Antibacterial Antibiotic Resistancein 2016 What Should an Internist Know? Disclosures. Objectives 3/6/2016. Achaogen: Allergan:
|
|
- Darcy Day
- 5 years ago
- Views:
Transcription
1 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, Disclosures Achaogen: Local PI on clinical trial of an investigational agent for CRE Allergan: Research grants CLSI: Member of the Subcommittee for Antimicrobial Susceptibility Testing 2 Objectives Overview of the problem Specific problematic pathogens 1) Drug resistant Neisseria gonorrhoeae 2) MRSA 3) MDR Enterobacteriaceae ESBLs CREs 4) Pseudomonas aeruginosa Rapid diagnostics Take home points 3 1
2 New antibacterial agents approved in the US from Incidence and diversity of MDR bacteria Boucher HW, et al. Clin Infect Dis CDC CDC
3 Drug resistant Gonorrhea 820,000 new cases each year in the USA The Gonococcal Isolate Surveillance Project (GISP). CDC % treatment failure rate with cefixime If elevated cefixime MIC -> 25% treatment failure rate (vs. 1.9%) Allen VG, et al. JAMA The Gonococcal Isolate Surveillance Project (GISP). CDC Current CDC Treatment Recommendations Ceftriaxone 250 mg IV x 1 + Azithromycin 1 gm po x 1 Cefixime 400 mg x 1 can be used with azithromycin only if ceftriaxone is not available 1) Penicillin allergy: If no anaphylaxis/sjs/ten -> give above If anaphylaxis, etc.: Gemifloxacin 320 mg po OR gentamicin 240 mg IM x 1) + azithromycin 2 gm po x 1 Azithro 2 gm alone not recommended 2) Pharyngeal infection: Cefixime not appropriate: <90% cure rates 3) Who to send routine test-of-cure on? Pharyngeal infection treated with an alternative regimen CDC
4 MRSA: Methicillin resistant Staph aureus CDC MRSA: Skin soft tissue infections MRSA resistant to all β-lactams except ceftaroline 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% %Susceptible: 2007 skin S. aureus from outpatients in USA 100% 99% 99% 65% 64% 85% 34% 44% Tillotson GS, et al. J Antimicrob Chemother McDougal LK, et al. Antmicrob Agents Chemother MRSA Skin soft tissue infections Paradigm shift with long acting agents with MRSA activity? Oritavancin 1 Dalbavancin mg over 3 hours x 1 Half-life: 10 days! ALT increases: 2-3% Cost: $ Single-dose non-inferior to 2 doses mg over 30 mins x 1 Half-life: 14 days! No increased AEs Cost:? for 1 time-dose of 1500 mg ($ ?) 1 Corey GR, et al. N Eng J Med Jensen IS, et al. Clin Drug Investig Boucher HW, et al. N Eng J Med Dunne MW, et al. Clin Infect Dis
5 MRSA: Invasive disease Vancomycin MIC creep 1 Rising MICs, but still in susceptible range ( 2 μg/ml) Vancomycin MICs of >1 μg/ml independently associated with treatment failure in MRSA bacteremia 2 Should other agents be used in MRSA bacteremia when vancomycin MIC >1 μg/ml? No randomized trials 2 cohort studies: Clinical failure and mortality less when switched to daptomycin than if stayed on vancomycin 3 4 Definitively should target vancomycin troughs of despite increased risk of nephrotoxicity 2,4 1 Moise PA, et al. Lancet Infect Dis Murray KP, et al. Clin Infect Dis Kullar R, et al. Clin Infect Dis van Hal SJ, et al. Antimicrob Agents Chemother Moore CL, et al. Clin Infect Dis Invasive MRSA Infections Alternative agents to vancomycin High dose TMP SMX (Bactrim)? Increased treatment failure compared to vanco 1 2 Daptomycin? 3 2 cohort studies: high rates of success for L sided MRSA endocarditis 4 5 Don t use for MRSA pneumonia: inactivated by surfactant Ceftaroline? Success rates: Pneumonia 86% (n=92); Bacteremia: 79% (n=141) 6 Linezolid? PROBABLY DEPENDS Pneumonia: RCT: increased clinical success with linezolid vs. vanco 7 Problem with bacteremia: toxicities if >2 weeks of therapy 1 Paul M, et al. BMJ Markowitz N, et al. Ann Intern Med Fowler VG Jr, et al. N Engl J Med Kullar R, et al. J Antimicrob Chemother Dohmen PM, et al. J Antimicrob Chemother Casapao AM, et al. Antimicrob Agents Chemother Wunderink RG, et al. Clin Infect Dis Staph aureus bacteremia: Role of an ID Consult Lahey T, et al. Medicine Dartmouth (n=240) Honda H, et al. Am J Med St. Louis (n=341) Rieg S, et al. J Infect Germany (n=521) Forsblom E, et al. Clin Infect Dis Finland (n=342) Tissot F, et al. J Infect Finland (n=156) Bai AD, et al. Clin Infect Dis Canada (n=847) 15 5
6 MDR Enterobacteriaceae 16 Why focus on MDR Enterobacteriaceae? Data from a CDC HAI surveillance network in Extended spectrum cephalosporin resistance (%) Bacteremia 19% 2% 29% 13% Carbapenem resistance (%) Bacteremia All Klebsiella pneumoniae Sievert DM, et al. Infect Control Hosp Epidemiol Braykov NP, et al. Infect Control Hosp Epidemiol ESBL producing Enterobacteriaceae Extended Spectrum Beta Lactamases 1 Many 100s of different types: not all the same Many highly mobile and on plasmids Enzymes that hydrolyze and inactivate penicillins and most cephalosporins Don t hydrolyze cefoxitin/cefotetan and carbapenems Plasmids often have genes that also confer fluoroquinolone, aminoglycoside, and sulfonamide resistance ESBL carriage rates increasing in the community 2 National surveillance of patients admitted with UTI complicated by bacteremia: 3 E. coli: 8% ESBL K. pneumoniae: 12% ESBL 1 Paterson DL, et al. Clin Microbiol Rev Woerther PL, et al. Clin Microbiol Rev Sader HS, et al. J Chemother
7 ESBL rates: Isolates from hospitalized patients in USA in 2012 Castanheira M, et al. Antimicrob Agents Chemother How do I know I have an ESBL? Antibiotic MIC (μg/ml) Interp. Ampicillin >16 R Ampicillin/sulbactam >16 R Aztreonam >16 R Cefepime 8 S DD Cefoxitin 8 S Ceftazidime >16 R Antibiotic MIC (μg/ml) Interp. Ceftriaxone >32 R Gentamicin 2 S Levofloxacin >4 R Meropenem <=1 S Piperacillin/tazobactam <=8 S TMP/SMX >2/38 R Escherichia coli or Klebsiella that is ceftriaxone resistant, meropenem susceptible Some labs will do a phenotypic test to confirm this Susceptibility rates of ESBL E Ceftazidime: 20 60% OR Cefepime: 60 75% (many have elevated MICs: S DD) Piperacillin tazobactam (Zosyn): % 1 Park SH, et al. Antimicrob Agents Chemother Castanheira M et al. Antimicrob Agents Chemother Doi Y, et al. Clin Infect Dis Should we always treat with carbapenems? Can we use cefepime and pip-tazo when ESBLs are susceptible? 20 ESBLs: Inoculum effect 10 5 CFU/mL is the standard inoculum for susceptibility testing and getting an MIC What if you use 10 7 CFU/mL? (e.g., pneumonia)? Meropenem Cefepime Pip tazo 1 Similar findings have been shown for CTX-M ESBLs (E. coli and K.pneumoniae) 2 1 Thomson KS, et al. Antimicrob Agents Chemother Harada Y, et al. Clin Microbiol Infect
8 Clinical observational studies also show poor outcomes with cefepime, even when susceptible 178 patients with ESBL producing bacteremia Beware of cefepime for serious ceftriaxone-resistant E.coli or Klebsiella infections! Lee NY, et al. Clin Infect Dis Cefepime S-DD; MIC 4-8 μg/ml 22 Cefepime Susceptible: Dose dependent? Based on 1 g q12h dosing Use 2 g q8h dosing 23 What about β lactam β lactamase inhibitors (like piperacillin tazobactam)? Post hoc analysis of patients with ESBL E.coli bacteremia in 6 prospective cohorts Compared use of carbapenem or BL/BLI as monotherapy either empirically or as definitive therapy No difference in mortality in multivariate analysis Notably: all E.coli, mostly CTX-M, mostly bacteremias from urinary or biliary source, the highest dose of pip-tazo was used (4.5 g q 6h), does not apply to ampicillin-sulbactam Rodriguez-Bano J, et al. Clin Infect Dis
9 ESBLs: Clinical Data: Pip tazo vs. Carbapenem 213 patients with ESBL bacteremia (Ec, Kp, Proteus mirabilis) All received definitive treatment with a carbapenem All isolates susceptible to pip tazo and a carbapenem Pip tazo (n=103) Empirical therapy 1 st 3 days Carbapenem (n=110) 14-day mortality 17% P=0.05 8% Multivariate model Adjusted HR of death 1.9 ( ) if received pip-tazo empirically Only 40% received 4.5 g IV q6h Urine and biliary sources: only 25% Included Klebsiella pneumoniae Tamma PD, et al. Clin Infect Dis Carbapenem resistant Enterobacteriaceae (CRE) Enzymes that hydrolyze not only penicillin and cephalosporins, but also carbapenems Klebsiella pneumoniae carbapenemase (KPC) is by far the most common mechanism for carbapenem resistance for the Enterobacteriaceae in the NE USA (but CRE KPC) Most common with Klebsiella pneumoniae KPC is encoded on a plasmid Usually test susceptible to polymyxin B/colistin, tigecycline sometimes susceptible to gentamicin, amikacin, doxycycline, and fosfomycin CRE bacteremia: 40 50% mortality rate Munoz-Price LS, et al. Lancet Infect Dis Satlin MJ, et al. Clin Infect Dis Where is KPC? Nordmann P, et al. Emerg Infect Dis
10 The CRE armamentarium: Early 2015 What agents are left that are active vs. CRE? Colistin Polymyxins Polymyxin B Tigecycline All have major limitations Aminoglycosides Sometimes ~50% susceptible to gent Tobra almost never active Fosfomycin 28 Problems with Polymyxins 1) Toxicities Nephrotoxicity: 40 60% with either colistin 1 or poly B 2 Neurotoxicity 3 : paresthesias, NM blockade; less common 2) PK/PD data only now becoming available For Poly B: we recently learned that we should not adjust for renal failure 4 Can t easily check levels 3) Unreliable susceptibility testing 5 No CLSI breakpoints for the Enterobacteriaceae 1 Rocco M, et al. Crit Care Rigatto MH, et al. J Antimicrob Chemother Landman D, et al. Clin Microbiol Rev Nation RL, et al. Clin Infect Dis Hindler JA, et al. J Clin Microbiol Troubles with Tigecycline 1) Bacteriostatic, not bactericidal 2) Low bloodstream and urine levels 1 Limits their use in bacteremias and UTIs Only approved for skin soft tissue and intraabominal infections and community acquired pneumonia Microbiologic clearance rates for CRKP UTI 2 Mortality in RCTs of FDA-approved indications 3 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 88% P = % P < % P < % AG PB TG UN 1 MacGowan AP, et al. J Antimicrob Chemother Satlin MJ, et al. Antimicrob Agents Chemother Prasad P, et al. Clin Infect Dis
11 Fosfomycin Seldom used agent that is FDA approved for UTIs Available as an IV formulation in Europe, only as a sachet in the USA Susceptibility rates of CRE: 45 93% 1 2 Resistance may develop rapidly on therapy 3 Study of 13 patients with CRKP UTI who received 3 doses 4 : Only 6/13 had microbiologic cure 1 Endimiani A, et al. Antimicrob Agents Chemother Chen S, et al. Antimicrob Agents Chemother Karageorgopoulos DE, et al. J Antimicrob Chemother Neuner EA, et al. Antimicrob Agents Chemother Combination therapy for CRE? Tumbarello et al: 125 patients with KPC Kp bacteremia 2 active drugs Daikos et al: 175 patients with carbapenemaseproducing Kp bacteremia (not all CRKP, not all KPC) Tumbarello M, et al. Clin Infect Dis Daikos GL, et al. Antimicrob Agents Chemother Ceftazidime/avibactam (Avycaz ) The first approved β lactam/β lactamase inhibitor with excellent in vitro activity vs. ESBL, AmpC, and KPCproducing Enterobacteriaceae 1 Not reliably active vs. metallo β lactamases (e.g. NDM) or an improvement vs. Acinetobacter Active vs. ~80% of ceftazidime resistant Pseudomonas 2 Bacteroides coverage limited 3 FDA approved in Feb 2015 for complicated intraabdominal and urinary tract infections No clinical data for use for KPC Kp or bacteremia Animal data also limited Dose: 2.5 g IV q8h (2 g ceftaz, 0.5 gm avibactam) Expensive! ($ /day) 1 Castanheira M, et al. Antimicrob Agents Chemother Sader HS, et al. Antimicrob Agents Chemother Citron DM, et al. Antimicrob Agents Chemother
12 Pseudomonas aeruginosa 34 Pseudomonas aeruginosa Susceptibility rates: 5328 USA isolates 100% 80% 84% 85% 80% 83% 75% 89% 97% 92% 60% 40% 20% 0% Ceftazidime Cefepime Pip tazo MeropenemLevofloxacin Gentamicin Amikacin Tobramycin Empirical therapy in a sick patient (while awaiting susceptibility results) Reasonable to give β-lactam + aminoglycoside OR fluoroquinolone Sader HS, et al. Diagn Microbiol Infect Dis Pseudomonas aeruginosa: Rationale for combination definitive therapy No quality randomized controlled trials But, most studies do not find a benefit Synergy Prevention of the emergence of resistance Increased adverse effects Cost Paul M, et al. Clin Infect Dis
13 Pseudomonas aeruginosa Emergence of resistance while on therapy Resistance emerges on therapy in at least 10% of cases 1 Highest with carbapenems and pneumonia 1 Solutions? 1) Use higher doses: pip tazo (4.5q6h) or cefepime (2q8h) 2) Add an aminoglycoside or a FQ to the β lactam (some supportive in vitro and animal models) 2 4 3) Prolonged infusion of β lactam (eg: over 3 4 h vs. 30 min) More likely to achieve PK target of keeping the concentration of β lactam > MIC for at least 50% of dosing interval 4 2 observational studies of prolonged infusion pip tazo and cefepime showed decreased mortality for serious Pa infections Carmeli Y, et al. Antimicrob Agents Chemother Drusano GL, et al. Antimicrob Agents Chemother Louie A, et al. Antimicrob Agents Chemother Michea-Hamzehpour M, et al. Antimicrob Agents Chemother Lodise TP, et al. Clin Infect Dis Bauer KA, et al. Antimicrob Agents Chemother Treatment options for MDR Pa resistant to all β lactams Polymyxins and aminoglycosides Not effective as monotherapy for Pa bacteremia in neutropenic patients Bodey GP, et al. Eur J Cancer Ceftolozane/tazobactam (Zerbaxa ) Ceftolozane is a new cephalosporin that is similar to ceftazidime, but less susceptible to AmpC hydrolysis Active against 70% of Pa isolates that are non susceptible to ceftazidime, pip tazo, and meropenem 1 Tazobactam gives it activity against most ESBLs 1 Gram positive coverage similar to ceftazidime and Bacteroides coverage not reliable 2 FDA approved in Dec 2014 for complicated intra abdominal (with metronidazole) and urinary tract infections No clinical data for use for MDR Pa OR bacteremia/pneumonia OR neutropenic patients Phase 3 clinical trial for pneumonia ongoing: using dose of 3 gm IV q8h (FDA approved dose 1.5 gm IV q8h) I recommend this dose for MDR Pa bacteremia or pneumonia Not as expensive as ceftazidime/avibactam (~$250 per day) 1 Farrell DJ, et al. Antimicrob Agents Chemother Snydman DR, et al. Antimicrob Agents Chemother
14 Patients with severe sepsis: The importance of rapid diagnostics and timely, appropriate therapy Kumar A, et al. Crit Care Med Rapid PCR systems from blood cultures 1) BioFire FilmArray Blood Culture ID Panel 2) Nanosphere Verigene Blood Culture Panels Organism ID (80-85%) of organisms 1 Resistance genes: MecA -> MRSA ID VanA and VanB -> VRE KPC (and other carbapenemases) -> 2 hrs CRE PCR CTX-M -> ESBL Final Hours Banerjee R, et al. Clin Infect Dis Antibacterial Resistance 2016 Take home messages 1) Slowing of antibiotic development has exacerbated the problem of resistance 2) Combination therapy recommended for gonorrhea 3) 1 dose treatments for skin/soft tissue infections (oritavancin, dalbavancin) 4) Call an ID Consult for Staph aureus bacteremia 5) Carbapenems are preferred treatments for invasive ESBL infections (pip tazo an alternative for less severe infections): 6) New treatment options available for CRE (ceftazidime avibactam) and β lactam resistant Pseudomonas (ceftolozane tazobactam) 7) Prolonged infusion β lactams should be considered for Pseudomonas 8) Rapid diagnostics are critical: Blood culture PCR systems a major potential advance 42 14
15 43 15
Treatment Strategies for Infections due to MDR-GNR
Treatment Strategies for Infections due to MDR-GNR Michael Satlin, MD Instructor in Medicine Division of Infectious Diseases Weill Cornell Medical College, New York, NY October 16, 2012 1 2 Faculty Disclosure
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 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 informationNightmare Bacteria. Disclosures. Technician Objectives. Pharmacist Objectives. Carbapenem Resistance in Carbapenem Resistance in 2017
Nightmare Bacteria How to Deal with the Reality of Carbapenem-resistant Organisms Disclosures I have no conflicts of interest relative to the content of this presentation Matthew L. Brown, Pharm.D., BCPS
More informationAntibiotic Treatment of GNR MDR Infections. Stan Deresinski
Antibiotic Treatment of GNR MDR Infections Stan Deresinski Kucers: The Use of Antibiotics 1st Edition 1972 392 pages Kucers: The Use of Antibiotics 7 th Edition 2017 5338 pages Carbapenem Susceptibility
More informationExpert rules. for Gram-negatives
Academic Perspective in Expert rules Emerging Issues of Resistance in Gram-ve Bacteria for Gram-negatives Trevor Winstanley Sheffield Teaching Hospitals Presented on behalf of David Livermore University
More informationFrequency of Occurrence and Antimicrobial Susceptibility of Bacteria from ICU Patients with Pneumonia
Frequency of Occurrence and Antimicrobial Susceptibility of Bacteria from ICU Patients with Pneumonia Helio S. Sader, M.D.* Mariana Castanheira, Ph.D. Rodrigo E. Mendes, Ph.D. Robert K. Flamm, Ph.D. JMI
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 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 informationALERT. Clinical microbiology considerations related to the emergence of. New Delhi metallo beta lactamases (NDM 1) and Klebsiella
ALERT Clinical microbiology considerations related to the emergence of New Delhi metallo beta lactamases (NDM 1) and Klebsiella pneumoniae carbapenemases (KPC) amongst hospitalized patients in South Africa
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 informationReporting blood culture results to clinicians: MIC, resistance mechanisms, both?
Reporting blood culture results to clinicians: MIC, resistance mechanisms, both? Christian G. Giske, MD, PhD Senior Consultant Physician/Associate Professor Department of Clinical Microbiology Karolinska
More informationDisclosure. Objectives. Evolution of β Lactamases. Extended Spectrum β Lactamases: The New Normal. Prevalence of ESBL Mystic Program
47 th Annual Meeting August 2-4, 2013 Orlando, FL Extended Spectrum β Lactamases: The New Normal Disclosure I do have a vested interest in or affiliation with the following companies or organizations Triax
More informationTreatment Options for Urinary Tract Infections Caused by Extended-Spectrum Β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae
Treatment Options for Urinary Tract Infections Caused by Extended-Spectrum Β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae medicine.missouri.edu/jahm/treatment-options-urinary-tract-infections-caused-extended-spectrum-β-lactamase-producingescherichia-coli-klebsiella-pneumoniae/
More informationControversial Issues in Susceptibility Testing: Point/Counterpoint. April N. Abbott, PhD D(ABMM) Romney M. Humphries, PhD D(ABMM)
Controversial Issues in Susceptibility Testing: Point/Counterpoint April N. Abbott, PhD D(ABMM) Romney M. Humphries, PhD D(ABMM) Disclosures RMH: Funding from BD, biomerieux, Beckman-Coulter, GenMark,
More informationNew insights in antibiotic and antifungal therapy in the compromised host
New insights in antibiotic and antifungal therapy in the compromised host Claudio Viscoli University of Genova Ospedale Policlinico San Martino, Genova Potential conflicts of interest (last 5 years) Received
More informationESCMID Online Lecture Library. by author
Hospital Universitario Virgen Macarena, Seville New drugs against MRSA and VRE L. Eduardo López Cortés Seville, 8th July Tedizolid Oxazolidinone Ceftaroline // Ceftobiprole 5 th gen cephalosporin Overview
More informationAcademic Perspective in. David Livermore Prof of Medical Microbiology, UEA Lead on Antibiotic resistance PHE
Academic Perspective in Emerging No, we can t Issues treat of carbapenemase Resistance and ESBL in Gram-ve producers Bacteria based on MIC David Livermore Prof of Medical Microbiology, UEA Lead on Antibiotic
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 informationUpdate on CLSI and EUCAST
Update on CLSI and EUCAST 1 Completed work» Cephalosporin breakpoints for Enterobacteriaceae ESBL screens MIC versus resistance mechanism» Carbapenem breakpoints for Enterobacteriaceae Modified Hodge Test»
More informationDiane M. Gomes, Pharm.D. Outcomes in Antimicrobial Stewardship Post-Doctoral Pharmacy Fellow Providence Veterans Affairs Medical Center
Diane M. Gomes, Pharm.D. Outcomes in Antimicrobial Stewardship Post-Doctoral Pharmacy Fellow Providence Veterans Affairs Medical Center The information disseminated in this lecture is given in my personal
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 informationSevere β-lactam allergy. Alternative (use for mild-moderate β-lactam allergy) therapy
Recommended Empirical Antibiotic Regimens for MICU Patients Notes: The antibiotic regimens shown are general guidelines and should not replace clinical judgment. Always assess for antibiotic allergies.
More informationLa neutropenia febbrile
XII Corso Avanzato di Terapia Antibiotica Pisa, 15-16 novembre 2017 La neutropenia febbrile Alessandra Micozzi Dipartimento di Biotecnologie Cellulari ed Ematologia Sapienza Università di Roma Fever developing
More informationNEW DEVELOPMENTS AND CHALLENGING CASES IN HOSPITAL INFECTIOUS DISEASES
Lisa G. Winston, MD Professor, University of California, San Francisco Vice Chief, Inpatient Medical Services and Hospital Epidemiologist, San Francisco General Hospital NEW DEVELOPMENTS AND CHALLENGING
More informationExpert rules in antimicrobial susceptibility testing: State of the art
Expert rules in antimicrobial susceptibility testing: State of the art ESCMID Postgraduate Education Course Antimicrobial Susceptibility Testing and Surveillance: from Laboratory to Clinic Hospital Universitario
More informationSep Oct Nov Dec Total
LB PAGE 2 LB PAGE 3 Sep Oct Nov Dec 2007 2007 2007 2007 Total Repeat Information Total Repeats 35 15 17 9 76 Repeat Rate 6.01% 0.17% 1.12% 0.39% 2.07% Repeat Chemistry 25 0 2 0 27 Repeat Extraction 1 0
More informationUrinary Tract Infections: From Simple to Complex. Adriane N Irwin, MS, PharmD, BCACP Clinical Assistant Professor Ambulatory Care October 25, 2014
Urinary Tract Infections: From Simple to Complex Adriane N Irwin, MS, PharmD, BCACP Clinical Assistant Professor Ambulatory Care October 25, 2014 Learning Objectives Develop empiric antimicrobial treatment
More informationIn Vitro Activity of Ceftazidime-Avibactam Against Isolates. in a Phase 3 Open-label Clinical Trial for Complicated
AAC Accepted Manuscript Posted Online 21 November 2016 Antimicrob. Agents Chemother. doi:10.1128/aac.01820-16 Copyright 2016, American Society for Microbiology. All Rights Reserved. 1 2 3 4 5 6 7 8 9 10
More informationActivity of Ceftolozane/Tazobactam Against a Broad Spectrum of Recent Clinical Anaerobic Isolates
AAC Accepts, published online ahead of print on 25 November 2013 Antimicrob. Agents Chemother. doi:10.1128/aac.02253-13 Copyright 2013, American Society for Microbiology. All Rights Reserved. Activity
More informationAntibiotics to treat multi-drug-resistant bacterial infections
Antibiotics to treat multi-drug-resistant bacterial infections July 2013 JUNE 2013 Copyright 2013 Tetraphase Pharmaceuticals, Inc. 1 Forward Looking Statements and Other Important Cautions Any statements
More informationAAC Accepts, published online ahead of print on 13 October 2008 Antimicrob. Agents Chemother. doi: /aac
AAC Accepts, published online ahead of print on 13 October 2008 Antimicrob. Agents Chemother. doi:10.1128/aac.00931-08 Copyright 2008, American Society for Microbiology and/or the Listed Authors/Institutions.
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 informationPublic Health Surveillance for Multi Drug Resistant Organisms in Orange County
Public Health Surveillance for Multi Drug Resistant Organisms in Orange County Matt Zahn, MD Medical Director Epidemiology and Assessment Orange County Public Health Antimicrobial Mechanisms of Action
More informationHelen Heffernan and Rosemary Woodhouse Antibiotic Reference Laboratory, Institute of Environmental Science and Research Limited (ESR); July 2014.
Annual survey of extended-spectrum -lactamase (ESBL)-producing Enterobacteriaceae, 2013 Helen Heffernan and Rosemary Woodhouse Antibiotic Reference Laboratory, Institute of Environmental Science and Research
More informationNDA Briefing Document Anti-Infective Drugs Advisory Committee 05 December 2014
CEFTAZIDIME-AVIBACTAM FOR INJECTION for Treatment of Complicated Intra-abdominal Infection (used in combination with metronidazole), Complicated Urinary Tract Infection including Acute Pyelonephritis,
More informationMay 11, Ceftriaxone for MSSA. Daptomycin Dosing Weight. Candidiasis Treatment
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
More informationTreatment Options for Carbapenem-Resistant Enterobacteriaceae Infections
REVIEW ARTICLE Treatment Options for Carbapenem-Resistant Enterobacteriaceae Infections Haley J. Morrill, 1,2 Jason M. Pogue, 3 Keith S. Kaye, 4 and Kerry L. LaPlante 1,2,5 1 Veterans Affairs Medical Center,
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 informationEmergence of Klebsiella pneumoniae ST258 with KPC-2 in Hong Kong. Title. Ho, PL; Tse, CWS; Lai, EL; Lo, WU; Chow, KH
Title Emergence of Klebsiella pneumoniae ST258 with KPC-2 in Hong Kong Author(s) Ho, PL; Tse, CWS; Lai, EL; Lo, WU; Chow, KH Citation International Journal Of Antimicrobial Agents, 2011, v. 37 n. 4, p.
More informationDevelopment of C sporins. Beta-lactam antibiotics - Cephalosporins. Second generation C sporins. Targets - PBP s
Beta-lactam antibiotics - Cephalosporins Development of C sporins Targets - PBP s Activity - Cidal - growing organisms (like the penicillins) Principles of action - Affinity for PBP s Permeability properties
More informationESCMID Online Lecture Library. by author
www.eucast.org EXPERT RULES IN ANTIMICROBIAL SUSCEPTIBILITY TESTING Dr. Rafael Cantón Hospital Universitario Ramón y Cajal SERVICIO DE MICROBIOLOGÍA Y PARASITOLOGÍA Departamento de Microbiología II Universidad
More informationPneumonia Community-Acquired Healthcare-Associated
Pneumonia Community-Acquired Healthcare-Associated Edwin Yu Clin Infect Dis 2007;44(S2):27-72 Am J Respir Crit Care Med 2005; 171:388-416 IDSA / ATS Guidelines Microbiology Principles and Practice of Infectious
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 informationNONFERMENTING GRAM NEGATIVE RODS. April Abbott Deaconess Health System Evansville, IN
NONFERMENTING GRAM NEGATIVE RODS April Abbott Deaconess Health System Evansville, IN OBJECTIVES Discuss basic limitations to assessing carbapenem resistance in nonfermenting GNRs Discuss antimicrobial
More informationGuidance on screening and confirmation of carbapenem resistant Enterobacteriacae (CRE) December 12, 2011
Guidance on screening and confirmation of carbapenem resistant Enterobacteriacae (CRE) December 12, 2011 Objectives: To discuss the guidelines for detection of CRE in the laboratory setting. To review
More informationAminoglycosides John A. Bosso, Pharm.D.
AMINOGLYCOSIDES Therapeutics/PHRMP-73 Aminoglycoside Mechanism of Action Aminoglycosides bind to 30s ribosomal subunit resulting in mistranslation of mrna thus disrupting protein synthesis. They are rapidly
More informationLa batteriocidia sierica: passato e presente
Genova, 23 settembre 2016 La batteriocidia sierica: passato e presente Dott.ssa Maddalena Giannella Clinica di Malattie Infettive AOU Policlinico Sant Orsola Malpighi Case 1 Case 2 Summary: Cured of cancer
More informationST11 KPC-2 Klebsiella pneumoniae detected in Taiwan
AAC Accepts, published online ahead of print on 30 January 2012 Antimicrob. Agents Chemother. doi:10.1128/aac.05576-11 Copyright 2012, American Society for Microbiology. All Rights Reserved. 1 2 3 4 5
More informationLessons from recent studies. João Gonçalves Pereira UCIP DALI
Lessons from recent studies João Gonçalves Pereira UCIP DALI 1 Patterns of Antimicrobial Activity Concentration C max Aminoglycosides Cmax/MIC>10 Metronidazol Area under the concentration curve Azithromycin
More informationHOW BUGS COMBAT DRUGS: ANTIMICROBIAL RESISTANCE MECHANISMS IN THE MODERN ERA. Romney Humphries, PhD D(ABMM)
HOW BUGS COMBAT DRUGS: ANTIMICROBIAL RESISTANCE MECHANISMS IN THE MODERN ERA Romney Humphries, PhD D(ABMM) Section Chief, UCLA Clinical Microbiology Los Angeles CA rhumphries@mednet.ucla.edu WHAT WE WILL
More informationDetermining the Optimal Carbapenem MIC that Distinguishes Carbapenemase-Producing
AAC Accepted Manuscript Posted Online 8 August 2016 Antimicrob. Agents Chemother. doi:10.1128/aac.00838-16 Copyright 2016, American Society for Microbiology. All Rights Reserved. 1 1 2 Determining the
More informationAdenium Biotech. Management: - Peter Nordkild, MD, CEO, ex Novo Nordisk, Ferring, Egalet - Søren Neve, PhD, project director, ex Lundbeck, Novozymes
Adenium Biotech Management: - Peter Nordkild, MD, CEO, ex Novo Nordisk, Ferring, Egalet - Søren Neve, PhD, project director, ex Lundbeck, Novozymes Board of Directors: - Stephan Christgau, PhD, chairman,
More informationMICHIGAN MEDICINE GUIDELINES FOR TREATMENT OF URINARY TRACT INFECTIONS IN ADULTS
When to Order a Urine Culture: Asymptomatic bacteriuria is often treated unnecessarily, and accounts for a substantial burden of unnecessary antimicrobial use. National guidelines recommend against testing
More informationNational Center for Emerging and Zoonotic Infectious Diseases The Biggest Antibiotic Resistance Threats
National Center for Emerging and Zoonotic Infectious Diseases The Biggest Antibiotic Resistance Threats Jean B. Patel, PhD, D(ABMM) Science Lead, Antibiotic Resistance and Coordination Unit Centers for
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 informationNew Antimicrobials: Now and In the Future
New Antimicrobials: Now and In the Future David C. Hooper, M.D. Division of Infectious Diseases Infection Control Unit Massachusetts General Hospital Harvard Medical School Conflicts of Interest Melinta
More informationXERAVATM (eravacycline): A Novel Fluorocycline Antibacterial
XERAVATM (eravacycline): A Novel Fluorocycline Antibacterial Matteo Bassetti, MD, PhD Infectious Diseases Division University of Udine and Santa Maria Misericordia University Hospital Udine, Italy Disclosures
More informationUse of imipenem. with the support of Wallonie-Bruxelles International. Magali Dodémont Microbiology Hospital Erasme Université Libre de Bruxelles
with the support of Wallonie-Bruxelles International Use of imipenem Magali Dodémont Microbiology Hospital Erasme Université Libre de Bruxelles 1 Β-lactams classification 2 Β-lactams: mode of action Inhibition
More informationPlazomicin Versus Meropenem for the Treatment of Complicated Urinary Tract Infection and Acute Pyelonephritis: Results of the EPIC Study
Plazomicin Versus Meropenem for the Treatment of Complicated Urinary Tract Infection and Acute Pyelonephritis: Results of the EPIC Study Daniel J. Cloutier 1, Loren G. Miller 2, Allison S. Komirenko 1,
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 informationCarbapenems and Enterobacteriaceae
Title Carbapenems and Enterobacteriaceae Presenter s details NHLS Dr Khine Swe Swe/Han FC Path ( Micro), SA MMed( micro), SA DTMH(Wits univ),sa PDIC(Stellen univ)sa MB,BS(Yangon),Myanmar Pathologist,Consultant/Lecturer,
More informationEvaluation of the in vitro activity of ceftazidime-avibactam and ceftolozane-tazobactam
AAC Accepted Manuscript Posted Online 14 March 2016 Antimicrob. Agents Chemother. doi:10.1128/aac.02969-15 Copyright 2016, American Society for Microbiology. All Rights Reserved. 1 2 Evaluation of the
More informationβ-lactamase inhibitors
β-lactamase inhibitors Properties, microbiology & enzymology DAVID M LIVERMORE Professor of Medical Microbiology, UEA Lead on Antibiotic Resistance, Public Health England β-lactamase classes A B C D Serine
More informationSurveillance of antimicrobial susceptibility of Enterobacteriaceae pathogens isolated from intensive care units and surgical units in Russia
Feb. 2016 THE JAPANESE JOURNAL OF ANTIBIOTICS 69 1 41 41 Surveillance of antimicrobial susceptibility of Enterobacteriaceae pathogens isolated from intensive care units and surgical units in Russia IRINA
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 informationMHSAL Guidelines for the Prevention and Control of Antimicrobial Resistant Organisms (AROs) - Response to Questions
MHSAL Guidelines for the Prevention and Control of Antimicrobial Resistant Organisms (AROs) - Response to Questions Dr. Andrew Walkty Medical Microbiologist, Diagnostic Services Manitoba (DSM) June. 17,
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 informationJournal of Infectious Diseases and
Journal of Infectious Diseases & Therapy ISSN: 2332-0877 Journal of Infectious Diseases and Therapy Santanirand et al., J Infect Dis Ther 2018, 6:5 DOI: 10.4172/2332-0877.1000378 Research Article Open
More informationβ- Lactamase Gene carrying Klebsiella pneumoniae and its Clinical Implication
Prevalence of Carbapenem-Hydrolyzing β- Lactamase Gene carrying Klebsiella pneumoniae and its Clinical Implication David Alcid M.D Balaji Yegneswaran M.D. Wanpen Numsuwan Introduction Klebsiella pneumoniae
More informationContinuous vs Intermittent Dosing of Antibiotics in Critically-Ill Patients
Continuous vs Intermittent Dosing of Antibiotics in Critically-Ill Patients Jan O Friedrich, MD DPhil Associate Professor of Medicine, University of Toronto Medical Director, MSICU St. Michael s Hospital,
More informationCefmetazole for bacteremia caused by ESBL-producing enterobacteriaceae comparing with carbapenems
Fukuchi et al. BMC Infectious Diseases (2016) 16:427 DOI 10.1186/s12879-016-1770-1 RESEARCH ARTICLE Open Access Cefmetazole for bacteremia caused by ESBL-producing enterobacteriaceae comparing with carbapenems
More informationCarbapenem-resistant Escherichia coli and Klebsiella pneumoniae in Taiwan
Carbapenem-resistant Escherichia coli and Klebsiella pneumoniae in Taiwan An Infection Control Emergency Speaker: L Kristopher Siu Principal Investigator Division of Infectious Diseases National Institute
More informationHUSRES Annual Report 2009 Martti Vaara
HUSRES Annual Report 2009 Martti Vaara www.huslab.fi www.intra.hus.fi Martti Vaara, 2/2010 1 The basis of this HUSRES 2009 report is the HUSLAB/Whonet database 2009, which contains susceptibility data
More informationTerapia delle infezioni da Pseudomonas aeruginosa MDR
Verona 23 ottobre 2010 Terapia delle infezioni da Pseudomonas aeruginosa MDR Pierluigi Viale Clinica di Malattie Infettive Policlinico S. Orsola Malpighi Global resistance surveillance of Pseudomonas aeruginosa
More informationSusceptibility rates in Latin American nations: report from a regional resistance surveillance program (2011)
b r a z j i n f e c t d i s. 2 0 1 3;1 7(6):672 681 The Brazilian Journal of INFECTIOUS DISEASES www.elsevier.com/locate/bjid Original article Susceptibility rates in Latin American nations: report from
More informationOther β-lactam. A. Carbapenems:
A. Carbapenems: Other β-lactam Carbapenems are synthetic β-lactam antibiotics Differ in structure from the penicillins in that the sulfur atom of the thiazolidine ring. Imipenem, meropenem, doripenem,
More informationAntibiotic Resistance Pattern of Blood and CSF Culture Isolates At NHLS Academic Laboratories (2005)
Antibiotic Resistance Pattern of Blood and CSF Culture Isolates At NHLS Academic Laboratories (2005) Streptococcus pneumoniae (SP) Blood Culture Isolates Penicillin intermediate Penicillin Cefotaxime 336
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 informationPolymyxin B and Colistin Debate: One of the Same Kind or Mutt and Jeff?
Polymyxin B and Colistin Debate: One of the Same Kind or Mutt and Jeff? Bruce M. Jones, PharmD, BCPS Clinical Pharmacy Specialist Infectious Diseases St. Joseph's/Candler Health System, Inc. Clinical Adjunct
More informationRevised AAC Version 2» New-Data Letter to the Editor ACCEPTED. Plasmid-Mediated Carbapenem-Hydrolyzing β-lactamase KPC-2 in
AAC Accepts, published online ahead of print on 3 December 2007 Antimicrob. Agents Chemother. doi:10.1128/aac.01180-07 Copyright 2007, American Society for Microbiology and/or the Listed Authors/Institutions.
More informationPrevalence of Extended Spectrum -Lactamases In E.coli and Klebsiella spp. in a Tertiary Care Hospital
ISSN: 2319-7706 Volume 3 Number 10 (2014) pp. 474-478 http://www.ijcmas.com Original Research Article Prevalence of Extended Spectrum -Lactamases In E.coli and Klebsiella spp. in a Tertiary Care Hospital
More informationMechanisms of Resistance to Ceftazidime-Avibactam. Romney M. Humphries, PhD D(ABMM) Chief Scientific Officer Accelerate Diagnostics.
Mechanisms of Resistance to Ceftazidime-Avibactam Romney M. Humphries, PhD D(ABMM) Chief Scientific Officer Accelerate Diagnostics UCLA, January 2015 62 year old woman with advanced pancreatic cancer Vomiting
More informationPREVENTION AND TREATMENT OF BACTERIAL INFECTIONS IN CIRRHOSIS
PREVENTION AND TREATMENT OF BACTERIAL INFECTIONS IN CIRRHOSIS Dr. J. Fernández. Head of the Liver Unit Hospital Clinic Barcelona, Spain AEEH Postgraduate Course, Madrid, February 15 2017 Prevalence of
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 informationPresented at the annual meeting of the American Society of Microbiology, June 1-5, 2017, New Orleans, LA, USA
Is Associated With Improved Survival and Safety Compared to Colistin in Serious Carbapenemresistant Enterobacteriaceae (CRE) Infections: Results of the CARE Study Lynn E. Connolly 1, Adrian M. Jubb 1,
More informationThis material is supported in part by unrestricted educational grants from: Abbott, Bayer HealthCare, Merck Frosst, Roche Diagnostics, and Wyeth Inc.
Division of Medical Microbiology Department of Laboratory Medicine and Pathology University of Alberta Hospital and Stollery Children's Hospital Antibiogram 2006 This material is supported in part by unrestricted
More informationNovel Approaches in the Management of C. difficile Infection. Stuart Johnson, MD
Novel Approaches in the Management of C. difficile Infection Stuart Johnson, MD Professor, Department of Medicine Stritch School of Medicine Loyola University Chicago, IL Overview Pathogenesis of CDI*
More informationInnovations in Antimicrobials Something Old, Something New
FSHP Disclosure Innovations in Antimicrobials Something Old, Something New Harrison Bachmeier, PharmD, BCPS Pharmacist Specialist-Infectious Diseases LeeHealth Fort Myers & Cape Coral, FL I do not have
More informationConsultation on the Revision of Carbapenem Breakpoints
Consultation on the Revision of Carbapenem Breakpoints July 2018 Please send comments to the EUCAST Scientific Secretary at jturnidge@gmail.com by September 15. EUCAST revision of carbapenem breakpoints
More informationShaun Yang, PhD, D(ABMM), MLS(ASCP) CM MB CM Assistant Professor of Pathology UNM Health Sciences Center Associate Director of Infectious Disease
Shaun Yang, PhD, D(ABMM), MLS(ASCP) CM MB CM Assistant Professor of Pathology UNM Health Sciences Center Associate Director of Infectious Disease Director of Molecular Infectious Disease TriCore Reference
More informationCeftazidime-Avibactam and Aztreonam an interesting strategy to Overcome β- Lactam Resistance Conferred by Metallo-β-Lactamases in Enterobacteriaceae
AAC Accepted Manuscript Posted Online 19 June 2017 Antimicrob. Agents Chemother. doi:10.1128/aac.01008-17 Copyright 2017 American Society for Microbiology. All Rights Reserved. 1 2 3 Ceftazidime-Avibactam
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 informationAnnual Surveillance Summary: Pseudomonas aeruginosa Infections in the Military Health System (MHS), 2016
Annual Surveillance Summary: Pseudomonas aeruginosa Infections in the Military Health System (MHS), 2016 Sarah Gierhart and Uzo Chukwuma Approved for public release. Distribution is unlimited. The views
More informationby author ESCMID Online Lecture Library
The Karyatides at the Erechtheion Temple Devoted to the Women in the Audience At the top of the Museum the Karyatides, watching you through the years to come FOSFOMYCIN IN THE TREATMENT OF INFECTIONS
More informationIn Vitro Susceptibility Pattern of Cephalosporin- Resistant Gram-Negative Bacteria
In Vitro Susceptibility Pattern of Cephalosporin- Resistant Gram-Negative Bacteria Warunee Punpanich MD*, Worraporn Tantichattanon MD**, Siriporn Wongwatcharapaiboon MD**, Vipa Treeratweeraphong BSc, MSc***
More informationCare Guideline DRAFT for review cycle 08/02/17 CARE OF THE ADULT PNEUMONIA PATIENT
Care Guideline DRAFT for review cycle 08/02/17 CARE OF THE ADULT PNEUMONIA PATIENT Target Audience: All MHS employed providers within Primary Care, Urgent Care, and In-Hospital Care. The secondary audience
More informationConsequences for the clinicians
30th Symposium : What will change in your daily practice with the new Elewijt, 26-05-2008 EUCAST breakpoints for antibiotic susceptibility testing Consequences for the clinicians Y.Van Laethem,MD CHU St
More informationOptimizing Antibiotic Therapy in the ICU For Pneumonia Current and Future Approaches
Optimizing Antibiotic Therapy in the ICU For Pneumonia Current and Future Approaches Andrew F. Shorr, MD, MPH Washington Hospital Center Georgetown Univ. Disclosures I have served as a consultant to, researcher/investigator
More informationClinical Management of Infections Caused by Enterobacteriaceae that Express Extended- Spectrum β-lactamase and AmpC Enzymes
56 Clinical Management of Infections Caused by Enterobacteriaceae that Express Extended- Spectrum β-lactamase and AmpC Enzymes Patrick N. A. Harris, BSc, MBBS, MRCP, DTM&H, FRACP, FRCPA 1 1 Infection and
More information