Abstract:
Background:Delayed pathogen identification and nonspecific clinical findings make definitive decisions regarding antibiotics challenging. The stimuli of bacterial toxins and inflammation make procalcitonin (PCT) unique in its ability to differentiate bacterial infection from other causes of inflammation, and thus it is useful for antibiotic management. The objective of our study was to evaluate the impact of a PCT algorithm (PCT-A) on current practice. Methods:A single-center, retrospective cohort study was conducted to evaluate the impact of adding PCT-A to stewardship practices. Data from 4 years prior to and after PCT-A implementation were compared in critical and acute care patients of all ages receiving parenteral antibiotics for a DRG coded for infection. A baseline PCT was obtained on admission in patients with suspected bacterial infection. Serial PCT measurements were repeated daily to evaluate effectiveness of therapy. Outcomes of interest were antibiotic exposure, hospital mortality, 30-day readmission, Clostridium difficile infection (CDI), and adverse drug events during hospitalization. Results:A total of 985 patients (pre-PCT-A group) were compared with 1167 patients (post-PCT-A group). Antimicrobial stewardship alone (pre-PCT-A) resulted in a median days of therapy (DOT) of 17 (interquartile range [IQR], 8.5-22.5) vs 9.0 (IQR, 6.5-12) in the post-PCT-A group (P < .0001). Secondary outcomes were also significantly reduced in the post-PCT-A group. Conclusion:The addition of PCT in a facility with an established stewardship program resulted in a significant reduction in antibiotic exposure and adverse outcomes. PCT may improve antibiotic management when diagnostic clarity and resolution of infection are lacking.
journal_name
Open Forum Infect Disjournal_title
Open forum infectious diseasesauthors
Broyles MRdoi
10.1093/ofid/ofx213subject
Has Abstractpub_date
2017-10-03 00:00:00pages
ofx213issue
4issn
2328-8957pii
ofx213journal_volume
4pub_type
杂志文章abstract:Background:To determine the effectiveness of implementing a locally developed clinical practice guideline (CPG) for antibiotic treatment in adults with community-acquired cellulitis at Siriraj Hospital in Bangkok, Thailand. Methods:The CPG for antibiotic treatment of community-acquired cellulitis was developed based o...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofaa411
更新日期:2020-09-07 00:00:00
abstract::A 7-year-old child of Turkish origin presented with headache and vomiting in the context of prolonged fever of unknown source. At examination, oral candidiasis and chronic onychomycosis were noted. A Candida meningoencephalitis was diagnosed and intravenous Amphotericin B liposomal was given during 6 months relayed by...
journal_title:Open forum infectious diseases
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abstract::Skin and soft tissue infections (SSTI) affect millions of people globally, which represents a significant burden on ambulatory care and hospital settings. The role of sulfamethoxazole-trimethoprim (SXT) in SSTI treatment, particularly when group A Streptococcus (GAS) is involved, is controversial. We conducted a syste...
journal_title:Open forum infectious diseases
pub_type: 杂志文章,评审
doi:10.1093/ofid/ofx232
更新日期:2017-11-02 00:00:00
abstract:Background:Hematogenous dissemination of Talaromyces marneffei can result in multiorgan involvement (skin, lung, and reticuloendothelial system involvement); however, few studies have reported intestinal T marneffei infections. We investigated clinical features, management, and patient outcomes concerning Talaromyces-r...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofaa128
更新日期:2020-04-27 00:00:00
abstract::Francisella tularensis has a low infectious dose and can infect laboratory staff handling clinical specimens. The risk to health care providers exposed during patient care is poorly defined. We describe 9 examples of health care providers who did not develop tularemia after significant exposures to infected patients. ...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
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更新日期:2019-11-19 00:00:00
abstract::Despite the widespread outbreak, few cases of Zika virus associated with cardiac manifestations have been described. We present a case of pericarditis in the setting of an acute, symptomatic Zika virus infection in a traveler returning from St. Thomas. Clinicians should be alert for this potential complication of Zika...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofx103
更新日期:2017-05-18 00:00:00
abstract:Background:Patients heterozygous for mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene may be more susceptible to respiratory infections than the general population. Methods :We conducted a retrospective case-control study using health insurance claims. We identified patients as either h...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofy219
更新日期:2018-11-01 00:00:00
abstract::Naegleria fowleri is a thermophilic free-living amoeba that is found in warm, fresh water and causes primary amebic meningoencephalitis (PAM). The following report demonstrates the rapid and destructive clinical features of PAM in an 8-year-old male who presented with severe headaches approximately 12 days after swimm...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
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更新日期:2019-07-29 00:00:00
abstract:Background:Dengue and Chikungunya viruses can cause large-scale epidemics, with attack rates of up to 80%. In Tanzania, there have been repeated outbreaks of dengue fever, the most recent in 2018 and 2019, mostly affecting the coastal areas. Despite the importance of these viruses, there is limited knowledge on the epi...
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pub_type: 杂志文章
doi:10.1093/ofid/ofaa626
更新日期:2020-12-26 00:00:00
abstract:BACKGROUND:The incidence of recurrent herpes zoster (HZ) and the relationship between initial and recurrent HZ are not clear. METHODS:The Miyazaki Dermatologist Society has surveyed ~5000 patients with HZ annually since 1997. A questionnaire regarding HZ and its recurrence was completed by the dermatologists. RESULTS...
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pub_type: 杂志文章
doi:10.1093/ofid/ofx007
更新日期:2017-01-28 00:00:00
abstract:Background:Recent observations provide evidence for group-specific immunity toward influenza A infections and raise the question of how often we can get the flu. Methods:We retrospectively analyzed 2308 cases of children and adolescents with clinically manifested influenza and a positive PCR-test during the last 4 epi...
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pub_type: 杂志文章
doi:10.1093/ofid/ofz195
更新日期:2019-04-23 00:00:00
abstract::Lyme disease accounted for more than two-thirds (56 of 81, 69.1%) of all tick-borne disease referrals to a large, academic infectious diseases clinic in a low-incidence state. Deviations from diagnostic testing guidelines and errors in test interpretation were common (23 of 35, 65.7%), suggesting that frontline provid...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofaa009
更新日期:2020-01-11 00:00:00
abstract::We engaged medical students with antimicrobial stewardship (AS) and antimicrobial resistance (AMR) through patient stories and a panel on AMR advocacy with experts from the Centers for Disease Control and Prevention and the Infectious Diseases Society of America. Students were surveyed on their perceptions about AS an...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofz487
更新日期:2019-11-13 00:00:00
abstract::Cryptococcus gattii infections, especially including those with severe clinical manifestations, may be related to underlying host immunologic factors. We present 2 cases with autoantibodies to granulocyte-macrophage colony-stimulating factor (GM-CSF), a key cytokine in macrophage function. Immunologic evaluation for a...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofx211
更新日期:2017-10-05 00:00:00
abstract:BACKGROUND:Our objective was to study the prognostic value of liver stiffness (LS) in HIV-infected patients with chronic hepatitis C (CHC). METHODS:We analyzed HIV-infected patients with compensated CHC and at least 1 determination of LS. The primary outcome was the occurrence of liver-related events (LRE), namely, de...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofw212
更新日期:2016-10-03 00:00:00
abstract::Persistent viral activity may cause enduring seropositivity and inflammation in treated people with HIV (PWH). We compared inflammatory biomarkers between early treated PWH who remained seronegative or seroconverted and found similar levels of D-dimer, soluble cluster of differentiation 14, C-reactive protein, and int...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofaa383
更新日期:2020-08-26 00:00:00
abstract:BACKGROUND:Infection causes 1 of every 5 neonatal deaths globally. Group B Streptococcus (GBS) is the most significant pathogen, although little is known about its epidemiology and risk in low-income countries. METHODS:A cross-sectional study in 2015 at a public hospital in Guatemala City enrolled women ≥35 weeks' ges...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofx020
更新日期:2017-02-08 00:00:00
abstract:Background:Hepatitis C remains a major cause of liver disease globally and is responsible for approximately 500 000 deaths annually. Newer direct-acting antivirals achieve cure rates at or above 90% with excellent tolerability for most patients. The literature focusing on identification of predictors of efficacy and sa...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofz087
更新日期:2019-02-19 00:00:00
abstract::Immune suppression is a recognized risk factor for necrotizing fasciitis. In patients with hematological malignancies, a profoundly immunocompromised group, the predominant causative organisms are Gram negative. Clinical presentation and outcomes in these patients are similar to the immunocompetent. The Laboratory Ris...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofv081
更新日期:2015-06-12 00:00:00
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pub_type: 杂志文章
doi:10.1093/ofid/ofw242
更新日期:2016-12-27 00:00:00
abstract:BACKGROUND:Amphotericin B is the preferred treatment for cryptococcal meningitis, but it has cumulative severe side effects, including nephrotoxicity, hypokalemia, and hypomagnesemia. Amphotericin-induced severe hypokalemia may predispose the patient to cardiac arrhythmias and death, and there is very little data avail...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofu070
更新日期:2014-08-25 00:00:00
abstract::Chronic pulmonary histoplasmosis (CPH) is an uncommon manifestation of Histoplasma infection with features similar to pulmonary tuberculosis (TB). In endemic areas, it may be misdiagnosed as smear-negative pulmonary TB. Historical case series mainly from patients with presumed TB described a high frequency of cavitati...
journal_title:Open forum infectious diseases
pub_type: 杂志文章,评审
doi:10.1093/ofid/ofaa119
更新日期:2020-04-06 00:00:00
abstract:Background:Staphylococcus aureus (SA) bacteremia often requires a long treatment duration with antibiotics to prevent relapse due to the ability of SA to establish reservoirs of infection in sites such as heart and bone. These metastatic sites of infection cannot be serially sampled to monitor the clearance of SA infec...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofz090
更新日期:2019-02-26 00:00:00
abstract:BACKGROUND:Avian influenza A/H5N1 has threatened human health for nearly 2 decades. Avian influenza A vaccine without adjuvant is poorly immunogenic. A flexible rapid tactic for mass vaccination will be needed if a pandemic occurs. METHODS:A multicenter, randomized, blinded phase 1 clinical trial evaluated safety and ...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofu102
更新日期:2014-11-18 00:00:00
abstract::Background. Varicella is a highly contagious vaccine-preventable illness. In 1996, the Advisory Committee for Immunization Practices recommended 1 dose of vaccine for children, and in 2006 it recommended 2 doses; Connecticut required 1 dose for school entry in 2000 and 2 doses for school entry starting in 2011. Conne...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofv150
更新日期:2015-10-09 00:00:00
abstract:Background:We recently reported that the levels of activation, exhaustion, and terminal differentiation within the peripheral T-cell compartment were increased in men who have sex with men (MSM) compared with blood bank donors. During activation and differentiation, T cells undergo metabolic changes to maintain their e...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofaa284
更新日期:2020-07-05 00:00:00
abstract:BACKGROUND:Despite the recognized benefit of antiretroviral therapy (ART) for preventing and treating HIV, some studies have reported adverse birth outcomes with in utero ART exposure. We evaluated the effect of infant in utero HIV and ART exposure on preterm delivery (PTD), low birth weight (LBW), small for gestationa...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofx187
更新日期:2017-08-30 00:00:00
abstract:Background:Whether antibiotic treatment of asymptomatic bacteriuria (AB) can prevent acute graft pyelonephritis (AGP) in kidney transplant (KT) recipients has not been elucidated. Methods:In this multicenter, open-label, nonblinded, prospective, noninferiority, randomized controlled trial, we compared antibiotic treat...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofz243
更新日期:2019-05-21 00:00:00
abstract:Background:Maintaining retention in preexposure prophylaxis (PrEP) care among diverse patient populations will be needed to support PrEP's efficacy. We characterized patterns of PrEP care retention in a US municipal primary care health network and examined whether missed visits, a metric of care retention that is easy ...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofz101
更新日期:2019-02-26 00:00:00
abstract::This study evaluated health outcomes among people who inject drugs who are infected with hepatitis C virus using an artificial intelligence platform. Mean (SD) cumulative adherence (visual confirmation of administration) was 91.3% (10.5%). Most subjects (88.2%) achieved ≥80% adherence to treatment, and 88.2% (15 of 17...
journal_title:Open forum infectious diseases
pub_type: 杂志文章
doi:10.1093/ofid/ofaa290
更新日期:2020-07-20 00:00:00