Article

Appropriate vs. inappropriate antimicrobial therapy.

Health Informatics Centre, Division of Community Health Sciences, Dundee, UK.
Clinical Microbiology and Infection (impact factor: 4.54). 05/2008; 14 Suppl 3:15-21. DOI:10.1111/j.1469-0691.2008.01959.x pp.15-21
Source: PubMed

ABSTRACT Inappropriate antimicrobial treatment (defined as use of antimicrobial agent to which a pathogen is resistant) or a delay in starting appropriate treatment are both associated with increased morbidity and mortality. Studies of ventilator-associated pneumonia, intra-abdominal infections or bacteraemia document higher mortality in patients who received inappropriate therapy. In addition, the outcome in patients switched from inappropriate to appropriate therapy is better than for patients who remained on inappropriate therapy, but the benefit is not as great as for those who were started on appropriate therapy initially. While inappropriate therapy undoubtedly has an important influence on outcomes, it needs to be considered in the context of other patient risk-factors, such as co-morbid conditions, severity score measures, and functional status. When assessing the impact of inappropriate therapy on outcomes such as length of hospital stay, it is important to be as precise as possible about the time of onset of infection. Failure to do so may lead to inaccurate estimation of the effect of inappropriate therapy. While the likelihood that resistant pathogens can increase costs throughout the healthcare system is generally recognised, an under-appreciated aspect of resistance is its consequences for patients and their carers. Initiatives are underway to gauge the impact of resistance and strategies to combat its spread.

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    Article: Early changes of procalcitonin may advise about prognosis and appropriateness of antimicrobial therapy in sepsis
    Antonia-Panagiota Georgopoulou, Athina Savva Md, Evangelos J Giamarellos-Bourboulis, Marianna Georgitsi, Maria Raftogiannis, Nicolaos Antonakos Md, Efterpi Apostolidou Md, Dionyssia-Pinelopi Carrer, George Dimopoulos, Aggelos Economou Md, [......], Garyfallia Poulakou, Athanassios Prekates, Styliani Sybardi Md, Maria Theodorakopoulou Md, Christina Trakatelli, Panagiotis Tsiaoussis Md, Charalambos Gogos, Helen Giamarellou, Apostolos Armaganidis, Michael Meisner
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    Article: Strategies for managing today’s infections
    Y. Carmeli
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    ABSTRACT: Bacterial infections are becoming more difficult to treat. At the present time c. 70% of nosocomial infections are resistant to at least one antimicrobial drug that previously was effective for the causative pathogen. Pathogens that are notorious for their virulence and ability to develop resistance include Staphylococcus aureus, Enterococcus spp., members of the Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter species. Notable resistance patterns that have emerged include methicillin resistance in S. aureus, which started in the healthcare setting but has now moved into the community. Vancomycin resistance in enterococci is frequently seen, and vancomycin resistance in methicillin-resistant S. aureus is a public health threat. Resistance patterns seen in pseudomonal and Acinetobacter infections are rapidly shifting. The situation has become sufficiently serious for clinical opinion leaders to call upon governments for assistance in addressing the problem. In this worsening environment, in which patients are at progressively greater risk of untreatable infections, clear recommendations for prescribers are urgently needed. Severity of infection and underlying conditions are key issues, as patients with the most serious diseases are those in most urgent need, and improvements in our ability to predict likely infecting pathogens when empirical therapy is necessary are needed. Risk-factors and local resistance patterns must be accounted for, and initial empirical therapy should be adequately broad spectrum and adequately dosed. Agents must be highly active, able to penetrate adequately to the site of infection, safe, and well-tolerated.
    Clinical Microbiology and Infection 03/2008; 14(s3):22 - 31. · 4.54 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

appropriate therapy
 
appropriate treatment
 
bacteraemia document higher mortality
 
carers
 
gauge
 
great
 
healthcare system
 
inaccurate estimation
 
inappropriate
 
Inappropriate antimicrobial treatment
 
inappropriate therapy
 
intra-abdominal infections
 
morbidity
 
patient risk-factors
 
patients
 
precise
 
resistant pathogens
 
severity score measures
 
under-appreciated aspect
 
ventilator-associated pneumonia
 

P G Davey