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CAMPUS GROSSHADERN CAMPUS INNENSTADT KLINISCHE MIKROBIOLOGIE UND KRANKENHAUSHYGIENE THE RIGHT CHOICE Dr. Béatrice Grabein Department Clinical Microbiology and Infection Prevention University Hospital Munich 24.03.2016

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Page 1: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

CAMPUS GROSSHADERN

CAMPUS INNENSTADT

KLINISCHE MIKROBIOLOGIE UND KRANKENHAUSHYGIENE

THE RIGHT CHOICE

Dr. Béatrice Grabein

Department Clinical Microbiology and Infection Prevention

University Hospital Munich

24.03.2016

Page 2: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

INADEQUATE ANTIMICROBIAL THERAPY ASSOCIATED WITH INCREASED MORTALITY

0

20

40

60

Ibrahim1 (n=492)

Alvarez-Lerma2 (n=430)

Rello3 (n=113)

Mo

rta

lity

(%

)

Adequate therapy Inadequate therapy

Bloodstream infections NP/VAP

1. Ibrahim EH et al. Chest. 2000;118:146-155. 2. Alvarez-Lerma F et al. Intensive Care Med. 1996;22:387-394. 3. Rello J et al. Am J Respir Crit Care Med. 1997;156:196-200.

11.9

29.9

16.2

24.7

15.6

37.0

Page 3: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

IS CHOOSING AN „OMNISPECTRUM“ THERAPY THE IDEAL SOLUTION?

24.03.2016

B. Grabein

Balance the need to get it right against need not to cause further resistance

Page 4: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

GLOBAL ANTIBIOTIC USE 2000-2010

2010 highest use in India (10,7 units per person

(u/P)), followed by China (7,5 u/P) and the USA (22,0 u/P)

24.03.2016

B. Grabein

Van Boeckel TP et al., Lancet Inf Dis, 2014, 14:742-50

Page 5: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

24.03.2016

B. Grabein

Page 6: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

HOW TO CHOOSE THE RIGHT ANTIBIOTIC(S) – IMPORTANT QUESTIONS TO ANSWER

What kind of infection do you have to treat?

Which pathogens do you expect?

Do you get to the point with the chosen antibiotic(s)?

How is your local epidemiology – in your hospital/on

your ward?

Are there risk factors for multiresistant organisms?

Do you have to consider allergies or organ

dysfunctions?

Have you taken enough specimens for the micobiology

lab?

24.03.2016

Page 7: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

HOW TO CHOOSE THE RIGHT ANTIBIOTIC(S) – IMPORTANT QUESTIONS TO ANSWER

What kind of infection do you have to treat?

Which microorganisms do you expect?

Do you get to the point with the chosen antibiotic(s)?

How is your local epidemiology – in your hospital/on

your ward?

Are there risk factors for multiresistant organisms?

Do you have to consider allergies or organ

dysfunctions?

Have you taken enough specimens for the micobiology

lab?

24.03.2016

Page 8: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

INFECTION AND PATHOGENS – EXAMPLES (GERMANY)

CAP – mostly S.pneumoniae, H. influenzae, Legionella, very rarely

P.aeruginosa or other MDR Gramnegatives

VAP – from MSSA to MRSA, from wild type E. coli to

MDR P. aeruginosa or A. baumannii

Sepsis – depending on the focus!

Peritonitis – polymicrobial, dependent on the gut flora of the patient

and whether community or nosocomially acquired...

Endocarditis – mostly Streptococci, Enterococci, Staphylococci,

others are very rare

...

24.03.2016

B. Grabein

Page 9: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

HOW TO CHOOSE THE RIGHT ANTIBIOTIC(S) – IMPORTANT QUESTIONS TO ANSWER

What kind of infection do you have to treat?

Which microorganisms do you expect?

Do you get to the point with the chosen antibiotic(s)?

How is your local epidemiology – in your hospital/on

your ward?

Are there risk factors for multiresistant organisms?

Do you have to consider allergies or organ

dysfunctions?

Have you taken enough specimens for the micobiology

lab?

24.03.2016

Page 10: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

LOCAL EPIDEMIOLOGY COUNTS!

Microorganism Antibiotic %R ICU 1 %R ICU 2

S.aureus Methicillin 4,3 22,6

E. coli Cefotaxim 6,5 12,8

Ciprofloxacin 9,6 29,5

K. pneumoniae Cefotaxim 5,3 16,4

Meropenem 0,0 0,2

P.aeruginosa Pip/Tazo 15,3 18,4

Ceftazidim 6,3 15,6

Meropenem 5,4 15,7

Ciprofloxacin 7,8 22,5

24.03.2016

B. Grabein

unpublished data

Page 11: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

HOW TO CHOOSE THE RIGHT ANTIBIOTIC(S) – IMPORTANT QUESTIONS TO ANSWER

What kind of infection do you have to treat?

Which microorganisms do you expect?

Do you get to the point with the chosen antibiotic(s)?

How is your local epidemiology – in your hospital/on

your ward?

Are there risk factors for multiresistant organisms?

Do you have to consider allergies or organ

dysfunctions?

Have you taken enough specimens for the micobiology

lab?

24.03.2016

Page 12: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

RISK FACTORS FOR MULTIRESISTANT ORGANISMS

Exposure to antibiotics

Recent hospitalisation

Indwelling devices

Chronic wounds

(Nursing home)

(Travelling)

24.03.2016

B. Grabein

Miller BM et al.: Am J Inf Contr 2016;44:134-37; Lowe CF et al.: ICHE 2013;34:49-55; Shorr AF et al.: CID 2012;54:183-98; Drinka P et al.: J Am Med Dir Assoc 2011;12:321-25

Page 13: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

HOW TO CHOOSE THE RIGHT ANTIBIOTIC(S) – IMPORTANT QUESTIONS TO ANSWER

What kind of infection do you have to treat?

Which microorganisms do you expect?

Do you get to the point with the chosen antibiotic(s)?

How is your local epidemiology – in your hospital/on

your ward?

Are there risk factors for multiresistant organisms?

Do you have to consider allergies or organ

dysfunctions?

Have you taken enough specimens for the micobiology

lab?

24.03.2016

Page 14: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

CONCLUSIONS

The initial right choice of the antibiotic therapy is

important for the success of the therapy

To choose wisely you have to look at the type and

severity of infection, the likely pathogens, the local

epidemiology and risk factors for resistant

organisms

It is not an easy task!

24.03.2016

B. Grabein

Page 15: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

VIELEN DANK FÜR IHRE AUFMERKSAMKEIT!

24.03.2016

Page 16: THE RIGHT CHOICEpictures.intensive.org/36ISICEM/2135729619_20425.pdf · The initial right choice of the antibiotic therapy is important for the success of the therapy To choose wisely

KLINISCHE MIKROBIOLOGIE UND

KRANKENHAUSHYGIENE

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

24.03.2016

B. Grabein