THE RIGHT CHOICE. Dr. Béatrice Grabein Department Clinical Microbiology and Infection Prevention University Hospital Munich

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1 CAMPUS GROSSHADERN CAMPUS INNENSTADT THE RIGHT CHOICE Dr. Béatrice Grabein Department Clinical Microbiology and Infection Prevention University Hospital Munich

2 Mortality (%) INADEQUATE ANTIMICROBIAL THERAPY ASSOCIATED WITH INCREASED MORTALITY 60 Adequate therapy Inadequate therapy Ibrahim 1 (n=492) Alvarez-Lerma 2 (n=430) Rello 3 (n=113) Bloodstream infections 1. Ibrahim EH et al. Chest. 2000;118: Alvarez-Lerma F et al. Intensive Care Med. 1996;22: Rello J et al. Am J Respir Crit Care Med. 1997;156: NP/VAP

3 B. Grabein IS CHOOSING AN OMNISPECTRUM THERAPY THE IDEAL SOLUTION? Balance the need to get it right against need not to cause further resistance

4 B. Grabein GLOBAL ANTIBIOTIC USE 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) Van Boeckel TP et al., Lancet Inf Dis, 2014, 14:742-50

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6 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?

7 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?

8 B. Grabein 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...

9 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?

10 B. Grabein 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 unpublished data

11 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?

12 B. Grabein RISK FACTORS FOR MULTIRESISTANT ORGANISMS Exposure to antibiotics Recent hospitalisation Indwelling devices Chronic wounds (Nursing home) (Travelling) 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

13 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?

14 B. Grabein 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!

15 VIELEN DANK FÜR IHRE AUFMERKSAMKEIT!

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