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Continuity of antibiotic therapy in patients admitted from the emergency department

ANNALS OF EMERGENCY MEDICINE 2003年第1期42卷 117-123页

作者： Shah, MN Schmit, J Croley, WC Meltzer, D Univ Rochester Sch Med & Dent Dept Emergency Med Rochester NY 14642 USA Univ Chicago Robert Wood Johnson Clin Scholars Program Chicago IL USA Univ Chicago Dept Med Chicago IL 60637 USA

Study objective: We describe discontinuities in antibiotic therapy in patients with community-acquired pneumonia admitted from the emergency department (ED) to an inpatient unit. Methods: We performed a retrospective cohort study of patients with community-acquired pneumonia admitted from the ED to the internal medicine service at an academic tertiary care hospital between July 1997 and June 1999. We characterized the frequency of antibiotic delays after arrival on the inpatient unit in relation to antibiotic dosing intervals. We performed paired analysis on the patients treated both with an antibiotic dosed every 6 hours and an antibiotic dosed every 24 hours. Results: Three hundred seventy-five patients were identified. The mean age was 61 years. Sixty-two percent were female. Five hundred fifty-one antibiotic doses were started in the ED and continued on the inpatient unit, with 177 ordered every 6 hours, and 351 ordered every 24 hours. Seventy-five percent of the antibiotics dosed every 6 hours and 19% of the antibiotics dosed every 24 hours were delayed more than 30 minutes (P<.001). Analysis of the 146 patients receiving both an antibiotic dosed every 6 and 24 hours showed that the first inpatient dose of antibiotics administered every 6 hours were 10 times more likely to be delayed than antibiotics dosed every 24 hours (95% confidence interval 5.0 to 23). The median delay for antibiotics dosed every 6 hours was 258 minutes (range 45 to 3,360 minutes), and the median delay for antibiotics dosed every 24 hours was 192 minutes (range 32 to 2,124 minutes). Conclusion: Discontinuous therapy, represented through a delayed first inpatient antibiotic dose, is common in patients with community-acquired pneumonia admitted from the ED. Although the effect on outcome is unknown, theoretical concerns should lead emergency physicians to consider using longer-acting antibiotics to minimize delayed therapy.

关键词：抗菌药/投药和剂量抗菌药/治疗应用社区获得性感染/药物疗法病人医护连续性用药计划表急诊室医院/统计学和数值数据保险健康病人转诊肺炎/药物疗法回顾性研究时间因素女(雌)性人类男(雄)性中年人

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Treatment of community-acquired pneumonia in the elderly: the role of cefepime, a fourth-generation cephalosporin

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 1999年第4期43卷 549-554页

作者： Grossman, RF Campbell, DA Landis, SJ Garber, GE Murray, G Stiver, HG Saginur, R McIvor, RA Laforge, J Rotstein, C Dubois, J Rivard, M Boulerice, F Mt Sinai Hosp Toronto ON M5G 1X5 Canada

In a prospective, multicentre double-blind trial, 151 patients over the age of 65 years were randomly assigned to receive either cefepime 2 g every 12 h for a minimum of 3 days and up to 14 days or ceftriaxone 1 g every 12 h for a minimum of 3 days and up to 14 days. Antibiotics were maintained until 48 h after fever had resolved;no other antibiotics were permitted. The average age in each group exceeded 77 years and significant co-morbidity was found in the majority of patients. The mean total duration of therapy was 5.8 +/- 2.4 days for the cefepime group and 6.7 +/- 2.7 days for the ceftriaxone group (P = 0.06). The clinical success rate at the end of therapy was 79.1% with cefepime and 75.4% with ceftriaxone (P = 0.62). At the end of follow-up, 91.7% of the cefepime-treated patients and 86.5% of the ceftriaxone patients had a satisfactory clinical response (P = 0.38). In 35 bacteriological evaluable patients, potential pathogens were eradicated in all but one patient receiving cefepime. Seven patients in each group died during the study period but in each case the death was unrelated to study drug. The commonest side-effect was diarrhoea (cefepime, five patients;ceftriaxone, two patients). The clinical and microbiological efficacy of cefepime is similar to that of ceftriaxone in elderly patients with community-acquired pneumonia requiring hospitalization. Cefepime is an appropriate choice for the treatment of community-acquired respiratory tract infections in the elderly.

关键词：头孢曲松/治疗应用头孢菌素类/治疗应用社区获得性感染/药物疗法社区获得性感染/微生物学双盲法肺炎细菌性/药物疗法前瞻性研究治疗结果老年人老年人 80以上女(雌)性人类男(雄)性

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Comparative in vitro activity of telithromycin (HMR 3647), three macrolides, amoxycillin, cefdinir and levofloxacin against Gram-positive clinical isolates in Japan

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 2000年第5期46卷 797-802页

作者： Okamoto, H Miyazaki, S Tateda, K Ishii, Y Yamaguchi, K Toho Univ Sch Med Dept Microbiol Ota Ku Tokyo Japan

The in vitro activities (MIC and MBC) of telithromycin (HMR 3647) against clinical isolates in Japan were investigated in comparison with those of erythromycin A, clarithromycin, azithromycin, amoxyciliin, cefdinir and levofloxacin, Telithromycin was more potent than the reference compounds against erythromycin A-susceptible or resistant Streptococcus pneumoniae isolates possessing either mef (mefA or mefE) genes or the ermB gene, Against erythromycin A-susceptible or inducibly resistant Staphylococcus aureus and erythromycin A-susceptible and intermediate Enterococcus faecalis, telithromycin was highly active.

关键词：阿莫西林/药理学阿莫西林/治疗应用抗菌药/药理学抗菌药/治疗应用头孢菌素类/药理学头孢菌素类/治疗应用社区获得性感染/药物疗法社区获得性感染/免疫学抗药性微生物/免疫学红霉素/治疗应用革兰氏阳性菌/药物作用革兰氏阳性菌/免疫学革兰氏阳性菌/分离和提纯日本酮内酯类抗生素大环内酯类微生物敏感性试验/方法氧氟沙星/药理学氧氟沙星/治疗应用青霉素类/药理学青霉素类/治疗应用呼吸道感染/药物疗法呼吸道感染/免疫学金黄色葡萄球菌/药物作用金黄色葡萄球菌/免疫学人类

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A community pseudo-outbreak of invasive Staphylococcus aureus infection

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DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE 2000年第3期37卷 219-221页

作者： Adderson, E Pavia, A Christenson, J Davis, R Leonard, R Carroll, K Univ Utah Sch Med Dept Pediat Salt Lake City UT USA Univ Utah Sch Med Dept Pathol Salt Lake City UT USA Assoc Reg Univ Pathologists Salt Lake City UT USA

Outbreaks of invasive infection caused by methicillin-susceptible and methicillin-resistant Staphylococcus aureus occur in hospitals, long term care institutions, and in patients discharged from these settings. In contrast, epidemic S. aureus infection has not been reported in well persons in the community. Here, we describe a group of healthy young adults who resided in the same neighborhood and participated together in school sports, and who developed serious S. aureus infections within 3 weeks of each other, suggesting a true community outbreak. Timely use of molecular epidemiological tools, however, demonstrated that their illnesses were caused by unrelated bacterial strains. (C) 2000 Elsevier Science Inc. All rights reserved.

关键词：抗菌药/药理学抗菌药/治疗应用头孢唑林/药理学头孢唑林/治疗应用克林霉素/药理学社区获得性感染/药物疗法社区获得性感染/微生物学 DNA 细菌/分析疾病暴发流行红霉素/药理学庆大霉素类/药理学庆大霉素类/治疗应用甲氧西林抗药性萘夫西林/药理学萘夫西林/治疗应用葡萄球菌感染/药物疗法葡萄球菌感染/流行病学葡萄球菌感染/微生物学金黄色葡萄球菌/药物作用金黄色葡萄球菌/遗传学金黄色葡萄球菌/分离和提纯青少年人类男(雄)性

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Risk of resistance related to antibiotic use before admission in patients with community-acquired bacteraemia

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 1999年第1期43卷 119-126页

作者： Pedersen, G Schonheyder, HC Steffensen, FH Sorensen, HT Aalborg Hosp Dept Med M Aalborg Denmark Aalborg Hosp Dept Clin Microbiol Aalborg Denmark Univ Aarhus Danish Epidemiol Sci Ctr Dept Epidemiol & Social Med Aarhus Denmark Aarhus Univ Hosp Dept Med 5 Aarhus Denmark

We analysed the association of antibiotic therapy before admission and antibiotic resistance of blood isolates in a total of 1717 community-acquired bacteraemias in the County of Northern Jutland during 1992-96. Antibiotics had been prescribed to 14% of the patients during the 30 days before admission and to 37% during the 6 months. The most frequently prescribed antibiotics within 30 days were ampicillin (28%), penicillin G (27%), sulphonamides and/or trimethoprim (16%) and macrolides (14%). The most frequent blood isolates were Escherichia coli (33%), other Enterobacteriaceae (8%), Streptococcus pneumoniae (23%) and Staphylococcus aureus (10%). Of the 575 isolates of E. coli, 425 (74%), 432 (75%) and 518 (90%) were susceptible to ampicillin, sulphonamides and trimethoprim, respectively. Previous antibiotic prescriptions were strongly associated with resistance to ampicillin, sulphonamides and trimethoprim in E. coli. The association was less pronounced for S. aureus and enteric rods other than E. coli. Antibiotic prescriptions within the last 3 months predicted antibiotic resistance, and this should be taken into account when selecting empirical antibiotic therapy of severe community-acquired infections.

关键词：氨苄西林/药理学氨苄西林/治疗应用抗菌药/药理学抗菌药/治疗应用菌血症/药物疗法菌血症/流行病学菌血症/微生物学社区获得性感染/药物疗法社区获得性感染/流行病学社区获得性感染/微生物学丹麦抗药性微生物药物利用/统计学和数值数据肠杆菌科/药物作用大肠杆菌/药物作用试验预期值处方药物/统计学和数值数据葡萄球菌金黄色/药物作用甲氧苄啶/药理学甲氧苄啶/治疗应用老年人女(雌)性人类男(雄)性中年人

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Emerging therapies for serious gram-positive bacterial infections: A focus on linezolid

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CLINICAL INFECTIOUS DISEASES 2000年第Sup4期31卷 S144-S149页

作者： Plouffe, JF Ohio State Univ Coll Med Div Infect Dis Columbus OH 43210 USA

Respiratory tract infections and skin and soft-tissue infections frequently are caused by gram-positive cocci, and treating these infections with standard antibiotics has recently become problematic. Many of the primary pathogens causing these infections are now resistant to current standard treatment regimens. In addition, the frequency of these infections is increasing, particularly among patients with complex medical conditions. Thus, new and effective antimicrobial agents are needed, and many are currently in various stages of development. Linezolid, the first approved oxazolidinone, has enhanced activity against gram-positive organisms. Recent results of 5 large, randomized, phase 3 trials evaluating linezolid for the treatment of community-acquired pneumonia, nosocomial pneumonia, and uncomplicated and complicated skin and soft-tissue infections are encouraging and indicate that linezolid is as effective as standard comparator agents as therapy for these infections. Thus, the recent availability of linezolid offers clinicians a promising new agent for the treatment of serious gram-positive bacterial infections.

关键词：乙酰胺类/治疗应用抗感染药/治疗应用社区获得性感染/药物疗法交叉感染/药物疗法革兰氏阳性菌感染/药物疗法恶唑烷酮类/治疗应用肺炎细菌性/药物疗法皮肤疾病细菌性/药物疗法人类

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Community-acquired methicillin-resistant Staphylococcus aureus in hospitalized adults and children without known risk factors

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CLINICAL INFECTIOUS DISEASES 1999年第4期29卷 797-800页

作者： Gorak, EJ Yamada, SM Brown, JD Tripler Army Med Ctr Dept Med Infect Dis Serv Honolulu HI USA Tripler Army Med Ctr Prevent Med Serv Honolulu HI USA Univ Hawaii John A Burns Sch Med Dept Med Honolulu HI 96822 USA Queens Med Ctr Honolulu HI USA

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are not commonly recognized in healthy patients without predisposing risk. We performed a retrospective study of patients hospitalized with community-acquired MRSA infections from 1992 to 1996 in Honolulu to determine if community-acquired MRSA infections occurred in patients without known risk. Patients hospitalized within the previous 6 months or transferred from other hospitals or nursing homes were excluded, Epidemiological and clinical data were obtained from an inpatient chart review, Ten (71%) of 14 patients with community-acquired MRSA infection had no discernible characteristics of MRSA infections. Thirteen (93%) patients had skin or soft-tissue infections and one patient had MRSA pneumonia, Isolates from patients with MRSA infection were more likely to be susceptible to ciprofloxacin (P =.05), clindamycin (P =.03), and erythromycin (P =.01) than were those from MRSA-colonized patients. In our population, the majority of community-acquired MRSA infections occurred in previously healthy individuals without characteristics suggestive of MRSA transmission.

关键词：社区获得性感染/药物疗法住院甲氧西林抗药性回顾性研究危险因素葡萄球菌感染/药物疗法青少年成年人儿童学龄前女(雌)性人类男(雄)性

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Antimicrobial resistance in Streptococcus pneumoniae:: Implications for patients with community-acquired pneumonia

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MAYO CLINIC PROCEEDINGS 2000年第11期75卷 1161-1168页

作者： Chenoweth, CE Saint, S Martinez, F Lynch, JP Fendrick, AM Univ Michigan Hlth Syst Dept Internal Med Div Infect Dis Ann Arbor MI 48109 USA Univ Michigan Hlth Syst Div Gen Med Ann Arbor MI 48109 USA Univ Michigan Hlth Syst Div Pulm Med Ann Arbor MI 48109 USA Univ Michigan Hlth Syst CHOICES Ann Arbor MI 48109 USA

Streptococcus pneumoniae is the leading cause of community-acquired pneumonia, During the past decade, the prevalence of penicillin resistance in S pneumoniae has increased dramatically, with resistance rates approaching 45% in some areas of the United States. Streptococcus pneumoniae has also acquired resistance to other commonly used antimicrobials, including cephalosporins, macrolides, and trimethoprim-sulfamethoxazole. While vancomycin and the newer quinolones are currently highly active against most strains of S pneumoniae, reduced susceptibilities to these agents have been identified in some strains. Prior use of antimicrobial agents is the major risk factor for colonization and infection with antibiotic-resistant strains. beta -Lactam antibiotics remain the treatment of choice for infections caused by susceptible S pneumoniae. The optimum therapy for penicillin-resistant strains remains unclear. Appropriate empirical therapy for patients with community-acquired pneumonia depends in part on the community-specific resistance patterns of S pneumoniae to various antibiotics. In this article, we provide an overview of the development of S pneumoniae resistance to commonly used antibiotics and discuss the implications of the development of resistance on treatment decisions.

关键词：社区获得性感染/药物疗法抗药性微生物内酰胺类青霉素抗药性肺炎细菌性/药物疗法预后毒力人类

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Local antibiotic guidelines for adult community-acquired pneumonia (CAP): a survey of UK hospital practice in 1999

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 2000年第1期46卷 141-143页

作者： Woodhead, M Macfarlane, J Manchester Royal Infirm Dept Resp Med Manchester M13 9WL Lancs England City Hosp Resp Infect Unit Nottingham NG5 1PB England

We investigated the guidelines in British hospitals for the management of adults admitted with community-acquired pneumonia (CAP). A questionnaire was sent to one consultant respiratory physician in each of the 263 hospitals in the British Thoracic Society (BTS) Directory of Training Posts and Services. Two hundred and thirteen (81%) responses were received: 178 (84%) had written CAP guidelines, of which 123 (69%) printed copies were received. For non-severe CAP a single antibiotic (74% of guidelines-most frequently amoxycillin or ampicillin) was the usual recommendation with the combination of a beta-lactam and a macrolide the second most frequent (24%). The latter combination was recommended for severe CAP in 81% of guidelines. Clostridium difficile-associated diarrhoea had influenced guideline recommendations, or was commented on as a concern, in 18% of responses. Written guidelines for antibiotic therapy in adults with CAP exist in most British hospitals and follow broadly the 1993 BTS guidelines, although combination therapy is used not infrequently for non-severe CAP.

关键词：抗菌药/治疗应用社区获得性感染/药物疗法指导方针(主题) 肺炎细菌性/药物疗法成年人人类

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Changing physician prescribing behavior: The Community-Acquired Pneumonia Intervention Trial

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 2000年第16期57卷 1506-1510页

作者： Coley, KC Skledar, SJ Fine, MJ Yealy, DM Gleason, PP Ryan, ML Kapoor, W Branch, RA Univ Pittsburgh Sch Pharm Pittsburgh PA 15261 USA Univ Minnesota Coll Pharm Minneapolis MN 55455 USA

The Notes section welcomes the following types of contributions: (1) practical innovations or solutions to everyday practice problems, (2) substantial updates or elaborations on work previously published by the same authors, (3) important confirmations of research findings previously published by others, and (4) short research reports, including practice surveys, of modest scope or interest. Notes should be submitted with AJHP's manuscript checklist. The text should be concise, and the number of references, tables, and figures should be limited.

关键词：抗感染药/治疗应用病例对照研究头孢呋辛/治疗应用头孢菌素类/治疗应用社区获得性感染/分类社区获得性感染/药物疗法药物处方急诊室医院住院医师的作用肺炎/分类肺炎/药物疗法疾病严重程度指数老年人女(雌)性人类男(雄)性

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