Sunday, June 29, 2008
Scand J Infect Dis. 2008
Waagsbø B, Sundøy A, Quist Paulsen E.
From the Medisinsk avdeling, Sørlandet Sykehus Kristiansand, Norway.
This study was designed to help physicians consider change from intravenous to oral antibiotic therapy for any infection from d 3 of hospital stay, by implementing guidelines for antibiotic switch. A 2-centre intervention study was conducted at Sorlandet Hospital HF Kristiansand and Arendal. All patients admitted to the Medical Clinic at these hospitals prescribed with intravenous antibiotics at hospitalization, were included. After collecting data in an observation period, antibiotic switch guidelines were launched in the respective departments of both hospitals. The length of unnecessary intravenous d, duration of hospital stay and outcome of treatment were compared before (observation group) and after (intervention group) the guidelines were implemented. Antibiotic switch was considered from d 3 and onward. The effect of switch guidelines implementation was measured as a reduction of unnecessary intravenous d. Duration of unnecessary intravenous antibiotic therapy was significantly reduced from 3.4 d in the observation group to 1.4 d in the intervention group. Unnecessary intravenous d were found to constitute 83% of total intravenous therapy duration in the observation group and 48% in the intervention group. Duration of hospital stay was significantly reduced from 7.0 to 6.3 d. There was no statistically significant difference in mortality rate, re-prescription of intravenous antibiotic therapy or re-admittance to the hospital. In conclusion, implementing antibiotic switch guidelines significantly reduces the duration of unnecessary intravenous antibiotic therapy. The switch guidelines were based on general criteria for antibiotic switch for any infection.
Scand J Infect Dis. 2008
Erlandsson M, Gill H, Nordlinder D, Giske CG, Jonas D, Nilsson LE, Walther S, Hanberger H.
From the Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linkoping University, Linkoping.
Pseudomonas aeruginosa is 1 of the bacteria most adaptive to anti-bacterial treatment. Previous studies have shown nosocomial spread and transmission of clonal strains of P. aeruginosa in European hospitals. In this study we investigated antibiotic susceptibility and clonality in 101 P. aeruginosa isolates from 88 patients admitted to 8 Swedish ICUs during 2002. We also compared phenotypes and genotypes of P. aeruginosa and carried out cluster analysis to determine if phenotypic data can be used for surveillance of clonal spread. All isolates were collected on clinical indication as part of the NPRS II study in Sweden and were subjected to AFLP analysis for genotyping. 68 isolates with unique genotypes were found. Phenotyping was performed using MIC values for 5 anti-pseudomonal agents. Almost 6% of the isolates were multi-drug resistant (MDR), and this figure rose to almost 8% when intermediate isolates were also included. We found probable clonal spread in 9 cases, but none of them was found to be an MDR strain. Phenotypical cluster analysis produced 40 clusters. Comparing partitions did not demonstrate any significant concordance between the typing methods. The conclusion of our study is that cross-transmission and clonal spread of MDR P. aeruginosa does not present a clinical problem in Swedish ICUs, but probable cross-transmission of non-MDR clones indicate a need for improved hygiene routines bedside. The phenotype clusters were not concordant with genotype clusters, and genotyping is still recommended for epidemiological tracking.
Friday, June 27, 2008
Ann Pharmacother. 2008 Jun 24
McPherson C, Gal P, Ransom JL.
Departments of Neonatal Medicine and Pharmacy, Women's Hospital, Greensboro, NC.
OBJECTIVE: To report a case of successful treatment of Citrobacter koseri infection in a preterm infant as a means of challenging the current treatment recommendations on the basis of pharmacodynamic and pharmacokinetic considerations.
CASE SUMMARY: A premature infant was diagnosed with C. koseri sepsis after 3 weeks in intensive care. Concern for meningitis was based on the propensity for central nervous system (CNS) involvement with Citrobacter infection along with new findings of ventriculomegaly and hydrocephalus shown on cranial ultrasound (CUS).
The infant was treated with ciprofloxacin 10-20 mg/day and cefotaxime 100 mg/day for 21 days. After treatment, lumbar puncture was normal, follow-up CUS returned to baseline, and the infant passed a hearing screen after discharge. A favorable outcome was achieved in this case.
DISCUSSION: Approximately 76% of neonatal patients infected with C. koseri develop brain abscesses. The mortality rate for meningitis due to Citrobacter spp. is approximately 30%, and of the infants who survive, more than 80% have some degree of mental retardation. Third-generation cephalosporins and aminoglycosides are traditional therapies against this infection.
The current antibiotic strategies have failed to prevent the high rates of morbidity and mortality associated with Citrobacter infections. A possible basis for these poor outcomes is failure to apply appropriate pharmacokinetic and pharmacodynamic principles in selecting antibiotics that will achieve adequate concentrations to kill the bacteria in granulocytes within the CNS. Based on favorable sensitivity data, penetration into neutrophils and the CNS, and favorable toxicity profiles, ciprofloxacin and meropenem would appear to be the most appropriate antibiotic treatment options for systemic infection or meningitis caused by C. koseri.
CONCLUSIONS: Ciprofloxacin and meropenem should be considered antibiotic treatment options for systemic infection or meningitis caused by C. koseri.
Annals of Pharmcotherapy
Tuesday, June 10, 2008
Int J Antimicrob Agents. 2008 Jun
Research Centre for Medical Studies, Institute of Clinical Pharmacology, Charité Universitätsmedizin Berlin, Hohenzollerndamm 2, D-10717 Berlin, Germany.
In the current context of increasing antimicrobial resistance, it is important to use antibiotics rationally and to re-assess regularly the clinical usefulness of commonly used agents. This review focuses on the efficacy of the beta-lactam ampicillin co-administered with the beta-lactamase inhibitor sulbactam, either parenterally (ampicillin/sulbactam) or orally (sultamicillin), for the treatment of bacterial infections. Clinical findings from the past decade confirm the results of numerous older studies and together provide good evidence to support the continued use of ampicillin/sulbactam and sultamicillin in hospital- and community-acquired infections both in adults and children.
This is also recognised in recent published national and international guidelines, many of which recommend ampicillin/sulbactam as first-line therapy for various respiratory and skin infections.