Stopping Antibiotics Research Articles

Clofazimine for Rapidly Growing Mycobacterial Infections

BackgroundRapidly growing mycobacteria (RGM) have high rates of antibiotic resistance and require prolonged therapy with considerable toxicity. Less toxic and more effective therapies are needed. One promising agent is clofazimine (CFZ), an antibiotic with favorable in vitro data but limited clinical data in RGM.MethodsWe performed a retrospective cohort study to assess outcomes of adult patients treated with CFZ for RGM infection. Primary outcome was cure, defined as no evidence of clinical, radiographic, or microbiologic recurrence within 1 year of follow-up after stopping treatment. If a patient was retreated for infection, only the index treatment was included in the analysis.ResultsWe treated 55 adults for RGM infection with CFZ in combination with a median of 5 other antibiotic classes over the entire course of treatment. Of these patients, 58% had pulmonary infection (81% nodular-bronchiectatic and 19% cavitary); 100% of pulmonary infections were M. abscessus. Non-pulmonary disease sites included skin (65%), bone (13%), intra-abdominal (9%), and other (13%); 48% were M. abscessus, 39% were M. chelonae, and 13% were M. fortuitum.Patients with pulmonary infection were treated for a median duration of 11.9 months and non-pulmonary for a median of 7.9 months. CFZ was well tolerated. There were 2 (4%) cases of hepatitis and 3 (5%) cases of QT prolongation. For patients who completed treatment for pulmonary infections (n = 27), 67% achieved symptomatic improvement, 65% achieved radiographic improvement, and 71% achieved negative cultures. For patients who completed treatment for non-pulmonary infection (n = 22), 100% achieved clinical improvement.For patients who had at least 1 year of follow up after stopping antibiotics (pulmonary n = 21, non-pulmonary n = 14), 43% of patients with pulmonary infections achieved clinical cure and 79% of patients with non-pulmonary infections achieved clinical cure. Within 1 year of follow-up 19% of pulmonary infection patients and none of the non-pulmonary patients had died.ConclusionAs a part of multidrug therapy, CFZ is useful in the in the treatment of drug-resistant RGM infections, particularly skin infections, and offers a better tolerated option compared with other available antibiotics.Disclosures All authors: No reported disclosures.

Can antibiotic De-escalation Be Measured Without Chart Review? A Proposed Electronic Definition

BackgroundAntimicrobial stewardship programs promote de-escalation: moving from broad to narrow spectrum agents and/or stopping antibiotics as more clinical data return. A standard definition of de-escalation objectively applied to electronic data could provide a means to assess stewardship improvement opportunities.MethodsWe performed a retrospective cohort study of de-escalation events among five hospitals from the Duke Health System and the Duke Antimicrobial Stewardship Outreach Network using 2016 electronic medication administration record data. Antibiotics were ranked into four categories: narrow spectrum (e.g., cefazolin), broad spectrum, extended spectrum, and agents typically targeted for protection (e.g., meropenem). Included patients were cared for on inpatient units, had antibiotic therapy for at least 2 days, and had at least 3 days of hospitalization after starting antibiotics. De-escalation was defined as reduction in either the number of antibiotics or rank measured at two time points: day 1 of initiation of antibiotic therapy and day 5 (or day of discharge if occurring on day 3 or 4). Escalation was an increase in either number or rank of agents. Unchanged was either no change or discordant directions of change in number and rank. For all categories, the outcome was percent among qualifying admissions. Descriptive statistics were used to describe de-escalation among hospitals, unit type, and ICD-10 diagnoses.ResultsAmong 39,226 included admissions, de-escalation occurred in 14,138 (36%), escalation in 5,129 (13%), and antibiotics were unchanged in 19,959 (51%) (Figure). Percent de-escalation was significantly different among hospitals (median 37%, range 31–39%, P < .001). Infectious diagnoses with lower rates of de-escalation included intra-abdominal infection (23%), skin and soft-tissue infection (28%), and ENT/upper respiratory tract infection (19%). Intensive care units had higher rates of both de-escalation and escalation (43% and 16%) when compared with non-ICU wards (35% and 13%, P < .001).ConclusionWe provided an objective, electronic definition of de-escalation and demonstrated variation among hospitals, units, and diagnoses. This metric may be useful for assessing stewardship opportunities.Disclosures All authors: No reported disclosures.

Safety of Stopping Antibiotics Prescribed “Just in Case” – Comparison of Mortality, Readmissions and Clostridium difficile in Patients with Accepted Stewardship Interventions Compared with Declined

BackgroundAntibiotics are often prescribed “just in case” when clinical conditions mimic an infection, such as the shortness of breath in heart failure, the erythema of venous stasis or when bacterial culture results are misleading such as asymptomatic bacteriuria (ABU) and C difficile colonization. Through prospective audit and feedback (PAF), antimicrobial stewardship programs (ASP) may guide providers toward appropriate antibiotic use. However, the safety of stopping antibiotics needs to be assessed. We retrospectively reviewed the clinical outcomes of patients with accepted ASP recommendations and compared these to patients in whom the primary team declined ASP recommendations.MethodsThe ASP database was used to identify patients receiving written PAF to stop antibiotics prescribed for noninfectious conditions from January 1, 2016 to December 31, 2016. The primary objective was to compare antibiotic days of therapy (DOT), total length of therapy (LOT), hospital length of stay (LOS), 30-day mortality, and the incidence of C. difficile within 6 months of the ASP intervention, occurring among patients whose primary treating team accepted vs. rejected the ASP recommendation. We compared the two groups using Chi-square and student t-test to determine statistical significance for categorical and continuous variables, respectively.ResultsThere were 232 ASP recommendations to stop antibiotics for noninfectious conditions: 150 (65%) interventions were accepted. Baseline demographic characteristics, comorbidities, intensive care admission and surgery during that hospitalization were similar between the two groups. The most common noninfectious conditions were ABU (55%), followed by respiratory (19%) and intra-abdominal (17%). The median antibiotic DOT and LOT were significantly reduced in the accepted group, 3 (3–5) vs. 8 (5–12.25) days (P < 0.001) and 3 (2–4) vs. 7 (5–10) days (P < 0.001), respectively. There were no statistical differences in 30-day mortality, 30-day readmission, and C.difficilewithin 6 months.ConclusionOur institutional ASP’s PAF to stop antibiotics for noninfectious conditions led to a significant reduction in antimicrobial exposure without negatively affecting mortality or hospital outcomes.Disclosures All authors: No reported disclosures.

No evidence that stopping antibiotics early encourages antibiotic resistance, say experts

No evidence that stopping antibiotics early encourages antibiotic resistance, say experts

Using Procalcitonin to Guide Antibiotic Therapy.

Procalcitonin levels rise in response to systemic inflammation, especially of bacterial origin. Multiple randomized controlled trials have demonstrated that procalcitonin-based algorithms can safely reduce antibiotic use in 2 clinical scenarios. First, in stable, low-risk patients with respiratory infections, procalcitonin levels of <0.25 µg/L can guide the decision to withhold antibiotics or stop therapy early. Second, in critically ill patients with suspected sepsis, clinicians should not initially withhold antibiotics, but procalcitonin levels of <0.5 µg/L or levels that decrease by ≥80% from peak can guide discontinuation once patients stabilize. The recent stop antibiotics on procalcitonin guidance study (SAPS), the largest procalcitonin trial to date, demonstrated reduction in both antibiotic exposure and mortality in critically ill patients. Although procalcitonin is ready for routine use, future research should examine optimal strategies for implementation in hospitals, its real-world impact on clinical outcomes and costs, its applicability to immunocompromised patients, and the generalizability of trials to the US population.

Penggunaan antibiotik di dua apotek di Surabaya: identifikasi faktor-faktor yang mempengaruhi kepatuhan pasien

Attention to factors that affects proper use of antibiotics need to be conducted to prevent community resistance. This study was aimed to identify factors that affect patients’ compliance of antibiotic use in two pharmacies in Surabaya, Bhumyamca (A) and Tiara 2 (B). Subject of this study was people who purchased antibiotics in the two pharmacies. Data were collected through questionnaires, analyzed using descriptive statistic, and underwent Hosmer and Lemeshow’s multiple regression tests. Factors such as: age, gender, income, duration and pattern of antibiotics use, antibiotics information, complaint and action after antibiotics side effect were observed. There were 94 respondents mainly 26 - 31 of age met the inclusion criteria. Female respondents in A were 74% and 68% in B. Respondents income was 2 to 3 million rupiah, in A (83%) and B (54%). Respondents use antibiotics mainly for 3 to 5 days, in A (47%) and B (50%). Most respondents use antibiotics after meals in A (92%) and B (88%). Antibiotics information was obtained mainly from healthcare providers in A (92%) and B (85%). Respondents had no complaints after antibiotics use in A (87%) and B (73%). Respondents (44%) stop antibiotics when complaints were occurred both in A and B, whereas 56% visited clinician. Respondents in A (86%) and B (89%) were consumed antibiotics in accordance to usage instruction. Conclusively, no factor was associated to patients’ compliance, except pattern of administration in B (0.011).

Safety and efficacy of outpatient parenteral antibiotic therapy in an academic infectious disease clinic.

Outpatient parenteral therapy (OPAT) has become a safe and effective modality for patients requiring intravenous or prolonged antimicrobial therapy since the 1970s. It is being increasingly utilized in various settings; however, studies evaluating the safety and efficacy of clinic-based OPAT are limited. Since 2012, patients being considered for OPAT have required an infectious disease (ID) consultation at our institution. Candidates receiving once-daily antimicrobials who were ineligible for home infusion or nursing home placement as determined by their insurance companies and those who preferred the clinic over nursing home or home infusion were referred to the ID clinic. This study assessed the safety and outcome of patients receiving OPAT in an academic inner-city ID clinic in Detroit, Michigan. This was a retrospective cross-sectional study of electronic medical records of patients, identified through clinic records, who received at least 2 days of OPAT from December 2012 to December 2015. Demographics, types of infections, antimicrobial regimen used, adverse events and outcome were evaluated. A total of 122 cases were identified during the study period. Mean age was 62 years with 55% male; 102 (84%) of 122 patients had peripherally inserted central catheter (PICC). Fifty-five per cent of patients participated in the clinic-based OPAT programme for insurance reasons, and 43% preferred the clinic over nursing home or home infusion. The most common infections were bone and joint (36%), followed by skin and soft tissue (18%) and urinary tract infections (12%). Ertapenem (44%) and daptomycin (41%) alone or in combination were used most frequently with 40% of patients receiving at least 4 weeks of treatment. Thirteen patients (11%) experienced one or more adverse drug events on daptomycin and/or ertapenem; of these, nine (69%) patients were receiving daptomycin monotherapy. Gastrointestinal symptoms (29%), cramping and myalgias (29%) and asymptomatic creatine phosphokinase (CPK) elevation (24%) were the most common adverse events. Three (3%) of 102 patients had PICC-related complications. Fourteen (88%) of 16 patients with adverse events or PICC-related complications required changing or stopping antibiotics; two (2%) had infection-related readmission. Conversely, 113 (93%) of 122 patients who completed treatment were considered cured and none had treatment failure at the end of 30 days of treatment. No patients died as a result of treatment or infection-related complications. Outpatient parenteral therapy in our academic ID clinic was a safe and effective alternative to home infusion or skilled nursing facilities for patients requiring long-term antibiotics with few adverse events and complications.

Management of Acute Osteomyelitis: A Ten-Year Experience

Osteomyelitis is an infection of the bone; proper management requires prolonged antibiotic treatment. Controversy exists as to when a patient should transition from intravenous to oral antibiotics. However, due to the high bioavailability of some oral antibiotics, optimal time to transition from high to low bioavailability antibiotics is a more valid consideration. Additionally, there are questions surrounding the efficacy of certain antibiotics, specifically trimethoprim-sulfamethoxazole (TMP-SMX), in treating osteomyelitis. After obtaining Institutional Review Board approval from both universities, a retrospective chart review was conducted, utilizing an author-created severity scale, on all patients seen by Pediatric Infectious Diseases at the Universities of Michigan and Toledo with an acute osteomyelitis diagnosis from 2002-2012. There were 133 patients, 106 treated successfully. Success was defined in this study specifically as treatment of <14 weeks without recurrence within 30 days of stopping antibiotics or permanent site disability. Seventeen patients were treated with TMP-SMX at comparable cure rates. Patients with pre-existing bone defects (noted in radiological reports), initial erythrocyte sedimentation rate (ESR)≥70, hematogenous osteomyelitis with soft tissue extension, and skull osteomyelitis were associated with increased failure rate. Switch to low bioavailability antibiotics occurred, on average, at 3.5 weeks; however, switching before then was not associated with decreased cure rate. As prevalence of methicillin-resistant Staphylococcus aureus (MRSA), especially clindamycin-resistant MRSA, increases, TMP-SMX appears to be an acceptable antibiotic. There does not appear to be a minimum length of high bioavailability treatment required for cure. Prior bone defect, extensive infection, ESR≥70, or skull osteomyelitis may be indications for more aggressive management.

Could procalcitonin be used as an indicator to start or stop antibiotics for acute upper and lower respiratory infections?

Could procalcitonin be used as an indicator to start or stop antibiotics for acute upper and lower respiratory infections?

HOW A CLINICAL ANTIMICROBIAL STEWARDSHIP TEAM COULD IMPROVE ANTIBIOTIC USE AT A CHILDREN'S HOSPITAL

Aim The Department of Health have published guidelines which provide an outline for evidence-based Antimicrobial Stewardship (AMS) in secondary healthcare settings.1 The guidance states antimicrobials should not be started without clinical evidence of a bacterial infection and that all patients should be reviewed at 48 hours to make a clear plan of action; the “Antimicrobial Prescribing Decision”. The aim of this audit is to establish how often the 48 hour review takes place at our centre, and to evaluate the appropriateness of the decisions made at 48 hours, and estimate the impact of establishing a dedicated AMS team on patient care. Methods Data collection took place from Jan to May 2013. Ten wards (mix of medical and surgical) were visited on five occasions over that period. Information was collected from patients prescribed IV antibiotics for 48 hours or longer, and included basic demographic data, diagnosis, antibiotic prescribed and dose, and whether a 48 hour review had taken place. The data was reviewed by a virtual AMS team (Infectious Diseases (ID) consultant and ID pharmacist) and each patient underwent a 48 hour “Antimicrobial Prescribing Decision”, which was compared to the clinical decision. In addition the team assessed the eligibility for the patient for Outpatient Parenteral Antimicrobial Therapy (OPAT). Results Of the 533 patients screened, 78 (15%) had been prescribed antibiotics for more than 48 hours. The most common indications for IV antibiotics were pneumonia, sepsis and surgical prophylaxis. The most frequent antimicrobials were cefuroxime and cefotaxime. The AMS team found that they would have stopped or switched IV antibiotics to oral at 48 hours in 36% of cases when they had actually been continued, this was most common for patients receiving IV antibiotics for pneumonia, UTI and surgical prophylaxis. Six out of 78 patients were found to be eligible for OPAT at the time of review. Conclusions This audit demonstrated that a systematic 48 hours review by a dedicated antimicrobial stewardship team could improve adherence with the Department of Health “Start Smart Then Focus” guidance1 and improve patient care by stopping antibiotics early or switching to oral therapy. This study also estimates that combining this systematic review at 48 hours with an improved OPAT service could save 1800 bed days per year locally.

Antibiotic and Diagnostic Discordance Between ED Physicians and Hospitalists for Pediatric Respiratory Illness.

Imperfect diagnostic tools make it difficult to know the extent to which a bacterial process is contributing to respiratory illness, complicating the decision to prescribe antibiotics. We sought to quantify diagnostic and antibiotic prescribing disagreements between emergency department (ED) and pediatric hospitalist physicians for children admitted with respiratory illness. Manual chart review was used to identify testing, diagnostic, and antibiotic prescribing decisions for consecutive children admitted for respiratory illness in a winter (starting February 20, 2012) and a summer (starting August 20, 2012) season to a tertiary, freestanding children's hospital. Respiratory illness diagnoses were grouped into 3 categories: bacterial, viral, and asthma. A total of 181 children admitted for respiratory illness were studied. Diagnostic discordance was significant for all 3 types of respiratory illness but greatest for bacterial (P<.001). Antibiotic prescribing discordance was significant (P<.001), with pediatric hospitalists changing therapy for 93% of patients prescribed antibiotics in the ED, including stopping antibiotics altogether for 62% of patients. Significant diagnostic and antibiotic discordance between ED and pediatric hospitalist physicians exists for children admitted to the hospital for respiratory illness.

Does procalcitonin, C-reactive protein, or interleukin-6 test have a role in the diagnosis of severe infection in patients with febrile neutropenia? A systematic review and meta-analysis.

The study aims to determine the usefulness of procalcitonin (PCT) and other blood markers for identification of bacterial infection among patients with febrile neutropenia (FN). The Medline, EMBASE, and Cochrane databases were searched for articles from 1966 to December 2012. We performed a search to identify articles that examined the diagnostic accuracy of PCT in patients with FN. Statistical analyses (fixed- or random-effect models) were conducted to summarize and calculate the sensitivity, specificity, likelihood ratios, and 95 % confidence intervals (CIs). Twenty-seven studies were included (1960 febrile episodes) for PCT analysis, 13 (1712 febrile episodes) for C-reactive protein (CRP) analysis, and five (314 febrile episodes) for interleukin (IL)-6 analysis. Increased PCT levels (odds ratio [OR] 11.5; 95 % CI 7.6 to 17.3), raised CRP levels (3.3; 2.7 to 4.2), and raised IL-6 levels (10.0; 5.5 to 18.0) were significantly associated with bacterial infection. Overall positive likelihood ratio was 5.49 (4.04-7.45) for PCT, 1.82 (1.42-2.33) for CRP, and 3.68 (2.41-5.60) for IL-6. Overall negative likelihood ratio was 0.40 (0.31-0.51) for PCT, 0.40 (0.26-0.61) for CRP, and 0.33 (0.23-0.46) for IL-6. Of the three potentially useful markers, PCT had the best positive likelihood ratio and can be used to confirm the diagnosis of bacterial infections in patients with FN. Due to unacceptably high negative likelihood ratio, medical decision for stopping antibiotics based on PCT alone in this high-risk population may not be possible.

Infections After Breast Surgery: Potential Ways to Reduce Infection Rates

SUMMARY Breast infection rates are higher than expected for clean cases and are decreased with the use of prophylactic preoperative antibiotics. Surgical care bundles include evidence-based measures such as selection of preoperative antibiotics to cover skin flora, skin preparation, stopping antibiotics within 24 h, normothermia and hair removal. Glycemic control should be addressed but there is no additional benefit with tight control. Drain antisepsis provides a promising new approach to reducing infections in breast operations that use surgical drains. Other surgical disciplines have shown benefit with methicillin-resistant Staphylococcus aureus decolonization, vancomycin powder application and use of gentamicin-impregnated collagen plugs.

Antimicrobial profile of Salmonella enterica serotype Choleraesuis from free-range swine in Kakamega fish market, western Kenya.

Salmonella enterica subspecies enterica serovar Choleraesuis is a host-adapted, facultative, intracellular pathogen that causes swine paratyphoid. Its antimicrobial resistance presents a challenge to feed manufacturing industries. However, stopping antibiotics in animal feed would have economic implications for the industry. Conventional microbial methods for isolation and identification of S. Choleraesuis were employed. The isolates were subjected to screening against 17 antimicrobial agents and genotyping of resistance markers by PCR. The data were then analyzed and presented in percentages. Phenotypically, 43 out of 95 isolates showed multidrug resistance. Among the 17 antibiotics tested, resistance was observed as follows: sulphonamides (45.2%), nalidixic acid (44.25%), tetracycline (42%), ampicillin (36.8%), erythromycin (34.7%), carbenicillin (31.5%), chrolamphenical (28.4%), gentamicin (27.3%), kanamycin (24.2%), spectinomycin (21%), sulfamethoxazole-trimethoprim (16.8%), streptomycin (12.6%), cephalothion (8.4%), ofloxacin (5.2%), ciprofloxacin (4.2%), and norfloxacin (4.2%). Fifty-two isolates were susceptible to the antimicrobial agents tested. A total of 3.1% of the isolates had the integron gene pattern combination of dfrA2-aadA2 (2100 bp), dfrA12 (2100 bp); 4.2% had dfrA12-aadA2-sulI (2100 bp); 2.1% had dfrA12-aadA2 (2100 bp); and 1% had dfrA2-aadA2-sulI (2100 bp), oxa1-aadA2 (1500 bp), dfrA12-aadA2-sulI, and blaPSE (2100 bp). The isolated S. Choleraesuis were resistant to more than 10% of the antimicrobial agents used in this study. Appropriate surveillance is warranted to gain more information about the epidemiology, as stopping antibiotics in animal feed would have economic implications for the industry.

Initiation and termination of antibiotic regimens in Veterans Affairs hospitals.

To assess rates of starting or stopping antibiotics across different hospitals. We used barcode medication administration data to measure antibiotic use on acute-care wards in 128 Veterans Affairs medical centres (VAMCs) in 2010. A treatment day (TD) was defined as the administration of any antibiotic on a given day. A treatment period (TP) was defined as an interval of inpatient antimicrobial therapy with gaps of ≤1 day in TDs. The rate of starting antibiotics was calculated for inpatients who had not yet started antibiotics, as the number of start events divided by the 'person-time at risk'. The rate of stopping antibiotics was calculated analogously for inpatients that were on antibiotics. Once individuals had stopped antibiotics they were removed from further analysis. Per-day start and stop rates were also calculated for each day of hospitalization. The hospital mean rate of starting the first TP was 18.1 start events/100 days at risk (range 8.4-25.6/100 days at risk). The mean hospital stopping rate was 21.1 stop events/100 days at risk (range 13.3-29.5/100 days at risk). The ratio of a facility's starting and stopping rates was highly correlated with overall antibiotic use in TDs/1000 patient-days (rs=0.92, P<0.001), while starting and stopping rates individually were only moderately correlated (rs=0.39, P<0.001). VAMCs with similar antibiotic use showed marked differences in their starting and stopping rates of antibiotics. It may be useful to target empirical therapy when starting rates are high and definitive therapy when stopping rates are low.

Spectrum of advice and curbside consultations of infectious diseases specialists

ObjectivesCurbside consultation (CC) of infectious diseases specialists for advice is very frequent but the corresponding workload has rarely been assessed. This activity is mostly oral (phone or direct contact) and poorly quantifiable because it is not charged. We had for aim to evaluate this activity in a French teaching hospital. MethodsWe recorded all CCs given during a 2.5-year period, from mid-2011 to the end of 2013. ResultsDuring the study period, 6789 CCs were recorded (2715 per year), or slightly more than 10 per day. These CCs were divided in 676 travel recommendations and 6113 for other reasons. They were mostly given by phone (77.4%). Most demands came from our hospital (61.4%), followed by community family physicians and specialist (27.1%), other local hospitals (6.5%) and clinics (4.3%). All the departments in our hospital consulted us for advice at least once and answers were mainly given by phone (70.1%) and at bedside (30.5%). The answers were principally advice (50.8%), modification of antibiotic prescription (22.9%), initiation of antibiotic course (14.8%), maintaining the same treatment (6.2%), and stopping antibiotics (4.3%). CCs accounted for 20% of clinical work for 1 physician. If the CCs in our hospital had been paid, our department would have received an additional 77,000€ in revenue. ConclusionThis curbside activity is very important and time-consuming for infectious diseases specialists, but it is currently not acknowledged or rewarded.

G393 Potential discharge of febrile infants at 36 hours following negative blood culture result: an audit

AimsTo determine if previously well infants (<1 year) admitted with undifferentiated febrile illness with a negative blood culture (BC) at 36 h could have antibiotics stopped and be safely discharged...

Challenges in Diagnosis of H. Pylori Infection in Children

H. pylori infection is usually acquired in early childhood. Its role in gastrointestinal and extra intestinal complaints and serious consequences in adulthood make it as challenging issues. Despite different clinical presentations, in most children, the presence of H. pylori infection does not lead to clinically apparent disease, even when it causes chronic active gastritis. Some of most important recommendations for managing H. pylori infection in children based on Guidelines from ESPGHAN and NASPGHAN consisted as: 1. Diagnostic testing for H pylori infection is not recommended in children with functional abdominal pain. 2. In children with first-degree relatives with gastric cancer, testing for H pylori may be considered. 3. In children with refractory iron-deficiency anemia, in which other causes have been ruled out, testing for H pylori infection may be considered. 4. There is insufficient evidence that H pylori infection is causally related to otitis media, upper respiratory tract infections, periodontal disease, food allergy, sudden infant death syndrome (SIDS), idiopathic thrombocytopenic purpura, and short stature. 5. It is recommended that the initial diagnosis of H pylori infection be based on a positive histopathology plus a positive rapid urease test or a positive culture. 6. The 13C-urea breath test (UBT) is a reliable noninvasive test to determine whether H pylori has been eradicated. 7. ELISA-test for detection of H pylori antigen in stool is a reliable noninvasive test to determine whether H pylori has been eradicated. 8. Tests based on the detection of antibodies (IgG, IgA) against H pylori in serum, whole blood, urine, and saliva are not reliable for use in the clinical setting. 9. It is recommended that clinicians wait at least 2 weeks after stopping proton pump inhibitor (PPI) therapy and 4 weeks after stopping antibiotics to perform biopsy-based and noninvasive tests (UBT, stool test) for H pylori.

Procalcitonin to Initiate or Discontinue Antibiotics in Acute Respiratory Tract Infections

Study Description and Results This summary is based on a Cochrane systematic review that included individual patient data from 14 randomized controlled trials (RCTs) with a total of 4211 participants. Inclusion criteria were adult patients with a clinical diagnosis of ARI, as well as patients with sepsis and suspected ARIs. The systematic review and individual patient data metaanalysis of RCTs was undertaken to compare the effects of using procalcitonin to guide initiation and duration of antibiotic treatment in patients with ARIs to patients without procalcitonin measurements. The aim of the analysis was to assess the safety and efficacy of a procalitonin-guided approach to treatment over a large range of patients with varying severity of ARIs. Trials were excluded if they exclusively focused on pediatric participants or if they used procalcitonin to escalate antibiotic therapy. No Review Question What is the safety and efficacy of using procalcitonin for starting or stopping antibiotics using individual patient data with varying severity of acute respiratory infections (ARIs) and from different clinical settings?

Contribution of systematic RT-PCR screening for influenza during the epidemic season

ObjectiveWe assessed the systematic RT-PCR screening of patients admitted to an infectious diseases department (IDD), during the 2012–2013 influenza outbreak. MethodologyPatients admitted with cough and fever underwent a nasopharyngeal smear for RT-PCR screening. ResultsNinety-eight patients were admitted in the IDD, from January 1st to February 22nd, 46 were screened; 11 male and 6 female patients (17.3%, mean age of 68 years) were positive. The diagnoses made in the emergency department, before RT-PCR screening, were most frequently lung infection and sepsis, but influenza in only 4 cases. The diagnosis of influenza led to stopping antibiotics (n=4), initiating curative (n=4) and preventive (n=4) treatments with oseltamivir, and isolating patients to prevent a hospital outbreak. ConclusionSystematic RT-PCR screening allows a rapid therapeutic management and the prevention of hospital epidemic through appropriate isolation measures.