Local Antibiogram Research Articles

Bacterial resistance to fluoroquinolones and contributing factors in Addis Ababa, Ethiopia: a mixed methods study

Fluoroquinolones are widely used globally and there is a growing trend of resistance to these agents. However, there is scanty information in Ethiopia and this study aimed to assess the level of bacterial resistance to fluoroquinolones and identify contributing factors in Addis Ababa, Ethiopia. Concurrent mixed methods study design was used. Records (January 2013 to December 2016) of the Microbiology Laboratory of International Clinical Laboratories were retrospectively reviewed. In addition, qualitative interviews were conducted with purposively selected 20 prescribers’ and dispensers’ to explore perceived contributing factors to resistance. Descriptive statistics was used to summarize the data and possible association was explored using multivariable logistic regression. Qualitative data was analyzed using thematic analysis. A total of 7,889 bacterial isolates were identified from 4,310 patients. The overall resistance of bacterial isolates to fluoroquinolones was 42.5% and the highest resistance was to nalidixic acid (63.3%). Enterococci and Escherichia coli developed high level of resistance to ciprofloxacin and norfloxacin; while Enterococci had higher resistant to nalidixic acid (77.8%). Resistance to fluoroquinolones was 5-times more likely in patients aged ≥ 60 years than those < 15 years old (AOR = 5.63, 95% CI: 4.71, 6.73). Resistance to fluoroquinolones increased from 40.4% in 2013 to 49.0% in 2015 but declined to 46.3% in 2016. Respondents of the qualitative interviews suggested that injudicious prescribing due to lack of institutional antibiogram and inadequate knowledge, nonprescription sales of antibiotics and/or patient hording and sharing practices contributed for the high level of fluoroquinolone resistance. The study showed a high level of bacterial resistance to fluoroquinolones. Patients’ age and year of testing were significantly associated with resistance. Moreover, inappropriate prescribing practice, illegal over-the-counter sales as well as their unreasonable use by patients were key drivers to the problem. This calls for the strict regulation of non-prescription sales of antibiotics, public awareness creation and development of local antibiogram to guide prescribing. Keywords: fluoroquinolones, bacterial resistance, qualitative interview, enterococci, Escherichia coli

Cefazolin versus vancomycin for neurosurgical operative prophylaxis – A single institution retrospective cohort study

ObjectivesCefazolin and vancomycin are common choices for neurosurgical antimicrobial prophylaxis. Cefazolin is typically first-line due to its lower toxicity profile and specificity for gram-positives such as skin commensals, while vancomycin is often reserved for patients with cephalosporin or penicillin allergies. However, one randomized clinical trial demonstrated superiority of vancomycin for cerebrospinal fluid (CSF) shunt insertions at a hospital with a high prevalence of methicillin-resistance Staphylococcus aureus (MRSA). We aimed to evaluate the association of prophylaxis choice and incidence of surgical site infection (SSI) at our own institution. Patients and methodsThis was a retrospective cohort study of patients who underwent a neurosurgical operation from January 2013 to April 2016 at one particular hospital belonging to our institution. We included patients who received either only cefazolin or only vancomycin as their pre-incisional prophylaxis. Vancomycin was substituted for cefazolin in patients with known penicillin or cephalosporin allergy. Procedures requiring multiple attending surgeons were excluded. We defined a SSI as a confirmed culture isolated from the wound, implant (if pertinent), or CSF (if pertinent) within a year of surgery. Multivariable logistic regression was performed with consideration of antibiotic, operation performed, wound class, and procedure length. ResultsA total of 859 operations met study criteria; 664 patients received Cefazolin, and 195 received Vancomycin. We identified 22 SSIs, with 14 in the cefazolin (2.2%) and 8 in the vancomycin (4.1%) group. Upon logistic regression, there was no significant association of vancomycin substitution with incidence of SSIs between the two groups (odds ratio, 1.59; 95% CI, 0.42–6.00, p = .49). In the cefazolin group, 8/14 cultures were positive for S. aureus compared to 1/8 of the vancomycin group. ConclusionsThere was no significant difference in neurosurgical site infection incidence when vancomycin prophylaxis was substituted for cefazolin. S. aureus was isolated from patients who received cefazolin at a higher rate although this was not statistically significant. At our institution, S. aureus makes up 36% of isolated organisms from inpatient and intensive care units. Institutions should consider their own investigations into local antibiograms, SSI rates, and choice of prophylaxis.

Review of a 7-Year Record of the Bacteriological Profile of Airway Secretions of Children with Cystic Fibrosis in North India

AbstractBackground: Cystic fibrosis (CF) is now a recognised entity in India, with prevalence rates between 1/10,000 and 1/50,000. However, no data were available with regard to the profile of respiratory pathogens in the Indian setting. Materials and Methods: The records of respiratory secretion bacterial cultures of children with CF in a tertiary care hospital in North India from January 2010 to December 2016 were reviewed. Culture data were evaluated; the organisms were noted and their antimicrobial susceptibilities were analysed. The microbiological profile and antimicrobial susceptibility pattern of CF patients were evaluated. Results: A total of 445 samples from 146 children were processed, of which 246 (55%) samples showed bacterial growth. Mixed infections 48 (19.5%) were common in older children. Children aged 3–6 months (62.5%) showed the highest culture positivity. The most commonly isolated organisms were Pseudomonas aeruginosa (52.6%) and Staphylococcus aureus. Children with initial cultures positive for P. aeruginosa had 55% of their subsequent cultures showing polymicrobial infections. P. aeruginosa was most susceptible to ciprofloxacin (89%) and piperacillin-tazobactum (88%). Among the staphylococcal isolates, 38% were methicillin-resistant S. aureus (MRSA). The percentage of MRSA increased from 66% in 2010 to 75% in 2012, followed by a decline to 24% in 2016. Conclusions: The pattern of airway colonisation in the Indian setting is different from the Caucasian population, and P. aeruginosa and Burkholderia cepacia complex appear early. Colonisation with P. aeruginosa benefits from therapy. In case of infection, care must be taken while initiating empiric therapy. It should be based on local antibiograms to prevent the emergence of resistant microbes.

Trends in antimicrobial susceptibility patterns in King Fahad Medical City, Riyadh, Saudi Arabia

Objectives:To describe and interpret local antibiograms from a single tertiary care center to monitor the trends of antimicrobial resistance (AMR) patterns and establish baseline data for further surveillance.Methods:We performed a retrospective descriptive review of antibiograms data between January 2010 and December 2015 from King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.Results:A total of 51,491 isolates were identified, and most were gram-negative (76.2%). Escherichia coli was the most frequently isolated organism (36.8%), followed by Coagulase-negative Staphylococcus (28.4%) and Staphylococcus aureus (27.5%). The detection of antibiotic-resistant organisms, especially extended-spectrum beta-lactamase-producing Escherichia coli (31%-41%), increased over time. The sensitivity of Streptococcus pneumoniae to penicillin improved from 66% to 100% (p<0.001). Gram-negative isolates had excellent overall susceptibility to amikacin, variable susceptibility to piperacillin-tazobactam and carbapenems, and declining susceptibility to ceftazidime, ciprofloxacin, and cefepime.Conclusion:Streptococcus pneumoniae susceptibility to penicillin significantly improved over time, which might be because of the introduction of the pneumococcal vaccine. Conversely, the upward trend in resistant gram-negative organisms is worrisome and warrants the implementation of antimicrobial stewardship programs.

A pilot point prevalence study of antimicrobial drugs in indoor patients of a teaching hospital in Central India.

Aim:To evaluate the point prevalence of antimicrobial drug use by using point prevalence survey method.Methodology:A cross-sectional point prevalence study was done on patients admitted in AIIMS Bhopal hospital. This study included all inpatients receiving an antimicrobial that were on the ward at 8 AM on a specific day in May 2018. Information regarding age, gender, occupation, income group, diagnosis, patient's present/past medical history, treatment, any adverse drug reactions, and investigations are recorded in a pro forma.Results:A total of 77 patients (31.95%) were included out of total 241 patients who received at least one antimicrobial. Of patients who received at least one antimicrobial, diagnosis was mentioned in 83.11% of prescriptions. Targeted treatment was given to 10.38% of patients. Reasons for antimicrobial were recorded in 12.98% of patients. Most common healthcare infection recorded was catheter-associated urinary tract infections followed by postoperative surgical site infections. Penicillin with beta lactamase inhibitors was most commonly prescribed antibiotic group followed by third generation cephalosporins and fluoroquinolones. Stop or review date was recorded in 19.48% of patients. Parenteral administration was given to 30.55% of patients. Compliance to guidelines was followed in 64.11% of patients. Local antibiotic guideline and antibiogram were available in hospital. Biomarkers were utilized in 9.77% of patients to guide the choice of therapy.Conclusion:Availability of antibiotic policy, antibiogram, local antibiotic guidelines, drugs, and therapeutic committee were some of the encouraging findings. Diagnosis was mentioned in majority of prescriptions. Most patients were prescribed oral antimicrobial drugs, which can reduce complications with parenteral route. Underutilizations of microbiological facilities, prolonged use of antibiotics for surgical prophylaxis, and polypharmacy were areas of concern.

Protocol-based perioperative antimicrobial prophylaxis in urologic surgeries: Feasibility and lessons learned.

Introduction:Rational use of antibiotics and strict adherence to practice guidelines is essential to prevent antibiotic resistance. The best surgical prophylaxis protocol requires tailoring of the available guidelines in accordance to the local bacterial flora. We designed a protocol for surgical prophylaxis to check the rampant abuse of antibiotics in the department of urology and evaluated its feasibility.Materials and Methods:Patients admitted for elective major surgeries under a single unit of our department over a period of 5 months were included in the study. A protocol for antibiotic prophylaxis was designed based on the European Association of Urology guidelines and the local hospital antibiogram. Single-dose intravenous cefuroxime was administered to the patients undergoing clean and clean-contaminated surgeries. Extended protocols were formulated for contaminated surgeries. Postoperative course and complications were recorded. Effectiveness was defined as adherence to the protocol (without an addition or a change in antibiotic regimen) along with an uneventful postoperative course. Prospectively maintained data were analyzed using descriptive statistics.Results:Data of 277 patients were analyzed. The mean age was 48.37 ± 17.39 years and 27.1% had comorbidities. Majority of the surgeries were clean contaminated (81%), and 60.3% of the total were endoscopic. The protocol was effective in 89.5% of the patients (248/277). The failure rate was higher for the contaminated procedures (41.7%) (odds ratio – 6.43; confidence interval = 1.51–27.2, P < 0.001). Post-operative sepsis with or without shock was the commonest cause (16/29, 55.2%) of protocol failure. Fourteen out of the 16 patients who developed sepsis had undergone endourological surgeries.Conclusions:Protocol-based perioperative antibiotic prophylaxis in urological surgeries is feasible. Similar protocols should be developed and validated at other major centers to limit the unnecessary use of antibiotics and prevent the emergence of antibiotic resistance.

1865. Antibiotic Susceptibilities of Organisms Isolated from Urine Cultures of Patients Diagnosed with a Urinary Tract Infection (UTI) and Discharged from the Emergency Department (ED)

BackgroundUrinary tract infections (UTIs) are among the most commonly treated infections in the Emergency Department (ED). Treatment is largely empiric and based on an institution-wide antibiogram comprised of isolates from all infection sites, which may overestimate antibiotic resistance of urinary pathogens of nonadmitted ED patients. The primary goal of this study was to determine the antibiotic susceptibilities of urinary pathogens isolated from adult patients with a UTI and discharged from the ED.MethodsThis was a single-center, retrospective chart review of adult patients discharged from the ED with a UTI from August to December 2017. Descriptive statistics were used to compare the antibiotic susceptibilities of pathogens isolated from urine cultures to the institutional and local Brooklyn antibiogram. Antibiotic susceptibilities were determined by MicroScan. Data on antibiotic prescribing patterns and previously described risk factors for multidrug-resistant organisms were collected.ResultsTwo hundred forty-six patients were included with 267 isolates identified. 61% (151) of patients were between ages 18 to 65 years old and 73% (180) were female. The most common organism isolated was Escherichia coli (164, 62%). E. coli urine isolates were most susceptible to nitrofurantoin (98%) followed by cefazolin (81%), ciprofloxacin (84%), and sulfamethoxazole/trimethoprim (64%). There was no difference in susceptibility rates of E. coli to cefazolin or sulfamethoxazole/trimethoprim, but isolates were more susceptible to ciprofloxacin in the ED compared with the institutional antibiogram (84% vs. 70%). Twenty-six (10.6%) patients grew an ESBL organism and of these, 42% (11/26) had no identifiable healthcare exposure within the last 90 days.ConclusionDespite limitations in sample size, this study supports using separate antibiograms and pathways for the treatment of UTI in the ED, especially in a community with high rates of local resistance to first-line agents.Disclosures All authors: No reported disclosures.

Microbial Spectrum in Infected Pancreatic Necrosis: An Analysis From Endoscopic Ultrasound Guided Drainage

Introduction: Necrotizing pancreatitis is a potentially life-threatening condition. Necrosis can remain sterile or infected leading to infected pancreatic necrosis (IPN) with a mortality rate as high as 30% - 50%. Antibiotics play an important role in IPN management. However, inappropriately chosen broadspectrum antibiotics will lead to the development of resistance over time. Therefore, microbiological analysis of the necrosum will help in selecting the appropriate antibiotics. Common causative organisms are gram-negative; however, some recent studies show the change in predominance to gram-positive organisms which has been attributed to the use of prophylactic antibiotics targeting gram negatives. Despite this, some reports from India and China continued to show predominant gram-negative infections. The primary aim was to identify the microbial spectrum in the IPN with the cultures obtained from Endoscopic Ultrasound (EUS) guided drainage at Asian Institute of Gastroenterology (AIG), a tertiary care center in India. Methods: A retrospective analysis of prospectively collected data of patients diagnosed with IPN at AIG from October 2013 to December 2014 was included in the study. IPN was diagnosed using computed tomography, as per revised Atlanta classification. All patients underwent EUS guided drainage of the IPN. The first aspirated sample from the pancreatic fluid collection on puncture with the 19G needle was sent for microbial analysis. The subsequent drainage procedure was completed with placement of either multiple plastic or FCSEMS. Results: A total of 113 patients (93 males, 20 females) aged 11-69 years were included in the study. Aspirates from 45 of 113 (40%) patients showed positive cultures. 38 out of 45 positive cultures were polymicrobial and 6 were monomicrobial. The most common organisms identified in the microbial spectrum were gram negatives and they were seen in 95.5% of the aspirates. The most common bacteria were Escherichia Coli which was seen in 49% of the aspirates followed by Klebsiella (40%). Remaining organisms include Pseudomonas (6%), Acinetobacter (6%) and Citrobacter (4.5%). Gram positives were seen in 2 patients (4.5%) and fungus was seen in 0 patients. Conclusion: While the recent studies demonstrate the predominance of gram-positive organisms in IPN, the findings in our study are contrary to them with gram-negative predominance. Microbial cultures and local antibiogram should be taken into account while treating IPN for better patient outcomes.81_A Figure 1. No Caption available.81_B Figure 2. No Caption available.

Bacteraemia post-autologous haematopoietic stem cell transplantation in the absence of antibacterial prophylaxis: a decade's experience from Lebanon.

In this study, we assessed the incidence, contributing factors and outcome of prolonged neutropenia above 7days and of bacteraemia in patients with lymphoma and multiple myeloma who underwent autologous haematopoietic stem cell transplantation (AHSCT) without antibacterial prophylaxis. This is a retrospective chart review of 190 adult patients who underwent AHSCT between 2005 and 2015 at a Lebanese hospital. Neutropenia of 7days duration and longer was documented in 66% of the patient population. Through univariate analysis, patients with lymphoma were significantly more likely to have prolonged neutropenia (≥ 7days) compared to those with myeloma. Mucositis above grade 3, diarrhoea and fever were more likely to occur in patients with prolonged neutropenia. Bacteraemia was documented in 12.6% of the patients. Total mortality rate was 3.7%, and that attributed to bacteraemia was 12.5% in the bacteraemia subgroup. Among bacterial isolates recovered from clinical specimens (89 isolates), 70% were Gram-negative, of which 57% were fluoroquinolone susceptible. Ninety-five percent of the Gram-negative bacteria causing bacteraemia were susceptible to fluoroquinolones. Bacterial pathogens causing bacteraemia were still highly susceptible to fluoroquinolones, despite the high prevalence of fluoroquinolone-resistant strains in the general bacterial ecology. Accordingly, the pertinence of fluoroquinolone prophylaxis in the AHSCT setting warrants further investigation. Moreover, continuous surveillance of local antibiograms in this patient population has become a must in an era of preponderant antibiotic resistance.

Local Antibiogram Predicts Appropriate Antibiotic Selection for Prostate Biopsy Prophylaxis

PurposeWe evaluate our local antibiogram to determine the accuracy of its use in antibiotic augmentation prior to transrectal prostate biopsy (TRPB). Materials and MethodsWe analyzed pre-TRPB rectal swabs from January 2016 to September 2017 at the South Texas Veterans Health Care System (STVHCS). A query was run on pre-procedure rectal swabs positive for fluoroquinolone resistance in men undergoing TRPB during this time. Culture results and antibiotic resistance profiles were recorded and compared to the proportion of antibiotic resistance in the STVHCS 2016 antibiogram. ResultsWe identified 611 patients who underwent pre-TRPB rectal culture, of which 98 were ciprofloxacin resistant E.coli (CRE) isolates. Our cohort demonstrated 80% sensitivity to ciprofloxacin as compared to the STVHCS antibiogram sensitivity of 65% (p<0.001). Gentamicin demonstrated similar sensitivities between the antibiogram and cohort (90% and 88% respectively). There were no statistically significant differences between the STVHCS antibiogram and the sensitivity profiles of our rectal swab cohort as demonstrated in figure 1, except for Ampicillin/Sulbactam, which was 57% in the antibiogram and 32% in our cohort (p=0.019). Of the CRE identified, 4% (4/98) were considered extended spectrum beta-lactamase producers (ESBL). ConclusionsOverall, resistance patterns in CRE isolates from our study population are consistent with the STVHCS antibiogram therefore; a local antibiogram may be utilized in an implementation strategy for targeted antibiotics or augmentation of fluoroquinolone prophylaxis for TRPB.

A decision support system for antibiotic prescription based on local cumulative antibiograms

BackgroundLocal cumulative antibiograms are useful tools with which to select appropriate empiric or directed therapies when treating infectious diseases at a hospital. However, data represented in traditional antibiograms are static, incomplete and not well adapted to decision-making. MethodsWe propose a decision support method for empiric antibiotic therapy based on the Number Needed to Fail (NNF) measure. NNF indicates the number of patients that would need to be treated with a specific antibiotic for one to be inadequately treated. We define two new measures, Accumulated Efficacy and Weighted Accumulated Efficacy in order to determine the efficacy of an antibiotic. We carried out two experiments: the first during which there was a suspicion of infection and the patient had empiric therapy, and the second by considering patients with confirmed infection and directed therapy. The study was performed with 15,799 cultures with 356,404 susceptibility tests carried out over a four-year period. ResultsThe most efficient empiric antibiotics are Linezolid and Vancomycin for blood samples and Imipenem and Meropenem for urine samples. In both experiments, the efficacies of recommended antibiotics are all significantly greater than the efficacies of the antibiotics actually administered (P < 0.001). The highest efficacy is obtained when considering 2 years of antibiogram data and 80% of the cumulated prevalence of microorganisms. ConclusionThis extensive study on real empiric therapies shows that the proposed method is a valuable alternative to traditional antibiograms as regards developing clinical decision support systems for antimicrobial stewardship.

The Use of Antibiograms in Orthopedic Surgery.

Organism identification and antibiotic selection remain a critical component of periprosthetic joint infection (PJI) treatment. Prior to organism identification and/or the availability of antibiotic sensitivities, empiric antibiotics are routinely started. A basic understanding of a region or institutions antibiogram is paramount for selection of an empiric treatment regimen. Evolving antibiogram results and regional antibiotic resistance are important to follow as this may change antibiotic selection in some patient populations. The Clinical Laboratory and Standards Institute (CLSI) has created guidelines and standards for the creation and maintenance of antibiograms that should be followed by institutions. The infecting organism during PJI may be different in acute vs chronic infections and empiric therapy may change depending on the timing. Antibiotic prophylaxis for major procedures in certain patient populations should be critically evaluated based on regional and national antibiogram results. The CLSI guides recommendations and antibiotic resistance testing techniques and should be consulted when creating an antibiogram. The local and regional antibiogram should be consulted prior to administration of empiric and prophylactic antibiotics.

Empirical Antibiotic Therapy Assessment of Patients diagnosed with Sepsis in Intermediate Care Ward of Internal Medicine Department of Dr. Soetomo General Hospital according to Gyssens Method

Rational empirical antimicrobial therapy is an important component of sepsis patient management. This study aimed to assess the rationality of empirical antimicrobial therapy in patients diagnosed with sepsis admitted in intermediate care ward of internal medicine department (RPI) of Dr. Soetomo General Hospital from January 2016 to July 2017. Medical records of 91 patients diagnosed with sepsis were collected and studied retrospectively in period from July 2017 to November 2017. 91 (85.05%) medical records from 107 sepsis patients were evaluated. Cultures and antimicrobial sensitivity tests were carried out in 21 (23.07%) patients. 14 patients yielded positive culture results, 9 of which were MDRO positive with ESBL as resistant marker. Empirical antibiotic therapies for these patients were reviewed according to Gyssens method.73 (80.2%) of 91 patients were deemed receiving appropriate empirical antibiotic therapies. Ceftriaxone IV injection as monotherapy or combination therapy were the most common empirical antibiotic therapies (82 in 91 patients, 90.1%), despite local microbiologic flora and antibiogram show most pathogens were resistant to ceftriaxone. Mortality rate in this study was high, 92.3% (84 patients died) despite rational empirical antibiotic therapies were high.This study concluded that empirical antibiotic therapies in sepsis patients according to guidelines adopted in Soetomo General Hospital, albeit deemed rational, was no longer appropriate according to local antibiogram issued by microbiological department of Soetomo General Hospital.

Nosocomial pneumonia: Search for an empiric and effective antibiotic regimen in high burden tertiary care centre.

The clinical practice guidelines on nosocomial pneumonia recommends an empirical regimen that would work in 95% of the patients based on the local antibiogram. The aim of the study was development of an antibiogram for guiding empiric therapy in settings with high prevalence of multi-drug resistant organisms. A retrospective review of electronic health records (e-hospital portal) was done to analyze all respiratory isolates from patients admitted in medical wards and intensive care unit between May 2016 and May 2017. The samples included brocho-alveolar lavage (BAL), mini broncho-alveolar lavage (mini-BAL) and endotracheal aspirate. The sensitivity pattern (combined and individual) of all bacterial isolates were analysed for commonly used antibiotics and their combinations. Out of the 269 isolates, the most common organisms were Pseudomonas aeruginosa (125, 46%), Acinetobacter baumanni (74, 27%) and Klebsiella pneumoniae (50, 19%). Cefoperazone-sulbactam (43%) had the best sensitivity pattern overall. Cefoperazone-sulbactam plus amikacin (56%) was the combination with the best combined sensitivity overall. There is a high prevalence of resistance in the commonly implicated organisms to the available antibiotics. There is an urgent need for implementation of effective anti-microbial stewardship programmes and development of newer antimicrobials.

MP15-20 ANTIBIOTIC SELECTION FOR PROSTATE BIOPSY PROPHYLAXIS USING RECTAL SWAB CULTURES REFLECTS LOCAL ANTIBIOGRAM

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia I1 Apr 2018MP15-20 ANTIBIOTIC SELECTION FOR PROSTATE BIOPSY PROPHYLAXIS USING RECTAL SWAB CULTURES REFLECTS LOCAL ANTIBIOGRAM Elizabeth Ann Rourke, Steven Madsen, Andrea Yunes, Joseph W Basler, and Michael A Liss Elizabeth Ann RourkeElizabeth Ann Rourke More articles by this author , Steven MadsenSteven Madsen More articles by this author , Andrea YunesAndrea Yunes More articles by this author , Joseph W BaslerJoseph W Basler More articles by this author , and Michael A LissMichael A Liss More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.533AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In the recent manuscript ″An Update of the AUA White Paper on the More Common Complications of Prostate Biopsy″, an emphasis was placed on utilization of an antibiogram to determine the community risk of resistant post biopsy infections. However, if an antibiotic augmentation strategy is utilized, there are no current recommendations regarding which antibiotic is preferred within individual communities. Herein, we evaluate the susceptibility profiles of ciprofloxacin resistant E.coli (CRE) identified from rectal swab cultures compared to our local antibiogram to determine if the antibiogram could accurately be utilized in the selection of antibiotic augmentation prior to transrectal prostate biopsy (TRPB). METHODS Pre-TRPB rectal swabs were initiated in January 2016 and data was collected through September 2017 at the South Texas Veterans Health Care System (STVHCS). Culture results and antibiotic resistance profiles were recorded and compared to the proportion of antibiotic resistance in the STVHCS 2016 antibiogram. Fisher Exact test was used for comparisons of proportions in a univariate analysis. RESULTS We identified 611 patients who underwent pre-PNB rectal culture, of which 98 were CRE isolates. Our cohort demonstrated an 80% sensitivity to ciprofloxacin as compared to the STVHCS antibiogram sensitivity of 65% (p<0.001). Gentamicin, a commonly used antibiotic augment, demonstrated similar sensitivities between the antibiogram and cohort (90% and 88% respectively). There were no statistically significant differences between the STVHCS antibiogram and the sensitivity profiles of our rectal swab cohort as demonstrated in figure 1, except for Ampicillin/Sulbactam, which was 57% in the antibiogram and 32% in our cohort (p=0.019). Of the CRE identified, 4% (4/98) were considered extended spectrum betalactamase producers (ESBL). CONCLUSIONS Overall, resistance patterns in CRE isolates from our study population are consistent with the STVHCS antibiogram therefore; a local antibiogram may be utilized in an implementation strategy for targeted antibiotics or augmentation of FQ prophylaxis for PNB. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e197 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Elizabeth Ann Rourke More articles by this author Steven Madsen More articles by this author Andrea Yunes More articles by this author Joseph W Basler More articles by this author Michael A Liss More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prevalence and antibiotic susceptibility patterns of pseudomonas aeruginosa in urinary tract infections in a Tertiary care hospital, Central Kerala: A retrospective study over 4 years

Background and Objective: Pseudomons aeruginosa (P.aeruginosa) is an important uropathogenthat has shown varied antibiotic susceptibility patterns. This study aims to findout the changing trends in th eprevalence and antibiotic susceptibility patterns ofurinary isolates of P.aeruginosa over four consecutive years. Methodology: A retrospective, record based study was conducted on all culture and sensitivity (C/S) reports ofurine samples obtained in the microbiology lab in a tertiary care centre, Central Kerala (January 2014 -December 2017). The C/S reports which were positive for significant growth of P.aeruginosa were analyzed to findout its prevalence and antibiotic susceptibility patterns. Descriptive statistics was used for data analysis and the results were expressed in percentages. Result: Out of total 6622 urine samples received (14%) showed significant bacteriuria. P.aeruginosa was the third most common uropathogen isolated with an isolation rate of 3.5%. The antibiotic resistance observed were Gentamicin (53.1%), Amikacin (28%), Cefipime (28%), Ceftazidime(34.4%), Ciprofloxacin (43.7%), Norfloxacin (40.6%), Ofloxacin (40.6%), Piperacillin (37.5%), Piperacilli-Tazobactam (25%) and Imipenem (28%). The isolation rates of P.aeruginosa were 3.9%, 2.6%, 4.5 % and 2.9% in 2014, 2015, 2016 and 2017 respectively and overthe years it maintained its third position.The year wise analysis of antibiotic resistance showed fluctuating pattern except Amikacin, Cefipime and Fluoroquinoles which displayed a decreasingtrend. The reserve drugs like Piperacillin –tazobactam and Imipenem showed alarming drug resistance, although a hopeful reduction in the resistance was noted in 2017. Conclusion: P.aeruginosa remains as a common uropathogen. Drug resistant strains are markedly high in our area. Antibiotic resistance of P.aeruginosado not show a consistent trend over years and vary from region to region. Soeach institution should have an antibiotic policy based on the local antibiogram which is to be renewed regularly. Instead of opting for higher antibioticseach time, strict implementation of restrictive and rotational antibiotic policies and adherence to the concept of ‘Reserve drugs” should be followed. This is the only modality to inhibit the emergence of resistance strains of all uropathogens especially opportunistic pathogens like P.aeruginosa.

Empiric Antibiotics for Sepsis.

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Early recognition and treatment are the cornerstones of management. Review of the English-language literature. For both sepsis and septic shock "antimicrobials [should be] be initiated as soon as possible and within one hour" (Surviving Sepsis Campaign). The risk of progression from severe sepsis to septic shock increases 8% for each hour before antibiotics are started. Selection of antimicrobial agents is based on a combination of patient factors, predicted infecting organism(s), and local microbial resistance patterns. The initial drugs should have activity against typical gram-positive and gram-negative causative micro-organisms. Anaerobic coverage should be provided for intra-abdominal infections or others where anaerobes are significant pathogens. Empiric antifungal or antiviral therapy may be warranted. For patients with healthcare-associated infections, resistant micro-organisms will further complicate the choice of empiric antimicrobials. Recommendations are given for specific infections. Early administration of broad-spectrum antimicrobial drugs is one of the most important, if not the most important, treatment for patients with sepsis or septic shock. Drugs should be initiated as soon as possible, and the choice of should take into account patient factors, common local pathogens, hospital antibiograms and resistance patterns, and the suspected source of infection. Antimicrobial agent therapy should be de-escalated as soon as possible.

Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. The Tokyo Guidelines 2018 (TG18) provides recommendations for the appropriate use of antimicrobials for community-acquired and healthcare-associated infections. The listed agents are for empirical therapy provided before the infecting isolates are identified. Antimicrobial agents are listed by class-definitions and TG18 severity grade I, II, and III subcategorized by clinical settings. In the era of emerging and increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored. Prudent antimicrobial usage and early de-escalation or termination of antimicrobial therapy are now important parts of decision-making. What is new in TG18 is that the duration of antimicrobial therapy for both acute cholangitis and cholecystitis is systematically reviewed. Prophylactic antimicrobial usage for elective endoscopic retrograde cholangiopancreatography is no longer recommended and the section was deleted in TG18. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

Role of neomycin polymyxin sulfate solution bladder wash for prevention of catheter associated urinary tract infection in traumatic brain injury patient admitted to Intensive Care Unit: A prospective randomized study.

Background:Catheter - associated urinary tract infection (CAUTI) remains a critical threat for patients in intensive care unit especially in traumatic brain injury patients with low Glasgow coma score (GCS). Almost all patients in ICU receive antibiotic either prophylactic or therapeutic based on local antibiogram of particular ICU or hospital. For prophylaxis, systemic antibiotics are used. It will be helpful to avoid systemic side effects by introducing antibiotics locally through bladder irrigation. The indwelling urinary catheter is an essential part of modern medical care.Aims and Objectives:The primary objective was to study the effect of Neomycin and Polymyxin sulphate solution for bladder wash on CAUTI in traumatic brain injury patients. The secondary objectives was to study the various organisms causing CAUTI and their antibiotic sensitivity and resistance pattern.Materials and Methods:This was a prospective randomized controlled study performed on 100 patients who met the inclusion criteria at the trauma intensive care unit of Banaras Hindu University between September and February 2016. The patients were randomized into two groups – one was the study group which received Neomycin and Polymyxin Sulphate solution bladder wash, while the other was the control group that received Normal saline bladder wash. Urine samples were collected at certain days and sent for culture and sensitivity.Results:There was significant reduction in the incidence of CAUTI in neomycin/polymyxin test group in comparison to normal saline irrigated control group. Out of 50 patients in test group 8 patients and in control group 26 patients was identified as CAUTI positive and they were statistically significant. In our study pseudomonas aeruginosa (51%) was the commonest isolated pathogen.Conclusions:Neomycin and Polymyxin Sulphate bladder wash was effective in preventing CAUTI. It can thus decrease the antibiotic usage thereby preventing the emergence of antibiotic resistance.

An Evidence-Based Protocol for Antibiotic Use Prior to Cystoscopy Decreases Antibiotic Use without Impacting Post-Procedural Symptomatic Urinary Tract Infection Rates

Symptomatic urinary tract infection is a complication of office based cystourethroscopy. Studies are mixed regarding the efficacy of antibiotic prophylaxis to prevent urinary tract infections. Our aim was to develop and evaluate an evidence-based protocol that reduces unnecessary antibiotic use while avoiding an increase in urinary tract infections. We created a clinic antibiogram based on all urology office visits performed during a 2-year period. Bacterial resistance rates, institutional risk related data and clinical guidelines were applied to create a protocol for antibiotic administration before cystourethroscopy. We then analyzed 1,245 consecutive patients without a renal transplant who underwent outpatient cystourethroscopy, including 610 after protocol initiation. Urinary tract infection rates and antibiotic use were analyzed for an association with the protocol change using the Fisher exact test. Cultures had an overall 20% rate of resistance to fluoroquinolones, representing 40% of the cultures that grew Escherichia coli. Before the protocol change 602 of 635 patients (94.8%) received a preprocedural antibiotic compared to 426 of 610 (69.9%) after protocol initiation (p <0.01). A total of 19 patients (3.0%) had a symptomatic urinary tract infection prior to the protocol change while 16 (2.6%) had a urinary tract infection after the change (p = 0.69). Regarding resistance, fluoroquinolone resistant organisms grew in the cultures of 12 of 19 patients (63.2%) with a urinary tract infection before the protocol change compared to 5 of 16 (31.3%) with a urinary tract infection after the change. Recent antibiotic administration, hospitalization and chronic catheterization were associated with urinary tract infection in the entire cohort (all p≤0.01). A local antibiogram with infection related risk data effectively risk stratifies patients before cystourethroscopy, decreasing the use of antibiotics without increasing the rate of symptomatic urinary tract infection.