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Urinary tract infection and antimicrobial stewardship

Aoife Fleming, Louise Barry, Stephen Byrne, Michael Prentice
BACKGROUND: Antimicrobial resistance in long-term care facilities (LTCFs) poses a risk to elderly residents. The aim of this observational study was to investigate recent patterns of antimicrobial susceptibility in urine samples submitted to the Microbiology Laboratory at Cork University Hospital (CUH) from LTCFs in the greater Cork region. The antimicrobial susceptibilities of LTCF and General Practitioner (GP) urine samples sent to CUH, for patients aged over 65 years of age, were compared...
October 24, 2016: European Journal of Public Health
Mazen S Bader, Mark Loeb, Annie A Brooks
Urinary tract infections (UTIs) caused by antibiotic-resistant Gram-negative bacteria are a growing concern due to limited therapeutic options. Gram-negative bacteria, specifically Enterobacteriaceae, are common causes of both community-acquired and hospital acquired UTIs. These organisms can acquire genes that encode for multiple antibiotic resistance mechanisms, including extended-spectrum-lactamases (ESBLs), AmpC- β -lactamase, and carbapenemases. The assessment of suspected UTI includes identification of characteristic symptoms or signs, urinalysis, dipstick or microscopic tests, and urine culture if indicated...
October 7, 2016: Postgraduate Medicine
Barbara W Trautner, M Todd Greene, Sarah L Krein, Heidi L Wald, Sanjay Saint, Andrew J Rolle, Sara McNamara, Barbara S Edson, Lona Mody
OBJECTIVE To assess knowledge about infection prevention among nursing home personnel and identify gaps potentially addressable through a quality improvement collaborative. DESIGN Baseline knowledge assessment of catheter-associated urinary tract infection, asymptomatic bacteriuria, antimicrobial stewardship, and general infection prevention practices for healthcare-associated infections. SETTING Nursing homes across 14 states participating in the national "Agency for Healthcare Research and Quality Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary Tract Infection...
October 4, 2016: Infection Control and Hospital Epidemiology
Curtis D Collins, Jared J Kabara, Sarah M Michienzi, Anurag N Malani
Implementation of an antimicrobial stewardship program bundle for urinary tract infections among 92 patients led to a higher rate of discontinuation of therapy for asymptomatic bacteriuria (52.4% vs 12.5%; P =.004), more appropriate durations of therapy (88.7% vs 63.6%; P =.001), and significantly higher overall bundle compliance (75% vs 38.2%; P < .001). Infect Control Hosp Epidemiol 2016;1499-1501.
December 2016: Infection Control and Hospital Epidemiology
James F Carbo, Christine A Ruh, Kari E Kurtzhalts, Michael C Ott, John A Sellick, Kari A Mergenhagen
BACKGROUND: The influence of antimicrobial stewardship programs (ASPs) on outcomes in male veterans treated for complicated urinary tract infection has not been determined. METHODS: This was a retrospective cohort study encompassing the study period January 1, 2005-October 31, 2014, which was conducted at a 150-bed Veterans Affairs Healthcare System facility in Buffalo, NY. Male veterans admitted for treatment of complicated urinary tract infection were identified using ICD-9-CM codes...
December 1, 2016: American Journal of Infection Control
Dean Ironmonger, Obaghe Edeghere, Savita Gossain, Peter M Hawkey
BACKGROUND: There is a marked variation in both antibiotic prescribing practice and urine sampling rates for diagnostic microbiology across general practices in England. To help understand factors driving this variation, we undertook a survey in 2012/13 to determine sampling protocols and antibiotic formularies used by general practitioners (GPs) for managing urinary tract infections (UTIs) in the West Midlands region of England. METHOD: Cross-sectional survey of all eligible general practices in the West Midlands region of England undertaken in November 2012...
2016: BMC Infectious Diseases
Enas Mamdouh Hefzy, Noha Anwar Hassuna
The multidrug-resistant sequence type 131 (ST131) Escherichia coli is a spreading epidemiological burden particularly among isolates resistant to fluoroquinolones. We aimed to evaluate the commonality of ST131-O25b and ST131-O16 among fluoroquinolone-resistant E. coli isolates causing community-acquired urinary tract infections (UTIs) at Fayoum University Hospital, in Egypt. Ninety-two fluoroquinolone-resistant E. coli isolates were subjected to multiplex PCR for detection of ST131 of either O25b or O16 subgroups...
May 23, 2016: Microbial Drug Resistance: MDR: Mechanisms, Epidemiology, and Disease
Noha El Sakka, Ian M Gould
INTRODUCTION: Urinary tract infection (UTI) is a common infection worldwide. The increase in multidrug resistance together with the paucity of new antibiotics highlights the need for alternative antimicrobials for management of UTI. Among which are older antimicrobials that had been used in the past and now were stopped. AREAS COVERED: In this article, we examine the evidence in literature for the value of use of various antimicrobial agents in UTI. We conducted systematic Pubmed search and journal literature review including early research work on older agents addressed in relation to recent clinical data...
August 2016: Expert Review of Clinical Pharmacology
Chien-Yu Cheng, Chien-Yu Lee, Min-Wen Wu, Chen-Hung Chang, Wan-Ying Huang, Yi-Fen Chuang, Pei-Hsin Tang, Shu-Hsing Cheng
INTRODUCTION: Although a prospective antimicrobial audit and feedback is an effective strategy in an antibiotic stewardship program, previous researchers have not adequately demonstrated a successful impact on patient outcomes. In this study, the causes of fatalities associated with a prospective antimicrobial audit and feedback were analyzed. METHODOLOGY: Between June and September 2014, applications for 16 target parenteral formulas (including ceftriaxone, ceftazidime, cefepime, piperacillin/tazobactam, vancomycin, teicoplanin, ertapenem, imipenem/cilastatin, meropenem, levofloxacin, moxifloxacin, ciprofloxacin, tigecycline, linezolid, daptomycin, and amikacin), which were not approved by infectious diseases (ID) specialists, were followed up until patients were either discharged or passed away...
2016: Journal of Infection in Developing Countries
Rose-Marie Scarlato, Michelle M Dowsey, Kirsty L Buising, Peter F M Choong, Trisha N Peel
BACKGROUND: Antimicrobial prophylaxis at the time of urinary catheter insertion and removal is commonly administered in patients undergoing joint arthroplasty, despite the lack of evidence to support this practice. The rationale is the theoretical risk of prosthetic joint infection arising from bacterial seeding from the urinary tract at the time of catheterization. In an era of antimicrobial stewardship, further assessment is warranted. METHODS: This study aimed to investigate the incidence of catheter-associated (CA) bacteriuria and bacteraemia in patients undergoing total joint arthroplasty and to assess the antimicrobial susceptibility of any isolated microorganisms...
April 20, 2016: ANZ Journal of Surgery
David van Duin, Robert A Bonomo
Ceftolozane/tazobactam and ceftazidime/avibactam are 2 novel β-lactam/β-lactamase combination antibiotics. The antimicrobial spectrum of activity of these antibiotics includes multidrug-resistant (MDR) gram-negative bacteria (GNB), including Pseudomonas aeruginosa. Ceftazidime/avibactam is also active against carbapenem-resistant Enterobacteriaceae that produce Klebsiella pneumoniae carbapenemases. However, avibactam does not inactivate metallo-β-lactamases such as New Delhi metallo-β-lactamases. Both ceftolozane/tazobactam and ceftazidime/avibactam are only available as intravenous formulations and are dosed 3 times daily in patients with normal renal function...
July 15, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Tomasz A Leski, Chris R Taitt, Umaru Bangura, Michael G Stockelman, Rashid Ansumana, William H Cooper, David A Stenger, Gary J Vora
BACKGROUND: The rising level of antimicrobial resistance among bacterial pathogens is one of the most significant public health problems globally. While the antibiotic resistance of clinically important bacteria is closely tracked in many developed countries, the types and levels of resistance and multidrug resistance (MDR) among pathogens currently circulating in most countries of sub-Saharan Africa are virtually unknown. METHODS: From December 2013 to April 2014, we collected 93 urine specimens from all outpatients showing symptoms of urinary tract infection (UTI) and 189 fomite swabs from a small hospital in Bo, Sierra Leone...
2016: BMC Infectious Diseases
Lilian M Abbo, Thomas M Hooton
Urinary tract infections are the most common bacterial infections encountered in ambulatory and long-term care settings in the United States. Urine samples are the largest single category of specimens received by most microbiology laboratories and many such cultures are collected from patients who have no or questionable urinary symptoms. Unfortunately, antimicrobials are often prescribed inappropriately in such patients. Antimicrobial use, whether appropriate or inappropriate, is associated with the selection for antimicrobial-resistant organisms colonizing or infecting the urinary tract...
2014: Antibiotics
Ann E Stapleton
Acute uncomplicated urinary tract infection (UTI) is a common clinical problem, accounting for millions of outpatient visits in the USA annually. Although routinely obtaining urine cultures in UTI is not recommended, there are circumstances in which obtaining a pre-therapy culture may be warranted or chosen by clinicians, such as when indicated by the need for careful antimicrobial stewardship. This review focuses on understanding reasons for obtaining a pre-therapy culture, methods of collection, and appropriately interpreting urine culture data...
May 2016: Current Infectious Disease Reports
Lindsey M Weiner, Scott K Fridkin, Zuleika Aponte-Torres, Lacey Avery, Nicole Coffin, Margaret A Dudeck, Jonathan R Edwards, John A Jernigan, Rebecca Konnor, Minn M Soe, Kelly Peterson, L Clifford McDonald
BACKGROUND: Health care-associated antibiotic-resistant (AR) infections increase patient morbidity and mortality and might be impossible to successfully treat with any antibiotic. CDC assessed health care-associated infections (HAI), including Clostridium difficile infections (CDI), and the role of six AR bacteria of highest concern nationwide in several types of health care facilities. METHODS: During 2014, approximately 4,000 short-term acute care hospitals, 501 long-term acute care hospitals, and 1,135 inpatient rehabilitation facilities in all 50 states reported data on specific infections to the National Healthcare Safety Network...
March 11, 2016: MMWR. Morbidity and Mortality Weekly Report
Lucretia C Davis, Robin B Covey, Jaye S Weston, Bee Bee Y Hu, Gregory A Laine
PURPOSE: A pharmacist-driven antimicrobial optimization service in the non-trauma emergency department (ED) of an 864-bed non-profit tertiary care teaching hospital was reviewed to assess its value. Local antimicrobial resistance patterns of urine, wound, stool, and blood cultures were also studied to determine whether or not empiric prescribing practices should be modified. METHODS: A retrospective electronic chart review was performed for ED patients with positive cultures during two different three-month periods...
March 1, 2016: American Journal of Health-system Pharmacy: AJHP
Joshua R Watson, Pablo J Sánchez, John David Spencer, Daniel M Cohen, David S Hains
OBJECTIVES: The aims of this study were to assess empiric antibiotic use for presumed urinary tract infection (UTI) in the emergency department (ED) and to determine how often urine culture results subsequently do not confirm the diagnosis. METHODS: This study is a retrospective cohort study of patients aged 21 years or younger in the Nationwide Children's Hospital ED from May 1, 2012, to October 31, 2012, who had a urinalysis and urine culture performed and were discharged home with empiric antibiotic therapy for presumed UTI...
February 6, 2016: Pediatric Emergency Care
Mia Yang, Karen Vleck, Michele Bellantoni, Geeta Sood
BACKGROUND: Multidrug-resistant organisms are an emerging and serious threat to the care of patients. Long-term care facilities are considered a reservoir of these organisms partly because of the over-prescribing of antibiotics. Antibiotic use is common in long-term care facilities. Antibiotic stewardship programs have been shown to reduce antibiotic consumption in acute-care facilities. The purpose of our study is to investigate existing infection-control practices and antibiotic stewardship programs in long-term care facilities in Maryland...
June 1, 2016: Journal of the American Medical Directors Association
Tommaso Cai, Sandra Mazzoli, Paolo Lanzafame, Patrizio Caciagli, Gianni Malossini, Gabriella Nesi, Florian M E Wagenlehner, Bela Köves, Robert Pickard, Magnus Grabe, Truls E Bjerklund Johansen, Riccardo Bartoletti
Asymptomatic bacteriuria (ABU) is a common clinical condition that often leads to unnecessary antimicrobial use. The reduction of antibiotic overuse for ABU is consequently an important issue for antimicrobial stewardship and to reduce the emergence of multidrug resistant strains. There are two issues in everyday urological practice that require special attention: the role of ABU in pre-operative prophylaxis and in women affected by recurrent urinary tract infections (rUTIs). Nowadays, this is the time to think over our practice and change our way of thinking...
January 5, 2016: Pathogens
Romney M Humphries, Jennifer Dien Bard
Urinary tract infections (UTIs) are frequent and lead to a large number of clinical encounters. A common management strategy for patients suspected of having a urinary tract infection is to test for pyuria and bacteria by urine analysis (UA) of midstream urine, with initiation of antibiotic therapy and urine culture if one or both tests are positive. Although this practice was first used in an outpatient setting with midstream urine samples, some institutions allow its use in the management of catheterized patients...
February 2016: Journal of Clinical Microbiology
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