Antimicrobials In Patients Research Articles

Ethical and Practical Issues with the Use of Antimicrobial Agents during the End of Life.

The use of antimicrobials in patients receiving end-of-life (EOL) care, which is generally defined as supportive care provided to patients anticipated to live less than 1 year, has been actively debated in the realm of palliative care medicine due to the nebulous nature of the topic. In this article, we explore the use of antimicrobial use near EOL as it relates to both the ethical and practical issues that face physicians. We also discuss the reasons underlying the scarcity of prospective studies on this topic.

The Efficacy of Topical or Systemic Antibiotics as Adjuvants to Non-Surgical Periodontal Treatment in Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Background: Periodontitis and diabetes mellitus (DM) exhibit a bidirectional relationship and are globally significant systemic chronic conditions. The utilization of antibiotics alongside non-surgical periodontal treatment (NSPT) has been a subject of investigation in numerous clinical studies involving human subjects. Thus, the objective of this systematic review is to address the following question: "What is the efficacy of scaling and root planing (SRP) associated with antimicrobials in patients with type 2 DM and periodontitis?". Methods: A systematic review of the literature was conducted encompassing databases such as MEDLINE/PubMed, Scopus, and Web of Science up to July 2024. Additionally, alerts were configured to capture studies published from the initial search until manuscript submission. Randomized clinical trials assessing clinical periodontal parameters in DM patients undergoing SRP and receiving either topical or systemic antibiotics were compared against a control group (SRP only). Two investigators independently screened articles, extracted data, and evaluated their quality. The selection process, study characteristics, risk of bias, impact of antibiotics on clinical parameters, and certainty of evidence were elucidated in both textual and tabular formats. Meta-analysis was performed separately with forest plots generated for treatment modalities, period of evaluation, and type of antibiotics used. Results: Following the analysis of abstracts and full articles, a total of 30 randomized clinical trials were incorporated into this review, comprising 9 studies on the association of topical antibiotics and 21 studies on systemic antibiotic administration. The principal periodontal parameters assessed included probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BoP). Conclusions: Analysis of the results led to the conclusion that adjunctive periodontal treatment with either topical or systemic antibiotics confers subtle clinical benefits. Nevertheless, owing to the heightened emergence of resistant bacteria and potential side effects, the use of antibiotic therapy in periodontal treatment should be judiciously administered.

Use of antimicrobials in patients in Palliative Care admitted to the Intensive Care Unit: A retrospective study

Introduction: Palliative care (PC) improves the quality of life of patients and their families. The use of antimicrobials is controversial in PC patients, especially in those admitted to the intensive care unit (ICU). Objective: To evaluate the use of antimicrobials in PC patients admitted to the ICU. Methods: This is a retrospective study, performed from August 2019 to September 2020. Data on demographic profile, hospitalization, PC, and use of antimicrobials were collected from the Erasto Gaertner Hospital database, in Curitiba, Brazil. Results: 182 patients were studied, median age of 65 years and 52% men. The median length of stay in the ICU was 3 days; the median total length of stay in the hospital was 6 days and 89.5% of the patients died. The time in ICU of patients treated with antibiotics (14.8%) was significantly longer (p=0.033) than for patients who were not (85.2%). Using or not using antibiotics did not change the outcome. Among those who took antibiotics, death occurred in 81.5% of cases and among those who did not use, 74.8% died (p=0.627). Between the cases that used broad-spectrum antibiotics 17/19 (89.5%) died and the mean hospital stay was 16.2 days. Among cases that used narrow-spectrum 5/9 (62.5%) died and the mean hospital stay was 6.4 days (p=0.033). Conclusion: The administration and/or the spectrum of antibiotics in PC patients admitted to the ICU did not change the mortality rate. The administration of antibiotics increased the length of stay in the ICU.

Influence of the COVID-19 pandemic on the defined daily dose of antimicrobials in patients requiring elective and emergency surgical procedures.

The COVID-19 pandemic has resulted in great incertitude and overwhelming changes in healthcare that have had a direct impact on antibiotic prescription. However, the influence of this pandemic on antibiotic consumption in patients undergoing surgery has not yet been analysed. The goal of this study was to analyse antimicrobial consumption and prescription in the same period of 2019 (pre-COVID-19), 2020 (beginning of the COVID-19 pandemic) and 2021 (established COVID-19) according to the DDD system in surgical patients at a tertiary-level hospital. A prospectively maintained database was analysed. All patients who underwent elective or emergency gastrointestinal surgery during the same period (2019, 2020 and 2021) were included. Those who received at least 1 of the 10 most frequently prescribed antimicrobials during those periods were analysed. A total of 2975 patients were included in this study. In 2020, the number of procedures performed decreased significantly (653 versus 1154 and 1168 in 2020 versus 2019 and 2021, respectively; P = 0.005). Of all patients who underwent surgery during these periods, 45.08% received at least one of the antimicrobials studied (45.8% in 2020 versus 22.9% and 22.97% in 2019 and 2021, respectively; P = 0.005). Of these, 22.97% of the patients received a combination of these antimicrobials, with ceftriaxone/metronidazole being the most frequent. Hepato-Pancreato-Biliary and Liver Transplant, Emergency Surgery and Colorectal Surgery units had higher antibiotic consumption. The COVID-19 pandemic has resulted in a significant decrease in surgical activity and higher post-operative antimicrobial prescription compared with previous and subsequent years.

The impact of colistin-based regimens on mortality compared to other antimicrobials in patients with carbapenem-resistant Enterobacterales bacteremia in South African hospitals: a cross-sectional study

BackgroundTreatment of carbapenem-resistant Enterobacterales (CRE) infections in low-resource settings is challenging particularly due to limited treatment options. Colistin is the mainstay drug for treatment; however, nephrotoxicity and neurotoxicity make this drug less desirable. Thus, mortality may be higher among patients treated with alternative antimicrobials that are potentially less efficacious than colistin. We assessed mortality in patients with CRE bacteremia treated with colistin-based therapy compared to colistin-sparing therapy.MethodsWe conducted a cross-sectional study using secondary data from a South African national laboratory-based CRE bacteremia surveillance system from January 2015 to December 2020. Patients hospitalized at surveillance sentinel sites with CRE isolated from blood cultures were included. Multivariable logistic regression modeling, with multiple imputations to account for missing data, was conducted to determine the association between in-hospital mortality and colistin-based therapy versus colistin-sparing therapy.ResultsWe included 1 607 case-patients with a median age of 29 years (interquartile range [IQR], 0–52 years) and 53% (857/1 607) male. Klebsiella pneumoniae caused most of the infections (82%, n=1 247), and the most common carbapenemase genes detected were blaOXA-48-like (61%, n=551), and blaNDM (37%, n=333). The overall in-hospital mortality was 31% (504/1 607). Patients treated with colistin-based combination therapy had a lower case fatality ratio (29% [152/521]) compared to those treated with colistin-sparing therapy 32% [352/1 086]) (p=0.18). In our imputed model, compared to colistin-sparing therapy, colistin-based therapy was associated with similar odds of mortality (adjusted odds ratio [aOR] 1.02; 95% confidence interval [CI] 0.78-1.33, p=0.873).ConclusionIn our resource-limited setting, the mortality risk in patients treated with colistin-based therapy was comparable to that of patients treated with colistin-sparing therapy. Given the challenges with colistin treatment and the increasing resistance to alternative agents, further investigations into the benefit of newer antimicrobials for managing CRE infections are needed.

Use of antimicrobials in the intensive care unit of a Loreto public hospital

Introduction. Inappropriate use of antimicrobials in the Intensive Care Unit (ICU) contributes to bacterial resistance. Objective. The purpose of the present study was to measure the use and type of antimicrobials in patients hospitalized in the Intensive Care Unit of the Loreto Regional Hospital (HRL). Methods. Descriptive study. We reviewed 120 medical records in ICU-HRL patients from January to June 2023. Results. Most patients used antimicrobials (74.2%), indicated for septic shock (42.7%), 1 to 3 antimicrobials (93.2%), with therapy of 1 to 3 days (45%). Of the total number of antimicrobials used, the greatest proportion were bactericides 89 (90.4%), from the cephalosporin family (33.1%) and carbapenemics (23.5%); the most commonly used drugs were ceftriaxone (26.5%) and meropenem (21.1%) by the intravenous route (90.4%). Conclusion. The highest proportion of hospitalized patients use antimicrobials of the cephalosporin and carbapenemics family.

Usage of antimicrobials in patients having intricate clean-contaminated head and neck surgeries.

Objective: The goal of this study is to characterize, the infectious complications and to identify the risk variables most frequently linked, after head and neck surgeries.Methodology: 47 patients who underwent major clean-contaminated head and neck surgery between 2019 and 2022 at the cervicomaxillofacial Surgery Department (Saint-Pierre Hospital) were the subject of a prospective cohort analysis. Two groups of patients were created: group I received a postoperative antibiotic regimen for just 24 hours; group II re-ceived a longer postoperative antibiotic course lasting more than 24 hours. Amoxicillin and clavulanate were given intra-venously 30 to 60 minutes before making the incision as antibacterial precautions. Following surgery, the antibiotic course was maintained. Univariate analysis was used to assess the predictive importance of the antibiotic regimen on postoperative outcomes, including clinical symptoms of infection and biological indicators like the white blood cell count and C-reactive protein levels was evaluated using univariate analysis.Results: 18 patients experienced SSIs. Antibiotics were used to treat each of these grade 2 illnesses. Only a history of hypothyroidism appears to be a predictor of SSI after univariate analysis (P = 0.038). When we compared the patients who received antibiotics for 24 h or more, there was no discernible difference in terms of onset and hospital stay. Addi-tionally, neither group had a different rate of germs that were multidrug resistant.Conclusion: Our findings imply that using postoperative antibiotics for more than 24 hours has no positive effects on SSI.
 Key words: Cervico-maxillofacial Surgery, clean contaminated surgery, antimicrobials, Surgical Site Infection.

Antimicrobials in patients with hematologic malignancies and recipients of hematopoietic cell transplantation and other cellular therapies.

Appropriate use of antimicrobials for hematologic malignancy, hematopoietic stem cell transplant recipients, and other cellular therapies is vital, with infection causing significant morbidity and mortality in this unique population of immunocompromised hosts. However, often in this population the choice and management of antimicrobial therapy is complex. When selecting an antimicrobial agent, key considerations include the need for dose adjustments due to renal or hepatic impairment, managing drug interactions, the potential for additive drug toxicity among those receiving polypharmacy and therapeutic drug monitoring. Other factors include leveraging pharmacodynamic principles to enable optimization of directed therapy against challenging pathogens, as well as judicious use of antimicrobials to limit drug resistance and adverse drug reactions. This review summarizes the clinical considerations for commonly used antimicrobials in this setting, including antibacterial, antiviral, and antifungal agents.

Early switch to oral antimicrobials in brain abscess: a narrative review

BackgroundEarly switch to oral antimicrobials has been suggested as a treatment strategy in patients with brain abscess, but the practice is controversial. ObjectivesThis review aimed to summarize the background, current evidence, and future perspectives for early transition to oral antimicrobials in patients with brain abscess. SourcesThe review was based upon a previous systematic review carried out during the development of the ESCMID guidelines on diagnosis and treatment of brain abscess. The search used ‘brain abscess’ or ‘cerebral abscess’ as text or MESH terms in PubMed, EMBASE, and the Cochrane Library. Studies included in the review were required to be published in the English language within the last 25 years and to have a study population of ≥10 patients. Other studies known by the authors were also included. ContentIn this review, the background for some experts to suggest early transition to oral antimicrobials in patients with mild and uncomplicated brain abscess was clarified. Next, results from observational studies were summarized and limitations discussed. Indirect support for early oral treatment of brain abscess was described with reference to other serious central nervous system infections and general pharmacological considerations. Finally, variations within and between countries in the use of early transition to oral antimicrobials in patients with brain abscess were highlighted. ImplicationsEarly transition to oral antimicrobials in patients with uncomplicated brain abscess may be of benefit for patients due to convenience of treatment and potential decreased risks associated with prolonged hospitalization and intravenous lines. The strategy may also confer a more rational allocation of healthcare resources and decrease expenses. However, the benefit/risk ratio for this strategy remains unresolved at present.

Improving diagnostic antimicrobial stewardship in respiratory tract infections: a protocol for a scoping review investigating point-of-care testing programmes in community pharmacy

IntroductionDiagnostic uncertainty regarding the cause of respiratory tract infections (RTIs) multiplies the problem of unnecessary use of antibiotics and antimicrobial resistance in primary care. Point-of-care testing (POCT) programmes have been...

Dose adjustments of antimicrobials in patients with hepatic impairment

Introduction Antimicrobial resistance (AMR) refers to the development of genetic mutations by micro-organisms (including bacteria, viruses, fungi and protozoa) that help them survive exposure to antimicrobial drugs​[1]​. These micro-organisms can then withstand the effects of antimicrobial drugs and continue to spread and cause infection. The rise in AMR affects the global human population and it […]

Dose adjustments of antimicrobials in patients with renal impairment

Caution should be exercised when prescribing medication in patients with renal impairment, owing to the risk of drug accumulation, poorly tolerated adverse effects and impaired efficacy​[1]​. These effects can generally be mitigated by adjusting the dose or increasing the dosing interval. This is the second article in a two-part series outlining the importance of antimicrobial […]

Pharmacist adjustment of preoperative antibiotic orders to the preferred preoperative antibiotic cefazolin for patients with penicillin allergy labeling.

Emerging literature has detailed the safe use of cefazolin in patients with immunoglobulin E-mediated penicillin allergy labeling (PAL) such as hives and anaphylaxis. The purpose of this article is to detail efforts led by an antimicrobial stewardship pharmacist working with an interdisciplinary team to optimize preoperative antimicrobials in patients with PAL. A pharmacist-led, interdisciplinary collaborative practice agreement (CPA) was activated in January 2020 to permit pharmacists to independently optimize preoperative antibiotics to the preferred cefazolin in patients with PAL if nonsevere or severe reactions had been reported. A patient registry was established covering the timeframe between January 8, 2020, and January 6, 2022. Reaction during surgery was assessed via 2-provider documentation, which included surgeon and anesthesiology staff documentation of any complications during the procedure related to a suspected allergic safety event. Utilization of cefazolin, clindamycin, and vancomycin for preoperative prophylaxis was monitored before and after implementation of the CPA. During the stated timeframe, 10,182 procedures and/or surgeries were completed on 1,572 (15.4%) patients with PAL and 659 (41.9%) patients previously reporting at least one reaction categorized as a severe reaction, which was hives for 71.2% of these patients. Of the 659 patients with PAL reporting a severe reaction, 356 received a preoperative cephalosporin (cefazolin, 98.8%; ceftriaxone, 1.2%) and tolerated it without a reported safety event, including 52 patients with PAL previously reporting anaphylaxis. An increase in preferred preoperative antimicrobial prophylaxis utilization was noted (cefazolin: 86% to 96.3%, P < 0.001; 2019 to 2021) with reductions noted in the use of nonpreferred preoperative antibiotics (clindamycin: 2.1% to 0.2%, P < 0.001; vancomycin: 3.2% to 0.4%, P < 0.001; 2019 to 2021). A pharmacist-led, interdisciplinary CPA increased preferred preoperative antimicrobial use in patients with PAL reporting severe allergic reactions, including hives and anaphylaxis, without reported safety events.

1767. Because I Could Not Stop for Death, They Gave Me Antibiotics? Perceptions And Reality of Antibiotic Prescribing When Patient Care Is Transitioned to CMO at an Academic Medical Center

Abstract Background Little is known about antimicrobial prescribing when patient care is transitioned to comfort measures only (CMO). We used a multi-disciplinary survey and retrospective chart review to gain insight into antimicrobial prescribing in this population at an academic medical center. Methods A survey focusing on antimicrobial prescribing during the transition to CMO was electronically distributed to providers in Infectious Disease, Pulmonary/Critical Care, Hematology/Oncology, Palliative Care, and Hospital Medicine, and responses were compared across divisions. A retrospective chart review was performed of patients admitted to Beth Israel Deaconess Medical Center in 2020 who were on antimicrobials in the 48 hours prior to CMO. We investigated the frequency of patients on antimicrobials after the transition to CMO and provider rationale for continuing antimicrobials. Results We received 113 survey responses for a response rate of 35%; 111 were included for analysis. 41% of respondents indicated that they “sometimes” or “often” continued an antimicrobial during the transition to CMO. Of the 546 patient charts reviewed, 140 (26%) patients were alive 48 hours after CMO order, and 19 (14%) of those patients remained on antimicrobials (Figure 1). Patient/family preference was the most common factor when deciding whether to continue antimicrobials in patients on CMO, identified by 77% of respondents (Figure 2). 5/19 (26%) patients who were alive on antimicrobials 48 hours after CMO had documentation that antimicrobials were continued due to patient/family preference. Symptom palliation was the second most common factor when deciding whether to continue antimicrobials in patients on CMO, identified by 62% of respondents. For patients already on symptom directed medications, many providers perceived antibiotics to be helpful to palliate symptoms, though there were inter-division differences (Table 1). 5/19 (26%) patients who were alive on antimicrobials 48 hours after CMO had documentation that antimicrobials were continued for palliation of symptoms. Perceived Helpfulness of Antimicrobials for Specific Symptoms by Division Number/percentage of survey responses indicating antimicrobials were at least somewhat helpful for specified symptoms in patients already on symptom directed medications. Divisions compared using Kruskal-Wallis Tests. Conclusion Even after transition to CMO, a substantial number of patients remain on antimicrobials. Patient/family preference and symptom palliation are important factors when continuing antimicrobials in this population. Disclosures All Authors: No reported disclosures.

Bacteriophage Cocktails in the Post-COVID Rehabilitation

Increasing evidence suggests that gut dysbiosis is associated with coronavirus disease 2019 (COVID-19) infection and may persist long after disease resolution. The excessive use of antimicrobials in patients with COVID-19 can lead to additional destruction of the microbiota, as well as to the growth and spread of antimicrobial resistance. The problem of bacterial resistance to antibiotics encourages the search for alternative methods of limiting bacterial growth and restoring the normal balance of the microbiota in the human body. Bacteriophages are promising candidates as potential regulators of the microbiota. In the present study, two complex phage cocktails targeting multiple bacterial species were used in the rehabilitation of thirty patients after COVID-19, and the effectiveness of the bacteriophages against the clinical strain of Klebsiella pneumoniae was evaluated for the first time using real-time visualization on a 3D Cell Explorer microscope. Application of phage cocktails for two weeks showed safety and the absence of adverse effects. An almost threefold statistically significant decrease in the anaerobic imbalance ratio, together with an erythrocyte sedimentation rate (ESR), was detected. This work will serve as a starting point for a broader and more detailed study of the use of phages and their effects on the microbiome.

Supportive Care Strategies in Myelodysplastic Syndromes and Acute Myeloid Leukemia in Older Adults: A National Survey of Canadian Hematologists

BACKGROUND: Myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) represent a spectrum of severe myeloid disorders characterized by marrow failure, cytopenias, and complications related to bleeding and infection. Due to patient and disease factors, many patients are treated with less-intensive therapy, such as transfusion support, erythropoietin stimulating agents, luspatercept, lenalidomide and hypomethylating agents. However, optimal supportive care strategies to minimize bleeding and infectious complications among older adults receiving less intensive therapy have not been systematically evaluated. OBJECTIVES: The objectives of the survey were to: a) evaluate self-reported use of tranexamic acid (TXA) and antimicrobial prophylaxis; b) identify perceived barriers and facilitators to the use of TXA and antimicrobial prophylaxis; c) characterize the degree of uncertainty regarding the benefits and harms of TXA and prophylactic antimicrobials in this patient population; and d) assess physician interest in future clinical trials of TXA and/or prophylactic antimicrobials. METHODS: We conducted a national cross-sectional survey of Canadian hematologists to explore current practice variation regarding the use of TXA and prophylactic antimicrobials in patients with MDS and AML treated with less intensive therapy, and evaluate equipoise for future trials. Survey items were generated iteratively through a combination of literature review and discussion with content experts until thematic saturation was achieved. The questionnaire was pilot-tested by collaborators prior to dissemination to assess the required completion time and provide feedback on flow, clarity, redundancy and comprehensiveness. The electronic platform REDCap was used to create and disseminate the survey tool. The survey was distributed to all hematologists affiliated with a Canadian university, representing both key knowledge users and potential participants in an investigative network for future clinical trials. RESULTS: The survey response rate was 52% (159/304 invited participants). Of the 159 hematologists, 105 indicated that they treated MDS/AML patients with less intensive therapy and responded to the further questions about this patient population. Most (97/105; 92%) hematologists worked in an academic/tertiary care setting; 8% (n=8/105) worked in a community setting. Prophylactic TXA was used by 57% (n=60/105) of hematologists; the most frequent reason for not using TXA was uncertainty about the benefits or harms. Nearly all (95%; 100/105) hematologists agreed that a trial of TXA is needed (n=78), or potentially needed (n=22). Use of prophylactic antimicrobials varied by the chemotherapy treatment regimen. The most frequently prescribed antibacterials were fluroquinolones (36% of respondents; n=38), trimethoprim/sulfamethoxazole (9%; n=9), and amoxicillin-clavulanate (5%; n=5). The most commonly used antifungals were fluconazole (35% of respondents; n=37) and voriconazole (19%; n=20). Valacyclovir (29% of respondents; n=30) and acyclovir (15%; n=16) were the antivirals prescribed. The most common reason for not using prophylactic antimicrobials was an insufficient level of evidence (70%; n=73). The majority (78%, n=82) of respondents agreed that a trial is needed to evaluate optimal antimicrobial prophylaxis in this at-risk patient population. CONCLUSIONS: Among survey respondents, there was variation in the use of supportive case strategies to address bleeding and infection risk in older adults with MDS/AML. Most hematologists who treat MDS/AML with less intensive therapy felt that clinical trials are needed to define the use of TXA and prophylactic antimicrobials in this patient population.

ANTIBACTERIAL THERAPY FOR PATIENTS WITH BURN INJURIES

Background. Treatment of burn wound infection is an urgent issue of contemporary medicine, including surgery, combustiology and microbiology. It is established that infectious complications are a challenge for burn patients. In the course of wound reparation, infectious complications may worsen. Along with surgical treatment, mechanical removal of pathogens from burn wounds is also important as well as antimicrobials for patients with severe burns. Objective. The aim of the study was to define the most common pathogens of purulent-inflammatory complications of burn wounds and their susceptibility to antibiotics. Methods. The study involved patients treated at the Center of Thermal Trauma and Plastic Surgery of Lviv I-Territorial Medical Association, the unit of St. Luke Hospital of Lviv. Collection of material from wound secretions of burn wounds was performed with sterile swab. The study was performed before prescription of antibiotics, at the end of the first and second weeks of the disease. The pathogens were isolated and identified. Antibiotic susceptibility was studied using standard research methods. The obtained results were analyzed by means of the software package of the microbiological monitoring system WHONET 5.2 (WHO Collaborating Centre for Surveillance of Antimicrobial Resistance) and the program Microsoft Office Excel 2007. Results. The study of smears from burn wounds proved that 240 strains of gram-positive and gram-negative microorganisms that caused purulent-inflammatory processes were isolated. Among the selected causative agents of a burn wound complicated by a purulent-inflammatory process, gram-negative bacteria predominated (60.8% of all detected microorganisms). Gram-positive flora of S. epidermidis and S. aureus were more common in the wound surface during the first week of the disease. In most patients with severe burns, bacterial associations were isolated from the wound surface (66.3%) in two and three weeks, and in three weeks Candida spp. were isolated. Non-fermenting rods A. baumannii and P. aeruginosa dominated among the gram-negative flora isolated from the wound surface of burns. The analysis of susceptibility of microorganisms isolated from patients with burns to antibiotics showed that almost all of the cultures were polyresistant. Conclusions. Gram-negative microorganisms, strains of non-fermenting bacteria predominated among the pathogens isolated from burn wounds complicated by purulent inflammation; Staphylococcus aureus prevailed among the gram-positive ones. The most significant clinical strains were highly polyresistant to antibiotics.

SARS-CoV-2 and Chlamydia pneumoniae co-infection: A review of the literature

Bacterial co-pathogens are commonly identified in viral respiratory infections and are important causes of morbid-mortality. The prevalence of Chlamydia (C.) pneumoniae infection in patients infected with SARS-CoV-2 has not been sufficiently studied. The objective of the present review was to describe the prevalence of C. pneumoniae in patients with coronavirus disease 2019 (COVID-19). A search in MEDLINE and Google Scholar databases for English language literature published between January 2020 and August 2021 was performed. Studies evaluating patients with confirmed COVID-19 and reporting the simultaneous detection of C. pneumoniae were included. Eleven articles were included in the systematic review (5 case cross-sectional studies and 6 retrospective studies). A total of 18450 patients were included in the eleven studies. The detection of laboratory-confirmed C. pneumoniae infection varied between 1.78 and 71.4% of the total number of co-infections. The median age of patients ranged from 35 to 71 years old and 65% were male. Most of the studies reported one or more pre-existing comorbidities and the majority of the patients presented with fever, cough and dyspnea. Lymphopenia and eosinopenia were described in COVID-19 co-infected patients. The main chest CT scan showed a ground glass density shadow, consolidation and bilateral pneumonia. Most patients received empirical antibiotics. Bacterial co-infection was not associated with increased ICU admission and mortality. Despite frequent prescription of broad-spectrum empirical antimicrobials in patients with coronavirus 2-associated respiratory infections, there is a paucity of data to support the association with respiratory bacterial co-infection. Prospective evidence generation to support the development of an antimicrobial policy and appropriate stewardship interventions specific for the COVID-19 pandemic are urgently required.

Antimicrobial prescriptions in cancer patients: An evaluation based on clinical and pharmacotherapeutic indicators

Context: The inappropriate use of antimicrobials is a public worldwide health problem that causes increased morbidity and mortality, bacterial resistance, and care costs and hospitalizations. Aims: To evaluate the prescription of antimicrobials in patients treated at a Cuban cancer hospital, based on clinical indicators and pharmacotherapeutics. Methods: Retrospective descriptive study of prescription-indication of antimicrobials, during the period of January-December 2018, in a Cuban cancer hospital. Hospitalized patients with antimicrobial treatment were included in the study. The determination of prevalent microorganisms and bacterial resistance was analyzed through the book of infection control and antibiograms. The adequate and inadequate categories of prescriptions based on clinical and pharmacotherapeutic indicators were established to evaluate the prescription. Results: In a sample of 50 patients, laryngeal cancer (40%), surgical wound infection (48%), and beta-lactam pharmacological group (46.4%) prevailed. Eight germs were isolated, with a predominance of Pseudomonas aeruginosa (26.3%) with gentamicin resistance (66.7%). Staphylococcus spp. presented resistance to ciprofloxacin (63.6%) and amikacin (54.5%). Escherichia coli exhibited resistance to gentamicin (66.7%) and ciprofloxacin (55.6%). Appropriate prescriptions predominated (52%), with the indicator ‘indication and therapeutic scheme’ being the most difficult. Conclusions: The inappropriate use of antimicrobials constitutes a problem in cancer patients and highlights the need to implement actions that contribute to raising the quality of prescriptions to prevent microbial resistance.

Impact of continuous pharmacist intervention for injectable antimicrobials on the treatment of patients with Escherichia coli bacteremia

BackgroundA prospective audit with intervention and feedback (PAF) by pharmacists is important for the appropriate use of antimicrobials. Clinically, Escherichia coli (E. coli) bacteremia is a common condition, but only few researchers have examined the role of PAF in its appropriate use of antimicrobials. MethodsWe started PAF by pharmacists in 2017 for all injectable antibiotics. This study included cases of E. coli bacteremia that resulted in hospitalization over a 4 year period from 2016 to 2019. Patients were grouped by year (Period 0–3), and clinical outcomes were examined. ResultsThe pharmacists had 12 and 54 suggestions in Periods 0 and 3, respectively. The most common suggestion was de-escalation. The median duration of antimicrobial use was 12 (interquartile range: 8–15) days in Periods 0–2. The duration of antimicrobial use was significantly reduced to 9 (7–12) days in Period 3. In Period 3, the duration of antimicrobial use was reduced by 29%, while anti-pseudomonal drug use was reduced by 42% compared with that in period 0. The 30 day mortality rates were not significantly different between the groups. ConclusionsPAF by pharmacists promotes the appropriate use of antimicrobials in patients with E. coli bacteremia; it is important to continue the program for several years.