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antibiótics stewardship

Larry K Kociolek, Preeta K Kutty, Philip M Polgreen, Susan E Beekmann
OBJECTIVE: To characterize healthcare provider diagnostic testing practices for identifying Clostridioides (Clostridium) difficile infection (CDI) and asymptomatic carriage in children. DESIGN: Electronic survey. METHODS: An 11-question survey was sent by e-mail or facsimile to all pediatric infectious diseases (PID) members of the Infectious Diseases Society of America's Emerging Infections Network (EIN). RESULTS: Among 345 eligible respondents who had ever responded to an EIN survey, 196 (57%) responded; 162 of these (83%) were aware of their institutional policies for CDI testing and management...
February 15, 2019: Infection Control and Hospital Epidemiology
Felicia Skelton, Lindsey Ann Martin, Charlesnika T Evans, Jennifer Kramer, Larissa Grigoryan, Peter Richardson, Mark E Kunik, Ivy Oiyee Poon, S Ann Holmes, Barbara W Trautner
BACKGROUND: Bacteriuria, either asymptomatic (ASB) or symptomatic, urinary tract infection (UTI), is common in persons with spinal cord injury (SCI). Current Veterans Health Administration (VHA) guidelines recommend a screening urinalysis and urine culture for every veteran with SCI during annual evaluation, even when asymptomatic, which is contrary to other national guidelines. Our preliminary data suggest that a positive urine culture (even without signs or symptoms of infection) drives antibiotic use...
February 14, 2019: JMIR Research Protocols
Peter Yao, Sunday Clark, Kriti Gogia, Baria Hafeez, Hanson Hsu, Peter Greenwald
BACKGROUND: Direct-to-consumer telemedicine is becoming part of mainstream medicine, but questions exist regarding the quality of care provided. We assessed antibiotic stewardship, one measure of quality, by comparing antibiotic prescription rates for acute respiratory infections (ARIs) between patients seen by telemedicine and patients seen in-person in two urban emergency departments (EDs). METHODS: In two urban EDs where low-acuity patients in the ED have the option of being seen by telemedicine rather than in-person, we analyzed telemedicine and in-person visits of patients ≥18 years who received ARI diagnoses between July 2016 and September 2017...
February 14, 2019: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Valerie M Vaughn, Tejal Gandhi, Anna Conlon, Vineet Chopra, Anurag N Malani, Scott A Flanders
Background: Fluoroquinolones increase the risk of Clostridioides difficile infection and antibiotic resistance. Hospitals often use pre-prescription approval or prospective audit and feedback to target fluoroquinolone prescribing. Whether these strategies impact aggregate fluoroquinolone use is unknown. Methods: This study is a 48-hospital, retrospective cohort of general-care, medical patients hospitalized with pneumonia or positive urine culture between December 2015-September 2017...
February 13, 2019: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Martin C Gulliford, A Toby Prevost, Judith Charlton, Dorota Juszczyk, Jamie Soames, Lisa McDermott, Kirin Sultana, Mark Wright, Robin Fox, Alastair D Hay, Paul Little, Michael V Moore, Lucy Yardley, Mark Ashworth
OBJECTIVES: To evaluate the effectiveness and safety at population scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic prescribing for self limiting respiratory tract infections. DESIGN: Open label, two arm, cluster randomised controlled trial. SETTING: UK general practices in the Clinical Practice Research Datalink, randomised between 11 November 2015 and 9 August 2016, with final follow-up on 9 August 2017...
February 12, 2019: BMJ: British Medical Journal
Jennifer Broom, Alex Broom, Phillip Good, Zarnie Lwin
The antibiotic optimisation imperative is now ubiquitous, with national policy frameworks in Organisation for Economic Co-operation and Development (OECD) countries incorporating the requirement for antimicrobial stewardship within healthcare services. Yet in practice, the optimisation agenda often raises complex ethical- and practice-based dilemmas. Antibiotic use at the end of life is multidimensional. It includes balancing complex issues, such as accuracy of prognostic estimates, benevolence to the individual versus the broader public health, personalised value judgement of time and quality of life and the right to treatment versus the right to die...
February 2019: Internal Medicine Journal
Tanya du Plessis, Genevieve Walls, Anthony Jordan, David J Holland
Background: Inaccurate allergy labelling results in inappropriate antimicrobial management of the patient, which may affect clinical outcome, increase the risk of adverse events and increase costs. Inappropriate use of alternative antibiotics has implications for antimicrobial stewardship programmes and microbial resistance. Methods: All adult inpatients labelled as penicillin allergic were identified and screened for eligibility by the study pharmacist. An accurate allergy and medication history was taken...
February 6, 2019: Journal of Antimicrobial Chemotherapy
Robert R Tanz, Elizabeth J Ranniger, Jason L Rippe, Renée L Dietz, Caroline L Oktem, Christine L Lowmiller, Stanford T Shulman
BACKGROUND: Timely, accurate diagnosis of streptococcal (GAS) pharyngitis prevents ARF and limits antibiotic overuse. The Illumigene® Group A Streptococcus assay (Meridian Bioscience) is a molecular test for GAS pharyngitis with high sensitivity and specificity. We sought to determine whether the Illumigene test is more likely than throat culture to be positive in patients without pharyngeal symptoms and explore the limits of detection of the test. METHODS: Patients aged 3-17 years were eligible if they had no history of pharyngitis or use of antibiotics within the previous 2 weeks; there were no URI symptoms, sore throat, or fever; and no signs of infection...
February 6, 2019: Pediatric Infectious Disease Journal
Giancarlo Ripabelli, Angelo Salzo, Andrea Mariano, Michela L Sammarco, Manuela Tamburro
BACKGROUND: Healthcare associated infections (HAIs) are a major public health concern both in acute hospitals and long-term care facilities (LTCFs), considering the clinical presentations and related costs. The study describes the first regional experience on HAIs and antimicrobials consumption obtained through point prevalence survey (PPS) 2016-2017 in the "Antonio Cardarelli" acute hospital, and in the LTCF of Larino municipality (Healthcare-associated infections and Antimicrobial use in European Long-Term care facilities, HALT-3) of Molise Region, Central Italy, both coordinated by the European Center for Disease Control (ECDC)...
February 7, 2019: Journal of Infection and Public Health
Frederick K Wangai, Moses M Masika, Godfrey N Lule, Emma M Karari, Marybeth C Maritim, Walter G Jaoko, Beatrice Museve, Antony Kuria
BACKGROUND: There is worldwide concern of rapidly increasing antimicrobial resistance (AMR). However, there is paucity of resistance surveillance data and updated antibiograms in Africa in general. This study was undertaken in Kenyatta National Hospital (KNH) -the largest public tertiary referral centre in East & Central Africa-to help bridge existing AMR knowledge and practice gaps. METHODS: A retrospective review of VITEK 2 (bioMérieux) records capturing antimicrobial susceptibility data for the year 2015 was done and analysed using WHONET and SPSS...
2019: PloS One
Bethany A Wattengel, John A Sellick, Megan K Skelly, Randal Napierala, Jennifer Schroeck, Kari A Mergenhagen
PURPOSE: Community-acquired pneumonia (CAP) is one of the leading causes of death in the United States. The primary objective of this study was to determine the prevalence of appropriate diagnosis and treatment of outpatients treated for CAP. Knowledge of problems with CAP treatment can be helpful in developing stewardship initiatives to improve care of outpatients with CAP. METHODS: Included in this study were patients 18 years and older who received antibiotic therapy for the treatment of CAP in the outpatient setting...
February 7, 2019: Clinical Therapeutics
E Baten, F Van Der Aa, C Orye, R Cartuyvels, I Arijs, K van Renterghem
PURPOSE: Antibiotic prophylaxis is standard procedure in transurethral resection of the prostate (TURP). We evaluated the necessity of antibiotic (AB) prophylaxis in TURP due to increasing microbial antibiotic resistance. METHODS: This is a prospective cohort study of 506 patients. Only patients with a pre-operative catheter/pyuria received AB-prophylaxis. Urine analysis (pre-operative, at discharge, and 3 week post-operative) was performed next to an analysis of the blood culture/irrigation fluid and of the resected prostatic tissue...
February 9, 2019: World Journal of Urology
Sarah Perreault, Dayna McManus, Noffar Bar, Francine Foss, Lohith Gowda, Iris Isufi, Stuart Seropian, Maricar Malinis, Jeffrey E Topal
BACKGROUND: Current guidelines recommend adding vancomycin to empiric treatment of FN in patients who meet specific criteria. After 48 hours, the guidelines recommend discontinuing vancomycin if resistant Gram-positive organisms are not identified. Based on these recommendations, a vancomycin stewardship team defined criteria for discontinuation of vancomycin at 48 hours and increased surveillance of vancomycin usage through a multimodal approach. The purpose of this retrospective analysis is to assess the impact of this multimodal approach on the discontinuation of empiric vancomycin at 48 hours in FN...
February 8, 2019: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Vatsala R Srinivasa, Rahman Hariri, Linda R Frank, Lawrence Kingsley, Emily Magee, Marian Pokrywka, Mohamed H Yassin
BACKGROUND: Clostridium difficile infection (CDI) is a leading cause of hospital-associated infections. Antibiotic stewardship, environmental disinfection, and reduction of transmission via health care workers are the major modes of CDI prevention within hospitals. METHODS: The aim of this study was to evaluate the role of the environment in the spread of CDI within hospital rooms. Bed tracing of positive-CDI inpatients was performed to detect the strength of association to specific rooms...
February 2, 2019: American Journal of Infection Control
Philipp Schuetz, Albertus Beishuizen, Michael Broyles, Ricard Ferrer, Gaetan Gavazzi, Eric Howard Gluck, Juan González Del Castillo, Jens-Ulrik Jensen, Peter Laszlo Kanizsai, Andrea Lay Hoon Kwa, Stefan Krueger, Charles-Edouard Luyt, Michael Oppert, Mario Plebani, Sergey A Shlyapnikov, Giulio Toccafondi, Jennifer Townsend, Tobias Welte, Kordo Saeed
Background Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Methods Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols...
February 6, 2019: Clinical Chemistry and Laboratory Medicine: CCLM
Jennifer Stallwood, Alex Shirlow, Angie Hibbert
OBJECTIVES: The aim of this study was to explore owners' knowledge of antibiotics, experience of antibiotic use in their cats and involvement in decision-making regarding antibiotic prescriptions. METHODS: Cat owners were recruited via social media and veterinary practices to complete a survey designed to evaluate general knowledge of antibiotics, attitudes to antibiotic stewardship and experiences of antibiotic use in their own cat between November 2017 and March 2018...
February 5, 2019: Journal of Feline Medicine and Surgery
Rogier M Hopstaken
Global initiatives to tackle the rise of antimicrobial resistance highlight the need to invest in the development and use of new, rapid diagnostic tools in routine patient care to differentiate bacterial from viral infections. Selective use may enhance antibiotic stewardship, but should be based on evidence for the target populations. The landmark study of Ieven et al. in 11 European countries describes the role of bacteria, viruses and mixed bacterial-viral infections in adults presenting with mostly non-severe lower respiratory tract infections in primary care...
January 29, 2019: Nederlands Tijdschrift Voor Geneeskunde
Shahista Nisa, Clément Bercker, Anne C Midwinter, Ian Bruce, Chris F Graham, Pierre Venter, Allan Bell, Nigel P French, Jackie Benschop, Karen M Bailey, David A Wilkinson
Staphylococcus pseudintermedius is an opportunistic and emerging zoonotic pathogen that primarily colonises the skin of dogs. Many common variants are methicillin resistant (MRSP) or multidrug resistant (MDR), and drug resistance is increasingly reported across the globe. In New Zealand, MRSP isolation remains rare in clinics. To pre-emptively inform diagnostic and antimicrobial stewardship practices, we examine isolates of S. pseudintermedius, MRSP and MDR-MRSP from New Zealand dogs using a combination of methodologies...
February 4, 2019: Scientific Reports
A M W Chan, W W Y Au, D V K Chao, K Choi, K W Choi, S M Y Choi, Y Chow, C Y M Fan, P L Ho, E M T Hui, K H Kwong, B Y S Kwong, T P Lam, E T K Lam, K W Lau, L Lui, K H L Ng, M C S Wong, T Y Wong, C F Yeung, J H S You, R W H Yung
The Centre for Health Protection of the Department of Health has convened the Advisory Group on Antibiotic Stewardship Programme in Primary Care (the Advisory Group) to formulate guidance notes and strategies for optimising judicious use of antibiotics and enhancing the Antibiotic Stewardship Programme in Primary Care. Acute pharyngitis is one of the most common conditions among out-patients in primary care in Hong Kong. Practical recommendations on the diagnosis and antibiotic treatment of acute streptococcal pharyngitis are made by the Advisory Group based on the best available clinical evidence, local prevalence of pathogens and associated antibiotic susceptibility profiles, and common local practice...
January 31, 2019: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Ahmed El-Nawawy, Magdy A-F Ramadan, Manal A-M Antonios, Shams A-F Arafa, Eman Hamza
PURPOSE: Therapy of severe pneumonia is very challenging in view of the current widespread bacterial resistance to many antibiotics especially extended spectrum ß-lactams, carbapenems, and anti-pseudomonal drugs. The current study aimed at assessing antimicrobial sensitivity pattern and optimization of the antibiotic stewardship program applied in a university affiliated pediatric intensive care unit (PICU). SUBJECTS AND METHODS: This prospective cohort study included all patients aged 1 month to 12 years, admitted to the PICU with severe pneumonia episodes indicated for mechanical ventilation, and were followed up and investigated...
January 30, 2019: Journal of Global Antimicrobial Resistance
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