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Management of diabetic foot
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Venu Kavarthapu, Raju Ahluwalia
A guide to the medical management of infected diabetic foot is provided in Table 19.4. In those with wound infection and suspected underlying osteomyelitis, attempts should be made to obtain a clean bone sample for microbiological culture and sensitivity (10). Antimicrobial therapy is then tailored to the appropriate cultured organism. A diabetic foot ulcer with no deep infection, significant deformity or marked vascular insufficiency usually responds well to bedside debridement and appropriate wound dressing, followed by culture specific oral antibiotic administration and offloading of the foot in a suitable brace until ulcer healing is achieved.
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.
Febrile Neutropenia in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Perrine Parize, Anne Pouvaret, Paul-Louis Woerther, Frédéric Pène, Olivier Lortholary
Finally, physicians should be aware that a wide range of non-infectious diagnosis can cause temperature elevation: Drugs, thromboembolisms, neoplastic fever, cytokines release, and transfusion-related events. Thus, initial evaluation reevaluation must be performed. Indeed, treating non-infectious causes with antimicrobial therapy may lead to adverse health effects, by delaying adequate treatment and increasing toxicity and risk for antimicrobial resistance acquisition.
Empirical antimicrobial therapy for bloodstream infections not compliant with guideline was associated with discordant therapy, which predicted poorer outcome even in a low resistance environment
Published in Infectious Diseases, 2022
Kornelius Grøv, Erling Håland, Bjørn Waagsbø, Øyvind Salvesen, Jan Kristian Damås, Jan Egil Afset
To describe the appropriateness of administered antimicrobial therapy, several methods were applied. The Norwegian national guideline for the appropriate use of antimicrobial therapy in hospitals was used to evaluate whether the initiated empirical regimen was compliant or not [28]. Empirical antimicrobial therapy was considered concordant or discordant depending on whether or not the patient received antimicrobial therapy that covered the detected pathogen based on ID and AST. If the microbe had not been tested for any of the given empirical antimicrobials, inferred values from antimicrobials within the same class were used, as recommended by EUCAST and NordicAST in 2019 [29]. If the AST report did not contain sufficient information for definite classification, the concordance of empirical antimicrobial therapy was classified as partial or uncertain. Targeted antimicrobial therapy was defined as any antimicrobial therapy given after the AST report was released by the microbiology department. Dosing of antimicrobial therapy was registered only for episodes with BSIs caused by S. aureus and treated with third-generation cephalosporins. In all other cases, dosing regimens were presumed to follow the standard regimen for each drug.
Reverse engineering approach: a step towards a new era of vaccinology with special reference to Salmonella
Published in Expert Review of Vaccines, 2022
Shania Vij, Reena Thakur, Praveen Rishi
The benefits provided by the clinical implementation of vaccines to prevent infections caused by antibiotic-resistant bacteria are indispensable (Figure 1). Upon exposure, vaccination leads to the neutralization of the pathogen, sometimes even before the development of clinical symptoms. On the contrary, antimicrobial therapy is prescribed after the onset of clinical symptoms. Thus, vaccination could bring down the economic burden on the healthcare systems posed by diagnosis followed by treatment of antibiotic-resistant infections significantly [22]. Additionally, vaccines play a crucial role in curbing the emergence and dissemination of antimicrobial resistance by several pathways. For instance, vaccination prevents the establishment of infection by antibiotic-resistant strains because of the generation of herd immunity. In addition to reducing the possibility of selection of antibiotic-resistant strains in the clinical as well as environmental settings, vaccination also averts the establishment of sensitive strains which require antimicrobial therapy, hence taking care of the selection pressure posed by antibiotics. Moreover, vaccination can also reduce the selective pressure mediated by antibiotic therapy on commensal bacteria such as gut microbiota, which also has been suggested as the reservoir of antibiotic resistance determinants [23].
A systems thinking approach for antimicrobial stewardship in primary care
Published in Expert Review of Anti-infective Therapy, 2022
Sajal K. Saha, David C.M. Kong, Danielle Mazza, Karin Thursky
Antimicrobial resistance (AMR) is a global public health crisis [1]. AMR is anticipated to become the number one cause of mortality and morbidity [1]. Multiple primary care studies [2,3] demonstrated that growing AMR is associated with increased antimicrobial consumption. Around 75% of antimicrobials are prescribed in primary care [4], and approximately 30–50% are inappropriate in choice, dose, or duration [5]. Inappropriate antimicrobial therapy leads to develop short-term and/or long-term adverse effects, reconsultations, increased costs associated with infections, and a greater risk of developing AMR [2]. The burden of inappropriate antimicrobial use in primary care is heavily influenced by a lack of team-based interdisciplinary health services, system structures, and policy actions. Therefore, primary care is a crucial setting for antimicrobial stewardship (AMS) and should be a priority for establishing AMS by all countries as part of their National Antimicrobial Resistance Action plans.