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Open Access

Narrowing antibiotic spectrum of activity for trauma-associated pneumonia through the use of a disease-specific antibiogram

Michelle H Ting, John J Radosevich, Jordan A Weinberg, Michael D Nailor
DOI: 10.1136/tsaco-2020-000602 Published 3 June 2021
Michelle H Ting
1Department of Pharmacy Services, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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John J Radosevich
1Department of Pharmacy Services, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Jordan A Weinberg
2Department of Surgery, Creighton University School of Medicine Phoenix Regional Campus, Phoenix, Arizona, USA
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Michael D Nailor
1Department of Pharmacy Services, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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  • Figure 1
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    Figure 1

    Patient flow diagram.

  • Figure 2
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    Figure 2

    Antibiogram for all included patients. CFZ, cefazolin; CRO, ceftriaxone; FEP, cefepime; LVX, levofloxacin; MEM, meropenem; SAM, ampicillin/sulbactam; TZP, piperacillin/tazobactam.

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    Figure 3

    Antibiogram for only bronchoalveolar lavage (BAL) sampled patients. CFZ, cefazolin; CRO, ceftriaxone; FEP, cefepime; LVX, levofloxacin; MEM, meropenem; SAM, ampicillin/sulbactam; TZP, piperacillin/tazobactam.

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    Figure 4

    Antiobiogram for illicit drug users. CFZ, cefazolin; CRO, ceftriaxone; FEP, cefepime; LVX, levofloxacin; MEM, meropenem; SAM, ampicillin/sulbactam; TZP, piperacillin/tazobactam.

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    Figure 5

    Antibiogram days 6–7. CFZ, cefazolin; CRO, ceftriaxone; FEP, cefepime; LVX, levofloxacin; MEM, meropenem; SAM, ampicillin/sulbactam; TZP, piperacillin/tazobactam.

Tables

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  • Table 1

    Patient and injury characteristics

    Characteristic
    Age45 (32–61)
    Male111 (84.7%)
    Race
     White72 (55.0%)
     Black15 (11.5%)
     Asian3 (2.3%)
     American Indian/Alaskan Native6 (4.6%)
     Unknown35 (26.7%)
    Hispanic50 (38.2%)
    Comorbidities
     Diabetes27 (20.6%)
     COPD9 (6.9%)
     HD dependent1 (0.8%)
     CHF6 (4.6%)
     Active cancer4 (3.1%)
     HIV/AIDS0 (0%)
     Cirrhosis2 (1.5%)
     None of the above85 (64.9%)
     Unknown8 (6.1%)
    Smoking status
     Smoker59 (45.0%)
     Non-smoker47 (35.9%)
     Unknown25 (19.1%)
    ISS18 (14–30)
    Blunt vs. penetrating injury
     Blunt114 (87.0%)
     Penetrating17 (13.0%)
    Type of injury
     TBI91 (69.5%)
     Chest trauma70 (53.4%)
     Pelvic or long-bone fracture43 (32.8%)
     Abdominal organ trauma27 (20.6%)
     Spinal cord injury44 (33.6%)
    Type of pneumonia
     CAP29 (22.1%)
     HAP19 (14.5%)
     VAP83 (63.4%)
    Hospital day of pneumonia diagnosis4 (3,6)
    White cell count11.9 (0.44)
    Temperature38.4 (0.07)
    Prophylactic antibiotics before cultures drawn
     Any67 (51.1%)
     Gentamicin5 (3.8%)
     Cefazolin33 (25.2%)
     Cefuroxime37 (28.2%)
     Cefoxitin6 (4.6%)
     Other2 (1.5%)
    Treatment antibiotics before cultures drawn
     Any23 (17.6%)
     Ceftriaxone5 (3.8%)
     Piperacillin/tazobactam10 (7.6%)
     Vancomycin7 (5.3%)
     Other2 (1.5%)
    • Results are presented as n (%), mean (SD), or median (IQR) as appropriate.

    • CAP, community-acquired pneumonia; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; HAP, hospital-acquired pneumonia; HD, hemodialysis; ISS, Injury Severity Score; TBI, traumatic brain injury; VAP, ventilator-associated pneumonia.;

  • Table 2

    Characteristics of respiratory samples

    Characteristicn (%)
    Respiratory sample
     Sputum24 (18.3)
     BAL101 (77.1)
     Endotracheal6 (4.6)
    Culture positive109 (83.2)
    Organism type
     Gram positive66 (46.1)
     Gram negative77 (53.8)
    Gram-positive organisms
     MSSA34 (23.8)
     MRSA12 (8.4)
     Streptococcus pneumoniae11 (7.7)
     S. agalactiae3 (2.1)
     S. pyogenes3 (2.1)
     Other2 (1.4)
    Gram-negative organisms
     Haemophilus influenzae21 (14.7)
     Klebsiella pneumoniae20 (13.9)
     Escherichia coli10 (7.0)
     Enterobacter sp8 (5.6)
     Pseudomonas aeruginosa7 (4.9)
     Moraxella catarrhalis3 (2.1)
     Other7 (4.9)
    • BAL, bronchoalveolar lavage; ; MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-sensitive Staphylococcus aureus.

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Narrowing antibiotic spectrum of activity for trauma-associated pneumonia through the use of a disease-specific antibiogram
Michelle H Ting, John J Radosevich, Jordan A Weinberg, Michael D Nailor
Trauma Surg Acute Care Open Jun 2021, 6 (1) e000602; DOI: 10.1136/tsaco-2020-000602

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Narrowing antibiotic spectrum of activity for trauma-associated pneumonia through the use of a disease-specific antibiogram
Michelle H Ting, John J Radosevich, Jordan A Weinberg, Michael D Nailor
Trauma Surg Acute Care Open Jun 2021, 6 (1) e000602; DOI: 10.1136/tsaco-2020-000602
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Narrowing antibiotic spectrum of activity for trauma-associated pneumonia through the use of a disease-specific antibiogram
Michelle H Ting, John J Radosevich, Jordan A Weinberg, Michael D Nailor
Trauma Surgery & Acute Care Open Jun 2021, 6 (1) e000602; DOI: 10.1136/tsaco-2020-000602
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