the right choicepictures.intensive.org/36isicem/2135729619_20425.pdf · the initial right choice of...
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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
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
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
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
KLINISCHE MIKROBIOLOGIE UND
KRANKENHAUSHYGIENE
KLINIKUM DER UNIVERSITÄT MÜNCHEN®
24.03.2016
B. Grabein
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
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
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
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
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
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
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
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
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
KLINIKUM DER UNIVERSITÄT MÜNCHEN®
KLINISCHE MIKROBIOLOGIE UND
KRANKENHAUSHYGIENE
VIELEN DANK FÜR IHRE AUFMERKSAMKEIT!
24.03.2016
KLINISCHE MIKROBIOLOGIE UND
KRANKENHAUSHYGIENE
KLINIKUM DER UNIVERSITÄT MÜNCHEN®
24.03.2016
B. Grabein