Initial Intravenous Antibiotic Research Articles

Antibiotic route and outcomes for children hospitalized with pneumonia.

Emerging evidence suggests that initial oral and intravenous (IV) antibiotics have similar efficacy in pediatric community-acquired pneumonia (CAP), but further data are needed. We determined the association between hospital-level initial oral antibiotic rates and outcomes in pediatric CAP. This retrospective cohort study included children hospitalized with CAP at 43 hospitals in the Pediatric Health Information System (2016-2022). Hospitals were grouped by whether initial antibiotics were given orally in a high, moderate, or low proportion of patients. Regression models examined associations between high versus low oral-utilizing hospitals and length of stay (LOS, primary outcome), intensive care unit (ICU) transfers, escalated respiratory care, complicated CAP, cost, readmissions, and emergency department (ED) revisits. Initial oral antibiotics were used in 16% (interquartile range: 10%-20%) of 30,207 encounters, ranging from 1% to 68% across hospitals. Comparing high versus low oral-utilizing hospitals (oral rate: 32% [27%-47%] and 10% [9%-11%], respectively), there were no differences in LOS, intensive care unit, complicated CAP, cost, or ED revisits. Escalated respiratory care occurred in 1.3% and 0.5% of high and low oral-utilizing hospitals, respectively (relative ratio [RR]: 2.96 [1.12, 7.81]), and readmissions occurred in 1.5% and 0.8% (RR: 1.68 [1.31, 2.17]). Initial oral antibiotics varied across hospitals without a difference in LOS. While high oral-utilizing hospitals had higher escalated respiratory care and readmission rates, these were rare, the clinical significance of these small differences is uncertain, and there were no differences in other clinically relevant outcomes. This suggests some children may benefit from initial IV antibiotics, but most would probably do well with oral antibiotics.

Analysis of the effect of therapy for severe intracranial infection after craniotomy

ObjectiveTo retrospectively analyze the distribution characteristics of pathogenic bacteria in the cerebrospinal fluid (CSF) of patients with severe intracranial infection after craniotomy and treatment results. The aim was to provide a clinical basis and reference for improving treatment for severe intracranial infections. MethodsThis was a retrospective analysis of the distribution of pathogenic bacteria and the therapeutic effect for 43 patients who developed severe intracranial infections after craniotomy. All patients had positive CSF cultures and were treated in two hospitals in Beijing from May 2015 to May 2020. All patients received an intravenous injection of sensitive antibiotics combined with a CSF lateral ventricle catheter or lumbar cistern drainage. Antibiotic lavage treatment was administered through an external drain. ResultsThe CSF bacterial culture results for the 43 patients showed 34 single-strain infections (26 Gram-positive bacteria and 8 Gram-negative bacteria) and 9 multistrain infections. Fifty-two pathogenic strains were isolated, namely 32 Gram-positive bacteria (61.54%), 18 Gram-negative bacteria (34.61%), and 2 fungi (3.85%). After combined treatment, 29 patients (67.44%) were cured; treatment was effective for 7 patients (16.28%) and ineffective for 7 patients (16.28%). After 6 months of follow-up, the 36 surviving patients were cured of infection. The Glasgow Outcome Scale score results showed that 5 of the 36 (13.9%) patients had a persistent vegetative state; 13 (36.1%) had severe disability; 12 (33.3%) had moderate disability; and 6 (16.7%) had mild disability. ConclusionCSF pathogenic bacteria in patients with intracranial infection after craniotomy were mainly Gram-positive bacteria, primarily Staphylococcus epidermidis. A small number of patients had mixed bacterial infections. Owing to the presence of implanted devices in patients who underwent ventriculoperitoneal shunt surgery, the antibacterial therapeutic effect was worse than that for other types of postoperative infections. Therefore, when initial intravenous antibiotics are ineffective, the shunt device should be removed or replaced as soon as possible. When initial intravenous antibiotics are ineffective and severe intracranial infection occurs, a combined treatment plan should be adopted. That is, CSF drainage and antibiotic lavage should be performed cautiously with the intravenous injection of sensitive antibiotics. Our clinical data confirmed that postoperative neurosurgical infection could lead to different degrees of nerve dysfunction, which should be considered.

Door-to-Needle Time for Administration of Antibiotic in Children with Cancer Within the Golden Hour- an Audit from a Tertiary Cancer Hospital in a Low-Middle Income Country

Abstract Background Fever neutropenia (FN) is the commonest complication during treatment in children with cancer. Most guidelines recommend administration of intravenous antibiotics within 60 minutes of presentation to the Emergency Room (ER) to minimize life threatening complications of FN(1). We performed a 3-month audit at our ER to see if this target was being met(2). The departmental FN management policy was revised and implemented from February 2021 based on the prevailing hospital antibiogram. All children undergoing treatment in the Paediatric Oncology Department are provided with written FN Alerts/Advice (Fig. 1). All patient prescriptions include instructions on antibiotic choice and dosage. Annual educational sessions are held with the ER staff and Paediatric Oncology Residents. A stock of essential antibiotics is maintained in the ER. Methods All children on chemotherapy or radiotherapy presenting to ER with fever (≥38°C) either at home or documented at ER had blood counts and blood cultures sent both from a peripheral vein and the indwelling central venous device (if present). The first dose of antibiotics as prescribed was administered without waiting for the blood count report or assessment by the Clinician. Time of patient’s arrival at ER and time of administration of the first antibiotic dose were obtained from ER nursing records and patient drug cards. Data was entered prospectively within 24 hours and tabulated for analysis on Microsoft Excel. Fig.1: Fever Neutropenia Sticker on Patient File Results Eighty-four children presented with 129 episodes of fever during the audit period (1st April 2022-30th June 2022). Median age was 6.4 years (IQR 3.1,12). Median time interval from last chemotherapy was 6 days (IQR 2,10). All children reporting to ER were seen by a Clinician, with 106 (82%) episodes seen within 30 minutes of reporting (median 15 minutes, IQR 5,21). All children received initial intravenous antibiotics after blood sampling. Median door-to-needle time was 45 minutes (IQR 35,60 minutes) There were 2 deaths in this cohort, one due to cancer progression and the other due to an unidentified infection of the central nervous system. Conclusions Over 80% children received the first dose of antibiotics within the target of <60 minutes. There were no deaths attributable to sepsis. Though the outcome was excellent in this cohort, we need to analyse the reasons for delay in administration of the first antibiotic dose and take remedial measures to improve compliance.

Sequential oral antibiotic in uncomplicated Staphylococcus aureus bacteraemia: a propensity-matched cohort analysis

ObjectivesWe aimed to analyse the efficacy and safety of oral sequential therapy (OST) in uncomplicated Staphylococcus aureus bacteraemia (SAB). MethodsSingle-centre observational cohort at a tertiary hospital in Spain, including all patients with the first SAB episode from January 2015 to December 2020. We excluded patients with complicated SAB and those who died during the first week. Patients were classified into the OST group (patients who received oral therapy after initial intravenous antibiotic therapy [IVT]), and IVT group (patients who received exclusively IVT). We performed a propensity-score matching to balance baseline differences. The primary composite endpoint was 90-day mortality or microbiological failure. Secondary endpoints included 90-day SAB relapse. ResultsOut of 407 SAB first episodes, 230 (56.5%) were included. Of these, 112 (n = 48.7%) received OST and 118 (51.3%) IVT exclusively. Transition to oral therapy was performed after 7 days (interquartile range, 4–11).The primary endpoint occurred in 10.7% (11/112) in OST vs. 30.5% (36/118) in IVT (p < 0.001). SAB relapses occurred in 3.6% (4/112) vs. 1.7% (2/118) (p 0.436). None of the deaths in OST were related to SAB or its complications.After propensity-score matching, the primary endpoint was not more frequent in the OST group (relative risk, 0.42; 95% CI, 0.22–0.79). Ninety-day relapses occurred similarly in both groups (relative risk, 1.35; 95% CI, 0.75–2.39). DiscussionAfter an initial intravenous antibiotic, patients with uncomplicated SAB can safely be switched to oral antibiotics without apparent adverse outcomes. This strategy could save costs and complications of prolonged hospital stays. Prospective randomized studies are needed.

Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom?

Osteoarticular infections (OAIs) are typically treated initially with intravenous antibiotics. The objective of this study was to evaluate whether an exclusive oral treatment in selected children may be appropriate. The Spanish Network of Osteoarticular Infections is a nationwide multicenter registry comprising 37 hospitals in Spain. The registry prospectively includes clinical characteristics and outcome of children with OAI. One of the hospitals from RioPed offers oral treatment to children meeting certain criteria. Patients were classified into 2 groups. Group 1: management with initial intravenous antibiotic therapy. Group 2: patients exclusively treated with oral antibiotics. A comparison between the 2 groups was performed. We compared 893 children who initially received intravenous antibiotics (group 1) with 64 children who received exclusively oral therapy (group 2). Patients from group 2 were younger (33.9 vs. 20.3 months; P = 0.001), had a lower percentage of Staphylococcus aureus (23.3% vs. 3.1%; P < 0.001), a higher proportion of Kingella kingae (12.1% vs. 28.1%; P = 0.001), higher erythrocyte sedimentation rate/C-reactive protein (CRP) ratio (1.4 interquartile range 0.6-3.6 vs. 3.3 interquartile range 1.7-5.7; P < 0.001) and showed lower rate of fever (63% vs. 48.8%; P = 0.024) than in group 1. Complications were not found in group 2. An exclusively oral administration could be a safe option in selected patients with OAI. Low-risk criteria are proposed: good general condition, no underlying disease, 6 months to 3 years old, appropriate oral tolerance, C-reactive protein <80 mg/L, erythrocyte sedimentation rate/C-reactive protein ratio ≥0.67, no skin injury, no recent surgery, no cervical spondylodiscitis and no local complications at onset.

Outcomes for Patients with Urinary Tract Infection After an Initial Intravenous Antibiotics Dose Before Emergency Department Discharge.

IntroductionTo investigate the effect of single-dose intravenous antibiotics before emergency department (ED) discharge on the outcomes of patients with urinary tract infections (UTIs).MethodsThis is a retrospective study conducted at the EDs of three medical centers. Patients aged over 18 years who presented to the ED with UTI and were discharged without admission between January 1, 2016 and December 31, 2017 were evaluated. The study group received a single dose of effective intravenous antibiotics on the basis of urine culture during the index ED visit following oral antibiotics, while the comparison group received oral antibiotics only. The primary outcomes were ED revisit within 72 h and admission following the return visit.ResultsA total of 8168 patients were included. Of these, 20.9% received intravenous antibiotics before ED discharge. Patients who received effective intravenous antibiotics before ED discharge were associated with less than 72-h ED revisit (adjusted odds ratio [OR] 0.791, 95% confidence interval [CI] 0.640–0.979]), but not decreased admission following the return visit (adjusted OR 0.921, 95% CI [0.731–1.153]). In subgroup analysis, parenteral antibiotic use during the index ED visit was associated with decreased admission following ED revisit in patients who presented with fever (adjusted OR 0.605; 95% CI 0.443–0.932).ConclusionFor patients with UTI and clinically well to be discharged from the ED, a single dose of effective intravenous antibiotics before ED discharge was associated with decreased 72-h ED revisit. In patients with febrile UTI, initial intravenous antibiotics were associated with decreased revisit leading to admissions.

Management of post-operative discitis following discectomy in a tertiary-level hospital.

To perform retrospective analysis of 75 post-operative disc space infections after open lumbar discectomy (OLD) and to assess the outcome of their medical and surgical management in a tertiary-level hospital. Records of 50 men and 25 women aged 26-65 (mean, 42.53) years who underwent treatment for post-operative discitis (POD) after single level OLD at L3-4 (n = 8), L4-5 (n = 42), L5-S1 (n = 25) level. The POD was diagnosed according to specific clinical signs, laboratory and radiographic investigations and all of them received initial intravenous antibiotics (IVA) for at least 4-6 weeks followed by oral ones. Successful responders (n = 55) were considered in Group-C and remainder [Group-S (n = 20)] were operated at least after 4 weeks of failure. Demographic data, clinical variables, hospital stay, duration of antibiotic treatment and post-treatment complications were collected from the hospital record and assessment before and after treatment were done by using visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score. Comprehensive outcome was evaluated by modified criteria of Kirkaldy-Willis. The mean follows up was 36.38 months. Significant improvement of mean VAS and JOA score was achieved in both conservative (76.36% satisfactory) and operative (90% satisfactory) groups although the difference was statistically insignificant. Although insignificant, early surgical intervention provided better results (e.g. functional outcomes, length of hospital stay and duration of antibiotic treatment therapy) than conventional conservative treatment in post-operative discitis.

Oral switch versus standard intravenous antibiotic therapy in left-sided endocarditis due to susceptible staphylococci, streptococci or enterococci (RODEO): a protocol for two open-label randomised controlled trials

IntroductionLeft-sided infective endocarditis (IE) is a serious infection with a heavy burden for patients and healthcare system. Oral switch after initial intravenous antibiotic therapy may reduce costs and improve patients’...

A Retrospective Chart Review on the Role of Suppressive Therapy in the Management of Spinal Infections Involving Hardware.

BackgroundOne percent to 8% of patients undergoing spinal instrumentation surgeries develop infections. There is no consensus on the medical and surgical management of these infections.MethodsWe conducted a retrospective chart review based on International Classification of Diseases, Ninth Revision, and Common Procedural Terminology codes relevant to spinal infections with hardware within Emory Healthcare over a 10-year period. Extracted data included patient demographics, clinical presentation, laboratory and microbiologic results, and surgical and medical management including choice and duration of suppressive therapy. Multivariable logistic regression was used to assess the association of length of use of suppressive antibiotics with treatment success and to identify predictors of use of suppressive antibiotics.ResultsOf 869 records, 124 met inclusion criteria. Fifty patients (40.3%) had an infection that occurred after hardware placement, mostly within 3 months postsurgery, while the remainder had vertebral osteomyelitis that required hardware placement. After initial intravenous antibiotic treatment for ≥4 weeks, 72 patients (64.5%) were given suppressive antibiotics. The overall treatment success rate was 78.2%. In spinal infections involving hardware with gram-negative rods, patients were less likely to receive suppressive antibiotics, less likely to have hardware removed, and less likely to have treatment success compared with patients with infections with Staphylococcus species.ConclusionsManagement of spinal infections involving hardware should be tailored to the timing of onset of infection and causative organism. Further studies are needed to determine best management practices, particularly for gram-negative rod infections where the role of further suppressive antibiotics and hardware removal may be warranted.

Oral antibiotic therapy in people who inject drugs (PWID) with bacteraemia.

Bacterial infections are a major cause of morbidity and mortality in people who inject drugs (PWID). Patients with bacteraemia have a particularly high risk of complications and are usually treated with intravenous antibiotics. Intravenous treatment is challenging in certain PWID because of difficult venous access and a high rate of catheter-associated complications. Therefore, oral treatment alternatives must be considered. This review discusses the potential options for oral antimicrobial treatment of gram-positive and gram-negative bacteraemia in PWID and the evidence for them. Data on oral antibiotic treatment of bacteraemia in PWID is scarce. Whenever possible, a course of intravenous antibiotic treatment should precede the switch to an oral regimen. For Staphylococcus aureus bacteraemia, there is growing evidence that initial intravenous antibiotics can be switched to oral treatment (e.g., a fluoroquinolone and rifampin or linezolid) when the patient is clinically stable and source control has been achieved. However, regimen selection remains challenging due to pharmacokinetic/pharmacodynamic issues, potential toxicity and drug-drug interactions of oral antibiotics. For some streptococcal bacteraemia, oral amoxicillin is probably a reasonable option. The best existing evidence for oral antibiotic treatment is for gram-negative bacteraemia, which, if susceptible, can be treated successfully with oral fluoroquinolones. Oral antibiotic options for fluoroquinolone-resistant gram-negative bacteraemia are very limited, although in selected patients oral trimethoprim-sulfamethoxazole can be considered. In conclusion, treatment of bacteraemia in PWID remains very complex, and an interdisciplinary approach is essential in order to select the best therapy for this vulnerable group of patients.

Sepsis in Complex Patients in the Emergency Department: Time to Recognition and Therapy in Pediatric Patients With High-Risk Conditions.

To compare timeliness of sepsis recognition and initial treatment in patients with and without high-risk comorbid conditions. This was a retrospective cohort study of patients presenting to a pediatric emergency department (ED) who triggered a vital sign-based electronic sepsis alert resulting in bedside "huddle" assessment per institutional practice. A positive sepsis alert was defined as age-specific tachycardia or hypotension, concern for infection, and at least 1 of the following: abnormal capillary refill, abnormal mental status, or a high-risk condition. High-risk conditions were derived from the American Academy of Pediatrics sepsis alert tool. Patients with a positive alert underwent bedside huddle resulting in a decision regarding initiation of sepsis protocol. Placement on the protocol and time to initiation of protocol and individual therapies were compared for patients with and without high-risk conditions. During the 1-year study period, there were 1107 sepsis huddle alerts out of 96,427 ED visits. Of these, 713 (65%) had identified high-risk conditions, and 394 (35%) did not. Among patients with sepsis huddles, there was no difference in sepsis protocol initiation for patients with high-risk conditions compared with those without (24.8% vs 22.0%, P = 0.305). Between patients with high-risk conditions and those without, there were no differences in median time from triage to sepsis protocol activation, triage to initial intravenous antibiotic, triage to initial intravenous fluid therapy, or ED length of stay. Timeliness of care initiation was no different in high-risk patients with sepsis when using an electronic sepsis alert and protocolized sepsis care.

The novel use of oral antibiotic monotherapy in prosthetic valve endocarditis caused by Finegoldia magna: a case study

BackgroundFinegoldia magna, a Gram-positive anaerobic coccus, is part of the human normal microbiota as a commensal of mucocutaneous surfaces. However, it remains an uncommon pathogen in infective endocarditis, with only eight clinical cases previously reported in the literature.Currently, infective endocarditis is routinely treated with prolonged intravenous antibiotic therapy. However, recent research has found that switching patients to oral antibiotics is non-inferior to prolonged parenteral antibiotic treatment, challenging the current guidelines for the treatment of infective endocarditis.Case presentationThis case report focuses on a 52-year-old gentleman, who presented with initially culture-negative infective endocarditis following bioprosthetic aortic valve replacement. Blood cultures later grew Finegoldia magna. Following initial intravenous antibiotic therapy and re-do surgical replacement of the prosthetic aortic valve, the patient was successfully switched to oral antibiotic monotherapy, an unusual strategy in the treatment of infective endocarditis inspired by the recent publication of the POET trial. He made excellent progress on an eight-week course of oral antibiotics and was successfully discharged from surgical follow-up.ConclusionsThis case is the 9th reported case of Finegoldia magna infective endocarditis in the literature. Our case also raises the possibility of a more patient-friendly and cost-effective means of providing long-term antibiotic therapy in suitable patients with prosthetic valve endocarditis and suggests that the principles highlighted in the POET trial can also be applicable to post-operative patients after cardiac surgery.

Fosfomycin-trometamol for Urinary Tract Infections in Kidney Transplant Recipients.

The treatment of urinary tract infections (UTIs) in kidney transplant recipients (KTRs) with oral antibiotics is complicated by increasing resistance to trimethoprim-sulfamethoxazole, amoxicillin/clavulanic acid, and ciprofloxacin. Fosfomycin-trometamol (FT) could be an alternative, but evidence on clinical effectiveness is scarce. We evaluated the use, effectiveness and safety of FT for UTI in KTRs. Data were retrospectively collected in 2 Dutch transplant hospitals from adult KTRs that were treated with FT as initial treatment for lower UTI or asymptomatic bacteriuria (ASB) or as stepdown treatment for upper UTI after initial intravenous antibiotics. Exclusion criteria were in vitro resistance to FT or concomitant antibiotic treatment. Endpoints were clinical cure within 14 days and severe clinical failure, microbiological cure, relapse, recurrence, and acquired resistance within 90 days postend of treatment. Fifty-three episodes in 40 KTRs were included (ASB, n = 15; lower UTI, n = 33; upper UTI, n = 5). Fosfomycin-trometamol was used for a median short duration in a heterogeneous gift interval. Fosfomycin-trometamol resulted in microbiological cure in 25%, 28%, and 100% of ASB, lower UTI and upper UTI with initial positive culture and follow-up culture performed, respectively. Clinical cure rates were 67% for lower UTI and 80% for upper UTI. Relapses or recurrences occurred in 31% and 24% of symptomatic UTI episodes, without severe clinical failure. Acquired resistance to fosfomycin was observed in 6 episodes. Fosfomycin-trometamol has a reasonable effectiveness as last-resort oral treatment for lower UTI and stepdown treatment for upper UTI in KTRs. Randomized controlled trials with optimal dosage regimens are warranted. Use of FT is not recommended for ASB.

Risk score-guided treatment for hospitalized pneumonia in older patients.

Initial intravenous antibiotic treatment strategy for pneumonia is debated in older people living in nursing homes. Guidelines of the American Thoracic Society identified American Health-Care Associated Pneumonia (HCAP) which covered Nursing Home-Acquired Pneumonia (NHAP) and can be used as a score. The Complicated Pathogen Risk Assessment Score (CPRS) focuses on comorbidities and clinical past history. This study assesses the usefulness of HCAP score and CPRS in choosing initial empiric therapy while comparing their predictive value for a required change in initial antibiotic regimen and for mortality in hospitalized older patients. This is a retrospective analysis of 175 patients aged 75years or more hospitalized for pneumonia from 2014 to 2015. They were treated according to the French guidelines as community-acquired pneumonia. The HCAP score and the CPRS were analyzed retrospectively. They were matched to in-hospital mortality and to change in initial antibiotic regimen rates. Therapy as recommended for CAP was started in all 175 patients. A change in antibiotic regimen was noted in 17% of patients: 30% of those with a CPR score > 2 and 20% of those with an HCAP score ≥ 1. The global mortality rated 11% for all patients, 20.5% for those with a CPRS score > 2, and 16.5% for those with an HCAP score ≥ 1. Both changes for antibiotic regimen (p < 0.001) and mortality ( p< 0.001) rates were more closely associated with a CPRS > 2 than with an HCAP score ≥ 1. Multidrug-resistant risk scores are useful in optimizing initial empirical therapy for NHAP in the elderly.

Orbital Cellulitis And Subperiosteal Abscess Of Frontal Bone Complicating Unilateral Pansinusitis: A Case Report

Objective: The aim of this report is to demonstrate that acute rhino-sinusitis may result in orbital cellulitis and even life threatening complications especially intracranial abscesses in children and young adults. Rare complications such as subperiosteal abscess seen in this patient may also occur Morbidity and mortality can be prevented through early diagnosis and treatment by relevant specialists.&#x0D; Method: We present a case report and literature review on unilateral pansinusitis complicated with orbital cellulitis and subperiosteal abscess of the frontal bone.&#x0D; Results: Following a diagnosis of orbital cellulitis and subperiosteal abscess of the frontal bone from a unilateral pansinusitis, an initial intravenous antibiotic was given for 72 hours, followed by a surgical drainage with subsequent rapid improvement.&#x0D; Conclusion: Acute rhinosinusitis may be complicated by orbital cellulitis and abscess formation. Prompt referral to a tertiary health facility as well as ooperation between the Ophthalmologists and Otorhinolaryngologists is very important to prevent life threatening complications.&#x0D; Key words: Orbital cellulitis, Pansinusitis, Subperiosteal abscess

Evaluation of antibiotic resistance to orally administrable antibiotics in staphylococcal bone and joint infections in one of the largest university hospitals in Germany: is there a role for fusidic acid?

Bone and joint infections (BJIs) are often difficult to treat. Staphylococcus spp. is the major pathogen causing these infections, which is often associated with biofilm formation on prosthetic materials. Therapeutic measures are complex, ranging from surgical intervention to initial intravenous and supportive long-term oral antibiotic therapy. The options for oral antimicrobial therapy are limited, mainly due to the resistance profile of the causative pathogen and the unfavourable pharmacodynamic and pharmacokinetic properties of most antibiotics in biofilm. Data analysis over a 5-year period was performed on staphylococci isolated from BJI patients in the Orthopaedic Department of the University Hospital Heidelberg (Heidelberg, Germany) to assess the plausibility of fusidic acid (FA)-based alternative oral treatment regimens. Six percent of BJIs were caused by meticillin-resistant Staphylococcus aureus (MRSA), and multiresistance was common. Over 75% of MRSA in BJIs were resistant to the commonly used rifampicin (RIF)-based combinations. Resistance to FA-based combinations was high. However, over 80% were susceptible to the combination RIF+FA. In coagulase-negative staphylococci, resistance to RIF-based combinations was similar to FA-based combinations. Almost two-thirds of the isolates tested were susceptible to RIF+FA. These data suggest FA as a possible option as a substitution for RIF or as a combination companion in case of resistance or unavailability.

Outcomes of hospitalized neutropenic oncology patients with Pseudomonas aeruginosa bloodstream infections: focus on oral fluoroquinolone conversion.

Pseudomonas aeruginosa bacteremia is a major cause of morbidity and mortality, especially in neutropenic oncology patients. Few studies have been published in the last decade on treatment outcomes of neutropenic oncology patients with Pseudomonas aeruginosa bacteremia. In addition, there is a lack of data addressing the role of oral fluoroquinolones in this patient setting. A retrospective chart review from 1999 to 2013 was conducted at a large academic medical center in neutropenic oncology patients with documented Pseudomonas aeruginosa bacteremia, who were initially treated with intravenous anti-pseudomonal antibiotics and then converted to an oral anti-pseudomonal fluoroquinolone. Patients were evaluated for the rate of cure and for the time from onset of intravenous antibiotic therapy to conversion to oral fluoroquinolones. Twenty-nine patients with Pseudomonas aeruginosa bacteremia were evaluated. The median absolute neutrophil count at the time of the first positive blood culture was 50 cells/mm(3), and the median duration of time below an absolute neutrophil count of 1000 cells/mm(3) was five days. The change to oral fluoroquinolones occurred at a median (range) of six (2-18) days after initiation of intravenous antibiotics and at a median absolute neutrophil count of 2610 (110-24790) cells/mm(3). The initial cure was 93.1%, while ultimate cure was 91.7%. Converting to oral fluoroquinolones after initial intravenous antibiotic therapy for Pseudomonas aeruginosa bacteremia in clinically stable neutropenic oncology patients appears to achieve successful outcomes. However, prospective trials are needed to validate these results in neutropenic oncology patients with Pseudomonas aeruginosa bacteremia who are converted to oral fluoroquinolones.

Intramedullary spinal cord abscess by Nocardia: A case report

Introduction: Nocardia is a Gram-positive bacteria that usually cause opportunistic infections but can affect the immunocompetent host. The central nervous system can be the primary site of infection in up to 40% of the cases but the involvement of the spinal cord is extremely rare. Case Report: We present a case of a middle age man with history of alcoholic liver cirrhosis and diabetes mellitus who presented with acute lower back pain that is associated with right leg weakness and numbness. Magnetic resonance imaging (MRI) scan showed a spinal cord intramedullary abscess. The cerebrospinal fluid analysis was consistent with meningitis and the organism was eventually identified with CSF culture as Nocardia Farcinica. Patient was treated with prolonged intravenous trimethoprim/sulfamethoxazole and meropenem. No neurosurgical intervention was done and the patient had full neurological recovery in few months. Discussion: Nocardia species are able to cause different kinds of disease in man. Spinal cord abscess are extremely rare and high index of clinic suspicion is required for diagnosis. Initial combination intravenous antibiotics treatment is essential and should be continued for at least three to six weeks. Treatment can be switched to oral and continued for a minimum of six months. Surgical intervention might be indicated in some patients. 16s rRNA gene sequencing allows earlier identification and thus adjustment of antibiotics. Conclusion: This report illustrates that a diagnosis can be made by neuroimaging and cerebrospinal fluid (CSF) 16s ribosomalRNA sequencing, allowing early and effective antibiotic therapy and obviating the need for a high-risk neurosurgical intervention.

Patient Outcomes on Day 4 of Intravenous Antibiotic Therapy in Non-Intensive Care Unit Hospitalized Adults With Community-Acquired Bacterial Pneumonia.

BackgroundCommunity-acquired bacterial pneumonia (CABP) is a leading cause of morbidity and mortality especially in hospitalized patients. In place of clinical end points traditionally used to evaluate antimicrobial efficacy for its treatment, Food and Drug Administration guidelines now require all registration trials to assess clinical response at day 4. The primary objective of this study was to assess health outcomes (length of stay [LOS] and hospital charges) between responders and nonresponders at this time point.MethodsThe Premier database was used to identify adult patients from 4 participating hospitals with a principal diagnosis of CABP (International Classification of Diseases, Ninth Revision, Clinical Modification, codes 481, 482.0, 483.8, 484.3, 484.5, 485, 486, or 487.0) hospitalized between July 1, 2010, and June 30, 2011. Only non–intensive care unit patients with hospital stays exceeding 2 days and receiving intravenous antibiotic agents within 24 hours of admission were included. After institutional review board approvals, a retrospective chart review extracted data for patient demographics, clinical efficacy variables at day 4, LOS, and total hospital charges. Data analysis included multivariable gamma regression models to control for patient demographics and clinical differences between responders and nonresponders.ResultsA total of 666 patients met study the criteria. Mean (SD) age was 70.7 (17.9) years, and 42.5% were males. Among these patients, 277 (41.6%) achieved clinical response by day 4 of initial antibiotic therapy. The unadjusted mean (SD) LOS was 6.3 (2.8) days for responders and 7.4 (5.6) days for nonresponders (P = 0.0009). Respective unadjusted total hospital charges were $22,827 (SD, $17,724) and $26,403 ($36,882) (P = 0.0031). Adjusted for demographics and clinical factors, nonresponders compared with responders had an increased LOS of 0.9 days (8.4 vs 7.5 days; P = 0.0008), resulting in associated charges of approximately $2500 ($34,139 vs $36,629; P = 0.0768).ConclusionsIn this real-world chart study, less than half of hospitalized patients with CABP achieved clinical response at day 4 of initial intravenous antibiotic therapy. The observed clinical response was associated with a significantly shorter hospital stay and trended toward lower total hospital charges. These findings corroborate the Food and Drug Administration guidance for assessing antimicrobial therapy at day 4 because responder is associated with improved health outcomes.

Improving inpatient cystic fibrosis pulmonary exacerbation care: two success stories

BackgroundPulmonary exacerbations (PEx) in cystic fibrosis (CF) are a frequent cause of hospitalisations and lead to long-term decline in pulmonary function. Successful CF inpatient care requires the coordination of multiple...