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Transplant stewardship

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https://www.readbyqxmd.com/read/28815897/multidrug-resistant-enterobacteriaceae-pseudomonas-aeruginosa-and-vancomycin-resistant-enterococci-three-major-threats-to-hematopoietic-stem-cell-transplant-recipients
#1
REVIEW
Michael J Satlin, Thomas J Walsh
Hematopoietic stem cell transplant (HSCT) recipients are uniquely threatened by the emergence of multidrug-resistant (MDR) bacteria because these patients rely on immediate active antimicrobial therapy to combat bacterial infections. This review describes the epidemiology and treatment considerations for three challenging MDR bacterial pathogens in HSCT recipients: MDR Enterobacteriaceae, including extended-spectrum β-lactamase (ESBL)-producing and carbapenem-resistant Enterobacteriaceae (CRE), Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus (VRE)...
August 16, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28781151/2016-guideline-strategies-for-the-use-of%C3%A2-antifungal-agents-in-patients-with-hematological-malignancies-or-hematopoietic-stem-cell-transplantation-recipients-in-taiwan
#2
REVIEW
Bor-Sheng Ko, Wei-Ting Chen, Hsiang-Chi Kung, Un-In Wu, Jih-Luh Tang, Ming Yao, Yee-Chun Chen, Hwei-Fang Tien, Shan-Chwen Chang, Yin-Ching Chuang, Dong-Tsamn Lin
The Infectious Diseases Society of Taiwan (IDST), the Hematology Society of Taiwan, the Taiwan Society of Blood and Marrow Transplantation, Medical Foundation in Memory of Dr. Deh-Lin Cheng, Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education, and CY Lee's Research Foundation for Pediatric Infectious Diseases and Vaccines cooperatively published this guideline for the use of antifungal agents in hematological patients with invasive fungal diseases (IFDs) in Taiwan. The guideline is the first one endorsed by IDST focusing on selection of antifungal strategies, including prophylaxis, empirical (or symptom-driven) and pre-emptive (or diagnostic-driven) strategy...
July 25, 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
https://www.readbyqxmd.com/read/28758610/reducing-second-gram-negative-antibiotic-therapy-on-pediatric-oncology-and-hematopoietic-stem-cell-transplantation-services
#3
Rachel L Wattier, Emily R Levy, Amit J Sabnis, Christopher C Dvorak, Andrew D Auerbach
OBJECTIVE To evaluate interventions to reduce avoidable antibiotic use on pediatric oncology and hematopoietic stem cell transplantation (HSCT) services. DESIGN Interrupted time series. SETTING Academic pediatric hospital with separate oncology and HSCT services. PARTICIPANTS Children admitted to the services during baseline (October 2011-August 2013) and 2 intervention periods, September 2013-June 2015 and July 2015-June 2016, including 1,525 oncology hospitalizations and 301 HSCT hospitalizations. INTERVENTION In phase 1, we completed an update of the institutional febrile neutropenia (FN) guideline for the pediatric oncology service, recommending first-line β-lactam monotherapy rather than routine use of 2 gram-negative agents...
July 31, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28542111/clostridium-difficile-infection-in-solid-organ-transplant-recipients
#4
Deepa Nanayakkara, Neha Nanda
PURPOSE OF REVIEW: Clostridium difficile infection (CDI) is a major healthcare-associated infection that causes significant morbidity and an economic impact in the United States. In this review, we provide an overview of Clostridium difficile infection in solid organ transplant recipients with an emphasis on recent literature. RECENT FINDINGS: C. difficile in solid organ transplant population has unique risk factors. Fecal microbiota transplantation has shown favorable results in treatment of recurrent C...
August 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28542093/feasibility-and-applicability-of-antimicrobial-stewardship-in-immunocompromised-patients
#5
Elizabeth Robilotti, Marisa Holubar, Susan K Seo, Stan Deresinski
PURPOSE OF REVIEW: Antimicrobial stewardship is the primary intervention in the battle against antimicrobial resistance, but clinicians do not always apply many key antimicrobial stewardship principles to patients with significant immune defects due to lack of data and fear of bad outcomes. We review evidence regarding the application of stewardship principles to immunocompromised patients, with a focus on solid organ and hematopoietic stem cell transplant recipients. RECENT FINDINGS: Antimicrobial stewardship programs (ASPs), targeting immunocompromised patient populations such as oncology and transplant, are gaining traction...
August 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/28458794/antimicrobial-stewardship-initiatives-throughout-europe-proven-value-for-money
#6
Edwin J M Oberjé, Marit A C Tanke, Patrick P T Jeurissen
Antimicrobial stewardship is recognized as a key component to stop the current European spread of antimicrobial resistance. It has also become evident that antimicrobial resistance is a problem that cannot be tackled by single institutions or physicians. Prevention of antimicrobial resistance needs rigorous actions at ward level, institution level, national level and at supra-national levels. Countries can learn from each other and possibly transplant best practices across borders to prevent antimicrobial resistance...
March 30, 2017: Infectious Disease Reports
https://www.readbyqxmd.com/read/28295646/the-epidemiology-of-clostridium-difficile-infection-in-a-national-kidney-transplant-center
#7
Claire Kennedy, Carmel Waldron, Mairead Skally, Leah Gaughan, Colm Magee, Karen Burns, Fidelma Fitzpatrick
BACKGROUND: We aimed to describe the epidemiology and outcomes of CDI in a national kidney transplant center from 2008 to 2015. METHODS: Adult kidney and kidney-pancreas transplant recipients were included for analysis if they met the surveillance CDI case definition. Rates of new healthcare-associated CDI (HA-CDI) were expressed per 10 000 KTR/KTPR bed days used (BDU) to facilitate comparisons. RESULTS: Fifty-two cases of CDI were identified in 42 KTRs and KPTRs...
March 15, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28147426/-spontaneous-bacterial-peritonitis
#8
Ľubomír Skladaný, Silvia Kasová, Anna Purgelová, Natália Bystrianska, Svetlana Adamcová-Selčanová
AIM OF STUDY: Spontaneous bacterial peritonitis (SBP) is the most frequent infectious complication of liver cirrhosis with serious consequences. Initially, SBP is always treated with empirical, not targeted, antibiotic therapy. Since a retrospective study performed in our department showed suboptimal effectiveness (only 40 %) of empirical antibiotic therapy in accordance with the EASL guidelines, a decision was made to change the protocol. The aims of this prospective study were to determine: (1) the incidence and characteristics of SBP in real clinical practice - in a liver unit of a tertiary hospital, (2) the effectiveness of new antibiotic therapy selected based on analysis of the spectrum of pathogens and their resistance to antibiotics as identified in a retrospective cohort study on SBP carried out in our department, (3) mortality, and to compare these findings with the literature data...
December 2016: Klinická Mikrobiologie a Infekc̆ní Lékar̆ství
https://www.readbyqxmd.com/read/28077203/clostridium-difficile-infection-in-older-adults-systematic-review-of-efforts-to-reduce-occurrence-and-improve-outcomes
#9
REVIEW
Leisa L Marshall, Samuel Peasah, Gregg A Stevens
OBJECTIVE: Provide a systematic review of the primary literature on efforts to reduce Clostridium difficile infection (CDI) occurrence and improve outcomes in older adults. DATA SOURCES, STUDY SELECTION, DATA EXTRACTION: PubMed and CINAHL databases were searched for research studies using search terms CDI, CDI prevention, reduction, control, management, geriatric, elderly, adults 65 years of age and older. The MeSH categories Aged and Aged, 80 and older, were used...
January 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/27880667/the-current-treatment-landscape-other-fungal-diseases-cryptococcosis-fusariosis-and-mucormycosis
#10
Olivier Lortholary, Mario Fernández-Ruiz, John R Perfect
Compared with major invasive mycoses such as aspergillosis and candidiasis, the antifungal stewardship management strategies of other fungal diseases have different opportunities and considerations. Cryptococcosis, fusariosis and mucormycosis are globally prevalent invasive fungal diseases (IFDs), but are not currently included in antifungal prophylaxis guidelines for immunocompromised hosts. Since the implementation of biomarkers as part of diagnostic screening strategies, the concept of pre-emptive antifungal therapy has emerged for these IFDs...
November 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27862115/pediatric-acute-liver-failure-of-undetermined-cause-a-research-workshop
#11
REVIEW
Estella M Alonso, Simon P Horslen, Edward M Behrens, Edward Doo
Pediatric acute liver failure (PALF) is a potentially devastating condition that occurs in previously healthy children of all ages and frequently leads to a rapid clinical deterioration. An identified cause for liver injury is lacking in approximately 30% of cases. Children with undetermined diagnosis have lower spontaneous survival and higher rates of transplantation and death than other diagnostic groups. A single-day workshop sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases brought together clinicians and basic scientists to integrate aligned research findings and develop a foundation for new mechanistic studies and future treatment trials...
March 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/27766987/fear-of-failure-engaging-patients-in-antimicrobial-stewardship-after-fecal-transplantation-for-recurrent-clostridium-difficile-infection
#12
Michelle T Hecker, Edith Ho, Curtis J Donskey
No abstract text is available yet for this article.
October 21, 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27758967/intravenous-immune-globulin-stewardship-program-at-a-tertiary-academic-medical-center
#13
Megan A Rocchio, James W Schurr, Aaron P Hussey, Paul M Szumita
BACKGROUND: In October 2010, a pharmacist-driven stewardship program was implemented at the Brigham and Women's Hospital to ensure continued adherence to the prescribing guideline, focusing on indications for intravenous immune globulin (IVIG) use and dosing per ideal body weight. OBJECTIVE: The primary objective was to describe an IVIG stewardship program at a tertiary academic medical center. METHODS: This was a prospective, observational study from January 2013 through December 2014...
February 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/27733304/solid-organ-transplant-antibiograms-an-opportunity-for-antimicrobial-stewardship
#14
COMPARATIVE STUDY
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...
December 2016: Diagnostic Microbiology and Infectious Disease
https://www.readbyqxmd.com/read/27710140/risk-factors-and-prophylaxis-against-invasive-fungal-disease-for-haematology-and-stem-cell-transplant-recipients-an-evolving-field
#15
Abby P Douglas, Monica A Slavin
Due to increasing intensity and complexity of therapies and longer survivorship, many patients with haematologic malignancy (HM) are at risk of invasive fungal disease (IFD). Mortality from IFD is high and treatment of an episode of IFD results in an excess length of hospital stay and costs and delays delivery of curative therapy of the underlying haematologic condition. Therefore, prevention and early recognition and treatment of IFD are crucial. Areas covered: Risk factors particular to certain HMs and haematopoietic stem cell transplantation, as well as those risk factors universal to all HM groups are examined...
December 2016: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/27692005/impact-of-an-infection-control-and-antimicrobial-stewardship-program-on-solid-organ-transplantation-and-hepatobiliary-surgical-site-infections
#16
Charles Frenette, David Sperlea, Yveta Leharova, Daniel J G Thirion
OBJECTIVE The goal of this long-term quasi-experimental retrospective study was to assess the impact of a 5-year serial infection control and antimicrobial stewardship intervention on surgical site infections (SSIs). METHODS This study was conducted in a tertiary-care public teaching institution over a 5-year period from January 2010 to December 2014. All patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas-kidney transplantation were included. Outcomes were compared between a preintervention group (2010-2011) and a postintervention group (2012-2014)...
December 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27457099/current-state-of-antimicrobial-stewardship-at-solid-organ-and-hematopoietic-cell-transplant-centers-in-the-united-states
#17
Susan K Seo, Kaming Lo, Lilian M Abbo
OBJECTIVE To assess the extent of antimicrobial stewardship programs (ASPs) at solid organ transplant (SOT) and hematopoietic cell transplant (HCT) centers in the United States. DESIGN An 18-item voluntary survey was developed to gauge current antimicrobial stewardship practices in transplant patients, examine the availability and perceived usefulness of novel diagnostics and azole levels to guide therapy, and identify challenges for implementation of ASPs at these centers. PARTICIPANTS The survey was distributed electronically to infectious disease physicians and pharmacists at adult and pediatric SOT and HCT centers during May 1-22, 2015...
October 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27194400/fecal-microbiota-transplantation-for-the-intestinal-decolonization-of-extensively-antimicrobial-resistant-opportunistic-pathogens-a-review
#18
REVIEW
Amee R Manges, Theodore S Steiner, Alissa J Wright
Treatment options for multidrug-resistant (MDR) bacterial infections are limited and often less effective. Non-pharmacologic approaches to preventing or treating MDR infections are currently restricted to improved antimicrobial stewardship and infection control practices. Fecal microbiota transplantation (FMT), a highly effective treatment for recurrent Clostridium difficile infection, has emerged as a promising therapy for intestinal MDR bacterial decolonization. A total of eight case reports have been published showing FMT resulted in intestinal decolonization of extended spectrum β-lactamase (ESBL)-producing and carbapenemase-producing Enterobacteriaceae, vancomycin-resistant Enterococci, or methicillin-resistant Staphylococcus aureus...
August 2016: Infectious Diseases
https://www.readbyqxmd.com/read/26992472/solid-organ-transplant-patients-are-there-opportunities-for-antimicrobial-stewardship
#19
Miranda So, Daisy Yu Yang, Chaim Bell, Atul Humar, Andrew Morris, Shahid Husain
OBJECTIVE: Rising incidence of Clostridium difficile and multidrug-resistant organisms' infections and a dwindling development of new antimicrobials are an impetus for antimicrobial stewardship in organ transplant recipients. We sought to understand antimicrobial prescribing practices and identify opportunities for interdisciplinary collaboration among the transplant, antimicrobial stewardship, and infectious diseases teams. METHODS: In 2013, two assessors conducted four real-time audits on all antimicrobial therapy in transplant patients, assessing each regimen against stewardship principles established by the Centers for Disease Prevention and Control, supplemented by applicable transplant-specific infection guidelines...
June 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/26972929/use-of-concomitant-antibiotics-during-treatment-for-clostridium-difficile-infection-cdi-in-pediatric-inpatients-an-observational-cohort-study
#20
Vanessa W Stevens, Cary Thurm, Elyse M Schwab, Matthew P Kronman, Jeffrey S Gerber, Samir S Shah, Jason G Newland, Joshua Courter, Sarah Parker, Thomas V Brogan, Adam L Hersh
Concomitant antibiotic use during treatment for Clostridium difficile infection (CDI) increases the risk of recurrence. Across a network of children's hospitals, 46% of patients treated for CDI received concomitant antibiotics for a median of 7 days. Concomitant antibiotic use was more common among patients with malignancies, and solid organ or bone marrow transplant. Unnecessary concomitant antibiotic use in CDI patients is a potential target for pediatric antimicrobial stewardship.
March 2016: Infectious Diseases and Therapy
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