Gram-Negative Infections in the Hospital Setting
In this CME offering, Dr. Trevor Van Schooneveld uses clinical trial results, his personal knowledge, and his passion for Antimicrobial Stewardship as he explains how we can better treat in-hospital gram-negative infections.
Dr. Schooneveld, Associate Professor of Infectious Disease as well as the Medical Director of the Antimicrobial Stewardship Program at the University of Nebraska Medical Center acknowledged that antibiotic misuse frequently makes the news. Due to media exposure, patients regularly express concern regarding their use in treating infections. As clinicians, it is important to understand not only the best choice now, but also to consider the possible future implications of current treatment options.
Dr. Schooneveld reminds us that antibiotics are unique among medications and that “we must change how we view and use them.” Considering the different drug classifications, “antibiotics are the only drugs that lose efficacy over time, are the only drugs that need to be used sparingly to prolong their efficacy, [and] are the only drugs that we actively discourage the use of when new drugs are approved.”
Use Begets Resistance
A study of 523 ICU patients screened weekly for imipenem-resistant Gram-negatives determined that the primary risk factor for complications was the receipt of imipenem. Inappropriate use leads to resistance, collateral damage (C. difficile, etc.), toxicity, and increased costs. Dr. Shooneveld stresses the importance of using the right medication or combination of medications to treat each patient individually.
This refers to the process designed to optimize the use of antimicrobials: guiding clinicians in determining when antibiotics are needed, what agent to use, and the right dose route and duration. Also, it reminds clinicians to focus on patient and public heath with goals to cure or prevent infection, minimize toxicity and resistance, and reduce treatment costs.
Dr. Schooneveld gives multiple examples of comparisons between medication options and combination therapies and their outcomes in terms of patient mortality, toxicity (impaired renal function), susceptibility, and medication costs.
Dr. Schoovenveld introduces us to a case study and references the patient throughout the lecture. One thing that we learn from “Evan” is that in most cases of sepsis, multiple antimicrobials are ordered for a patient as soon as the C&S has been determined. Evidence shows that “each hour without active antibiotics in septic shock increases mortality by 7.6%.” and that combination therapies are advocated as a strategy to improve early active therapy. There are caveats, though, and Dr. Schoovenveld explores these during his presentation.
New antimicrobials are not coming to market as rapidly as other classes of medications, but Avycaz and Zerbaxa are now available to combat infectious diseases. Both are combination drugs that Dr. Schoovenveld considers appropriate choices for certain infections. He reviews clinical studies for each medication, and compares indications, dosing, activity, and price per day, among other categories.
Proper, diligent use of the appropriate antimicrobial is the “corner stone” on which successful treatment and positive outcomes are built, according to Dr. Schoovenveld. To see the full presentation and obtain CME credits, please view “Gram-Negative Infections in the Hospital Setting: Outwitting an Old Enemy” presented by IDCARELIVE.
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