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Purpose Asthma is a common comorbidity in patients with bronchiectasis and has been shown to increase the risk of bronchiectasis exacerbations. This paper explores the impact of comorbid asthma on patients receiving intravenous antibiotic treatment for bronchiectasis exacerbations. Methods This was a post hoc analysis of the Meropenem randomised controlled trial of 90 patients that had intravenous antibiotic treatment for bronchiectasis exacerbations. The participants were split into two groups: group 1 (asthma and bronchiectasis) and group 2 (bronchiectasis). The authors assessed response to treatment and time to next exacerbation. Results There were 38 participants in group 1 and 34 participants in group 2. The groups were found to be comparable in terms of age, sex, and bronchiectasis severity (median (95% CI) group 1 and then group 2 data): age 64.0(59.3, 68.6) and 63.6(57.9, 69.4) years old, p = 0.8; 57.9% and 64.7% female, p = 0.6; Bronchiectasis Severity Index 11.1(9.8, 12.4) and 10.1(8.2, 12.0), p = 0.3. There was a similar response to treatment between the groups, but group 1 were found to relapse early by day 14, 31.6% in group 1 and 11.8% in group 2, p = 0.03. In the Cox proportional hazards model, asthma was the only independent risk factor for early relapse by day 14 (odds ratio (95% CI) 3.16 (1.02–9.79), p = 0.047). Conclusion The clinical response to treatment was similar but patients with coexisting asthma were at increased risk of early relapse within 14 days of stopping intravenous antibiotic therapy. Clinical Trial Registration: NCT02047773.

Bilateral recurrent periorbital cellulitis is a very rare condition, with only five cases having been reported. Two cases are presented of recurrent bilateral asynchronous eyelid oedema in two paediatric patients. It was associated with respiratory infections, with no systemic disease. The patients had recurrent episodes (three times) since nine months old. They received oral and intravenous antibiotics, with a good response. There were no complications and no surgery was needed.

Management of acute pancreatitis and its complications has rapidly evolved in recent years. The earlier pillars of management that included prolonged bowel rest, empiric intravenous antibiotics, and early surgical intervention for complications such as pancreatic necrosis have become much less common. The latest evidence-based approaches to acute pancreatitis are taking almost a diametrically different path to previous management. The current strategy focuses on early feeding, judicious use of antibiotics, and delayed use of invasive interventions. Even in complex cases, when surgical interventions may be indicated, there is an expressed preference for minimally invasive techniques. We review the changes that have evolved rapidly over the past decade in this common clinical problem.

The number of annual total joint arthroplasties (TJA) is increasing. Periprosthetic joint infections (PJI) occur when there is infection involving the prosthesis and surrounding tissue, which has the potential to develop into sepsis if left untreated. Sepsis in patients who have undergone TJA is life threatening and requires urgent treatment. If sepsis is due to PJI, the focus should be on early intravenous antibiotics with aspiration as soon as possible to diagnose the infection. Patients who develop sepsis after surgery for PJI are particularly at high risk for mortality and need to be treated in the intensive care unit.

Objective To evaluate the prognostic accuracy of qSOFA for predicting in-hospital mortality among patients with suspected infection presenting to the ED of a public tertiary hospital in Brazil. Methods We performed a retrospective cohort study of consecutive adult patients (age ≥ 18 years) with suspected infection who presented to an academic tertiary ED in Porto Alegre (Southern Brazil) during an 18-month period. The qSOFA was calculated by using information collected at triage and patients were followed throughout hospitalization for the primary outcome of in-hospital mortality. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratios with corresponding 95% CIs were calculated for the qSOFA and qSOFA65. Results A total of 7523 ED visits of patients with suspected infection in which an intravenous antibiotic was administered within 24 h were included, which resulted in 908 in-hospital deaths (12.1%). There were 690 (9.2%) patients whose triage qSOFA was ≥2 points. When such cutoff was used, the sensitivity for in-hospital death was 24.6% (95% CI 21.8 to 27.4%) and the specificity was 92.9% (95% CI 92.3% to 93.5%). The sensitivity increased to 67.4% (95% CI 64.2% to 70.3%) when a cutoff of ≥1 was tested, but the specificity decreased to 55.3% (95% CI 54.1% to 56.5%). Using a cutoff of ≥2, the qSOFA65 had a sensitivity of 51.0% (95% CI 47.7% to 54.3%) and a specificity of 75.7% (95% CI 74.6% to 76.7%). Conclusions The qSOFA score yielded very low sensitivity in predicting in-hospital mortality. Emergency physicians or ED triage nurses in low-to-middle income countries should not be using qSOFA or qSOFA65 as “rule-out” screening tools in the initial evaluation of patients with suspected infection.

When an entire cohort of patients receives a treatment, it is difficult to estimate the treatment effect in the treated because there are no directly comparable untreated patients. Attempts can be made to find a suitable control group (e.g., historical controls), but underlying differences between the treated and untreated can result in bias. Here we show how negative control outcomes combined with difference-in-differences analysis can be used to assess bias in treatment effect estimates and obtain unbiased estimates under certain assumptions. Causal diagrams and potential outcomes are used to explain the methods and assumptions. We apply the methods to UK Cystic Fibrosis Registry data to investigate the effect of ivacaftor, introduced in 2012 for a subset of the cystic fibrosis population with a particular genotype, on lung function and annual rate (days/year) of receiving intravenous (IV) antibiotics (i.e., IV days). We consider 2 negative control outcomes: outcomes measured in the pre-ivacaftor period and outcomes among persons ineligible for ivacaftor because of their genotype. Ivacaftor was found to improve lung function in year 1 (an approximately 6.5–percentage-point increase in ppFEV1), was associated with reduced lung function decline (an approximately 0.5–percentage-point decrease in annual ppFEV1 decline, though confidence intervals included 0), and reduced the annual rate of IV days (approximately 60% over 3 years).

Background Mycobacterium abscessus subspecies massiliense is a non-tuberculous mycobacteriosis and was subdivided from Mycobacterium abscessus in 2006. This article is the first report on nasopharyngitis caused by Mycobacterium abscessus subspecies massiliense. Case presentation A 45-year-old woman had an 18-month history of recurrent nasopharyngitis and presented with pain in the throat. Mycobacterial tissue culture and polymerase chain reaction testing revealed the presence of Mycobacterium abscessus subspecies massiliense in the nasopharyngeal tissue. This patient underwent surgery, followed by multiple rounds of chemotherapy with oral and intravenous antibiotic agents for 16 weeks. She has had no recurrence during the 56 weeks since treatment. Conclusion It is difficult to detect the presence of Mycobacterium abscessus subspecies massiliense in a culture from the swabbing sample. The tissue culture from a biopsy specimen is mandatory for the identification of the species. Currently, no definite treatment policy is available and only empirical treatment is applied. This case is an important for the diagnosis and treatment of this bacterial infection on nasopharynx.

Purpose To review treatment of osteomyelitis of the jaw (OMJ) and determine whether antibiotic route and/or length of administration impacts resolution of infection postsurgically. Methods The investigators designed a retrospective cohort study enrolling a sample of patients treated at Harborview Medical Center from January 1, 2009 to December 31, 2019. The primary predictor variable was antibiotic administration route: oral (PO) only, intravenous (IV) only, IV transitioned to PO (IV + PO), or none. The secondary predictor was duration of antibiotic therapy (≤6 weeks or >6 weeks). The primary outcome variable was resolution of infection at 2 months follow-up posttreatment completion. The secondary outcome variable was number of surgeries to resolution of infection. Descriptive, bivariate, and multiple linear regression statistics were computed, with statistical significance set at P Results Sixty-seven individuals met inclusion criteria (38 male), mean age 51 years (18 to 88). Forty-nine (73%) received PO antibiotics, 12 (18%) IV + PO, 3 (4%) IV, and 3 (4%) none. Both PO and IV antibiotics were associated with clinical resolution (P = .022, .005, respectively) compared with debridement alone. Antibiotic duration of ≤6 weeks compared with >6 weeks was not significant. Seventy-six percent (51 of 67) required only 1 surgery. In the multivariate logistic regression, PO was associated with clinical resolution (P = .025, OR = 5.05). Penicillin allergy (P = 0.049, OR = 0.223) and diabetes (P = .008, OR = 0.104) were adversely associated with outcome. Conclusions OMJ was successfully treated with oral antibiotics and surgery. Prescribing 6 weeks of IV antibiotics may be antiquated. Clinicians should consider oral penicillins as first line whenever possible. Further studies are recommended.

Background Cardiac implantable electronic device (CIED) implantation rate has been increasing worldwide. Despite proper surgical technique and preincisional intravenous antibiotics, the incidence of infected CIED remains high and leads to serious complications. When encountered with CIED infection, complete CIED system removal is indicated. Several lead extraction approaches have shown a high success rate. However, the facilities are limited in Thailand. In our current practice, we perform lead extraction using the Dotter basket snare femoral approach as our primary method. There are no prior data on this countertraction‐assisted transfemoral technique. Therefore, we aim to study the procedural outcome of countertraction‐assisted transfemoral lead removal technique of CIED infection in Thai patients. Methods Patients diagnosed with CIED infection and with a history of device infection were retrospectively included. Simple manual removal was performed. In case of failure, we proceeded with the modified countertraction‐assisted transfemoral technique. Results There were 35 patients in the study. The success rate was 94.3%. Most of the leads, 62.8%, were removed by simple manual traction. In the 37.1% who required further femoral approach lead extractions, procedural failure was observed in 5.7% and procedure‐related adverse events in 5.6%. CIED infection‐related death accounted for 5.7% and nosocomial infection‐related death, 2.8%. Conclusion The success rate of CIED infection lead explant and countertraction‐assisted transfemoral lead extraction technique was high with small complications and can be performed without advanced facilities. However, the procedure required a main center with a cardiovascular thoracic surgery support team., Countertraction is the cornerstone of the lead extraction in preventing of right ventricular (RV) inversion with less complications. Improvised technique, using telescopic system consisted of ablation catheter and deflectable sheath placement at RV apex, provided countertraction force whilst applying femoral lead extraction.

In children, spontaneous mediastinitis is a rare, severe and commonly misdiagnosed disease. Although standard of care treatment frequently involves surgery, we report a case of mediastinitis in a five-year-old child, successfully treated with 4 weeks of intravenous antibiotics. Ultrasound imaging was used to monitor patient response to conservative treatment while reducing radiation exposure.

Background: In 2017, a national drug shortage of small volume solutions significantly affected the preparation of intravenous antibiotics. In response, a continuous infusion administration protocol for piperacillin/tazobactam (PIP/TAZ) was implemented. Objective: To compare the outcomes of continuous to prolonged infusions of PIP/TAZ in the setting of drug shortages. Methods: This study is a single-center, retrospective cohort study in a community hospital of patients 18 years and older who received intravenous PIP/TAZ through 2 different dosing strategies of intravenous antibiotics from December 2016 to January 2018. Data were collected for 2 months on patients receiving prolonged infusions of PIP/TAZ prior to November 2017 and for 2 months on patients receiving continuous infusions of PIP/TAZ after November 2017. Results: A total of 90 patients who received PIP/TAZ via either prolonged (n = 47) or continuous infusion (n = 43) were evaluated. There were no differences between the groups in mortality (3 vs 2 deaths, P = 1.00), length of therapy (6 ± 4 vs 6 ± 3 days, P = .86), or length of stay (9 ± 7 vs 8 ± 6 days, P = .47). Additionally, no differences were noted between incidences of thrombocytopenia ( P = .41), Clostridioides difficile infection ( P = .48), acute renal failure ( P = 1.00), seizures ( P = 1.0), or 30-day readmission rates ( P = .27). Conclusions: Administration of continuous infusion PIP/TAZ appears to be a viable mitigation strategy during small volume fluid shortages. Future cost-effectiveness studies may provide information on the financial impact of continuous infusions during costly drug shortages.

Background Panton-Valentine leukocidin (PVL) is one of the major virulence factor of Staphylococcus aureus (SA) that might be associated with invasive life-threating infections. A prompt diagnosis and adequate treatment are essential in achieving the best outcome and avoiding serious sequelae. We describe a case of severe invasive PVL-SA infection in an infant. A literature review starting from 2010 was also performed in order to discuss clinical presentations, radiological findings, treatment and outcome. Case presentation This is a case of a 6-month-old boy who rapidly developed high fever and poor general condition. He was diagnosed as having multiple muscular abscesses, multiple foci of osteomyelitis and bloodstream infections caused by Panton-Valentine leukocidin Methicillin-resistant Staphylococcus aureus. He received intravenous antibiotics and surgical drainage of the abscess with progressive recovery. Conclusion Our report highlights the importance of improving awareness of this severe infection, as a prompt diagnosis and adequate manage is essential in order to save life and to prevent serious complications.

A questionnaire regarding splenic embolization in trauma was submitted to an international sample of IR faculty members, to compare their practice to the available recommendations. A 21 multiple-choice questionnaire was sent to an international cohort of 96 IR faculty. Questions included the initial patient evaluation, embolization materials and techniques, post-procedure management, availability of an institutional protocol, and use of guidelines. For each question, there were from a minimum of 45 to a maximum of 52 responders: 94% require a CT with contrast prior to embolization, and 87% use the American Association for the Surgery of Trauma (AAST) scale to grade the splenic injuries. Embolization is performed across all values of the AAST scale. Of the patients with injuries of grade III or greater, embolization is primarily done for those patients who are hemodynamically stable. Unstable patients are embolized less frequently and primarily in cases in which the injuries are of a lower grade. Coils are the preferred material for proximal embolization (69%). Particles/Gelfoam is the preferred material for distal embolization (38%). In total, 63% administer intravenous antibiotics before the procedure and 15% administer intra-arterial antibiotics during the procedure. After embolization, follow-up imaging is recommended by 87%, antibiotics are administered regularly by 33%, clinical follow-up is recommended by 73%, and vaccination against encapsulated organisms is routinely recommended by 39%. There is significant variability among a heterogeneous cohort of respondents. Available recommendations may not be sufficiently addressing the practice of splenic embolization.

Paediatric patients with cancer and those undergoing haematopoietic cell transplantation are at high risk of bacterial infections. The 8th European Conference on Infections in Leukaemia (ECIL-8) convened a Paediatric Group to review the literature and to formulate recommendations for the use of antibiotics according to the European Society of Clinical Microbiology and Infectious Diseases grading system. The evaluation of antibacterial prophylaxis included mortality, bloodstream infection, febrile neutropenia, emergence of resistance, and adverse effects as endpoints. Initial antibacterial therapy and antibiotic de-escalation or discontinuation focused on patients with a clinically stable condition and without previous infection or colonisation by resistant bacteria, and on patients with a clinically unstable condition or with previous infection or colonisation by resistant bacteria. The final considerations and recommendations of the ECIL-8 Paediatric Group on antibacterial prophylaxis, initial therapy, and de-escalation strategies are summarised in this Policy Review.

COVID-19 became a pandemic with a worldwide impact leading to stay-at-home orders, death, economic difficulties, and a significant influence on daily lives. Dental services became limited at this time, causing increased concerns for patients requiring urgent dental care. We report the case of a 5-year-old previously healthy male who presented to our hospital’s emergency department (ED) with facial swelling secondary to infected maxillary left molars. Extractions were performed in the ED with moderate sedation. He was later found to be COVID-19 positive before admission for intravenous antibiotics. The use of universal precautions during the pandemic in treating patients with possible COVID-19 symptoms and in aerosol-generating procedures is recommended. Evaluating and providing treatment to our patients with urgent dental care should not be delayed to prevent further complications and decrease the burden placed on the ED, which may be limited in its ability to provide definitive care.

This case report presents a 48-year-old patient with suspicion for chronic osteomyelitis caused by oral pathogens including species of Actinomyces, Eikenella and Stenotrophomonas. The symptoms included progressive swelling of the right thigh and hyperpyrexia with up to 41°C. Imaging methods included standard X-ray as well as MRI. Furthermore, two operations were necessary for surgical infection therapy. Histological and microbiological investigations of intraoperative samples showed polymicrobial osteomyelitis. Since local trauma could be excluded as the cause for the disease, the patient’s dental status was evaluated and proved as the possible infectious focus with a hematogenous spread. The patient was treated with intravenous antibiotics for two weeks and oral antibiotics for four further weeks. The patient’s clinical condition drastically improved with that treatment.

BACKGROUND AND OBJECTIVES: Children with deep neck infections (DNIs) are increasingly being managed nonsurgically with intravenous antibiotics. Our objective was to examine variation in the management of children with DNIs across US children’s hospitals. METHODS: We conducted a retrospective cohort study using the Pediatric Health Information System database. Children ≤12 years of age hospitalized for retropharyngeal or parapharyngeal abscesses from 2010 to 2018 were included. Hospital variation in management modality and imaging use was described. Temporal trends in management modality were assessed by using logistic regression. Medical management alone versus a combination of medical and surgical management was assessed, and the characteristics of children in these 2 groups were compared. The relationship between hospital rates of initial medical management and failed medical management was assessed by using linear regression. RESULTS: Hospitals varied widely in their rates of surgical management from 17% to 70%. The overall rate of surgical management decreased from 42.0% to 33.5% over the study period. Children managed surgically had higher rates of ICU admission (11.5% vs 3.2%; P < .001) and higher hospital charges ($25 241 vs $15 088; P < .001) compared with those managed medically alone. Seventy-three percent of children underwent initial medical management, of whom 17.9% went on to undergo surgery. Hospitals with higher rates of initial medical management had lower rates of failed medical management (β = −.43). CONCLUSIONS: Although rates of surgical management of pediatric DNI are decreasing over time, there remains considerable variation in management across US children’s hospitals. Children managed surgically have higher rates of resource use and costs.

Introduction The duration adequacy of antibiotic regimens is one of the key points of Antimicrobial Stewardship Programs (ASP) given the relationship between the risk of resistance and days of exposure to antimicrobials. Methods Monitoring activities of intravenous antibiotics longer than 7 days at Hospital Infantil Vall d’Hebron, Barcelona, by reviewing data over a 34-weeks period from weekly cross-sectional analysis, followed by recommendations to prescribers to adapt their use. Results A total of 81 patients with 146 prolonged intravenous antibiotic treatments (78.8% of prescriptions were adequate) were reviewed. A total of 190 revisions were performed. 31 interventions on inappropriate prescriptions were carried out (61.3% of adherence to recommendation). Nineteen treatments were optimized (14 suspended, 5 de-escalated) reducing their duration by 8.75%. Conclusions Active intervention of ASP group is an effective tool to improve antibiotic optimization, reducing unnecessarily prolonged treatments, mainly on these areas with a greater range of improvement.

Delayed inflammatory and infectious complications occurred in a 63-year-old woman after receiving AQUAfilling filler injection in the forehead and nasolabial folds. The complications were idiopathic and occurred at different time points at different sites. Her condition improved after the removal of the injected materials and capsule, and administration of intravenous antibiotics. Although injection sites differ, inflammation can occur at any site at different time points. The possibility of inflammation at other injection sites should always be considered during periodic follow-up, even if the filler injection site initially shows no signs of complications.Level of Evidence: Level IV.

Oral versus Intravenous Antibiotics for Endocarditis This interactive feature about the treatment of endocarditis offers a case vignette accompanied by two essays supporting a full 6-week course of...

In the era of the COVID-19 pandemic, children are spared from severe disease, accounting for 0.39–12.3%. According to a study in Wuhan China, only 2.7% of children are developed severe pneumonia. There are few cases reported with COVID-19 pneumonia in infants. We report the case of a 45-day-old infant who presented with respiratory distress with COVID-19 pneumonia required mechanical ventilation with an intercostal drainage tube for pyopneumothorax. The child was treated with intravenous antibiotics with supportive oxygen therapy. The fluid report of the pyopneumothorax was showing MRSA growth, so antibiotics were modified according to the sensitivity report. In this case report, COVID-19 pneumonia presented with complications in the form of pyopneumothorax with secondary bacterial infection and was successfully treated with a vigilant approach.

Rationale: Pulmonary exacerbations (PExs) are associated with significant morbidity in people with cystic fibrosis (CF). Severe PExs are treated with intravenous antibiotics, including tobramycin. ...

Emergency department (ED) patients with cellulitis requiring intravenous antibiotics may be eligible for outpatient parenteral antibiotic therapy (OPAT). The primary objective was to determine whether implementation of an OPAT clinic results in decreased hospitalizations and return ED visits for patients receiving OPAT. We conducted an interrupted time series study involving adults with cellulitis presenting to two EDs and treated with intravenous antibiotics. The intervention was the OPAT clinic, which involved follow up at 48–96 h with an infectious disease physician to determine the need for ongoing intravenous antibiotics (implemented January 1, 2014). The primary outcomes were hospital admission and return ED visits within 14 days. Secondary outcomes were treatment failure (admission after initiating OPAT) and adverse peripheral line or antibiotic events. We used an interrupted time series design with segmented regression analysis over one-year pre-intervention and one-year post-intervention. 1666 patients were included. At the end of the study period, there was a non-significant 12% absolute increase in hospital admissions (95% CI − 1.6 to 25.5%; p = 0.084) relative to what would have been expected in the absence of the intervention, but a significant 40.7% absolute reduction in return ED visits (95% CI 25.6–55.9%; p

There is little consensus regarding the use of postoperative antibiotics in the management of perforated appendicitis in children. Patients are commonly discharged with oral antibiotics after a course of intravenous antibiotics; however, recent literature suggests that patients can be safely discharged without any oral antibiotics. To further evaluate this protocol, we conducted a multicenter retrospective preimplementation/postimplementation study comparing rates of abscess formation and rehospitalization between patients discharged with and without oral antibiotics.We reviewed the records of all pediatric patients who underwent appendectomies for perforated appendicitis at NYU Tisch Hospital, Bellevue Hospital, and Hackensack University Medical Center from January 2014 to June 2019. Data pertaining to patient demographics, hospital course, intraoperative appearance of the appendix, antibiotic treatment, abscess formation, and rehospitalization were collected.A total of 253 patients were included: 162 received oral antibiotics and 91 did not. The median length of antibiotic treatment (oral and intravenous) was 11 (10-14) d for patients on oral antibiotics and 5 (3-6) d for patients without oral antibiotics (P 0.01). The median leukocyte count at discharge was 9.5 (7.4-10.9) and 8.1 (6.8-10.4) for these groups, respectively (P = 0.02). Postoperative abscesses occurred in 22% of patients receiving oral antibiotics and 15% of patients on no antibiotics (P = 0.25). Rates of rehospitalization for these groups were 10% and 11%, respectively (P = 0.99).Children who have undergone appendectomy for perforated appendicitis can be safely discharged without oral antibiotics on meeting clinical discharge criteria and white blood cell count normalization.

La mediastinitis necrosante descendente es una enfermedad rara y posee alta letalidad. Pocos casos se han descrito en adultos y, mucho menos en niños. Presentamos el caso de un niño con esta entidad, sometido a drenaje quirúrgico profundo de absceso retrofaríngeo y a antibióticos endovenosos dirigidos al germen aislado, Staphylococcus aureus, y a anaerobios propios de la flora oral. Su desenlace fue satisfactorio.

Antimicrobial resistance (AMR) is an ever-developing global threat and children are becoming increasingly affected. In addition to established antimicrobial stewardship (AMS) measures, it is important to recognise the need for a paediatric focus to manage the physiological and pathological differences unique to children. Most studies on paediatric AMS are drawn from resource-rich, hospital settings. They support interventions including AMS programmes, bundled groups of interventions, guidelines and education initiatives. These must be tailored to specific institutions, populations and resources as translating interventions between these may not be effective. There are knowledge gaps in paediatric AMS, which pose challenges to designing both interventions and research in this area. These include quantifying antimicrobial consumption, defining AMS outcomes and understanding the development of AMR. Finding answers to fill these gaps needs urgent attention. There is also a need to think outside the box to improve AMS in children. Potential opportunities include intravenous antibiotics at home via hospital-in-the-home programmes, earlier switching to oral antibiotics, repurposing old antibiotics and re-evaluating children labelled as having antibiotic allergy. Using all of the possibilities available gives us the best chance of staying ahead of the relentless march of AMR in children.

Aim:To examine changes in door-to-antibiotic time in pre- and post-intervention groups.Materials and Methods:A quasi-experimental study was conducted in the Emergency Department involving adult patients who were diagnosed with sepsis or septic shock in a university-based hospital. The patients were distributed into one of two groups: a pre-intervention or post-intervention group. In the post-intervention group, among patients with a suspected infection and a National Early Warning Score (NEWS) of ≥5, the sepsis fast track protocol was used in the normotensive group and the sepsis with shock fast track protocol was used in the hypotensive group. Our primary outcome was the difference in the door-to-antibiotic time in the pre- and post-intervention groups.Results:Overall, 117 patients were included in the pre-intervention group and 102 patients in the post-intervention group. The median door-to-antibiotic time in the pre-intervention group was 45 min [interquartile range (IQR): 30-65], and the median door-to-antibiotic time in the post-intervention group was 30 min (IQR: 20-55, p=0.009). However, there was no significant difference in the mortality rate (p=0.194).Conclusion:Using an activated system with NEWS for screening patients suspected with sepsis helped reduce the door-to-antibiotic time.

Open pediatric forearm fractures are common injuries that present to emergency departments across the United States. A total of 32% to 80% of all open pediatric fractures involve the forearm. Standard treatment for these injuries includes prompt intravenous antibiotic administration, tetanus prophylaxis, and usually bedside irrigation as a temporizing measure. Gustilo and Anderson type 2 and 3 open pediatric forearm fractures are generally managed with formal irrigation and debridement and fracture stabilization in the operating room. Management of Gustilo and Anderson type 1 open pediatric forearm fractures is not standardized, and level I evidence is currently lacking. Based on the existing data available, early antibiotic administration, bedside irrigation, and fracture stabilization in the emergency department may be a safe and effective initial treatment for these injuries, conferring a low risk for subsequent infection.

Background Urinary tract infection (UTI) is a common infectious disease managed in the emergency department (ED). Patients may be initially treated with an intravenous (IV) antibiotic and subsequently discharged with an oral antibiotic regimen. Objective The purpose of this study was to determine whether the current Infectious Diseases Society of America guideline recommendation for an initial dose of long-acting IV antibiotic for treatment of UTI when the prevalence of fluoroquinolone resistance exceeds 10% improves the likelihood of providing in vitro susceptibility to the isolated uropathogen. Methods This was a retrospective study of patients in ED presenting between May 2009 and August 2018 who received treatment for UTI. The primary outcome was susceptibility of uropathogen to the IV antibiotic administered. Secondary outcomes included susceptibility to the oral antibiotic regimen prescribed at discharge, repeat health care visit within 30 days related to UTI follow-up, adverse events (AEs) associated with antibiotic use, and identification of risk factors associated with pathogen resistance. Results A total of 255 patients were included for analysis. Of these patients, 230 (90.2%) had pathogens susceptible to the administered IV antibiotic. The oral regimen susceptibility was 81.6% with 29 patients returning for UTI follow-up and 4 patients reporting AEs related to antibiotic use. Men and long-term care facility residents were more likely to have resistant uropathogens. Conclusion Administration of a long-acting IV antibiotic for treatment of UTI prior to ED discharge is recommended when the fluoroquinolone resistance rate exceeds 10% to improve in vitro susceptibility coverage.

Background Peritonitis is a common and clinically important complication in patients receiving peritoneal dialysis (PD). Antibiotic administration is essential for PD-related peritonitis, but routes of administration have not been established enough. Here, we performed a systematic review to assess the efficacy and safety of intraperitoneal (IP) antibiotic administration compared to intravenous (IV) antibiotic administration in patients with PD-related peritonitis. Methods Cochrane CENTRAL, MEDLINE, and Ichushi-Web were searched in June 2017. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed, and articles were screened by four independent reviewers. Results Two randomized controlled trials (113 patients) were identified. IP antibiotic administration was more effective than IV antibiotic administration. The pooled risk difference between IP and IV was 0.13 (95% CI − 0.17 to 0.43). Safety assessment indicated less frequency of side effects in patients receiving IP antibiotic administration. The pooled risk ratios of IV to IP regarding adverse drug reaction-related and administration route-related side effects were 5.13 (0.63 to 41.59) and 3.00 (0.14 to 65.90), respectively. Conclusion The systematic review and meta-analysis suggested that IP antibiotic administration is more effective and safer in patients with PD-related peritonitis compared to IV antibiotic administration.

espanolObjetivo: estudiar si el uso de cemento con alta dosis de antibioticos es un factor asociado a una menor tasa de infeccion en hemiartroplastia de cadera tras fractura del cuello femoral. Material y metodo: estudio retrospectivo de cohortes de 144 pacientes consecutivos tratados quirurgicamente por fractura cervical de cadera mediante hemiartroplastia cementada entre febrero 2015 y febrero 2017. En 88 casos (61,1%) se utilizo cemento a alta dosis de antibioticos, definida como una concentracion ≥ al 5% del peso total (Grupo 1) y en 56 (38,9%) se utilizo cemento sin antibioticos (Grupo 2). La variable principal de resultado era la infeccion periprotesica. Resultados: se presentaron 2 (1,38%) infecciones que fueron clasificadas como profundas, ambas en el grupo 1 de pacientes y 1 (0,69%) como superficial en el grupo 2. No encontramos diferencias en la tasa de infecciones entre los dos grupos. Dentro de las complicaciones intraquirurgicas encontramos dos fallos de la interfase cemento-protesis (no adherencia del cemento al vastago al cumplir el tiempo de fraguado) ambos casos ocurrieron en el grupo 1. No se presento ninguna reaccion alergica o toxica. El tiempo medio de supervivencia de todos los pacientes operados fue de 2,7 anos (IC95%: 2,4-2,9) al final del seguimiento. No encontramos diferencias en la supervivencia al estratificarla por el uso o no de antibioticos en el cemento, p=0,874.Conclusion: En nuestra experiencia el uso de cemento con alta dosis de antibiotico no esta asociado a menores tasas infeccion cuando la profilaxis antibiotica endovenosa es correcta en los pacientes sometidos a hemiartroplastias de cadera. EnglishObjective: to study whether the use of cement with a high dose of antibiotics is a factor associated with a lower infection rate in hip hemiarthroplasty after femoral neck fracture.Material and methods: a retrospective cohort study of 144 consecutive patients treated surgically for a cervical hip fracture with cemented hip hemiarthroplasty between February 2015 and February 2017. In 88 (61.1%) high dose antibiotic cement was used, defined as a concentration ≥ 5% of the total weight (Group 1) and in 56 (38.9%) cement without antibiotics was used (Group 2). The primary outcome variable was periprosthetic infection.Results: there were 2 (1.38%) infections that were classified as deep, both in group 1. One of patients had a superficial infection in group 2. We did not find differences in the rate of infections between the two groups. Among the intra-surgical complications, we found two failures of the cement-prosthesis interface (non-adherence of the cement to the stem at the end of the setting time), both cases occurred in group 1. There was no allergic or toxic reaction. The mean survival time of all operated patients was 2.7 years (95% CI: 2.4-2.9) at the end of follow-up. We found no differences in survival when stratified by the use or not of antibiotics in cement, p = 0.874.Conclusion:In our experience, in patients undergoing hip hemiarthroplasties the use of cement with a high dose of antibiotic is not associated with lower infection rate when intravenous antibiotic prophylaxis is correct.

Background Adherence to medication administration guidelines is the basic medical and nursing standard and a critical component in medication safety. Specifically, for antibiotics, this helps to minimize serious and life-threatening adverse effects. Patients and methods A cross-sectional study was performed to determine adherence to intravenous (i.v.) antibiotic administration recommendations, especially rate of administration among health care providers, especially nurses. by direct prospective observation of 210 nurses in 14 clinical departments in Menoufia University Hospital, Menoufia, Egypt. Observations were guided using a checklist to collect quantitative data. Results Quantitative data analysis revealed that 46.7% of nurses stuck to administration rate guidelines. Nurses who read medical labels showed a higher rate of i.v. antibiotics administration as recommended (95 vs 64.7%, P

Invasive infections due to Streptococcus dysgalactiae are uncommon in the adult population, and sternoclavicular joint septic arthritis (SCSA) is usually caused by other organisms such as Staphylococcus aureus and Pseudomonas aeruginosa. We hereby report a case of SCSA caused by this organism. The patient responded well to intravenous antibiotics and recovered fully without any surgical intervention.

Aim To examine differences in risk factors, clinical features and outcomes of cellulitis between those 75 + years and those, Highlights • To examine the differences in outcomes of cellulitis in hospitalized patients who are 75 + years and those

Major complications of laryngoscopy and tracheal intubation are rare. However, mucosal trauma during airway management can lead to the introduction of oropharyngeal bacterial flora into the deep neck spaces, with the potential for fatal complications. This report describes the development of a paratracheal abscess in a healthy 62‐year‐old man following an outpatient herniorrhaphy. The patient was treated with intravenous antibiotics and underwent ultrasound‐guided needle aspiration of the abscess. He was later re‐admitted to the hospital with re‐accumulation of the abscess, which was successfully treated by open surgical drainage. Though deep neck space infection following laryngoscopy is more common in patients with significant comorbidities and when tracheal intubation has been difficult, this case highlights the need for careful airway management in all patients.

Background Osteoarticular infections are typically treated initially with intravenous antibiotics. The objective of this study was to evaluate whether an exclusive oral treatment in selected children may be appropriate. Methods The Spanish Network of Osteoarticular Infections is a nationwide multicenter registry comprising 37 hospitals in Spain. The registry prospectively includes clinical characteristics and outcome of children with OAI. One of the hospitals from RioPed offers oral treatment to children meeting certain criteria. Patients were classified into two groups. Group 1: management with initial intravenous antibiotic therapy. Group 2: patients exclusively treated with oral antibiotics. A comparison between the two groups was performed. Results We compared 893 children who initially received intravenous antibiotics (Group 1) with 64 children who received exclusively oral therapy (Group 2). Patients from Group 2 were younger (33.9 vs 20.3 months; p=0.001), had a lower percentage of Staphylococcus aureus (23.3% vs 3.1%, p Kingella kingae (12.1% vs 28.1%; p = 0.001), higher ESR/CRP ratio (1.4 IQR 0.6-3.6 vs 3.3 IQR 1.7-5.7, p

AIM: To investigate the efficacy and safety of home-treatment with oral piv-mecillinam or amoxicillin-clavulanate in children with acute pyelonephritis.METHODS: Children aged over 6 months diagnosed with culture confirmed pyelonephritis at Danish Paediatric Departments were home-treated with piv-mecillinam (tablets) or amoxicillin-clavulanate (liquid or tablets). Follow-up was performed by phone (second treatment day) and clinical review of the patients in the hospital (day three).RESULTS: Four hundred eighteen children were included. In total, 333/418 (80%) responded well to the initial oral antibiotic treatment. 85/418 (20%) were changed to another treatment of these 47/418 (11%) to a second-line oral antibiotic and 38/418 (9%) to intravenous antibiotics due to insufficient clinical improvement or bacterial resistance. Bacterial resistance was similar for piv-mecillinam and amoxicillin-clavulanate: 4/74 (5%) versus 33/333 (10%) (p = 0.22). Insufficient clinical improvement, despite no resistance, primarily occurred in children treated with piv-mecillinam: 16/74 (22%) versus 28/344 (8%) (p < 0.001), and predominantly occurred in piv-mecillinam treated children CONCLUSION: A home-treatment regime for pyelonephritis in children >6 months is safe; however, during treatment, clinical re-evaluation is required as in 20% of cases a change in treatment was necessary.

Background Chronic pulmonary infection is the leading cause of mortality and morbidity in patients with cystic fibrosis (CF). The most common pathogens isolated in CF are Staphylococcus aureus (SA) and Pseudomonas aeruginosa (PA). Chronic infection of PA and methicillin-resistant S. aureus (MRSA) are associated with worse survival and antibiotic eradication treatment is recommended for both. This study compared the outcomes between intravenous (IV) and non-IV antibiotics in eradication of PA and MRSA. Methods This was a single-center retrospective study. All respiratory specimen cultures of 309 CF patients and eradication regimens between 2015 and 2019 were reviewed. Patients received eradication treatment in case of first ever isolation or new isolation after being infection-free >= 1 year. The primary analysis was the comparison of the percentage of successful eradication after receiving IV and non-IV eradication regimens. Demographic and clinical risk factors for eradication failure were also analyzed. Results One hundred and two patients with PA isolations and 48 patients with MRSA were analyzed. At 1 year, 21.6% in PA group and 35.4% in MRSA group were successfully eradicated. There was not any statistically significant difference between IV versus non-IV antibiotic regimens on eradication in either group. Additionally, none of the clinical risk factors was significantly associated with eradication failure in PA and MRSA groups. Conclusion In the eradication of PA and MRSA, IV and non-IV treatment regimens did not show any superiority to one another. Non-parenteral eradication could be a better option considering the cost-effectiveness and the treatment burden of IV treatments due to hospitalization and the need for IV access.

BACKGROUND After surgery for complicated appendicitis (CA), common practice is to treat all patients with a standardised long-course of intravenous antibiotics (IVAB) to reduce the risk of postoperative surgical infections (PSI). The aim of the current study was to evaluate the safety and efficacy of a short-course IVAB after CA in selected patients. METHODS The Department's prospectively collected database identified CA patients treated between2015 and 2019. Baseline and treatment characteristics and postoperative outcomes were analysed. The cut-off between short- and long-course IVAB was 2 days. Outcomes of interest were PSI and 30-day unplanned readmission. RESULTS In total, 226 patients had CA: Ninety-nine CA (43.8%) received short-course IVAB and 127 (56.2%) received long-course. PSI occurred in 6% and 10% of the short-course and long-course patients, respectively (p = 0.34). Length of IVAB after a PSI was comparable to that of patients without PSI (median 3 and 2 days of IVAB respectively; p = 0.28). 30-day unplanned readmission rates were 7% and 6%, respectively (p = 0.99). Length of IVAB for readmitted patients was similar to those who were not readmitted (median 3 days of IVAB in both; p = 0.91). Multivariable analysis showed that the intraoperative findings of the appendix (p = 0.04) was a prognostic predictor for PSI. ASA score (p = 0.02) and surgical approach (p = 0.05) were prognostic predictors for 30-day unplanned readmission. CONCLUSIONS This study shows that when patients respond well, a short-course IVAB can safely be applied after CA without increasing risk of PSI or 30-day unplanned readmission.

Background: We conducted a study to compare the duration of surgery in single dose intravenous antibiotic prophylaxis over no antibiotic prophylaxis in the prevention of wound infection following Lichtenstein tension free inguinal hernioplasty Methods: This prospective study was conducted in the Department of Surgery, Dr. Rajendra Prasad Government Medical College Kangra at Tanda from May 2018 to December 2019after being approved by institutional protocol review committe and ethics committee.50 patients were included in the study.These patients were randomised into two groups i.e. Group A (Antibiotic Group) and Group B (Non-antibiotic Group). Results: The mean duration of surgery in Antibiotic group (Group-A) was 56.6±15.66 minutes whereas it was 50.2±9.62 minutes in Non-antibiotic group (Group-B). The mean duration of surgery was more in Antibiotic group (Group-A) as compared to Non-antibiotic group (Group-B), however the difference was not statistically significant (p= 0.088). Conclusion: In our study, we concluded that statistically insignificant difference was found in the duration of surgery in Antibiotic and Non-antibiotic Group Keywords: Duration of surgery, Antibiotic, Pre-operative

Acute suppurative thyroiditis (AST) is serious and rare infection of the thyroid gland, often it can progress to thyroid abscess. Both anatomical defects and underlying thyroid disorders are attributed to etiopathogenesis of the disease. Bacteria usually reach the gland either by lymphatic spread or via hematogenous routes. If untreated it has fatal outcome and had serious complications. The mainstay of treatment is usually a combination of intravenous antibiotics and drainage, and sometimes surgery.

Necrotizing fasciitis (NF) is an aggressive rapidly spreading infection of the skin and the subcutaneous tissue. Its occurrence in the breast is extremely rare especially after routine procedures like core-needle biopsy. We present the case of a 35-year-old non-lactating female who presented with swelling and a necrotic patch with pus discharge over her right breast following a core needle biopsy. She was immediately treated with aggressive debridement and culture-specific intravenous antibiotics following which she had an uneventful recovery. It is quintessential to diagnose the condition and initiate the treatment as early as possible to prevent the progression of the disease to sepsis and multi-organ dysfunction.

Background Antibiotics are one of the most frequently prescribed medication classes worldwide. Inappropriate prescription of antibiotics has increased the risk of drug-resistant infections and associated mortality. The aim of this study was to examine the patterns of intravenous antibiotics prescribing in emergency and outpatient departments of a tertiary children's hospital in China. Methods Data on intravenous prescriptions dispensed by the emergency and outpatient department from January 1, 2015 to May 31, 2016 were extracted from the information system of the Children's Hospital of Fudan University. Prevalence of intravenous antibiotics use and the suitability of intravenous antibiotic prescription were evaluated on the basis of a completed microbiological examination, antibiotics susceptibility testing, and dose prescribed for patients diagnosed with pneumonia, acute bronchitis, fever, and acute upper respiratory infection (AURI) patients. The prescription rate was expressed as the number of intravenous antibiotic prescriptions per total number of prescriptions. Results Overall, 94.2% of pediatric patients and 78.5 % of issued intravenous prescriptions were for antibiotics. beta-lactam antibacterial (90.5 %) and macrolides (18.5 %) were the most commonly used categories of antibiotics, while cefuroxime (28.8 %) was the most used antibiotic. Besides, pneumonia (31.3 %), acute bronchitis (14.1 %), fever (6.5 %), and AURI (5.5 %) were the most commonly recorded infections. However, in these four diseases, the rate of conducting microbiological examination was 0.3 %, 0.2 %, 2.1 %, and 2.8 %, respectively. Approximately, 52.1 %, 40.0 %, 40.4 %, and 30.5 % of intravenous antibiotic prescriptions were inappropriately used in pneumonia, acute bronchitis, fever, and AURI, respectively. Doses higher and lower than the recommended were often for each of these four diseases. Conclusions The frequency of intravenous antibiotic prescription was high in pediatric emergency and outpatient departments. Inappropriate use of intravenous antibiotics commonly occurred in pneumonia, acute bronchitis, fever, and AURI. Appropriate interventions and prevention strategies need to be developed to curtail inappropriate prescribing of antibiotics.

An 86-year-old female presented to the Emergency Department (ED) in respiratory distress after choking on a sandwich at home. Her family had noticed that she had had difficulty during and coughing after swallowing for several months. Her initial chest x-ray showed diffuse alveolar infiltrates in both lungs and blood tests showed normal white cells and C-Reactive Protein (CRP). She was started on intravenous antibiotics for presumed aspiration pneumonia and received 15 L of oxygen. However, the infiltration had dramatically improved, both radiologically and clinically, within 24 hours. She was diagnosed with negative pressure pulmonary oedema (NPPE) type 1 and made a rapid recovery. The Speech and Language Team diagnosed an impaired swallow and advised soft or bite-sized suitable foods. We discussed the ongoing risk of aspiration and long-term feeding options with the patient’s family. We agreed on a conservative plan for ‘risk feeding’, given her frailty and co-morbidities, and began discussions on ceilings of care. This case aims to raise awareness of NPPE so that it can be diagnosed, investigated and treated promptly. Although seen most commonly by intensivists and anaesthetists, it is relevant to those on the acute medical take and geriatricians managing patients with swallowing difficulties.

Background: Acute, direct inoculation osteomyelitis of the hand has traditionally been managed by intravenous antibiotics. With proven high levels of bone and joint penetration, specific oral antimicrobials may deliver clinical efficacy but at substantially lower cost. Methods: Sixty-nine adult patients with surgically proven acute, direct inoculation osteomyelitis of the hand were evaluated for clinical response on a 6-week postdebridement regimen of susceptibility-matched oral antibiotics. Inclusion required gross purulence and bone loss demonstrated at the initial debridement and radiographic evidence of bone loss. Excluded were 2 patients with extreme medical comorbidities. There were 53 men and 16 women with a mean age of 46 years. Mean follow-up was 16 weeks (±10). The cost model for the outpatient oral antibiotic treatment was intentionally maximized using Walgreen’s undiscounted cash price. The cost model for the traditional intravenous treatment regimen was intentionally minimized using the fully discounted Medicare fee schedule. Results: All patients achieved resolution of osteomyelitis by clinical and radiographic criteria. In addition, 7 patients underwent successful subsequent osteosynthesis procedures at the previously affected site without reactivation. The mean postdebridement direct cost of care per patient in the study cohort was $482.85, the cost of the antibiotic alone. The postdebridement direct cost of care per patient on a regimen of vancomycin 1.5 g every 12 hours via peripherally inserted central catheter line was $21 646.90. Conclusions: Acute, direct inoculation osteomyelitis of the hand can be successfully managed on oral antibiotic agents with substantial direct and indirect cost savings.

This article identifies, compares, and assesses residential models of care to treat infectious complications among people who inject drugs (PWID) through intravenous antibiotic (IV) therapy. Database searches in Ovid MEDLINE, Embase, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature Studies were performed. A Google web search was also performed. Studies published in English between 2000 and May 2017 that presented data on an out-of-hospital residential program for IV antibiotic treatment of infectious complications among PWID were included. Of the 2355 unique articles screened, 218 were reviewed in their entirety and three were included. Across the three included studies, no mortalities were reported during the study. Each study reported similar outcomes compared to in-hospital care. In the two studies reporting costs, residential care was substantially less expensive. This review indicates that residential treatment appears to be beneficial to PWID, hospitals, and the health care system.

Intravenous antibiotics a subset of parenteral route help in reducing the post-operative infections in dento-alveolar surgery such as the removal of third molar. However, this route lacks evidential support in the literature and thus has received less attention among the oral clinicians and proportionally in pharmacologists. A systematic review was performed in the Pubmed, Pubmed Central and Scopus electronic data bases from January 2003- January 2017 with a view to express the last fifteen years performance. From the primary queries, only 74 references could be collected pertinent to antibiotic therapy in third molar surgery including the protocols laid by American Association of Oral maxillofacial Surgeons and American Academic of Pediatric Dentistry. In the final stage, a couple of articles on in vitro studies, three short discussions, one evidence-based report and a letter to editor met the required desired criteria. The results revealed that it is highly preferable to administrate intravenous antibiotics in high-risk individuals to reduce surgical site infections. From the retrieved evidences, it can be asserted that candidates with clinical signs of rapid progressive infection, total osseous impaction and compromised health deserve to receive a pre-operative single dose of intravenous antibiotics during third molar surgery on the grounds of their vulnerability to bacteremia. Key words: Antibiotics, Bacteremia, Intravenous, Oral Surgery, Impacted, Third Molar.

The practice of 'vancomycin wrapping' of harvested hamstring autografts during Anterior Cruciate Ligament Reconstruction (ACLR) surgery has gathered recent interest. This practice involves the wrapping of harvested grafts in a vancomycin-soaked swab during the preparatory phase. Different techniques are observed, and a small number of studies have shown that pre-soaking hamstring ACLR grafts in this manner dramatically reduces the post-surgical infection rate compared with standard intravenous antibiotic prophylaxis alone. However, the literature surrounding this practice is surprisingly limited and thus the basis and rationale of the 'vancomycin wrap' has established itself largely without question. The exact popularity of this practice is difficult to establish but there has been increasing disclosure of its efficacy in reducing post-operative infection in ACLR since 2012. We provide a synopsis of the current literature surrounding vancomycin and its use in 'wraps' in ACLR to help apprise the surgeon of the nature of infection in ACLR, the rationale for vancomycin, whilst considering evidence to support alternatives and discussing potential ramifications for future practice.