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Antibiotic/ antimicrobial stewardship

Mayur S Ramesh, Jerry Yee
Clostridioides difficile infection (CDI) is a major health-care burden and increasingly seen in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Increased antibiotic use, alteration in host defenses, and gastric acid suppression are some of the etiologies for increased risk of CDI in these populations. Patients with CKD/ESRD have a higher risk of initial episode, recurrence, and development of severe CDI than those without CKD or ESRD. Diagnosis and management of CDI in patients with CKD/ESRD are similar to that in the general population...
January 2019: Advances in Chronic Kidney Disease
Ahmad FarajzadehSheikh, Hojat Veisi, Mojtaba Shahin, Muhammad Getso, Abbas Farahani
Background: As an opportunistic pathogen, Escherichia coli ( E. coli ) is widely recognized as the main cause of nosocomial infections as well as some disorders especially those associated with urinary tract infections (UTIs). This study, therefore, sets out to determine the extent of antibiotic resistance to quinolones and to measure the frequency of qnr genes (A, B, and S) within extended-spectrum beta-lactamase (ESBL) and non-ESBL-producing strains of E. coli isolated from UTI-diagnosed patients as well as to investigate their antimicrobial susceptibility patterns for some selected antibiotics in southwest Iran...
2019: Tropical Medicine and Health
K Schmitt, C Lehner, S Schuller, G Schüpbach-Regula, M Mevissen, R Peter, C R Müntener, H Naegeli, B Willi
BACKGROUND: Antibiotic use in human and veterinary medicine is considered a main driver of antimicrobial resistance. Although guidelines to promote appropriate use of antimicrobials in veterinary patients have been developed, antibiotic overprescription is assumed to be a common problem. The goal of this study was to investigate antimicrobial use in cats in Switzerland with acute upper respiratory tract disease (aURTD), feline lower urinary tract disease (FLUTD) and abscesses, and to assess compliance of prescription with consensus guidelines...
March 14, 2019: BMC Veterinary Research
M Devchand, C M J Kirkpatrick, W Stevenson, K Garrett, D Perera, S Khumra, K Urbancic, M L Grayson, J A Trubiano
BACKGROUND: Antibiotic allergy labels (AALs), reported by up to 25% of hospitalized patients, are a significant barrier to appropriate prescribing and a focus of antimicrobial stewardship (AMS) programmes. METHODS: A prospective audit of a pharmacist-led AMS penicillin allergy de-labelling ward round at Austin Health (Melbourne, Australia) was evaluated. Eligible inpatients with a documented penicillin allergy receiving an antibiotic were identified via an electronic medical report and then reviewed by a pharmacist-led AMS team...
March 14, 2019: Journal of Antimicrobial Chemotherapy
Alexis T White, Collin M Clark, John A Sellick, Kari A Mergenhagen
BACKGROUND: Outpatient prescriptions comprise 60% of antibiotic use. This study prospectively identified inappropriate antibiotic use enabling a focused approach to outpatient antimicrobial stewardship. METHODS: Outpatients at the Veterans Affairs Western New York Healthcare System were identified via an electronic antibiotic alert from June 2017 to September 2017. Descriptive statistics and multivariable logistic regression identified stewardship targets. RESULTS: Of the 1,063 patients, 40% of antibiotic prescriptions were not indicated...
March 9, 2019: American Journal of Infection Control
Solen Kernéis, Kim Blanc, Julien Caliez, Etienne Canouï, Julien Loubinoux, Rémy Gauzit, Yen-Lan Nguyen, Anne Casetta, Aurélie Lefebvre, Jean-François Regnard, Samir Bouam, Marco Alifano, Antoine Rabbat
BACKGROUND: Post-operative pneumonia (POP) is a severe complication of major lung resection. Our objective was to describe the current epidemiology and appropriateness of antibiotic prescriptions in severe POP, four years after implementation of an antimicrobial stewardship program based on weekly multidisciplinary review of all antibiotic therapies. METHODS: Retrospective analysis of a prospectively collected database. We included all cases of severe POP occurring within 30 days after major lung resection of our 1500-bed hospital between 2013 and 2015...
March 7, 2019: Annals of Thoracic Surgery
Young June Choe, Ju-Young Shin
Inappropriate use of antibiotics is the most important factor that causes an increase in bacterial resistance to antibiotics, thus affecting patient outcomes. Multidrug-resistant bacteria have become a serious public health threat causing significant morbidity and mortality worldwide. In Korea, the burden of antibiotic resistant bacteria have become an important public health issues. There is increasing evidence of overuse and misuse of antibiotics in Korea observed from cohorts of large sample size. In specific, antibiotic use in children should be highlighted because of the frequency of acquiring community-associated infections and the elevated risk of transmission to other population...
March 4, 2019: Korean Journal of Pediatrics
Buket Ertürk Şengel, Hüseyin Bilgin, Beyza Ören Bilgin, Tolga Gidener, Simge Saydam, Aslıhan Pekmezci, Önder Ergönül, Volkan Korten
OBJECTIVES: Antimicrobial stewardship programs (ASPs) have an important role in the appropriate utilization of antibiotics. Some of the core strategies recommended for ASPs are preauthorization, prospective audit and feedback. In Turkey, a unique nationwide antibiotic restriction program (NARP) is in use since 2003. We aimed to measure the effect of a prospective audit and feedback strategy system along with NARP. METHODS: We designed a prospective quasi-experimental study between March and June of 2017...
March 4, 2019: International Journal of Infectious Diseases: IJID
Saskia J Bogers, Frederike V van Daalen, Sacha D Kuil, Menno D de Jong, Suzanne E Geerlings
The appropriate use of microbiological investigations is an important cornerstone of antibiotic stewardship programmes, but receives relatively limited attention. This study aimed to identify influencing factors in performing microbiological diagnostic tests and to assess the need for a clinical guideline. We performed a qualitative (focus group) and quantitative (online questionnaire survey) study among medical specialists and residents to identify physicians' considerations in performing microbiological diagnostic tests and to assess the need for a diagnostic guideline...
March 7, 2019: European Journal of Clinical Microbiology & Infectious Diseases
Ban Al-Sayyed, Jeremy Le, Mohammad Mousbah Al-Tabbaa, Brian Barnacle, Jinma Ren, Richard Tapping, Meenakshy Aiyer
OBJECTIVES: Antimicrobial stewardship programs target antimicrobial use within the inpatient care setting. However, most antimicrobials are prescribed at ambulatory sites. We aim to determine the appropriateness of the diagnosis and treatment of uncomplicated urinary tract infection (UTI) in children within the outpatient setting at our institution, and to evaluate the cost of antibiotic treatment in our patient cohort. METHODS: This retrospective study was conducted by reviewing electronic records of patients aged 2 to 18 years diagnosed with uncomplicated UTI and treated with antibiotics in the outpatient setting from January 1, 2016, to April 30, 2016...
January 2019: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Joseph Y Ting, Ashley Roberts, Rebecca Sherlock, Cecil Ojah, Zenon Cieslak, Michael Dunn, Keith Barrington, Eugene W Yoon, Prakesh S Shah
: media-1vid110.1542/5984244681001PEDS-VA_2018-2286 Video Abstract BACKGROUND: Overuse of antibiotics can facilitate antibiotic resistance and is associated with adverse neonatal outcomes. We studied the association between duration of antibiotic therapy and short-term outcomes of very low birth weight (VLBW) (<1500 g) infants without culture-proven sepsis. METHODS: We included VLBW infants admitted to NICUs in the Canadian Neonatal Network between 2010-2016 who were exposed to antibiotics but did not have culture-proven sepsis in the first week...
March 2019: Pediatrics
James B Brock, David A Cretella, Jason J Parham
INTRODUCTION: Staphylococcus aureus bloodstream infections (SABSI) are a major cause of morbidity and mortality in the United States, and proper management is important to effect cure and prevent metastatic foci of infection. We aimed to utilize our antimicrobial stewardship program (ASP) to improve practices at a large academic hospital system. METHODS: Our ASP implemented a SABSI educational campaign directed at the hospital medicine, cardiology, and infectious diseases divisions...
February 26, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
P Ny, A Ozaki, J Pallares, P Nieberg, A Wong-Beringer
Background: A subset of bacteremia cases are caused by organisms not detected by the rapid diagnostics platform, BioFire® blood culture identification (BCID) with unknown clinical characteristics and outcomes. Methods: Patients with ≥1 positive blood culture over a 15-month period were grouped by Negative (NB-PC) vs. Positive BioFire® BCID (PB-PC) results and compared on demographics, infection characteristics, antibiotic therapy and outcomes (length of hospital stay (LOS) and in-hospital mortality). Results: Six percent of 1,044 positive blood cultures were NB-PC...
February 27, 2019: Journal of Clinical Microbiology
Roberto Vivas, Ana Andréa Teixeira Barbosa, Silvio Santana Dolabela, Sona Jain
Antibiotic resistance is one of the greatest challenges in the health system nowadays, representing a serious problem for public health. Initially, antibiotic-resistant strains were restricted to the hospital environment, but now they can be found everywhere. Globalization, excessive use of antibiotics in animal husbandry and aquaculture, use of multiple broad-spectrum agents, and lack of good antimicrobial stewardship can be listed as the factors most responsible for the spread of antibiotic resistance. The increase in the prevalence of antibiotic-resistant pathogens implies having fewer antimicrobial agents to treat infections...
February 27, 2019: Microbial Drug Resistance: MDR: Mechanisms, Epidemiology, and Disease
David N Johnston, Fatemeh Keshtkar, William Campbell
BACKGROUND: Antimicrobial resistance is a growing global problem. There has been increasing emphasis on promoting antimicrobial stewardship. Accurate completion of antibiotic prescriptions, such as documentation of clinical indication and a stop/review date, helps promote antimicrobial stewardship. AIMS: To investigate the impact of educational interventions on the completeness of antibiotic prescriptions at Causeway Hospital surgical unit. METHODS: Inpatient drug prescription charts were audited to monitor the completeness of antibiotic prescriptions on the surgical unit...
February 27, 2019: Irish Journal of Medical Science
Takashi Niwa, Jun Yonetamari, Nozomi Hayama, Ayasa Fujibayashi, Syuri Ito-Takeichi, Keiko Suzuki, Hirotoshi Ohta, Ayumi Niwa, Mayumi Tsuchiya, Masayo Yamamoto, Daijiro Hatakeyama, Hideki Hayashi, Michiko Obara, Tadashi Sugiyama, Hisashi Baba, Akio Suzuki, Nobuo Murakami
BACKGROUND: Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has the potential to permit early organism identification and optimization of antibiotic therapy. However, MALDI-TOF MS combined with antimicrobial stewardship is available at only a limited number of institutions. Here, we evaluated the clinical impact of implementing MALDI-TOF MS combined with antimicrobial stewardship intervention in patients with bloodstream infections. METHODS: We conducted a single-center, prospective cohort study to evaluate the clinical impact of implementing MALDI-TOF MS combined with antimicrobial stewardship intervention in patients with bloodstream infections...
February 27, 2019: International Journal of Clinical Practice
Dilip Nathwani, Della Varghese, Jennifer Stephens, Wajeeha Ansari, Stephan Martin, Claudie Charbonneau
Background: Hospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of antimicrobials to combat antimicrobial resistance. For ASPs to be developed, adopted, and implemented, an economic value assessment is essential. Few studies demonstrate the cost-effectiveness of ASPs. This systematic review aimed to evaluate the economic and clinical impact of ASPs. Methods: An update to the Dik et al. systematic review (2000-2014) was conducted on EMBASE and Medline using PRISMA guidelines...
2019: Antimicrobial Resistance and Infection Control
E Charani, Enrique Castro-Sanchéz, S Bradley, D Nathwani, Alison H Holmes, P Davey
Background: Antibiotic stewardship interventions are being implemented across different healthcare settings. We report the findings of a global survey of healthcare professionals on the implementation of antibiotic stewardship programmes. Methods: Learners of a Massive Online Open Course (MOOC) on antibiotic stewardship were invited to complete an online survey on the core available organisational resources for stewardship. The categorical variables were analysed using chi-squared test, and Likert questions were analysed using an ordinal regression model...
2019: Antimicrobial Resistance and Infection Control
Getachew Alemkere, Admasu Tenna, Ephrem Engidawork
BACKGROUND: Malpractice and excess use of antimicrobials have been associated with multiple costs, including the development of resistant bacteria, which has become a threat to the human health. The aim of this study, therefore, was to assess the antibiotic use practice and to identify predictors of hospital outcome to uncover targets for stewardship. METHODS: An Institution-based prospective observational study was performed from 9 April to 7 July 2014 in the internal medicine wards of Tikur Anbessa Specialized Hospital...
2019: PloS One
Jonathan A T Sandoe, Kordo Saeed, Achyut Guleri, Kieran S Hand, Ryan Dillon, Mike Allen, Amazigom Mayes, Fiona Glen, Armando Gonzalez-Ruiz
Purpose: The objective of this prospective, observational study was to describe the treatment, severity assessment and healthcare resources required for management of patients with acute bacterial skin and skin structure infections who were unsuitable for beta-lactam antibiotic treatments. Methods: Patients were enrolled across five secondary care National Health Service hospitals. Eligible patients had a diagnosis of acute bacterial skin and skin structure infection and were considered unsuitable for beta-lactam antibiotics (e...
January 2019: Therapeutic Advances in Infectious Disease
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