Cronobacter Support
03-20-2009, 01:30 PM
Follow-up
Inpatient & Outpatient Medications
Enterobacter infections that are improving may warrant switch to an oral medication such as a quinolone or TMP-SMZ in accordance with sensitivity testing, when feasible. Ciprofloxacin (500-750 mg PO q12h) is an acceptable alternative in patients who are able to tolerate oral medication as long as they are not coadministered products that contain divalent cations (calcium or dairy products, iron, magnesium, zinc). No documentation exists for managing endocarditis with oral medications.
Some patients with Enterobacter infections may require longer therapy with intravenous antibiotics. In those who meet criteria for home antibiotic therapy, the selected intravenous medication should not usually require more than 3-times-daily infusion. Ertapenem and tigecycline may be considered for such patients in conjunction with infectious disease specialists and home infusion therapy experts.
Deterrence/Prevention
When hospital (ICU) outbreaks of Enterobacter infections occur, isolation and barrier protection should be implemented. Isolation precautions should also be implemented when a multidrug-resistant organism is isolated.
Hand washing or use of alcohol or other disinfecting hand gels by health care workers between contacts with patients prevents transmission of these and other nosocomial bacteria. This is particularly true in ICUs.
Prior antibiotic administration is a major factor for colonization and secondary infections with these multiple-antibiotic–resistant organisms. Clinicians are advised to avoid unnecessary administration of antimicrobial agents or to avoid unnecessary prolonged administration. For surgical prophylaxis, administration of antibiotics for longer than 24 hours is rarely justifiable.
Education programs for physicians and hospital personnel regarding risk reduction for transmission of Enterobacter species and other nosocomial pathogens should be implemented in every hospital. This is usually the responsibility of the infection-control team.
Comprehensive guidelines regarding isolation for and prevention of nosocomial infections and management of infections by multidrug-resistant organisms (eg, ESBL-producing Enterobacter species) in health care settings are available at the Centers for Disease Control Web site (Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007; Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006).
Prognosis
See Mortality/Morbidity.
Miscellaneous
Medicolegal Pitfalls
Failure to select appropriate antibiotics for treatment is a significant problem with potential legal implications. Selecting agents based only on susceptibility testing reports could be dangerous because rapid resistance could develop during therapy. Consultation with an infectious diseases specialist can be of tremendous help in determining appropriate antibiotic treatment.
Special Concerns
Bacterial resistance to antibiotics continues to be a significant threat. Many strains of Enterobacter species are already resistant to many antibiotics. The presence of inducible resistance genes on plasmids in other members of the Enterobacteriaceae family is concerning for the possibility of transfer of genes between bacteria, resulting in the development of further resistance in Enterobacter species.
Good antibiotic prescription, good monitoring of bacterial resistance, and good infection-control practices are among the most important measures that should be in place in each hospital. Laboratory microbiologists, infectious diseases clinicians, pharmacists, hospital epidemiologists, and hospital administrators can assist in reducing the rates of nosocomial infections.
Continued post from emedicine.medscape.com/article/216845-followup
Inpatient & Outpatient Medications
Enterobacter infections that are improving may warrant switch to an oral medication such as a quinolone or TMP-SMZ in accordance with sensitivity testing, when feasible. Ciprofloxacin (500-750 mg PO q12h) is an acceptable alternative in patients who are able to tolerate oral medication as long as they are not coadministered products that contain divalent cations (calcium or dairy products, iron, magnesium, zinc). No documentation exists for managing endocarditis with oral medications.
Some patients with Enterobacter infections may require longer therapy with intravenous antibiotics. In those who meet criteria for home antibiotic therapy, the selected intravenous medication should not usually require more than 3-times-daily infusion. Ertapenem and tigecycline may be considered for such patients in conjunction with infectious disease specialists and home infusion therapy experts.
Deterrence/Prevention
When hospital (ICU) outbreaks of Enterobacter infections occur, isolation and barrier protection should be implemented. Isolation precautions should also be implemented when a multidrug-resistant organism is isolated.
Hand washing or use of alcohol or other disinfecting hand gels by health care workers between contacts with patients prevents transmission of these and other nosocomial bacteria. This is particularly true in ICUs.
Prior antibiotic administration is a major factor for colonization and secondary infections with these multiple-antibiotic–resistant organisms. Clinicians are advised to avoid unnecessary administration of antimicrobial agents or to avoid unnecessary prolonged administration. For surgical prophylaxis, administration of antibiotics for longer than 24 hours is rarely justifiable.
Education programs for physicians and hospital personnel regarding risk reduction for transmission of Enterobacter species and other nosocomial pathogens should be implemented in every hospital. This is usually the responsibility of the infection-control team.
Comprehensive guidelines regarding isolation for and prevention of nosocomial infections and management of infections by multidrug-resistant organisms (eg, ESBL-producing Enterobacter species) in health care settings are available at the Centers for Disease Control Web site (Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007; Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006).
Prognosis
See Mortality/Morbidity.
Miscellaneous
Medicolegal Pitfalls
Failure to select appropriate antibiotics for treatment is a significant problem with potential legal implications. Selecting agents based only on susceptibility testing reports could be dangerous because rapid resistance could develop during therapy. Consultation with an infectious diseases specialist can be of tremendous help in determining appropriate antibiotic treatment.
Special Concerns
Bacterial resistance to antibiotics continues to be a significant threat. Many strains of Enterobacter species are already resistant to many antibiotics. The presence of inducible resistance genes on plasmids in other members of the Enterobacteriaceae family is concerning for the possibility of transfer of genes between bacteria, resulting in the development of further resistance in Enterobacter species.
Good antibiotic prescription, good monitoring of bacterial resistance, and good infection-control practices are among the most important measures that should be in place in each hospital. Laboratory microbiologists, infectious diseases clinicians, pharmacists, hospital epidemiologists, and hospital administrators can assist in reducing the rates of nosocomial infections.
Continued post from emedicine.medscape.com/article/216845-followup