1. be used to annihilate the resistant bacteria

1.    
What are (a) the hypotheses tested and (b) the
logically formulated rationale for each? Explain both LOGICALLY and in terms of
the Biological Sciences. Begin rationale with importance of the field.

The
authors tested for and hypothesized that there would be differing rates of
blood stream infection between a group of inpatients and a group of outpatients
who were being treated for hematological malignancies with induction
chemotherapy. They also hypothesized that the inpatient group of patients would
show a higher rate of antimicrobial resistance in being treated for the blood
stream infections with first line antibiotics. Since hematology patients
treated with chemotherapy have a high risk of becoming neutropenic due to their
immunocompromised state, the authors performed this experiment so future
neutropenic patients can get the effective antimicrobial treatment they need in
case they contain a contaminant that is resistant to the first line of
antibiotics. It was also done so there could be a consideration for future
development of advanced techniques to quickly identify the resistant
contaminants.

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2.    
Why is the area of study important? Be logical,
thoughtful, and comprehensive.

Hematology patients are at a high risk of contracting
infection as well as chemotherapy-induced neutropenia due to their
immunocompromised state. Febrile neutropenia, responsible for many
hospitalizations, morbidity, and mortality in these patients, is rapidly
treated with broad-spectrum antibiotics. However, with the emergence of drug
resistant bacteria, treating febrile neutropenia is becoming more difficult,
increasing the rates of mortality. By identifying the resistant contaminants as
well as measuring their rates of resistance to various medications used to
treat neutropenia, accurate medications can be used to annihilate the resistant
bacteria and decrease mortality rates.

3.    
How was each experiment carried out (i.e., methods)
and why? Examine data in the tables & figures and briefly describe what was
done (techniques) to generate them (i.e., the data in the figures & tables)
and indicate the reasons for the experiment. State whether methods used
directly tested the hypothesis. Be clear, complete and concise.

Relevant
data was collected from the study population, such as demographic and
diagnostic information, number of hospital admissions and blood cultures drawn
and positive results of the cultures, length of stay, neutropenic episodes, and
mortality data, as well as data from standard empiric antimicrobial treatment
regimen (1). Blood cultures were also collected using standard procedures and
the organisms identified were tested for antimicrobial susceptibility and
resistance to empiric antibiotic treatment. This was all done in a five-year
period at a single health center. The methods used were done to categorize the
hematology patients into inpatient or outpatient groups, the number of
neutropenic episodes they would have as well as what types of bacteria were
resistant to the empiric antimicrobial treatment in neutropenic and
non-neutropenic episodes as well as the rates of resistance overall. These
methods did directly test the hypotheses as they were able to collect the data
needed to support or reject their hypotheses, such as what the rates were for
blood stream infections in neutropenic and non-neutropenic hematology patients
and which group of patients had the higher rates of antimicrobial resistance to
the first line of antibiotic treatment.

4.    
What were the general results of the paper? Use
numerical descriptions: %, means, modes, averages, i.e., numbers. Be clear,
complete, and concise. Do not mix up results (i.e., data) with conclusions or
other aspects.

Out
of 212 patients studied, 9 of them (5.9%) contracted an all-cause mortality
within 30 days of blood stream infection where 2 deaths occurred (1). The
contaminants isolated were Clostridium
septicum (2 cases), Pseudomonas
aeruginosa, Enterobacter cloacae, Serratia marcescens, Stenotrophomonas
maltophilia, and Escherichia coli. Contaminants
in the neutropenic patients were mainly Gram negative (76.2%), where Escherichia coli, Pseudomonas aeruginosa, Enterobacter
cloacae, and Klebsiella pneumoniae showed
up in 90.4% of the cases. The remaining 19.9% were Gram positive Streptococcus and Staphylococcus species, a single case of Candida tropicalis and 3% anaerobic contaminants (1). 88.4% of the
isolates were vulnerable to a combination treatment of piperacillin/tazobactam
and gentamicin. 11.6% of the pathogenic isolates were resistant to empiric
antibiotic treatment. Lastly, inpatients showed a higher rate of contaminant
resistance than outpatients; 17.4% compared to 7.5%.

5.    
What were the general conclusions made by the authors
for each experiment? Be logical and/or indicate alternative conclusions.

The
authors’ conclusions were that they had a low rate of blood stream infection mortality
in their health center as well as a low rate of antimicrobial resistance to empiric
antibiotics. They further call attention to the safety of using fluoroquinolone
prophylaxis-free medications in infectious mortality. Especially since that
type of medication has had a low rate of antimicrobial resistance. The authors
also mention how new molecular methods of diagnosing blood stream infections as
well as identifying resistant contaminants may be developed as a more quick,
efficient, and beneficial alternative for neutropenic patients instead of using
their current methods of taking blood cultures.

6.    
List numerically all the scientific limitations (i.e.,
scientific criticisms and analysis) of the paper. These should be original,
logical, and scientifically valid.

1.      The
authors unnecessarily stated that they had low rates of ciprofloxacin
resistance in the contaminants of the hematology patients’ blood stream
infections. The center where they performed that study does not generally use
that specific medication, nor did the authors use that medication in their
study (which was stated as well). They used a different medication,
trimethoprim/sulfamethoxazole and valaciclovir. Although they are in the same
family of fluoroquinolone-free prophylactic medications, they should have
reported the rates of antimicrobial resistance of the medications used in the
experiment, or they could have included those rates with the ciprofloxacin rate
to make a comparison.

 

Reference:

1.
Conn J, Catchpoole E, Runnegar N, Mapp S, Markey K. 2017. Low rates of
antibiotic resistance and infectious mortality in a cohort of high-risk
hematology patients: A single center, retrospective analysis of blood stream
infection. PLOS ONE 12: e0178059.