May 11, Ceftriaxone for MSSA. Daptomycin Dosing Weight. Candidiasis Treatment
|
|
- Deborah Allison
- 6 years ago
- Views:
Transcription
1 Diagnostics and Debates: An Update on Rapid Diagnostic Testing and Current Controversies in Infectious Diseases Nicholas Torney, PharmD, BCPS Derek Vander Horst, PharmD Munson Medical Center WMSHP Annual Convention 2016 May 11 th, 2016 Disclosures Derek Vander Horst has no actual or potential conflict of interest in relation to this presentation Learning Objectives What Is a Controversy? Discuss several controversial topics in the realm of infectious diseases Images available from: Infectious Diseases Controversies Daptomycin Dosing Weight Candidiasis Treatment 1
2 Ceftriaxone: Third generation cephalosporin with both gram-positive and gram-negative activity, including MSSA Pros Cons Image available from: Treatment Outcomes for Osteoarticular Infections Caused By MSSA Wieland B et al. Clin Infect Dis. 5 Dec 2011;54(5): Treatment Success at 3-6 months follow-up Treatment Success > 6 months follow-up Oxacillin Ceftriaxone p-value Total: 32/37 (86%) Osteomyelitis: 15/17 (88%) Septic arthritis: 8/8 (100%) Total: 26/32 (81%) Osteomyelitis: 12/14 (86%) Septic arthritis: 7/8 (88%) Wieland B et al. Clin Infect Dis. 5 Dec 2011;54(5): Total: 50/60 (83%) Osteomyelitis: 26/30 (87%) Septic arthritis: 18/22 (82%) Total: 43/56 (77%) Osteomyelitis: 24/29 (83%) Septic arthritis: 15/20 (75%) Total: 0.7 Osteomyelitis: >0.99 Septic arthritis: 0.6 Total: 0.6 Osteomyelitis: >0.99 Septic arthritis: 0.6 Patel et al. Int J Clin Pharm. 2014;36: Patel et al. Int J Clin Pharm. 2014;36:
3 Patel et al. Int J Clin Pharm. 2014;36: Ceftriaxone-Resistant MSSA Ceftriaxone-Resistant MSSA Pickering A et al. Clin Infect Dis. 14 March (Retraction, 2014) Phe K et al. Antimicrob Agents Chemother. 17 Nov 2014;59:1730. Ceftriaxone-Resistant MSSA Phe K et al tested 17 isolates of MSSA and found 100% concordance between oxacillin and ceftriaxone Ceftriaxone MIC ranged from 1-8 µg/ml MRSA isolate was tested and shown to be resistant to ceftriaxone Ceftriaxone MIC = 32 µg/ml Ceftriaxone susceptibility for MSSA predicted by oxacillin*for and/or staphylococcal cefoxitin infections, sensitivity. a Clinical & daily Laboratory dose of 2-4 Standards grams daily Institute (CLSI) no longer should publishes be administered breakpoints to for ceftriaxone achieve > 90% target attainment and MSSA FDA breakpoints revised in 2011 FDA Breakpoints for MSSA Susceptible Intermediate Resistant MSSA* Adapted from: Ceftriaxone Reappraisal of Food and Drug Administration In Vitro Susceptibility Test Interpretive Criteria by Paul G. Ambrose, Pharm.D., FIDSA 3
4 Ceftriaxone Target Attainment Ceftriaxone Target Attainment Ceftriaxone 2g daily will attain ~25% free-drug time above MIC for a MIC 4 µg/ml with 90% probability Ceftriaxone 1g will attain this target at MIC 2 µg/ml Adapted from: Ceftriaxone Reappraisal of Food and Drug Administration In Vitro Susceptibility Test Interpretive Criteria by Paul G. Ambrose, Pharm.D., FIDSA Nguyen H et al. Clin Infect Dis. 2013;57: Ceftriaxone Using Oxacillin MIC Ceftriaxone Using Oxacillin MIC Probability of errors: Oxacillin-susceptible/ceftriaxone-resistant < 0.1% Oxacillin-susceptible/ceftriaxone-intermediate ~ 4.3% Probability of Ceftriaxone MIC 8 µg/ml in Oxacillin Susceptible MSSA Oxacillin MIC (µg/ml) Probability (%) Nguyen H et al. Clin Infect Dis. 2013;57: Nguyen H et al. Clin Infect Dis. 2013;57: The Bottom Line Ceftriaxone has been used with success for infections caused by MSSA Ceftriaxone MIC data is inferred from oxacillin and/or cefoxitin susceptibility Ceftriaxone gets adequate target attainment with a MIC 4 µg/ml with ~90% probability with daily doses 2g The Bottom Line Oxacillin MIC data may be used to predict ceftriaxone treatment success It has been suggested that success is optimized: Oxacillin MIC 0.5 µg/ml Ceftriaxone daily dose 2g/day Patients should be assessed on an individual basis until higher quality data exists 4
5 Daptomycin Daptomycin: lipopeptide antibacterial agent with gram-positive activity, including vancomycin-resistant Enterococcus sp. (VRE) Image available from: Daptomycin Usage Pros Cons Daptomycin Generally dosed on mg/kg basis of actual body weight (ABW) Some institutions have decided to use a dosing weight (DW) Doses vary from 4-12 mg/kg One 500mg vial~$ Image available from: Dose (mg/kg) Calculated Dose of Daptomycin for Common Patient Weights Weight (kg) One vial ~$ Two vials ~$1, Three vials ~$1, Daptomycin Clearance in Obese All per dose! Dvorchik B et al. J Clin Pharmacol. 2005;45(8):
6 Daptomycin in the Obese Daptomycin Dosing Daptomycin levels: C min 24.3 mg/l correlated with increased probability for CPK elevation Obese patients have impaired clearance of daptomycin Higher doses and impaired clearance can lead to increases in C min and thus cause increased incidence of CPK elevations Bhavnani SM et al. Clin Infect Dis. 15 Jun 2010;50(12): Donovan B et al. Clin Infect Dis. 2010;51(8):989. Ng J et al. Antimicrob Agents Chemother. 21 Oct 2013;58(1): Daptomycin IBW vs ABW Outcomes Two Major Arms: ABW IBW Inclusion Criteria: 17 years of age Positive culture Daptomycin therapy 72 hours Exclusion Criteria: ABW < IBW Continuation of outside institution Renal impairment Preexisting rhabdomyolysis Ng J et al. Antimicrob Agents Chemother. 21 Oct 2013;58(1): Daptomycin IBW vs ABW Outcomes Daptomycin IBW vs ABW Ng J et al. Antimicrob Agents Chemother. 21 Oct 2013;58(1): Ng J et al. Antimicrob Agents Chemother. 21 Oct 2013;58(1):
7 The Bottom Line Overdosing on daptomycin doesn t seem to be a terrible safety concern in most patients, including the obese population Single study only included 4mg/kg and 6mg/kg regimens Study showed no significant differences between IBW or ABW The Bottom Line Most of the benefit of dosing on IBW appears to be cost related More data should likely exist before we dose all our patients on IBW Perhaps, the new generic daptomycin will help this problem as well Echinocandin Therapy Pros Cons Echinocandins vs Azoles Anidulafungin vs Fluconazole Reboli A et al. N Eng J Med. 2007;356: Reboli A et al. N Eng J Med. 2007;356:
8 The Bottom Line Candidiasis Guideline Update 2009 Guidelines 2016 Guidelines Empiric Therapy: Non-neutropenic Patients: Fluconazole Neutropenic Patients: Fluconazole Echinocandin recommended if patient has recent azole use Empiric Therapy: Non-neutropenic Patients: Echinocandin Neutropenic Patients: Echinocandin Pappas P et al. Clin Infect Dis. 15 Feb 2016;62(4): The Bottom Line Post-Assessment Question 1. Which of the following is a controversial topic discussed in today s lecture involving treatment of patients with daptomycin? a) Daptomycin dosing weight b) Treating infections caused by Klebsiella pneumoniae c) Potential creatinine kinase elevations d) Treating patients with pneumonia Pappas P et al. Clin Infect Dis. 15 Feb 2016;62(4): Post-Assessment Question Questions 1. Which of the following is NOT a potential benefit of using an echinocandin for therapy in patients with invasive candidiasis? a) Fewer drug interactions b) Cost c) Superior microbiologic response d) Empiric coverage for all Candida sp. 8
9 Rapid Diagnostic Tests and Antimicrobial Stewardship Disclosures Nicholas Torney does not have any conflicts of interest as it pertains to this presentation. Nicholas Torney, Pharm.D., BCPS PGY-2 Infectious Diseases Pharmacy Resident Objective Introduction 1. Describe the available rapid molecular diagnostic tests and how they can be incorporated into an antimicrobial stewardship program. Conventional Microbiological Methods Rapid Molecular Diagnostic Tests Conventional Methods Utilizing Rapid Tests Day Blood Draw (+) Blood Culture Gram Stain Organism Identification Susceptibilities Day Blood Draw (+) Blood Culture Gram Stain Organism Identification Susceptibilities Empiric, Broad Spectrum therapy Targeted therapy Empiric, Broad Spectrum therapy Targeted therapy
10 What s the Big Deal? Mortality Depends on Appropriate Initial Therapy in Patients With Bacteremia Delay of Appropriate Antibiotic Therapy in Septic Shock Survival 7.6% for every 1 hour delay in antibiotics Leibovici L, et al. J Intern Med 1998 Nov;244(5): Micek ST, et al. J Hosp Med 2011 Sep;6(7): Kumar A,, et al. Crit Care Med 2006 Jun;34(6): Rapid Diagnostic Tests (RDT) Rapid Molecular Diagnostic Technologies Rapid Test MALDI-TOF FilmArray Verigene PNA FISH, Quick-FISH, Express-FISH T2-Candida Technology Mass spectrometry Nucleic acid amplification Nucleic acid amplification Nucleic acid hybridization Magnetic resonance imaging 57 Add-on systems 58 MALDI-TOF FilmArray vs. Verigene Need bacterial growth to run sample Sample takes ~1hr to run Reduced time to organism ID by hours Library contains MANY organisms High initial cost, low cost per test Cannot detect resistance mechanisms or susceptibilities Image available from : 59 Gram stain prior to processing FilmArray (BioFire) Unnecessary Verigene (Nanosphere) Necessary Hands on time 2 minutes < 5 minutes Run time 1 hour 2.5 hours Technology Rapid multiplex PCR Gold Nanoparticle Pathogens detected Resistance mechanisms detected 8 Gram (+) 11 Gram (-) 5 candida spp. 15 Gram (+) 14 Gram (-) Gram (+) Gram (-) Gram (+) Gram (-) meca vana, vanb KPC meca vana, vanb CTX-M KPC NMD OXA VIM 60 10
11 PNA-FISH, Quick-FISH, Xpress-FISH FISH = Fluorescent In Situ Hybridization Advantages: Strong evidence with clinical benefit Quick-FISH is really Quick Disadvantages: Current products only test up to 3 targets Limited ability to detect resistance organisms T2-Candida Magnetic resonance imaging Blood to bug detection Detects 5 candida spp. from whole blood in 3-5 hrs Albicans Glabrata Krusei Parapsilosis Tropicalis Sensitivity 91.1% Specificity 99.4% 61 Mylonakis E, et al. Clin Infect Dis. 2015;60(6): Impact on Mortality and Length of Stay RDT Incorporation into Antimicrobial Stewardship Study Forrest (2008) Bauer (2010) Perez (2013) Huang (2013) RDT [Pathogen(s)] PNA FISH [Enterococcus spp.] Rapid PCR [S. aureus] MALDI-TOF [GNRs] MALDI-TOF [All pathogens] Outcomes time to appropriate abx (3.1 vs. 1.3 days) 30 day mortality (45% vs. 26%) LOS (21.5 vs days)* LOS (11.9 vs. 9.3 days) 30 day mortality (10.7% vs. 5.6%)* LOS (14.2 vs days)* 30 day mortality (20.3 % vs. 12.7%) LOS = Length of stay *not statistically significant All study designs: Pre/Post Intervention, including antimicrobial stewardship intervention Impact of RDTs + ASPs Impact of RDTs + ASPs Impact on Gram-negative bacteremia using MALDI-TOF Passive notification via EMR Cost avoidance (avg): $3,411 (p = 0.04) Mortality: 9.4% vs. 4.9% (p=0.07) Active antimicrobial stewardship Adjust Therapy Pre: 71 (±41) hrs Int: 30 (±30) hrs p < After culture positivity Lockwood A, et al. Infect Control Hosp Epidemiol 2016 Jan 7;00(0): Lockwood A, et al. Infect Control Hosp Epidemiol 2016 Jan 7;00(0):
12 Impact of RDTs + ASPs Impact of RDTs + ASPs Box M, et al. Pharmacotherapy 2015;35(3): Box M, et al. Pharmacotherapy 2015;35(3): Impact of RDTs + ASPs Time to Targeted Therapy Economic Impact RDT + Real-Time Culture Review $25,000 Cost Difference per Bacteremic Episode $20,000 $21,387 $19,583 $19,253 Unnecessary Duration of Antibiotic Therapy $15,000 $10,000 Box M, et al. Pharmacotherapy 2015;35(3): $5,000 Bauer (2010) Perez (2013) Huang (2013) Rapid PCR MALDI-TOF MALDI-TOF [S. aureus] [GNRs] [All Pathogens] 70 PCR without ASP Intervention PCR identification of Staphylococcal species from blood Compared to a historical control group PCR without ASP Intervention PCR identification of Staphylococcal species from blood Compared to a historical control group Time to Organism Identification hr hr Control Intervention Frye AM, et al. J Clin Microbiol 2012;50: hr difference (P < ) 71 Time to Optimal Therapy Unchanged in the post-intervention Group Difference 1.2 hours [95% CI : to 9.8 hrs] Demonstrates the necessity of prospective audit and feedback Frye AM, et al. J Clin Microbiol 2012;50:
13 PNA FISH CoNS Without ASP Intervention Blood Culture ID - Rapid Multiplex PCR Randomized Controlled Trial 3 groups 1. Control 2. Rapid Multiplex PCR 3. Rapid Multiplex PCR + Real-Time Stewardship Baseline Interventions (all groups) MALDI-TOF pathogen identification M-F antimicrobial stewardship interventions Prospective audit and feedback Restricted antimicrobial authorization Holtzman C, et al. J Clin Microbiol 2011;49(4); Banerjee R, et al. Clin Infect Dis 2015;61(7): Blood Culture ID - Rapid Multiplex PCR Randomized Controlled Trial Blood Culture ID - Rapid Multiplex PCR Randomized Controlled Trial Control (n=207) Standard Blood Culture Bottle processing rmpcr (n=198) Reported into EMR with templated comments rmpcr + Stewardship (n=212) Reported into EMR with templated comments Result paged to ID pharmacist (24/7) with real-time audit and feedback Gram Stain Result Banerjee R, et al. Clin Infect Dis 2015;61(7): Banerjee R, et al. Clin Infect Dis 2015;61(7): Blood Culture ID - Rapid Multiplex PCR Randomized Controlled Trial Most bang for your buck: Rapid molecular diagnostics coupled with real-time stewardship intervention Most interventions were made during the day may not need 24/7 coverage. Rapid Diagnostic Test Summary Common Theme rmpcr = Add-on test to baseline micro workflow Antimicrobial stewardship capabilities: Increased narrow-spectrum antibiotic use Less unnecessary vancomycin use Decreased treatment of blood culture contaminants Pharmacist Mortality LOS Cost Banerjee R, et al. Clin Infect Dis 2015;61(7):
14 Question #1 1. Which of the following rapid diagnostic testing technologies has the ability to detect pathogens from whole blood in 3-5 hours (i.e. without a blood culture incubation period)? a) PNA-FISH (Nucleic acid hybridization) b) Biofire Fimarray (Nucleic acid amplification) c) Nanosphere Verigene (Nucleic acid amplification) d) T2Candida - T2Biosystems (Nanoparticle- Magnetic Resonance Imaging) Question #2 2. Studies evaluating the use of rapid diagnostic tests have concluded all of the following except: a) Increased time to appropriate antibiotics b) Decreased length of stay c) Decreased mortality d) Decreased total hospital costs
MALDI-TOF MS: Translating Microbiology Laboratory Alphabet Soup to Optimize Antibiotic Therapy
MALDI-TOF MS: Translating Microbiology Laboratory Alphabet Soup to Optimize Antibiotic Therapy September 8, 2017 Amy Carr, PharmD PGY-2 Infectious Diseases Pharmacy Resident Seton Healthcare Family amy.carr@ascension.org
More informationAn Update in the Management of Candidiasis
An Update in the Management of Candidiasis Daniel B. Chastain, Pharm.D., AAHIVP Infectious Diseases Pharmacy Specialist Phoebe Putney Memorial Hospital Adjunct Clinical Assistant Professor UGA College
More informationLa «Fast Microbiology» applicata alla sepsi: prospettive ed opportunità
La «Fast Microbiology» applicata alla sepsi: prospettive ed opportunità Maurizio Sanguinetti Istituto di Microbiologia Fondazione Policlinico Universitario «A. Gemelli» - IRCCS Rapid diagnostic tests:
More informationSepsis Treatment: Early Identification Remains the Key Issue
Sepsis Treatment: Early Identification Remains the Key Issue Marin H. Kollef, MD Professor of Medicine Washington University School of Medicine Director, Medical Critical Care Director, Respiratory Care
More informationMicafungin and Candida spp. Rationale for the EUCAST clinical breakpoints. Version February 2013
Micafungin and Candida spp. Rationale for the EUCAST clinical breakpoints. Version 1.0 5 February 2013 Foreword EUCAST The European Committee on Antimicrobial Susceptibility Testing (EUCAST) is organised
More informationImpact of rapid meca polymerase chain reaction rapid diagnostic testing for Staphylococcus aureus in a pediatric setting
Butler University Digital Commons @ Butler University Undergraduate Honors Thesis Collection Undergraduate Scholarship 2018 Impact of rapid meca polymerase chain reaction rapid diagnostic testing for Staphylococcus
More informationEvaluation of Vancomycin Continuous Infusion in Trauma Patients
OBJECTIVES Evaluation of Vancomycin Continuous Infusion in Trauma Patients Brittany D. Bissell, Pharm.D. PGY-2 Critical Care Pharmacy Resident Jackson Memorial Hospital Miami, Florida Evaluate the potential
More informationClinical Trial Data Supporting FDA Clearance of the T2Bacteria Panel Versus Blood Culture for the Diagnosis of Bacteremia
Clinical Trial Data Supporting FDA Clearance of the T2Bacteria Panel Versus Blood Culture for the Diagnosis of Bacteremia New diagnostic test overcomes time, sensitivity, and antimicrobial interference
More informationThe Challenge of Managing Staphylococcus aureus Bacteremia
The Challenge of Managing Staphylococcus aureus Bacteremia M A R G A R E T G R A Y B S P F C S H P C L I N I C A L P R A C T I C E M A N A G E R N O R T H / I D P H A R M A C I S T A L B E R T A H E A
More informationFungal Infection in the ICU: Current Controversies
Fungal Infection in the ICU: Current Controversies Andrew F. Shorr, MD, MPH, FCCP, FACP Washington Hospital Center Georgetown University, Washington, DC Disclosures I have served as a consultant to, researcher/investigator
More informationAdult Inpatient Antibiogram. Antimicrobial Susceptibilities of Frequently Recovered Clinical Isolates. January to December 2016
Adult Inpatient Antibiogram Antimicrobial Susceptibilities of Frequently Recovered Clinical Isolates January to December 2016 Department of Pathology Camille Hamula, PhD Director, Clinical Microbiology
More informationThe Culture of Culturing: Laboratory Diagnostic Stewardship
The Culture of Culturing: Laboratory Diagnostic Stewardship Isabella W. Martin, MD Medical Director of Clinical Microbiology Laboratory, Dartmouth-Hitchcock Medical Center Michael S. Calderwood, MD, MPH
More informationTitle: Author: Speciality / Division: Directorate:
Antifungal guidelines for CANDIDIASIS INFECTIONS (Adults) Proven infection: Targeted antifungal therapy should be prescribed for: o Positive cultures from a sterile site with clinical or radiological abnormality
More informationThe CLSI Approach to Setting Breakpoints
The CLSI Approach to Setting Breakpoints Jean B. Patel, PhD, D(ABMM) Deputy Director, Office of Antimicrobial Resistance Division of Healthcare Quality Promotion National Center for Emerging and Zoonotic
More informationChallenges in Therapeutic Drug Monitoring:
Challenges in Therapeutic Drug Monitoring: Focus on Vancomycin Pharmacodynamics and Pharmacokinetics Katherine Gallaga, PharmD PGY1 Pharmacy Practice Resident CHRISTUS Spohn Health System 1 Pharmacist
More informationCubicin (Daptomycin) Priv.Doz. Dr. med. Markus Rothenburger
Cubicin (Daptomycin) Priv.Doz. Dr. med. Markus Rothenburger Cubicin (Daptomycin): A new generation of antibiotics First-in-class cyclic natural lipopeptide Activity against major gram positive pathogens
More informationD DAVID PUBLISHING. 1. Introduction. Kathryn Koliha 1, Julie Falk 1, Rachana Patel 1 and Karen Kier 2
Journal of Pharmacy and Pharmacology 5 (2017) 607-615 doi: 10.17265/2328-2150/2017.09.001 D DAVID PUBLISHING Comparative Evaluation of Pharmacist-Managed Vancomycin Dosing in a Community Hospital Following
More informationGiving the Proper Dose: How Can The Clinical and Laboratory Standards Institute(CLSI)Help?
Giving the Proper Dose: How Can The Clinical and Laboratory Standards Institute(CLSI)Help? Pranita D. Tamma, M.D., M.H.S. Director, Pediatric Antimicrobial Stewardship Johns Hopkins University School of
More information2/6/14. What s Hot in ID Objectives
What s Hot in ID 2014 James S. Lewis II, Pharm.D., FIDSA ID Clinical Pharmacy Coordinator Oregon Health and Science University Portland, OR Objectives Describe highlights of the Interscience Conference
More informationRapid susceptibility testing: new phenotypic and non-wgs genotypic approaches
Rapid susceptibility testing: new phenotypic and non-wgs genotypic approaches BSAC Spring Conference 2018 Next generation Antimicrobial Susceptibility Testing of Bacteria Oskar Ekelund, MD Clinical Microbiology
More information9/7/2018. Faculty. Overcoming Challenges in the Management of Invasive Fungal Infections. Learning Objectives. Faculty Disclosure
Faculty Overcoming Challenges in the Management of Invasive Fungal James S. Lewis II, PharmD, FIDSA ID Clinical Pharmacy Coordinator Oregon Health and Science University Departments of Pharmacy and Infectious
More informationLaboratory CLSI M100-S18 update. Paul D. Fey, Ph.D. Associate Professor/Associate Director Josh Rowland, M.T. (ASCP) State Training Coordinator
Nebraska Public Health Laboratory 2008 CLSI M100-S18 update Paul D. Fey, Ph.D. Associate Professor/Associate Director Josh Rowland, M.T. (ASCP) State Training Coordinator Agenda Discuss 2008 M100- S18
More informationEvidence-Based Approaches to the Safe and Effective Management of Invasive Fungal Infections. Presenter. Disclosures
Evidence-Based Approaches to the Safe and Effective Management of Invasive Fungal Infections Presenter James S. Lewis II, PharmD, FIDSA ID Clinical Pharmacy Coordinator Oregon Health and Science University
More informationInfectious Disease in the Critically Ill Patient
Infectious Disease in the Critically Ill Patient Heather L. Evans, MD MS FACS Director of Surgical Infectious Disease Harborview Medical Center Asst. Professor UW Department of Surgery New Antibiotics:
More informationSCMID Online Lecture Library. by author. Optimizing antimicrobial therapy in the elderly. Dose Finding - The Past
Optimizing antimicrobial therapy in the elderly Johan W. Mouton MD PhD FIDSA Professor pharmacokinetics and pharmacodynamics Dosing should be such that the level of antmicrobial activity is associated
More informationDepartment of Pharmacy Services, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA; 2
Pathogens 2015, 4, 599-605; doi:10.3390/pathogens4030599 Article OPEN ACCESS pathogens ISSN 2076-0817 www.mdpi.com/journal/pathogens Assessing the Surrogate Susceptibility of Oxacillin and Cefoxitin for
More informationDecember 3, 2015 Severe Sepsis and Septic Shock Antibiotic Guide
Severe Sepsis and Septic Shock Antibiotic Guide Surviving Sepsis: The choice of empirical antimicrobial therapy depends on complex issues related to the patient s history, including drug intolerances,
More informationDiscussion points CLSI M100 S19 Update. #1 format of tables has changed. #2 non susceptible category
Discussion points 2009 CLSI M100 S19 Update Nebraska Public Health Laboratory Changes most important to routine antimicrobial susceptibility testing. Documents available Janet Hindler discussion slide
More informationReducing the antifungal drugs consumption in the ICU
Reducing the antifungal drugs consumption in the ICU Philippe Montravers Département d Anesthésie et Réanimation Chirurgicale CHU Bichat Claude Bernard Pole TCAUR, HUPNVS Assistance Publique-Hôpitaux de
More informationESCMID Online Lecture Library. by author
Microbiological evaluation: how to report the results Alvaro Pascual MD, PhD Infectious Diseases and Clinical Microbiology Unit. University Hospital Virgen Macarena University of Sevilla BSI management
More informationCLINICAL USE OF GLYCOPEPTIDES. Herbert Spapen Intensive Care Department University Hospital Vrije Universiteit Brussel
CLINICAL USE OF GLYCOPEPTIDES Herbert Spapen Intensive Care Department University Hospital Vrije Universiteit Brussel Glycopeptides Natural Vancomycin introduced in 1958 Teicoplanin introduced in Europe
More informationCubicin A Guide to Dosing
Cubicin A Guide to Dosing Cubicin (Daptomycin) powder for solution for injection or infusion Indications (see SmPC) 1 : Cubicin is indicated for the treatment of the following infections (see sections
More information2015 Update in Infectious Diseases: New Tools in Diagnostic Microbiology
2015 Update in Infectious Diseases: New Tools in Diagnostic Microbiology Bert K. Lopansri, MD Chief, Intermountain Division of Infectious Diseases Medical Director, Central Microbiology Lab Conflicts of
More informationFKS Mutant Candida glabrata: Risk Factors and Outcomes in Patients With Candidemia
Clinical Infectious Diseases Advance Access published July 9, 2014 MAJOR ARTICLE FKS Mutant Candida glabrata: Risk Factors and Outcomes in Patients With Candidemia Nicholas D. Beyda, 1 Julie John, 1 Abdullah
More informationVoriconazole Rationale for the EUCAST clinical breakpoints, version March 2010
Voriconazole Rationale for the EUCAST clinical breakpoints, version 2.0 20 March 2010 Foreword EUCAST The European Committee on Antimicrobial Susceptibility Testing (EUCAST) is organised by the European
More information1 Guidelines for the Management of Candidaemia
1 Guidelines for the Management of Candidaemia LIVERPOOL CLINICAL LABORATORIES GUIDELINE FOR THE MANAGEMENT OF CANDIDAEMIA IN NON-NEUTROPENIC ADULT PATIENTS AND PROPHYLAXIS/PRE-EMPTIVE TREATMENT IN HIGH
More informationDaptomycin in Clinical Practice. Paolo Grossi
Clinica delle Malattie Infettive e Tropicali Università degli Studi dell Insubria Ospedale di Circolo e Fondazione Macchi, Varese Second Opinion Infettivologica Centro Nazionale Trapianti, ISS, Roma Daptomycin
More informationFungal infections in ICU. Tang Swee Fong Department of Paediatrics Universiti Kebangsaan Malaysia
Fungal infections in ICU Tang Swee Fong Department of Paediatrics Universiti Kebangsaan Malaysia Epidemiology of invasive fungal infections - US +300% Martin GS, et al. N Engl J Med 2003;348:1546-1554
More informationAndrea Blotsky MDCM FRCPC General Internal Medicine, McGill University Thursday, October 15, 2015
The TIMES Project: (Time to Initiation of Antibiotic Therapy in Medical Patients Presenting to the Emergency Department with Sepsis) - Preliminary Findings Andrea Blotsky MDCM FRCPC General Internal Medicine,
More informationSuperhero or Superzero? Vancomycin vs. Linezolid for MRSA Pneumonia
Superhero or Superzero? Vancomycin vs. Linezolid for MRSA Pneumonia Brandon Dionne, PharmD, BCPS, AAHIVP Assistant Clinical Professor Northeastern University Seth Housman, PharmD, MPA Clinical Assistant
More informationEarly Diagnosis and Therapy for Fungal Infections
Early Diagnosis and Therapy for Fungal Infections Debra Goff PharmD, FCCP Clinical Associate Professor Infectious Disease Specialist The Ohio State University Medical Center Columbus Ohio, USA The Ohio
More informationAntifungal Stewardship. Önder Ergönül, MD, MPH Koç University, School of Medicine, Istanbul 6 October 2017, ESGAP course, Istanbul
Antifungal Stewardship Önder Ergönül, MD, MPH Koç University, School of Medicine, Istanbul 6 October 2017, ESGAP course, Istanbul 1 2 Objectives What do we know? Invasive Candida and Aspergillosis Impact
More informationESCMID Online Lecture Library. by author
Disclosures Pk/Pd of antifungal drugs Johan W. Mouton MD PhD FIDSA Professor pharmacokinetics and pharmacodynamics Research grants advisory boards speaker Dosing should be such that the level of antmicrobial
More informationAntimicrobial prophylaxis in liver transplant A multicenter survey endorsed by the European Liver and Intestine Transplant Association
Antimicrobial prophylaxis in liver transplant A multicenter survey endorsed by the European Liver and Intestine Transplant Association Els Vandecasteele, Jan De Waele, Dominique Vandijck, Stijn Blot, Dirk
More informationAntifungal susceptibility testing: Which method and when?
Antifungal susceptibility testing: Which method and when? Maiken Cavling Arendrup mad@ssi.dk SSI & Juan Luis Rodriguez Tudela jlrtudela@isciii.es ISCIII Agenda Summary of current standards and selected
More informationAntifungal Pharmacodynamics A Strategy to Optimize Efficacy
Antifungal Pharmacodynamics A Strategy to Optimize Efficacy David Andes, MD Associate Professor, Department of Medicine Division of Infectious Diseases Medical Microbiology and Immunology University of
More informationCandida auris: an Emerging Hospital Infection
National Center for Emerging and Zoonotic Infectious Diseases Candida auris: an Emerging Hospital Infection Paige Armstrong MD MHS Epidemic Intelligence Service Officer Mycotic Diseases Branch Association
More informationThink Globally: Strategies to Improve the Culture of Antibiotic Prescribing
Think Globally: Strategies to Improve the Culture of Antibiotic Prescribing October 11, 2017 Paul Lewis, PharmD, BCPS (AQ-ID) Johnson City Medical Center Johnson City, TN 1 Outline Introduction to stewardship
More informationDevelopment of Drugs for Bacteremia
Development of Drugs for Bacteremia Charles Knirsch, MD, MPH VP, Clinical Research Pfizer Inc 1 Bacteremia Guidance Issues EMA guidance suggests that bacteremia is not a primary diagnosis but represents
More informationCommunity Acquired & Nosocomial Pneumonias
Community Acquired & Nosocomial Pneumonias IDSA/ATS 2007 & 2016 Guidelines José Luis González, MD Clinical Assistant Professor of Medicine Outline Intro - Definitions & Diagnosing CAP treatment VAP & HAP
More informationMANAGEMENT OF HOSPITAL-ACQUIRED FUNGAL INFECTIONS
MANAGEMENT OF HOSPITAL-ACQUIRED FUNGAL INFECTIONS Paul D. Holtom, MD Associate Professor of Medicine and Orthopaedics USC Keck School of Medicine Numbers of Cases of Sepsis in the United States, According
More informationDRUG UTILIZATION EVALUATION
DRUG UTILIZATION EVALUATION Prescribing Trends with Daptomycin (Cubicin) For the Treatment of Gram-Positive Infections Noreen H. Chan Tompkins, PharmD, and Stephen J. Harnicar, PharmD INTRODUCTION Daptomycin
More informationContinuous Infusion of Antibiotics In The ICU: What Is Proven? Professor of Medicine Vice-Chairman, Department of Medicine SUNY at Stony Brook
Continuous Infusion of Antibiotics In The ICU: What Is Proven? Michael S. Niederman, M.D. Chairman, Department of Medicine Winthrop-University Hospital Mineola, NY Professor of Medicine Vice-Chairman,
More informationAntifungals and current treatment guidelines in pediatrics and neonatology
Dragana Janic Antifungals and current treatment guidelines in pediatrics and neonatology Dragana Janic. University Children`s Hospital, Belgrade, Serbia 10/10/17 Hotel Crowne Plaza, Belgrade, Serbia; www.dtfd.org
More informationWHICH ANTIFUNGAL AGENT IS THE CHOICE FOR SUSPECTED FUNGAL INFECTIONS?
WHICH ANTIFUNGAL AGENT IS THE CHOICE FOR SUSPECTED FUNGAL INFECTIONS? Assoc. Prof. Dr. Serkan SENER Acibadem University Medical School Department of Emergency Medicine, Istanbul Acibadem Ankara Hospital,
More informationDifficult to diagnose fungal infections: Non-fungaemic candidiasis
Difficult to diagnose fungal infections: Non-fungaemic candidiasis Director, Mycology Research Unit and XDR Pathogen Laboratory University of Pittsburgh Cornelius J. Clancy, M.D. Chief, Infectious Diseases
More informationChain of Infection Agent Mode of transmission Contact (direct, indirect, droplet spread) Airborne Common-vehicle spread Host
Goals Microbiology of Healthcare-associated Infections William A. Rutala, Ph.D., M.P.H. Director, Statewide Program for Infection Control and Epidemiology and Research Professor of Medicine, University
More informationESCMID Online Lecture Library. by author
What is the best antifungal strategy for severe intra-abdominal infections? Philippe Montravers MD, PhD Anaesthesia and Surgical ICU Bichat Claude Bernard Hospital Assistance Publique Hopitaux de Paris
More informationOutline. Pharmacists Improving Outcomes in the Management of. of Infectious Diseases. Threats Against Desired Outcomes 7/11/2010
Pharmacists Improving Outcomes in the Management of Infectious Diseases Christine Teng, MSc(Clin Pharm) BCPS Assistant Professor Dept of Pharmacy, National University of Singapore Principal Pharmacist
More informationProficiency Testing Materials for use with BioFire FilmArray Panels
Proficiency Materials for use with BioFire FilmArray Panels Introduction This document provides a listing of proficiency testing materials that have been tested at BioFire and are compatible with the BioFire
More informationCurrent options of antifungal therapy in invasive candidiasis
Current options of antifungal therapy in invasive candidiasis Saloua Ladeb Bone Marrow Transplant Center Tunis HAMMAMET 24 th April 2012 DEFINITION One or more positive results on blood culture for Candida
More informationMesporin TM. Ceftriaxone sodium. Rapid onset, sustained action, for a broad spectrum of infections
Ceftriaxone sodium Rapid onset, sustained action, for a broad spectrum of infections 1, 2, 3 Antibiotic with a broad spectrum of activity Broad spectrum of activity against gram-positive* and gram-negative
More informationAugmented Renal Clearance: Let s Get the Discussion Flowing
Augmented Renal Clearance: Let s Get the Discussion Flowing Terry Makhoul, PharmD PGY-2 Emergency Medicine Pharmacy Resident University of Rochester Medical Center Strong Memorial Hospital Disclosures
More informationPharmacologyonline 1: (2010) ewsletter Singh and Kochbar. Optimizing Pharmacokinetic/Pharmacodynamics Principles & Role of
Optimizing Pharmacokinetic/Pharmacodynamics Principles & Role of Cefoperazone Sulbactam Singh M*, Kochhar P* Medical & Research Division, Pfizer India. Summary Antimicrobial resistance is associated with
More informationMolecular Testing in Infectious Diseases. Objectives 5/9/2014. Implementing Molecular Testing for Infectious Diseases Diagnosis
Molecular Testing in Infectious Diseases Elizabeth Palavecino, M.D. Director Clinical Microbiology Co-Director Clinical & Translational Mass Spec Center Associate Professor of Pathology Wake Forest School
More informationClinical Safety & Effectiveness Cohort # 10
1 Clinical Safety & Effectiveness Cohort # 10 Improving Weight-Based Vancomycin Dosing and Monitoring DATE Educating for Quality Improvement & Patient Safety 2 Financial Disclosure lizabeth A. Walter,
More informationCarbapenemase Producing Enterobacteriaceae: Screening
Carbapenemase Producing Enterobacteriaceae: Screening Dr David Harvey Consultant Microbiology and Infection Prevention and Control Nov 2015 Aims Is CPE a problem? Does screening have the potential to help?
More informationWork up of Respiratory & Wound Cultures:
Work up of Respiratory & Wound Cultures: Culture work up 2 Systematic approaches 1 Work up of Respiratory & Wound Cultures Resident flora Colonizing organisms Pathogens 2 Work up of Respiratory & Wound
More informationImpact of Antimicrobial Stewardship Intervention on Coagulase-Negative Staphylococcus Blood. Cultures in Conjunction with Rapid Diagnostic Testing
JCM Accepts, published online ahead of print on 28 May 2014 J. Clin. Microbiol. doi:10.1128/jcm.00682-14 Copyright 2014, American Society for Microbiology. All Rights Reserved. 1 2 Impact of Antimicrobial
More informationMupirocin Rationale for the EUCAST clinical breakpoints, version th July 2010
Mupirocin Rationale for the EUCAST clinical breakpoints, version 1.0 6 th July 2010 Foreword EUCAST The European Committee on Antimicrobial Susceptibility Testing (EUCAST) is organised by the European
More informationIs the package insert correct? PK considerations
Is the package insert correct? PK considerations Jason A Roberts B Pharm (Hons), PhD, FSHP Professor of Medicine and Pharmacy The University of Queensland, Australia Royal Brisbane and Women s Hospital,
More informationCost Analysis of Implementing MALDI-TOF plus Real-time Antimicrobial Stewardship
JCM Accepted Manuscript Posted Online 19 October 2016 J. Clin. Microbiol. doi:10.1128/jcm.01452-16 Copyright 2016 American Society for Microbiology. 1 2 Cost Analysis of Implementing MALDI-TOF plus Real-time
More informationEDUCATIONAL COMMENTARY VANCOMYCIN MONITORING
EDUCATIONAL COMMENTARY VANCOMYCIN MONITORING Commentary provided by: Julie Hall, MHS, MT (ASCP) Assistant Dean, College of Health Professions Assistant Professor, Medical Laboratory Science Grand Valley
More informationSepsi: nuove definizioni, approccio diagnostico e terapia
GIORNATA MONDIALE DELLA SEPSI DIAGNOSI E GESTIONE CLINICA DELLA SEPSI Giovedì, 13 settembre 2018 Sepsi: nuove definizioni, approccio diagnostico e terapia Nicola Petrosillo Società Italiana Terapia Antiinfettiva
More informationOptimizing MALDI-TOF Use. Clinical Impact Laboratory Impact
Optimizing MALDI-TOF Use Clinical Impact Laboratory Impact Christine C. Ginocchio, PhD, MT (ASCP) Clinical Professor of Medicine Hofstra North Shore-LIJ School of Medicine, NY VP, Global Microbiology Affairs,
More informationA Snapshot of Colistin Use in South-East Europe and Particularly in Greece
A Snapshot of Colistin Use in South-East Europe and Particularly in Greece Helen Giamarellou 02.05.2013 When Greek Physicians Prescribe Colistin? It is mainly prescribed in the ICU for VAP, bacteremia
More informationCigna Drug and Biologic Coverage Policy
Cigna Drug and Biologic Coverage Policy Subject Voriconazole Effective Date... 3/15/2018 Next Review Date... 3/15/2019 Coverage Policy Number... 4004 Table of Contents Coverage Policy... 1 General Background...
More informationThe Role of POCT in Management of Infectious Disease in the Critical Care Setting
The Role of POCT in Management of Infectious Disease in the Critical Care Setting Nathan A Ledeboer Associate Professor of Pathology Medical College of Wisconsin Medical Director, Microbiology and Molecular
More informationAntifungal Resistance in Asia: Mechanisms, Epidemiology, and Consequences
5th MMTN Conference 5-6 November 2016 Bangkok, Thailand 10:20-10:45, 6 Nov, 2016 Antifungal Resistance in Asia: Mechanisms, Epidemiology, and Consequences Yee-Chun Chen, M.D., PhD. Department of Medicine,
More informationVANCOMYCIN DOSING AND MONITORING GUIDELINES
VANCOMYCIN DOSING AND MONITORING GUIDELINES NB Provincial Health Authorities Anti-Infective Stewardship Committee Approved: May 2017 GENERAL COMMENTS Vancomycin is a glycopeptide antibiotic with bactericidal
More informationNo Need to Agonize! Tips for the Diagnosis and Treatment of Complicated UTIs
ASCENSION TEXAS No Need to Agonize! Tips for the Diagnosis and Treatment of Complicated UTIs Austin Area Society of Health-System Pharmacists April 26, 2018 Amy Carr, PharmD PGY-2 Infectious Diseases Pharmacy
More informationSepsis new definitions of sepsis and septic shock and Novelities in sepsis treatment
Sepsis new definitions of sepsis and septic shock and Novelities in sepsis treatment What is sepsis? Life-threatening organ dysfunction caused by a dysregulated host response to infection A 1991 consensus
More informationThe antibiotic dose and the obese ICU patient
The antibiotic dose and the obese ICU patient Philippe Montravers, M.D., Ph.D. Anaesthesia and Surgical ICU CHU Bichat Claude Bernard Assistance Publique-Hôpitaux de Paris INSERM UMR 1152 University Paris
More informationORIGINAL ARTICLE DOI: (e) ISSN Online: (p) ISSN Print: Anand Kumar Singh 1, Poonam Verma 2. Sciences, Dehradun
ORIGINAL ARTICLE CLINICAL ASSESSMENT OF NEPHROTOXICITY ASSOCIATED WITH VANCOMYCIN TROUGH CONCENTRATIONS DURING TREATMENT OF DEEP-SEATED INFECTIONS: A RETROSPECTIVE ANALYSIS Anand Kumar Singh 1, Poonam
More information10/4/16. mcr-1. Emerging Resistance Updates. Objectives. National Center for Emerging and Zoonotic Infectious Diseases. Alex Kallen, MD, MPH, FACP
National Center for Emerging and Zoonotic Infectious Diseases Emerging Resistance Updates Alex Kallen, MD, MPH, FACP Lead Antimicrobial Resistance and Emerging Pathogens Team Prevention and Response Branch
More informationAntibacterial Antibiotic Resistancein 2016 What Should an Internist Know? Disclosures. Objectives 3/6/2016. Achaogen: Allergan:
Antibacterial Antibiotic Resistancein 2016 What Should an Internist Know? Michael Satlin, MD, MS Assistant Professor of Medicine Division of Infectious Diseases Weill Cornell Medicine March 4, 2016 1 Disclosures
More informationScottish Medicines Consortium
Scottish Medicines Consortium anidulafungin 100mg powder and solvent for concentrate for solution for infusion (Ecalta ) No. (465/08) Pfizer Ltd 09 May 2008 The Scottish Medicines Consortium (SMC) has
More informationGuess or get it right?
Guess or get it right? Antimicrobial prescribing in the 21 st century Robert Masterton Traditional Treatment Paradigm Conservative start with workhorse antibiotics Reserve more potent drugs for non-responders
More informationWHAT IS THE ROLE OF EMPIRIC TREATMENT FOR SUSPECTED INVASIVE CANDIDIASIS IN NONNEUTROPENIC PATIENTS IN THE ICU?
WHAT IS THE ROLE OF EMPIRIC TREATMENT FOR SUSPECTED INVASIVE CANDIDIASIS IN NONNEUTROPENIC PATIENTS IN THE ICU? Empiric antifungal therapy should be considered in critically ill patients with risk factors
More informationCandidemia: New Sentinel Surveillance in the 7-County Metro
Candidemia: New Sentinel Surveillance in the 7-County Metro Brittany VonBank, MPH Paula Vagnone, MT (ASCP) 651-201-5414 www.health.state.mn.us Health Care-associated Infections & Antimicrobial Resistance
More informationMedication Dosing in CRRT
Medication Dosing in CRRT Linda Awdishu, PharmD, MAS Associate Clinical Professor of Pharmacy and Medicine Learning Objectives 1. List the pharmacokinetic changes associated with AKI. 2. Determine the
More informationOvercoming the PosESBLities of Enterobacteriaceae Resistance
Overcoming the PosESBLities of Enterobacteriaceae Resistance Review of current treatment options Jamie Reed, PharmD Pharmacy Grand Rounds August 28, 2018 Rochester, MN 2018 MFMER slide-1 Disclosure No
More informationLa farmacologia in aiuto
Ferrara, 15 giugno 2018 La farmacologia in aiuto Pier Giorgio Cojutti, Federico Pea Istituto di Farmacologia Clinica Azienda Sanitaria Universitaria Integrata di Udine Therapeutic Drug Monitoring of Beta-Lactams
More informationNational Center for Emerging and Zoonotic Infectious Diseases AR Lab Network Candida Testing
National Center for Emerging and Zoonotic Infectious Diseases AR Lab Network Candida Testing Snigdha Vallabhaneni, MD, MPH Medical Epidemiologist Centers for Disease Control and Prevention Invasive Candidiasis
More informationADEQUATE ANTIFUNGAL USE FOR BLOODSTREAM INFECTIONS
ADEQUATE ANTIFUNGAL USE FOR BLOODSTREAM INFECTIONS COMMERCIAL RELATIONS DISCLOSURE 2500 9000 15000 Astellas Gilead Sciences Pfizer Inc Expert advice Speaker s bureau Speaker s bureau OUTLINE OF THE PRESENTATION
More informationDisclosures. Efficacy of the drug. Optimizing Dosing Based on PKPD- An overview. Dose Finding - The Past
Disclosures Optimizing Dosing Based on PKPD- An overview Johan W. Mouton MD PhD FIDSA FAAM Professor pharmacokinetics and pharmacodynamics Research grants advisory boards speaker This Patient Needs Antibiotics.
More information9/18/2018. Invasive Candidiasis. AR Lab Network Candida Testing. Most Common Healthcare Associated Bloodstream Infection in the United States?
National Center for Emerging and Zoonotic Infectious Diseases AR Lab Network Candida Testing Invasive Candidiasis Snigdha Vallabhaneni, MD, MPH Medical Epidemiologist Centers for Disease Control and Prevention
More informationCentral Venous Access Devices and Infection
Central Venous Access Devices and Infection Dr Andrew Daley Microbiology & Infectious Diseases Women s & Children s Health Melbourne Background Types of infection! Local site infection! Blood stream infection!
More informationD DAVID PUBLISHING. Evaluation of the Effectiveness of a Vancomycin Nomogram at Predicting Trough Levels within a Therapeutic Range. 1.
Journal of Pharmacy and Pharmacology 2 (2014) 713-721 doi: 10.17265/2328-2150/2014.12.004 D DAVID PUBLISHING Evaluation of the Effectiveness of a Vancomycin Nomogram at Predicting Trough Levels within
More informationInfections Amenable to OPAT. (Nabin Shrestha + Ajay Mathur)
3 Infections Amenable to OPAT (Nabin Shrestha + Ajay Mathur) Decisions regarding outpatient treatment of infections vary with the institution, the prescribing physician, the individual patient s condition
More information