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Pneumonia and antimicrobial stewardship

Lori Rutman, Davene R Wright, James OʼCallaghan, Suzanne Spencer, K Casey Lion, Matthew P Kronman, Chuan Zhou, Rita Mangione-Smith
OBJECTIVE: In September 2012, our institution implemented an emergency department (ED) and inpatient pathway for community-acquired pneumonia (CAP) based on national guideline recommendations. The objective of this study was to determine the relationship between standardizing ED and inpatient care for CAP and antimicrobial stewardship, clinical testing, and cost. METHODS: We used descriptive statistics, statistical process control, and interrupted time series analysis to analyze measures 12 months before and after implementation...
November 1, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
Elizabeth A Neuner, Andrea M Pallotta, Simon W Lam, David Stowe, Steven M Gordon, Gary W Procop, Sandra S Richter
OBJECTIVE To describe the impact of rapid diagnostic microarray technology and antimicrobial stewardship for patients with Gram-positive blood cultures. DESIGN Retrospective pre-intervention/post-intervention study. SETTING A 1,200-bed academic medical center. PATIENTS Inpatients with blood cultures positive for Staphylococcus aureus, Enterococcus faecalis, E. faecium, Streptococcus pneumoniae, S. pyogenes, S. agalactiae, S. anginosus, Streptococcus spp., and Listeria monocytogenes during the 6 months before and after implementation of Verigene Gram-positive blood culture microarray (BC-GP) with an antimicrobial stewardship intervention...
November 2016: Infection Control and Hospital Epidemiology
Sara Tedeschi, Filippo Trapani, Maddalena Giannella, Francesco Cristini, Fabio Tumietto, Michele Bartoletti, Annalisa Liverani, Salvatore Pignanelli, Luisa Toni, Roberto Pederzini, Augusto Cavina, Pierluigi Viale
OBJECTIVE To assess the impact of an antimicrobial stewardship program (ASP) on antibiotic consumption, Clostridium difficile infections (CDI), and antimicrobial resistance patterns in a rehabilitation hospital. DESIGN Quasi-experimental study of the periods before (from January 2011 to June 2012) and after (from July 2012 to December 2014) ASP implementation. SETTING 150-bed rehabilitation hospital dedicated to patients with spinal-cord injuries. INTERVENTION Beginning in July 2012, an ASP was implemented based on systematic bedside infectious disease (ID) consultation and structural interventions (ie, revision of protocols for antibiotic prophylaxis and education focused on the appropriateness of antibiotic prescriptions)...
October 17, 2016: Infection Control and Hospital Epidemiology
Rossana Rosa, Jacques Simkins, Jose F Camargo, Octavio Martinez, Lilian M Abbo
OBJECTIVES: We aimed to compare the antimicrobial susceptibility percentages in blood and urine bacterial isolates recovered from solid organ transplant (SOT) recipients with those reported in the hospital-wide antibiogram. METHODS: Retrospective review of the antimicrobial susceptibilities of bacterial isolates recovered from SOT recipients at a 1550-bed hospital over a 2-year period. Antibiograms were categorized by anatomic site (blood and urine). Percentage of bacterial susceptibilities to specific antibiotics were compared with the hospital-wide antibiogram...
August 26, 2016: Diagnostic Microbiology and Infectious Disease
G Kampf
Chlorhexidine digluconate (CHG) is an antimicrobial agent used for different types of applications in hand hygiene, skin antisepsis, oral care, and patient washing. Increasing use raises concern regarding development of acquired bacterial resistance. Published data from clinical isolates with CHG minimum inhibitory concentrations (MICs) were reviewed and compared to epidemiological cut-off values to determine resistance. CHG resistance is rarely found in Escherichia coli, Salmonella spp., Staphylococcus aureus or coagulase-negative staphylococci...
August 26, 2016: Journal of Hospital Infection
Consuelo Velázquez-Acosta, Patricia Cornejo-Juárez, Patricia Volkow-Fernández
OBJECTIVE: To describe the incidence and patterns of bacterial resistance in urine samples from a tertiary care oncology hospital in Mexico, from 2004 to 2013. MATERIALS AND METHODS: We included the strains obtained from urine cultures, describing separately multidrug-resistant (MDR) bacteria. We analyzed the susceptibility to different antibiotics. RESULTS: 51 202 urine cultures were processed during the study; 14 480 (28.3%) cultures were positive...
August 2016: Salud Pública de México
Sumanth Gandra, Nestor Mojica, Eili Y Klein, Ashvin Ashok, Vidya Nerurkar, Mamta Kumari, Uma Ramesh, Sunanda Dey, Viral Vadwai, Bibhu R Das, Ramanan Laxminarayan
OBJECTIVE: There have been no long-term studies on trends in antibiotic resistance (ABR) on a national scale in India. Using a private laboratory network, the ABR patterns of organisms most commonly associated with bacteremia, obtained from patients across India between 2008 and 2014, were examined. METHODS: A retrospective study of patient blood cultures collected over a 7-year period (January 1, 2008-December 31, 2014) was conducted. Data on the microorganism(s) identified and their antimicrobial susceptibility were obtained from SRL Diagnostics (Mumbai, India)...
September 2016: International Journal of Infectious Diseases: IJID
Cheston B Cunha
No abstract text is available yet for this article.
September 2016: Infection Control and Hospital Epidemiology
Thomas P Hellyer, Niall H Anderson, Jennie Parker, Paul Dark, Tina Van Den Broeck, Suveer Singh, Ronan McMullan, Ashley M Agus, Lydia M Emerson, Bronagh Blackwood, Savita Gossain, Tim S Walsh, Gavin D Perkins, Andrew Conway Morris, Daniel F McAuley, A John Simpson
BACKGROUND: Ventilator-acquired pneumonia (VAP) is a common reason for antimicrobial therapy in the intensive care unit (ICU). Biomarker-based diagnostics could improve antimicrobial stewardship through rapid exclusion of VAP. Bronchoalveloar lavage (BAL) fluid biomarkers have previously been shown to allow the exclusion of VAP with high confidence. METHODS/DESIGN: This is a prospective, multi-centre, randomised, controlled trial to determine whether a rapid biomarker-based exclusion of VAP results in fewer antibiotics and improved antimicrobial management...
2016: Trials
A Mothes, S Léotard, I Nicolle, A Smets, D Chirio, C Rotomondo, F Tiger, P Del Giudice, C Perrin, D Néri, C Foucault, M Della Guardia, H Hyvernat, P-M Roger
BACKGROUND: The use of rapid microbiological tests is supported by antimicrobial stewardship policies. Targeted antibiotic therapy (TAT) for community-acquired pneumonia (CAP) with positive urinary antigen test (UAT) has been associated with a favorable impact on outcome. We aimed to determine the factors associated with TAT prescription. PATIENTS AND METHODS: We conducted a retrospective multicenter study including all patients presenting with CAP and positive UAT for Streptococcus pneumoniae or Legionella pneumophila from January 2010 to December 2013...
July 1, 2016: Médecine et Maladies Infectieuses
Kari E Kurtzhalts, John A Sellick, Christine A Ruh, James F Carbo, Michael C Ott, Kari A Mergenhagen
PURPOSE: The purpose of this study was to evaluate the impact of an antimicrobial stewardship program (ASP) on outcomes for inpatients with pneumonia, including length of stay, treatment duration, and 30-day readmission rates. METHODS: A retrospective chart review comparing outcomes of veterans admitted with pneumonia before (2005-2006) and after (2013-2014) implementation of an ASP was conducted; pneumonia was defined according to International Classification of Diseases, Ninth Revision (ICD-9) codes...
July 2016: Clinical Therapeutics
Heather C Yun, Clinton K Murray
Up to 50% of combat injured patients from recent conflicts have suffered infectious complications, predominantly with multidrug-resistant (MDR) bacteria acquired nosocomially in the chain of tactical combat casualty care. These bacteria have ranged from MDR Acinetobacter baumannii-calcoaceticus associated with Operation Iraqi Freedom (OIF), to extended spectrum beta-lactamase producing Enterobacteriaceae from operations in Afghanistan. Experience from interventions at Level III facilities demonstrate that basic infection control (IC) procedures, such as improvements in hand hygiene, use of ventilator associated pneumonia bundles, and antimicrobial stewardship, can improve outcomes even in austere environments...
April 2016: U.S. Army Medical Department Journal
Danielle M Zerr, Arianna Miles-Jay, Matthew P Kronman, Chuan Zhou, Amanda L Adler, Wren Haaland, Scott J Weissman, Alexis Elward, Jason G Newland, Theoklis Zaoutis, Xuan Qin
The objective of this study was to determine whether antibiotic exposure is associated with extended-spectrum-beta-lactamase- or AmpC-producing Escherichia coli or Klebsiella pneumoniae infections in children. We collected extended-spectrum-beta-lactamase- or AmpC-producing E. coli or K. pneumoniae isolates and same-species susceptible controls from normally sterile sites of patients aged ≤21 years, along with associated clinical data, at four free-standing pediatric centers. After controlling for potential confounders, the relative risk of having an extended-spectrum-beta-lactamase-producing isolate rather than a susceptible isolate was 2...
July 2016: Antimicrobial Agents and Chemotherapy
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
Christopher D Walker, Shivanjali Shankaran
Infections caused by carbapenemase-producing Klebsiella pneumoniae resistant to tigecycline, colistin, or aminoglycosides are a growing health concern. In our retrospective chart review, we noted increased resistance to colistin compared with tigecycline, despite limited prior use of colistin. This may affect the choice of presumptive antibiotics used in these hard to treat infections. Improved infection control and antimicrobial stewardship practices are essential to prevent the spread of these multidrug-resistant organisms...
September 1, 2016: American Journal of Infection Control
Jeremy R Huddy, Melody Z Ni, James Barlow, Azeem Majeed, George B Hanna
OBJECTIVES: Point-of-care (POC) C reactive protein (CRP) is incorporated in National Institute of Health and Care Excellence (NICE) guidelines for the diagnosis of pneumonia, reduces antibiotic prescribing and is cost effective. AIM: To determine the barriers and facilitators to adoption of POC CRP testing in National Health Service (NHS) primary care for the diagnosis of lower respiratory tract infection. DESIGN: The study followed a qualitative methodology based on grounded theory...
March 3, 2016: BMJ Open
Giulio DiDiodato, Leslie McArthur, Joseph Beyene, Marek Smieja, Lehana Thabane
BACKGROUND: The purpose of this study was to demonstrate an antimicrobial stewardship intervention can reduce length of stay for patients admitted to hospital with community-acquired pneumonia (CAP). METHODS: Starting April 1, 2013, consecutive adult patients with CAP admitted to an acute care community hospital in Barrie, Ontario, Canada, were eligible for enrollment until March 31, 2015. The antimicrobial stewardship intervention was a prospective audit and feedback recommendation implemented in a stepped-wedge design across 4 wards...
May 1, 2016: American Journal of Infection Control
Sivakami Janahiraman, Muhammad Nazri Aziz, Fan Kee Hoo, Hon Shen P'ng, Yang Liang Boo, Vasudevan Ramachandran, Ahmad Fuad Shamsuddin
BACKGROUNDS & OBJECTIVE: Antimicrobial resistance is a major health problem worldwide in hospitals. The main contributing factors are exposures to broad-spectrum antimicrobials and cross-infections. Understanding the extent and type of antimicrobial use in tertiary care hospitals will aid in developing national antimicrobial stewardship priorities. METHODS: In this study, we have analyzed the antimicrobial agents' usage for acquisition of multidrug resistant using retrospective, cross-sectional, single-centre study in a multidisciplinary ICU at tertiary care hospital...
November 2015: Pakistan Journal of Medical Sciences Quarterly
Elizabeth Cerceo, Steven B Deitelzweig, Bradley M Sherman, Alpesh N Amin
The increasing prevalence of infections due to multidrug-resistant (MDR) gram-negative bacteria constitutes a serious threat to global public health due to the limited treatment options available and the historically slow pace of development of new antimicrobial agents. Infections due to MDR strains are associated with increased morbidity and mortality and prolonged hospitalization, which translates to a significant burden on healthcare systems. In particular, MDR strains of Enterobacteriaceae (especially Klebsiella pneumoniae and Escherichia coli), Pseudomonas aeruginosa, and Acinetobacter baumannii have emerged as particularly serious concerns...
July 2016: Microbial Drug Resistance: MDR: Mechanisms, Epidemiology, and Disease
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