Timing Of Antibiotic Administration Research Articles

Isolated injury, Charlson Comorbidity Index, and transfer from another facility are associated with delay in antibiotic administration: a retrospective study of 963 patients with open fractures.

To identify factors associated with delays in administration and pharmacy and nursing preparation of antibiotics for patients with open fractures. Retrospective review. Level I trauma center. Nine hundred sixty-three adults with open fractures administered antibiotics. Delay in antibiotic administration greater than 66 minutes from arrival and significant pharmacy-related and nursing-related delay. Isolated injury, Charlson Comorbidity Index, and transfer from another facility were associated with delay in antibiotic administration greater than 66 minutes. Injury Severity Score, transfer, and trauma team activation were associated with pharmacy-related or nursing-related delay. Interventions to reduce antibiotic administration time for open fractures should focus on early identification of open fractures and standardization of antibiotic protocols to ensure timely administration even in complex or resource-scarce care situations. Prognostic level III.

Management of open fracture and related complications: the Japanese way.

Open fractures continue to be a challenging clinical problem throughout the world, and Japan is no exception. Surgeons are faced with critical decisions throughout the care of these injuries that can have significant effects in clinical outcome, ranging from the type and timing of antibiotic administration, fixation, soft-tissue management, and interventions for postfracture complications. In October 2022, the Japanese Society for Fracture Repair (JSFR) was invited to represent Japan as the Guest Nation society at the 38th Annual Meeting of the Orthopaedic Trauma Society held in Tampa, Florida. The JSFR organized a symposium, entitled "Management of Open Fracture and related complications-the Japanese way," that featured cutting-edge approaches to open fractures in their country, including presentations on the "fix-and-flap" approach, local antibiotics perfusion delivery, and a "chipping" method for the stimulation of bone healing. This article summarizes the content of these 3 presentations from that symposium.

Nurse-Initiated Protocol to Improve Timely Antibiotic Administration in Pediatric Open Fractures.

Early administration of antibiotics in the presence of open fractures is critical in reducing infections and later complications. Current guidelines recommend administering antibiotics within 60min of patient arrival to the emergency department, yet trauma centers often struggle to meet this metric. This study aims to evaluate the impact of a nurse-initiated evidence-based treatment protocol on the timeliness of antibiotic administration in pediatric patients with open fractures. A retrospective pre-post study of patients who met the National Trauma Data Standard registry inclusion criteria for open fractures of long bones, amputations, or lawn mower injuries was performed at a Midwestern United States Level II pediatric trauma center. The time of patient arrival and time of antibiotic administration from preimplementation (2015-2020) to postimplementation (2021-2022) of the protocol were compared. Patients transferred in who received antibiotics at an outside facility were excluded. A total of N =73 participants met the study inclusion criteria, of which n =41 were in the preimplementation group and n =32 were in the postimplementation group. Patients receiving antibiotics within 60min of arrival increased from n =24/41 (58.5%) preimplementation to n =26/32 (84.4%) postimplementation (p<.05). Our study demonstrates that initiating evidence-based treatment orders from triage helped decrease the time from arrival to time of antibiotic administration in patients with open fractures. We sustained improvement for 24months after the implementation of our intervention.

Evaluation of Administration Prophylactic Antibiotic against Incidence of Surgical Site Infection in Post Appendectomy at Panembahan Senopati Hospital, Indonesia

Appendicitis is a prevalent abdominal surgical emergency in Indonesia, occurring at a rate of 5 per 1,000 people, with around 10 million cases each year. Appendectomy, the surgical removal of the vermiform, is the primary treatment for appendicitis but carries a high risk of surgical site infections. Prophylactic antibiotics are given to minimize the risk of infection resulting from surgery, administered in accordance with established guidelines. This study aims to evaluate the administration of antibiotic prophylactic against SSIs. This study used a mixed-methods approach to evaluate prophylactic antibiotic administration and the incidence of surgical site infection in post-appendectomy patients. The researchers conducted in-depth interviews with surgeons and nurses and an analytical observational study with a cross-sectional design, observing various indicators such as the timing and duration of prophylactic antibiotic administration and the presence of surgical site infections. The study found that the duration of antibiotic administration ≤24 hours had a higher number of infection-free patients (62.50%). The researchers analyzed the relationship between the duration of antibiotic administration and surgical site infection in post-appendectomy patients and found a significant relationship (p &lt;0.05) at the hospital. There is a relationship between prophylactic antibiotic administration and surgical site infection. All patients were given prophylactic antibiotics with appropriate timing, duration, and method of administration.

Inulin mitigated antibiotic-induced intestinal microbiota dysbiosis - a comparison of different supplementation stages.

Antibiotics are unavoidable to be prescribed to subjects due to different reasons, and they decrease the relative abundance of beneficial microbes. Inulin, a fructan type of polysaccharide carbohydrate, on the contrary, could promote the growth of beneficial microbes. In this study, we investigated the effect of inulin on antibiotic-induced intestinal microbiota dysbiosis and compared their overall impact at different supplementation stages, i.e., post-antibiotic, at the time of antibiotic administration or prior to antibiotic treatment, in the C57BL/6 mice model. Although supplementation of inulin after antibiotic treatment could aid in the reconstruction of the intestinal microbial community its overall impact was limited and no remarkable differences were identified as compared to the spontaneous restoration. On the contrary, the effect of simultaneous and pre-supplementation was more remarkable. Simultaneous inulin supplementation significantly mitigated the antibiotic-induced dysbiosis based on alterations as evaluated using weighted and unweighted UniFrac distance between baseline and after treatment. Moreover, comparing the effect of simultaneous supplementation, pre-supplemented inulin further mitigated the antibiotic-induced dysbiosis, especially on the relative abundance of dominant microbes. Collectively, the current study found that the use of inulin could alleviate antibiotic-induced microbiota dysbiosis, and the best supplementation stage (overall effect as evaluated by beta diversity distance changes) was before the antibiotic treatment, then simultaneous supplementation and supplementation after the antibiotic treatment.

Assessment of Delay in Door-to-antibiotic Administration Time after Arrival to the Hospital among Post-chemotherapy Febrile Neutropenia Patients: A Cohort Study

ntroduction: Febrile Neutropenia (FN), a common side effect of chemotherapy, is regarded as an oncologic emergency necessitating prompt treatment. A delay in door-to-antibiotic administration time is associated with poor patient outcomes. Aim: To assess the time lag in the administration of antibiotics after arrival at the hospital in patients with solid/haematological malignancy presenting with post-chemotherapy FN. Materials and Methods: This was a cohort study conducted in the Department of Medical Oncology at Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India, over a period of one year from December 2019 to November 2020 among 80 patients with solid or haematological malignancy who presented with fever and Absolute Neutrophil Count (ANC) &lt;1000/mm3 to the Outpatient Department (OPD) or the Emergency Department and were diagnosed with FN post-chemotherapy. Upon obtaining consent, these patients were enrolled, and the timing of antibiotic administration was noted for the study participants. The participants were further followed-up for the assessment of morbidity {in terms of Intensive Care Unit (ICU) admission)}, duration of hospital stay, delay in the further chemotherapy schedule, and survival status. Data was entered into MS Excel and analysed using Statistical Packages for Social Sciences (SPSS) version 16.0. Associations were established using Chi-square tests. Results: Out of a total of 80 study participants, the mean±SD age was 45.6±18.3 years, and the number of males was 43 (53.8%). Total 57 (71.25%) patients were on chemotherapy for solid organ malignancies. The median delay in door-to-antibiotic time was 120 minutes (ranging from 30 to 260 minutes). The median day of presentation with FN after chemotherapy was day 7. Delay in antibiotic administration was found to have a significant impact on the further chemotherapy schedule and doses (p=0.004). However, ICU admission rates (p=0.133), length of hospital stay (p=0.662), and mortality (p=0.201) were not significantly associated with the delay in antibiotic administration. Conclusion: The adoption of standardised algorithms and protocols for the management of FN and ensuring timely healthseeking by the patients shall help reduce the delay in Time-toantibiotic Administration (TTA).

Increasing compliance rate of administration timing of antimicrobial prophylaxis in elective surgery within four months at a 100-bed capacity hospital

Objective: This quality improvement project aimed to work towards achieving more than 80% compliance with correct preoperative antibiotic administration timing within four months. Methods: Data obtained from the operating room (OR) during a four-month period from February to September, 2023 were retrospectively analyzed. All patients who underwent elective surgery were included in the study. Therefore, the recovery room (RR) was used as a holding area to ensure that the patients received antibiotic prophylaxis at the appropriate time. The ward nurse endorsed the patients along with the antibiotic prophylaxis, which was then administered by the OR nurse under the supervision and monitoring of an anesthesia physician. A clear procedure guideline was written in the form of a flowchart to be followed pre-surgery. Results: There was an increase in the mean correctly timed administration of preoperative antimicrobial prophylaxis from 59.6% at baseline to 81.45% during the post-intervention period (P = 0.013). Conclusion: Using the RR as a holding area helped us to achieve more than 80% compliance with correct preoperative antimicrobial prophylaxis timing. It also brought us closer to achieve 100% on-time compliance with preoperative antibiotic administration.

Effect of Intravenous Push and Piggyback Administration of Ceftriaxone on Mortality in Sepsis

BackgroundThere is a lack of evidence-based guidelines for the administration methods of ceftriaxone in emergency departments (EDs), resulting in the reliance on individual institutional protocols for decision-making. ObjectiveThis study was performed to compare the effects of administering ceftriaxone via intravenous push (IVP) and intravenous piggyback (IVPB) on 28-day mortality in patients with sepsis. MethodsThis was a retrospective study of patients aged 18 years or older with sepsis or septic shock who visited an ED and were treated with ceftriaxone as an initial antibiotic between March 2010 and February 2019. Patients were divided into the IVP group and the IVPB group based on the administration method. The primary outcome was 28-day mortality, and multivariable Cox proportional hazards regression analysis was performed to evaluate the relationship between antibiotic administration methods and 28-day mortality. ResultsDuring the study period, a total of 939 patients were included in the final analysis, and the overall mortality rate was 12.2%. The antibiotic administration time was significantly lower in the IVP group than in the IVPB group, and the rates of antibiotic administration within 1 h and within 3 h were higher in the IVP group than in the IVPB group (p < 0.05). However, there was no significant difference in 28-day mortality between the two groups (hazard ratio 1.07, 95% confidence interval 0.69–1.65). ConclusionsIVP administration of ceftriaxone reduced the time of antibiotic administration compared with IVPB, but there was no difference in 28-day mortality.

The use of probabilistic graphical models in pediatric sepsis: a feasibility and scoping review.

Recent research has demonstrated that machine learning (ML) has the potential to improve several aspects of medical application for critical illness, including sepsis. This scoping review aims to evaluate the feasibility of probabilistic graphical model (PGM) methods in pediatric sepsis application and describe the use of pediatric sepsis definition in these studies. Literature searches were conducted in PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL+), and Web of Sciences from 2000-2023. Keywords included "pediatric", "neonates", "infants", "machine learning", "probabilistic graphical model", and "sepsis". A total of 3,244 studies were screened, and 72 were included in this scoping review. Sepsis was defined using positive microbiology cultures in 19 studies (26.4%), followed by the 2005's international pediatric sepsis consensus definition in 11 studies (15.3%), and Sepsis-3 definition in seven studies (9.7%). Other sepsis definitions included: bacterial infection, the international classification of diseases, clinicians' assessment, and antibiotic administration time. Among the most common ML approaches used were logistic regression (n=27), random forest (n=24), and Neural Network (n=18). PGMs were used in 13 studies (18.1%), including Bayesian classifiers (n=10), and the Markov Model (n=3). When applied on the same dataset, PGMs show a relatively inferior performance to other ML models in most cases. Other aspects of explainability and transparency were not examined in these studies. Current studies suggest that the performance of probabilistic graphic models is relatively inferior to other ML methods. However, its explainability and transparency advantages make it a potentially viable method for several pediatric sepsis studies and applications.

Cytarabine Plus Etoposideis+Peg-Rhg-CSF Is More Effective Than Cyclophosphamide + G-CSF As a Stem Cell Mobilization Regimen in Poorly Mobilized MM and Lymphoma

There are several methods for hematopoietic stem cell (HSC) mobilization in lymphoma and multiple myeloma (MM)，of which Cyclophosphamide(Cy) plus granulocyte-colony stimulating factor(G-CSF)is a commonly used HSC mobilization regimen,but this regimen often fails to collect a sufficient number of stem cells, especially for poorly mobilized patients.However,previous studies have shown that the mobilization effect of cytarabine plus etoposide and G-CSF seems to have a higher mobilization efficacy. The purpose of this study is to retrospectively compare the mobilization effects of using cytarabine ，etoposide plus polyethylene glycol recombinant human granulocyte stimulating factor(PEG-rhG-CSF)(EAP) and Cy+G-CSF in proven poor mobilizer or predicted poor mobilizer of MM or lymphoma. A total of 43 patients were mobilized by EAP regimen and the 44 patients by Cy+G-CSF, including 56 patients with MM and 31 patients with lymphoma.Both groups were comparable. The target yield of 2× 10 6 CD34 + cells/kg was achieved in 90.7% (EAP) and 70.7% (Cy) of patients(P=0.003) by 1.3 and 1.6 apheresis (means).By single apheresis in 76.7% (EAP) and 29.5% (Cy) of patients achieve the ideal yield of 5× 10 6 CD34 + cells/kg .EAP mobilization resulted in higher peak concentration of CD34+ cells in blood in the first apheresis (median 59.4 vs 9.5/µL, p＜0.001)and second apheresis(median 23.2 vs 8.5/µL, p=0.001)compared to Cy mobilization. The median time of antibiotic administration in EAP mobilization was shorter than that in Cy mobilization (median 1.2 vs 3.1/d, p=0.041). The toxicity is different,the median time of agranulocytosis (median 1.2 vs 3.1/d, p=0 .003) after EAP mobilization were shorter than those after Cy，however, the median time for thrombocytopenia gr.4 (median 0.5 vs 0.2/d, p=0.001) was longer in the EAP group. In view of these results, we conclude that mobilization with EAP is excellent mobilization regimen with acceptable toxicity and could be considered in MM and lymphoma patients with factors of poor mobilization.

1476. Optimizing Preoperative Antibiotic Administration Timing to Reduce Surgical Site Infections

Abstract Background The administration of clinically indicated antibiotics prior to surgery in combination with other evidence-based practices reduces the risk of surgical site infection (SSI). A retrospective study of SSI at a community-based hospital that performs 5,700 procedures annually revealed broad variability in the timing of prophylactic antibiotic administration in relation to the time of incision. A Tableau dashboard was created to compare antibiotic administration to surgical incision timing and the impact variability may have on the incidence of SSI. Methods A multidisciplinary team was formed with surgeons, anesthesia, nursing, antimicrobial and diagnostic stewardship, infection prevention, and analytics representatives. Antibiotics selected for inclusion were those most prescribed for surgical prophylaxis according to organizational practice guidelines. Using the dashboard, optimal administration times were identified based upon the pharmacokinetics of the antibiotic as well as the expected tissue concentration at the incision site when available. (See table) Surgical encounters that received an antibiotic were classified as “pass”, “fail”, or “other”. Antibiotics started within the determined timeframe passed, those started earlier or later than the timeframe failed, and the others received antibiotics not included in the dashboard logic. Results In a baseline review 35.5% of cases failed timing criteria. Failures occurred most frequently with cefazolin, ceftriaxone and clindamycin. A retrospective analysis of SSI (n = 34) classified using the National Healthcare Safety Network (NHSN) definitions correlated with the baseline data. The outliers were comprised of antibiotics started too close to or after incision (14.7%) and antibiotics started much earlier than the dosing timeframe and incision (17.6%). Conclusion The surgical prophylaxis timing dashboard helped to identify gaps in administration practices and highlighted the need for process improvement initiatives. Ongoing interventions to improve adherence to national guidelines will be evaluated to determine the impact on SSI rates. Disclosures All Authors: No reported disclosures

Preoperative Prophylactic Antibiotics Administration Does Not Influence Culture Yield in Revision Shoulder Arthroplasty.

The importance of administrating prophylactic antibiotics prior to a surgical procedure is well established. Given the difficulty in diagnosing shoulder periprosthetic infections, which are more indolent in nature, some advocate holding prophylactic antibiotics prior to obtaining cultures as there is a concern antibiotics may lead to a false negative culture result. The purpose of this study is to determine whether administration of antibiotics prior to obtaining cultures in revision shoulder arthroplasty influences culture yield. This was a retrospective analysis of revision shoulder arthroplasty cases performed at a single institution between 2015 and 2021. During the study period, each surgeon had a standardized protocol that dictated whether antibiotics were given or held prior to each revision surgery. Each case was categorized into either a Pre-culture antibiotic group, if antibiotics were administered prior to incision, or a Post-culture antibiotic group if antibiotics were administered after incision and obtaining cultures. Basic demographics and the International Consensus Meeting (ICM) scoring criteria provided by the Musculoskeletal Infection Society was used to categorize the probability of periprosthetic joint infection for each case. Culture positivity was calculated as the ratio of positive cultures and total number of cultures obtained. One hundred and twenty-four patients met inclusion criteria. There were 48 patients in the Pre-culture group and 76 patients in the Post-culture group. No significant difference in patient demographics or ICM criteria (p=0.09) was observed between the two groups. With regards to culture positivity, there was no difference between the Pre-culture antibiotic group and the Post-culture antibiotic group (16% vs 15%, p=0.82, confidence interval= 8-25% vs. 10-20%, respectively). In the setting of revision shoulder arthroplasty, timing of antibiotic administration did not significantly influence culture yield. This study supports the use of prophylactic antibiotics prior to obtaining cultures in revision shoulder arthroplasty.

Timing of prophylactic antibiotics administration and suspected systemic infection after percutaneous biliary intervention.

Prophylactic antibiotics administration before percutaneous biliary intervention (PBI) is currently recommended, but the underlying evidence is mostly extrapolated from prophylactic antibiotics before surgery. The aim of this study was to evaluate the impact of prophylactic antibiotics administration timing on the incidence of suspected systemic infection after PBI. The incidence of suspected systemic infection after PBI was compared in patients who received prophylactic antibiotics at four different time intervals between antibiotics administration and skin puncture for PBI. Suspected post-intervention systemic infection was assessed according to predetermined clinical criteria. There were 98 (21.6%) suspected systemic infections after 454 PBIs in 404 patients. There were significant differences among the four groups in the incidence of suspected systemic infection after the intervention (p = .020). Fever was the most common sign of suspected systemic infection. Administration of prophylactic antibiotics more than an hour before PBI was identified as an independent risk factor of suspected systemic infection after adjusting for other relevant factors (adjusted odds ratio = 10.54; 95% confidence interval, 1.40-78.86). The incidence of suspected systemic infection after the PBI was significantly lower when prophylactic antibiotics were administered within an hour before the intervention.

Surgical prophylaxis in pediatric orthopedic patients with penicillin allergy: a multicentered retrospective prognostic study.

Up to 20% of orthopedic surgeons still avoid the use of cephalosporins in patients with penicillin allergies despite its reported safety in the adult and general surgery pediatric population. The primary objective is to determine the incidence of adverse effects and allergic reactions when using cephalosporins in pediatric orthopedic patients labeled as penicillin-allergic as compared to those without previously reported penicillin allergy. A multicenter retrospective chart review was performed across three level 1 trauma centers from January 2013 to February 2020 to identify penicillin-allergic as well as non-penicillin-allergic pediatric patients treated for orthopedic injuries. Data were collected regarding patient demographics, antibiotic administered, timing of antibiotic administration, reported drug allergy, and described allergic reaction. Postoperative or intraoperative allergic reactions to antibiotics, surgical site infections, and complications were recorded. A total of 2289 surgeries performed by four fellowship-trained surgeons were evaluated. Eighty-five patients diagnosed with penicillin allergy were identified and underwent 95 surgeries and 95 patients without previously reported penicillin allergy underwent 95 surgeries. One patient, with a documented history of anaphylaxis to cefazolin, sustained an anaphylactic reaction intraoperatively to cefazolin. There were no other reported reactions, surgical site infections, or complications. There was no statistically significant difference in rate of allergic reaction in patients with previously reported penicillin allergy treated with cefazolin and those with no previous reported reaction ( P > 0.05). Prophylaxis with cephalosporins is not associated with increased risk for allergic reaction. Cephalosporins can be safely administered to pediatric patients with penicillin allergy undergoing orthopedic intervention. Level of evidence: Level II, Multicenter Retrospective Prognostic Study.

Timing of antibiotics in febrile children meeting sepsis criteria at a paediatric emergency department.

Delay in antibiotic administration in paediatric sepsis is associated with increased mortality and prolonged organ dysfunction. This pre-intervention study evaluated performance in paediatric sepsis management. Retrospective cohort study of febrile children admitted through the ED at The Children's Hospital at Westmead, Sydney, between 1 May and 31 July 2017. Participants were children aged 29 days to 60 months excluding children with simple febrile seizures, neonates and children who had received intravenous antibiotics elsewhere. We assessed the timing of antibiotic administration in children meeting local sepsis guidelines. We conducted a survey of clinicians in ED in 2018 to describe contributing factors. There were 160 febrile children admitted and 144 presentations were included in the analysis. Male 53% (n = 76); median age 20.1 months (interquartile range [IQR] 3.9-37 months). Thirty-seven (26%) febrile children met local sepsis criteria. The median time from triage to first dose of intravenous antibiotic was 109 min (IQR 62-183 min). Delay (>60 min) occurred in 26 (76%) children. Reported reasons contributing to delay included high patient load, long waiting times, difficult intravenous access, delayed prescribing, inadequate staffing and difficulty distinguishing between a viral infection and serious bacterial infection. There was frequent delay in administering antibiotics in children meeting local sepsis criteria, more commonly in young infants. Reasons contributing to delay were specific to young children along with departmental factors that will require addressing through targeted quality improvement interventions.

Timing of antibiotic administration determines the spread of plasmid-encoded antibiotic resistance during microbial range expansion

Plasmids are the main vector by which antibiotic resistance is transferred between bacterial cells within surface-associated communities. In this study, we ask whether there is an optimal time to administer antibiotics to minimize plasmid spread in new bacterial genotypes during community expansion across surfaces. We address this question using consortia of Pseudomonas stutzeri strains, where one is an antibiotic resistance-encoding plasmid donor and the other a potential recipient. We allowed the strains to co-expand across a surface and administered antibiotics at different times. We find that plasmid transfer and transconjugant proliferation have unimodal relationships with the timing of antibiotic administration, where they reach maxima at intermediate times. These unimodal relationships result from the interplay between the probabilities of plasmid transfer and loss. Our study provides mechanistic insights into the transfer and proliferation of antibiotic resistance-encoding plasmids within microbial communities and identifies the timing of antibiotic administration as an important determinant.

713 Acute Change in qSOFA Score as a Prognostic Tool for Diagnosing Sepsis in Burn Patients

Abstract Introduction Sepsis is a diagnostic challenge in all critically ill patients, but particularly so in the burn patient population. The objective of this study was to evaluate if the modified sepsis-3 criteria defined as an acute change in SOFA score ≥2 was predictive of clinical infection. Methods The hospital database was reviewed between 2016 and 2019 to identify patients who received broad spectrum antibiotics within 2 days of sustaining their injury. Culture specimens taken at the time of antibiotic administration determined presence of a clinical infection. Results Between 2016 and 2019, a total of 98 patients were admitted to the burn unit within 2 days of their injury and received prophylactic meropenum and/or piperacillin/tazobactam for suspicion of clinical infection. When stratified based on an acute change in SOFA score within 48 hours prior to receiving antibiotics, 67 (72%) patients received antibiotics with an acute change in SOFA score ≤1, and 26 (27%) patients received antibiotics with an acute change in SOFA score ≥2. Of those patients with the acute change in SOFA score ≥2, 22 patients (85%) had positive cultures associated with the timing of prophylactic antibiotics, as compared to 60 patients (90%) with a change in SOFA score ≤1 (p value 0.05). Conclusions Our data suggests that the modified sepsis-3 criteria is not a reliable tool for diagnosing burn sepsis. Applicability of Research to Practice Improving our ability to accurately predict sepsis in burn patients can improve patient outcomes and decrease unnecessary administration of broad spectrum antibiotics.

Metagenomic next-generation sequencing vs. conventional detection methods for detecting the pulmonary infections.

The absence of proper pathogen treatment in the early stages can result in missing out on treatment chances or the overuse of antibiotics, both of which are the primary factors behind fatalities caused by lung infections. In this study, we aimed to investigate the efficacy of metagenomic next-generation sequencing (mNGS) in comparison to conventional detection methods in detecting infectious pathogens. In this retrospective study, the infection pathogens of 104 patients were examined, and 86 bronchoalveolar lavage fluid (BALF), eight pleural effusions, and ten sputum samples were collected. The conventional detection approaches and mNGS analysis were used to determine the infection pathogen profiles and their detection rates were analyzed. Our study showed that mNGS was more sensitive (89.42%) than the conventional detection methods (56.73%) (p < 0.001), with a 32.69% improvement in sensitivity. The efficacy of mNGS in detecting mixed infections was significantly higher than that of conventional detection methods, with a detection rate of 85.29% compared to 17.65% (p < 0.001). The study demonstrated that mNGS had a higher sensitivity than the conventional detection methods when it came to diagnosing pulmonary infections, making it a potentially useful tool for clinical diagnosis. Combining mNGS with other pathogenic detection techniques can be an effective way to increase the rate of detecting pulmonary infections, as well as to provide guidance for treatment adjustments. Furthermore, the timing of sample collection and antibiotic administration can influence the effectiveness of mNGS when used on BALF specimens.

Proper Timing for Administration of Prophylactic Intravenous Antibiotics for Elective Surgical Procedures

Background: Preoperative antibiotic prophylaxis is administering antibiotics before performing surgery to help decrease the risk of postoperative infections. The antibiotic selected should only cover the likely pathogens. It should be given at the correct time. The timing of antibiotic administration may vary, but the goal of administering preoperative systemic prophylactic antibiotics is to have the concentration in the tissues at its highest at the start and during surgery. The literature supports at least 30 minutes, but no greater than 60 minutes before the skin incision is made to the optimal timing for the preoperative administration of most commonly used antibiotics. Aims and Objectives: To obtain precise information on the optimal time window for surgical antimicrobial prophylaxis (SAP). Methodology: A retrospective observational study design was used to investigate the effect of timing of SAP on the risk of surgical site infection (SSI) from September 2021 until September 2022. Patients with Inguinal hernia who performed elective inguinal hernia repair were eligible for enrollment in the study. The risk of SSI was compared between patients, categorized by the time interval between SAB administration and incision, and adjusted for confounding through Univariate Analysis logistic regression. Hakeem data base was used to collect the required data. This study was performed in King Hussein Medical Center (KHMC) at the Royal Medical Services in Amman/Jordan. Results: Data included in the current study was collected for the period between September 2021 until September 2022, in which 500 patients were randomly assigned into two arms; Patients in arm A received the in a time window of 60 to 30 minutes before the scheduled incision while Patients in arm B received the antibiotics in time window of less than 30 minutes to 0 minutes before the scheduled incision. In 52% of the procedures, SAP was administered within 60 minutes before incision Inpatient and ...........

Estimating treatment effects for time-to-treatment antibiotic stewardship in sepsis.

Sepsis is a life-threatening condition with a high in-hospital mortality rate. The timing of antibiotic administration poses a critical problem for sepsis management. Existing work studying antibiotic timing either ignores the temporality of the observational data or the heterogeneity of the treatment effects. Here we propose a novel method (called T4) to estimate treatment effects for time-to-treatment antibiotic stewardship in sepsis. T4 estimates individual treatment effects by recurrently encoding temporal and static variables as potential confounders, and then decoding the outcomes under different treatment sequences. We propose mini-batch balancing matching that mimics the randomized controlled trial process to adjust the confounding. The model achieves interpretability through a global-level attention mechanism and a variable-level importance examination. Meanwhile, we equip T4 with an uncertainty quantification to help prevent overconfident recommendations. We demonstrate that T4 can identify effective treatment timing with estimated individual treatment effects for antibiotic stewardship on two real-world datasets. Moreover, comprehensive experiments on a synthetic dataset exhibit the outstanding performance of T4 compared with the state-of-the-art models on estimation of individual treatment effect.