal UTI.