Impact of antibiotic therapy in severe community-acquired pneumonia:

Antibiotic therapy (AT) is the cornerstone of the management of severe community-acquired pneumonia (CAP). However, the best treatment strategy is far from being established | Journal of Critical Care

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Highlights:

  • In SCAP patients, the use of combination of antibiotics that includes a macrolide is associated a better hospital and long term (6 months) survival.
  • Courses of antibiotic therapy longer than 7 days are not associated with survival benefit but lead to longer ICU and hospital LOS.
  • Serum lactate showed to be a good prognostic marker of hospital mortality in SCAP patients.

Full reference: Pereira, J.M. et al. (2017) Impact of antibiotic therapy in severe community-acquired pneumonia: Data from the Infauci study. Journal of Critical Care. Published online: 4 September 2017

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Can improving patient hand hygiene impact Clostridium difficile infection events at an academic medical center?

Highlights: 

  • An educational intervention study was completed to improve patient hand hygiene opportunities for patients at a large academic medical center.
  • After the intervention, it was possible to study the effects of improved patient hand hygiene on health care facility–onset Clostridium difficile infection events.
  • C difficile infection events decreased significantly (P ≤ .05) for 6 months after the intervention.
  • Patient hand hygiene may be an underused prevention measure for C difficile disease; successful implementation requires staff to engage the patient with opportunities, reminders, and encouragement to keep their hands clean

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Full reference: Pokrywka, M. et al. (2017) Can improving patient hand hygiene impact Clostridium difficile infection events at an academic medical center? American Journal of Infection Control. Vol. 45 (Issue 9) pp. 959–963

Reducing catheter-associated urinary tract infections in the ICU

This review provides a summary of CAUTI reduction strategies that are specific to the intensive care setting | Current Opinion in Critical Care

Patients in the ICU are at higher risk for catheter-associated urinary tract infection (CAUTI) due to more frequent use of catheters and lower threshold for obtaining urine cultures.

The surveillance definition for CAUTI is imprecise and measures catheter-associated bacteriuria rather than true infection. Alternatives have been proposed, but CAUTI rates measured by this definition are currently required to be reported to the Centers for Medicare and Medicaid Services and high CAUTI rates can result in financial penalties. Although CAUTI may not directly result in significant patient harm, it has several indirect patient safety implications and CAUTI reduction has several benefits. Various bundles have been successful at reducing CAUTI both in individual institutions and on larger scales such as healthcare networks and entire states.

Full reference: Sampathkumar, P. (2017) Reducing catheter-associated urinary tract infections in the ICU. Current Opinion in Critical Care. Vol. 23 (Issue 5) pp. 372–377

 

A Role for Antimicrobial Stewardship in Clinical Sepsis Pathways

The aim of this study was to evaluate the impact of early infectious diseases (ID) antimicrobial stewardship (AMS) intervention on inpatient sepsis antibiotic management | Infection Control & Hospital Epidemiology

All patients reviewed by an ID Fellow within 24 hours of sepsis pathway trigger underwent case review and clinic file documentation of recommendations. Those not reviewed by an ID Fellow were considered controls and received standard sepsis pathway care. The primary outcome was antibiotic appropriateness 48 hours after sepsis trigger.

In total, 164 patients triggered the sepsis pathway: 6 patients were excluded (previous sepsis trigger); 158 patients were eligible; 106 had ID intervention; and 52 were control cases. Of these 158 patients, 91 (58%) had sepsis, and 15 of these 158 (9.5%) had severe sepsis. Initial antibiotic appropriateness, assessable in 152 of 158 patients, was appropriate in 80 (53%) of these 152 patients and inappropriate in 72 (47%) of these patients. In the intervention arm, 93% of ID Fellow recommendations were followed or partially followed, including 53% of cases in which antibiotics were de-escalated. ID Fellow intervention improved antibiotic appropriateness at 48 hours by 24% (adjusted risk ratio, 1.24; 95% confidence interval, 1.04–1.47; P=.035). The appropriateness agreement among 3 blinded ID staff opinions was 95%. Differences in intervention and control group mortality (13% vs 17%) and median length of stay (13 vs 17.5 days) were not statistically significant.

Sepsis overdiagnosis and delayed antibiotic optimization may reduce sepsis pathway effectiveness. Early ID AMS improved antibiotic management of non-ICU inpatients with suspected sepsis, predominantly by de-escalation.

Full reference: Burston, J. et al. (2017) A Role for Antimicrobial Stewardship in Clinical Sepsis Pathways: a Prospective Interventional Study. Infection Control & Hospital Epidemiology. Vol. 38 (Issue 9) pp. 1032-1038

Screening programmes | Childhood flu vaccination

Public Health England has updated the following documents:

 

Carbapenem-resistant Enterobacteriaceae in patients admitted to the Emergency Department

New risk factors and occurrence in patients coming directly from the community | Journal of Hospital Infection

Aim: To investigate the prevalence of patients harboring CRE on hospital admission, risk factors associated and the acquisition rate within the emergency department (ED).

Methods: We conducted a cross-sectional with 676 patients consecutively admitted to the ED study during the months of May to July 2016. A questionnaire was performed and rectal swabs were collected from patients on admission, for culture and for multiplex real-time polymerase chain-reaction (RT-PCR). If the patient was hospitalized for more than one week in the ED, samples were taken again to determine the acquisition rate of CRE.

Findings: Forty-six patients were colonized, all positive RT-PCR were KPC. The acquisition rate was 18%. Patients CRE colonized presented a higher mortality rate. Previous exposure to healthcare in the last year, liver disease and use of antibiotics in the last month were risk factors for colonization. Six patients with no previous exposure to healthcare were CRE-colonized on admission, suggesting transmission of CRE within the community.

Conclusion: Screening of high-risk patients on admission to the ED is a strategy to early identify CRE carriage and may contribute to control CRE dissemination.

Full reference: Salomão, M.C. et al. (2017) Carbapenem-resistant Enterobacteriaceae in patients admitted to the Emergency Department: new risk factors and occurrence in patients coming directly from the community. Journal of Hospital Infection. Published online: 18 August 2017

Incidence, prevalence, and management of MRSA bacteremia across patient populations

A review of recent developments in MRSA management and treatment | Critical Care

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Image source: Annie Cavanagh – Wellcome Images // CC BY-NC 4.0

Image shows clusters of methicillin-resistant Staphylococcus aureus bacteria.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is still a major global healthcare problem. Of concern is S. aureus bacteremia, which exhibits high rates of morbidity and mortality and can cause metastatic or complicated infections such as infective endocarditis or sepsis. MRSA is responsible for most global S. aureus bacteremia cases, and compared with methicillin-sensitive S. aureus, MRSA infection is associated with poorer clinical outcomes. S. aureus virulence is affected by the unique combination of toxin and immune-modulatory gene products, which may differ by geographic location and healthcare- or community-associated acquisition.

Management of S. aureus bacteremia involves timely identification of the infecting strain and source of infection, proper choice of antibiotic treatment, and robust prevention strategies. Resistance and nonsusceptibility to first-line antimicrobials combined with a lack of equally effective alternatives complicates MRSA bacteremia treatment.

This review describes trends in epidemiology and factors that influence the incidence of MRSA bacteremia. Current and developing diagnostic tools, treatments, and prevention strategies are also discussed.

Full reference: Hassoun, A. et al. (2017) Incidence, prevalence, and management of MRSA bacteremia across patient populations—a review of recent developments in MRSA management and treatment. Critical Care. 21:211