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Initial Antibiotic Therapy (initial + antibiotic_therapy)

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Medical Sciences100%

Selected Abstracts

Risk factors and outcome of community-acquired pneumonia due to Gram-negative bacilli

RESPIROLOGY, Issue 1 2009
Miquel FALGUERA
Background and objective: Several sets of guidelines have advocated initial antibiotic treatment for community-acquired pneumonia due to Gram-negative bacilli in patients with specific risk factors. However, evidence to support this recommendation is scarce. We sought to identify risk factors for community-acquired pneumonia due to Gram-negative bacilli, including Pseudomonas aeruginosa, and to assess outcomes. Methods: An observational analysis was carried out on prospectively collected data for immunocompetent adults hospitalized for community-acquired pneumonia in two acute-care hospitals. Cases of pneumonia due to Gram-negative bacilli were compared with those of non-Gram-negative bacilli causes. Results: Sixty-one (2%) of 3272 episodes of community-acquired pneumonia were due to Gram-negative bacilli. COPD (odds ratio (OR) 2.4, 95% confidence interval (CI): 1.2,5.1), current use of corticosteroids (OR 2.8, 95% CI: 1.2,6.3), prior antibiotic therapy (OR 2.6, 95% CI: 1.4,4.8), tachypnoea ,30 cycles/min (OR 2.1, 95% CI: 1.1,4.2) and septic shock at presentation (OR 6.1, 95% CI: 2.5,14.6) were independently associated with Gram-negative bacilli pneumonia. Initial antibiotic therapy in patients with pneumonia due to Gram-negative bacilli was often inappropriate. These patients were also more likely to require admission to the intensive care unit, had longer hospital stays, and higher early (<48 h) (21% vs 2%; P < 0.001) and overall mortality (36% vs 7%; P < 0.001). Conclusions: These results suggest that community-acquired pneumonia due to Gram-negative bacilli is uncommon, but is associated with a poor outcome. The risk factors identified in this study should be considered when selecting initial antibiotic therapy for patients with community-acquired pneumonia. [source]

Empirical therapy for diabetic foot infections: are there clinical clues to guide antibiotic selection?

CLINICAL MICROBIOLOGY AND INFECTION, Issue 4 2007
B. A. Lipsky
Abstract Initial antibiotic therapy for diabetic foot infections is usually empirical. Several principles may help to avoid selecting either an unnecessarily broad or inappropriately narrow regimen. First, clinically severe infections require broad-spectrum therapy, while less severe infections may not. Second, aerobic Gram-positive cocci, particularly Staphylococcus aureus (including methicillin-resistant S. aureus (MRSA) for patients at high-risk) should always be covered. Third, therapy should also be targeted at aerobic Gram-negative pathogens if the infection is chronic or has failed to respond to previous antibiotic therapy. Fourth, anti-anaerobe agents should be considered for necrotic or gangrenous infections on an ischaemic limb. Parenteral therapy is needed for severe infections, but oral therapy is adequate for most mild or moderate infections. [source]

Sensitivity of superficial cultures in lower extremity wounds,

JOURNAL OF HOSPITAL MEDICINE, Issue 7 2010
Chayan Chakraborti MD
Abstract BACKGROUND: Superficial wound cultures are routinely used to guide therapy, despite a lack of clear supporting evidence. PURPOSE: To conduct a systematic review of the correlation between superficial wound cultures and the etiology of skin and soft tissue infections. DATA SOURCES: Medline, EMBASE, CINAHL, Scopus. STUDY SELECTION: Articles published between January 1960 and August 2009 involving superficial wound cultures and deeper comparison cultures. DATA EXTRACTION: Two reviewers independently searched for abstracted information pertaining to the microbiology of lower extremity wounds sufficient to calculate the sensitivity and specificity of superficial wound cultures versus comparison cultures. DATA SYNTHESIS: Data pooled using a random-effects meta-analysis model. RESULTS: Of 9032 unique citations, 8 studies met all inclusion criteria. Inter-rater reliability was substantial (Kappa = 0.78). Pooled test sensitivity for superficial wound swabs was 49% (95% confidence interval [CI], 37-61%], and specificity was 62% (95% CI, 51-74%). The pooled positive and negative likelihood ratios (LRs) were 1.1 (95% CI, 0.71-1.5) and 0.67 (95% CI, 0.52-0.82). The median number of isolates for surface cultures (2.7, interquartile range [IQR] 1.8-3.2) was not significantly different than that for comparison cultures, (2.2, IQR 1.7-2.9) (P = 0.75). CONCLUSION: Few studies show a strong relationship between superficial wound swabs and deep tissue cultures, and the current data demonstrate poor overall sensitivity and specificity. The positive and negative LRs were found to provide minimal utility in influencing pretest probabilities. Results of this analysis show that wound cultures should not be used in lieu of local antibiograms to guide initial antibiotic therapies. Journal of Hospital Medicine 2010;5:415,420. © 2010 Society of Hospital Medicine. [source]

Risk factors and outcome of community-acquired pneumonia due to Gram-negative bacilli

RESPIROLOGY, Issue 1 2009
Miquel FALGUERA
Background and objective: Several sets of guidelines have advocated initial antibiotic treatment for community-acquired pneumonia due to Gram-negative bacilli in patients with specific risk factors. However, evidence to support this recommendation is scarce. We sought to identify risk factors for community-acquired pneumonia due to Gram-negative bacilli, including Pseudomonas aeruginosa, and to assess outcomes. Methods: An observational analysis was carried out on prospectively collected data for immunocompetent adults hospitalized for community-acquired pneumonia in two acute-care hospitals. Cases of pneumonia due to Gram-negative bacilli were compared with those of non-Gram-negative bacilli causes. Results: Sixty-one (2%) of 3272 episodes of community-acquired pneumonia were due to Gram-negative bacilli. COPD (odds ratio (OR) 2.4, 95% confidence interval (CI): 1.2,5.1), current use of corticosteroids (OR 2.8, 95% CI: 1.2,6.3), prior antibiotic therapy (OR 2.6, 95% CI: 1.4,4.8), tachypnoea ,30 cycles/min (OR 2.1, 95% CI: 1.1,4.2) and septic shock at presentation (OR 6.1, 95% CI: 2.5,14.6) were independently associated with Gram-negative bacilli pneumonia. Initial antibiotic therapy in patients with pneumonia due to Gram-negative bacilli was often inappropriate. These patients were also more likely to require admission to the intensive care unit, had longer hospital stays, and higher early (<48 h) (21% vs 2%; P < 0.001) and overall mortality (36% vs 7%; P < 0.001). Conclusions: These results suggest that community-acquired pneumonia due to Gram-negative bacilli is uncommon, but is associated with a poor outcome. The risk factors identified in this study should be considered when selecting initial antibiotic therapy for patients with community-acquired pneumonia. [source]

Rare Species of Actinomyces as Causative Pathogens in Breast Abscess

THE BREAST JOURNAL, Issue 5 2007
Kaka Hama Attar MRCS
Abstract:, Actinomyces species are commensal flora usually found in the oropharynx, gastrointestinal tract, and female genital tract. Primary actinomycosis of the breast is an unusual condition, where the most commonly isolated pathogen has been Actinomyces israelii. In recent years, other Actinomyces strains have been found associated with breast disease. We present the first reported cases of breast infection caused by the rare species, Actinomyces turicensis and Actinomyces radingae. Both infections displayed chronicity and abscess formation. In the first case, the infection was refractory to recurrent aspirations and initial antibiotic therapy. In the second case, aspiration and prolonged antibiotic therapy was required to overcome the chronic infection. [source]