Iv Antibiotic Treatment Research Articles

SURVIVAL ANALYSIS OF UNDER-FIVE CHILDREN WITH SEVERE ACUTE MALNUTRITION IN WOLDIA HOSPITAL: RETROSPECTIVE COHORT STUDY

Abstract
 Background: Globally, 52 million children of age under five years were affected by acute malnutrition from which 17 million were severely wasted. In Ethiopia every month over 25,000 children with severe acute malnutrition are admitted to hospitals, if not identified early and treated properly, these children could die. Therefore this study aimed to assess the determinants of time to death of under-five children with SAM admitted to inpatient therapeutic feeding center in Woldia General Hospital.
 
 Methods: A retrospective cohort study was conducted. The study population were children with severe acute malnutrition aged from 0 to 59 months who have been admitted to woldia general hospital from September 2017 to August 2019.The sample was 150 that fulfils the inclusion criteria were included. Non parametric survival analysis was used to estimate survival time to death and Cox PH model was carried out to determine independent predictors.
 
 Results: The accounted proportion of death of under-five children in the study period was 10%. And the estimated mean survival time of the patient was 4.48 weeks. Both estimates was almost on the recommended Sphere standard which should < 10% and <4 weeks respectively. In the estimated model HR for age groups (24-35 months) is 0.000 with 95% CI [0.000-4.591], wasting is 0.010 with 95% CI [0.000-0.065], referred from is 0.000 with 95% CI [0.000-0.061], cough 133.04 with 95% CI [3.596-4922.83], HIV is 1209.61 with 95% CI [1.137-1286998.42], Iv antibiotic treatment is 0.000 with 95% CI [0.000-0.037] and amoxicillin is 0.001 with 95% CI [0.000-0.736] were significant predictors for time to death of under-five children with SAM.
 
 Conclusions: From the fitted model, age of the children, admission criteria, children referred from,cough, HIV, IV antibiotic treatment and Amoxicillin are the covariates that have significant effect on time to death of under five children by SAM at 5% level of significance. Early identifying cases and giving special attention for children with co morbidities such as HIV and cough is vital for decrease child mortality Ethiopia. 
 Keywords: Severe acute malnutrition, inpatient, semi parametric, non parametric, death

New evidence showing that the destruction of gut bacteria by antibiotic treatment could increase the honey bee's vulnerability to Nosema infection.

It has become increasingly clear that gut bacteria play vital roles in the development, nutrition, immunity, and overall fitness of their eukaryotic hosts. We conducted the present study to investigate the effects of gut microbiota disruption on the honey bee’s immune responses to infection by the microsporidian parasite Nosema ceranae. Newly emerged adult workers were collected and divided into four groups: Group I—no treatment; Group II—inoculated with N. ceranae, Group III—antibiotic treatment, and Group IV—antibiotic treatment after inoculation with N. ceranae. Our study showed that Nosema infection did not cause obvious disruption of the gut bacterial community as there was no significant difference in the density and composition of gut bacteria between Group I and Group II. However, the elimination of gut bacteria by antibiotic (Groups III and IV) negatively impacted the functioning of the honey bees’ immune system as evidenced by the expression of genes encoding antimicrobial peptides abaecin, defensin1, and hymenoptaecin that showed the following ranking: Group I > Group II > Group III > Group IV. In addition, significantly higher Nosema levels were observed in Group IV than in Group II, suggesting that eliminating gut bacteria weakened immune function and made honey bees more susceptible to Nosema infection. Based on Group IV having displayed the highest mortality rate among the four experimental groups indicates that antibiotic treatment in combination with stress, associated with Nosema infection, significantly and negatively impacts honey bee survival. The present study adds new evidence that antibiotic treatment not only leads to the complex problem of antibiotic resistance but can impact honey bee disease resistance. Further studies aimed at specific components of the gut bacterial community will provide new insights into the roles of specific bacteria and possibly new approaches to improving bee health.

Eradication of methicillin resistant Staphylococcus aureus detected for the first time in cystic fibrosis: A single center observational study.

To retrospectively identify CF patients with methicillin resistant Staphylococcus aureus (MRSA) and to assess the long-term success of an eradication scheme introduced in 2002 for all newly colonized patients. All microbiological results from all 505 CF patients followed between 2002 and 2012 were analyzed focusing on the detection of MRSA. Retrospective patient record analysis of MRSA positive CF patients regarding eradication and clinical outcome. We identified 57 patients with MRSA, mean age 15.3 years (range: 0.6-36.9, incidence 0.9%/year). Of these, nine patients were lost to follow-up; seven chronically colonized patients were excluded from the intervention. Eradication was suggested to all patients, 37/41 gave their consent to the following two-step approach: (i) dual iv antibiotic treatment over 3 weeks, accompanied by hygienic directives and topical therapy for 5 days followed by a 6-week period with dual oral antibiotic therapy and inhalation with vancomycin. (ii) Each new MRSA detection was treated with 6 weeks inhalation of vancomycin and topical therapy for 5 days. Long-term eradication was rated by the microbiological status in the third year after first detection. MRSA was eradicated in 31 of 37 patients (84%) whose clinical course was stable (mean FEV1 one year before MRSA 80.4%, 3 years after MRSA 81.0%). MRSA colonization mandates complex and expensive hygienic measures which are not well accepted by patients. Therefore, MRSA eradication is desirable. Intensive therapy regimens may be successful in patients with CF and might help to maintain a stable clinical course. Pediatr Pulmonol. 2016;51:1010-1019. © 2016 Wiley Periodicals, Inc.

Reduced effect of intravenous antibiotic treatment on sinonasal markers in pulmonary inflammation.

Chronic bacterial rhinosinusitis is a common feature in Cystic fibrosis (CF) as mucociliary clearance in the sinonasal compartment is impaired. Aim of the present prospective study was to compare dynamics of inflammatory markers in the upper and lower airways (UAW/LAW) during systemic antibiotic therapy. Nasal lavage and sputum of 16 CF-patients receiving an IV-antibiotic treatment against Pseudomonas aeruginosa and/ or Staphylococcus aureus were collected before and during treatment (median after 7.5 days). Cytological changes, DNA concentration, and inflammatory markers interleukin (IL)-4, IL-8, IL-13 and Myeloperoxidase (MPO) were assessed in samples from both airway compartments. Total cell count declined significantly in LAW-samples but not in UAW. Although MPO and IL-8 decreased significantly in both airway compartments, this was considerably more pronounced for LAW (median decrease MPO: LAW=9.8-fold vs UAW=1.75-fold, respectively; IL-8: LAW=3-fold vs UAW=1.9-fold, respectively). This is the first publication demonstrating substantially lower effects of IV-antibiotic treatment on sinonasal than on pulmonary inflammatory markers. Consequently, our findings highlight limitations of systemic antibiotic treatment to control infection in the sinonasal compartment. Primarily, we attribute this to the paranasal sinus ́ structure: these hollow organs, which in bacterial sinusitis are frequently filled with pus, mucoeceles and polyps, are not reached effectively by systemic antibiotic treatment.

270 Home antibiotic treatment in cystic fibrosis: An effective, cost saving and preferred choice among patients with CF

Aim A prospective clinical study was carried out to compare safety, efficacy and cost benefits of home and hospital iv antibiotic treatment among CF children and adolescents. Method The clinical, quality of life outcome and cost benefits of Home vs. Hospital antibiotic treatment were assessed. Evaluation of clinical outcome was assessed by measuring forced expiratory volume in one second (FEV 1 ) and weight before and one months after antibiotic treatment. Quality of life was also assessed using the DISABKIDS questionnaire. Cost analysis was performed to assess cost benefits from home iv treatment. Results 35 patients with cystic fibrosis (mean age: 12.6±7 years, 56% male) colonized with Pseudomonas aeruginosa were treated with iv antibiotics for two weeks either at hospital (15 patients), or at home (20 patients). Mean FEV1% was 80.9 (±26), mean weight was 37.7 (±17) kg; mean height was 142.9 (±26) cm. The clinical outcome was beneficial in 92% of the studied population. Lung function (FEV1) and weight improved significantly in both groups (p Conclusions Home iv therapy, monitored by regular visits by a home care nurse, is a safe, effective and cost saving therapeutic option in CF.

Changes of Proteases, Antiproteases, and Pathogens in Cystic Fibrosis Patients' Upper and Lower Airways after IV-Antibiotic Therapy.

Background. In cystic fibrosis (CF) the upper (UAW) and lower airways (LAW) are reservoirs for pathogens like Pseudomonas aeruginosa. The consecutive hosts' release of proteolytic enzymes contributes to inflammation and progressive pulmonary destruction. Objectives were to assess dynamics of protease : antiprotease ratios and pathogens in CF-UAW and LAW sampled by nasal lavage (NL) and sputum before and after intravenous- (IV-) antibiotic therapy. Methods. From 19 IV-antibiotic courses of 17 CF patients NL (10 mL/nostril) and sputum were collected before and after treatment. Microbiological colonization and concentrations of NE/SLPI/CTSS (ELISA) and MMP-9/TIMP-1 (multiplex bead array) were determined. Additionally, changes of sinonasal symptoms were assessed (SNOT-20). Results. IV-antibiotic treatment had more pronounced effects on inflammatory markers in LAW, whereas trends to decrease were also found in UAW. Ratios of MMP-9/TIMP-1 were higher in sputum, and ratios of NE/SLPI were higher in NL. Remarkably, NE/SLPI ratio was 10-fold higher in NL compared to healthy controls. SNOT-20 scores decreased significantly during therapy (P = 0.001). Conclusion. For the first time, changes in microbiological patterns in UAW and LAW after IV-antibiotic treatments were assessed, together with changes of protease/antiprotease imbalances. Delayed responses of proteases and antiproteases to IV-antibiotic therapy were found in UAW compared to LAW.

Reduced effect of intravenous antibiotic treatment on sinonasal markers in pulmonary inflammation

Chronic bacterial rhinosinusitis is a common feature in Cystic fibrosis (CF) as mucociliary clearance in the sinonasal compartment is impaired. Aim of the present prospective study was to compare dynamics of inflammatory markers in the upper and lower airways (UAW/LAW) during systemic antibiotic therapy. Nasal lavage and sputum of 16 CF-patients receiving an IV-antibiotic treatment against Pseudomonas aeruginosa and/ or Staphylococcus aureus were collected before and during treatment (median after 7.5 days). Cytological changes, DNA concentration, and inflammatory markers interleukin (IL)-4, IL-8, IL-13 and Myeloperoxidase (MPO) were assessed in samples from both airway compartments. Total cell count declined significantly in LAW-samples but not in UAW. Although MPO and IL-8 decreased significantly in both airway compartments, this was considerably more pronounced for LAW (median decrease MPO: LAW=9.8-fold vs UAW=1.75-fold, respectively; IL-8: LAW=3-fold vs UAW=1.9-fold, respectively). This is the first publication demonstrating substantially lower effects of IV-antibiotic treatment on sinonasal than on pulmonary inflammatory markers. Consequently, our findings highlight limitations of systemic antibiotic treatment to control infection in the sinonasal compartment. Primarily, we attribute this to the paranasal sinus ́ structure: these hollow organs, which in bacterial sinusitis are frequently filled with pus, mucoeceles and polyps, are not reached effectively by systemic antibiotic treatment.

212 Cystic fibrosis (CF) adult patients and nebulized treatments: knowledge, beliefs and practices

Background: In Cystic Fibrosis (CF) lung function testing is a useful tool for monitoring progression of lung disease. Studies in CF children have shown that lung clearance index (LCI) is significantly greater than healthy controls. Aim: The objectives of this study were: (a) To compare LCI among CF preschoolers (aged 2 to 5 years) and healthy controls and (b) to assess the effect of two-week iv antibiotic treatment on LCI among CF preschoolers with CF. Method: Twenty-eight children with CF (20 were infected with Pseudomonas aeruginosa) and 27 healthy controls performed Multiple-Breath Washout (MBW) measurements and LCI was assessed. The ones with Ps. aeruginosa infection were measured again one month following a two-week course of iv antibiotics. Results: Children with CF had significantly higher LCI compared to controls (mean difference for CF vs control [95%CI] 2.6 [1.8, 3.7], p< 0.001). Children with CF who were infected with Ps. aeruginosa had significantly higher LCI, when compared with Ps. Negative CF children (mean difference [95%CI]: 1.75 [0.38, 3.5], p< 0.05). LCI was reduced significantly after two-weeks course of iv antibiotics (mean difference [95%CI]: −1.97 [1.2, 3.6], p< 0.001). Conclusions: LCI is a sensitive marker to detect lung function abnormalities among preschoolers with CF. It can be used to assess severity of the disease and the effect of treatment.

211* Lung clearance index (LCI) as a tool to assess the effect of antibiotics among preschoolers with cystic fibrosis

Background: In Cystic Fibrosis (CF) lung function testing is a useful tool for monitoring progression of lung disease. Studies in CF children have shown that lung clearance index (LCI) is significantly greater than healthy controls. Aim: The objectives of this study were: (a) To compare LCI among CF preschoolers (aged 2 to 5 years) and healthy controls and (b) to assess the effect of two-week iv antibiotic treatment on LCI among CF preschoolers with CF. Method: Twenty-eight children with CF (20 were infected with Pseudomonas aeruginosa) and 27 healthy controls performed Multiple-Breath Washout (MBW) measurements and LCI was assessed. The ones with Ps. aeruginosa infection were measured again one month following a two-week course of iv antibiotics. Results: Children with CF had significantly higher LCI compared to controls (mean difference for CF vs control [95%CI] 2.6 [1.8, 3.7], p< 0.001). Children with CF who were infected with Ps. aeruginosa had significantly higher LCI, when compared with Ps. Negative CF children (mean difference [95%CI]: 1.75 [0.38, 3.5], p< 0.05). LCI was reduced significantly after two-weeks course of iv antibiotics (mean difference [95%CI]: −1.97 [1.2, 3.6], p< 0.001). Conclusions: LCI is a sensitive marker to detect lung function abnormalities among preschoolers with CF. It can be used to assess severity of the disease and the effect of treatment.

Reapplication of High-Dose Chemotherapy and Autologous Blood Stem Cell Transplantation as Salvage Treatment for Patients with Relapsed or Refractory Multiple Myeloma – a Single Center Experience.

Abstract 3418Poster Board III-306 IntroductionA wide range of therapeutic options is currently available for the treatment of patients with relapsed or refractory multiple myeloma (MM). For patients treated with a prior high-dose therapy (HDT) followed by autologous blood stem stem cell transplantation (PBSCT) the reapplication of HDT is a widely used salvage strategy. However, data on the use of a second salvage HDT followed by autologous PBSCT is rare, particularly as no randomised studies have been reported in this situation. MethodIn this retrospective study we report on 55 patients with relapsed or refractory MM, who were treated with a salvage HDT between 1997 – 2007 at our institution. Prior therapies consisted of HDT in all patients, thalidomide in 69% and bortezomib in 27% of patients. The median number of prior lines of therapy was 2 (range:1-6) and time from diagnosis to second HDT was in median 45 months. At the time of salvage HDT median age was 56 years (range: 42-69) and ISS stage was 1 in 63% of patients, 2 in 11% and 3 in 16% (not assessable 11%). The median duration of the remission of the last line of treatment was 21 months (range:0-71) with 43% of patients being refractory to their last line of therapy and 57% suffering from relapse.Induction treatment before reapplication of HDT included conventional chemotherapy, bortezomib and immunmodulatory drugs (IMID) in 56%, 40% and 22% of patients. Conditioning consisted either of melphalan 100mg/m2 on day -3 and -2 (Mel200, 27%), melphalan 140mg/m2 on day -2 and busulphan 3mg/kg/BW on days -6 to -3 (Bu-Me, 38%) or melphalan 100mg/m2 on day -3 and -2 and bortezomib 1.3 mg/m2 delivered day -3 before the infusion of melphalan (Mel200-Vel, 35%). Palifermin and pegfilgrastim were used for supportive care in 36% of patients. After HDT 62% of patients received no maintenance therapy, 27% received thalidomide and 11% interferon alpha until relapse. ResultsTreatment-related mortality was 5% and response rates were as follows: 9% CR, 9% vgPR, 57% PR, 11% MR+SD and 4% PD (5% not assessable). The median event-free (EFS) and overall survival (OS) was 14 and 52 months, respectively. Toxicity was moderate as shown by a median duration of neutropenia (<0.5 × 10E9/l) and thrombocytopenia (<50 × 10E9/l) of 9 (range:5-16) and 14 (range:5-42) days, respectively. Patients needed iv antibiotic treatment for in median 6 (range:0-23) days, parenteral narcotic analgesia for 2 (range:0-15) days and parenteral nutrition for 2 (range:0-21) days resulting in a hospilitation of in median 21 days (range:5-48).Patients treated with palifermin and pegfilgrastim had a significantly shorter duration of neutropenia (9 vs. 11;p=0.03) with a trend towards less days with parenteral narcotic analgesia (4 vs. 1;p=0.1) and parenteral nutrition (5 vs. 0;p=0.1) as well as a shorter stay in hospital (18 vs 21;p=0.1).In our group of patients there were no differences in terms of remission rates, EFS and OS or toxicity for patients treated with different kinds of induction treatment (bortezomib vs IMID vs chemotherapy), conditioning regimen (Mel200, Bu-Me, Mel200-Vel) or maintenance therapy (thalidomide vs INF/none). In univariaten analysis long lasting duration of remission after the first transplant, platelet count >140×10E9/l and achievement of CR or PR after salvage HDT were associated with longer EFS, whereas duration of remission after first HDT, platelet count and age >60 years were favourable prognostic factors for OS. In multivariate analysis a duration of remission after prior HDT of less than 12 months was the only adverse prognostic parameter for both, EFS (p=0.002) and OS (p=0.004). Further subgroup analysis showed a significantly (p<0.001) different median EFS and OS for patients with a previous remission duration after the first transplant of 1-12 months (4 and 7 months, respectively), 13-24 months (15 and 41 months) and 25-36 months (15 and 78 months). ConclusionSecond salvage HDT followed by autologous SCT is an effective treatment option with favourable risk profile for patients with relapsed or refractory MM. The supportive application of palifermin and pegfilgrastim can further reduce toxicity. Still, patients with an early relapse of less than 12 months after their first transplant do not benefit from this treatment modality DisclosuresFenk:Celgene: Consultancy, Honoraria, Research Funding; OrhtoBiotec: Honoraria. Kobbe:Celgene: Consultancy, Honoraria, Research Funding; OrhtoBiotec: Consultancy, Honoraria; Amgen: Consultancy, Honoraria, Research Funding.

Outcomes of early switching from intravenous to oral antibiotics on medical wards

ObjectivesTo evaluate outcomes following implementation of a checklist with criteria for switching from intravenous (iv) to oral antibiotics on unselected patients on two general medical wards.MethodsDuring a 12 month intervention study, a printed checklist of criteria for switching on the third day of iv treatment was placed in the medical charts. The decision to switch was left to the discretion of the attending physician. Outcome parameters of a 4 month control phase before intervention were compared with the equivalent 4 month period during the intervention phase to control for seasonal confounding (before–after study; April to July of 2006 and 2007, respectively): 250 episodes (215 patients) during the intervention period were compared with the control group of 176 episodes (162 patients). The main outcome measure was the duration of iv therapy. Additionally, safety, adherence to the checklist, reasons against switching patients and antibiotic cost were analysed during the whole year of the intervention (n = 698 episodes).ResultsIn 38% (246/646) of episodes of continued iv antibiotic therapy, patients met all criteria for switching to oral antibiotics on the third day, and 151/246 (61.4%) were switched. The number of days of iv antibiotic treatment were reduced by 19% (95% confidence interval 9%–29%, P = 0.001; 6.0–5.0 days in median) with no increase in complications. The main reasons against switching were persisting fever (41%, n = 187) and absence of clinical improvement (41%, n = 185).ConclusionsOn general medical wards, a checklist with bedside criteria for switching to oral antibiotics can shorten the duration of iv therapy without any negative effect on treatment outcome. The criteria were successfully applied to all patients on the wards, independently of the indication (empirical or directed treatment), the type of (presumed) infection, the underlying disease or the group of antibiotics being used.

426 Home intravenous (iv) antibiotic (ab) treatment: education to achieve complete patient autonomy

426 Home intravenous (iv) antibiotic (ab) treatment: education to achieve complete patient autonomy

Home and hospital antibiotic treatment prove similarly effective in cystic fibrosis.

Home intravenous antibiotic treatment has added to therapeutic options against Pseudomonas aeruginosa in cystic fibrosis (CF) patients leading to increased flexibility. A prospective clinical study was carried out to compare home and hospital iv antibiotic treatment in CF patients with chronic P. aeruginosa infection. Treatment courses were planned selectively, exacerbations were excluded. 28 consecutive hospital courses (group 1) were compared with 30 home care courses (group 2). Chest physiotherapy and nutrition therapy were carried on in both groups. Antibiotic treatment in both groups consisted of tobramycin and ceftazidime, with equal dosage and application. Groups were compared using clinical, inflammatory and microbiological parameters. There was a significant difference (p </= 0.05) in peripheral leukocyte counts before and after therapy in both groups. The same was true for forced expiratory volume in 1 sec (FEV(1); p </= 0.05), weight for height (p </= 0.005) and for Pseudomonas counts (p </= 0.005) in sputa. There was no statistical difference between the two groups for any of the parameters tested. It is concluded that, when exacerbations are excluded, home iv therapy is an effective therapeutic option in CF. Long-term comparison is still needed to effectively evaluate the pros and cons of home and hospital antibiotic treatment in CF.

Home intravenous antibiotic treatment of patients with cystic fibrosis.

We report one-year's experience of home iv antibiotic treatment in 31 patients with cystic fibrosis chronically colonized with Pseudomonas aeruginosa. The patients were aged 4-67 years and had a mild to severe disease as indicated by a Shwachman score of 46-95 (mean 77). Ninety-two courses of iv antibiotic therapy were given (mean 3.0 per patient). The mean duration of the courses was 15.4 days. The entire antibiotic course, except for the first dose, was administered at home in 70% of the courses. Most patients (94%) were given a combined treatment of a beta-lactam and an aminoglycoside, administered by the patients themselves or their parents. One inserted venous cannula could be used for the whole treatment period in 30% of the courses. There were no complications. The clinical and bacteriological outcome was good to excellent in 89% of the courses, with temporary eradication or semi-quantitative decrease of Pseudomonas growth in sputum. Lung function (forced expiratory volume at 1 s) and blood gases improved significantly (p less than 0.001) and p less than 0.01, respectively). Most patients were able to attend work or school as usual, and 96% of the patients preferred this type of treatment to hospitalization. Apart from the psychosocial advantages, the economical savings were substantial. In comparison to traditional treatments in hospital (21 patients, 41 courses) home iv antibiotic treatment was safe and effective.