Antibiotics and Adverse Events: Doctors, Do No Harm!
Length of Stay; Patient Safety; Internal Medicine; Clostridium Infections; Adverse Drug Event; Drug Toxicity; Pruritus; Medical Practice; Evidence-Based; Antibiotics – Therapeutic Use; Antibiotics – Administration and Dosage; Antibiotics – Adverse Effects; Clostridium Infections – Etiology; Hospitalization – Statistics and Numerical Data; Adverse Drug Event – Classification; Adverse Drug Event – Etiology; Adverse Drug Event – Risk Factors; Anaphylaxis – Risk Factors
A retrospective study found that among 1,488 hospitalized patients who received an antibiotic, 298 (20%) experienced at least one antibiotic-associated adverse drug event. Furthermore, 287 (19%) of the antibiotic regimens were not clinically indicated, and 56 (20%) of these were associated with an adverse drug event.
Watkins Richard R
Hospital Medicine Alert
2017
2017-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Clindamycin Improves Outcomes in Necrotizing Fasciitis due to Group A Streptococcus.
Debridement; Treatment Outcomes; Streptococcus; Clindamycin – Therapeutic Use; Fasciitis; Necrotizing – Drug Therapy; Necrotizing – Therapy
Despite aggressive surgical and medical therapy (i.e., debridement and potent intravenous antibiotics), necrotizing fasciitis (NF) remains a devastating infection with a mortality rate of 15-36%. Recent Infectious Diseases Society of America (IDSA) guidelines recommend using clindamycin in the treatment of NF, although strong scientific evidence is lacking. Therefore, Andreoni and colleagues aimed to determine whether clindamycin improves outcomes in NF by modulating virulence factors of clindamycin-susceptible and clindamycinresistant strains of invasive Group A Streptococcus (GAS) in vitro and using a mouse model. The investigators injected either a clindamycinsusceptible or a clindamycin-resistant GAS clinical isolate into the flanks of mice, and then treated them with either low-dose clindamycin, high-dose clindamycin, or saline. The mice were sacrificed on day 3 post-inoculation, and the size of the resulting skin lesions and their bacterial counts were measured. Also, biopsy material from a patient with NF of the arm who underwent multiple debridements (on days 0, 2, and 4) was prepared in the same fashion as the mouse tissue. This patient was treated with intravenous ceftriaxone 2 g daily and clindamycin 900 mg qid. Treatment with clindamycin in the mice that were infected with clindamycin-susceptible strains significantly reduced skin lesion sizes, but the bacterial burden was the same compared to the untreated animals. Interestingly, the animals infected with clindamycin-resistant strains who received clindamycin also had smaller skin lesions but reduced bacterial counts. When mice were injected with a clindamycin dose lower than the MIC of the infecting strain, the severity of the clinical manifestations was similar or slightly less compared to the untreated ones. In both the clindamycin-susceptible and clindamycin-resistant groups, GAS virulence factors DNase and SLO were inhibited by clindamycin. However, the in vitro model showed sub-inhibitory clindamycin concentrations caused upregulation of GAS virulence factors in both the clindamycin-susceptible and clindamycin-resistant GAS isolates. In the debrided tissue from the patient with NF, clindamycin concentration in the necrotic tissue was 10 times higher than the MIC of the infecting GAS strain. The bacterial load in the necrotic tissue was 106 CFU/g compared to 103 in the apparently adjacent healthy tissue. DNase activity was greater in the tissue with the higher bacterial counts and, by the second debridement (day 2), was undetectable.
Watkins Richard R
Hospital Medicine Alert
2017
2017-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Dual Antibiotic Therapy Is Not Routinely Necessary for Uncomplicated Cellulitis.
Emergency Service; Emergency Patients; Bacterial Toxins; Cellulitis; Cephalexin; Methicillin-Resistant Staphylococcus Aureus; Sulfamethoxazole
A randomized, multicenter, placebo-controlled clinical trial that enrolled patients presenting to emergency departments with uncomplicated cellulitis found the addition of trimethoprim-sulfamethoxazole to cephalexin did not lead to better outcomes.
Watkins Richard R
Hospital Medicine Alert
2017
2017-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Infective Endocarditis Trends and Outcomes.
Incidence; New York; California; Endocarditis; Methicillin-Resistant Staphylococcus Aureus; Staphylococcus Aureus; Bacterial – Epidemiology; Bacterial – Mortality; Bacterial – Diagnosis; Bacterial – Etiology; Bacterial – Trends
Watkins Richard R
Hospital Medicine Alert
2017
2017-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Restricting Fluoroquinolone Use Reduces CDI More Than Infection Control Methods.
England; Antiinfective Agents; Infection Control – Methods; Clostridium Infections – Drug Therapy; Fluoroquinolone – Therapeutic Use; Incidence – England
Watkins Richard R
Hospital Medicine Alert
2017
2017-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Growing Threat of Pyelonephritis Caused by Antibiotic-resistant Escherichia coli.
Antibiotics; Practice Guidelines; Escherichia Coli; Escherichia Coli Infections; Pyelonephritis; Urinary Tract Infections
Watkins Richard R
Hospital Medicine Alert
2016
2016-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Reported Beta-lactam Allergy Is Associated with More Adverse Events Among Inpatients.
Inpatients; Hypersensitivity; Adverse Drug Event; Centers for Disease Control and Prevention (U.S.); Adverse Health Care Event; Drug Reaction With Eosinophilia and System Symptoms Syndrome
Watkins Richard R
Hospital Medicine Alert
2016
2016-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Screening for C. difficile Carriers at Hospital Admission Reduces Subsequent CDI.
Watkins Richard R
Hospital Medicine Alert
2016
2016-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Steroids Increase the Risk for Community-acquired Staphylococcus aureus Bacteremia.
Steroids; Communities; Methicillin-Resistant Staphylococcus Aureus; Staphylococcus Aureus; Bacteremia; Steroids – Adverse Effects
Watkins Richard R
Hospital Medicine Alert
2016
2016-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Antibiotics for Intra-abdominal Infections: Less Is More.
Watkins Richard R
Hospital Medicine Alert
2015
2015-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Hospital wards with higher rates of antibiotic prescribing associated with increased risk for C. diff infection.
Adult; Aged; Age Factors; Drug Administration Schedule; Readmission; Cross Infection; 80 and Over; Antibiotics – Administration and Dosage; Clostridium Infections – Risk Factors
Watkins Richard R
Hospital Medicine Alert
2015
2015-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Using Procalcitonin to Differentiate Bacterial from Viral Meningitis.
C-Reactive Protein; Meningitis; Biological Markers – Blood; Bacterial – Diagnosis; Viral – Diagnosis; Calcitonin – Diagnostic Use; Cerebrospinal Fluid – Analysis
Watkins Richard R
Hospital Medicine Alert
2015
2015-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Increase in Sudden Death with ARBs or ACE Inhibitors and Co-trimoxazole.
Death; Hyperkalemia; Creatinine – Blood; Angiotensin II Type I Receptor Blockers – Adverse Effects; Angiotensin-Converting Enzyme Inhibitors – Adverse Effects; Potassium – Blood; Sudden – Risk Factors; Trimethoprim-Sulfamethoxazole Combination – Adverse Effects; Urinary Tract Infections – Drug Therapy
Watkins Richard R
Hospital Medicine Alert
2015
2015-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Early use of Daptomycin Compared to Vancomycin for MRSA Bacteremia.
Costs and Cost Analysis; Comparative Studies; Retrospective Design; Treatment Outcomes; Methicillin-Resistant Staphylococcus Aureus; Treatment Duration; Antibiotics – Therapeutic Use; Bacteremia – Drug Therapy; Vancomycin – Administration and Dosage; Daptomycin – Administration and Dosage
Watkins Richard R
Hospital Medicine Alert
2013
2013-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Early Surgery for Infective Endocarditis Decreases Risk of Embolization, Mortality.
Postoperative Complications; Hospital Mortality; Endocarditis; Bacterial – Mortality; Recurrence – Prevention and Control; Bacterial – Surgery; Embolism – Prevention and Control
Watkins Richard R
Hospital Medicine Alert
2012
2012-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Fidaxomicin after Vancomycin for Patients with Multiple C. difficile Recurrences.
Aged; Treatment Outcomes; Antibiotics – Therapeutic Use; Clostridium Infections – Drug Therapy; Vancomycin – Administration and Dosage; Recurrence – Prevention and Control
Watkins Richard R
Hospital Medicine Alert
2012
2012-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Should Cefazolin Be Preferred Treatment for Methicillinsusceptible S. aureus Bacteremia Instead of Nafcillin?
Staphylococcal Infections – Drug Therapy; Staphylococcus Aureus – Drug Effects; Bacteremia – Drug Therapy; Cefazolin – Therapeutic Use; Nafcillin – Therapeutic Use; Bacteremia – Microbiology; Methicillin-Resistant Staphylococcus Aureus – Drug Effects
Watkins Richard R
Hospital Medicine Alert
2012
2012
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Successful Decrease in Therapy Duration for Community-Acquired Pneumonia...including commentary by Watkins RR... this article originally appeared in the December 2012 issue of Infectious Disease Alert
Research; Program Development; Drug Resistance; Microbial; Readmission; Treatment Duration; United States Centers for Medicare and Medicaid Services; Antibiotics – Therapeutic Use; Clostridium Infections – Risk Factors; Community-Acquired Pneumonia – Drug Therapy; Community-Acquired Pneumonia – Complications; Patient Discharge – Evaluation
Watkins Richard R
Hospital Medicine Alert
2013
2013-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Upon Further Review: Femoral Venous Catheters Do Not Increase Risk of Catheter-Related Bloodstream Infection.
Femoral Vein; Jugular Veins; Subclavian Vein; Catheter-Related Bloodstream Infections – Etiology; Catheters – Adverse Effects; Sepsis – Etiology
Watkins Richard R
Hospital Medicine Alert
2013
2013-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).