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Pneumonia and antimicrobial stewardship

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https://www.readbyqxmd.com/read/28526309/antimicrobial-stewardship-for-hospitalized-patients-with-viral-respiratory-tract-infections
#1
Christopher F Lowe, Michael Payne, David Puddicombe, Allison Mah, Davie Wong, Allison Kirkwood, Mark W Hull, Victor Leung
BACKGROUND: The purpose of this study was to implement a targeted antimicrobial stewardship intervention for patients with a viral respiratory tract infection. METHODS: This was a quasi-experimental before and after audit and feedback intervention of adult inpatients with a positive polymerase chain reaction for a respiratory virus in 2 acute care hospitals in Vancouver, Canada. Audit and feedback was implemented based on 2 criteria: microbiology (no positive bacterial cultures) and chest imaging (absence of pneumonia or consolidation on radiology dictation)...
May 16, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28524255/enablers-and-barriers-to-the-use-of-antibiotic-guidelines-in-the-assessment-and-treatment-of-community-acquired-pneumonia-a-qualitative-study-of-clinicians-perspectives
#2
Antoine Sedrak, Mahesan Anpalahan, Karen Luetsch
BACKGROUND: Community-acquired pneumonia (CAP) is a common condition and a number of guidelines have been developed for its assessment and treatment. Adherence to guidelines by clinicians varies and particularly the prescribing of antibiotics often remains suboptimal. OBJECTIVE: The aim of this study was to elucidate potential barriers and enablers to the adherence to antibiotic guidelines by clinicians treating CAP in an Australian hospital. METHODS: Semi-structured interviews were conducted with purposively recruited senior prescribers who regularly treat CAP in an Australian hospital...
May 19, 2017: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/28503879/impact-of-an-antimicrobial-stewardship-intervention-on-appropriateness-of-prescribing-for-community-acquired-pneumonia-in-an-australian-regional-hospital
#3
Stuart E Bond, Craig S Boutlis, Wilfred W Yeo, Spiros Miyakis
Community-acquired pneumonia (CAP) is the second commonest indication for antibiotic use in Australian hospitals and is therefore a frequent target for antimicrobial stewardship. A single-centre prospective study was conducted in a regional referral hospital comparing management of adult patients with CAP before and after an educational intervention. We demonstrated a reduction in duration of therapy and reduced inappropriate use of ceftriaxone-based regimens for non-severe CAP.
May 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28485087/impact-of-an-antimicrobial-stewardship-programme-on-antibiotic-usage-and-resistance-in-a-tertiary-hospital-in-china
#4
Z-G Zhang, F Chen, Y Ou
WHAT IS KNOWN AND OBJECTIVE: Antimicrobial misuse has been commonly observed in China. This phenomenon can cause antibiotic resistance. This study was designed to evaluate the impact of an antimicrobial stewardship programme implemented in a tertiary hospital in China from 2011 to 2014. METHODS: The antimicrobial stewardship programme began in 2011. Data on the consumption of antibiotics and antimicrobial resistance between 2011 and 2014 were collected. RESULTS: Comparison of the 2011 data with those of 2014 showed that antibiotic defined daily doses/per 100 patient-days decreased from 92...
May 8, 2017: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/28480242/outcomes-associated-with-antimicrobial-de-escalation-of-treatment-for-pneumonia-within-the-veterans-healthcare-administration
#5
Jefferson G Bohan, Richard Remington, Makoto Jones, Matthew Samore, Karl Madaras-Kelly
De-escalation, an antimicrobial stewardship concept, involves narrowing broad-spectrum empiric antimicrobial therapy based on clinical data. Current health outcomes evidence is lacking to support de-escalation. Studying Veterans Healthcare Administration pneumonia patients, de-escalation was associated with improved length of stay without affecting 30-day readmission or 30-day Clostridium difficile infection rates.
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/28475792/clinical-and-molecular-epidemiology-of-carbapenem-resistant-enterobacteriaceae-among-adult-inpatients-in-singapore
#6
Kalisvar Marimuthu, Indumathi Venkatachalam, Wei Xin Khong, Tse Hsien Koh, Benjamin Pei Zhi Cherng, My Van La, Partha Pratim De, Prabha Unny Krishnan, Thean Yen Tan, Raymond Fong Kok Choon, Surinder Kaur Pada, Choong Weng Lam, Say Tat Ooi, Rama Narayana Deepak, Nares Smitasin, Eng Lee Tan, Jia Jun Lee, Asok Kurup, Barnaby Young, Nancy Tee Wen Sim, Koh Cheng Thoon, Dale Fisher, Moi Lin Ling, Brenda Ang Sze Peng, Yik-Ying Teo, Li Yang Hsu, Raymond Tzer Pin Lin, Rick Twee-Hee Ong, Jeanette Teo, Oon Tek Ng
Background: Since 2010, the incidence of carbapenem-resistant Enterobacteriaceae (CRE) has been increasing in Singapore. We analyzed the clinical and molecular epidemiology of CRE among adult inpatients in Singapore. Methods: Quarterly incidence of unique subjects (per 100000 patient-days) with positive clinical and surveillance cultures for CRE were estimated based on mandatory data submitted to the National Public Health Laboratory by public hospitals between 2010 and 2015...
May 15, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28458799/the-use-of-bloodstream-infection-mortality-to-measure-the-impact-of-antimicrobial-stewardship-interventions-assessing-the-evidence
#7
REVIEW
Sonali Coulter, Jason A Roberts, Krispin Hajkowicz, Kate Halton
This review sets out to evaluate the current evidence on the impact of inappropriate therapy on bloodstream infections (BSI) and associated mortality. Based on the premise that better prescribing practices should result in better patient outcomes, BSI mortality may be a useful metric to evaluate antimicrobial stewardship (AMS) interventions. A systematic search was performed in key medical databases to identify papers published in English between 2005 and 2015 that examined the association between inappropriate prescribing and BSI mortality in adult patients...
March 30, 2017: Infectious Disease Reports
https://www.readbyqxmd.com/read/28431848/epidemiology-of-device-associated-infections-in-an-intensive-care-unit-of-a-teaching-hospital-in-nepal-a-prospective-surveillance-study-from-a-developing-country
#8
Narayan Prasad Parajuli, Subhash Prasad Acharya, Santosh Dahal, Jaya Prasad Singh, Shyam Kumar Mishra, Hari Prasad Kattel, Basista Prasad Rijal, Bharat Mani Pokhrel
BACKGROUND: Device-associated health care-acquired infections (DA-HAIs) in intensive care unit patients are a major cause of morbidity, mortality, and increased health care costs. METHODS: A prospective, structured clinicomicrobiological surveillance was carried out for 3 common DA-HAIs: ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) present in the patients of an intensive care unit of a teaching hospital in Nepal...
April 18, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28385463/clinical-and-social-barriers-to-antimicrobial-stewardship-in-pulmonary-medicine-a-qualitative-study
#9
Jennifer K Broom, Alex F Broom, Emma R Kirby, Alexandra F Gibson, Jeffrey J Post
BACKGROUND: The treatment of pulmonary infections is one of the largest indications for antibiotics in human health care, offering significant potential for antibiotic optimization internationally. This study explores the perspectives of pulmonary clinicians on antibiotic use in hospital pulmonary infections. METHODS: Twenty-eight pulmonary doctors and nurses from 2 hospitals participated in semi-structured interviews focusing on their experiences of antibiotic use...
April 3, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28384858/antimicrobial-resistance-surveillance-among-intensive-care-units-of-a-tertiary-care-hospital-in-southern-india
#10
Kailash Moolchandani, Apurba Sankar Sastry, R Deepashree, Sujatha Sistla, B N Harish, Jharna Mandal
INTRODUCTION: Hospital Acquired Infections (HAIs) are the rising threat in the health care facilities across the globe. As most Intesive Care Unit (ICU) patients are frequently on broad spectrum antimicrobials, this induces selective antibiotic pressure which leads to development of Antimicrobial Resistance (AMR) among the microorganisms of ICUs. AIM: To study the occurrence of different types of HAIs in patients admitted to various ICUs of JIPMER and the AMR pattern of the bacterial pathogens isolated from them...
February 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28345481/cost-effectiveness-analysis-of-implementing-an-antimicrobial-stewardship-program-in-critical-care-units
#11
Jesus Ruiz-Ramos, Juan Frasquet, Eva Romá, Jose Luis Poveda-Andres, Miguel Salavert-Leti, Alvaro Castellanos, Paula Ramirez
AIMS: To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting. MATERIALS AND METHODS: A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed...
April 13, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28339675/high-reported-rates-of-antimicrobial-resistance-in-indian-neonatal-and-pediatric-blood-stream-infections
#12
Dhanya Dharmapalan, Anita Shet, Vijay Yewale, Mike Sharland
Background.: There is real shortage of national data on antimicrobial resistance rates in Indian neonates and children. A descriptive review was conducted to determine the patterns of antimicrobial resistance in isolates of blood stream infection among hospitalized children in India. Methods.: Published and gray literature on antibiotic resistance in children was searched using "Google Scholar", "Scopus", and "PubMed" databases between January 2000 and July 2015...
February 18, 2017: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/28284685/identifying-priorities-to-improve-paediatric-in-hospital-antimicrobial-use-by-cross-sectional-evaluation-of-prevalence-and-appropriateness-of-prescription
#13
Walter Alfredo Goycochea-Valdivia, Francisco Moreno-Ramos, José Ramón Paño-Pardo, Francisco Javier Aracil-Santos, Fernando Baquero-Artigao, Teresa Del Rosal-Rabes, María José Mellado-Peña, Luis Escosa-García
INTRODUCTION: Information about paediatric in-hospital antimicrobial usage and prescribing patterns to guide improvement strategies is scant. We aim to use an evaluation of the prevalence and appropriateness of antimicrobial prescription to identify antimicrobial stewardship priorities in children. METHODS: A cross-sectional point study was performed on hospitalised paediatric patients in a Spanish tertiary hospital, assessing the prevalence of antimicrobial prescription (PAP) and appropriateness of antimicrobial prescription (AAP)...
March 8, 2017: Enfermedades Infecciosas y Microbiología Clínica
https://www.readbyqxmd.com/read/28270546/variability-in-antibiotic-prescribing-for-community-acquired-pneumonia
#14
Lori K Handy, Matthew Bryan, Jeffrey S Gerber, Theoklis Zaoutis, Kristen A Feemster
BACKGROUND AND OBJECTIVES: Published guidelines recommend amoxicillin for most children with community-acquired pneumonia (CAP), yet macrolides and broad-spectrum antibiotics are more commonly prescribed. We aimed to determine the patient and clinician characteristics associated with the prescription of amoxicillin versus macrolide or broad-spectrum antibiotics for CAP. METHODS: Retrospective cohort study in an outpatient pediatric primary care network from July 1, 2009 to June 30, 2013...
March 7, 2017: Pediatrics
https://www.readbyqxmd.com/read/28257317/pulmonary-infections-in-critical-intensive-care-rapid-diagnosis-and-optimizing-antimicrobial-usage
#15
Ivor S Douglas
PURPOSE OF REVIEW: Diagnosis of pulmonary infection, including hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in the critically ill patient remains a common and therapeutically challenging diagnosis with significant attributable morbidity, mortality, and cost. Current clinical approaches to surveillance, early detection and, conventional culture-based microbiology are inadequate for optimal targeted antibiotic treatment and stewardship. Efforts to enhance diagnosis of HAP and VAP and the impact of these novel approaches on rational antimicrobial selection and stewardship are the focus of recent studies reviewed here...
May 2017: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/28202493/a-klebsiella-pneumoniae-antibiotic-resistance-mechanism-that-subdues-host-defences-and-promotes-virulence
#16
Timothy J Kidd, Grant Mills, Joana Sá-Pessoa, Amy Dumigan, Christian G Frank, José L Insua, Rebecca Ingram, Laura Hobley, José A Bengoechea
Klebsiella pneumoniae is an important cause of multidrug-resistant infections worldwide. Recent studies highlight the emergence of multidrug-resistant K. pneumoniae strains which show resistance to colistin, a last-line antibiotic, arising from mutational inactivation of the mgrB regulatory gene. However, the precise molecular resistance mechanisms of mgrB-associated colistin resistance and its impact on virulence remain unclear. Here, we constructed an mgrB gene K. pneumoniae mutant and performed characterisation of its lipid A structure, polymyxin and antimicrobial peptide resistance, virulence and inflammatory responses upon infection...
April 2017: EMBO Molecular Medicine
https://www.readbyqxmd.com/read/28178922/risk-factors-for-excessively-prolonged-meropenem-use-in-the-intensive-care-setting-a-case-contol-study
#17
Juri Katchanov, Benno Kreuels, Florian P Maurer, Kai Wöstmann, Johannes Jochum, Christina König, Kariem Seoudy, Holger Rohde, Ansgar W Lohse, Dominic Wichmann, Michael Baehr, Camilla Rothe, Stefan Kluge
BACKGROUND: Inappropriate use of broad-spectrum antimicrobials affects adversely both the individual patient and the general public. The aim of the study was to identify patients at risk for excessively prolonged carbapenem treatment in the ICU as a target for antimicrobial stewardship interventions. METHODS: Case-control study in a network of 11 ICUs of a university hospital. Patients with uninterrupted meropenem therapy (MT) > 4 weeks were compared to controls...
February 8, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28173888/current-state-of-antimicrobial-stewardship-in-children-s-hospital-emergency-departments
#18
Rakesh D Mistry, Jason G Newland, Jeffrey S Gerber, Adam L Hersh, Larissa May, Sarah M Perman, Nathan Kuppermann, Peter S Dayan
BACKGROUND Antimicrobial stewardship programs (ASPs) effectively optimize antibiotic use for inpatients; however, the extent of emergency department (ED) involvement in ASPs has not been described. OBJECTIVE To determine current ED involvement in children's hospital ASPs and to assess beliefs and preferred methods of implementation for ED-based ASPs. METHODS A cross-sectional survey of 37 children's hospitals participating in the Sharing Antimicrobial Resistance Practices collaboration was conducted. Surveys were distributed to ASP leaders and ED medical directors at each institution...
February 8, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28160269/infections-in-cancer-patients-with-solid-tumors-a-review
#19
REVIEW
Kenneth V I Rolston
Solid tumors are much more common than hematologic malignancies. Although severe and prolonged neutropenia is uncommon, several factors increase the risk of infection in patients with solid tumors, and the presence of multiple risk factors in the same patient is not uncommon. These include obstruction (most often caused by progression of the tumor), disruption of natural anatomic barriers such as the skin and mucosal surfaces, and treatment-related factors such as chemotherapy, radiation, diagnostic and/or therapeutic surgical procedures, and the increasing use of medical devices such as various catheters, stents, and prostheses...
March 2017: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/28159174/antimicrobial-therapy-for-legionnaire-s-disease-antibiotic-stewardship-implications
#20
REVIEW
Cheston B Cunha, Burke A Cunha
Legionnaire's disease is a common cause of community-acquired pneumonia (CAP). Although no single clinical feature is diagnostic, if characteristic extrapulmonary findings are present a presumptive clinical syndromic diagnosis is possible. Depending on geographic location, season, and physician awareness, Legionnaire's disease may be included in the differential diagnosis of CAP. Some antibiotics effective against Legionella sp are also effective in treating the typical bacterial causes of CAP. From an antimicrobial stewardship program (ASP) perspective, monotherapy is preferred to double-drug therapy...
March 2017: Infectious Disease Clinics of North America
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