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Basic Principles of Antibiotic Treatment
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
In managing patients with infections, very often, clinicians will need to initiate empirical antibiotics before definitive culture results become available. While the antimicrobial spectrum should be sufficiently broad so as to cover the most common pathogens involved, it is equally important to ensure that overly broad-spectrum antimicrobial agents are not being indiscriminately used, as this might create extensive ‘collateral damage’ to the resident flora and lead to emergence of multidrug-resistant pathogens. Once the infecting organisms are known, targeted antimicrobial therapy using the agent with the narrowest spectrum and the most favourable pharmacokinetic/pharmacodynamic profiles should be used to complete therapy. It is therefore worthwhile to consider the following.
Perioperative antimicrobial prophylaxis in patients undergoing pancreatoduodenectomy: retrospective analysis of bacteriological profile and susceptibility
Published in Acta Chirurgica Belgica, 2023
Reza Chinikar, Daniel Patricio, Juliette Gosse, Brigitte Ickx, Myriam Delhaye, Jean Closset, Imad El Moussaoui, Maya Hites, Julie Navez
Pancreatoduodenectomy is a high-risk procedure which exposes the patient to multiple complications such as post-operative infections despite the use of antimicrobial prophylaxis. In the present study, most patients undergoing PBD before PD had bacterial contamination of the intraoperative biliary sample, compared to those who did not need PBD. PBD was an independent risk factor for bile contamination during PD. Even if postoperative infectious complications were similar in both groups, duration of antibacterial therapy was significantly increased in the PBD + compared to the PBD– groups. Furthermore, this often led to a broader antimicrobial spectrum or required reintroduction of a drug with in vitro efficacy. In the majority of cases, the usual intraoperative narrow-spectrum antimicrobial prophylaxis did not cover microorganisms identified in bile cultures which often showed lowered susceptibility to the antibiotics administered for prophylaxis.
Blood culture-negative infective endocarditis: a worse outcome? Results from a large multicentre retrospective Spanish cohort study
Published in Infectious Diseases, 2021
Lorenzo Roberto Suardi, Arístides de Alarcón, María Victoria García, Antonio Plata Ciezar, Carmen Hidalgo Tenorio, Francisco Javier Martinez-Marcos, Elena Concejo-Martínez, Javier De la Torre Lima, David Vinuesa García, Rafael Luque Márquez, Guillermo Ojeda, José M. Reguera Iglesias, José M. Lomas, Luis E. Lopez-Cortes
Despite medical support and cardiac-surgery advances, infective endocarditis (IE) is still related to a high mortality and morbidity. Microbiological diagnosis is crucial to assess an appropriate targeted antibiotic therapy, according to the identified pathogen and for a suitable duration of therapy. Moreover, the chance to narrow the antimicrobial spectrum allows to decrease toxicity risk and multidrug resistance development. In the literature, blood culture-negative infective endocarditis (BCNIE) refers to an episode in which three or more aerobic and anaerobic blood cultures remain negative despite prolonged (>7 days) incubation [1,2]. The rate of BCNIE accounts for 3–31% in the literature, and these patients have been frequently related with a worse outcome due to delay in diagnosis, more difficulty to achieve an adequate antimicrobial therapy and increased need for surgery [3–7]. However, some studies are often referred to a single centre, have a low number of patients for achieving valid conclusions and sometimes include possible cases of IE, with a high number of undiagnosed cases. Our aim was to describe the clinical features and outcome of BCNIE comparing to blood culture positive counterpart and to evaluate its impact on the mortality. For this purpose, we analysed a large multicentre but homogenous cohort of patients with definite IE.
In vitro synergistic activity of fosfomycin in combination with meropenem, amikacin and colistin against OXA-48 and/or NDM-producing Klebsiella pneumoniae
Published in Journal of Chemotherapy, 2020
Buket Erturk Sengel, Gulsen Altinkanat Gelmez, Guner Soyletir, Volkan Korten
Its effectiveness as a drug for multidrug-resistant pathogens has recently attracted attention.9–11 When it is used as monotherapy, resistance develops rapidly.12,13 The resistance rate ranges from <3 to 17.9% in recent studies.14 Combination therapies may provide benefits of antimicrobial synergy and breadth of antimicrobial spectrum to combat the emerging resistance.15 However, there is no consensus regarding which combinations should be used against these organisms. The combination of FOS with other antimicrobials may show a synergistic effect against CPKp both in vitro and in vivo.16–19 Most of the in vitro synergy studies were performed using KPC-producing isolates, and studies with organisms producing other carbapenemases are limited.