Big coffee around the stove, discuss the diagnosis and treatment of ESBLs and antibiotic selection!

For medical professionals only

ESBLs diagnosis and treatment and antibiotic selection can be seen in these.

How to effectively diagnose and rationally treat ESBLs in the early stage of infection, while improving patient prognosis, has become an urgent problem

ESBLs, the silent "killer" in the multidrug-resistant Enterobacteriaceae family

Evidence-based data, prevention strategies

Professor Zheng Bo of the First Hospital of Peking University first reviewed the current situation

Professor Zhang Suiyang of the Rocket Force Special Medical Center of the Chinese People's Liberation Army focused on the diagnosis and precise stratification optimization treatment of ESBLs, as well as the types, types and epidemiological characteristics

Finally, Professor Zhang Suiyang explained how to stratify and treat antibiotics according to the severity of the

In the following panel discussion, Professor Meng Fanliang of Chaohu Hospital affiliated to Anhui Medical University, Professor Zhang Yindi of Dehongzhou People's Hospital, and Professor Zheng Bin of Xiangcheng County People's Hospital all said that clinicians need to pay enough attention to common ESBLs resistant strains, and the treatment of infections caused by ESBL strains is more complicated, and it is necessary to reasonably choose treatment plans for different individual situations

Figure ESBLs dedicated section 1 discussion session

Rational use of drugs, focus on actual combat

Professor Kong Xudong of China-Japan Friendship Hospital introduced the characteristics
of common negative antibacterial drugs.

Among them, Enterobacteriaceae bacteria are the most common, mainly including Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis
.

β-lactams may be preferred for these bacteria, particularly in patients with severe infections
.

β-lactams are suitable for infections in all areas and have a broad
antimicrobial spectrum.

Carbapenems have the strongest effect on Enterobacteriaceae bacteria and have low
rates of resistance.

Other β-lactams such as aztreonam are effective against Pseudomonas aeruginosa and sulbactam are commonly used to treat Acinetobacter.


Finally, Professor Kong Xudong pointed out that clinically, the characteristics of different negative bacteria should be followed and the principle of rational drug use should be followed to reduce the occurrence
of multi-drug resistance of bacteria.

Professor Zhang Yuanli of the Affiliated Hospital of Guangdong Medical University next analyzed a case of complex severe infection, in which the difficulty of handling the case was that the patient had primary chest loss, traumatic wet lung, and chest infection
.

Due to the complexity of the patient's condition, the identification of pathogenic microorganisms poses a challenge
.

Professor Zhang Yuanli pointed out that the rational use of antibacterial drugs, standardizing hospital infection control measures, and selecting treatment options according to the severity of infection are very important
for reducing the generation of bacterial drug resistance and managing life-threatening severe infections.

In the discussion session of the second section, Professor Zhu Tao of Suining Central Hospital, Professor Lin Ying of the First People's Hospital of Zhaoqing City, and Professor Song Xu of Rizhao City People's Hospital discussed
the principles that clinicians should follow in the case of limited diagnostic conditions in grass-roots hospitals.

Experts said that antimicrobial selection should be based on the individual characteristics of patients, pathogenic characteristics, antibiotic characteristics, and strengthen communication and cooperation with laboratory professional and technical personnel, which plays an important role
in improving the effective early diagnosis of ESBLs resistant strains and reducing the occurrence of bacterial resistance.

Figure ESBLs session 2 discussion session

Antibiotics should be selected in conjunction with the lowest inhibitory concentration values

In the noon case review meeting, Professor Chen Baiyi of the First Affiliated Hospital of China Medical University opened the meeting as the chairman and introduced the guests
.

Professor Zhang Suiyang then explored the delicate treatment of pulmonary gram-negative bacillus (GNB) infection based on the pharmacokinetics/pharmacodynamics (PK/PD) of lung antibiotics
.

He pointed out that when encountering Klebsiella pneumoniae and E.
coli resistant to some third-generation cephalosporin and aztreonam, it is necessary to consider whether the bacteria produce ESBLs and perform risk stratification
.

The 2022 Guidelines of the European Society of Microbiology, Infectious Diseases and Critical Care Medicine recommend the use of cefoperazone/sulbactam, piperacillin/tazobactam, amoxicillin/tazobactam, amoxicillin/clavulanate, or quinolones
in patients resistant to enterobacterium cephalosporine (3GCephRE).

However, for patients with severe infection, carbapenems are recommended and descending therapy
after stabilization.

In addition, in the choice of antibiotics, Professor Zhang Suiyang suggested considering the distribution of drug concentrations at the site of antibiotic infection, the minimum inhibitory concentration (MIC) value of antibiotics mediated by possible microbial sensitivity, the effect of pathophysiological changes of sepsis and septic shock on the distribution of antibiotics, and the principle of optimizing PK/PD parameters, and try to select antibiotics with high drug concentrations at the site of infection or high drug concentration/plasma concentration ratio at the infection site and high activity in drug susceptibility experiments
.

Three dosing principles are also followed when treating lung infections with different antibiotics: loading dose, increasing maintenance dose, and topical use
of the lungs.

Professor Hu Xiaoyong of Suining Central Hospital followed suit, sharing a case of a patient with sepsis complicated by viral encephalitis
.

The patient was diagnosed with "peritonitis, gastrointestinal infection, and sepsis"
upon admission.

Later, due to the aggravation of the patient's condition, he was transferred to the intensive care department, and combined with the admission examination, the patient was initially diagnosed with "sepsis (septic shock), acute respiratory distress signs, intestinal infection, lung infection" and so on
.

He was given cefoperazone/sulbactam sodium 3.
0 Q6h and linezolid glucose injection 600 mg Q12h anti-infective therapy
.

Microcirculation disorders were significantly improved after treatment, but then there was confusion with short-burst limb twitches and respiratory depression
.

After multidisciplinary diagnosis and treatment (MDT), considering the presence of Japanese encephalitis, the patient was given ribavirin 300 mg Q8h in combination with hydrocortisone succinate 100 mg Qd and ceftriaxone
.

After treatment, the patient's condition improved and he was eventually discharged from the hospital
.

Professor Hu Xiaoyong pointed out that for multi-site mixed complex infection, it is necessary to pay attention to its atypical manifestations, and cautiously use pluralism or monism to explain clinical infectious diseases
.

Metagenomic/transcriptome high-throughput sequencing (mNGS) is also used to assist in the diagnosis of disease and is appropriately dependent on MDT
.

In the subsequent discussion session, Professor Zhang Suiyang, Professor Hu Xiaoyong and Professor Chen Baiyi further expressed their respective views, believing that in the selection of antibiotics, attention should be paid to the selection of antibiotics according to the risk stratification of patients, emphasizing that in the treatment of empiric anti-infective therapy, patients should be evaluated for pathogens and their drug resistance risks, and then clinical decisions
should be made in combination with the severity of the disease.

In addition, the epidemiology of the pathogen at the site of infection lays the foundation
for the correct empirical treatment direction.

Empiric therapy should not only be designed according to high MIC values, but also take into account the patient's specific pathophysiological state in order to use a full dose of antibiotics
.

Figure The discussion session of the noon case review meeting

Intestinal microbacterium is the most important pathogenic bacteria in clinical infectious diseases, with Escherichia coli and Klebsiella pneumoniae having the highest isolation rate, ranking first and second
.

Early diagnosis of ESBLs-producing bacterial infections, rational treatment to improve patient prognosis, and delay the development of drug resistance have become important problems
to be solved in clinical practice.

In order to better avoid the problem of drug resistance, the choice of antibiotics also needs to be considered
by many parties.
At this point, the "one 'hui' baiying, feeling a new life" - infection standard diagnosis and treatment forum ESBLs special session and noon case review meeting came to a successful conclusion, the content discussed in this forum can provide reference for clinicians to further standardize and improve the level
of diagnosis, treatment and prevention and control in the field of infection in China.

This information is for medical and scientific reference only and is not recommended for use in any way that is inconsistent with the prescribing information approved in your country,