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Pneumonia and antimicrobial stewardship

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https://www.readbyqxmd.com/read/29740931/antimicrobial-prescription-in-patients-dying-from-chronic-obstructive-pulmonary-disease
#1
John Taverner, Lauren Ross, Claire Bartlett, M Luthe, J Ong, Louis Irving, Natasha Smallwood
INTRODUCTION: Despite rising antimicrobial resistance, treatment guidelines for COPD exacerbations are frequently ignored. Patients with terminal conditions are often prescribed antimicrobials despite the goal of care to reduce burdensome treatments. The appropriateness of antimicrobials in patients dying from an exacerbation of COPD is unknown. AIM: To review antimicrobial prescription at the time of death in patients who died from COPD. METHODS: A retrospective medical record audit was performed for 475 patients who died over twelve years (2004-2015)...
May 9, 2018: Internal Medicine Journal
https://www.readbyqxmd.com/read/29707660/changes-in-the-incidence-and-antimicrobial-susceptibility-of-healthcare-associated-infections-in-a-new-york-hospital-system-2006-2012
#2
B Cohen, J Liu, E Larson
Introduction: National efforts to curtail healthcare-associated infections (HAI) proliferated recently, though data detailing progress over time are limited. This retrospective cohort study aims to describe changes in incidence and antimicrobial susceptibility of HAI in four New York City hospitals over seven years. Methods: Electronic data were collected retrospectively for all patients discharged from 2006 through 2012. Previously validated computerized algorithms based on National Healthcare Safety Network criteria detected bloodstream infections, pneumonia, surgical site infections, and urinary tract infections with Enterococcus spp...
December 2017: Journal of Preventive Medicine and Hygiene
https://www.readbyqxmd.com/read/29679383/shortened-courses-of-antibiotics-for-bacterial-infections-a-systematic-review-of-randomized-controlled-trials
#3
Alexandra M Hanretty, Jason C Gallagher
BACKGROUND: Commonly prescribed durations of therapy for many, if not most, bacterial infections are not evidence-based. Misunderstandings by clinicians and patients alike influence perspectives on antibiotic use, including duration of therapy and its role in antibiotic resistance. OBJECTIVE: To demonstrate that shorter durations of antibiotic therapy are as efficacious as longer durations for many infections. DATA SOURCES: A systematic review of English language articles using PubMed were identified for inclusion...
April 20, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29669956/nosocomial-pneumonia-search-for-an-empiric-and-effective-antibiotic-regimen-in-high-burden-tertiary-care-centre
#4
Nitin Gupta, Manish Soneja, Yogiraj Ray, Monalisa Sahu, Kutty Sharada Vinod, Arti Kapil, Ashutosh Biswas, Naveet Wig, Rita Sood
The clinical practice guidelines on nosocomial pneumonia recommends an empirical regimen that would work in 95% of the patients based on the local antibiogram. The aim of the study was development of an antibiogram for guiding empiric therapy in settings with high prevalence of multi-drug resistant organisms. A retrospective review of electronic health records (e-hospital portal) was done to analyze all respiratory isolates from patients admitted in medical wards and intensive care unit between May 2016 and May 2017...
April 17, 2018: Drug Discoveries & Therapeutics
https://www.readbyqxmd.com/read/29659885/results-from-the-survey-of-antibiotic-resistance-soar-2014-16-in-ukraine-and-the-slovak-republic
#5
D Torumkuney, T Pertseva, E Bratus, A Dziublik, V Yachnyk, A Liskova, O Sopko, K Malynovska, I Morrissey
Objectives: To determine antibiotic susceptibility in isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2014-16 from Ukraine and the Slovak Republic. Methods: MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results: S. pneumoniae isolates collected in Ukraine (n = 100) showed susceptibility rates ≥97% for amoxicillin, amoxicillin/clavulanic acid, penicillin [intravenous (iv) non-meningitis] and fluoroquinolones, between 83% and 86% for oral penicillin, macrolides and cefaclor, and 75% for trimethoprim/sulfamethoxazole...
April 1, 2018: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29605887/delafloxacin-place-in-therapy-and-review-of-microbiologic-clinical-and-pharmacologic-properties
#6
REVIEW
Sarah C J Jorgensen, Nicholas J Mercuro, Susan L Davis, Michael J Rybak
Delafloxacin (formerly WQ-3034, ABT492, RX-3341) is a novel fluoroquinolone chemically distinct from currently marketed fluoroquinolones with the absence of a protonatable substituent conferring a weakly acidic character to the molecule. This property results in increased intracellular penetration and enhanced bactericidal activity under acidic conditions that characterize the infectious milieu at a number of sites. The enhanced potency and penetration in low pH environments contrast what has been observed for other zwitterionic fluoroquinolones, which tend to lose antibacterial potency under acidic conditions, and may be particularly advantageous against methicillin-resistant Staphylococcus aureus, for which the significance of the intracellular mode of survival is increasingly being recognized...
March 31, 2018: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/29534629/use-of-an-anti-infective-medication-review-process-at-hospital-discharge-to-identify-medication-errors-and-optimize-therapy
#7
Christy P Su, Levita Hidayat, Shafiqur Rahman, Veena Venugopalan
BACKGROUND: Medication reconciliation is a major patient safety concern, and the impact of a structured process to evaluate anti-infective agents at hospital discharge warrants further review. OBJECTIVE: The aim of this study was to (1) describe a structured, multidisciplinary approach to review anti-infectives at discharge and (2) measure the impact of a stewardship-initiated antimicrobial review process in identifying and preventing anti-infective-related medication errors (MEs) at discharge...
January 1, 2018: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29511909/resistance-trends-and-treatment-options-in-gram-negative-ventilator-associated-pneumonia
#8
REVIEW
Nathaniel J Rhodes, Caroline E Cruce, J Nicholas O'Donnell, Richard G Wunderink, Alan R Hauser
PURPOSE OF REVIEW: Hospital-acquired and ventilator-associated pneumonia (VAP) are frequent causes of infection among critically ill patients. VAP is the most common hospital-acquired bacterial infection among mechanically ventilated patients. Unfortunately, many of the nosocomial Gram-negative bacteria that cause VAP are increasingly difficult to treat. Additionally, the evolution and dissemination of multi- and pan-drug resistant strains leave clinicians with few treatment options. VAP patients represent a dynamic population at risk for antibiotic failure and under-dosing due to altered antibiotic pharmacokinetic parameters...
March 6, 2018: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/29489898/effects-of-clinical-pathway-implementation-on-antibiotic-prescriptions-for-pediatric-community-acquired-pneumonia
#9
Daniele Donà, Silvia Zingarella, Andrea Gastaldi, Rebecca Lundin, Giorgio Perilongo, Anna Chiara Frigo, Rana F Hamdy, Theoklis Zaoutis, Liviana Da Dalt, Carlo Giaquinto
BACKGROUND: Italian pediatric antimicrobial prescription rates are among the highest in Europe. As a first step in an Antimicrobial Stewardship Program, we implemented a Clinical Pathway (CP) for Community Acquired Pneumonia with the aim of decreasing overall prescription of antibiotics, especially broad-spectrum. MATERIALS AND METHODS: The CP was implemented on 10/01/2015. We collected antibiotic prescribing and outcomes data from children aged 3 months-15 years diagnosed with CAP from 10/15/2014 to 04/15/2015 (pre-intervention period) and from 10/15/2015 to 04/15/2016 (post-intervention period)...
2018: PloS One
https://www.readbyqxmd.com/read/29483115/an-antibiotic-stewardship-program-blueprint-for-optimizing-verigene-bc-gn-within-an-institution-a-tale-of-two-cities
#10
Jason M Pogue, Emily L Heil, Paul Lephart, J Kristie Johnson, Ryan P Mynatt, Hossein Salimnia, Kimberly C Claeys
Rapid diagnostic tests (RDTs) have revolutionized the management of Gram-negative bacteremia by allowing antimicrobial stewardship teams the ability to escalate therapy and improve patient outcomes through timely organism identification and detection of certain resistance determinants. However, given the complex nature of Gram-negative resistance, stewardship teams are left without clear direction for how to respond when resistance determinants are absent, as the safety of de-escalation in this setting is unknown...
May 2018: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/29480032/current-and-future-treatment-options-for-community-associated-mrsa-infection
#11
A Khan, B Wilson, I M Gould
Community-associated MRSA (CA-MRSA) represents a global epidemic which beautifully encapsulates the fascinating ability of bacterial organisms to adapt quickly on an evolutionary basis to the extreme selective pressure of antibiotic exposure. In stark contrast to Healthcare-associated MRSA (HA-MRSA), it has become apparent that CA-MRSA is less straight forward of a challenge in terms of controlling its transmission, and has forced clinicians to adjust empiric management of clinical syndromes such as skin and soft tissue infection (SSTI) as well as pneumonia...
April 2018: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/29454592/effective-antimicrobial-stewardship-strategies-for-cost-effective-utilization-of-telavancin-for-the-treatment-of-patients-with-hospital-acquired-bacterial-pneumonia-caused-by-staphylococcus-aureus
#12
James A McKinnell, Shelby Corman, Dipen Patel, Grace H Leung, Lynne M Gordon, Thomas P Lodise
PURPOSE: Clinicians and stewardship programs are challenged with positioning of novel, higher priced antibiotic agents for the treatment of clinical infections. We developed a decision-analytic model to describe costs, including drug, total treatment costs, and health care outcomes, associated with telavancin (TLV) compared with vancomycin (VAN) for patients with Staphylococcus aureus (SA) hospital-acquired bacterial pneumonia (HABP). METHODS: This decision-analytic model assessed the treatment of SA-HABP with TLV versus VAN...
March 2018: Clinical Therapeutics
https://www.readbyqxmd.com/read/29449171/changes-in-antimicrobial-susceptibility-of-commonly-clinically-significant-isolates-before-and-after-the-interventions-on-surgical-prophylactic-antibiotics-spas-in-shanghai
#13
Su Wang, Li-Zhong Han, Yu-Xing Ni, Yi-Bo Zhang, Qun Wang, Da-Ke Shi, Wen-Hui Li, Yi-Chen Wang, Chen-Rong Mi
Surveillances and interventions on antibiotics use have been suggested to improve serious drug-resistance worldwide. Since 2007, our hospital have proposed many measures for regulating surgical prophylactic antibiotics (carbapenems, third gen. cephalosporins, vancomycin, etc.) prescribing practices, like formulary restriction or replacement for surgical prophylactic antibiotics and timely feedback. To assess the impacts on drug-resistance after interventions, we enrolled infected patients in 2006 (pre-intervention period) and 2014 (post-intervention period) in a tertiary hospital in Shanghai...
February 12, 2018: Brazilian Journal of Microbiology: [publication of the Brazilian Society for Microbiology]
https://www.readbyqxmd.com/read/29438527/effects-of-hospital-practice-patterns-for-antibiotic-administration-for-pneumonia-on-hospital-lengths-of-stay-and-costs
#14
Eric W Christensen, Alicen Burns Spaulding, William F Pomputius, Steven P Grapentine
Background: Hospital practice patterns vary for switching from intravenous to oral antibiotics for community-acquired pneumonia in pediatric patients, but it is unknown how these practice patterns affect hospital lengths of stay and costs. Methods: We conducted a retrospective study of 78673 pediatric patients (aged 3 months to 17 years) hospitalized for community-acquired pneumonia. Analyses were performed with data from the Pediatric Health Information System between 2007 and 2016, including discharge data from 48 freestanding children's hospitals...
February 8, 2018: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/29434387/antimicrobial-utilization-pattern-in-pediatric-patients-in-tertiary-care-hospital-eastern-ethiopia-the-need-for-antimicrobial-stewardship
#15
Samuel Girma, Mekonnen Sisay, Getnet Mengistu, Firehiwot Amare, Dumessa Edessa
Background: Antimicrobials are among the most frequently prescribed medications for pediatric patients. However, inappropriate use of them can increase morbidity, mortality, healthcare costs, and largely antimicrobial resistance. This study aims to assess the antimicrobial utilization pattern in the pediatric ward of Hiwot Fana Specialized University Hospital. Methods: Retrospective cross-sectional study was conducted to assess the antimicrobial utilization. In this study, 403 pediatric medical records selected by systematic random sampling were reviewed...
February 2018: Hospital Pharmacy
https://www.readbyqxmd.com/read/29429440/neonatal-and-paediatric-bloodstream-infections-pathogens-antimicrobial-resistance-patterns-and-prescribing-practice-at-khayelitsha-district-hospital-cape-town-south-africa
#16
H Crichton, N O'Connell, H Rabie, A C Whitelaw, A Dramowski
BACKGROUND: The epidemiology of neonatal and paediatric community-acquired and healthcare-associated bloodstream infections (BSI) at South African (SA) district hospitals is under-researched. OBJECTIVE: Retrospective review of neonatal and paediatric BSI (0 - 13 years) at Khayelitsha District Hospital, Cape Town, SA, over 3 years (1 March 2012 - 28 February 2015). METHODS: We used laboratory, hospital, patient and prescription data to determine BSI rates, blood culture yield and contamination rates, pathogen profile, antimicrobial resistance, patient demographics, BSI outcome and antibiotic prescribing practice...
February 1, 2018: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/29423923/stewardship-opportunities-in-viral-pneumonia-why-not-the-immunocompromised
#17
Nicholas J Mercuro, Rachel M Kenney, Linoj Samuel, Robert J Tibbetts, George J Alangaden, Susan L Davis
Antimicrobial management of viral pneumonia has proven to be a challenge in hospitalized immunocompromised patients. A host of factors contribute to the dilemma, such as diagnostic uncertainty, lack of organism identification, and clinical status of the patient. Respiratory virus panel (RVP) use was compared between 131 immunocompromised patients who received send-out (n = 56) vs in-house (n = 75) testing. Antimicrobial optimization interventions consisted of antiviral addition/discontinuation, antibiotic discontinuation/de-escalation, or modification of immunosuppressive regimen...
April 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/29410253/global-forecast-of-antimicrobial-resistance-in-invasive-isolates-of-escherichia-coli-and-klebsiella-pneumoniae
#18
Gerardo Alvarez-Uria, Sumanth Gandra, Siddhartha Mandal, Ramanan Laxminarayan
OBJECTIVES: To project future antimicrobial resistance (AMR) in Escherichia coli and Klebsiella pneumoniae. METHODS: Mixed linear models were constructed from a sample of countries with AMR data in the ResistanceMap database. Inverse probability weighting methods were used to account for countries without AMR data. RESULTS: The estimated prevalence of AMR in 2015 was 64.5% (95% confidence interval (CI) 42-87%) for third-generation cephalosporin-resistant (3GCR) Escherichia coli, 5...
March 2018: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/29401338/a-tertiary-care-center-s-experience-with-novel-molecular-meningitis-encephalitis-diagnostics-and-implementation-with-antimicrobial-stewardship
#19
David Chang, Jason F Okulicz, Lindsey E Nielsen, Brian K White
Background: Novel molecular techniques, such as the Biofire FilmArray Meningitis/Encephalitis (ME) panel, are increasingly used to improve pathogen detection and time to detection (TtD). The Brooke Army Medical Center antibiotic stewardship program evaluated the impact of the ME panel on empiric antimicrobial usage. Methods: Negative ME panels were analyzed for days of therapy (DOT). The ME panel became available at Brooke Army Medical Center on January 1, 2016 and a retrospective chart review was performed on all hospitalized patients tested by ME panel through April 30, 2016...
January 1, 2018: Military Medicine
https://www.readbyqxmd.com/read/29340593/the-clinical-utility-of-methicillin-resistant-staphylococcus-aureus-mrsa-nasal-screening-to-rule-out-mrsa-pneumonia-a-diagnostic-meta-analysis-with-antimicrobial-stewardship-implications
#20
Diane M Parente, Cheston B Cunha, Eleftherios Mylonakis, Tristan T Timbrook
Background: Recent literature has highlighted MRSA nasal screening as a possible antimicrobial stewardship program (ASP) tool for avoiding unnecessary empiric MRSA therapy for pneumonia, yet current guidelines recommend MRSA therapy based on risk factors. The objective of this meta-analysis was to evaluate the diagnostic value of MRSA nasal screening in MRSA pneumonia. Methods: Pubmed and EMBASE were searched from inception to November 2016 for English studies evaluating MRSA nasal screening and development of MRSA pneumonia...
January 11, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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