Inappropriate antibiotic use for a child with a viral respiratory infection is not a “one and done” error. Children who receive antibiotics when diagnosed with a viral respiratory infection are more likely to seek care for viral infections subsequently and to receive inappropriate antibiotics again.
A retrospective cohort study from a single California hospital found the administration of probiotics to patients receiving antibiotics did not reduce the incidence of healthcare facility-onset Clostridioides difficile infection.
When the Severe Sepsis and Septic Shock Early Management Bundle was used to identify patients with severe sepsis or patients in septic shock, delays in lactate measurements for patients with abnormal lactate levels were associated with delayed initiation of antibiotic therapy and increased mortality.
Investigators evaluated 135 patients with Staphylococcus aureus bacteremia (SAB) in a prospective cohort study comparing early switch to oral linezolid to continued treatment with standard parenteral therapy (SPT). Patients with complicated SAB and osteoarticular infection were excluded. Early switch to oral therapy yielded similar outcomes to continued SPT and allowed earlier hospital discharge.
Researchers compared outcomes in patients with aspiration pneumonitis who received prophylactic antibiotics during the first two days after macro-aspiration to patients who received only supportive care during this time. Among the 200 patients meeting the acute aspiration pneumonitis case definition, antimicrobial prophylaxis was not associated with improvement in mortality. However, patients receiving prophylactic antibiotics required more frequent escalation of antibiotics and received more days of antibiotics than those who were managed initially with supportive care alone.
The authors of a before-and-after intervention study and a meta-analysis found that probiotics reduce the incidence of Clostridium difficile infection (CDI). The strategy seems to work best in hospital settings where the incidence of CDI is ≥ 5% and for patients receiving two or more antibiotics.
The Infectious Diseases Society of America withheld its support for the Surviving Sepsis guidelines. The general concerns included vagueness and inconsistency in definition of sepsis, “one size fits all” prescription of time to administer antibiotics, lack of clarity around drawing blood cultures through IV catheters, recommendation of combination antibiotics, lack of definition around when to use procalcitonin levels, when and how to use pharmacokinetic and pharmacodynamic data effectively, prolonged antibiotic “prophylaxis,” and duration of therapy.