Division of Newborn Medicine, Kravis Children's Hospital, Mount Sinai Medical Center, New York, N.Y., USA.
Background: Initiation of empiric antibiotic treatment for possible early-onset sepsis is recommended for late preterm and term neonates with respiratory distress. There is no evidence base to this approach.
Objectives: To determine the incidence of adverse infectious events in neonates with transient tachypnea of the newborn (TTN) managed with a risk-factor-based restrictive antibiotic use policy.
Methods:This is a single institution retrospective cohort study of neonates with primary diagnosis of TTN between 2004 and 2010. The relationship between antibiotic exposure and infectious outcomes during the neonatal hospitalization was evaluated. An infectious outcome was defined as pneumonia, bacteremia, clinical sepsis, or death. Analysis included t test, χ(2) test, and analysis of variance as appropriate.
Results:745 neonates with TTN met inclusion criteria. None of the 494 antibiotic-naive infants, and 212 of the 251 antibiotic-exposed infants had identifiable risk factors for sepsis. No infectious outcomes occurred in infants who did not receive antibiotics. Eight neonates with TTN received full antibiotic treatment for early-onset sepsis. Each was appropriately identified for early receipt of antibiotics based on historical or clinical risk factors for early-onset sepsis.
Conclusions:This study suggests that empiric postnatal antibiotictreatment may not be warranted for late preterm and term infants with TTN in the absence of specific infectious risk factors.
INESC-ID/IST, Technical University of Lisbon, Lisbon, Portugal.
The rise of antibiotic resistance in pathogenic bacteria is a significant problem for the treatment of infectious diseases. Resistance is usually selected by the antibiotic itself; however, biocides might also co-select for resistance to antibiotics. Although resistance to biocides is poorly defined, different in vitro studies have shown that mutants presenting low susceptibility to biocides also have reduced susceptibility to antibiotics. However, studies with natural bacterial isolates are more limited and there are no clear conclusions as to whether the use of biocides results in the development of multidrug resistant bacteria.
The main goal is to perform an unbiased blind-based evaluation of the relationship between antibiotic and biocide reduced susceptibility in natural isolates of Staphylococcus aureus. One of the largest data sets ever studied comprising 1632 human clinical isolates of S. aureus originated worldwide was analysed. The phenotypic characterization of 13 antibiotics and 4 biocides was performed for all the strains. Complex links between reduced susceptibility to biocides and antibiotics are difficult to elucidate using the standard statistical approaches in phenotypic data. Therefore, machine learning techniques were applied to explore the data.
In this pioneer study, we demonstrated that reduced susceptibility to two common biocides, chlorhexidine and benzalkonium chloride, which belong to different structural families, is associated to multidrug resistance. We have consistently found that a minimum inhibitory concentration greater than 2 mg/L for both biocides is related to antibiotic non-susceptibility in S. aureus.
Two important results emerged from our work, one methodological and one other with relevance in the field of antibiotic resistance. We could not conclude on whether the use of antibiotics selects for biocide resistance or vice versa. However, the observation of association between multiple resistance and two biocides commonly used may be of concern for the treatment of infectious diseases in the future.
Department of Orthopedics, Henan Provincial People's Hospital, No. 7, Weiwu Road, 450003, Zhengzhou, China.
To investigate the clinical outcome of two-stage revision total hip arthroplasty for infected hip arthroplasty usingantibiotic-impregnated cement prosthesis.
MATERIALS AND METHODS:
Forty-one patients, who suffered from an infection after hip replacement or internal fixation of femoral neck and trochanteric fractures, were treated with a two-stage revision hip arthroplasty and followed up for an average of 37 months. All the patients were implanted with antibiotic-impregnated cement prosthesis as one-stage treatment and were then managed with two-stage revision hip arthroplasty after 12-24 weeks. During the follow-up, Merle d'Aubigné hip score and Harris score were employed for assessment of hip function, and infection recurrence was observed.
According to Merle d'Aubigné hip score, 16 patients (39.2 %) were excellent, 19 (46.3 %) were good, 6 (14.6 %) were moderate, and no bad result and the average score was 15.42. Mean Harris score of preoperation, interval period, and postoperation was 46.7, 66.5, and 92.3, respectively. There was no infection recurrence.
Two-stage revision total hip arthroplasty for infected hip arthroplasty using antibiotic-impregnated cement prosthesis has a satisfying clinical outcome.
University of Valle, Cra 35 No 3a-38 Ap 301, Cali, Colombia, firstname.lastname@example.org.
To establish the efficacy of antibiotic prophylaxis prior to cystoscopy in outpatients in decreasing the incidence of post-procedure urinary tract infection.
STUDY DESIGN AND SETTING:
A randomized clinical trial in patients (men and women) older than 18 who underwent cystoscopy for any non-urgent indication. The intervention was Levofloxacin 500 mg single dose, and the control was placebo 500 mg single dose made with similar characteristics. The primary outcome was urinary tract infection (UTI) measured 3-10 days after the procedure. It was performed as per protocol analysis.
Hundred and thirty-eight patients in each study arm completed the trial. The incidence of UTI in the intervention group was 0.7 % and in the placebo group was 3 % (p = 0.17), and no significant differences were found. The incidence of asymptomatic bacteriuria in the intervention group was 5.8 % and in the control group was 14.5 % (p = 0.01).
No significant differences were found in the use of prophylactic antibiotic compared to placebo to reduce the incidence of UTI in patients who undergo cystoscopy as an outpatient procedure with sterile urine demonstrated by urine culture.
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, USA.
The treatment of hepatic encephalopathy (HE) is complex and therapeutic regimens vary according to the acuity of presentation and the goals of therapy. Most treatments for HE rely on manipulating the intestinal milieu and therefore antibiotics that act on the gut form a key treatment strategy. Prominent antibiotics studied in HE are neomycin, metronidazole, vancomycin and rifaximin. For the management of the acute episode, all antibiotics have been tested. However the limited numbers studied, adverse effects (neomycin oto- and nephrotoxicity, metronidazole neurotoxicity) and potential for resistance emergence (vancomycin-resistant enterococcus) has limited the use of most antibiotics, apart from rifaximin which has the greatest evidence base. Rifaximin has also demonstrated, in conjunction with lactulose, to prevent overt HE recurrence in a multi-center, randomized trial. Despite its cost in the US, rifaximin may prove cost-saving by preventing hospitalizations for overt HE. In minimal/covert HE, rifaximin is the only systematically studied antibiotic. Rifaximin showed improvement in cognition, inflammation, quality-of-life and driving simulator performance but cost-analysis does not favor its use at the current time. Antibiotics, especially rifaximin, have a definite role in the management across the spectrum of HE.
1Department of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA 2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 3Division of Pediatric Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA 4Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.
ABSTRACT:Study Design: Retrospective cohort study using the Pediatric Health Information Systems (PHIS) database.
Objective:To describe longitudinal patterns of prophylactic antibiotic use and determinants of antibiotic choice for spinal fusion surgeries performed at US children's hospitals.Summary of Background Data: Surgical Site Infections (SSIs) account for a significant proportion of post-spinal surgery complications, particularly among children with complex conditions such as neuromuscular disease. Antimicrobial prophylaxis with intravenous (IV) cefazolin or cefuroxime has been a standard practice, but postoperative infections caused by organisms resistant to these antibiotics are increasing in prevalence. Studies describing the choice of antibiotic prophylaxis for pediatric spinal surgery are lacking.
Methods: We included children 6 months to 18 years of age discharged from 37 US children's hospitals between January 1, 2006 - June 30, 2009 with 1) an ICD9-CM procedure code indicating a spinal fusion and 2) combinations of diagnosis codes indicating adolescent idiopathic scoliosis (AIS, n = 5,617) or neuromuscular scoliosis (NMS, n = 3,633). After identifying antibiotics ordered on the operative day, we described variation in broad-spectrum antibiotic use over time, and measured associations between patient/surgery characteristics and antibiotic choice.
Results:Prophylactic antibiotic choice varied across hospitals and over time. Broad-spectrum antibiotics were used in 37% of AIS and 52% of NMS operations. Seven (19%) hospitals used broad spectrum coverage for greater than 80% of all cases. For NMS procedures, broad-spectrum antibiotic use was associated with patient characteristics known to be associated with high SSI risk. Use of vancomycin and broad gram-negative agents increased over time.
Conclusion:Broad-spectrum antimicrobial prophylaxis varied across hospitals, and was often associated with known risk factors for SSI. These results highlight the need for future studies comparing the effectiveness of various prophylaxis strategies, particularly in high risk subgroups. This research can inform the development of best practice for SSI prevention in spinal fusion procedures.