Appropriate Antibiotics and Mortality from Bloodstream Infections



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Appropriate Antibiotics and Mortality from Bloodstream Infections

















Streptococcal Myositis - Clindamycin



Streptococcal Toxic Shock: Clindamycin vs. -lactams

  • Deep Superficial

  • Cell wall inhibitors 1/7 (14 %) 12/25 (48%)

  • Protein synthesis 10/12 (83%)* 10/12 (83%)*

  • inhibitors (87% clindamycin)

  • Zimbelman J. Pediatr Infect Dis 1999;18:1096.









The Role of Protein C in Sepsis



PROWESS Study of Protein C in Sepsis



Activated Protein C (Drotregcogin alfa, Xigris) vs. Placebo for Severe Sepsis

  • 28 day all cause 24.7% 30.8%

  • mortality

  • Relative risk reduction 19.4 % (6.6% - 30.5%)

  • Serious bleeding (#fatal) 3.5% (2) 2.0% (1) [p=.06]

  • Intracranial 0.2% 0.1%



Activated Protein C for Severe Sepsis: FDA Approved Indication



Activated Protein C (Drotregcogin alfa, Xigris) - Long-Term Survival

  • Median survival 1113 846

  • (days)

  • Persons > 60 years 252 130

  • APACHE II > 25 450 71





Dexamethasone for Bacterial Meningitis in Adults

  • Mortality (%) all pts 7 15(53%,p=0.04)

  • S. pneumoniae (%) 14 34(58%p=.002)

  • Glascow Outcome Score all pts 15 25 (p=0.03)

  • 0-5, 0-4* unfavorable - %)

  • S. pneumoniae, n=108 (%) 26 52 (p=.006)

  • *4= unable to return to work/school



Low-Dose Maintenance Corticosteroids in Septic Shock

  • 28-day mortality

  • Non-responders (n,%) 60/114 (53) 73/115 (63) (16%, p=.02)

  • Responders (n,%) 22/36 (61) 18/34 (53)

  • All patients (n,%) 82/150 (55) 91/149 (61)













Streptococcal Toxic Shock: IVIG

  • 30 day survival (%) 67 34 (50%, p=.02)















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