Day 1

Keep Antimicrobials Working

Epidemiology (UK):
- Incidence: 75k/yr
- Deaths following HAP: 15k
- Each HAP assc. with ~9 extra bed-days
Diagnostics:
- Currently a mess; some use definition below, some use ‘LRTI after inpatient for >48h OR resident in nursing facility’,
- 3 Criteria:
  - Clinical syndrome of LRTI
  - Inflammatory response (Fever, raised WCC/CRP)
  - Imaging changes c/w HAP (e.g. CXR, CT)
- Current being trialled in HAPFAST in UK
  - Note sample acquisition is quite poor; average SpCx in 14%
Treatment:
- NICE guidance: Based on 9 RCTs, but only 1 was in the UK (N=10)
- Low-risk AMR: Co-amox (or Cotrim, Cefalexin, Doxy, Levo)
- High risk AMR, Severe, Allergic: Lots of options, some quite confusing:
  
  | Reserve | Meropenem Ceftazidime-avibactam | | --- | --- | | Watch (Pseudo cover) | Piperacillin-tazobactam Ceftazidime Levofloxacin | | Watch (No Pseudo cover) | Ceftriaxone Cefuroxime |
  
  With no guidance as to which to choose and why.
Interesting fact: with PsA, Mero + Amikacin given together has less risk of resistance evolving compared to meropenem monotherapy

CNS Ab Penetrance:
Need to X BBB, then Blood-CSF barrier to penetrate to CSF (?+ parenchyma?)
Intraventricular ABx in children:
- No apparent advantage normally
- Neurosurgical: definite advantage