DOCSLIB.ORG

IJMM July 07.Indd

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
IJMM July 07.Indd July-SeptemberIndian Journal of 2007 Medical Microbiology, (2007) 25 (3):203-8 203 Original Article SENSITIVITY PATTERN OF GRAM NEGATIVE BACILLI TO THREE β-LACTAM/β-LACTAMASE INHIBITOR COMBINATIONS USING THE AUTOMATED API SYSTEM K Anuradha, VV Sailaja, P Umabala, T Satheesh, *V Lakshmi Abstract Purpose: To evaluate the spectrum of activity of three β-lactamase inhibitors such as amoxicillin/ clavulanic acid, ticarcillin/ clavulanic acid and piperacillin/ tazobactam in comparison to cephalosporins against gram negative bacilli. Methods: Gram-negative bacilli isolated from the clinical specimens received in the laboratory were included in the study. Using the API system (bioMérieux) during a one-year period, a total of 1,252 Enterobacteriaceae and 385 non-fermenters were evaluated. Results: The percentage resistance of the Enterobacteriaceae isolates was 82.92% to amoxicillin/ clavulanic acid, 58.22% to ticarcillin/clavulanic acid and 22.44% to piperacillin/tazobactam respectively. Pseudomonas aeruginosa showed resistance of 96% to ticarcillin/ clavulanic acid and 61% to piperacillin/ tazobactam and Acinetobacter baumannii showed 49% resistance to ticarcillin/ clavulanic acid and 77% resistance to piperacillin/ tazobactam respectively. The isolates exhibited high resistance to all the generations of cephalosporins and the other groups of antibiotics except carbapenems. Conclusions: Piperacillin/tazobactam was found to be the most active combination of the three against Enterobacteriaceae and Pseudomonas spp. and ticarcillin/clavulanic acid against Acinetobacter spp. and Stenotrophomonas maltophilia. Key words: API, β-lactamase inhibitors, gram negative bacteria, sensitivity An extensive use of β-lactam antibiotics in hospitals and emerging nosocomial pathogens such as Acinetobacter spp. community has created major resistance problems leading to and Stenotrophomonas maltophilia.5 increased morbidity, mortality and health-care costs.1 Of the several mechanisms of resistance, the most widespread and This study compared the spectrum of activity of β-lactam/ most important is the destruction of the β-lactam ring, which β-lactamase inhibitors to that of cephalosporins against gram- is mediated by β-lactamases.2 Extended spectrum β-lactamases negative bacilli. (ESBLs) are of greater concern because they are capable of Materials and Methods hydrolyzing several groups of β-lactam antibiotics, notably third and fourth generation cephalosporins and extended The in vitro activity of three β-lactamase inhibitors in spectrum penicillins such as piperacillin. There are 255 known comparison with cephalosporins was evaluated against clinical β-lactamases to date and the continued use of β-lactams may isolates from patients admitted in our institute using the API select for newer variants.3 system. Amoxycillin/clavulanic acid (AUG), ticarcillin/ (www.medknow.com).clavulanic acid (TIM) and piperacillin/tazobactam (TZP) and The use of β-lactamase inhibitors in combination with all the four generations of cephalosporins were included in β-lactam antibiotics is currently the most successful strategy the study. to combat this specific resistance mechanism. These β- lactamase inhibitorsThis are PDFthoughta site tois behosted available “suicide inhibitors” by forMedknow freeA totaldownload ofPublications 1252 Enterobacteriaceae from isolates and 385 that form stable complexes between the bacterial β-lactamase isolates from non-fermenters were tested for AUG, TIM and and the β-lactamase inhibitor in a multi-step chemical TZP and TIM and TZP respectively. Tables 1 and 2 show all 4 reaction. Their broad spectrum of activity originates from the isolates tested and the antibiotics used. the ability of respective inhibitors to inactivate a wide range of β-lactamases produced by gram-positive, gram-negative, All the isolates were identified and their minimum anaerobic and even acid-fast pathogens. β-lactam/ β-lactamase inhibitory concentrations (MICs) were determined by API inhibitor combinations are particularly useful against mixed system (bioMérieux) using the relevant panels. The inoculum infections and play a useful role in treating various multi was prepared as per the standard protocol given in the resistant pathogens such as ESBLs. These agents are gaining instruction manual of the API system. Quality control was importance in the treatment of various multi-resistant and performed by using Escherichia coli strain ATCC 25922 for Enterobacteriaceae and Pseudomonas aeruginosa strain ATCC *Corresponding author (email: <[email protected]>) 27853 for non-fermenters, with each new batch of strips. Department of Microbiology, Nizam’s Institute of Medical Sciences, Hyderabad - 500 082, Andhra Pradesh, India Results Received: 29-09-04 Accepted: 12-12-05 Among the Enterobacteriaceae, the overall resistance www.ijmm.org 204 Indian Journal of Medical Microbiology vol. 25, No. 3 to amoxicillin/clavulanic acid, ticarcillin/ clavulanic acid Discussion and piperacillin/tazobactam was 82.92, 58.22 and 22.44% respectively (Table 3) and 82-65% resistance to cephalosporins Penicillin, the Þ rst of the β-lactam antibiotics, was Þ rst from Þ rst to fourth generations. introduced into medical practice in the 1940s. Since then, a large number of different β-lactams, including penicillins, Table 4 shows the MICs of different β-lactam/β-beta- cephalosporins, monobactams and carbapenems have been lactamase organisms to Enterobacteriaceae group of inhibitors developed, all of which are structurally related through and Tables 5-10 show the MICs against cephalosporins. Table the presence of a core β-lactam ring.2 The most common 11 shows the MICs of different β-lactam/β-beta-lactamase mechanism of resistance to beta-lactam antibiotics is inhibitors and cephalosporins to various non-fermenters. the production of β-lactamase, which destroys β-lactam antibiotics before they reach the bacterial target.6 A highly effective and proven approach for tackling β-lactamase Table 1: Isolates of Enterobacteriaceae group and non- mediated resistance to β-lactams is the use of the β-lactam/ fermenters β-lactamase inhibitor combinations.7 In recent years, the use Enterobacteriaceae Non-fermenters of these combinations has been proven to be a useful and an Species No. of isolates Species No. of isolates effective strategy to improve upon the therapeutic value of β-lactam antibiotics.8 Several factors inß uence the activity E. coli 769 Acinetobacter 106 baumannii and pharmacodynamics of these combinations, including K. pneumoniae 236 Acinetobacter 12 potency of these agents, pharmacokinetics of the inhibitor, lwofÞ i type and quality of β-lactamase produced by the target Enterobacter 101 Pseudomonas 195 bacterium and potential for the inhibitor to induce expression cloacae aeruginosa of chromosomal cephalosporinases in the target bacterium.9 Other 56 Other 46 The overall antibacterial spectrum of these drug combinations Enterobacter spp. Pseudomonas spp. depends on the intrinsic activity of the β-lactam as well as the Proteus mirabilis 36 Stenotrophomonas 26 characteristics of the individual inhibitor towards different maltophilia β-lactamases.5 The differences among these β-lactam/ β- Proteus vulgaris 2 _ _ Providencia rettgeri 6 _ _ lactamase inhibitors such as spectrum of activity, need to be Serratia marcescens 39 _ _ considered in choosing an agent for a speciÞ c case. Other Serratia spp. 7 _ _ Currently, there are three commercially available Total 1252 Total 385 β-lactamase inhibitors-clavulanic acid, sulbactam and Table 2: Antibiotics with concentrations (μg/L) tested against Enterobacteriaceae group and non-fermenters β-Lactamase inhibitors Cephalosporins Group AUG TIM TZP 1 G CEPH CEF CF/CTX CB FEP CPO Enterobacteriaceae + + (www.medknow.com).+ + + + + + + n=1252 4/2 16/2 8/4 8 8 4 4 4 4 Non-fermenters _ + + _ _ _ + + _ n= 385 This PDFa site is 16/2-hosted available 16/4 by - forMedknow free download Publications from4-32 4-32 64/2 64/4 + - Tested against, - - Not tested, API strips used for antimicrobial sensitivity-For Enterobacteriaceae -rapid ID 32 E For Non-fermenters - ATB PSE, AUG - Amoxicillin/Clavulanic acid, TIM - Ticarcillin/Clavulanic acid, TZP - Piperacillin/Tazobactum, 1 G Ceph - First generation cephalosporin, CEF - Cefuroxime, CF/CTX - Cefotaxime/Ceftriaxone, CB - Ceftazidime, FEP - Cefepime, CPO - Cefpirome Table 3: Resistance pattern of Enterobacteriaceae and non-fermenters to β-lactamase inhibitors and cephalosporins Group AUG TIM TZP 1 G CEPH CEF CF/CTX CB FEP CPO Enterobacteriaceae n =1252 82.92 58.22 22.44 82.18 75.07 66.61 66.77 64.77 65.17 Non-fermenters n= 385 __ 49.61 48.83 __ __ __ 63.11 47.01 __ AUG - Amoxicillin/Clavulanic acid, TIM - Ticarcillin/Clavulanic acid, TZP - Piperacillin/Tazobactum, 1 G Ceph - First generation cephalosporin, CEF - Cefuroxime, CF/CTX - Cefotaxime/Ceftriaxone, CB - Ceftazidime, FEP - Cefepime, CPO - Cefpirome www.ijmm.org July-September 2007 Anuradha et al - Testing of GNB against β-lactamase Inhibitors using API System 205 Table 4: Sensitivity pattern of organisms of Enterobacteriaceae group to β-lactamase inhibitors Organism No. of AUG TIM TZP isolates S I R S I R S I R (%) (%) (%) (%) (%) (%) (%) (%) (%) E. coli 88 2 679 244 52 473 586 50 133 769 (11) (1) (88) (32) (7) (62) (76) (7) (17) K. pneumoniae 80 0 156 95 12 129 156 10 70 236 (34) (0) (66) (40) (5) (55) (66) (4) (30) Enterobacter 0 5 96 26 11 64 50 5 46 cloacae 101 (0) (5) (95) (26) (11) (63) (50) (5) (45) Other 8 1 47 25 2 29 36 1 19 Enterobacter spp. 56 (14) (2) (84) (44) (4) (52) (64) (2) (34) Proteus 29 0 7 33 3 0 35 1 0 mirabilis 36 (83) (0) (17) (91) (9) (0) (97) (3) (0) Proteus 0 0 2 2 0 0 2 0 0 vulgaris 2 (0) (0) (100) (100) (0) (0) (100) (0) (0) Providencia 0 0 6 5 0 1 5 0 1 rettgeri 6 (0) (0) (100) (83) (0) (17) (83) (0) (17) Serratia 0 0 39 9 3 27 17 12 10 marcescens 39 (0) (0) (100) (23) (8) (69) (44) (931) (26) Other 0 0 7 2 1 4 4 1 2 Serratia spp. 7 (0) (0) (100) (29) (14) (57) (57) (14) (29) S - Sensitive, I - Intermediate, R - Resistant, AUG - Amoxicillin/Clavulanic acid, TIM - Ticarcillin/Clavulanic acid, TZP - Piperacillin/ Tazobactum Table 5: Sensitivity pattern of E.
Load more

Recommended publications
  • Medical Review(S) Clinical Review
    CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 200327 MEDICAL REVIEW(S) CLINICAL REVIEW Application Type NDA Application Number(s) 200327 Priority or Standard Standard Submit Date(s) December 29, 2009 Received Date(s) December 30, 2009 PDUFA Goal Date October 30, 2010 Division / Office Division of Anti-Infective and Ophthalmology Products Office of Antimicrobial Products Reviewer Name(s) Ariel Ramirez Porcalla, MD, MPH Neil Rellosa, MD Review Completion October 29, 2010 Date Established Name Ceftaroline fosamil for injection (Proposed) Trade Name Teflaro Therapeutic Class Cephalosporin; ß-lactams Applicant Cerexa, Inc. Forest Laboratories, Inc. Formulation(s) 400 mg/vial and 600 mg/vial Intravenous Dosing Regimen 600 mg every 12 hours by IV infusion Indication(s) Acute Bacterial Skin and Skin Structure Infection (ABSSSI); Community-acquired Bacterial Pneumonia (CABP) Intended Population(s) Adults ≥ 18 years of age Template Version: March 6, 2009 Reference ID: 2857265 Clinical Review Ariel Ramirez Porcalla, MD, MPH Neil Rellosa, MD NDA 200327: Teflaro (ceftaroline fosamil) Table of Contents 1 RECOMMENDATIONS/RISK BENEFIT ASSESSMENT ......................................... 9 1.1 Recommendation on Regulatory Action ........................................................... 10 1.2 Risk Benefit Assessment.................................................................................. 10 1.3 Recommendations for Postmarketing Risk Evaluation and Mitigation Strategies ........................................................................................................................
    [Show full text]
  • “Ceftriaxone– Sulbactam–EDTA” and Various Antibiotics Against Gram
    ORIGINAL ARTICLE A Comparative In Vitro Sensitivity Study of “Ceftriaxone– Sulbactam–EDTA” and Various Antibiotics against Gram- negative Bacterial Isolates from Intensive Care Unit Sweta Singh1, Chinmoy Sahu2, Sangram Singh Patel3, Abhay Singh4, Nidhi Yaduvanshi5 ABSTRACT Introduction: A rapid increase in multidrug-resistant (MDR) strains is being seen across the globe especially in the Southeast Asian region, including India. Carbapenems and colistin form the mainstay of treatment against gram-negative pathogens, especially extended-spectrum beta-lactamase (ESBL)- and metallo-beta-lactamse (MBL)-producing isolates. However, due to increased resistance to carbapenems and toxicity of colistin, especially in intensive care units (ICUs), carbapenem-sparing antibiotics like ceftriaxone–sulbactam–EDTA (CSE) combination needs to be evaluated. Materials and methods: Bacterial isolates cultured from various clinical samples from all ICUs for a period of 9 months were evaluated. Bacterial identification was performed by matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS) and antibiotic susceptibility testing were performed by disk diffusion and E test method. Antibiogram of various antibiotics was noted. Extended-spectrum beta-lactamase- and MBL-producing bacteria were identified by phenotypic methods. Antibiotic sensitivity results of CSE were compared with the comparator drugs like colistin, carbapenems, and tigecycline in Enterobacteriaceae, Acinetobacter spp., and Pseudomonas spp. along with ESBL and MBL producers. Results: A total of 2,760 samples of blood, cerebrospinal fluid (CSF), respiratory samples, tissue, and pus were collected from ICUs with maximum isolates from pus (37%) followed by respiratory samples (31%) and blood (27%). Escherichia coli and Klebsiella pneumoniae were the predominant gram-negative pathogens accounting for 56% of the isolates followed by Acinetobacter spp.
    [Show full text]
  • Cefoxitin Versus Piperacillin– Tazobactam As Surgical Antibiotic Prophylaxis in Patients Undergoing Pancreatoduodenectomy: Protocol for a Randomised Controlled Trial
    Open access Protocol BMJ Open: first published as 10.1136/bmjopen-2020-048398 on 4 March 2021. Downloaded from Cefoxitin versus piperacillin– tazobactam as surgical antibiotic prophylaxis in patients undergoing pancreatoduodenectomy: protocol for a randomised controlled trial Nicole M Nevarez ,1 Brian C Brajcich,2 Jason Liu,2,3 Ryan Ellis,2 Clifford Y Ko,2 Henry A Pitt,4 Michael I D'Angelica,5 Adam C Yopp1 To cite: Nevarez NM, ABSTRACT Strengths and limitations of this study Brajcich BC, Liu J, et al. Introduction Although antibiotic prophylaxis is Cefoxitin versus piperacillin– established in reducing postoperative surgical site tazobactam as surgical ► A major strength of this study is the multi- infections (SSIs), the optimal antibiotic for prophylaxis in antibiotic prophylaxis institutional, double- arm, randomised controlled in patients undergoing pancreatoduodenectomy (PD) remains unclear. The study trial design. objective is to evaluate if administration of piperacillin– pancreatoduodenectomy: ► A limitation of this study is that all perioperative care protocol for a randomised tazobactam as antibiotic prophylaxis results in decreased is at the discretion of the operating surgeon and is controlled trial. BMJ Open 30- day SSI rate compared with cefoxitin in patients not standardised. 2021;11:e048398. doi:10.1136/ undergoing elective PD. ► All data will be collected through the American bmjopen-2020-048398 Methods and analysis This study will be a multi- College of Surgeons National Surgical Quality ► Prepublication history for institution, double- arm, non- blinded randomised controlled Improvement Program, which is a strength for its this paper is available online. superiority trial. Adults ≥18 years consented to undergo PD ease of use but a limitation due to the variety of data To view these files, please visit for all indications who present to institutions participating included.
    [Show full text]
  • Cefoperazone Sodium
    Disclaimer While these labels are the most current Drug Control Authority (DCA) approved versions of content, these are not necessarily reflective of final printed labeling currently in distribution LPD Title : Cefoperazone Sodium LPD Date : 07 February 2017 Country : Malaysia Reference : CDS version 5.0 dated 07 January 2017 Reason : Addition of adverse drug reactions (ADRs) Haemorrhage and Coagulopathy to Section 4.8 Undesirable effects, and also, addition of serious hemorrhage and coagulopathy to the warning about vitamin K deficiency in Section 4.4 Special warnings and precautions for use Addition of ADRs Anaphylactic reaction and Anaphylactic shock to Section 4.8 Undesirable effects Addition of ADR Dermatitis exfoliative to Section 4.8 Undesirable Effects and a warning statement on severe cutaneous adverse reactions (SCARs) to Section 4.4, Special warnings and precautions for use 1. NAME OF THE MEDICINAL PRODUCT CEFOBID 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Cefoperazone sodium is a semisynthetic broad-spectrum cephalosporin antibiotic for parenteral use only. Cefoperazone contains 34 mg sodium (1.5 mEq) per gram. Cefoperazone is a white crystalline powder which is freely soluble in water. The pH of a 25% aqueous solution is 5.0 to 6.5 and the solution is colorless to straw-yellow, depending on the concentration. The empirical formula is C25H26N9NaO8S2. 3. PHARMACEUTICAL FORM Cefoperazone sodium is available in vials containing 1 and 2 grams. Not For Distribution PFIZER CONFIDENTIAL Not all product strengths or pack sizes
    [Show full text]
  • Lactamase-Producing Antibiotic-Resistant Escherichia Coli and Klebsiella Pneumoniae in Ready-To-Eat Street Foods
    antibiotics Article Prevalence and Characterization of Extended-Spectrum β-Lactamase-Producing Antibiotic-Resistant Escherichia coli and Klebsiella pneumoniae in Ready-to-Eat Street Foods Shobha Giri 1 , Vaishnavi Kudva 1, Kalidas Shetty 2 and Veena Shetty 1,* 1 Department of Microbiology, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore 575018, India; [email protected] (S.G.); [email protected] (V.K.) 2 Department of Plant Sciences, North Dakota State University, Fargo, ND 58102, USA; [email protected] * Correspondence: [email protected] Abstract: As the global urban populations increase with rapid migration from rural areas, ready-to- eat (RTE) street foods are posing food safety challenges where street foods are prepared with less structured food safety guidelines in small and roadside outlets. The increased presence of extended- spectrum-β-lactamase (ESBL) producing bacteria in street foods is a significant risk for human health because of its epidemiological significance. Escherichia coli and Klebsiella pneumoniae have become important and dangerous foodborne pathogens globally for their relevance to antibiotic resistance. The present study was undertaken to evaluate the potential burden of antibiotic-resistant E. coli and K. pneumoniae contaminating RTE street foods and to assess the microbiological quality of foods in a Citation: Giri, S.; Kudva, V.; Shetty, typical emerging and growing urban suburb of India where RTE street foods are rapidly establishing K.; Shetty, V. Prevalence and with public health implications. A total of 100 RTE food samples were collected of which, 22.88% Characterization of were E. coli and 27.12% K. pneumoniae. The prevalence of ESBL-producing E.
    [Show full text]
  • Severe Sepsis and Septic Shock Antibiotic Guide
    Stanford Health Issue Date: 05/2017 Stanford Antimicrobial Safety and Sustainability Program Severe Sepsis and Septic Shock Antibiotic Guide Table 1: Antibiotic selection options for healthcare associated and/or immunocompromised patients • Healthcare associated: intravenous therapy, wound care, or intravenous chemotherapy within the prior 30 days, residence in a nursing home or other long-term care facility, hospitalization in an acute care hospital for two or more days within the prior 90 days, attendance at a hospital or hemodialysis clinic within the prior 30 days • Immunocompromised: Receiving chemotherapy, known systemic cancer not in remission, ANC <500, severe cell-mediated immune deficiency Table 2: Antibiotic selection options for community acquired, immunocompetent patients Table 3: Antibiotic selection options for patients with simple sepsis, community acquired, immunocompetent patients requiring hospitalization. Risk Factors for Select Organisms P. aeruginosa MRSA Invasive Candidiasis VRE (and other resistant GNR) Community acquired: • Known colonization with MDROs • Central venous catheter • Liver transplant • Prior IV antibiotics within 90 day • Recent MRSA infection • Broad-spectrum antibiotics • Known colonization • Known colonization with MDROs • Known MRSA colonization • + 1 of the following risk factors: • Prolonged broad antibacterial • Skin & Skin Structure and/or IV access site: ♦ Parenteral nutrition therapy Hospital acquired: ♦ Purulence ♦ Dialysis • Prolonged profound • Prior IV antibiotics within 90 days ♦ Abscess
    [Show full text]
  • Comparative Effects of Cefpirome (Hr 810) and Other Cephalosporins on Experimentally Induced Pneumonia in Mice
    VOL. XXXIX NO. 7 THE JOURNAL OF ANTIBIOTICS 971 COMPARATIVE EFFECTS OF CEFPIROME (HR 810) AND OTHER CEPHALOSPORINS ON EXPERIMENTALLY INDUCED PNEUMONIA IN MICE N. KLESEL, D. ISERT, M. LIMBERT, G. SEIBERT, I. WINKLER and E. SCHRINNER Hoechst Aktiengesellschaft, Dept. of Chemotherapy, 6230 Frankfurt a. M. 80, FRG (Received for publication March 24, 1986) The chemotherapeutic efficacy of cefpirome (HR 810), a new polar aminothiazolyl- cephalosporin and that of ceftazidime, cefotaxime, cefoperazone, latamoxef and cefodizime were examined against experimental pneumonia caused by Klebsiella pneammlliae DT-S in mice. When compared in terms of MIC values against the infecting organism and the phar- macokinetic pattern, cefpirome showed equal activity and a similar pharmacokinetic behavior to ceftazidime and cefotaxime in mice. Trials to assess the bactericidial activity in vhro, however, showed that cefpirome displayed a more marked bactericidal effect in pneumonic mice than the other cephalosporins tested. Only cefodizime, a cephalosporin with extremely high and prolonged blood and tissue levels in experimental animals exerted chemotherapeutic effects similar to cefpirome. After cefpirome or cefodizime medication (50 mg/kg), the viable counts in the lungs of experimental animals fell steadily to 1/10,000 of the pretreatment level and, in contrast to the reference compounds, no regrowth of the challenge organisms could be observed with both drugs. Moreover, with ED.-,,,,sranging from 1.1 to 59.1 mg/kg in treatment studies, cefpirome as well as cefodizime were two to ten times more effective than ceftazidime and cefotaxime, whereas cefoperazone and latamoxef were considerably less effective. Cefpirome (3-((2,3-cyclopenteno-I-pyridium)methyl)-7-(2-syn-methoximino-2-(2-aminothiazol-4- yl)acetamido)ceph-3-em-4-carboxylate, HR 810) is a new semi-synthetic parenteral cephalosporin antibiotic with a broad spectrum of antibacterial activity in vitro and in rivo.
    [Show full text]
  • Severe Sepsis Tipsheet
    Severe Sepsis Tipsheet SEVERE SEPSIS A, B, and C of the following must be met within 6 hours of each other. A. Documentation of a suspected infection. There may be reference to “possible infection,” “suspect infection,” “rule out infection,” or similar documentation. B. TWO or more manifestations of systemic infection according to the Systemic Inflammatory Response Syndrome (SIRS) criteria, which are: • Temperature > 38.3 C or < 36.0 C (> 100.9 F or < 96.8 F) • Heart rate (pulse) > 90 • Respiration > 20 per minute • White blood cell count > 12,000 or < 4,000 or > 10% bands C. Organ dysfunction, evidenced by any one of the following: • Systolic blood pressure (SBP) < 90 mmHg, or mean arterial pressure < 65 mmHg, or a systolic blood pressure decrease of more than 40 mmHg. Physician/APN/PA documentation must be present in the medical record indicating a > 40 mmHg decrease in SBP has occurred and is related to infection, severe sepsis or septic shock and not other causes. • Acute respiratory failure as evidenced by a new need for invasive or non-invasive mechanical ventilation. To use acute respiratory failure as a sign of organ dysfunction there must be: • Documentation of acute respiratory failure AND • Documentation the patient is on mechanical ventilation • Invasive mechanical ventilation requires an endotracheal or tracheostomy tube. Non-invasive mechanical ventilation may be referred to as BiPAP or CPAP. • New need for mechanical ventilation indicates the patient was not using the same type of mechanical ventilation prior to the current acute respiratory failure. • Use the time at which there is documentation the patient has both acute respiratory failure and is on mechanical ventilation.
    [Show full text]
  • Below Are the CLSI Breakpoints for Selected Bacteria. Please Use Your Clinical Judgement When Assessing Breakpoints
    Below are the CLSI breakpoints for selected bacteria. Please use your clinical judgement when assessing breakpoints. The lowest number does NOT equal most potent antimicrobial. Contact Antimicrobial Stewardship for drug selection and dosing questions. Table 1: 2014 MIC Interpretive Standards for Enterobacteriaceae (includes E.coli, Klebsiella, Enterobacter, Citrobacter, Serratia and Proteus spp) Antimicrobial Agent MIC Interpretive Criteria (g/mL) Enterobacteriaceae S I R Ampicillin ≤ 8 16 ≥ 32 Ampicillin-sulbactam ≤ 8/4 16/8 ≥ 32/16 Aztreonam ≤ 4 8 ≥ 16 Cefazolin (blood) ≤ 2 4 ≥ 8 Cefazolin** (uncomplicated UTI only) ≤ 16 ≥ 32 Cefepime* ≤ 2 4-8* ≥ 16 Cefotetan ≤ 16 32 ≥ 64 Ceftaroline ≤ 0.5 1 ≥ 2 Ceftazidime ≤ 4 8 ≥ 16 Ceftriaxone ≤ 1 2 ≥ 4 Cefpodoxime ≤ 2 4 ≥ 8 Ciprofloxacin ≤ 1 2 ≥ 4 Ertapenem ≤ 0.5 1 ≥ 2 Fosfomycin ≤ 64 128 ≥256 Gentamicin ≤ 4 8 ≥ 16 Imipenem ≤ 1 2 ≥ 4 Levofloxacin ≤ 2 4 ≥ 8 Meropenem ≤ 1 2 ≥ 4 Piperacillin-tazobactam ≤ 16/4 32/4 – 64/4 ≥ 128/4 Trimethoprim-sulfamethoxazole ≤ 2/38 --- ≥ 4/76 *Susceptibile dose-dependent – see chart below **Cefazolin can predict results for cefaclor, cefdinir, cefpodoxime, cefprozil, cefuroxime axetil, cephalexin and loracarbef for uncomplicated UTIs due to E.coli, K.pneumoniae, and P.mirabilis. Cefpodoxime, cefinidir, and cefuroxime axetil may be tested individually because some isolated may be susceptible to these agents while testing resistant to cefazolin. Cefepime dosing for Enterobacteriaceae ( E.coli, Klebsiella, Enterobacter, Citrobacter, Serratia & Proteus spp) Susceptible Susceptible –dose-dependent (SDD) Resistant MIC </= 2 4 8 >/= 16 Based on dose of: 1g q12h 1g every 8h or 2g every 8 h Do not give 2g q12 Total dose 2g 3-4g 6g NA Table 2: 2014 MIC Interpretive Standards for Pseudomonas aeruginosa and Acinetobacter spp.
    [Show full text]
  • Fosfomycin Resistance in Escherichia Coli Isolates from South Korea and in Vitro Activity of Fosfomycin Alone and in Combination with Other Antibiotics
    antibiotics Article Fosfomycin Resistance in Escherichia coli Isolates from South Korea and in vitro Activity of Fosfomycin Alone and in Combination with Other Antibiotics Hyeri Seok 1 , Ji Young Choi 2, Yu Mi Wi 3, Dae Won Park 1, Kyong Ran Peck 4 and Kwan Soo Ko 2,* 1 Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea; [email protected] (H.S.); [email protected] (D.W.P.) 2 Department of Microbiology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea; [email protected] 3 Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; [email protected] 4 Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; [email protected] * Correspondence: [email protected]; Tel.: +82-31-299-6223 Received: 17 February 2020; Accepted: 3 March 2020; Published: 6 March 2020 Abstract: We investigated fosfomycin susceptibility in Escherichia coli clinical isolates from South Korea, including community-onset, hospital-onset, and long-term care facility (LTCF)-onset isolates. The resistance mechanisms and genotypes of fosfomycin-resistant isolates were also identified. Finally, the in vitro efficacy of combinations of fosfomycin with other antibiotics were examined in susceptible or extended spectrum β-lactamase (ESBL)-producing E. coli isolates. The fosfomycin resistance rate was 6.7% and was significantly higher in LTCF-onset isolates than community-onset and hospital-onset isolates. Twenty-one sequence types (STs) were identified among 19 fosfomycin-resistant E. coli isolates, showing diverse genotypes. fosA3 was found in only two isolates, and diverse genetic variations were identified in three genes associated with fosfomycin resistance, namely, GlpT, UhpT, and MurA.
    [Show full text]
  • Piperacillin/Tazobactam Drug Class1 Antibiotic – Penicillin with Β-Lactamase Inhibitor
    Monographs for Commonly Administered Intravenous Medications in Home and Community Care Piperacillin/Tazobactam Drug Class1 Antibiotic – penicillin with β-lactamase inhibitor Spectrum1 Refer to product monograph for complete spectrum For β-lactamase producing bacteria strains (e.g., Haemophilus influenza, Escherichia coli, and Staphylococcus aureus). Also to susceptible Acinetobacter species, Klebsiella pneumonia, Pseudomonas aeruginosa often combined with aminoglycoside). Cross Sensitivities / Allergies1 Cross sensitivities with penicillin and possibly cephalosporin and/or beta-lactam inhibitors Indications1,2 Intra-abdominal Respiratory tract Skin and skin structure Septicemia Gynecological Urinary tract Other conditions based on culture and sensitivity results Outpatient Considerations1 For patients with a documented allergy to penicillin, cephalosporin or beta-lactam inhibitor, the first dose should be administered in a hospital or clinic setting. Must be able to access laboratory monitoring (either at outpatient laboratory or by arranging in-home lab) if using an interacting oral medication (see Potential Drug Interactions section) Prescribing Considerations At time of ordering please provide the following to the pharmacist: and Dosage in Adults1,2 Height, weight Most recent serum creatinine with date obtained Indication (infection being treated) Usually dosed every 6 to 8 hours. Available as 2 g/0.25 g, 3 g/0.375 g, 4 g/0.5 g piperacillin/tazobactam (dose selected based on indication) Maximum 18 g/ 2.25 g piperacillin/tazobactam daily Dose and administration interval require adjustment for renal impairment Errors have occurred due to unusual ordering as combined dose of piperacillin and tazobactam. Order may be expressed only as piperacillin component or as a total of piperacillin + tazobactam (8:1 ratio).
    [Show full text]
  • Time-Series Analysis of the Relationship of Antimicrobial Use and Hand Hygiene Promotion with the Incidence of Healthcare-Associated Infections
    The Journal of Antibiotics (2012) 65, 311–316 & 2012 Japan Antibiotics Research Association All rights reserved 0021-8820/12 www.nature.com/ja ORIGINAL ARTICLE Time-series analysis of the relationship of antimicrobial use and hand hygiene promotion with the incidence of healthcare-associated infections Yuan-Ti Lee1,2,3, Shiuan-Chih Chen1,2,4, Meng-Chih Lee1,2,4, Hung-Chang Hung1,2,5, Huey-Jen Huang3,6, Hui-Chih Lin1,7, Der-Jinn Wu1,2,3 and Shih-Ming Tsao1,2,3 We analyzed the effect of antimicrobial use and implementation of a hand hygiene program on the incidence of healthcare- associated infections (HAIs) and healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) infections at the Chung Shan Medical University Hospital (Taichung, Taiwan). Monthly data were retrospectively reviewed from January 2004 to December 2010. Use of antimicrobials and alcohol-based hand cleaner were separately regressed against the incidences of HAIs and HA-MRSA infections. Infection incidence was expressed as persons per 1000 patient days (PDs), monthly use of i.v. antibiotics was expressed as defined daily doses per 1000 PDs and monthly alcohol-based hand cleaner use was expressed as bottle per 1000 PDs. Multivariate analysis indicated that use of hand cleaner was associated with reduced incidence of HAIs (P ¼ 0.0001) and HA-MRSA infections (Po0.0001). Time-series analysis indicated that increased use of hand cleaner was significantly associated with significant decreases in the incidences of HAIs and HA-MRSA infections. Total antibiotic use had no significant effect on HAIs, but was associated with more HA-MRSA infections.
    [Show full text]